The pluralization of the international: Resistance and alter-standardization in regenerative stem cell medicine

PubMed Central

Rosemann, Achim; Chaisinthop, Nattaka

2016-01-01

The article explores the formation of an international politics of resistance and ‘alter-standardization’ in regenerative stem cell medicine. The absence of internationally harmonized regulatory frameworks in the clinical stem cell field and the presence of lucrative business opportunities have resulted in the formation of transnational networks adopting alternative research standards and practices. These oppose, as a universal global standard, strict evidence-based medicine clinical research protocols as defined by scientists and regulatory agencies in highly developed countries. The emergence of transnational spaces of alter-standardization is closely linked to scientific advances in rapidly developing countries such as China and India, but calls for more flexible regulatory frameworks, and the legitimization of experimental for-profit applications outside of evidence-based medical care, are emerging increasingly also within more stringently regulated countries, such as the United States and countries in the European Union. We can observe, then, a trend toward the pluralization of the standards, practices, and concepts in the stem cell field. PMID:26983174

Emergency department-based interventions for women suffering domestic abuse: a critical literature review.

PubMed

Ansari, Sereena; Boyle, Adrian

2017-02-01

Domestic abuse represents a serious public health and human rights concern. Interventions to reduce the risk of abuse include staff training and standardized documentation improving detection and adherence to referral pathways. Interventional studies have been conducted in primary care, maternity and outpatient settings. Women disclosing abuse in emergency departments differ from women attending other healthcare settings, and it is unclear whether these interventions can be transferred to the emergency care setting. This review examines interventional studies to evaluate the effectiveness of emergency department-based interventions in reducing domestic abuse-related morbidity. Medline, EMBASE, CINAHL, PsycINFO and Cochrane Library were searched, according to prespecified selection criteria. Study quality was assessed using the Jadad scale. Of 273 search results, nine were eligible for review. Interventions involving staff training demonstrated benefits in subjective measures, such as staff knowledge regarding abuse, but no changes in clinical practice, based on detection and referral rates. When staff training was implemented in conjunction with supporting system changes - for example, standardized documentation for assessment and referral - clinically relevant improvements were noted. Interventions centred around staff training are insufficient to bring about improvements in the management and, thus, outcome of patients suffering abuse. Instead, system changes, such as standardized documentation and referral pathways, supported by training, may bring about beneficial changes. It remains uncertain whether surrogate outcomes employed by most studies translate to changes in abuse-related morbidity: the ultimate goal.

A randomized trial of protocol-based care for early septic shock.

PubMed

Yealy, Donald M; Kellum, John A; Huang, David T; Barnato, Amber E; Weissfeld, Lisa A; Pike, Francis; Terndrup, Thomas; Wang, Henry E; Hou, Peter C; LoVecchio, Frank; Filbin, Michael R; Shapiro, Nathan I; Angus, Derek C

2014-05-01

In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary. In 31 emergency departments in the United States, we randomly assigned patients with septic shock to one of three groups for 6 hours of resuscitation: protocol-based EGDT; protocol-based standard therapy that did not require the placement of a central venous catheter, administration of inotropes, or blood transfusions; or usual care. The primary end point was 60-day in-hospital mortality. We tested sequentially whether protocol-based care (EGDT and standard-therapy groups combined) was superior to usual care and whether protocol-based EGDT was superior to protocol-based standard therapy. Secondary outcomes included longer-term mortality and the need for organ support. We enrolled 1341 patients, of whom 439 were randomly assigned to protocol-based EGDT, 446 to protocol-based standard therapy, and 456 to usual care. Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids, vasopressors, inotropes, and blood transfusions. By 60 days, there were 92 deaths in the protocol-based EGDT group (21.0%), 81 in the protocol-based standard-therapy group (18.2%), and 86 in the usual-care group (18.9%) (relative risk with protocol-based therapy vs. usual care, 1.04; 95% confidence interval [CI], 0.82 to 1.31; P=0.83; relative risk with protocol-based EGDT vs. protocol-based standard therapy, 1.15; 95% CI, 0.88 to 1.51; P=0.31). There were no significant differences in 90-day mortality, 1-year mortality, or the need for organ support. In a multicenter trial conducted in the tertiary care setting, protocol-based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes. (Funded by the National Institute of General Medical Sciences; ProCESS ClinicalTrials.gov number, NCT00510835.).

The probability of probability and research truths.

PubMed

Fatovich, Daniel M; Phillips, Michael

2017-04-01

The foundation of much medical research rests on the statistical significance of the P-value, but we have fallen prey to the seductive certainty of significance. Other scientific disciplines work to a different standard. This may partly explain why medical reversal is an increasing phenomenon, whereby new studies (based on the 0.05 standard) overturn previous significant findings. This has generated a crisis in the rigour of evidence-based medicine, as many people erroneously believe that a P < 0.05 means the treatment effect is clinically important. However, statistics are not facts about the world. Nor should they be based on an arbitrary threshold that arose for historical reasons. This arbitrary threshold encourages an unthinking automatic response that contributes to industry's influence on medical research. Examples from emergency medicine practice illustrate these themes. Study replication needs to be valued as much as discovery. Careful and thoughtful unbiased thinking about the results we do have is undervalued. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Roadside-based communication system and method

NASA Technical Reports Server (NTRS)

Bachelder, Aaron D. (Inventor)

2007-01-01

A roadside-based communication system providing backup communication between emergency mobile units and emergency command centers. In the event of failure of a primary communication, the mobile units transmit wireless messages to nearby roadside controllers that may take the form of intersection controllers. The intersection controllers receive the wireless messages, convert the messages into standard digital streams, and transmit the digital streams along a citywide network to a destination intersection or command center.

Review and Implementation of the Emerging CCSDS Recommended Standard for Multispectral and Hyperspectral Lossless Image Coding

NASA Technical Reports Server (NTRS)

Sanchez, Jose Enrique; Auge, Estanislau; Santalo, Josep; Blanes, Ian; Serra-Sagrista, Joan; Kiely, Aaron

2011-01-01

A new standard for image coding is being developed by the MHDC working group of the CCSDS, targeting onboard compression of multi- and hyper-spectral imagery captured by aircraft and satellites. The proposed standard is based on the "Fast Lossless" adaptive linear predictive compressor, and is adapted to better overcome issues of onboard scenarios. In this paper, we present a review of the state of the art in this field, and provide an experimental comparison of the coding performance of the emerging standard in relation to other state-of-the-art coding techniques. Our own independent implementation of the MHDC Recommended Standard, as well as of some of the other techniques, has been used to provide extensive results over the vast corpus of test images from the CCSDS-MHDC.

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

Addressing Dual Patient and Staff Safety Through A Team-Based Standardized Patient Simulation for Agitation Management in the Emergency Department.

PubMed

Wong, Ambrose H; Auerbach, Marc A; Ruppel, Halley; Crispino, Lauren J; Rosenberg, Alana; Iennaco, Joanne D; Vaca, Federico E

2018-06-01

Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in behavioral emergency care.

Criteria-based audit to improve a district referral system in Malawi: a pilot study.

PubMed

Kongnyuy, Eugene J; Mlava, Grace; van den Broek, Nynke

2008-09-22

To study the feasibility of using criteria-based audit to improve a district referral system. A criteria-based audit was used to assess the Salima District referral system in Malawi. A retrospective review of 60 obstetric emergencies referred from 12 health centres was conducted and compared with prior established standards for optimal referral of emergencies. Recommendations were made and implemented. Three months later, a re-audit was conducted (62 cases). There were significant improvements in 4 out of 7 standards: adequate resuscitation before referral (33.3% vs 88.7%; p = 0.001); delay of less than 2 hours from the time the ambulance is called to when the ambulance brought the patient to the hospital (42.8% vs 88.3%; p = 0.014); clinician attends to patient within 30 minutes of arrival to hospital (30.8% vs 92.6%; p = 0.001) and feedback given to the referring health centres (1.7% vs 91.9%; p <0.001). The rest of the three standards showed a high level of attainment (>95%) in both the initial audit and the re-audit: referred patients accompanied by a referral form; ambulances are available at all times and the district hospital is informed through short-wave radio by the health centre when a patient is referred. Criteria-based audit can improve the ability of a district referral system to handle obstetric emergencies in countries with limited resources.

HMOs and the barriers to access for the pediatric population requiring emergency medical services.

PubMed

Uva, J L

1996-06-01

The main objectives of this study are to analyze the Massachusetts Health Maintenance Organizations (HMOs) in order to determine their standard definition of an emergency, the HMOs instructions for seeking emergency care, and distribution of such instructions for the pediatric population. A 15-question survey concerning pediatric emergency care policies and procedures was asked of each of the 20 HMOs contacted. Quarterly statements of each of the 20 HMOs were obtained from the Division of Insurance as well as the HMO's written materials distributed to the enrollees as member handbooks. Ninety percent of the HMOs had a definition of emergency care for the adult population, whereas 0% had a definition of emergency care specifically for the pediatric population. One hundred percent of the HMOs had instructions for emergency care, but 0% had specific provisions for pediatric emergency care. All 20 HMOs inform their enrollees about emergency policies through a member handbook. The results of this study reveal the lack of a standard definition of an emergency for HMOs. The current definitions of "urgent," "emergency," and "life-threatening emergency" care do not reflect the pediatric population, rather, these definitions are based on the adult population. The lack of specific pediatric guidelines could compromise the health of the children in HMOs.

Reconciling an Ecological Curricular Framework Focusing on Quality of Life Outcomes with the Development and Instruction of Standards-Based Academic Goals

ERIC Educational Resources Information Center

Hunt, Pam; McDonnell, John; Crockett, Margret A.

2012-01-01

The emergence of the standards-based reform movement has raised a number of issues related to the design of educational programs for students with severe disabilities, and a debate has arisen that presents an "either/or" choice between the general education curriculum and an ecological curricular framework that has traditionally guided…

A standardized method of preventing and managing emergencies within the context of evidence-based therapy implementation.

PubMed

Urgelles, Jessica; Donohue, Brad; Wilks, Chelsey; Van Hasselt, Vincent B; Azrin, Nathan H

2012-07-01

Families served within child welfare settings evidence a wide range of emergencies or unexpected crises or circumstances that may lead to danger and make it difficult for them to focus on treatment planning. Mental health treatment providers are often unprepared to effectively manage emergencies during implementation of evidence-based prescribed therapy sessions. In this study, the authors empirically developed a standardized intervention to assist mental health providers in emergency prevention and management (EPM) with their clients. EPM includes assessment of emergent conditions and a self-control procedure that may be utilized by consumers to prevent or resolve emergencies. EPM responses of 26 mothers referred by Child Protective Services for 6 months of evidence-supported treatment were examined. Relevant to clinical utility, the results indicated that providers implemented EPM in a little more than half (56.9%) of their treatment sessions, and all emergencies assessed in EPM were endorsed by at least 8% of the sample throughout their treatment. EPM was implemented with fidelity according to service providers, and corroborated by blind raters. Participants were found to be compliant and satisfied with EPM. The average number of emergencies endorsed over the course of EPM administrations was negatively correlated with the frequency of EPM administrations, suggesting that EPM may have helped reduce emergencies. Pretreatment factors (e.g., household income, child abuse potential, family functioning, parental stress, child behavior problems, number of days child removed from home) and hard drug use (but not marijuana or alcohol) during treatment were associated with the number of emergencies reported by participants.

Emergency medical dispatch : national standard curriculum ready

DOT National Transportation Integrated Search

1996-05-01

This Traffic Tech describes the recently updated "Emergency Medical Dispatch: National Standard Curriculum," which was developed in 1972. Emergency service providers use these uniform standards to develop or select an emergency medical dispatch progr...

Building of communication system for nuclear accident emergency disposal based on IP multimedia subsystem

NASA Astrophysics Data System (ADS)

Wang, Kang; Gao, Guiqing; Qin, Yuanli; He, Xiangyong

2018-05-01

The nuclear accident emergency disposal must be supported by an efficient, real-time modularization and standardization communication system. Based on the analysis of communication system for nuclear accident emergency disposal which included many functions such as the internal and external communication, multiply access supporting and command center. Some difficult problems of the communication system were discussed such as variety access device type, complex composition, high mobility, set up quickly, multiply business support, and so on. Taking full advantages of the IP Multimedia Subsystem (IMS), a nuclear accident emergency communication system was build based on the IMS. It was studied and implemented that some key unit and module functions of communication system were included the system framework implementation, satellite access, short-wave access, load/vehicle-mounted communication units. The application tests showed that the system could provide effective communication support for the nuclear accident emergency disposal, which was of great practical value.

Standard and transmission-based precautions: an update for dentistry.

PubMed

Harte, Jennifer A

2010-05-01

Standard Precautions are the foundation of all infection control programs and include infection control practices that apply to all patients and situations regardless of whether the infection status is suspected, confirmed or unknown. The author reviewed Standard Precautions, including two new elements introduced by the Centers for Disease Control and Prevention in 2007: safe injection practices and respiratory hygiene and cough etiquette. Standard Precautions sometimes are referred to as the first tier of precautions because for some diseases and circumstances, transmission cannot be interrupted completely with Standard Precautions alone and it is necessary to use second-tier Transmission-Based Precautions. The author reviewed the three categories of Transmission-Based Precautions--Airborne, Droplet and Contact--with an emphasis on their use in dental health care outpatient settings. Dental health care personnel (DHCP) should update their infection control programs to ensure that safe injection practices and respiratory hygiene and cough etiquette measures are used routinely. In addition, with the emergence of new pathogens, re-emergence of variant organisms and more patients seeking care in ambulatory care facilities, DHCP need to be aware of additional measures to take when treating patients in their offices who are actively infected with certain organisms to protect fully other patients, their staff members and themselves.

Stock markets as Minority Games: cognitive heterogeneity and equilibrium emergence

NASA Astrophysics Data System (ADS)

Brandouy, O.

2005-04-01

Standard finance theory generally assumes homogeneous agents relatively to their preferences, heuristics and investment strategies. We propose to study, in an agent-based simulation, the emergence of equilibrium under various heterogeneous conditions. Market interaction is stylized with the Minority Game representation. It is shown that inductive rational equilibrium emerges even though agents do not share the same representations of the value. This may lead to consider again the roots of EMH and REH.

Standards-Based Technology Integration for Emergent Bilinguals

ERIC Educational Resources Information Center

Ronan, Briana

2018-01-01

Today's educators serve the United States public-school system at a time of considerable curricular, technological, and demographic change. In 2010, the Common Core State Standards in Math and English Language Arts significantly altered the curricular landscape of K-12 classrooms. On the heels of this reform came the adoptions of English…

Progressive Education Standards: A Neuroscience Framework

ERIC Educational Resources Information Center

O'Grady, Patty

2011-01-01

This paper proposes a coherent and unique set of 12 standards, adopting a neuroscience framework for biologically based on school reform. This model of educational principles and practices aligns with the long-standing principles and practices of the Progressive Education Movement in the United States and the emerging principles of neuroscience.…

Intrajudge Consistency Using the Angoff Standard-Setting Method.

ERIC Educational Resources Information Center

Plake, Barbara S.; Impara, James C.

This study investigated the intrajudge consistency of Angoff-based item performance estimates. The examination used was a certification examination in an emergency medicine specialty. Ten expert panelists rated the same 24 items twice during an operational standard setting study. Results indicate that the panelists were highly consistent, in terms…

Emergency healthcare process automation using mobile computing and cloud services.

PubMed

Poulymenopoulou, M; Malamateniou, F; Vassilacopoulos, G

2012-10-01

Emergency care is basically concerned with the provision of pre-hospital and in-hospital medical and/or paramedical services and it typically involves a wide variety of interdependent and distributed activities that can be interconnected to form emergency care processes within and between Emergency Medical Service (EMS) agencies and hospitals. Hence, in developing an information system for emergency care processes, it is essential to support individual process activities and to satisfy collaboration and coordination needs by providing readily access to patient and operational information regardless of location and time. Filling this information gap by enabling the provision of the right information, to the right people, at the right time fosters new challenges, including the specification of a common information format, the interoperability among heterogeneous institutional information systems or the development of new, ubiquitous trans-institutional systems. This paper is concerned with the development of an integrated computer support to emergency care processes by evolving and cross-linking institutional healthcare systems. To this end, an integrated EMS cloud-based architecture has been developed that allows authorized users to access emergency case information in standardized document form, as proposed by the Integrating the Healthcare Enterprise (IHE) profile, uses the Organization for the Advancement of Structured Information Standards (OASIS) standard Emergency Data Exchange Language (EDXL) Hospital Availability Exchange (HAVE) for exchanging operational data with hospitals and incorporates an intelligent module that supports triaging and selecting the most appropriate ambulances and hospitals for each case.

Simulation-based Assessment of the Management of Critical Events by Board-certified Anesthesiologists.

PubMed

Weinger, Matthew B; Banerjee, Arna; Burden, Amanda R; McIvor, William R; Boulet, John; Cooper, Jeffrey B; Steadman, Randolph; Shotwell, Matthew S; Slagle, Jason M; DeMaria, Samuel; Torsher, Laurence; Sinz, Elizabeth; Levine, Adam I; Rask, John; Davis, Fred; Park, Christine; Gaba, David M

2017-09-01

We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to nine ordinal scale) ratings of participant's technical and nontechnical performance. Raters also judged whether the performance was at a level expected of a board-certified anesthesiologist. Rater reliability for most measures was good. In 284 simulated emergencies, participants were rated as successfully completing 81% (interquartile range, 75 to 90%) of the critical performance elements. The median rating of both technical and nontechnical holistic performance was five, distributed across the nine-point scale. Approximately one-quarter of participants received low holistic ratings (i.e., three or less). Higher-rated performances were associated with younger age but not with previous simulation experience or other individual characteristics. Calling for help was associated with better individual and team performance. Standardized simulation-based assessment identified performance gaps informing opportunities for improvement. If a substantial proportion of experienced anesthesiologists struggle with managing medical emergencies, continuing medical education activities should be reevaluated.

Competency-Based Education: A Framework for Measuring Quality Courses

ERIC Educational Resources Information Center

Krause, Jackie; Dias, Laura Portolese; Schedler, Chris

2015-01-01

The growth of competency-based education in an online environment requires the development and measurement of quality competency-based courses. While quality measures for online courses have been developed and standardized, they do not directly align with emerging best practices and principles in the design of quality competency-based online…

Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy.

PubMed

Venkatesh, Arjun K; Savage, Dan; Sandefur, Benjamin; Bernard, Kenneth R; Rothenberg, Craig; Schuur, Jeremiah D

2017-01-01

Over 25 years, emergency medicine in the United States has amassed a large evidence base that has been systematically assessed and interpreted through ACEP Clinical Policies. While not previously studied in emergency medicine, prior work has shown that nearly half of all recommendations in medical specialty practice guidelines may be based on limited or inconclusive evidence. We sought to describe the proportion of clinical practice guideline recommendations in Emergency Medicine that are based upon expert opinion and low level evidence. Systematic review of clinical practice guidelines (Clinical Policies) published by the American College of Emergency Physicians from January 1990 to January 2016. Standardized data were abstracted from each Clinical Policy including the number and level of recommendations as well as the reported class of evidence. Primary outcomes were the proportion of Level C equivalent recommendations and Class III equivalent evidence. The primary analysis was limited to current Clinical Policies, while secondary analysis included all Clinical Policies. A total of 54 Clinical Policies including 421 recommendations and 2801 cited references, with an average of 7.8 recommendations and 52 references per guideline were included. Of 19 current Clinical Policies, 13 of 141 (9.2%) recommendations were Level A, 57 (40.4%) Level B, and 71 (50.4%) Level C. Of 845 references in current Clinical Policies, 67 (7.9%) were Class I, 272 (32.3%) Class II, and 506 (59.9%) Class III equivalent. Among all Clinical Policies, 200 (47.5%) recommendations were Level C equivalent, and 1371 (48.9%) of references were Class III equivalent. Emergency medicine clinical practice guidelines are largely based on lower classes of evidence and a majority of recommendations are expert opinion based. Emergency medicine appears to suffer from an evidence gap that should be prioritized in the national research agenda and considered by policymakers prior to developing future quality standards.

Evidence-Based Practices and Autism

ERIC Educational Resources Information Center

Mesibov, Gary B.; Shea, Victoria

2011-01-01

Interventions for autism are increasing being held to standards such as "evidence-based practice" in psychology and "scientifically-based research" in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special…

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

PubMed

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

2017-08-15

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

Nonstandard Advance Directives in Emergency Medicine: What Should We Do?

PubMed

Iserson, Kenneth V

2018-07-01

Critically ill or injured emergency department or prehospital patients who lack decision-making capacity sometimes present with a non-standard advance directive, such as a "Do Not Resuscitate" tattoo or medallion. Emergency clinicians must immediately address the question of whether to withhold treatment based on what may or may not be a valid patient directive. Advance directives have been standardized for a good reason. Emergency department or prehospital healthcare providers must be able to immediately interpret and act on them without needing a legal interpretation. When faced with non-standard directives, physicians can follow them, ignore them, or simply use them as an additional piece of information about the individual's wishes for some situations at one point in his or her life. Absent the patient's input or that of aknowledgeable surrogate, both the patient's initial reasons for their non-standard directive and his or her present wishes concerning resuscitation cannot be independently known. Therefore, healthcare providers must initiate treatment while they buy time, attempt to return the patient to lucidity, and search for probative information regarding their current wishes concerning medical treatment. Without such additional information, the moral weight will always favor initiating treatment, since withholding treatment is often irreversible and any treatment instituted can later be withdrawn. Copyright © 2018 Elsevier Inc. All rights reserved.

DoD Global Emerging Infections Surveillance & Response System (DoD-GEIS). Global Influenza Surveillance Efforts

DTIC Science & Technology

2007-01-08

DoD Global Emerging Infections Surveillance & Response System (DoD-GEIS) Global Influenza Surveillance Efforts 8 January 2007 COL (Ret.) Jose L...SUBTITLE DoD Global Emerging Infections Surveillance & Response System (DoD-GEIS) Global Influenza Surveillance Efforts 5a. CONTRACT NUMBER 5b. GRANT...PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Lab-Based Influenza Surveillance • Sentinel Surveillance • Air Force

Web-Based Real-Time Emergency Monitoring

NASA Technical Reports Server (NTRS)

Harvey, Craig A.; Lawhead, Joel

2007-01-01

The Web-based Real-Time Asset Monitoring (RAM) module for emergency operations and facility management enables emergency personnel in federal agencies and local and state governments to monitor and analyze data in the event of a natural disaster or other crisis that threatens a large number of people and property. The software can manage many disparate sources of data within a facility, city, or county. It was developed on industry-standard Geo- Spatial software and is compliant with open GIS standards. RAM View can function as a standalone system, or as an integrated plugin module to Emergency Operations Center (EOC) software suites such as REACT (Real-time Emergency Action Coordination Tool), thus ensuring the widest possible distribution among potential users. RAM has the ability to monitor various data sources, including streaming data. Many disparate systems are included in the initial suite of supported hardware systems, such as mobile GPS units, ambient measurements of temperature, moisture and chemical agents, flow meters, air quality, asset location, and meteorological conditions. RAM View displays real-time data streams such as gauge heights from the U.S. Geological Survey gauging stations, flood crests from the National Weather Service, and meteorological data from numerous sources. Data points are clearly visible on the map interface, and attributes as specified in the user requirements can be viewed and queried.

Interpreting the Right to an Education as a Norm Referenced Adequacy Standard

ERIC Educational Resources Information Center

Pijanowski, John

2016-01-01

Our current conceptions of educational adequacy emerged out of an era dominated by equity-based school resource litigation. During that time of transitioning between successful litigation strategies, legal opinions provided clues as to how future courts might view a norm-referenced approach to establishing an adequacy standard--an approach that…

76 FR 20089 - Energy Conservation Program: Energy Conservation Standards for Fluorescent Lamp Ballasts

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

... = high output. ** The proposed standards are based on an equation that is a function of the natural... High estimate Discount rate (emerging (existing Primary estimate technologies, roll- technologies, up...$) is the average of the low and high values used in DOE's analysis. [dagger] Total Benefits for both...

From Expert Protocols to Standardized Management of Infectious Diseases.

PubMed

Lagier, Jean-Christophe; Aubry, Camille; Delord, Marion; Michelet, Pierre; Tissot-Dupont, Hervé; Million, Matthieu; Brouqui, Philippe; Raoult, Didier; Parola, Philippe

2017-08-15

We report here 4 examples of management of infectious diseases (IDs) at the University Hospital Institute Méditerranée Infection in Marseille, France, to illustrate the value of expert protocols feeding standardized management of IDs. First, we describe our experience on Q fever and Tropheryma whipplei infection management based on in vitro data and clinical outcome. Second, we describe our management-based approach for the treatment of infective endocarditis, leading to a strong reduction of mortality rate. Third, we report our use of fecal microbiota transplantation to face severe Clostridium difficile infections and to perform decolonization of patients colonized by emerging highly resistant bacteria. Finally, we present the standardized management of the main acute infections in patients admitted in the emergency department, promoting antibiotics by oral route, checking compliance with the protocol, and avoiding the unnecessary use of intravenous and urinary tract catheters. Overall, the standardization of the management is the keystone to reduce both mortality and morbidity related to IDs. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Evidence-Based Practice Empowers Early Childhood Professionals and Families. FPG Snapshot #33

ERIC Educational Resources Information Center

FPG Child Development Institute, 2006

2006-01-01

Evidence-based practice emerged as a result of the gap often seen between research and practice and gained momentum with the standards and accountability movement. Yet it originates in medicine. Healthcare professionals using evidence-based medicine determine a patient's treatment based on an assessment of evidence from the literature and current…

[Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?].

PubMed

Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H

2010-08-01

There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

44 CFR 75.11 - Standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Standards. 75.11 Section 75.11 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... PROPERTIES UNDER SELF-INSURANCE PLAN Standards for Exemption § 75.11 Standards. (a) In order to be exempt...

BIM based virtual environment for fire emergency evacuation.

PubMed

Wang, Bin; Li, Haijiang; Rezgui, Yacine; Bradley, Alex; Ong, Hoang N

2014-01-01

Recent building emergency management research has highlighted the need for the effective utilization of dynamically changing building information. BIM (building information modelling) can play a significant role in this process due to its comprehensive and standardized data format and integrated process. This paper introduces a BIM based virtual environment supported by virtual reality (VR) and a serious game engine to address several key issues for building emergency management, for example, timely two-way information updating and better emergency awareness training. The focus of this paper lies on how to utilize BIM as a comprehensive building information provider to work with virtual reality technologies to build an adaptable immersive serious game environment to provide real-time fire evacuation guidance. The innovation lies on the seamless integration between BIM and a serious game based virtual reality (VR) environment aiming at practical problem solving by leveraging state-of-the-art computing technologies. The system has been tested for its robustness and functionality against the development requirements, and the results showed promising potential to support more effective emergency management.

Some contingencies of spelling

PubMed Central

Lee, Vicki L.; Sanderson, Gwenda M.

1987-01-01

This paper presents some speculation about the contingencies that might select standard spellings. The speculation is based on a new development in the teaching of spelling—the process writing approach, which lets standard spellings emerge collateral to a high frequency of reading and writing. The paper discusses this approach, contrasts it with behavior-analytic research on spelling, and suggests some new directions for this latter research based on a behavioral interpretation of the process writing approach to spelling. PMID:22477529

Opportunities in SMR Emergency Planning

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

Moe, Wayne L.

2014-10-01

Using year 2014 cost information gathered from twenty different locations within the current commercial nuclear power station fleet, an assessment was performed concerning compliance costs associated with the offsite emergency Planning Standards contained in 10 CFR 50.47(b). The study was conducted to quantitatively determine the potential cost benefits realized if an emergency planning zone (EPZ) were reduced in size according to the lowered risks expected to accompany small modular reactors (SMR). Licensees are required to provide a technical basis when proposing to reduce the surrounding EPZ size to less than the 10 mile plume exposure and 50 mile ingestion pathwaymore » distances currently being used. To assist licensees in assessing the savings that might be associated with such an action, this study established offsite emergency planning costs in connection with four discrete EPZ boundary distances, i.e., site boundary, 2 miles, 5 miles and 10 miles. The boundary selected by the licensee would be based on where EPA Protective Action Guidelines are no longer likely to be exceeded. Additional consideration was directed towards costs associated with reducing the 50 mile ingestion pathway EPZ. The assessment methodology consisted of gathering actual capital costs and annual operating and maintenance costs for offsite emergency planning programs at the surveyed sites, partitioning them according to key predictive factors, and allocating those portions to individual emergency Planning Standards as a function of EPZ size. Two techniques, an offsite population-based approach and an area-based approach, were then employed to calculate the scaling factors which enabled cost projections as a function of EPZ size. Site-specific factors that influenced source data costs, such as the effects of supplemental funding to external state and local agencies for offsite response organization activities, were incorporated into the analysis to the extent those factors could be representatively apportioned.« less

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.38 Emergency action plans. (a) Application. An employer must have an emergency action plan whenever an OSHA standard in this...) Written and oral emergency action plans. An emergency action plan must be in writing, kept in the...

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.38 Emergency action plans. (a) Application. An employer must have an emergency action plan whenever an OSHA standard in this...) Written and oral emergency action plans. An emergency action plan must be in writing, kept in the...

GIO-EMS and International Collaboration in Satellite based Emergency Mapping

NASA Astrophysics Data System (ADS)

Kucera, Jan; Lemoine, Guido; Broglia, Marco

2013-04-01

During the last decade, satellite based emergency mapping has developed into a mature operational stage. The European Union's GMES Initial Operations - Emergency Management Service (GIO-EMS), is operational since April 2012. It's set up differs from other mechanisms (for example from the International Charter "Space and Major Disasters"), as it extends fast satellite tasking and delivery with the value adding map production as a single service, which is available, free of charge, to the authorized users of the service. Maps and vector datasets with standard characteristics and formats ranging from post-disaster damage assessment to recovery and disaster prevention are covered by this initiative. Main users of the service are European civil protection authorities and international organizations active in humanitarian aid. All non-sensitive outputs of the service are accessible to the public. The European Commission's in-house science service Joint Research Centre (JRC) is the technical and administrative supervisor of the GIO-EMS. The EC's DG ECHO Monitoring and Information Centre acts as the service's focal point and DG ENTR is responsible for overall service governance. GIO-EMS also aims to contribute to the synergy with similar existing mechanisms at national and international level. The usage of satellite data for emergency mapping has increased during the last years and this trend is expected to continue because of easier accessibility to suitable satellite and other relevant data in the near future. Furthermore, the data and analyses coming from volunteer emergency mapping communities are expected to further enrich the content of such cartographic products. In the case of major disasters the parallel activity of more providers is likely to generate non-optimal use of resources, e.g. unnecessary duplication; whereas coordination may lead to reduced time needed to cover the disaster area. Furthermore the abundant number of geospatial products of different characteristics and quality can become confusing for users. The urgent need for a better coordination has led to establishment of the International Working Group on Satellite Based Emergency Mapping (IWG-SEM). Members of the IWG-SEM, which include JRC, USGS, DLR-ZKI, SERVIR, Sentinel Asia, UNOSAT, UN-SPIDER, GEO, ITHACA and SERTIT have recognized the need to establish the best practice between operational satellite-based emergency mapping programs. The group intends to: • work with the appropriate organizations on definition of professional standards for emergency mapping, guidelines for product generation and reviewing relevant technical standards and protocols • facilitate communication and collaboration during the major emergencies • stimulate coordination of expertise and capacities. The existence of the group and the cooperation among members already brought benefits during recent disasters in Africa and Europe in 2012 in terms of faster and effective satellite data provision and better product generation.

American Association for Emergency Psychiatry Task Force on Medical Clearance of Adults Part I: Introduction, Review and Evidence-Based Guidelines

PubMed Central

Anderson, Eric L.; Nordstrom, Kimberly; Wilson, Michael P.; Peltzer-Jones, Jennifer M.; Zun, Leslie; Ng, Anthony; Allen, Michael H.

2017-01-01

Introduction In the United States, the number of patients presenting to the emergency department (ED) for a mental health concern is significant and expected to grow. The breadth of the medical evaluation of these patients is controversial. Attempts have been made to establish a standard evaluation for these patients, but to date no nationally accepted standards exist. A task force of the American Association of Emergency Psychiatry, consisting of physicians from emergency medicine and psychiatry, and a psychologist was convened to form consensus recommendations on the medical evaluation of psychiatric patients presenting to EDs. Methods The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED (Part I) and then combined this with expert consensus (Part II). Results In Part I, we discuss terminological issues and existing evidence on medical exams and laboratory studies of psychiatric patients in the ED. Conclusion Emergency physicians should work cooperatively with psychiatric receiving facilities to decrease unnecessary testing while increasing the quality of medical screening exams for psychiatric patients who present to EDs. PMID:28210358

Strategies for Optimal MAC Parameters Tuning in IEEE 802.15.6 Wearable Wireless Sensor Networks.

PubMed

Alam, Muhammad Mahtab; Ben Hamida, Elyes

2015-09-01

Wireless body area networks (WBAN) has penetrated immensely in revolutionizing the classical heath-care system. Recently, number of WBAN applications has emerged which introduce potential limits to existing solutions. In particular, IEEE 802.15.6 standard has provided great flexibility, provisions and capabilities to deal emerging applications. In this paper, we investigate the application-specific throughput analysis by fine-tuning the physical (PHY) and medium access control (MAC) parameters of the IEEE 802.15.6 standard. Based on PHY characterizations in narrow band, at the MAC layer, carrier sense multiple access collision avoidance (CSMA/CA) and scheduled access protocols are extensively analyzed. It is concluded that, IEEE 802.15.6 standard can satisfy most of the WBANs applications throughput requirements by maximum achieving 680 Kbps. However, those emerging applications which require high quality audio or video transmissions, standard is not able to meet their constraints. Moreover, delay, energy efficiency and successful packet reception are considered as key performance metrics for comparing the MAC protocols. CSMA/CA protocol provides the best results to meet the delay constraints of medical and non-medical WBAN applications. Whereas, the scheduled access approach, performs very well both in energy efficiency and packet reception ratio.

44 CFR 206.401 - Local standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Local standards. 206.401 Section 206.401 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Minimum Standards § 206.401 Local...

44 CFR 206.401 - Local standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Local standards. 206.401 Section 206.401 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Minimum Standards § 206.401 Local...

Evaluating Emergency Department Asthma Management Practices in Florida Hospitals.

PubMed

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

2016-01-01

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

Twisted injectivity in projected entangled pair states and the classification of quantum phases

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

Buerschaper, Oliver, E-mail: obuerschaper@perimeterinstitute.ca

We introduce a class of projected entangled pair states (PEPS) which is based on a group symmetry twisted by a 3-cocycle of the group. This twisted symmetry is expressed as a matrix product operator (MPO) with bond dimension greater than 1 and acts on the virtual boundary of a PEPS tensor. We show that it gives rise to a new standard form for PEPS from which we construct a family of local Hamiltonians which are gapped, frustration-free and include fixed points of the renormalization group flow. Based on this insight, we advance the classification of 2D gapped quantum spin systems bymore » showing how this new standard form for PEPS determines the emergent topological order of these local Hamiltonians. Specifically, we identify their universality class as DIJKGRAAF–WITTEN topological quantum field theory (TQFT). - Highlights: • We introduce a new standard form for projected entangled pair states via a twisted group symmetry which is given by nontrivial matrix product operators. • We construct a large family of gapped, frustration-free Hamiltonians in two dimensions from this new standard form. • We rigorously show how this new standard form for low energy states determines the emergent topological order.« less

TPACK and Pre-Service Teacher Mathematics Education: Defining a Signature Pedagogy for Mathematics Education Using ICT and Based on the Metaphor "Mathematics Is a Language"

ERIC Educational Resources Information Center

Larkin, Kevin; Jamieson-Proctor, Romina; Finger, Glenn

2012-01-01

National professional standards for teachers in Australia (AITSL, 2011) expect teacher education graduates to demonstrate technological, pedagogical and content knowledge (TPACK). Those standards have emerged concurrently with the development of a new Australian mathematics curriculum. Thus, the expectation is that graduates can demonstrate the…

Curriculum-­Based Assessment: A Primer. 4th Edition

ERIC Educational Resources Information Center

Hargis, Charles H.

2013-01-01

Thoroughly updated and expanded, this fourth edition focuses on the use of curriculum-based assessment to ensure learning disabled and low achieving students adequate educational opportunities. The text explores ways of providing detail and explanation in the context of current and emerging issues in educational assessment and standards. The point…

Environmentally Based Assessment Practices: Viable Alternatives to Standardized Assessment for Assessing Emergent Literacy Skills in Young Children

ERIC Educational Resources Information Center

Thurman, S. Kenneth; McGrath, Marie C.

2008-01-01

Ecological validity is an important construct in the assessment of young children. The argument is made that using environmentally based assessment practices as well as understanding the child's ecology will help assure that assessments are carried out in an ecologically valid manner. The discussion focuses on play-based assessment,…

Bridging the gap: to what extent do socioeconomic barriers impede response to emerging public health threats

DTIC Science & Technology

2017-03-01

severe acute respiratory syndrome SDoH social determinants of health SES socioeconomic status SNS strategic national stockpile TJC The...CLAS) standards, severe acute respiratory syndrome (SARS), social determinants of health, and emergency response. Web-based resources were...Control the Spread of the Severe Acute Respiratory Syndrome during the Outbreak in Toronto,” New England Journal of Medicine 350 (June 3, 2004): 2352

First responder and physician liability during an emergency.

PubMed

Eddy, Amanda

2013-01-01

First responders, especially emergency medical technicians and paramedics, along with physicians, will be expected to render care during a mass casualty event. It is highly likely that these medical first responders and physicians will be rendering care in suboptimal conditions due to the mass casualty event. Furthermore, these individuals are expected to shift their focus from individually based care to community- or population-based care when assisting disaster response. As a result, patients may feel they have not received adequate care and may seek to hold the medical first responder or physician liable, even if they did everything they could given the emergency circumstances. Therefore, it is important to protect medical first responders and physicians rendering care during a mass casualty event so that their efforts are not unnecessarily impeded by concerns about civil liability. In this article, the author looks at the standard of care for medical first responders and physicians and describes the current framework of laws limiting liability for these persons during an emergency. The author concludes that the standard of care and current laws fail to offer adequate liability protection for medical first responders and physicians, especially those in the private sector, and recommends that states adopt clear laws offering liability protection for all medical first responders and physicians who render assistance during a mass casualty event.

Towards Standardized Patient Data Exchange: Integrating a FHIR Based API for the Open Medical Record System.

PubMed

Kasthurirathne, Suranga N; Mamlin, Burke; Grieve, Grahame; Biondich, Paul

2015-01-01

Interoperability is essential to address limitations caused by the ad hoc implementation of clinical information systems and the distributed nature of modern medical care. The HL7 V2 and V3 standards have played a significant role in ensuring interoperability for healthcare. FHIR is a next generation standard created to address fundamental limitations in HL7 V2 and V3. FHIR is particularly relevant to OpenMRS, an Open Source Medical Record System widely used across emerging economies. FHIR has the potential to allow OpenMRS to move away from a bespoke, application specific API to a standards based API. We describe efforts to design and implement a FHIR based API for the OpenMRS platform. Lessons learned from this effort were used to define long term plans to transition from the legacy OpenMRS API to a FHIR based API that greatly reduces the learning curve for developers and helps enhance adhernce to standards.

BIM Based Virtual Environment for Fire Emergency Evacuation

PubMed Central

Rezgui, Yacine; Ong, Hoang N.

2014-01-01

Recent building emergency management research has highlighted the need for the effective utilization of dynamically changing building information. BIM (building information modelling) can play a significant role in this process due to its comprehensive and standardized data format and integrated process. This paper introduces a BIM based virtual environment supported by virtual reality (VR) and a serious game engine to address several key issues for building emergency management, for example, timely two-way information updating and better emergency awareness training. The focus of this paper lies on how to utilize BIM as a comprehensive building information provider to work with virtual reality technologies to build an adaptable immersive serious game environment to provide real-time fire evacuation guidance. The innovation lies on the seamless integration between BIM and a serious game based virtual reality (VR) environment aiming at practical problem solving by leveraging state-of-the-art computing technologies. The system has been tested for its robustness and functionality against the development requirements, and the results showed promising potential to support more effective emergency management. PMID:25197704

Emergency preparedness.

PubMed

Mahon, Christine F; Long, Carol O

2006-01-01

The Boy Scout motto is "be prepared," but can your home health agency abide by this standard? The post-9/11 days of 2001 and the natural disasters that have threatened people and plagued our home and countries abroad illustrate the heightened level of awareness and preparedness home healthcare agencies must achieve to satisfactorily meet emergency preparedness standards. Community-based nurses often are on the front line of response to a man-made, biological, or naturally occurring event. You may have been assigned to work on a plan for your agency's response or have had questions asked about preparedness by your clients and family members. Here are six Web sites to get you started on the answers to those questions and concerns.

Rapid Capability Fielding Toolbox Study

DTIC Science & Technology

2010-03-01

templates derived from best  practices.  The Object Management Group (OMG) is incorporating emerging standards for W3C, SysML, RDF, OWL,  and  BPMN ...capabilities to the  warfighter. 33  Glossary  Acronyms    BPMN   Business Process Modeling Notation  CAD  Computer‐Aided Design  CAE  Computer‐Aided...deployed  on  standards‐based  run‐time  environments.    The  trend  is  that  the  emerging  standards  for  W3C,  SysML,  RDF,  OWL,  and  BPMN   are

Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods.

PubMed

Atiyeh, Bishara S

2007-01-01

Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.

Patient-Centered Research

PubMed Central

Wicki, J; Perneger, TV; Junod, AF; Bounameaux, H; Perrier, A

2000-01-01

PURPOSE We aimed to develop a simple standardized clinical score to stratify emergency ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS Analysis of a database of 1090 consecutive patients admitted to the emergency ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score < 4), of which 50 (10.3%) had a proven PE. The prevalence of PE was 38% in the 437 patients with an intermediate probability (score 5–8, n = 437) and 81% in the 63 patients with a high probability (score>9). CONCLUSION This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to emergency ward patients suspected of PE could allow a more efficient diagnostic process.

Sensor Web Interoperability Testbed Results Incorporating Earth Observation Satellites

NASA Technical Reports Server (NTRS)

Frye, Stuart; Mandl, Daniel J.; Alameh, Nadine; Bambacus, Myra; Cappelaere, Pat; Falke, Stefan; Derezinski, Linda; Zhao, Piesheng

2007-01-01

This paper describes an Earth Observation Sensor Web scenario based on the Open Geospatial Consortium s Sensor Web Enablement and Web Services interoperability standards. The scenario demonstrates the application of standards in describing, discovering, accessing and tasking satellites and groundbased sensor installations in a sequence of analysis activities that deliver information required by decision makers in response to national, regional or local emergencies.

Connecting Emergent Curriculum and Standards in the Early Childhood Classroom: Strengthening Content and Teaching Practice. Early Childhood Education Series

ERIC Educational Resources Information Center

Schwartz, Sydney L.; Copeland, Sherry M.

2010-01-01

The most pressing challenge in early childhood education today is to find a way to meet the standards within a developmentally appropriate approach. In this book, two active early childhood educators provide teachers with resources to bring content alive and document it in every-day, action-based pre-K and Kindergarten classrooms. The book…

Production of renewable diesel fuel from biologically based feedstocks.

DOT National Transportation Integrated Search

2014-09-01

Renewable diesel is an emerging option to achieve the goal set by the Federal Renewable Fuel Standard of displacing 20% of our nations petroleum consumption with : renewable alternatives by 2022. It involves converting readily available vegetable ...

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...

Team-Based Simulations: Learning Ethical Conduct in Teacher Trainee Programs

ERIC Educational Resources Information Center

Shapira-Lishchinsky, Orly

2013-01-01

This study aimed to identify the learning aspects of team-based simulations (TBS) through the analysis of ethical incidents experienced by 50 teacher trainees. A four-dimensional model emerged: learning to make decisions in a "supportive-forgiving" environment; learning to develop standards of care; learning to reduce misconduct; and learning to…

Update on Smoking Cessation: E-Cigarettes, Emerging Tobacco Products Trends, and New Technology-Based Interventions.

PubMed

Das, Smita; Tonelli, Makenzie; Ziedonis, Douglas

2016-05-01

Tobacco use disorders (TUDs) continue to be overly represented in patients treated in mental health and addiction treatment settings. It is the most common substance use disorder (SUD) and the leading cause of health disparities and increased morbidity/mortality amongst individuals with a psychiatric disorder. There are seven Food and Drug Administration (FDA) approved medications and excellent evidence-based psychosocial treatment interventions to use in TUD treatment. In the past few years, access to and use of other tobacco or nicotine emerging products are on the rise, including the highly publicized electronic cigarette (e-cigarette). There has also been a proliferation of technology-based interventions to support standard TUD treatment, including mobile apps and web-based interventions. These tools are easily accessed 24/7 to support outpatient treatment. This update will review the emerging products and counter-measure intervention technologies, including how clinicians can integrate these tools and other community-based resources into their practice.

47 CFR 64.706 - Minimum standards for the routing and handling of emergency telephone calls.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of emergency telephone calls. 64.706 Section 64.706 Telecommunication FEDERAL COMMUNICATIONS... Operator Services § 64.706 Minimum standards for the routing and handling of emergency telephone calls. Upon receipt of any emergency telephone call, providers of operator services and aggregators shall...

Ambulance Design Survey 2011: A Summary Report

PubMed Central

Lee, Y Tina; Kibira, Deogratias; Feeney, Allison Barnard; Marshall, Jennifer

2013-01-01

Current ambulance designs are ergonomically inefficient and often times unsafe for practical treatment response to medical emergencies. Thus, the patient compartment of a moving ambulance is a hazardous working environment. As a consequence, emergency medical services (EMS) workers suffer fatalities and injuries that far exceed those of the average work place in the United States. To reduce injury and mortality rates in ambulances, the Department of Homeland Security Science and Technology Directorate has teamed with the National Institute of Standards and Technology, the National Institute for Occupational Safety and Health, and BMT Designers & Planners in a joint project to produce science-based ambulance patient compartment design standards. This project will develop new crash-safety design standards and improved user-design interface guidance for patient compartments that are safer for EMS personnel and patients, and facilitate improved patient care. The project team has been working with practitioners, EMS workers’ organizations, and manufacturers to solicit needs and requirements to address related issues. This paper presents an analysis of practitioners’ concerns, needs, and requirements for improved designs elicited through the web-based survey of ambulance design, held by the National Institute of Standards and Technology. This paper also introduces the survey, analyzes the survey results, and discusses recommendations for future ambulance patient compartments design. PMID:26401439

WebGIS based community services architecture by griddization managements and crowdsourcing services

NASA Astrophysics Data System (ADS)

Wang, Haiyin; Wan, Jianhua; Zeng, Zhe; Zhou, Shengchuan

2016-11-01

Along with the fast economic development of cities, rapid urbanization, population surge, in China, the social community service mechanisms need to be rationalized and the policy standards need to be unified, which results in various types of conflicts and challenges for community services of government. Based on the WebGIS technology, the article provides a community service architecture by gridding management and crowdsourcing service. The WEBGIS service architecture includes two parts: the cloud part and the mobile part. The cloud part refers to community service centres, which can instantaneously response the emergency, visualize the scene of the emergency, and analyse the data from the emergency. The mobile part refers to the mobile terminal, which can call the centre, report the event, collect data and verify the feedback. This WebGIS based community service systems for Huangdao District of Qingdao, were awarded the “2015’ national innovation of social governance case of typical cases”.

Team Training and Institutional Protocols to Prevent Shoulder Dystocia Complications.

PubMed

Smith, Samuel

2016-12-01

Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance.

40 CFR 60.4202 - What emission standards must I meet for emergency engines if I am a stationary CI internal...

Code of Federal Regulations, 2010 CFR

2010-07-01

... emergency engines if I am a stationary CI internal combustion engine manufacturer? 60.4202 Section 60.4202... Combustion Engines Emission Standards for Manufacturers § 60.4202 What emission standards must I meet for emergency engines if I am a stationary CI internal combustion engine manufacturer? (a) Stationary CI...

A Methodological Analysis of Randomized Clinical Trials of Computer-Assisted Therapies for Psychiatric Disorders: Toward Improved Standards for an Emerging Field

PubMed Central

Kiluk, Brian D.; Sugarman, Dawn E.; Nich, Charla; Gibbons, Carly J.; Martino, Steve; Rounsaville, Bruce J.; Carroll, Kathleen M.

2013-01-01

Objective Computer-assisted therapies offer a novel, cost-effective strategy for providing evidence-based therapies to a broad range of individuals with psychiatric disorders. However, the extent to which the growing body of randomized trials evaluating computer-assisted therapies meets current standards of methodological rigor for evidence-based interventions is not clear. Method A methodological analysis of randomized clinical trials of computer-assisted therapies for adult psychiatric disorders, published between January 1990 and January 2010, was conducted. Seventy-five studies that examined computer-assisted therapies for a range of axis I disorders were evaluated using a 14-item methodological quality index. Results Results indicated marked heterogeneity in study quality. No study met all 14 basic quality standards, and three met 13 criteria. Consistent weaknesses were noted in evaluation of treatment exposure and adherence, rates of follow-up assessment, and conformity to intention-to-treat principles. Studies utilizing weaker comparison conditions (e.g., wait-list controls) had poorer methodological quality scores and were more likely to report effects favoring the computer-assisted condition. Conclusions While several well-conducted studies have indicated promising results for computer-assisted therapies, this emerging field has not yet achieved a level of methodological quality equivalent to those required for other evidence-based behavioral therapies or pharmacotherapies. Adoption of more consistent standards for methodological quality in this field, with greater attention to potential adverse events, is needed before computer-assisted therapies are widely disseminated or marketed as evidence based. PMID:21536689

Dissecting the determinants of depressive disorders outcome: an in depth analysis of two clinical cases

PubMed Central

Serretti, Alessandro; Calati, Raffaella; Oasi, Osmano; De Ronchi, Diana; Colombo, Cristina

2007-01-01

Clinicians face everyday the complexity of depression. Available pharmacotherapies and psychotherapies improve patients suffering in a large part of subjects, however up to half of patients do not respond to treatment. Clinicians may forecast to a good extent if a given patient will respond or not, based on a number of data and sensations that emerge from face to face assessment. Conversely, clinical predictors of non response emerging from literature are largely unsatisfactory. Here we try to fill this gap, suggesting a comprehensive assessment of patients that may overcome the limitation of standardized assessments and detecting the factors that plausibly contribute to so marked differences in depressive disorders outcome. For this aim we present and discuss two clinical cases. Mr. A was an industrial manager who came to psychiatric evaluation with a severe depressive episode. His employment was demanding and the depressive episode undermined his capacity to manage it. Based on standardized assessment, Mr. A condition appeared severe and potentially dramatic. Mrs. B was a housewife who came to psychiatric evaluation with a moderate depressive episode. Literature predictors would suggest Mrs. B state as associated with a more favourable outcome. However the clinician impression was not converging with the standardized assessment and in fact the outcome will reverse the prediction based on the initial formal standard evaluation. Although the present report is based on two clinical cases and no generalizability is possible, a more detailed analysis of personality, temperament, defense mechanisms, self esteem, intelligence and social adjustment may allow to formalize the clinical impressions used by clinicians for biologic and pharmacologic studies. PMID:17286859

Approaches to emergency management teaching at the master's level.

PubMed

Alexander, David

2013-01-01

Training and education enable emergency managers to deal with complex situations, create durable networks of people with appropriate expertise, and ensure that knowledge is utilized to improve resilience in the face of disaster risk. Although there is a discrete literature on emergency management training, few attempts have been made to create an overview that discusses the key issues and proposes a standardized approach. This article examines the nature of training and education in emergency and disaster management. It analyzes the composition and requirements of courses at the master's degree level, which is considered to be the most appropriate tier for in-depth instruction in this field. This article defines "training" and "education" in the context of emergency management courses. It reviews the developing profile of the emergency manager in the light of training requirements. This article examines the question of whether emergency management is a branch of management science or whether it is something distinct and separate. Attention is given to the composition of a core curriculum and to the most appropriate pedagogical forms of delivering it. The article reviews the arguments for and against standardization of the curriculum and describes some of the pedagogical methods for delivering courses. Briefly, it considers the impact on training and education of new pedagogic methods based on information technology. It is concluded that the master's level is particularly suited to emergency and crisis management education, as it enables students to complement the in-depth knowledge they acquired in their disciplinary first degrees with a broader synthetic approach at the postgraduate level. Some measures of standardization of course offerings are desirable, in favor of creating a core curriculum that will ensure that essential core knowledge is imparted. Education and training in this field should include problem-solving approaches that enable students to learn practical skills as well as theory.

Emergency Medical Technician-Ambulance: National Standard Curriculum. Student Study Guide (Third Edition).

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This student study guide is one of three documents prepared for the Emergency Medical Technician (EMT), National Standard Curriculum. The course is designed to develop skills in symptom recognition and in all emergency care procedures and techniques currently considered to be within the responsibilities of an EMT providing emergency medical care…

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 5 2011-07-01 2011-07-01 false Emergency action plans. 1910.38 Section 1910.38 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Means of Egress § 1910.38 Emergency action plans. (a) Application. An employer must have an emergency action plan whenever an OSHA standard in this part requires one. The...

Low weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission.

PubMed

Swenne, Ingemar; Ros, Helena Salonen

2017-10-01

This study examined predictors of emergency hospitalisation of adolescent girls with restrictive eating disorders and weight loss treated by a family-based intervention programme. We studied 339 girls aged 10-17 years treated in a specialist unit at Uppsala University Children's Hospital, Sweden, from August 2010 to December 2015. Historical weight data were obtained from school health services, and other weight data were determined at presentation. Weight controlling behaviour was recorded, and patients were evaluated using the Eating Disorder Examination Questionnaire. A family-based intervention started after assessment and the early weight gain after one week, one month and three months was assessed. There were 17 emergency admissions of 15 patients for refusing food, progressive weight loss and medical instability. Logistic regression analysis showed that emergency admissions were predicted by a low body mass index standard deviation score at presentation (odds ratio 2.57), a high rate of weight loss before presentation (odds ratio 4.38) and a low rate of weight gain at the start of treatment (odds ratio 4.59). Poor weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

A Study on Active Disaster Management System for Standardized Emergency Action Plan using BIM and Flood Damage Estimation Techniques

NASA Astrophysics Data System (ADS)

Jeong, C.; Om, J.; Hwang, J.; Joo, K.; Heo, J.

2013-12-01

In recent, the frequency of extreme flood has been increasing due to climate change and global warming. Highly flood damages are mainly caused by the collapse of flood control structures such as dam and dike. In order to reduce these disasters, the disaster management system (DMS) through flood forecasting, inundation mapping, EAP (Emergency Action Plan) has been studied. The estimation of inundation damage and practical EAP are especially crucial to the DMS. However, it is difficult to predict inundation and take a proper action through DMS in real emergency situation because several techniques for inundation damage estimation are not integrated and EAP is supplied in the form of a document in Korea. In this study, the integrated simulation system including rainfall frequency analysis, rainfall-runoff modeling, inundation prediction, surface runoff analysis, and inland flood analysis was developed. Using this system coupled with standard GIS data, inundation damage can be estimated comprehensively and automatically. The standard EAP based on BIM (Building Information Modeling) was also established in this system. It is, therefore, expected that the inundation damages through this study over the entire area including buildings can be predicted and managed.

Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department.

PubMed

Neighbors, Charles J; Barnett, Nancy P; Rohsenow, Damaris J; Colby, Suzanne M; Monti, Peter M

2010-05-01

Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury. This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained. Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases. Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates. This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.

Establishing Recommendations for Stroke Systems in the Thrombectomy Era: The Upstate New York Stakeholder Proceedings.

PubMed

Magdon-Ismail, Zainab; Benesch, Curtis; Cushman, Jeremy T; Brissette, Ian; Southerland, Andrew M; Brandler, Ethan S; Sozener, Cemal B; Flor, Sue; Hemmitt, Roseanne; Wales, Kathleen; Parrigan, Krystal; Levine, Steven R

2017-07-01

The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale. Six weeks later, participants finalized recommendations. Seventy-one stakeholders (45% of invitees) attended. Six themes around goals/concerns emerged: (1) emergency medical services capacity, (2) validated prehospital screening tools, (3) facility capability, (4) triage/transport guidelines, (5) data capture/feedback tools, and (6) facility competition. In response, high-impact (level A) prehospital recommendations, stratified by implementation feasibility, were (1) use of online medical control for triage (6%); (2) regional transportation strategy (31%), standardized emergency medical services checklists (18%), quality metrics (14%), standardized prehospital screening tools (13%), and feedback for performance improvement (7%); and (3) smartphone application algorithm for screening/decision-making (6%) and ambulance-based telemedicine (6%). Level A interfacility transfer recommendations were (1) standardized transfer process (32%)/timing goals (16%)/regionalized systems (11%), performance metrics (11%), image sharing capabilities (7%); (2) provider education (9%) and stroke toolbox (5%); and (3) interfacility telemedicine (7%) and feedback (2%). The methods used and recommendations generated provide models for stroke system enhancement. Implementation may vary based on geographic need/capacity and be contingent on establishing standard care practices. Further research is needed to establish optimal implementation strategies. © 2017 American Heart Association, Inc.

Remodeling Science Education

ERIC Educational Resources Information Center

Hestenes, David

2013-01-01

Radical reform in science and mathematics education is needed to prepare citizens for challenges of the emerging knowledge-based global economy. We consider definite proposals to establish: (1) "Standards of science and math literacy" for all students. (2) "Integration of the science curriculum" with structure of matter,…

Blood pressure in firefighters, police officers, and other emergency responders.

PubMed

Kales, Stefanos N; Tsismenakis, Antonios J; Zhang, Chunbai; Soteriades, Elpidoforos S

2009-01-01

Elevated blood pressure is a major risk factor for cardiovascular morbidity and mortality. Increased risk begins in the prehypertensive range and increases further with higher pressures. The strenuous duties of emergency responders (firefighters, police officers, and emergency medical services (EMS) personnel) can interact with their personal risk profiles, including elevated blood pressure, to precipitate acute cardiovascular events. Approximately three-quarters of emergency responders have prehypertension or hypertension, a proportion which is expected to increase, based on the obesity epidemic. Elevated blood pressure is also inadequately controlled in these professionals and strongly linked to cardiovascular disease morbidity and mortality. Notably, the majority of incident cardiovascular disease events occur in responders who are initially prehypertensive or only mildly hypertensive and whose average premorbid blood pressures are in the range in which many physicians would hesitate to prescribe medications (140-146/88-92). Laws mandating public benefits for emergency responders with cardiovascular disease provide an additional rationale for aggressively controlling their blood pressure. This review provides a background on emergency responders, summarizes occupational risk factors for hypertension and the metabolic syndrome, their prevalence of elevated blood pressure, and evidence linking hypertension with adverse outcomes in these professions. Next, discrepancies between relatively outdated medical standards for emergency responders and current, evidence-based guidelines for blood pressure management in the general public are highlighted. Finally, a workplace-oriented approach for blood pressure control among emergency responders is proposed, based on the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

A Call for a Community of Practice to Assess the Impact of Emerging Technologies on Undergraduate Biology Education †

PubMed Central

Jensen, Jamie L.; Dario-Becker, Juville; Hughes, Lee E.; Amburn, D. Sue Katz; Shaw, Joyce A.

2012-01-01

Recent recommendations for educational research encourage empirically tested, theory-based, completely transparent, and broadly applicable studies. In light of these recommendations, we call for a research standard and community of practice in the evaluation of technology use in the undergraduate life science classroom. We outline appropriate research methodology, review and critique the past research on technology usage and, lastly, suggest a new and improved focus for research on emerging technologies. PMID:23653777

A call for a community of practice to assess the impact of emerging technologies on undergraduate biology education.

PubMed

Jensen, Jamie L; Dario-Becker, Juville; Hughes, Lee E; Amburn, D Sue Katz; Shaw, Joyce A

2012-01-01

Recent recommendations for educational research encourage empirically tested, theory-based, completely transparent, and broadly applicable studies. In light of these recommendations, we call for a research standard and community of practice in the evaluation of technology use in the undergraduate life science classroom. We outline appropriate research methodology, review and critique the past research on technology usage and, lastly, suggest a new and improved focus for research on emerging technologies.

High-fidelity hybrid simulation of allergic emergencies demonstrates improved preparedness for office emergencies in pediatric allergy clinics.

PubMed

Kennedy, Joshua L; Jones, Stacie M; Porter, Nicholas; White, Marjorie L; Gephardt, Grace; Hill, Travis; Cantrell, Mary; Nick, Todd G; Melguizo, Maria; Smith, Chris; Boateng, Beatrice A; Perry, Tamara T; Scurlock, Amy M; Thompson, Tonya M

2013-01-01

Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation. To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills. Allergy clinics were invited to Arkansas Children's Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training. Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P < .003). Follow-up in situ scenarios 10-12 months later demonstrated retention of skills training at both clinics (all P ≤ .004). Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

[Preclinical treatment of multiple trauma : what is important?].

PubMed

Schweigkofler, U; Hoffmann, R

2013-09-01

Multiple trauma is still the most common cause of death in the age group below 40 years but rarely occurs in prehospital emergencies in Germany. Therefore, personal experience of emergency physicians in prehospital treatment of multiple trauma is often limited. Priority-based therapy according to standardized algorithms and advances in clinical and intensive care have reduced hospital mortality down to 13 %. Time factors, treatment and transport by Helicopter Emergency Medical Services seem to have had a significant impact on the outcome. The current German multiple trauma S3 guidelines provide algorithms for preclinical treatment. The underlying scientific evidence in this respect is, however, low.

Protocol for Standardizing High-to-Moderate Abundance Protein Biomarker Assessments Through an MRM-with-Standard-Peptides Quantitative Approach.

PubMed

Percy, Andrew J; Yang, Juncong; Chambers, Andrew G; Mohammed, Yassene; Miliotis, Tasso; Borchers, Christoph H

2016-01-01

Quantitative mass spectrometry (MS)-based approaches are emerging as a core technology for addressing health-related queries in systems biology and in the biomedical and clinical fields. In several 'omics disciplines (proteomics included), an approach centered on selected or multiple reaction monitoring (SRM or MRM)-MS with stable isotope-labeled standards (SIS), at the protein or peptide level, has emerged as the most precise technique for quantifying and screening putative analytes in biological samples. To enable the widespread use of MRM-based protein quantitation for disease biomarker assessment studies and its ultimate acceptance for clinical analysis, the technique must be standardized to facilitate precise and accurate protein quantitation. To that end, we have developed a number of kits for assessing method/platform performance, as well as for screening proposed candidate protein biomarkers in various human biofluids. Collectively, these kits utilize a bottom-up LC-MS methodology with SIS peptides as internal standards and quantify proteins using regression analysis of standard curves. This chapter details the methodology used to quantify 192 plasma proteins of high-to-moderate abundance (covers a 6 order of magnitude range from 31 mg/mL for albumin to 18 ng/mL for peroxidredoxin-2), and a 21-protein subset thereof. We also describe the application of this method to patient samples for biomarker discovery and verification studies. Additionally, we introduce our recently developed Qualis-SIS software, which is used to expedite the analysis and assessment of protein quantitation data in control and patient samples.

Examining the importance of incorporating emergency preparedness and disaster training core competencies into allied health curricula.

PubMed

Curtis, Tammy

2015-01-01

Preparation for responding to emergency events that does not warrant outside help beyond the local community resources or responding to disaster events that is beyond the capabilities of the local community both require first responders and healthcare professionals to have interdisciplinary skills needed to function as a team for saving lives. To date, there is no core emergency preparedness and disaster planning competencies that have been standardized at all levels across the various allied health curricula disciplines. To identify if emergency preparedness and disaster training content are currently being taught in allied health program courses, to identify possible gaps within allied health curricula, and to explore the perceptions of allied health college educators for implementing emergency preparedness and disaster training core competencies into their existing curricula, if not already included. A quantitative Internet-based survey was conducted in 2013. Convenient sample. Fifty-one allied health college educators completed the survey. Descriptive statistics indicated that the majority of allied health college instructors do not currently teach emergency preparedness and disaster training core competency content within their current allied health discipline; however, their perceived level of importance for inclusion of the competencies was high. The results of this study supported the need for developing and establishing a basic national set of standardized core emergency preparedness and disaster planning competencies at all levels across various allied health curricula disciplines to ensure victims receive the best patient care and have the best possible chance of survival.

Development and Implementation of Inquiry-Based and Computerized-Based Laboratories: Reforming High School Chemistry in Israel

ERIC Educational Resources Information Center

Barnea, Nitza; Dori, Yehudit Judy; Hofstein, Avi

2010-01-01

Reforms in science education in general and in chemistry education in particular have been introduced in many countries since the beginning of the 21st Century. Similarly, at this time in Israel both the content and pedagogy of the chemistry curriculum in high schools were reformed. New content and pedagogical standards emerged, fostering…

Two-year outcome of team-based intensive case management for patients with schizophrenia.

PubMed

Aberg-Wistedt, A; Cressell, T; Lidberg, Y; Liljenberg, B; Osby, U

1995-12-01

Two-year outcomes of patients with schizophrenic disorders who were assigned to an intensive, team-based case management program and patients who received standard psychiatric services were assessed. The case management model featured increased staff contact time with patients, rehabilitation plans based on patients' expressed needs, and patients' attendance at team meetings where their rehabilitation plan was discussed. Forty patients were randomly assigned to either the case management group or the control group that received standard services. Patients' use of emergency and inpatient services, their quality of life, the size of their social networks, and their relatives' burden of care were assessed at assignment to the study groups and at two-year follow-up. Patients in the case management group had significantly fewer emergency visits compared with the two years before the study, and their relatives reported significantly reduced burden of care associated with relationships with psychiatric services over the two-year period. The size of patients' social networks increased for the case management group and decreased for the control group. A team-based intensive case management model is an effective intervention in the rehabilitation of patients with chronic schizophrenia.

Public nutrition in complex emergencies.

PubMed

Young, Helen; Borrel, Annalies; Holland, Diane; Salama, Peter

Public nutrition is a broad-based, problem-solving approach to addressing malnutrition in complex emergencies that combines analysis of nutritional risk and vulnerability with action-oriented strategies, including policies, programmes, and capacity development. This paper focuses on six broad areas: nutritional assessment, distribution of a general food ration, prevention and treatment of moderate malnutrition, treatment of severe malnutrition in children and adults, prevention and treatment of micronutrient deficiency diseases, and nutritional support for at-risk groups, including infants, pregnant and lactating women, elderly people, and people living with HIV. Learning and documenting good practice from previous emergencies, the promotion of good practice in current emergencies, and adherence to international standards and guidelines have contributed to establishing the field of public nutrition. However, many practical challenges reduce the effectiveness of nutritional interventions in complex emergencies, and important research and programmatic questions remain.

Guidance for Product Category Rule Development, Version 1.0

EPA Science Inventory

Environmental claims based on life cycle assessment (LCA) can provide quantitative, full life cycle information on products in a format that can permit comparisons and thereby inform purchasing decisions. In recent years, a number of standards and guides have emerged for making b...

Ethics for Earthquakes And Other Emergencies

ERIC Educational Resources Information Center

McKenna, David L.

1976-01-01

As the demand for educational resources outruns the supply, higher education will enter a new ethical era. Anticipating the future, admissions counselors should review the ethics of their profession. Standards should be based on the new reality that higher education is now an interdependent system. (Author)

44 CFR 13.20 - Standards for financial management systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... attendance records, contract and subgrant award documents, etc. (7) Cash management. Procedures for... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Standards for financial management systems. 13.20 Section 13.20 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT...

44 CFR 13.20 - Standards for financial management systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... attendance records, contract and subgrant award documents, etc. (7) Cash management. Procedures for... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Standards for financial management systems. 13.20 Section 13.20 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT...

44 CFR 13.20 - Standards for financial management systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... attendance records, contract and subgrant award documents, etc. (7) Cash management. Procedures for... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Standards for financial management systems. 13.20 Section 13.20 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT...

75 FR 61386 - Emergency Escape Breathing Apparatus Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-05

...-0044, Notice No. 1] RIN 2130-AC14 Emergency Escape Breathing Apparatus Standards AGENCY: Federal... breathing apparatus (EEBA) to the members of the train crew and certain other employees while they are... EEBA--emergency escape breathing apparatus FRA--Federal Railroad Administration FRSA--the former...

Hypothermia in a Rural Setting: An Emergency Medicine Simulation Scenario

PubMed Central

Jong, Robert; Heroux, Aron; Dubrowski, Adam

2017-01-01

Patients presenting with hypothermia in a rural emergency department can be quite challenging to manage without significant mortality and morbidity. Standard medical school curricula do not fully prepare trainees for the unique aspects of practice in northern rural and remote communities. Training opportunities on site may provide a solution to this lack of experience. However, these communities often have limited simulation-based resources and expertise for conducting and developing simulation scenarios. In this technical report, we outline a hypothermia simulation that utilizes only basic resources and is, thus, practical for rural and remote facilities. The aim of this report is to better equip trainees, clinicians, and emergency department staff who may encounter such a scenario in their practice. While the simulation is specifically designed for medical students, resident doctors, and emergency department staff, it could also be applicable in other low-resource settings, such as military bases, search and rescue stations, and arctic travel and tourism infirmaries. PMID:29511605

The National Falls and Bone Health Audit: implications for UK emergency care.

PubMed

Banerjee, Jay; Benger, Jonathan; Treml, Jonathan; Martin, Finbarr C; Grant, Rob; Lowe, Derek; Potter, Jonathan; Husk, Janet

2012-10-01

The National Clinical Audit of Falls and Bone Health, coordinated by the Royal College of Physicians, assesses progress in implementing integrated falls services across the UK against national standards and enables benchmarking between service providers. Nationally, falls are a leading contributor towards mortality and morbidity in older people and account for 700,000 visits to emergency departments and 4 million annual bed days in England alone. Two rounds of national organisational audit in 2005 and 2008 and one national clinical audit in 2006 were carried out based on indicators developed by a multidisciplinary group. These showed that management of falls and bone health in older people remains suboptimal in emergency departments and minor injury units and opportunities are being missed in carrying out evidence-based risk assessment and management. Older people attending emergency departments in the UK following a fall are receiving a poor deal. There is an urgent need to ensure more effective assessment and management to prevent further falls and fractures.

40 CFR Table 1 to Subpart Jjjj of... - NOX, CO, and VOC Emission Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Stationary Non-Emergency SI Engines â¥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI Landfill... Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI...-Emergency SI Natural Gas b and Non-Emergency SI Lean Burn LPG b 100≤HP HP 25 HP Table 1 to Subpart JJJJ of...

The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care.

PubMed

Dvorak, Jiri; Kramer, Efraim B; Schmied, Christian M; Drezner, Jonathan A; Zideman, David; Patricios, Jon; Correia, Luis; Pedrinelli, André; Mandelbaum, Bert

2013-12-01

Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

Providing emergency medical care to offshore oil and gas platforms in the Gulf of Mexico using telemedicine

NASA Astrophysics Data System (ADS)

Bouabene, Anis

2002-08-01

UTMB is developing with industrial partners the "24/7 telemedicine triage project" to provide emergency medical care to offshore oil and gas rigs and platforms in the Gulf of Mexico. The oil and gas industry is second only to the US department of defense in the number of employees stationed in remote areas. Providing medical care to such populations is logistically complex and expensive. In addition, emergency evacuation is often time-consuming and poses risks for both patients and medical crews. By utilizing high-resolution videoconferencing technology, through a satellite communication, patient visits will be conducted in real time and will provide more informed decisions about the need for more extensive treatment, thereby reducing unnecessary evacuations. In addition, patients who require evacuation will receive a higher standard of care while waiting for transport to a medical facility. UTMB physicians report that 39% of all patients from offshore facilities treated in the emergency department, could have been successfully treated through telemedicine without being evacuated to a hospital. The telemedicine project will employ standard procedures for medical triage, in which patients are directed to appropriate medical experts based on their symptoms or type of injury.

Meta-analysis of toxicity and teratogenicity of 133 chemicals from zebrafish developmental toxicity studies

EPA Science Inventory

Zebrafish developmental toxicity testing is an emerging field, which faces considerable challenges regarding data meta-analysis and the establishment of standardized test protocols. Here, we present an initial correlation study on toxicity of 133 chemicals based on data in the li...

Differential diagnosis in inflammatory bowel disease colitis: State of the art and future perspectives

PubMed Central

Tontini, Gian Eugenio; Vecchi, Maurizio; Pastorelli, Luca; Neurath, Markus F; Neumann, Helmut

2015-01-01

Distinction between Crohn’s disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis cannot be reached in up to 10% of patients presenting with IBD colitis. This topic is receiving emerging attention, as medical therapies, surgical approaches and leading prognostic outcomes require more and more disease-specific strategies in IBD patients. The optimization of standard diagnostic approaches based on clinical features, biomarkers, radiology, endoscopy and histopathology appears to provide only marginal benefits. Conversely, emerging diagnostic techniques in the field of gastrointestinal endoscopy, molecular pathology, genetics, epigenetics, metabolomics and proteomics have already shown promising results. Novel advanced endoscopic imaging techniques and biomarkers can shed new light for the differential diagnosis of IBD, better reflecting diverse disease behaviors based on specific pathogenic pathways. PMID:25574078

The systemic inflammatory response syndrome (SIRS) to identify infected patients in the emergency room.

PubMed

Jaimes, Fabián; Garcés, Jenny; Cuervo, Jorge; Ramírez, Federico; Ramírez, Jorge; Vargas, Andrea; Quintero, Claudia; Ochoa, Jorge; Tandioy, Fabio; Zapata, Láder; Estrada, Juan; Yepes, Maria; Leal, Hiulber

2003-08-01

Evaluation of the usefulness of criteria for systemic inflammatory response syndrome (SIRS) compared with the final diagnosis of infection in patients admitted to the emergency room of two university-based hospitals. Longitudinal cohort study. Hospital Universitario San Vicente de Paul and Hospital General de Medellín, Medellín, Colombia. PATIENTS. Seven hundred thirty-four patients with suspected infection as main diagnosis for admittance into the emergency room. Sensitivity, specificity, predictive values and likelihood ratios (LR) of SIRS criteria at admission were determined using, as gold standards, the diagnosis at the time of discharge based on clinical history and evolution, and microbiological confirmation of infection. SIRS criteria were met by 503 patients (68.5%); the discharge diagnosis of infection was found in 657 (89.4%) and 276 (37%) had microbiological confirmation. SIRS criteria exhibited a sensitivity of 69%, specificity of 35%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 12% and positive LR of 1.06. There were no differences between the two gold standards. The finding of two or more SIRS criteria was of little usefulness for diagnosis of infection. It is necessary to work with new criteria and probably with biological markers, in order to obtain a simple, precise and operative definition of the sepsis phenomenon.

44 CFR 13.20 - Standards for financial management systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... management systems. 13.20 Section 13.20 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... Standards for financial management systems. (a) A State must expand and account for grant funds in... financial management systems of other grantees and subgrantees must meet the following standards: (1...

[Assessment of capacity for logisty, public education, and training in public health emergency management in China].

PubMed

Hu, Guo-qing; Rao, Ke-qin; Sun, Zhen-qiu; Yu, Ren-he

2008-10-01

To assess the capacity for logistics, public education, and training in managing public health emergency in China at present. Four provinces were selected using stratified sampling. All the municipalities of these 4 provinces were assessed using the 9th and 10th subscales (logistics, public education and training) of Preparedness and response capacity questionnaire for public health emergencies for provincial or municipal governments developed by the Center for Health Statistics and Information, Ministry of Health of China. Sixty of the 66 questionnaires (90.91%) were collected. Among the 60 investigated municipalities, 80% established a specific agency to take charge of emergency material storage, management and allocation, 65% developed standard for material storage, 35% developed standard of places for material storage, 25% built regulation for testing, maintaining, and updating the emergency materials regularly, 45% arranged budget for routine payment, 27% established standard of emergency fund, and 28% set up the procedure to initiate emergency fund. The average of standard score of subscale 9 was 43.33 (95% confidence interval, 35.65~51.01). 25% of the 60 municipalities conducted assessment for training in the past 2 years, 53% developed plan for emergency personnel training, 20% developed effectiveness assessment regulation of emergency personnel training, 80% assigned a specific agency to be responsible for public education, and 23% established regulation for public education. The average of standard score of subscale 10 was 47.43 (95% confidence interval, 40.69~54.17). Serious problems are found in logistics, public education, and training for public health emergency management in China. Measures should be taken immediately by the central and local government to improve these capacities.

Enhancing security and improving interoperability in healthcare information systems.

PubMed

Gritzalis, D A

1998-01-01

Security is a key issue in healthcare information systems, since most aspects of security become of considerable or even critical importance when handling healthcare information. In addition, the intense need for information exchange has revealed interoperability of systems and applications as another key issue. Standardization can play an important role towards both these issues. In this paper, relevant standardization activities are briefly presented, and existing and emerging healthcare information security standards are identified and critically analysed. The analysis is based on a framework which has been developed for this reason. Therefore, the identification of gaps and inconsistencies in current standardization, the description of the conflicts of standards with legislation, and the analysis of implications of these standards to user organizations, are the main results of this paper.

Adaptation of industry standards to PACS

NASA Astrophysics Data System (ADS)

Lee, Joseph K.; Yin, Lloyd; Huang, H. K.; Wong, Albert W. K.

1994-05-01

Imagery and textual communications among healthcare information systems, medical imaging equipment, and picture archiving and communication systems (PACS) have always been difficult as each of these components varies with platforms, modalities, and manufacturers. With the emerging of industry standards, it become feasible to integrate all these heterogeneous, disparate medical images and textual data. This paper describes two such major industry standards: Health Level 7 (HL7) and ACR/NEMA. In conforming to the HL7 standard, we are able to share medical information between the hospital information systems, radiology information systems, and PACS. By adapting the ACR/NEMA 2.0 standard, we also can convert medical images generated from a variety of modalities and manufacturers to its standardized data format. The conversion is based on the data dictionary defined in the ACR/NEMA 2.0 document.

Education in Disaster Management and Emergencies: Defining a New European Course.

PubMed

Khorram-Manesh, Amir; Ashkenazi, Michael; Djalali, Ahmadreza; Ingrassia, Pier Luigi; Friedl, Tom; von Armin, Gotz; Lupesco, Olivera; Kaptan, Kubilay; Arculeo, Chris; Hreckovski, Boris; Komadina, Radko; Fisher, Philipp; Voigt, Stefan; James, James; Gursky, Elin

2015-06-01

Unremitting natural disasters, deliberate threats, pandemics, and humanitarian suffering resulting from conflict situations necessitate swift and effective response paradigms. The European Union's (EU) increasing visibility as a disaster response enterprise suggests the need not only for financial contribution but also for instituting a coherent disaster response approach and management structure. The DITAC (Disaster Training Curriculum) project identified deficiencies in current responder training approaches and analyzed the characteristics and content required for a new, standardized European course in disaster management and emergencies. Over 35 experts from within and outside the EU representing various organizations and specialties involved in disaster management composed the DITAC Consortium. These experts were also organized into 5 specifically tasked working groups. Extensive literature reviews were conducted to identify requirements and deficiencies and to craft a new training concept based on research trends and lessons learned. A pilot course and program dissemination plan was also developed. The lack of standardization was repeatedly highlighted as a serious deficiency in current disaster training methods, along with gaps in the command, control, and communication levels. A blended and competency-based teaching approach using exercises combined with lectures was recommended to improve intercultural and interdisciplinary integration. The goal of a European disaster management course should be to standardize and enhance intercultural and inter-agency performance across the disaster management cycle. A set of minimal standards and evaluation metrics can be achieved through consensus, education, and training in different units. The core of the training initiative will be a unit that presents a realistic situation "scenario-based training."

Ethical triage and scarce resource allocation during public health emergencies: tenets and procedures.

PubMed

Kuschner, Ware G; Pollard, John B; Ezeji-Okoye, Stephen C

2007-01-01

Public health emergencies may result in mass casualties and a surge in demand for hospital-based care. Healthcare standards may need to be altered to respond to an imbalance between demands for care and resources. Clinical decisions that involve triage and scarce resource allocation may present unique ethical challenges. To address these challenges, the authors detailed tenets and procedures to guide triage and scarce resource allocation during public health emergencies. The authors propose health care organizations deploy a Triage and Scarce Resource Allocation Team to over-see and guide ethically challenging clinical decision-making during a crisis period. The authors' goal is to help healthcare organizations and clinicians balance public health responsibilities and their duty to individual patients during emergencies in as equitable and humane a manner as possible.

The 2014 Academic College of Emergency Experts in India's INDO-US Joint Working Group (JWG) White Paper on “Developing Trauma Sciences and Injury Care in India”

PubMed Central

Pal, Ranabir; Agarwal, Amit; Galwankar, Sagar; Swaroop, Mamta; Stawicki, Stanislaw P; Rajaram, Laxminarayan; Paladino, Lorenzo; Aggarwal, Praveen; Bhoi, Sanjeev; Dwivedi, Sankalp; Menon, Geetha; Misra, MC; Kalra, OP; Singh, Ajai; Radjou, Angeline Neetha; Joshi, Anuja

2014-01-01

It is encouraging to see the much needed shift in the understanding and recognition of the concept of “burden of disease” in the context of traumatic injury. Equally important is understanding that the impact of trauma burden rivals that of nontraumatic morbidities. Subsequently, this paradigm shift reinstates the appeal for timely interventions as the standard for management of traumatic emergencies. Emergency trauma care in India has been disorganized due to inadequate sensitivity toward patients affected by trauma as well as the haphazard, nonuniform acceptance of standardization as the norm. Some of the major hospitals across various regions in the country do have trauma care units, but even those lack protocols to ensure that all trauma cases are handled by those units, largely owing to lack of structured referral system. As a first step to reform the state of trauma care in the country, a detailed overview is needed to gain insight into the prevailing reality. The objectives of this paper are to thus weave a foundation based on the statistical and qualitative burden of trauma in the country; the available infrastructure of trauma care centers equipped to deal with trauma; the need and scope of standardized protocols for intervention; and most importantly, the application of these in shaping educational initiatives in advancing emergency trauma care in the country. PMID:25024939

Is a mobile emergency severity index (ESI) triage better than the paper ESI?

PubMed

Savatmongkorngul, Sorravit; Yuksen, Chaiyaporn; Suwattanasilp, Chanakarn; Sawanyawisuth, Kittisak; Sittichanbuncha, Yuwares

2017-12-01

This study aims to evaluate the mobile emergency severity index (ESI) tool in terms of validity compared with the original ESI triage. The original ESI and mobile ESI were used with patients at the Department of Emergency Medicine, Ramathibodi Hospital, Thailand. Eligible patients were evaluated by sixth-year medical students/emergency physicians using either the original or mobile ESI. The ESI results for each patient were compared with the standard ESI. Concordance and kappa statistics were calculated for pairs of the evaluators. There were 486 patients enrolled in the study; 235 patients (48.4%) were assessed using the mobile ESI, and 251 patients (51.6%) were in the original ESI group. The baseline characteristics of patients in both groups were mostly comparable except for the ED visit time. The percentages of concordance and kappa statistics in the original ESI group were lower than in the mobile group in all three comparisons (medical students vs gold standard, emergency physicians vs gold standard, and medical students vs emergency physicians). The highest kappa in the original ESI group is 0.69, comparing emergency physicians vs gold standard, while the lowest kappa in the application group is 0.84 comparing the medical students vs gold standard. Both medical students and emergency physicians are more confident with the mobile ESI application triage. In conclusion, the mobile ESI has better inter-rater reliability, and is more user-friendly than the original paper form.

40 CFR Table 1 to Subpart Jjjj of... - NOX, CO, and VOC Emission Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Stationary Non-Emergency SI Engines â¥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI Landfill... Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI...-Emergency SI Natural Gas b and Non-Emergency SI Lean Burn LPG b 100≤HP<500 7/1/2008 2.0 4.0 1.0 160 540 86 1...

40 CFR Table 1 to Subpart Jjjj of... - NOX, CO, and VOC Emission Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Stationary Non-Emergency SI Engines â¥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI Landfill... Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI...-Emergency SI Natural Gas b and Non-Emergency SI Lean Burn LPG b 100≤HP<500 7/1/2008 2.0 4.0 1.0 160 540 86 1...

40 CFR Table 1 to Subpart Jjjj of... - NOX, CO, and VOC Emission Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Stationary Non-Emergency SI Engines â¥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI Landfill... Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI...-Emergency SI Natural Gas b and Non-Emergency SI Lean Burn LPG b 100≤HP<500 7/1/2008 2.0 4.0 1.0 160 540 86 1...

Vaccine-related standard of care and willingness to respond to public health emergencies: a cross-sectional survey of California vaccine providers.

PubMed

Seib, Katherine; Barnett, Daniel J; Weiss, Paul S; Omer, Saad B

2012-12-17

Responding to a vaccine-related public health emergency involves a broad spectrum of provider types, some of whom may not routinely administer vaccines including obstetricians, pharmacists and other specialists. These providers may have less experience administering vaccines and thus less confidence or self-efficacy in doing so. Self-efficacy is known to have a significant impact on provider willingness to respond in emergency situations. We conducted a survey of 800 California vaccine providers to investigate standard of care, willingness to respond, and how vaccine-related standard of care impacts willingness to respond among these providers. We used linear regression to examine how willingness to respond was impacted by vaccine-related standard of care. Forty percent of respondents indicated that they had participated in emergency preparedness training, actual disaster response, or surge capacity initiatives with significant differences among provider types for all measures (p=0.007). When asked to identify barriers to responding to a public health emergency, respondents indicated that staff size or capacity, training and resources were the top concerns. Respondents in practices with a higher vaccine-related standard of care had a higher willing to respond index (β=0.190, p=0.001). Respondents who had participated in emergency training or actual emergency response had a higher willing to respond index (β=1.323, p<0.0001). Our study suggests that concerns about staff size and surge capacity need to be more explicitly addressed in current emergency preparedness training efforts. In the context of boosting response willingness, larger practice environments stand to benefit from self-efficacy focused training and exercise efforts that also incorporate standard of care. Copyright © 2012 Elsevier Ltd. All rights reserved.

Medical Emergency Exceptions in State Abortion Statutes: The Statistical Record.

PubMed

Linton, Paul Benjamin

2016-01-01

This article attempts to determine, first, whether emergency exceptions in statutes regulating abortion have been abused and, second, whether the standard used in such an exception--subjective or objective--makes a difference in the reported incidence of such emergencies. A review of the statistical data supports two conclusions. First, physicians who perform abortions and have complied with state reporting requirements have not relied upon the medical emergency exceptions in state abortion statutes to evade the requirements of those statutes. Second, the use of an objective standard for evaluating medical emergencies ("reasonable medical judgment") has not been associated with fewer reported emergencies (per number of abortions performed) than the use of a subjective standard ("good faith clinical judgment"). Both of these conclusions may be relevant in drafting other abortion statutes including prohibitions (e.g., post-viability abortions).

[Quality management in emergency departments: Lack of uniform standards for fact-based controlling].

PubMed

Ries, M; Christ, M

2015-11-01

The general high occupancy of emergency departments during the winter months of 2014/2015 outlined deficits in health politics. Whether on the regional, province, or federal level, verifiable and accepted figures to enable in depth analysis and fact-based controlling of emergency care systems are lacking. As the first step, reasons for the current situation are outlined in order to developed concrete recommendations for individual hospitals. This work is based on a selective literature search with focus on quality management, ratio driven management, and process management within emergency departments as well as personal experience with implementation of a key ratio system in a German maximum care hospital. The insufficient integration of emergencies into the DRG systematic, the role as gatekeeper between inpatient and outpatient care sector, the decentralized organization of emergency departments in many hospitals, and the inconsistent representation within the medical societies can be mentioned as reasons for the lack of key ratio systems. In addition to the important role within treatment procedures, emergency departments also have an immense economic importance. Consequently, the management of individual hospitals should promote implementation of key ratio systems to enable controlling of emergency care processes. Thereby the perspectives finance, employees, processes as well as partners and patients should be equally considered. Within the process perspective, milestones could be used to enable detailed controlling of treatment procedures. An implementation of key ratio systems without IT support is not feasible; thus, existing digital data should be used and future data analysis should already be considered during implementation of new IT systems.

Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future.

PubMed

Rossignol, Patrick; Legrand, Matthieu; Kosiborod, Mikhail; Hollenberg, Steven M; Peacock, W Frank; Emmett, Michael; Epstein, Murray; Kovesdy, Csaba P; Yilmaz, Mehmet Birhan; Stough, Wendy Gattis; Gayat, Etienne; Pitt, Bertram; Zannad, Faiez; Mebazaa, Alexandre

2016-11-01

Hyperkalemia is a common electrolyte disorder, especially in chronic kidney disease, diabetes mellitus, or heart failure. Hyperkalemia can lead to potentially fatal cardiac dysrhythmias, and it is associated with increased mortality. Determining whether emergency therapy is warranted is largely based on subjective clinical judgment. The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT) aimed to evaluate the current knowledge pertaining to the emergency treatment of hyperkalemia. The INI-CRCT developed a treatment algorithm reflecting expert opinion of best practices in the context of current evidence, identified gaps in knowledge, and set priorities for future research. We searched PubMed (to August 4, 2015) for consensus guidelines, reviews, randomized clinical trials, and observational studies, limited to English language but not by publication date. Treatment approaches are based on small studies, anecdotal experience, and traditional practice patterns. The safety and real-world effectiveness of standard therapies remain unproven. Prospective research is needed and should include studies to better characterize the population, define the serum potassium thresholds where life-threatening arrhythmias are imminent, assess the potassium and electrocardiogram response to standard interventions. Randomized, controlled trials are needed to test the safety and efficacy of new potassium binders for the emergency treatment of severe hyperkalemia in hemodynamically stable patients. Existing emergency treatments for severe hyperkalemia are not supported by a compelling body of evidence, and they are used inconsistently across institutions, with potentially significant associated side effects. Further research is needed to fill knowledge gaps, and definitive clinical trials are needed to better define optimal management strategies, and ultimately to improve outcomes in these patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Development of national standardized all-hazard disaster core competencies for acute care physicians, nurses, and EMS professionals.

PubMed

Schultz, Carl H; Koenig, Kristi L; Whiteside, Mary; Murray, Rick

2012-03-01

The training of medical personnel to provide care for disaster victims is a priority for the physician community, the federal government, and society as a whole. Course development for such training guided by well-accepted standardized core competencies is lacking, however. This project identified a set of core competencies and performance objectives based on the knowledge, skills, and attitudes required by the specific target audience (emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel) to ensure they can treat the injuries and illnesses experienced by victims of disasters regardless of cause. The core competencies provide a blueprint for the development or refinement of disaster training courses. This expert consensus project, supported by a grant from the Robert Wood Johnson Foundation, incorporated an all-hazard, comprehensive emergency management approach addressing every type of disaster to minimize the effect on the public's health. An instructional systems design process was used to guide the development of audience-appropriate competencies and performance objectives. Participants, representing multiple academic and provider organizations, used a modified Delphi approach to achieve consensus on recommendations. A framework of 19 content categories (domains), 19 core competencies, and more than 90 performance objectives was developed for acute medical care personnel to address the requirements of effective all-hazards disaster response. Creating disaster curricula and training based on the core competencies and performance objectives identified in this article will ensure that acute medical care personnel are prepared to treat patients and address associated ramifications/consequences during any catastrophic event. Copyright © 2012 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

A Grid Infrastructure for Supporting Space-based Science Operations

NASA Technical Reports Server (NTRS)

Bradford, Robert N.; Redman, Sandra H.; McNair, Ann R. (Technical Monitor)

2002-01-01

Emerging technologies for computational grid infrastructures have the potential for revolutionizing the way computers are used in all aspects of our lives. Computational grids are currently being implemented to provide a large-scale, dynamic, and secure research and engineering environments based on standards and next-generation reusable software, enabling greater science and engineering productivity through shared resources and distributed computing for less cost than traditional architectures. Combined with the emerging technologies of high-performance networks, grids provide researchers, scientists and engineers the first real opportunity for an effective distributed collaborative environment with access to resources such as computational and storage systems, instruments, and software tools and services for the most computationally challenging applications.

Don't panic--prepare: towards crisis-aware models of emergency department operations.

PubMed

Ceglowski, Red; Churilov, Leonid; Wasserheil, Jeff

2005-12-01

The existing models of Emergency Department (ED) operations that are based on the "flow-shop" management logic do not provide adequate decision support in dealing with the ED overcrowding crises. A conceptually different crisis-aware approach to ED modelling and operational decision support is introduced in this paper. It is based on Perrow's theory of "normal accidents" and calls for recognizing the inevitable nature of ED overcrowding crises within current health system setup. Managing the crisis before it happens--a standard approach in crisis management area--should become an integral part of ED operations management. The potential implications of adopting such a crisis-aware perspective for health services research and ED management are outlined.

Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe.

PubMed

Twomey, Michèle; Šijački, Ana; Krummrey, Gert; Welzel, Tyson; Exadaktylos, Aristomenis K; Ercegovac, Marko

2018-03-12

Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM) introduced a standardized triage process at the Clinical Centre of Serbia (CCS). This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways.

Getting the Argument Started: A Variation on the Density Investigation

ERIC Educational Resources Information Center

Walker, Joi P.; Wolf, Steven F.

2017-01-01

The ability to "engage in argument from evidence" is one of the eight practices identified in the "Next Generation Science Standards" as well as an emerging focus of undergraduate chemistry curricula. Guiding students to make evidence-based claims that engender argumentation will require faculty to revise conventional…

Ownership of Language in Yucatec Maya Revitalization Pedagogy

ERIC Educational Resources Information Center

Guerrettaz, Anne Marie

2015-01-01

This classroom-based study examined a Yucatec Maya language course for teachers and the pedagogical implementation of national language policy in Mexico. Analysis of this teacher education program focused on various dimensions of teachers' Maya-language expertise, the teaching of the emergent standard Maya, and hegemonic constructions of…

Establishing Derived Equivalence Relations of Basic Geography Skills in Children with Autism

ERIC Educational Resources Information Center

Dixon, Mark R.; Stanley, Caleb; Belisle, Jordan; Galliford, Megan E.; Alholail, Amani; Schmick, Ayla M.

2017-01-01

The present study evaluated the efficacy of a stimulus-equivalence training procedure in teaching basic geography skills to two children with autism. The procedures were taken directly from a standardized training curriculum based in stimulus equivalence theory called "Promoting the Emergence of Advanced Knowledge Equivalence Module"…

[Improvement of emergency physician education through simulator training. Consideration on the basis of the model project "NASimSaar25"].

PubMed

Armbruster, W; Kubulus, D; Schlechtriemen, T; Adler, J; Höhn, M; Schmidt, D; Duchêne, S; Steiner, P; Volk, T; Wrobel, M

2014-09-01

Prehospital emergency medicine is a challenge for trainee emergency physicians. Rare injuries and diseases as well as patients in extreme age groups can unexpectedly face emergency physicians. In the regulations on medical education the German Medical Association requires participation in 50 emergency missions under the supervision of an experienced emergency physician. This needs to be improved because on-the-job training does not generally represent the whole spectrum of emergency medicine and a good and structured training under on call conditions is nearly impossible. The subject of the model project described was whether practical training for emergency physicians can be achieved by participation in simulation training instead of real emergency situations. After modification of the Saarland regulations on medical education it was possible to replace up to 25 participations in emergency missions by simulation training. The concept of the course NASimSaar25 requires participants to complete 25 simulator cases in 3 days in small training groups. Emergency situations from all medical disciplines need to be treated. A special focus is on the treatment of life-threatening and rare diseases and injuries. Modern simulators and actors are used. The debriefings are conducted by experienced tutors based on approved principles. Medical contents, learning targets from the field of crew resource management (CRM) and soft skills are discussed in these debriefings. Education in the field of emergency medicine can be improved by simulator-based learning and training. However, practical work under a tutor in real and clinical experience cannot be completely replaced by simulation. Simulator training can only be successful if theoretical knowledge has already been acquired. A simulator-based course concept can result in an improvement of emergency medical education. The model project NASimSaar25 was well received by the target audience and mostly very well evaluated in terms of learning and reality. If this project becomes established the demand on simulation-based training will increase. The training should achieve a consistent standard of quality.

Noise pollution in intensive care units and emergency wards.

PubMed

Khademi, Gholamreza; Roudi, Masoumeh; Shah Farhat, Ahmad; Shahabian, Masoud

2011-01-01

The improvement of technology has increased noise levels in hospital Wards to higher than international standard levels (35-45 dB). Higher noise levels than the maximum level result in patient's instability and dissatisfaction. Moreover, it will have serious negative effects on the staff's health and the quality of their services. The purpose of this survey is to analyze the level of noise in intensive care units and emergency wards of the Imam Reza Teaching Hospital, Mashhad. This research was carried out in November 2009 during morning shifts between 7:30 to 12:00. Noise levels were measured 10 times at 30-minute intervals in the nursing stations of 10 wards of the emergency, the intensive care units, and the Nephrology and Kidney Transplant Departments of Imam Reza University Hospital, Mashhad. The noise level in the nursing stations was tested for both the maximum level (Lmax) and the equalizing level (Leq). The research was based on the comparison of equalizing levels (Leq) because maximum levels were unstable. In our survey the average level (Leq) in all wards was much higher than the standard level. The maximum level (Lmax) in most wards was 85-86 dB and just in one measurement in the Internal ICU reached 94 dB. The average level of Leq in all wards was 60.2 dB. In emergency units, it was 62.2 dB, but it was not time related. The highest average level (Leq) was measured at 11:30 AM and the peak was measured in the Nephrology nursing station. The average levels of noise in intensive care units and also emergency wards were more than the standard levels and as it is known these wards have vital roles in treatment procedures, so more attention is needed in this area.

A dynamic vulnerability evaluation model to smart grid for the emergency response

NASA Astrophysics Data System (ADS)

Yu, Zhen; Wu, Xiaowei; Fang, Diange

2018-01-01

Smart grid shows more significant vulnerability to natural disasters and external destroy. According to the influence characteristics of important facilities suffered from typical kinds of natural disaster and external destroy, this paper built a vulnerability evaluation index system of important facilities in smart grid based on eight typical natural disasters, including three levels of static and dynamic indicators, totally forty indicators. Then a smart grid vulnerability evaluation method was proposed based on the index system, including determining the value range of each index, classifying the evaluation grade standard and giving the evaluation process and integrated index calculation rules. Using the proposed evaluation model, it can identify the most vulnerable parts of smart grid, and then help adopting targeted emergency response measures, developing emergency plans and increasing its capacity of disaster prevention and mitigation, which guarantee its safe and stable operation.

Fever management in the emergency department of the Children's Hospital of Fudan University: a best practice implementation project.

PubMed

Hu, Fei; Zhang, Jiayan; Shi, Shupeng; Zhou, Zhang

2016-09-01

Febrile illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. It is very important that healthcare professionals know how to recognize fever, assess children with fever, treat children with fever and role of nurses and parents. This paper outlines a best practice implementation project on the management of fever in children in an emergency department. To audit current practice of fever management for children in an emergency department and to implement strategies to standardize pediatric fever management based on evidence-based practice guidelines. We used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice to examine compliance with fever management criteria based on the best available evidence before and after the implementation of strategies to spread the use of evidence-based practice protocols. We found significant improvements in pediatric fever management as measured by the knowledge scores of parents (54.5-83.7) and nurses (67.6-90.3). This suggested a need for continuous education. We found a noticeable improvement in compliance across all the five criteria; using correct methods to measure temperature (86-98%), staff education (0-100%), parents education (0-100%), using assessment tools (0-100%) and observed management (0-98%). This best practice implementation project demonstrated the use of effective strategies to standardize the protocol for fever management, implement assessment tool, develop multimedia materials, deliver continuous staff education and update nursing documentation and patient education pamphlets to ensure best practice is delivered by nurses to improve patient outcomes.

Emergency Medical Technician-Ambulance: National Standard Curriculum. Instructor's Lesson Plans (Third Edition).

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This set of instructor's lesson plans is one of three documents prepared for the Emergency Medical Technician (EMT) National Standard Curriculum. It contains detailed outlines of course content and guidance for teaching each course lesson. The training course contains 33 lessons covering all emergency medical techniques currently considered to be…

ECLIPSE, an Emerging Standardized Modular, Secure and Affordable Software Toolset in Support of Product Assurance, Quality Assurance and Project Management for the Entire European Space Industry (from Innovative SMEs to Primes and Institutions)

NASA Astrophysics Data System (ADS)

Bennetti, Andrea; Ansari, Salim; Dewhirst, Tori; Catanese, Giuseppe

2010-08-01

The development of satellites and ground systems (and the technologies that support them) is complex and demands a great deal of rigor in the management of both the information it relies upon and the information it generates via the performance of well established processes. To this extent for the past fifteen years Sapienza Consulting has been supporting the European Space Agency (ESA) in the management of this information and provided ESA with ECSS (European Cooperation for Space Standardization) Standards based Project Management (PM), Product Assurance (PA) and Quality Assurance (QA) software applications. In 2009 Sapienza recognised the need to modernize, standardizing and integrate its core ECSS-based software tools into a single yet modularised suite of applications named ECLIPSE aimed at: • Fulfilling a wider range of historical and emerging requirements, • Providing a better experience for users, • Increasing the value of the information it collects and manages • Lowering the cost of ownership and operation • Increasing collaboration within and between space sector organizations • Aiding in the performance of several PM, PA, QA, and configuration management tasks in adherence to ECSS standards. In this paper, Sapienza will first present the toolset, and a rationale for its development, describing and justifying its architecture, and basic modules composition. Having defined the toolset architecture, this paper will address the current status of the individual applications. A compliance assessment will be presented for each module in the toolset with respect to the ECSS standard it addresses. Lastly experience from early industry and Institutional users will be presented.

The scientifically substantiated art of teaching: A study in the development of standards in the new academic field of neuroeducation (mind, brain, and education science)

NASA Astrophysics Data System (ADS)

Tokuhama-Espinosa, Tracey Noel

Concepts from neuroeducation, commonly referred in the popular press as "brain-based learning," have been applied indiscreetly and inconsistently to classroom teaching practices for many years. While standards exist in neurology, psychology and pedagogy, there are no agreed upon standards in their intersection, neuroeducation, and a formal bridge linking the fields is missing. This study used grounded theory development to determine the parameters of the emerging neuroeducational field based on a meta-analysis of the literature over the past 30 years, which included over 2,200 documents. This research results in a new model for neuroeducation. The design of the new model was followed by a Delphi survey of 20 international experts from six different countries that further refined the model contents over several months of reflection. Finally, the revised model was compared to existing information sources, including popular press, peer review journals, academic publications, teacher training textbooks and the Internet, to determine to what extent standards in neuroeducation are met in the current literature. This study determined that standards in the emerging field, now labeled Mind, Brain, and Education: The Science of Teaching and Learning after the Delphi rounds, are the union of standards in the parent fields of neuroscience, psychology, and education. Additionally, the Delphi expert panel agreed upon the goals of the new discipline, its history, the thought leaders, and a model for judging quality information. The study culminated in a new model of the academic discipline of Mind, Brain, and Education science, which explains the tenets, principles and instructional guidelines supported by the meta-analysis of the literature and the Delphi response.

An Audiovisual Teaching Module to Assist Examiners in the Administration of a Practical Performance Examination for the Emergency Medical Technician-Ambulance (EMT-A). Consisting of a 90-Minute Audiovisual Presentation In Either 16mm Sound or 3/4" Video-Cassette Plus a "User's Guide" Describing in Detail the Total Examination Procedure. Final Report.

ERIC Educational Resources Information Center

National Registry of Emergency Medical Technicians, Columbus, OH.

A structured, time-referenced, performance examination was designed as part of the certification procedure for Emergency Medical Technicians-Ambulance in an attempt to increase objectivity and standardization. This examination is based on a model developed by the University of Southern California, School of Medicine, Department of Emergency…

Undergraduate medical education in emergency medical care: a nationwide survey at German medical schools.

PubMed

Beckers, Stefan K; Timmermann, Arnd; Müller, Michael P; Angstwurm, Matthias; Walcher, Felix

2009-05-12

Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6). Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care.

The "prudent layperson" definition of an emergency medical condition.

PubMed

Li, James; Galvin, Hannah K; Johnson, Sandra C

2002-01-01

The study objectives, based on federal and state legislative language, were to objectively define symptoms and signs commonly agreed on by "prudent laypersons" as "emergency medical conditions." After comprehensive tabulation of symptom classifications from the International Classification of Diseases (ICD-9), we performed a survey of nonmedical laypersons. Data analysis included descriptive statistics, proportional calculations, and 95% confidence intervals. A minority of symptoms and signs (25/87, 29%) were considered emergency medical conditions by more than half of nonmedical survey respondents who were self-defined as prudent laypersons. The leading conditions deemed emergencies were loss of consciousness, seizure, no recognition of one side of the body, paralysis, shock, gangrene, coughing blood, trouble breathing, chest pain, and choking. Pain, except for renal colic or chest pain, was not considered an emergency. No symptoms or signs specifically related to gynecologic disorders were considered emergencies. Most symptoms and signs tabulated in the diagnostic coding manual, ICD-9, are not considered emergency medical conditions by self-designated prudent laypersons. These include many conditions that are commonly investigated and treated in the emergency department setting. Use of the prudent layperson standard for reimbursable emergency health services may not reflect the actual scope of symptoms necessitating emergency care.

Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings.

PubMed

Gomes, Carlos Augusto; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, Luca; Catena, Fausto; Coccolini, Federico; Inaba, Kenji; Demetriades, Demetrios; Gomes, Felipe Couto; Gomes, Camila Couto

2015-01-01

Advances in the technology and improved access to imaging modalities such as Computed Tomography and laparoscopy have changed the contemporary diagnostic and management of acute appendicitis. Complicated appendicitis (phlegmon, abscess and/ or diffuse peritonitis), is now reliably distinguished from uncomplicated cases. Therefore, a new comprehensive grading system for acute appendicitis is necessary. The goal is review and update the laparoscopic grading system of acute appendicitis and to provide a new standardized classification system to allow more uniform patient stratification. During the last World Society of Emergency Surgery Congress in Israel (July, 2015), a panel involving Acute Appendicitis Experts and the author's discussed many current aspects about the acute appendicitis between then, it will be submitted a new comprehensive disease grading system. It was idealized based on three aspect of the disease (clinical and imaging presentation and laparoscopic findings). The new grading system may provide a standardized system to allow more uniform patient stratification for appendicitis research. In addition, may aid in determining optimal management according to grade. Lastly, what we want is to draw a multicenter observational study within the World Society of Emergency Surgery (WSES) based on this design.

Production, concentration and titration of pseudotyped HIV-1-based lentiviral vectors.

PubMed

Kutner, Robert H; Zhang, Xian-Yang; Reiser, Jakob

2009-01-01

Over the past decade, lentiviral vectors have emerged as powerful tools for transgene delivery. The use of lentiviral vectors has become commonplace and applications in the fields of neuroscience, hematology, developmental biology, stem cell biology and transgenesis are rapidly emerging. Also, lentiviral vectors are at present being explored in the context of human clinical trials. Here we describe improved protocols to generate highly concentrated lentiviral vector pseudotypes involving different envelope glycoproteins. In this protocol, vector stocks are prepared by transient transfection using standard cell culture media or serum-free media. Such stocks are then concentrated by ultracentrifugation and/or ion exchange chromatography, or by precipitation using polyethylene glycol 6000, resulting in vector titers of up to 10(10) transducing units per milliliter and above. We also provide reliable real-time PCR protocols to titrate lentiviral vectors based on proviral DNA copies present in genomic DNA extracted from transduced cells or on vector RNA. These production/concentration methods result in high-titer vector preparations that show reduced toxicity compared with lentiviral vectors produced using standard protocols involving ultracentrifugation-based methods. The vector production and titration protocol described here can be completed within 8 d.

An Evidence Framework for Off-Patent Pharmaceutical Review (EFOR) for Health Technology Assessment in Emerging Markets.

PubMed

Brixner, Diana; Kaló, Zoltán; Maniadakis, Nikos; Kim, Kyoo; Wijaya, Kalman

2018-03-29

This article introduces an Evidence Framework for Off-Patent Pharmaceutical Review (EFOR), which establishes value-based criteria in a template that manufacturers use to provide evidence showing how their products meet those criteria. Health authorities in emerging markets can then use the evidence presented in the EFOR to evaluate off-patent pharmaceuticals (OPPs) in a consistent, transparent, and evidence-based manner to support policy decisions, including pricing, reimbursement, formulary listing, and drug procurement. A literature search found no multi-criteria evidence framework for evaluating OPPs in emerging markets. An International Outcomes Research Board (IORB) of academia and industry experts conducted extensive research, meetings, and workshops to define high-priority criteria to incorporate into an evidence-based health technology assessment (HTA) tool using the multi-criteria decision analysis (MCDA) technique. The resulting framework was further tailored for country-specific needs in workshops in three emerging countries (Kazakhstan, Vietnam, and Indonesia). The IORB defined nine criteria four categories (Product, Manufacturing, Service, and Value Assessment), which OPP manufacturers can use to provide evidence for reimbursement and health policy decision making. Then the IORB developed the EFOR as a base case document, which can be adapted and used as a template by health authorities in emerging countries. Emerging countries have a significant need for an HTA tool that balances affordability with accurate evidence showing the value differentiation of OPPs. The value attributes in this setting often are different from those in developed markets, which emphasize new products and have high regulation and manufacturing standards. The EFOR is an easy-to-use, adaptable framework that emerging countries can use to increase the consistency, transparency, and effectiveness of drug decision making. The open source EFOR is available as Supplemental Materials. Copyright © 2018. Published by Elsevier Inc.

The 2017 International Joint Working Group White Paper by INDUSEM, the Emergency Medicine Association and the Academic College of Emergency Experts on Establishing Standardized Regulations, Operational Mechanisms, and Accreditation Pathways for Education and Care Provided by the Prehospital Emergency Medical Service Systems in India

PubMed Central

Sikka, Veronica; Gautam, V.; Galwankar, Sagar; Guleria, Randeep; Stawicki, Stanislaw P.; Paladino, Lorenzo; Chauhan, Vivek; Menon, Geetha; Shah, Vijay; Srivastava, R. P.; Rana, B. K.; Batra, Bipin; Kalra, OP.; Aggarwal, P.; Bhoi, Sanjeev; Krishnan, S. Vimal

2017-01-01

The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India. PMID:28855780

EarthCache as a Tool to Promote Earth-Science in Public School Classrooms

NASA Astrophysics Data System (ADS)

Gochis, E. E.; Rose, W. I.; Klawiter, M.; Vye, E. C.; Engelmann, C. A.

2011-12-01

Geoscientists often find it difficult to bridge the gap in communication between university research and what is learned in the public schools. Today's schools operate in a high stakes environment that only allow instruction based on State and National Earth Science curriculum standards. These standards are often unknown by academics or are written in a style that obfuscates the transfer of emerging scientific research to students in the classroom. Earth Science teachers are in an ideal position to make this link because they have a background in science as well as a solid understanding of the required curriculum standards for their grade and the pedagogical expertise to pass on new information to their students. As part of the Michigan Teacher Excellence Program (MiTEP), teachers from Grand Rapids, Kalamazoo, and Jackson school districts participate in 2 week field courses with Michigan Tech University to learn from earth science experts about how the earth works. This course connects Earth Science Literacy Principles' Big Ideas and common student misconceptions with standards-based education. During the 2011 field course, we developed and began to implement a three-phase EarthCache model that will provide a geospatial interactive medium for teachers to translate the material they learn in the field to the students in their standards based classrooms. MiTEP participants use GPS and Google Earth to navigate to Michigan sites of geo-significance. At each location academic experts aide participants in making scientific observations about the locations' geologic features, and "reading the rocks" methodology to interpret the area's geologic history. The participants are then expected to develop their own EarthCache site to be used as pedagogical tool bridging the gap between standards-based classroom learning, contemporary research and unique outdoor field experiences. The final phase supports teachers in integrating inquiry based, higher-level learning student activities to EarthCache sites near their own urban communities, or in regional areas such as nature preserves and National Parks. By working together, MiTEP participants are developing a network of regional EarthCache sites and shared lesson plans which explore places that are meaningful to students while simultaneously connecting them to geologic concepts they are learning in school. We believe that the MiTEP EarthCaching model will help participants emerge as leaders of inquiry style, and virtual place-based educators within their districts.

Shiny FHIR: An Integrated Framework Leveraging Shiny R and HL7 FHIR to Empower Standards-Based Clinical Data Applications.

PubMed

Hong, Na; Prodduturi, Naresh; Wang, Chen; Jiang, Guoqian

2017-01-01

In this study, we describe our efforts in building a clinical statistics and analysis application platform using an emerging clinical data standard, HL7 FHIR, and an open source web application framework, Shiny. We designed two primary workflows that integrate a series of R packages to enable both patient-centered and cohort-based interactive analyses. We leveraged Shiny with R to develop interactive interfaces on FHIR-based data and used ovarian cancer study datasets as a use case to implement a prototype. Specifically, we implemented patient index, patient-centered data report and analysis, and cohort analysis. The evaluation of our study was performed by testing the adaptability of the framework on two public FHIR servers. We identify common research requirements and current outstanding issues, and discuss future enhancement work of the current studies. Overall, our study demonstrated that it is feasible to use Shiny for implementing interactive analysis on FHIR-based standardized clinical data.

Southern Hospitality: How We Changed the NPO Practice in the Emergency Department.

PubMed

Denton, Traci D

2015-07-01

In the Vanderbilt Medical Center adult emergency department, the practice has been to keep patients on "nothing by mouth" (NPO) status throughout their assessment, diagnostic, and treatment phases. As a result, most patients have NPO status for a period of several hours to days. The consequences are patient discomfort, hunger, thirst, dehydration, interruptions in routine medication schedules, poor glucose control, and compromised acid/base balance. The purpose of this project was to modify the NPO practice in the adult emergency department. A survey of nursing staff perceptions demonstrated both staff and patient dissatisfaction with the NPO practice. Responses to postdischarge satisfaction surveys demonstrated that patients experienced some discomfort because of hunger or thirst. A search of the literature revealed that the American Society of Anesthesiologists (ASA) adopted guidelines in 1999 that patients should fast 6 hours from solids and 2 hours from liquids preoperatively. These guidelines were implemented in the adult emergency department using the Standard Rollout Process. Physician order sets for the emergency department and the ED chest pain unit were modified to reflect the ASA guidelines. After implementation of the ASA guidelines, a follow-up survey of nursing staff showed increased staff and patient satisfaction. After implementation, the patient satisfaction survey demonstrated an increase in patients who reported "no discomfort" because of hunger or thirst. No adverse outcomes or delays were reported in relation to the change in NPO standards. This change in practice resulted in improved satisfaction for patents and staff. The ASA guidelines have been in existence for more than a decade. They are evidence based. The role of the nurse is to advocate for the patient. Nurses need to be proactive in determining the timing of procedures and asking physicians to give diet orders that are in accordance with the ASA guidelines. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

75 FR 80761 - National Emission Standards for Hazardous Air Pollutants for Reciprocating Internal Combustion...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

... National Emission Standards for Hazardous Air Pollutants for Reciprocating Internal Combustion Engines... March 3, 2010, final national emission standards for hazardous air pollutants for reciprocating internal... engines to allow emergency engines to operate for up to 15 hours per year as part of an emergency demand...

40 CFR 266.204 - Standards applicable to emergency responses.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SOLID WASTES (CONTINUED) STANDARDS FOR THE MANAGEMENT OF SPECIFIC HAZARDOUS WASTES AND SPECIFIC TYPES OF HAZARDOUS WASTE MANAGEMENT FACILITIES Military Munitions § 266.204 Standards applicable to emergency... CFR 262.10(i), 263.10(e), 264.1(g)(8), 265.1(c)(11), and 270.1(c)(3), or alternatively to 40 CFR 270...

40 CFR 266.204 - Standards applicable to emergency responses.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) SOLID WASTES (CONTINUED) STANDARDS FOR THE MANAGEMENT OF SPECIFIC HAZARDOUS WASTES AND SPECIFIC TYPES OF HAZARDOUS WASTE MANAGEMENT FACILITIES Military Munitions § 266.204 Standards applicable to emergency... CFR 262.10(i), 263.10(e), 264.1(g)(8), 265.1(c)(11), and 270.1(c)(3), or alternatively to 40 CFR 270...

40 CFR 266.204 - Standards applicable to emergency responses.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) SOLID WASTES (CONTINUED) STANDARDS FOR THE MANAGEMENT OF SPECIFIC HAZARDOUS WASTES AND SPECIFIC TYPES OF HAZARDOUS WASTE MANAGEMENT FACILITIES Military Munitions § 266.204 Standards applicable to emergency... CFR 262.10(i), 263.10(e), 264.1(g)(8), 265.1(c)(11), and 270.1(c)(3), or alternatively to 40 CFR 270...

Traffic Management for Emergency Vehicle Priority Based on Visual Sensing.

PubMed

Nellore, Kapileswar; Hancke, Gerhard P

2016-11-10

Vehicular traffic is endlessly increasing everywhere in the world and can cause terrible traffic congestion at intersections. Most of the traffic lights today feature a fixed green light sequence, therefore the green light sequence is determined without taking the presence of the emergency vehicles into account. Therefore, emergency vehicles such as ambulances, police cars, fire engines, etc. stuck in a traffic jam and delayed in reaching their destination can lead to loss of property and valuable lives. This paper presents an approach to schedule emergency vehicles in traffic. The approach combines the measurement of the distance between the emergency vehicle and an intersection using visual sensing methods, vehicle counting and time sensitive alert transmission within the sensor network. The distance between the emergency vehicle and the intersection is calculated for comparison using Euclidean distance, Manhattan distance and Canberra distance techniques. The experimental results have shown that the Euclidean distance outperforms other distance measurement techniques. Along with visual sensing techniques to collect emergency vehicle information, it is very important to have a Medium Access Control (MAC) protocol to deliver the emergency vehicle information to the Traffic Management Center (TMC) with less delay. Then only the emergency vehicle is quickly served and can reach the destination in time. In this paper, we have also investigated the MAC layer in WSNs to prioritize the emergency vehicle data and to reduce the transmission delay for emergency messages. We have modified the medium access procedure used in standard IEEE 802.11p with PE-MAC protocol, which is a new back off selection and contention window adjustment scheme to achieve low broadcast delay for emergency messages. A VANET model for the UTMS is developed and simulated in NS-2. The performance of the standard IEEE 802.11p and the proposed PE-MAC is analysed in detail. The NS-2 simulation results have shown that the PE-MAC outperforms the IEEE 802.11p in terms of average end-to-end delay, throughput and energy consumption. The performance evaluation results have proven that the proposed PE-MAC prioritizes the emergency vehicle data and delivers the emergency messages to the TMC with less delay compared to the IEEE 802.11p. The transmission delay of the proposed PE-MAC is also compared with the standard IEEE 802.15.4, and Enhanced Back-off Selection scheme for IEEE 802.15.4 protocol [EBSS, an existing protocol to ensure fast transmission of the detected events on the road towards the TMC] and the comparative results have proven the effectiveness of the PE-MAC over them. Furthermore, this research work will provide an insight into the design of an intelligent urban traffic management system for the effective management of emergency vehicles and will help to save lives and property.

Professional Competencies of Cuban Specialists in Intensive Care and Emergency Medicine.

PubMed

Véliz-Martínez, Pedro L; Jorna-Calixto, Ana R; Oramas-González, René

2016-10-01

INTRODUCTION The quality of medical training and practice reflects the competency level of the professionals involved. The intensive care and emergency medicine specialty in Cuba has not defined its competencies. OBJECTIVE Identify the competencies required for specialty practice in intensive care and emergency medicine. METHODS The study was conducted from January 2014 to December 2015, using qualitative techniques; 48 professionals participated. We undertook functional occupational analysis, based on functions defined in a previous study. Three expert groups were utilized: the first used various group techniques; the second, the Delphi method; and the third, the Delphi method and a Likert questionnaire. RESULTS A total of 73 specific competencies were defined, grouped in 11 units: 44 in the patient care function, 16 in management, 7 in teaching and 6 in research. A competency map is provided. CONCLUSIONS The intensive care and emergency medicine specialty competencies identified will help improve professional standards, ensure health workforce quality, improve patient care and academic performance, and enable objective evaluation of specialists' competence and performance. KEYWORDS Clinical competency, competency-based education, professional education, intensive care, emergency medicine, urgent care, continuing medical education, curriculum, medical residency, Cuba.

National nanotechnology partnership to protect workers

NASA Astrophysics Data System (ADS)

Howard, John; Murashov, Vladimir

2009-10-01

Nanotechnology is predicted to improve many aspects of human life. By 2015, it is estimated to represent 3.1 trillion in manufactured goods. Data is emerging that exposure to nanomaterials may pose a health risk to workers. If the economic promise of nanotechnology is to be achieved, ways need to be found to protect nanotechnology workers now. The Occupational Safety and Health Act of 1970 (OSHAct) gave the responsibility to protect workers to the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) through research, standards adoption, and standards enforcement. Since 1980, adopting new occupational health standards has grown more complex. The increased complexity has greatly slowed efforts to adopt protective standards for toxic agents that are well-known to pose significant risks. The likelihood of rapidly adopting standards to protect workers from nanomaterials, whose risks are just emerging, seems even more unlikely. Use of the OSHAct's general duty clause to protect workers also seems uncertain at this time. In the interim, a national partnership led by NIOSH involving nanotech manufacturers and downstream users, workers, academic researchers, safety, and health practitioners is proposed. A National Nanotechnology Partnership would generate knowledge about the nature and the extent of worker risk, utilize that knowledge to develop risk control strategies to protect nanotechnology workers now, and provide an evidence base for NIOSH recommendations to OSHA for a nanotechnology program standard at a future date.

Emergency medical technician-basic : national standard curriculum (instructor's course guide)

DOT National Transportation Integrated Search

1994-01-01

The curriculum, Emergency Medical Technician-Basic: National Standard Curriculum, : is the cornerstone of EMS prehospital training. Presented here is the : instructor's guide. This new curriculum parallels the recommendations of the : National EMS Ed...

Development and implementation of an emergency practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department.

PubMed

D'Onofrio, Gail; Pantalon, Michael V; Degutis, Linda C; Fiellin, David A; O'connor, Patrick G

2005-03-01

1) To develop and teach a brief intervention (BI) for "hazardous and harmful" (HH) drinkers in the emergency department (ED); 2) to determine whether emergency practitioners (EPs) (faculty, residents, and physician associates) can demonstrate proficiency in the intervention; and 3) to determine whether it is feasible for EPs to perform the BI during routine clinical care. The Brief Negotiation Interview (BNI) was developed for a population of HH drinkers. EPs working in an urban, teaching hospital were trained during two-hour skills-based sessions. They were then tested for adherence to and competence with the BNI protocol using standardized patient scenarios and a checklist of critical components of the BNI. Finally, the EPs performed the BNI as part of routine ED clinical care in the context of a randomized controlled trial to test the efficacy of BI on patient outcomes. The BNI was developed, modified, and finalized in a manual, based on pilot testing. Eleven training sessions with 58 EPs were conducted from March 2002 to August 2003. Ninety-one percent (53/58) of the trained EPs passed the proficiency examination; 96% passed after remediation. Two EPs left prior to remediation. Subsequently, 247 BNIs were performed by 47 EPs. The mean (+/- standard deviation) number of BNIs per EP was 5.28 (+/- 4.91; range 0-28). The mean duration of the BNI was 7.75 minutes (+/- 3.18; range 4-24). A BNI for HH drinkers can be successfully developed for EPs. EPs can demonstrate proficiency in performing the BNI in routine ED clinical practice.

Emerging Evidence for Instructional Practice: Repeated Viewings of Sign Language Models

ERIC Educational Resources Information Center

Beal-Alvarez, Jennifer S.; Huston, Sandra G.

2014-01-01

Current initiatives in education, such as No Child Left Behind and the National Common Core Standards movement, call for the use of evidence-based practices, or those instructional practices that are supported by documentation of their effectiveness related to student learning outcomes, including students with special needs. While hearing loss is…

Prevention of Targeted School Violence by Responding to Students' Psychosocial Crises: The NETWASS Program

ERIC Educational Resources Information Center

Leuschner, Vincenz; Fiedler, Nora; Schultze, Martin; Ahlig, Nadine; Göbel, Kristin; Sommer, Friederike; Scholl, Johanna; Cornell, Dewey; Scheithauer, Herbert

2017-01-01

The standardized, indicated school-based prevention program "Networks Against School Shootings" combines a threat assessment approach with a general model of prevention of emergency situations in schools through early intervention in student psychosocial crises and training teachers to recognize warning signs of targeted school violence.…

Treatment of Children with Speech Oral Placement Disorders (OPDs): A Paradigm Emerges

ERIC Educational Resources Information Center

Bahr, Diane; Rosenfeld-Johnson, Sara

2010-01-01

Epidemiological research was used to develop the Speech Disorders Classification System (SDCS). The SDCS is an important speech diagnostic paradigm in the field of speech-language pathology. This paradigm could be expanded and refined to also address treatment while meeting the standards of evidence-based practice. The article assists that process…

The Effect of Font Selection on Student Test Anxiety

ERIC Educational Resources Information Center

Murphy, Peter V.

2014-01-01

The emergence of standards-based curriculums has resulted in an increased frequency of student testing, including high-stakes testing. Of students who take tests, up to 65% may experience test anxiety, which can have negative effects on student outcomes. For this reason, the purpose of this single-group, repeated measures design, quantitative…

Promoting Access through Segregation: The Emergence of the "Prioritized Curriculum" Class

ERIC Educational Resources Information Center

Bacon, Jessica; Ferri, Beth A.; Rood, Carrie E.

2016-01-01

The continuously evolving standards-based reform (SBR) movement is one of the most prominent features of today's educational policy landscape. As SBR has continued to drive educational policy, local schools and districts have adopted many approaches to comply with legal mandates. This paper critically examines one particular resultant phenomenon…

Smart Desktops for Teachers. ECS Issue Paper: Technology.

ERIC Educational Resources Information Center

Palaich, Robert M.; Good, Dixie Griffin; Stout, Connie; Vickery, Emily

This report presents the results of a study of how emerging technologies can help educators deliver standards-based education to K-12 students. The first section of the report provides background on the new technology offerings and defines smart desktop systems. The second section lists critical questions for decisionmakers related to general…

Development and use of a population based injury surveillance system: the All Wales Injury Surveillance System (AWISS)

PubMed Central

Lyons, R; Jones, S; Kemp, A; Sibert, J; Shepherd, J; Richmond, P; Bartlett, C; Palmer, S

2002-01-01

This report details the development and use of a population based emergency room surveillance system in the UK. Despite some difficulties in accessing high quality data the system has stimulated a considerable number of research and intervention projects. While surveillance systems with high quality data collection and coding parameters remain the gold standard, imperfect systems, particularly if population based, can play a substantial part in stimulating injury prevention initiatives. PMID:11928983

Work Scope for Developing Standards for Emergency Preparedness and Response: Fiscal Year 2004 Final Report

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

Stenner, Robert D.

2005-09-28

Summarizes the fiscal year 2004 work completed on PNNL's Department of Homeland Security Emergency Preparedness and Response Standards Development Project. Also, the report includes key draft standards, in various stages of development and publication, that were associated with various tasks of the fiscal year 2004 scope of the project.

Image quality metrics for volumetric laser displays

NASA Astrophysics Data System (ADS)

Williams, Rodney D.; Donohoo, Daniel

1991-08-01

This paper addresses the extensions to the image quality metrics and related human factors research that are needed to establish the baseline standards for emerging volume display technologies. The existing and recently developed technologies for multiplanar volume displays are reviewed with an emphasis on basic human visual issues. Human factors image quality metrics and guidelines are needed to firmly establish this technology in the marketplace. The human visual requirements and the display design tradeoffs for these prototype laser-based volume displays are addressed and several critical image quality issues identified for further research. The American National Standard for Human Factors Engineering of Visual Display Terminal Workstations (ANSIHFS-100) and other international standards (ISO, DIN) can serve as a starting point, but this research base must be extended to provide new image quality metrics for this new technology for volume displays.

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.

Symptom Burden among Latino Patients with End-Stage Renal Disease and Access to Standard or Emergency-Only Hemodialysis.

PubMed

Cervantes, Lilia; Hull, Madelyne; Keniston, Angela; Chonchol, Michel; Hasnain-Wynia, Romana; Fischer, Stacy

2018-05-30

Patients with end-stage renal disease (ESRD) have a high symptom burden and this negatively impacts health-related quality of life. Little is known about the symptom burden of Latinos with ESRD and variable access to hemodialysis. To estimate the symptom burden of Latinos with ESRD and access to standard or emergency-only hemodialysis. Observational descriptive study of Latino adults with ESRD receiving standard or emergency-only hemodialysis. Patients completed the Edmonton Symptom Assessment System Revised: Renal (ESAS-r:Renal). We used descriptive statistics and propensity score adjustment to conduct the analysis. ESAS-r:Renal. Participants (N = 67) had a mean age of 58 years (standard deviation [SD] ±13) and a mean Charlson Comorbidity Index of 6.6 ± 2.5, and had been on hemodialysis a mean of 42 months (SD ±43). On average, Latinos with ESRD experienced 7 (SD ±3) symptoms with a mean of 5 ± 3 symptoms reported as moderate or severe. After adjusting for propensity score, emergency-only hemodialysis patients reported experiencing more nausea compared to standard hemodialysis patients (odds ratio 8.95, 95% confidence interval: 1.17-68.31, p = 0.03). Latinos with ESRD have a high symptom burden and compared to patients with standard hemodialysis, patients who rely on emergency-only hemodialysis report more nausea. A national treatment strategy that provides standard hemodialysis for undocumented immigrants with ESRD is an important next step.

77 FR 282 - Proposed Settlement Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-04

... revised the National Emission Standards for Hazardous Air Pollutants for Reciprocating Internal Combustion... the stationary internal combustion engine new source performance standards (ICE NSPS) to allow owners and operators of emergency stationary internal combustion engines to operate emergency stationary...

Prehospital emergency medicine services in Europe: structure and equipment.

PubMed

Huemer, G; Pernerstorfer, T; Mauritz, W

1994-06-01

In order to get an update on prehospital emergency medicine practice all over Europe we submitted questionnaires with a total of 61 questions concerning prehospital emergency medicine in Europe, to 123 European members of the World Association of Emergency and Disaster Medicine (WAEDM). Sixty (49%) questionnaires were returned. One up to seven questionnaires from 22 European countries were analysed: 37 (62%) from urban and 23 (38%) suburban or rural areas; 12 being from former Eastern European countries. Sixteen of the questions--those concerning rescue systems and equipment--are analysed and presented in this paper. A fleet of ambulance cars staffed with paramedics/nurses based at the emergency organization is the most frequently used system in 59% (10/17) of the countries. The same percentage claims to have a ground-based coverage of its area of 80-100%. Airborne coverage between 80-100% and below 60% of the areas is given in the same percentage of 35% (6/17). Physicians are frequently involved in prehospital emergency care in the Eastern European Countries, France, Germany, Italy, Belgium and Turkey, rarely in Switzerland, Denmark, the United Kingdom, Greece, Ireland and Finland, never in the Netherlands and Sweden. In more than 50%, a combination of national, regional and local organizations provide emergency care, which results in large differences of standards. We discovered remarkable differences which could be overcome by enhanced co-ordination and information exchange provided by the European Society for Emergency Medicine, WAEDM, the European Red Cross or the European Academy of Anaesthesiologists.

Case study and case-based research in emergency nursing and care: Theoretical foundations and practical application in paramedic pre-hospital clinical judgment and decision-making of patients with mental illness.

PubMed

Shaban, Ramon Z; Considine, Julie; Fry, Margaret; Curtis, Kate

2017-02-01

Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

The forgotten realm of the new and emerging psychosocial risk factors.

PubMed

Chirico, Francesco

2017-09-28

In Europe, employers of all private and public enterprises have a legal obligation to protect their employers by all the different types of workplace hazards to the safety and health of workers. The most important methods developed for the work-related stress risk assessment are based on the Cox's research commissioned by European Agency for Safety and Health at Work (EU-OSHA) and are the Management Standard HSE for work-related stress in United Kingdom, the START method in Germany, the Screening, Observation, Analysis, Expertise (SOBANE) in Belgium, and the National Institute for Prevention and Safety at Work (INAIL-ISPESL) model in Italy, the latter based on the British Management Standard. Unfortunately, the definition of "work-related stress" elaborated by EU-OSHA was criticized, because it is not completely equal to the broader "psychosocial risk," which includes new and emerging psychosocial risk factors, such as the combined exposure to physical and psychosocial risks, job insecurity, work intensification and high demands at work, high emotional load related to burnout, work-life balance problems, and violence and harassment at work. All these new emerging psychosocial hazards could require different and additional methodologies to save workers' health and safety. For this reason, the concept that stakeholders and policy makers should keep in mind in order to develop better national regulations and strategies is that work-related stress risk and psychosocial risk factors are not the same.

Emergency medicine in the United Arab Emirates

PubMed Central

2014-01-01

It has been a decade since emergency medicine was recognized as a specialty in the United Arab Emirates (UAE). In this short time, emergency medicine has established itself and developed rapidly in the UAE. Large, well-equipped emergency departments (EDs) are usually located in government hospitals, some of which function as regional trauma centers. Most of the larger EDs are staffed with medically or surgically trained physicians, with board-certified emergency medicine physicians serving as consultants overseeing care. Prehospital care and emergency medical services (EMS) operate under the auspices of the police department. Standardized protocols have been established for paramedic certification, triage, and destination decisions. The majority of ambulances offer basic life support (BLS/Type 2) with a growing minority offering advanced life support (ALS/Type 3). Medicine residency programs were established 5 years ago and form the foundation for training emergency medicine specialists for UAE. This article describes the full spectrum of emergency medicine in the UAE: prehospital care, EMS, hospital-based emergency care, training in emergency medicine, and disaster preparedness. We hope that our experience, our understanding of the challenges faced by the specialty, and the anticipated future directions will be of importance to others advancing emergency medicine in their region and across the globe. PMID:24401695

A Serious Game for Clinical Assessment of Cognitive Status: Validation Study.

PubMed

Tong, Tiffany; Chignell, Mark; Tierney, Mary C; Lee, Jacques

2016-05-27

We propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening. The objective of this work is to demonstrate the feasibility of a game-based cognitive assessment delivered on tablet technology to a clinical sample and to conduct preliminary validation against standard mental status tools commonly used in elderly populations. We carried out a feasibility study in a hospital emergency department to evaluate the use of a serious game by elderly adults (N=146; age: mean 80.59, SD 6.00, range 70-94 years). We correlated game performance against a number of standard assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM). After a series of modifications, the game could be used by a wide range of elderly patients in the emergency department demonstrating its feasibility for use with these users. Of 146 patients, 141 (96.6%) consented to participate and played our serious game. Refusals to play the game were typically due to concerns of family members rather than unwillingness of the patient to play the game. Performance on the serious game correlated significantly with the MoCA (r=-.339, P <.001) and MMSE (r=-.558, P <.001), and correlated (point-biserial correlation) with the CAM (r=.565, P <.001) and with other cognitive assessments. This research demonstrates the feasibility of using serious games in a clinical setting. Further research is required to demonstrate the validity and reliability of game-based assessments for clinical decision making.

A Serious Game for Clinical Assessment of Cognitive Status: Validation Study

PubMed Central

Chignell, Mark; Tierney, Mary C.; Lee, Jacques

2016-01-01

Background We propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening. Objective The objective of this work is to demonstrate the feasibility of a game-based cognitive assessment delivered on tablet technology to a clinical sample and to conduct preliminary validation against standard mental status tools commonly used in elderly populations. Methods We carried out a feasibility study in a hospital emergency department to evaluate the use of a serious game by elderly adults (N=146; age: mean 80.59, SD 6.00, range 70-94 years). We correlated game performance against a number of standard assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM). Results After a series of modifications, the game could be used by a wide range of elderly patients in the emergency department demonstrating its feasibility for use with these users. Of 146 patients, 141 (96.6%) consented to participate and played our serious game. Refusals to play the game were typically due to concerns of family members rather than unwillingness of the patient to play the game. Performance on the serious game correlated significantly with the MoCA (r=–.339, P <.001) and MMSE (r=–.558, P <.001), and correlated (point-biserial correlation) with the CAM (r=.565, P <.001) and with other cognitive assessments. Conclusions This research demonstrates the feasibility of using serious games in a clinical setting. Further research is required to demonstrate the validity and reliability of game-based assessments for clinical decision making. PMID:27234145

A Future of Satellite-Aided Search and Rescue

NASA Technical Reports Server (NTRS)

Wallace, Ronald

1998-01-01

Satellite technology has been an integral part of maritime search and rescue since the Cospas-Sarsat system began operation in 1984. This system, credited with more than eighty-six hundred lives saved, has recently been augmented to provide immediate response through geostationary satellites. The other satellite-based distress alerting system, INMARSAT, launched its emergency Standard C service in 1991 and Standard E in 1997. Current plans call for a continuation of service from both of these vital systems at least through the first decade of the next century. We are currently witnessing the construction of a number of new satellite systems that will have the potential for revolutionizing mobile communications. These systems will be capable of emergency communication, and must be given due consideration in any look at the future, This paper reviews existing systems using satellites for distress alerting, describes the plans in place for them, and discusses likely developments.

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2010 CFR

2010-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2013 CFR

2013-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2014 CFR

2014-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2012 CFR

2012-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2011 CFR

2011-07-01

... responsibilities at all times; (2) Keep written standard operating procedures that address anticipated emergency... the employer's standard operating procedures; (5) Train new fire response employees before they engage in emergency operations; (6) At least quarterly, provide training on the written operating procedures...

Desperately seeking cancer drugs: explaining the emergence and outcomes of accelerated pharmaceutical regulation.

PubMed

Davis, Courtney; Abraham, John

2011-07-01

Government regulators have increasingly accelerated new cancer drugs on to the market by granting them approval based on less clinical data supporting drug efficacy than permitted under standard regulations. With more lenient regulatory standards, pharmaceutical companies have keenly sought to develop cancer drugs. Focusing on the US, this article examines how the emergence and implementation of such accelerated approvals should be understood, particularly in relation to corporate bias and disease-politics theories. Drawing on longitudinal and case study data analysis, it is argued that the emergence of accelerated approval regulations for cancer drugs should be regarded primarily as part of a deregulatory regime driven by the interests of the pharmaceutical industry in partnership with all major aspects of the state, rather than as a response to patient activism in the aftermath of AIDS. Furthermore, even in cases when some patients successfully demand accelerated marketing approval of cancer drugs, such approval by regulators, while in manufacturers' interests, may not be in the interests of patients' health because the political culture of the regulatory agency is reluctant to uphold its own techno-regulatory standards of public-health protection when that would challenge the agenda-setting influence of manufacturers, including industry collaborations with patients and the medical profession. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Standardizing Chaos: A Neo-Institutional Analysis of the INEE Minimum Standards for Education in Emergencies, Chronic Crises and Early Reconstruction

ERIC Educational Resources Information Center

Bromley, Patricia; Andina, Marina

2010-01-01

Violent conflict and humanitarian disasters such as floods, famines, or tsunamis, have existed since the start of human history. However, it is only recently that education in these emergency situations has emerged as a visible organizational field. We aim to use a unique theoretical application of sociological neo-institutionalism to explain the…

40 CFR 60.4204 - What emission standards must I meet for non-emergency engines if I am an owner or operator of a...

Code of Federal Regulations, 2011 CFR

2011-07-01

... non-emergency engines if I am an owner or operator of a stationary CI internal combustion engine? 60... Compression Ignition Internal Combustion Engines Emission Standards for Owners and Operators § 60.4204 What... internal combustion engine? (a) Owners and operators of pre-2007 model year non-emergency stationary CI ICE...

40 CFR 60.4204 - What emission standards must I meet for non-emergency engines if I am an owner or operator of a...

Code of Federal Regulations, 2013 CFR

2013-07-01

... non-emergency engines if I am an owner or operator of a stationary CI internal combustion engine? 60... Compression Ignition Internal Combustion Engines Emission Standards for Owners and Operators § 60.4204 What... internal combustion engine? (a) Owners and operators of pre-2007 model year non-emergency stationary CI ICE...

40 CFR 60.4204 - What emission standards must I meet for non-emergency engines if I am an owner or operator of a...

Code of Federal Regulations, 2014 CFR

2014-07-01

... non-emergency engines if I am an owner or operator of a stationary CI internal combustion engine? 60... Compression Ignition Internal Combustion Engines Emission Standards for Owners and Operators § 60.4204 What... internal combustion engine? (a) Owners and operators of pre-2007 model year non-emergency stationary CI ICE...

40 CFR 60.4204 - What emission standards must I meet for non-emergency engines if I am an owner or operator of a...

Code of Federal Regulations, 2012 CFR

2012-07-01

... non-emergency engines if I am an owner or operator of a stationary CI internal combustion engine? 60... Compression Ignition Internal Combustion Engines Emission Standards for Owners and Operators § 60.4204 What... internal combustion engine? (a) Owners and operators of pre-2007 model year non-emergency stationary CI ICE...

Fault Tolerance in ZigBee Wireless Sensor Networks

NASA Technical Reports Server (NTRS)

Alena, Richard; Gilstrap, Ray; Baldwin, Jarren; Stone, Thom; Wilson, Pete

2011-01-01

Wireless sensor networks (WSN) based on the IEEE 802.15.4 Personal Area Network standard are finding increasing use in the home automation and emerging smart energy markets. The network and application layers, based on the ZigBee 2007 PRO Standard, provide a convenient framework for component-based software that supports customer solutions from multiple vendors. This technology is supported by System-on-a-Chip solutions, resulting in extremely small and low-power nodes. The Wireless Connections in Space Project addresses the aerospace flight domain for both flight-critical and non-critical avionics. WSNs provide the inherent fault tolerance required for aerospace applications utilizing such technology. The team from Ames Research Center has developed techniques for assessing the fault tolerance of ZigBee WSNs challenged by radio frequency (RF) interference or WSN node failure.

Trends and Issues in California's Low Carbon Fuel Standard - Learning from Response to Existing Climate Policy

NASA Astrophysics Data System (ADS)

Witcover, J.

2015-12-01

Debate over lower greenhouse gas (GHG) emissions from transportation has included heated discussion about appropriate policies and their cost and feasibility. One prominent policy mechanism, a carbon intensity standard, rates transport fuels based on analysis of lifecycle GHG emissions, and targets lower fuel pool carbon intensity through a market mechanism that uses a system of tradable, bankable credits and deficits. California instituted such a policy -- the Low Carbon Fuel Standard (LCFS) - in 2010, which targets a 10% carbon intensity (CI) reduction by 2020. The program rolled out amid concerns over slow development of new fuels expected to be very low carbon (such as cellulosic) and has faced court challenges that added considerable policy uncertainty. Since the program's start, state transport energy mix has shifted modestly but noticeably. Looking ahead, emerging issues for the program include amendments and re-adoption in response to a court ruling, potential interaction with California's multi-sector cap on carbon emissions (which started covering transport fuels in 2015), and impacts from similar CI standards in other jurisdictions. This study provides an analysis of fuel mix changes since the LCFS was implemented in 2011, and a discussion of emerging issues focusing on policy interaction. Descriptive statistics on alternative fuel use, available fuel pathways, and CI ratings are presented based on data from the California Air Resources Board (which runs the program). They document a shift towards more alternative fuels in a more diverse mix, with lower average CI ratings for most alternative fuel types. Financial incentives for various fuels are compared under the LCFS and the US federal Renewable Fuel Standard; disincentives from conceptually different carbon pricing schemes under the LCFS and the Cap-and-Trade are also outlined. The results provide important information on response to an existing market-based policy mechanism for addressing GHG emissions in transportation, as other jurisdictions weigh similar climate policies and debate mechanisms and costs and California announced an ambitious target of halving petroleum use by 2030.

Types of diagnostic errors in neurological emergencies in the emergency department.

PubMed

Dubosh, Nicole M; Edlow, Jonathan A; Lefton, Micah; Pope, Jennifer V

2015-02-01

Neurological emergencies often pose diagnostic challenges for emergency physicians because these patients often present with atypical symptoms and standard imaging tests are imperfect. Misdiagnosis occurs due to a variety of errors. These can be classified as knowledge gaps, cognitive errors, and systems-based errors. The goal of this study was to describe these errors through review of quality assurance (QA) records. This was a retrospective pilot study of patients with neurological emergency diagnoses that were missed or delayed at one urban, tertiary academic emergency department. Cases meeting inclusion criteria were identified through review of QA records. Three emergency physicians independently reviewed each case and determined the type of error that led to the misdiagnosis. Proportions, confidence intervals, and a reliability coefficient were calculated. During the study period, 1168 cases were reviewed. Forty-two cases were found to include a neurological misdiagnosis and twenty-nine were determined to be the result of an error. The distribution of error types was as follows: knowledge gap 45.2% (95% CI 29.2, 62.2), cognitive error 29.0% (95% CI 15.9, 46.8), and systems-based error 25.8% (95% CI 13.5, 43.5). Cerebellar strokes were the most common type of stroke misdiagnosed, accounting for 27.3% of missed strokes. All three error types contributed to the misdiagnosis of neurological emergencies. Misdiagnosis of cerebellar lesions and erroneous radiology resident interpretations of neuroimaging were the most common mistakes. Understanding the types of errors may enable emergency physicians to develop possible solutions and avoid them in the future.

Acupuncture combined with Chinese herbs for the treatment in hemivertebral French bulldogs with emergent paraparesis.

PubMed

Liu, Ching Ming; Holyoak, G Reed; Lin, Chung Tien

2016-10-01

This study follows the treatment of six French bulldogs with paraparesis caused by congenital hemivertebra which were structurally mild but clinically severe. A standardized acupuncture ( zhēn jiǔ) treatment using Hua-Tuo-Jiaji (HTJJ) as local points and other distant points combined with Chinese herbs improved the clinical signs. Few, if any, published papers mention Traditional Chinese Veterinary Medicine (TCVM) for treatment of hemivertebral paraparesis in French bulldogs. Based on the rapid treatment outcome, we encourage practitioners to integrate this form of conservative management into emergency treatment.

Emergency medical personnel training: I. An historical perspective.

PubMed

Sytkowski, P A; Jacobs, L M; Meany, M

1983-01-01

The status of Emergency Medical Technicians has evolved from an undefined role with few rules, regulations, or standards to an established health care profession and a nationally administered program. The evolution of this profession received major impetus from the 1966 report by the National Academy of Science/National Research Council that provided recommended training standards. Development of a training course curriculum for basic life support (BLS) followed. The need for coordinated training of Emergency Medical Technical Technicians was recognized, and funds became available to aid in the national standardization of education, examination, certification, and recertification procedures for EMTs. Concomitant with the attempt to standardize BLS training, advanced life support (ALS) programs grew in number. By 1977 the National Standard Training Curriculum became available and was soon followed by a national certification exam. As states have the option to accept or reject the federal standards embodied in the national training course, there remains variation among programs offered by each state. Because of the difference in need for specific emergency services among the states at a time of increased professional mobility, arguments still exist regarding the desirability of federally mandated training and certification programs.

Simulation-based Randomized Comparative Assessment of Out-of-Hospital Cardiac Arrest Resuscitation Bundle Completion by Emergency Medical Service Teams Using Standard Life Support or an Experimental Automation-assisted Approach.

PubMed

Choi, Bryan; Asselin, Nicholas; Pettit, Catherine C; Dannecker, Max; Machan, Jason T; Merck, Derek L; Merck, Lisa H; Suner, Selim; Williams, Kenneth A; Jay, Gregory D; Kobayashi, Leo

2016-12-01

Effective resuscitation of out-of-hospital cardiac arrest (OHCA) patients is challenging. Alternative resuscitative approaches using electromechanical adjuncts may improve provider performance. Investigators applied simulation to study the effect of an experimental automation-assisted, goal-directed OHCA management protocol on EMS providers' resuscitation performance relative to standard protocols and equipment. Two-provider (emergency medical technicians (EMT)-B and EMT-I/C/P) teams were randomized to control or experimental group. Each team engaged in 3 simulations: baseline simulation (standard roles); repeat simulation (standard roles); and abbreviated repeat simulation (reversed roles, i.e., basic life support provider performing ALS tasks). Control teams used standard OHCA protocols and equipment (with high-performance cardiopulmonary resuscitation training intervention); for second and third simulations, experimental teams performed chest compression, defibrillation, airway, pulmonary ventilation, vascular access, medication, and transport tasks with goal-directed protocol and resuscitation-automating devices. Videorecorders and simulator logs collected resuscitation data. Ten control and 10 experimental teams comprised 20 EMT-B's; 1 EMT-I, 8 EMT-C's, and 11 EMT-P's; study groups were not fully matched. Both groups suboptimally performed chest compressions and ventilations at baseline. For their second simulations, control teams performed similarly except for reduced on-scene time, and experimental teams improved their chest compressions (P=0.03), pulmonary ventilations (P<0.01), and medication administration (P=0.02); changes in their performance of chest compression, defibrillation, airway, and transport tasks did not attain significance against control teams' changes. Experimental teams maintained performance improvements during reversed-role simulations. Simulation-based investigation into OHCA resuscitation revealed considerable variability and improvable deficiencies in small EMS teams. Goal-directed, automation-assisted OHCA management augmented select resuscitation bundle element performance without comprehensive improvement.

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study.

PubMed

Layani, Géraldine; Fleet, Richard; Dallaire, Renée; Tounkara, Fatoumata K; Poitras, Julien; Archambault, Patrick; Chauny, Jean-Marc; Ouimet, Mathieu; Gauthier, Josée; Dupuis, Gilles; Tanguay, Alain; Lévesque, Jean-Frédéric; Simard-Racine, Geneviève; Haggerty, Jeannie; Légaré, France

2016-01-01

Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013. Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators. Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments.

Video calls from lay bystanders to dispatch centers - risk assessment of information security.

PubMed

Bolle, Stein R; Hasvold, Per; Henriksen, Eva

2011-09-30

Video calls from mobile phones can improve communication during medical emergencies. Lay bystanders can be instructed and supervised by health professionals at Emergency Medical Communication Centers. Before implementation of video mobile calls in emergencies, issues of information security should be addressed. Information security was assessed for risk, based on the information security standard ISO/IEC 27005:2008. A multi-professional team used structured brainstorming to find threats to the information security aspects confidentiality, quality, integrity, and availability. Twenty security threats of different risk levels were identified and analyzed. Solutions were proposed to reduce the risk level. Given proper implementation, we found no risks to information security that would advocate against the use of video calls between lay bystanders and Emergency Medical Communication Centers. The identified threats should be used as input to formal requirements when planning and implementing video calls from mobile phones for these call centers.

Video calls from lay bystanders to dispatch centers - risk assessment of information security

PubMed Central

2011-01-01

Background Video calls from mobile phones can improve communication during medical emergencies. Lay bystanders can be instructed and supervised by health professionals at Emergency Medical Communication Centers. Before implementation of video mobile calls in emergencies, issues of information security should be addressed. Methods Information security was assessed for risk, based on the information security standard ISO/IEC 27005:2008. A multi-professional team used structured brainstorming to find threats to the information security aspects confidentiality, quality, integrity, and availability. Results Twenty security threats of different risk levels were identified and analyzed. Solutions were proposed to reduce the risk level. Conclusions Given proper implementation, we found no risks to information security that would advocate against the use of video calls between lay bystanders and Emergency Medical Communication Centers. The identified threats should be used as input to formal requirements when planning and implementing video calls from mobile phones for these call centers. PMID:21958387

The medico-legal prerequisite for initiating quarantine and isolation practices in public health emergency management in hospitals in Ghana.

PubMed

Norman, I D; Aikins, M; Binka, F N

2011-12-01

Hospitals and other health facilities in Ghana do not appear to have standardized practices for quarantine and isolation in public health emergency management. This paper reviews the legislative framework governing the medico-legal prerequisites for initiating quarantine and isolation procedures as articulated in the Infectious Disease Act (Cap 78) 1908 amended, 1935, the Quarantine Act (Cap 77) 1915 amended, 1938, the Emergency Powers Act of 1994, (Act 472), and the National Disaster Management Act, 1996, (Act 517) in consonance with the 1992 Constitution of Ghana. The findings provide that (1) The legislative framework outlines systematic standards and protocols to be followed in the committal of person or persons in quarantine and isolation during public health emergencies. (2) These standards and protocols consider as imperative, the creation of standardized national templates for the initiation of quarantine and isolation measures. (3) The non-compliance of the standards and protocols renders vulnerable medical facilities and hospitals with their personnel to the threat of medical malpractice suits and breach of professional ethics. This paper provides suggestions to hospital administrators and medical personnel of how to develop administrative templates in compliance with the law in managing public health emergencies. It also provides examples of such templates for possible adoption by hospitals and other health administrators.

NEW COLUMN SEPARATION METHOD FOR EMERGENCY URINE SAMPLES

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

Maxwell, S; Brian Culligan, B

2007-08-28

The Savannah River Site Environmental Bioassay Lab participated in the 2007 NRIP Emergency Response program administered by the National Institute for Standards and Technology (NIST) in May, 2007. A new rapid column separation method was applied directly to the NRIP 2007 emergency urine samples, with only minimal sample preparation to reduce preparation time. Calcium phosphate precipitation, previously used to pre-concentrate actinides and Sr-90 in NRIP 2006 urine and water samples, was not used for the NRIP 2007 urine samples. Instead, the raw urine was acidified and passed directly through the stacked resin columns (TEVA+TRU+SR Resins) to separate the actinides andmore » strontium from the NRIP urine samples more quickly. This improvement reduced sample preparation time for the NRIP 2007 emergency urine analyses significantly. This approach works well for small volume urine samples expected during an emergency response event. Based on initial feedback from NIST, the SRS Environmental Bioassay Lab had the most rapid analysis times for actinides and strontium-90 analyses for NRIP 2007 urine samples.« less

Legal, Social, Ethical, and Medical Perspectives on the Care of the Statutory Rape Adolescent in the Emergency Department.

PubMed

Tsai, Shiu-Lin; Acosta, Elvira; Cardenas, Toni; Sigall, Jeremy K; Van Geem, Kevin

2017-07-01

Rapes involving adolescents who present to the emergency department (ED) are fraught with ethical and legal complexities and are often emotionally turbulent for patients, their families, and medical providers. Management requires a thoughtful approach from multiple standpoints, including legal, psychosocial, ethical, and medical ones. However, there is no standardized sexual assault education for emergency medicine residents, and management practices vary widely. 1,2 We present a hypothetical statutory rape case based on real cases that occurred in New York City and bring together the perspectives of an attorney on the legal parameters, two social workers on the psychosocial issues, an ethicist on the moral considerations, and a pediatric emergency physician-who is also a sexual assault forensic examiner-on the medical treatments. We aim to provide a framework for physicians to navigate issues of patient-physician privilege involving minors, privacy rules, and mandatory reporting laws. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Air Force Inspection System: An Application for System-of-Systems (SOS) Engineering

DTIC Science & Technology

2014-06-19

Program, 15 Dec 11 5. AFI 10-210, Prime Base Engineer Emergency Force ( BEEF ) Program, 6 Sep 12 6. AFI 10-245, Antiterrorism (AT), 21 Sep 12 AFI 10...Aircraft Carrying Hazardous Materials, 11 Nov 94 79. AFMAN 11-226 (I), US Standard for Terminal Instrument Procedures (TERPS) 92 80. AFMAN 10

An Integrative Framework for the Teaching of Information Management in a Business Context

ERIC Educational Resources Information Center

Kesner, Richard M.; Zack, Mike; Russell, Bruce; Dias, Martin

2013-01-01

As professional, academic and accrediting bodies have periodically reviewed the need for and content of foundational college curricula in information management, a broad-based consensus has emerged as to what is to be covered in the standard management information systems (MIS) course. Within U.S. business schools today, there is little debate…

Development of a Scale to Explore Technology Literacy Skills of Turkish 8th Graders

ERIC Educational Resources Information Center

Misirli, Zeynel A.; Akbulut, Yavuz

2013-01-01

The use of emerging technologies shape learners' knowledge creation and transformation processes. In this regard, this study aimed to develop a scale to investigate 8 th graders' competencies regarding the educational technology standards based on ISTE-NETS. After a review of relevant literature, an item pool was prepared. The pool was improved…

To amend the executive compensation provisions of the Emergency Economic Stabilization Act of 2008 to prohibit unreasonable and excessive compensation and compensation not based on performance standards.

THOMAS, 111th Congress

Rep. Grayson, Alan [D-FL-8

2009-03-23

Senate - 04/23/2009 Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 50. (All Actions) Tracker: This bill has the status Passed HouseHere are the steps for Status of Legislation:

75 FR 78172 - Fisheries of the Exclusive Economic Zone Off Alaska; Groundfish Retention Standard; Emergency Rule

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-15

... fish under the GRS may be offset by increased profitability because they are no longer operating in a... preamble). Using information from NMFS' catch accounting database and the methodology used in the Amendment... requirements must remain effective to ensure proper catch accounting under the Amendment 80 quota-based catch...

On the Nature of and Teachers' Goals for Students' Mathematical Argumentation in High School Classrooms

ERIC Educational Resources Information Center

Howell, Tracey H.

2013-01-01

In an era of new standards and emerging accountability systems, an understanding of the supports needed to aid teachers and students in making necessary transitions in mathematics teaching and learning is critical. Given the established research base demonstrating the importance of justification and reasoning in students' mathematics learning and…

An Emergent Leadership Model Based on Confucian Virtues and East Asian Leadership Practices

ERIC Educational Resources Information Center

Lang, LingLing; Irby, Beverly J.; Brown, Genevieve

2012-01-01

For more than 2000 years, Confucian teaching has had tremendous influence on the history, politics, economy, and culture of East Asian countries and regions. Despite the rapid growth in gross domestic product (GDP), people's standard of living, and economic advancements, Confucian Asia continues to adhere to the Confucian cultural values that they…

Three Key Conditions to Revitialise an ePortfolio Program in Response to Increasing Regulation of Teacher Education

ERIC Educational Resources Information Center

Kertesz, John Leslie

2016-01-01

This paper describes a study undertaken within the education faculty of a mid-sized university in response to the recommendations of the Teacher Education Ministerial Advisory Group (TEMAG) (2014) that initial teacher education (ITE) graduates emerge with an evidence-based professional standards-focused portfolio of teaching competency. In…

[Assessment of quality indicators in pediatric poisoning in an emergency service].

PubMed

Giménez Roca, C; Martínez Sánchez, L; Calzada Baños, Y; Trenchs Sainz de la Maza, V; Quintilla Martínez, J M; Luaces Cubells, C

2014-01-01

Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2hours of poison ingestion (standard=90%, result=83.5%); attention within the first 15minutes of arriving in the emergency service (standard=90%, result=60.4%); start of gastrointestinal decontamination within 20minutes of arrival in emergency services (standard=90%, result=29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard=95%, result=87%); judicial communication of cases of poisoning that could conceal a crime (standard=95%, result=31.3%), and collection of the minimal set of information of poisoned patients (standard=90%, result=1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (<5). The main deficiencies are related to delay in assistance, collection of information and completion of judicial reports. Giving these patients priority, designing a checklist to collect the main points of their management, and creating obligatory fields for data in computerized medical records, are the main actions available to achieve pediatric poisoning quality indicators in this emergency service. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Implementation experiences of ISO/IEEE11073 standard applied to new use cases for e-health environments.

PubMed

Martinez, I; Escayola, J; Martinez-Espronceda, M; Serrano, L; Trigo, J D; Led, S; Garcia, J

2009-01-01

Recent advances in biomedical engineering and continuous technological innovations in last decade are promoting new challenges, especially in e-Health environments. In this context, the medical devices interoperability is one of the interest fields wherein these improvements require a standard-based design in order to achieve homogeneous solutions. Furthermore, the spreading of wearable devices, oriented to the paradigm of patient environment and supported by wireless technologies as Bluetooth or ZigBee, is bringing new medical use cases based on Ambient Assisted Living, home monitoring of elderly, heart failure, chronic, under palliative care or patients who have undergone surgery, urgencies and emergencies, or even fitness auto-control and health follow-up. In this paper, several implementation experiences based on ISO/IEEE11073 standard are detailed. These evolved e-Health services can improve the quality of the patient's care, increase the user's interaction, and assure these e-Health applications to be fully compatible with global telemedicine systems.

40 CFR Table 1 to Subpart Jjjj of... - NOX, CO, and VOC Emission Standards for Stationary Non-Emergency SI Engines ≥100 HP (Except...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false NOX, CO, and VOC Emission Standards for Stationary Non-Emergency SI Engines â¥100 HP (Except Gasoline and Rich Burn LPG), Stationary SI Landfill... Landfill/Digester Gas Engines, and Stationary Emergency Engines >25 HP Engine type and fuel Maximum engine...

Development of an Easy-to-Use Tool for the Assessment of Emergency Department Physical Design.

PubMed

Majidi, Alireza; Tabatabaey, Ali; Motamed, Hassan; Motamedi, Maryam; Forouzanfar, Mohammad Mehdi

2014-01-01

Physical design of the emergency department (ED) has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study, we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a "Yes or No" question for ease of analysis, meaning that the criterion is either met or not.

Traffic Management for Emergency Vehicle Priority Based on Visual Sensing

PubMed Central

Nellore, Kapileswar; Hancke, Gerhard P.

2016-01-01

Vehicular traffic is endlessly increasing everywhere in the world and can cause terrible traffic congestion at intersections. Most of the traffic lights today feature a fixed green light sequence, therefore the green light sequence is determined without taking the presence of the emergency vehicles into account. Therefore, emergency vehicles such as ambulances, police cars, fire engines, etc. stuck in a traffic jam and delayed in reaching their destination can lead to loss of property and valuable lives. This paper presents an approach to schedule emergency vehicles in traffic. The approach combines the measurement of the distance between the emergency vehicle and an intersection using visual sensing methods, vehicle counting and time sensitive alert transmission within the sensor network. The distance between the emergency vehicle and the intersection is calculated for comparison using Euclidean distance, Manhattan distance and Canberra distance techniques. The experimental results have shown that the Euclidean distance outperforms other distance measurement techniques. Along with visual sensing techniques to collect emergency vehicle information, it is very important to have a Medium Access Control (MAC) protocol to deliver the emergency vehicle information to the Traffic Management Center (TMC) with less delay. Then only the emergency vehicle is quickly served and can reach the destination in time. In this paper, we have also investigated the MAC layer in WSNs to prioritize the emergency vehicle data and to reduce the transmission delay for emergency messages. We have modified the medium access procedure used in standard IEEE 802.11p with PE-MAC protocol, which is a new back off selection and contention window adjustment scheme to achieve low broadcast delay for emergency messages. A VANET model for the UTMS is developed and simulated in NS-2. The performance of the standard IEEE 802.11p and the proposed PE-MAC is analysed in detail. The NS-2 simulation results have shown that the PE-MAC outperforms the IEEE 802.11p in terms of average end-to-end delay, throughput and energy consumption. The performance evaluation results have proven that the proposed PE-MAC prioritizes the emergency vehicle data and delivers the emergency messages to the TMC with less delay compared to the IEEE 802.11p. The transmission delay of the proposed PE-MAC is also compared with the standard IEEE 802.15.4, and Enhanced Back-off Selection scheme for IEEE 802.15.4 protocol [EBSS, an existing protocol to ensure fast transmission of the detected events on the road towards the TMC] and the comparative results have proven the effectiveness of the PE-MAC over them. Furthermore, this research work will provide an insight into the design of an intelligent urban traffic management system for the effective management of emergency vehicles and will help to save lives and property. PMID:27834924

Using Geo-Data Corporately on the Response Phase of Emergency Management

NASA Astrophysics Data System (ADS)

Demir Ozbek, E.; Ates, S.; Aydinoglu, A. C.

2015-08-01

Response phase of emergency management is the most complex phase in the entire cycle because it requires cooperation between various actors relating to emergency sectors. A variety of geo-data is needed at the emergency response such as; existing data provided by different institutions and dynamic data collected by different sectors at the time of the disaster. Disaster event is managed according to elaborately defined activity-actor-task-geodata cycle. In this concept, every activity of emergency response is determined with Standard Operation Procedure that enables users to understand their tasks and required data in any activity. In this study, a general conceptual approach for disaster and emergency management system is developed based on the regulations to serve applications in Istanbul Governorship Provincial Disaster and Emergency Directorate. The approach is implemented to industrial facility explosion example. In preparation phase, optimum ambulance locations are determined according to general response time of the ambulance to all injury cases in addition to areas that have industrial fire risk. Management of the industrial fire case is organized according to defined actors, activities, and working cycle that describe required geo-data. A response scenario was prepared and performed for an industrial facility explosion event to exercise effective working cycle of actors. This scenario provides using geo-data corporately between different actors while required data for each task is defined to manage the industrial facility explosion event. Following developing web technologies, this scenario based approach can be effective to use geo-data on the web corporately.

Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond

PubMed Central

Rosenman, Elizabeth D.; Branzetti, Jeremy B.; Fernandez, Rosemarie

2016-01-01

Background Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education. Objective This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine. Methods We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment. Results Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct. Conclusions Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature. PMID:27413434

Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond.

PubMed

Rosenman, Elizabeth D; Branzetti, Jeremy B; Fernandez, Rosemarie

2016-07-01

Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education. This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine. We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment. Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct. Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature.

A randomized controlled trial of simulation-based training for ear, nose, and throat emergencies.

PubMed

Smith, Matthew Edward; Navaratnam, Annakan; Jablenska, Lily; Dimitriadis, Panagiotis A; Sharma, Rishi

2015-08-01

Life-threatening ear, nose, and throat (ENT) emergencies are uncommon but require immediate skilled management. We investigated if traditional lecture-based teaching can be improved by a simulation and lecture hybrid approach. A single-blinded, prospective, randomized controlled trial. Two groups of interns with no previous ENT experience were randomized to one of two training groups: a simulation/lecture hybrid group or a lecture-only control group. Both groups received 90 minutes of training covering the assessment of critically ill patients and four ENT emergency topics. Both groups received the same initial lecture slides. The control group received additional slides, and the simulation group received simulated emergency scenario training using basic mannequins. Following the training, candidates were asked to provide feedback on their perception of training, and they were formally assessed with a standardized one-to-one viva. Thirty-eight interns were recruited: 18 in the control group and 20 in the simulation group. The candidates in the simulation group performed significantly better in all viva situations (P < .05) and had better perception of learning (P < .05). Additionally, the simulation group was more likely to recommend the training to a colleague (P < .05). We have demonstrated that replacing traditional lecture-based training with a mixture of lectures and emergency scenario simulation is more effective at preparing junior doctors for ENT emergencies, and better met their learning needs. Implementing this kind of teaching is feasible with a minimum of additional resources or time. 1b © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

IEC 61850: Technology Standards and Cyber-Security Threats

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

Youssef, Tarek A; El Hariri, mohamed; Bugay, Nicole

Substations constitute a fundamental part in providing reliable electricity to consumers. For a substation to maintain electricity reliability and its own real-time operability, communication between its components is inevitable. Before the emergence of IEC 61850, inter-substation communication was established via expensive copper wires with limited capabilities. IEC 61850 is the standard set by the International Electrotechnical Commission (IEC) Technical Committee Number 57 Working Group 10 and IEEE for Ethernet (IEEE 802.3)-based communication in electrical substations. Like many power grid systems standards, IEC 61850 was set without extensive consideration for critical security measures. This paper discusses IEC 61850 technology standards andmore » applications thoroughly and points out major security vulnerabilities it introduces in the context of current cyber-physical smart grid systems.« less

Emergent technologies: 25 years

NASA Astrophysics Data System (ADS)

Rising, Hawley K.

2013-03-01

This paper will talk about the technologies that have been emerging over the 25 years since the Human Vision and Electronic Imaging conference began that the conference has been a part of, and that have been a part of the conference, and will look at those technologies that are emerging today, such as social networks, haptic technologies, and still emerging imaging technologies, and what we might look at for the future.Twenty-five years is a long time, and it is not without difficulty that we remember what was emerging in the late 1980s. Yet to be developed: The first commercial digital still camera was not yet on the market, although there were hand held electronic cameras. Personal computers were not displaying standardized images, and image quality was not something that could be talked about in a standardized fashion, if only because image compression algorithms were not standardized yet for several years hence. Even further away were any standards for movie compression standards, there was no personal computer even on the horizon which could display them. What became an emergent technology and filled many sessions later, image comparison and search, was not possible, nor the current emerging technology of social networks- the world wide web was still several years away. Printer technology was still devising dithers and image size manipulations which would consume many years, as would scanning technology, and image quality for both was a major issue for dithers and Fourier noise.From these humble beginnings to the current moves that are changing computing and the meaning of both electronic devices and human interaction with them, we will see a course through the changing technology that holds some features constant for many years, while others come and go.

Call for national dialogue: Adapting standards of care in extreme events. We are not ready.

PubMed

Cusack, Lynette; Gebbie, Kristine

Clinical practices are based on a common understanding of nursing's professional standards in all aspects of patient care, no matter what the circumstances are. Circumstances can however, change dramatically due to emergencies, disasters, or pandemics and may make it difficult to meet the standard of care in the way nurses are accustomed. The Australian nursing profession has not yet facilitated a broad discussion and debate at the professional and institutional level about adapting standards of care under extreme conditions, a dialogue which goes beyond the content of basic emergency and disaster preparedness. The purpose of this paper is to encourage discussion within the nursing profession on this important ethical and legal issue. A comprehensive review of the literature was undertaken to determine the state of the evidence in relation to adapting standards of care under extreme conditions. Content analysis of the literature identified categories related to adapting standards of care that have been considered by individuals or groups that should be considered in Australia, should a dialogue be undertaken. The categories include ethical expectations of professional practice; legal interpretation of care requirements, resource priority between hospital and public health and informing communities. Literature reviews and commentary may provide the background for a national dialogue on the nursing response in an extreme event. However, it is only with the engagement of a broadly representative segment of the professional nursing community that appropriate guidance on adapting standards of care under extreme conditions can be developed and then integrated into the professional worldview of nursing in Australia.

Emergency Medical Dispatch. National Standard Curriculum. Instructor Guide. Trainee Guide.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This guide contains all instructor materials and requirements for the National Highway Traffic Safety Administration (NHTSA), Emergency Medical Dispatch (EMD) National Standard Curriculum. It includes lesson plans, instructional aids, and tools and supporting information designed to elevate trained and experienced public safety telecommunicators…

WE-G-BRD-07: Automated MR Image Standardization and Auto-Contouring Strategy for MRI-Based Adaptive Brachytherapy for Cervix Cancer

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

Saleh, H Al; Erickson, B; Paulson, E

Purpose: MRI-based adaptive brachytherapy (ABT) is an emerging treatment modality for patients with gynecological tumors. However, MR image intensity non-uniformities (IINU) can vary from fraction to fraction, complicating image interpretation and auto-contouring accuracy. We demonstrate here an automated MR image standardization and auto-contouring strategy for MRI-based ABT of cervix cancer. Methods: MR image standardization consisted of: 1) IINU correction using the MNI N3 algorithm, 2) noise filtering using anisotropic diffusion, and 3) signal intensity normalization using the volumetric median. This post-processing chain was implemented as a series of custom Matlab and Java extensions in MIM (v6.4.5, MIM Software) and wasmore » applied to 3D T2 SPACE images of six patients undergoing MRI-based ABT at 3T. Coefficients of variation (CV=σ/µ) were calculated for both original and standardized images and compared using Mann-Whitney tests. Patient-specific cumulative MR atlases of bladder, rectum, and sigmoid contours were constructed throughout ABT, using original and standardized MR images from all previous ABT fractions. Auto-contouring was performed in MIM two ways: 1) best-match of one atlas image to the daily MR image, 2) multi-match of all previous fraction atlas images to the daily MR image. Dice’s Similarity Coefficients (DSCs) were calculated for auto-generated contours relative to reference contours for both original and standardized MR images and compared using Mann-Whitney tests. Results: Significant improvements in CV were detected following MR image standardization (p=0.0043), demonstrating an improvement in MR image uniformity. DSCs consistently increased for auto-contoured bladder, rectum, and sigmoid following MR image standardization, with the highest DSCs detected when the combination of MR image standardization and multi-match cumulative atlas-based auto-contouring was utilized. Conclusion: MR image standardization significantly improves MR image uniformity. The combination of MR image standardization and multi-match cumulative atlas-based auto-contouring produced the highest DSCs and is a promising strategy for MRI-based ABT for cervix cancer.« less

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 vital emergency action plan at the Navarre Hospital (Spain)].

PubMed

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

2010-07-01

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

A quantification of the physiological demands of the army emergency responder in the Australian army.

PubMed

Tofari, Paul J; Laing Treloar, Alison K; Silk, Aaron J

2013-05-01

The Australian Defence Force is reviewing the physical demands of all employment categories in the Australian Army to establish valid and legally defensible assessments. The current assessments, performed in physical training attire, are not specific to job demands. Moreover, the fitness standards decrease based on age and are lower for females, and as job requirements are constant, these assessments are counterintuitive. With regard to the Army Emergency Responder employment category, tasks of physical demand in the present study were selected through consultation with subject-matter experts. Participants consisted of 10 qualified Army Emergency Responder soldiers and three noncareer firefighters under instruction. Real-life firefighting scenarios were witnessed by researchers and helped form task simulations allowing measurement of heart rate and oxygen consumption. Peak oxygen consumption ranged from 21.8 ± 3.8 to 40.0 ± 3.4 mL kg(-1) min(-1) during cutting activities and a search and rescue task, respectively, representing values similar to or higher than the current entry standards. Manual handling tasks were also assessed, with the heaviest measured being two soldiers lifting a 37.7-kg Utility Trunk to 150 cm. The findings provide a quantitative assessment of the physiological demands of Army Emergency Responders, and highlight the need for change in current fitness assessments. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

PubMed

Klinginsmith, Michael; Jolley, Jennifer; Lomelin, Daniel; Krause, Crystal; Heiden, Jace; Oleynikov, Dmitry

2016-05-01

Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. We demonstrate that laparoscopic PEH repair has become accepted in emergent cases. Open PEH repair is often reserved for emergent surgeries and less commonly includes an AR procedure. Laparoscopy with an AR procedure is clearly the standard of care in elective surgery. The decision to perform an open or laparoscopic surgery, with or without adjunctive techniques, may be based more on the physician's comfort with laparoscopic surgery and surgical practices than the patient's condition. Long-term follow-up studies are needed to determine the functional outcomes of these strategies.

Undergraduate medical education in emergency medical care: A nationwide survey at German medical schools

PubMed Central

Beckers, Stefan K; Timmermann, Arnd; Müller, Michael P; Angstwurm, Matthias; Walcher, Felix

2009-01-01

Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6). Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care. PMID:19435518

National Apprenticeship and Training Standards for Emergency Medical Technicians.

ERIC Educational Resources Information Center

Employment and Training Administration (DOL), Washington, DC.

Developed jointly by several professional organizations and government agencies, these national standards depict the essential skills, knowledge, and ability required of certified emergency medical technicians (EMT) to provide optimal prehospital care and transportation to the sick and injured. Topics covered include definitions of terms EMT's…

36 CFR 28.14 - Emergency action.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Emergency action. 28.14 Section 28.14 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR FIRE ISLAND NATIONAL SEASHORE: ZONING STANDARDS Federal Standards and Approval of Local Ordinances § 28.14...

46 CFR 160.026-1 - Applicable specifications and standard.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Water, Emergency Drinking (In...) General. The following specifications and standard, of the issue in effect on the date emergency drinking water is packed, form a part of this subpart: (1) Military specifications: MIL-L-7178—Lacquer; cellulose...

46 CFR 160.026-1 - Applicable specifications and standard.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Water, Emergency Drinking (In...) General. The following specifications and standard, of the issue in effect on the date emergency drinking water is packed, form a part of this subpart: (1) Military specifications: MIL-L-7178—Lacquer; cellulose...

46 CFR 160.026-1 - Applicable specifications and standard.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Water, Emergency Drinking (In...) General. The following specifications and standard, of the issue in effect on the date emergency drinking water is packed, form a part of this subpart: (1) Military specifications: MIL-L-7178—Lacquer; cellulose...

46 CFR 160.026-1 - Applicable specifications and standard.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Water, Emergency Drinking (In...) General. The following specifications and standard, of the issue in effect on the date emergency drinking water is packed, form a part of this subpart: (1) Military specifications: MIL-L-7178—Lacquer; cellulose...

[Seed vigor evaluation based on adversity resistance index of wheat seed germination under stress conditions.

PubMed

Chen, Lei Tai; Sun, Ai Qing; Yang, Min; Chen, Lu Lu; Ma, Xue Li; Li, Mei Ling; Yin, Yan Ping

2016-09-01

A total of 16 wheat cultivars were selected to detect seed vigor of different genotypes using standard germination test, seed germination test under stress conditions and field emergence test. The adversity resistance indices of seed vigor indices and field emergence percentage under different germination conditions were used as the indices to evaluate adversity resistance. Principal component analysis and cluster analysis were used for the comprehensive evaluation of seed vigor. Results showed that drought stress, artificial aging and cold soaking treatments affected seed vigor to some extent. The adversity resistance indices of the artificial aging and cold soaking tests were significantly positively correlated with the field emergence percentage, while the adversity resistance index of drought stress test had no significant correlation with the field emergence percentage. 16 wheat cultivars were classified as three groups based on the principal component analysis and cluster analysis. Yunong 949, Yumai 49-198, Luyuan 502, Zhengyumai 9987, Shimai 21, Shannong 23, and Shixin 828 belonged to high vigor seeds. Xunong 5, Yunong 982, Tangmai 8, Jimai 20, Jimai 22, Jinan 17, and Shannong 20 belonged to medium vigor seeds. The other two cultivars, Chang 4738 and Lunxuan 061, belonged to low vigor seeds.

Standardized protocols for quality control of MRM-based plasma proteomic workflows.

PubMed

Percy, Andrew J; Chambers, Andrew G; Smith, Derek S; Borchers, Christoph H

2013-01-04

Mass spectrometry (MS)-based proteomics is rapidly emerging as a viable technology for the identification and quantitation of biological samples, such as human plasma--the most complex yet commonly employed biofluid in clinical analyses. The transition from a qualitative to quantitative science is required if proteomics is going to successfully make the transition to a clinically useful technique. MS, however, has been criticized for a lack of reproducibility and interlaboratory transferability. Currently, the MS and plasma proteomics communities lack standardized protocols and reagents to ensure that high-quality quantitative data can be accurately and precisely reproduced by laboratories across the world using different MS technologies. Toward addressing this issue, we have developed standard protocols for multiple reaction monitoring (MRM)-based assays with customized isotopically labeled internal standards for quality control of the sample preparation workflow and the MS platform in quantitative plasma proteomic analyses. The development of reference standards and their application to a single MS platform is discussed herein, along with the results from intralaboratory tests. The tests highlighted the importance of the reference standards in assessing the efficiency and reproducibility of the entire bottom-up proteomic workflow and revealed errors related to the sample preparation and performance quality and deficits of the MS and LC systems. Such evaluations are necessary if MRM-based quantitative plasma proteomics is to be used in verifying and validating putative disease biomarkers across different research laboratories and eventually in clinical laboratories.

Evidence-Based Practice: Video-Discharge Instructions in the Pediatric Emergency Department.

PubMed

Wood, Elyssa B; Harrison, Gina; Trickey, Amber; Friesen, Mary Ann; Stinson, Sarah; Rovelli, Erin; McReynolds, Serena; Presgrave, Kristina

2017-07-01

While a high quality discharge from a Pediatric Emergency Department helps caregivers feel informed and prepared to care for their sick child at home, poor adherence to discharge instructions leads to unnecessary return visits, negative health outcomes, and decreased patient satisfaction. Nurses at the Inova Loudoun Pediatric ED utilized the Johns Hopkins Model of Evidence Based Practice to answer the following question: Among caregivers who have children discharged from the ED, does the addition of video discharge instructions (VDI) to standard written/verbal discharge instructions (SDI) result in improved knowledge about the child's diagnosis, treatment, illness duration, and when to seek further medical care? A multidisciplinary team reviewed available evidence and created VDI for three common pediatric diagnoses: gastroenteritis, bronchiolitis, and fever. Knowledge assessments were collected before and after delivery of discharge instructions to caregivers for both the SDI and VDI groups. Analysis found that the VDI group achieved significantly higher scores on the post test survey (P < .001) than the SDI group, particularly regarding treatment and when to seek further medical care. After integrating the best evidence with clinical expertise and an effective VDI intervention, the team incorporated VDI into the discharge process. VDI offer nurses an efficient, standardized method of providing enhanced discharge instructions in the ED. Future projects will examine whether VDI are effective for additional diagnoses and among caregivers for whom English is not the primary language. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

WWC Quick Review of the Article "Promoting Academic and Social-Emotional School Readiness: The Head Start REDI Program"

ERIC Educational Resources Information Center

What Works Clearinghouse, 2009

2009-01-01

This study examined whether the Head Start Research-based Developmentally Informed (REDI) program is more effective than the standard Head Start program at improving the language, emergent literacy, and social-emotional skills of preschoolers. Head Start centers in three Pennsylvania counties were randomly assigned either to use the REDI program…

78 FR 27898 - Approval and Promulgation of State Implementation Plan Revisions; Infrastructure Requirements for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-13

... arithmetic mean PM 2.5 concentration from single or multiple community- oriented monitors, and 65 [mu]g/m\\3...-oriented monitor within an area. In addition, the 24-hour PM 10 standard was revised to be based on the...): Stationary source monitoring and reporting. 110(a)(2)(G): Emergency powers. 110(a)(2)(H): Future SIP...

An Application of Extreme Value Theory to Learning Analytics: Predicting Collaboration Outcome from Eye-Tracking Data

ERIC Educational Resources Information Center

Sharma, Kshitij; Chavez-Demoulin, Valérie; Dillenbourg, Pierre

2017-01-01

The statistics used in education research are based on central trends such as the mean or standard deviation, discarding outliers. This paper adopts another viewpoint that has emerged in statistics, called extreme value theory (EVT). EVT claims that the bulk of normal distribution is comprised mainly of uninteresting variations while the most…

Precision-Based Item Selection for Exposure Control in Computerized Adaptive Testing

ERIC Educational Resources Information Center

Carroll, Ian A.

2017-01-01

Item exposure control is, relative to adaptive testing, a nascent concept that has emerged only in the last two to three decades on an academic basis as a practical issue in high-stakes computerized adaptive tests. This study aims to implement a new strategy in item exposure control by incorporating the standard error of the ability estimate into…

Impacts of Academic R&D on High-Tech Manufacturing Products: Tentative Evidence from Supercomputer Data

ERIC Educational Resources Information Center

Le, Thanh; Tang, Kam Ki

2015-01-01

This paper empirically examines the impact of academic research on high-tech manufacturing growth of 28 Organisation for Economic Co-operation and Development (OECD) and emerging countries over the 1991-2005 period. A standard research and development (R&D) expenditure based measure is found to be too general to capture the input in high-tech…

Circular Dichroism of G-Quadruplex: A Laboratory Experiment for the Study of Topology and Ligand Binding

ERIC Educational Resources Information Center

Carvalho, Josue´; Queiroz, João A.; Cruz, Carla

2017-01-01

Circular dichroism (CD) has emerged as one of the standard biophysical techniques for the study of guaninequadruplex (G4) folding, cation effect, and ligand binding. The utility of this technique is based on its robustness, ease of use, and requirement of only small quantities of nucleic acid. This experiment is also extendable to the classroom…

A Study to Formulate Quantitative Guidelines for the Audio-Visual Communications Field. Final Report.

ERIC Educational Resources Information Center

Faris, Gene; Sherman, Mendel

Quantitative guidelines for use in determining the audiovisual (AV) needs of educational institutions were developed by the Octobe r 14-16, 1965 Seminar of the NDEA (National Defense Education Act), Faris-Sherman study. The guidelines that emerged were based in part on a review of past efforts and existing standards but primarily reflected the…

Compliance of child care centers in Pennsylvania with national health and safety performance standards for emergency and disaster preparedness.

PubMed

Olympia, Robert P; Brady, Jodi; Kapoor, Shawn; Mahmood, Qasim; Way, Emily; Avner, Jeffrey R

2010-04-01

To determine the preparedness of child care centers in Pennsylvania to respond to emergencies and disasters based on compliance with National Health and Safety Performance Standards for Out-of-Home Child Care Programs. A questionnaire focusing on the presence of a written evacuation plan, the presence of a written plan for urgent medical care, the immediate availability of equipment and supplies, and the training of staff in first aid/cardiopulmonary resuscitation (CPR) as delineated in Caring for Our Children: National Health and Safety Performance Standards for Out-of-Home Child Care Programs, 2nd Edition, was mailed to 1000 randomly selected child care center administrators located in Pennsylvania. Of the 1000 questionnaires sent, 496 questionnaires were available for analysis (54% usable response rate). Approximately 99% (95% confidence interval [CI], 99%-100%) of child care centers surveyed were compliant with recommendations to have a comprehensive written emergency plan (WEP) for urgent medical care and evacuation, and 85% (95% CI, 82%-88%) practice their WEP periodically throughout the year. More than 20% of centers did not have specific written procedures for floods, earthquakes, hurricanes, blizzards, or bomb threats, and approximately half of the centers did not have specific written procedures for urgent medical emergencies such as severe bleeding, unresponsiveness, poisoning, shock/heart or circulation failure, seizures, head injuries, anaphylaxis or allergic reactions, or severe dehydration. A minority of centers reported having medications available to treat an acute asthma attack or anaphylaxis. Also, 77% (95% CI, 73%-80%) of child care centers require first aid training for each one of its staff members, and 33% (95% CI, 29%-37%) require CPR training. Although many of the child care centers we surveyed are in compliance with the recommendations for emergency and disaster preparedness, specific areas for improvement include increasing the frequency of practice of the WEP, establishing specific written procedures for external disasters and urgent medical emergencies, maintaining the immediate availability of potentially life-saving medications, and ensuring that all child care center staff are trained in first aid and CPR.

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

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

Hoel, D.D.

1984-01-01

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

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

PubMed

Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H; Nolan, Jerry P

2015-11-01

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. Copyright © 2014 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier Ireland Ltd.. All rights reserved.

Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

PubMed

Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Huei-Ming Ma, Matthew; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Eng Hock Ong, Marcus; Travers, Andrew H; Nolan, Jerry P

2015-09-29

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. © 2014 by the American Heart Association, Inc., and European Resuscitation Council.

77 FR 25500 - Standard on Hazardous Waste Operations and Emergency Response (HAZWOPER); Extension of the Office...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-30

...] Standard on Hazardous Waste Operations and Emergency Response (HAZWOPER); Extension of the Office of Management and Budget's (OMB) Approval of Information Collection (Paperwork) Requirements AGENCY... solicits public comments concerning its proposal to extend the Office of Management and Budget's (OMB...

40 CFR 267.58 - What notification and recordkeeping must I do after an emergency?

Code of Federal Regulations, 2013 CFR

2013-07-01

... AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.58 What..., and details of any incident that requires implementing the contingency plan in the operating record...

77 FR 19132 - Federal Motor Vehicle Safety Standards; Bus Emergency Exits and Window Retention and Release

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-30

... DEPARTMENT OF TRANSPORTATION National Highway Traffic Safety Administration 49 CFR Part 571 [Docket No. NHTSA-2012-0037] RIN 2127-AK20 Federal Motor Vehicle Safety Standards; Bus Emergency Exits and Window Retention and Release AGENCY: National Highway Traffic Safety Administration (NHTSA), Department...

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... action plan must include at a minimum: (1) Procedures for reporting a fire or other emergency; (2... 29 Labor 5 2013-07-01 2013-07-01 false Emergency action plans. 1910.38 Section 1910.38 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.38 Emergency action plans...

Knowledge representation and management enabling intelligent interoperability - principles and standards.

PubMed

Blobel, Bernd

2013-01-01

Based on the paradigm changes for health, health services and underlying technologies as well as the need for at best comprehensive and increasingly automated interoperability, the paper addresses the challenge of knowledge representation and management for medical decision support. After introducing related definitions, a system-theoretical, architecture-centric approach to decision support systems (DSSs) and appropriate ways for representing them using systems of ontologies is given. Finally, existing and emerging knowledge representation and management standards are presented. The paper focuses on the knowledge representation and management part of DSSs, excluding the reasoning part from consideration.

Empowering genomic medicine by establishing critical sequencing result data flows: the eMERGE example.

PubMed

Aronson, Samuel; Babb, Lawrence; Ames, Darren; Gibbs, Richard A; Venner, Eric; Connelly, John J; Marsolo, Keith; Weng, Chunhua; Williams, Marc S; Hartzler, Andrea L; Liang, Wayne H; Ralston, James D; Devine, Emily Beth; Murphy, Shawn; Chute, Christopher G; Caraballo, Pedro J; Kullo, Iftikhar J; Freimuth, Robert R; Rasmussen, Luke V; Wehbe, Firas H; Peterson, Josh F; Robinson, Jamie R; Wiley, Ken; Overby Taylor, Casey

2018-05-31

The eMERGE Network is establishing methods for electronic transmittal of patient genetic test results from laboratories to healthcare providers across organizational boundaries. We surveyed the capabilities and needs of different network participants, established a common transfer format, and implemented transfer mechanisms based on this format. The interfaces we created are examples of the connectivity that must be instantiated before electronic genetic and genomic clinical decision support can be effectively built at the point of care. This work serves as a case example for both standards bodies and other organizations working to build the infrastructure required to provide better electronic clinical decision support for clinicians.

Reparative resynchronization in ischemic heart failure: an emerging strategy.

PubMed

Yamada, Satsuki; Terzic, Andre

2014-08-01

Cardiac dyssynchrony refers to disparity in cardiac wall motion, a serious consequence of myocardial infarction associated with poor outcome. Infarct-induced scar is refractory to device-based cardiac resynchronization therapy, which relies on viable tissue. Leveraging the prospect of structural and functional regeneration, reparative resynchronization has emerged as a potentially achievable strategy. In proof-of-concept studies, stem-cell therapy eliminates contractile deficit originating from infarcted regions and secures long-term synchronization with tissue repair. Limited clinical experience suggests benefit of cell interventions in acute and chronic ischemic heart disease as adjuvant to standard of care. A regenerative resynchronization option for dyssynchronous heart failure thus merits validation.

The state of the Universe.

PubMed

Coles, Peter

2005-01-20

The past 20 years have seen dramatic advances in cosmology, mostly driven by observations from new telescopes and detectors. These instruments have allowed astronomers to map out the large-scale structure of the Universe and probe the very early stages of its evolution. We seem to have established the basic parameters describing the behaviour of our expanding Universe, thereby putting cosmology on a firm empirical footing. But the emerging 'standard' model leaves many details of galaxy formation still to be worked out, and new ideas are emerging that challenge the theoretical framework on which the structure of the Big Bang is based. There is still a great deal left to explore in cosmology.

Legal considerations during pediatric emergency mass critical care events.

PubMed

Courtney, Brooke; Hodge, James G

2011-11-01

Recent public health emergencies, such as the 2009 Influenza A/H1N1 Pandemic and Hurricane Katrina, underscore the importance of developing healthcare response plans and protocols for disasters impacting large populations. Significant research and scholarship, including the 2009 Institute of Medicine report on crisis standards of care and the 2008 Task Force for Mass Critical Care recommendations, provide guidance for healthcare responses to catastrophic emergencies. Most of these efforts recognize but do not focus on the unique needs of pediatric populations. In 2008, the Centers for Disease Control and Prevention supported the formation of a task force to address pediatric emergency mass critical care response issues, including legal issues. Liability is a significant concern for healthcare practitioners and facilities during pediatric emergency mass critical care that necessitates a shift to crisis standards of care. This article describes the legal considerations inherent in planning for and responding to catastrophic health emergencies and makes recommendations for pediatric emergency mass critical care legal preparedness. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010, to review the pediatric emergency mass critical care recommendations developed by a 17-member steering committee. During the meeting, experts determined that the recommendations would be strengthened by a manuscript addressing legal issues. Authors drafted the manuscript through consensus-based study of peer-reviewed research, literature reviews, and expert opinion. The manuscript was reviewed by Pediatric Emergency Mass Critical Care Steering Committee members and additional legal counsel and revised. While the legal issues associated with providing pediatric emergency mass critical care are not unique within the overall context of disaster healthcare, the scope of the parens patriae power of states, informed consent principles, and security should be considered in pediatric emergency mass critical care planning and response efforts because parents and legal guardians may be unavailable to participate in healthcare decision making during disasters. In addition, practitioners who follow properly vetted and accepted pediatric emergency mass critical care disaster protocols in good faith should be protected from civil liability, and healthcare facilities that provide pediatric care should incorporate informed consent and security protocols into their disaster plans.

A National Coordinating Center for Prehospital Trauma Research Funding Transfusion Using Stored Fresh Whole Blood

DTIC Science & Technology

2016-09-01

bank data base 28-30 5% Analyze blood bank data base 28-33 0% Other Major Tasks: Identification of communities in the UCLA catchment area 1-3 N/A...coagulopathy in real-time is underway. The Blood Bank is working to identify a pool of whole blood donors and incorporating the new product (FWB) in...Blood Bank , emergency Room, Trauma, Operating Room, Intensive Care Unit, etc) to coordinate and streamline standard operating procedures for the

Responding to the deaf in disasters: establishing the need for systematic training for state-level emergency management agencies and community organizations.

PubMed

Engelman, Alina; Ivey, Susan L; Tseng, Winston; Dahrouge, Donna; Brune, Jim; Neuhauser, Linda

2013-03-07

Deaf and hard-of-hearing (Deaf/HH) individuals have been underserved before and during emergencies. This paper will assess Deaf/HH related emergency preparedness training needs for state emergency management agencies and deaf-serving community-based organizations (CBOs). Four approaches were used: 1) a literature review; 2) results from 50 key informant (KI) interviews from state and territorial-level emergency management and public health agencies; 3) results from 14 KI interviews with deaf-serving CBOs in the San Francisco Bay Area; and 4) a pilot program evaluation of an emergency responder training serving the Deaf/HH in one urban community. Results from literature review and state and territorial level KIs indicate that there is a substantive gap in emergency preparedness training on serving Deaf/HH provided by state agencies. In addition, local KI interviews with 14 deaf-serving CBOs found gaps in training within deaf-serving CBOs. These gaps have implications for preparing for and responding to all-hazards emergencies including weather-related or earthquake-related natural disasters, terrorist attacks, and nuclear-chemical disasters. Emergency preparedness trainings specific to responding to or promoting preparedness of the Deaf/HH is rare, even for state agency personnel, and frequently lack standardization, evaluation, or institutionalization in emergency management infrastructure. This has significant policy and research implications. Similarly, CBOs are not adequately trained to serve the needs of their constituents.

LEGOS: Object-based software components for mission-critical systems. Final report, June 1, 1995--December 31, 1997

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

NONE

1998-08-01

An estimated 85% of the installed base of software is a custom application with a production quantity of one. In practice, almost 100% of military software systems are custom software. Paradoxically, the marginal costs of producing additional units are near zero. So why hasn`t the software market, a market with high design costs and low productions costs evolved like other similar custom widget industries, such as automobiles and hardware chips? The military software industry seems immune to market pressures that have motivated a multilevel supply chain structure in other widget industries: design cost recovery, improve quality through specialization, and enablemore » rapid assembly from purchased components. The primary goal of the ComponentWare Consortium (CWC) technology plan was to overcome barriers to building and deploying mission-critical information systems by using verified, reusable software components (Component Ware). The adoption of the ComponentWare infrastructure is predicated upon a critical mass of the leading platform vendors` inevitable adoption of adopting emerging, object-based, distributed computing frameworks--initially CORBA and COM/OLE. The long-range goal of this work is to build and deploy military systems from verified reusable architectures. The promise of component-based applications is to enable developers to snap together new applications by mixing and matching prefabricated software components. A key result of this effort is the concept of reusable software architectures. A second important contribution is the notion that a software architecture is something that can be captured in a formal language and reused across multiple applications. The formalization and reuse of software architectures provide major cost and schedule improvements. The Unified Modeling Language (UML) is fast becoming the industry standard for object-oriented analysis and design notation for object-based systems. However, the lack of a standard real-time distributed object operating system, lack of a standard Computer-Aided Software Environment (CASE) tool notation and lack of a standard CASE tool repository has limited the realization of component software. The approach to fulfilling this need is the software component factory innovation. The factory approach takes advantage of emerging standards such as UML, CORBA, Java and the Internet. The key technical innovation of the software component factory is the ability to assemble and test new system configurations as well as assemble new tools on demand from existing tools and architecture design repositories.« less

Integrating a framework for conducting public health systems research into statewide operations-based exercises to improve emergency preparedness

PubMed Central

2012-01-01

Background Due to the uncommon nature of large-scale disasters and emergencies, public health practitioners often turn to simulated emergencies, known as “exercises”, for preparedness assessment and improvement. Under the right conditions, exercises can also be used to conduct original public health systems research. This paper describes the integration of a research framework into a statewide operations-based exercise program in California as a systems-based approach for studying public health emergency preparedness and response. Methods We developed a research framework based on the premise that operations-based exercises conducted by medical and public health agencies can be described using epidemiologic concepts. Using this framework, we conducted a survey of key local and regional medical and health agencies throughout California following the 2010 Statewide Medical and Health Exercise. The survey evaluated: (1) the emergency preparedness capabilities activated and functions performed in response to the emergency scenario, and (2) the major challenges to inter-organizational communications and information management. Results Thirty-five local health departments (LHDs), 24 local emergency medical services (EMS) agencies, 121 hospitals, and 5 Regional Disaster Medical and Health Coordinators/Specialists (RDMHC) responded to our survey, representing 57%, 77%, 26% and 83%, respectively, of target agencies in California. We found two sets of response capabilities were activated during the 2010 Statewide Exercise: a set of core capabilities that were common across all agencies, and a set of agency-specific capabilities that were more common among certain agency types. With respect to one response capability in particular, inter-organizational information sharing, we found that the majority of respondents’ comments were related to the complete or partial failure of communications equipment or systems. Conclusions Using the 2010 Statewide Exercise in California as an opportunity to develop our research framework, we characterized several aspects of the public health and medical system’s response to a standardized emergency scenario. From a research perspective, this study provides a potential new framework for conducting exercise-based research. From a practitioner’s perspective, our results provide a starting point for preparedness professionals’ dialogue about expected and actual organizational roles, responsibilities, and resource capacities within the public health system. Additionally, the identification of specific challenges to inter-organizational communications and information management offer specific areas for intervention. PMID:22905991

Comparative Effectiveness of STEMI Regionalization Strategies

PubMed Central

Concannon, Thomas W.; Kent, David M.; Normand, Sharon-Lise; Newhouse, Joseph P.; Griffith, John L.; Cohen, Joshua; Beshansky, Joni R.; Wong, John B.; Aversano, Thomas; Selker, Harry P.

2010-01-01

BACKGROUND Primary percutaneous coronary intervention (PCI) is more effective on average than fibrinolytic therapy (FT) in the treatment of ST-segment elevation myocardial infarction (STEMI). Yet most U.S. hospitals are not equipped for PCI and FT is still widely used. This study evaluated the comparative effectiveness of STEMI regionalization strategies to increase the use of PCI against standard emergency transport and care. METHODS AND RESULTS We estimated incremental treatment costs and quality-adjusted life expectancies of 2,000 patients with STEMI who received PCI or FT in simulations of emergency care in a regional hospital system. To increase access to PCI across the system, we compared a base case strategy to 12 hospital-based strategies of building new PCI labs or extending the hours of existing labs, and one emergency medical services (EMS)-based strategy of transporting all patients with STEMI to existing PCI-capable hospitals. The base case resulted in 609 (569, 647) patients getting PCI. Hospital-based strategies increased the number of patients receiving PCI, the costs of care, and quality-adjusted life years (QALYs) saved, and were cost effective under a variety of conditions. An EMS-based strategy of transporting every patient to an existing PCI facility was less costly and more effective than all hospital expansion options. CONCLUSION Our results suggest that new construction and staffing of PCI labs may not be warranted if an EMS strategy is both available and feasible. PMID:20664025

Continuing Medical Education for Air Medical Providers: The Successes and Challenges.

PubMed

Miller, Jenna O; Thammasitboon, Satid; Hsu, Deborah C; Shah, Manish I; Minard, Charles G; Graf, Jeanine M

2016-02-01

Research has shown that patients transported by nonpediatric teams have higher rates of morbidity and mortality. There is currently a paucity of pediatric standardized ongoing medical education for emergency medical service providers, thus we aimed to develop a model curriculum to increase their knowledge regarding pediatric respiratory distress and failure. The curriculum was based on the Kolb Learning Cycle to optimize learning. Target learners were flight nurses (registered nurse) and emergency medical technicians of a private helicopter emergency transport team. The topics included were pediatric stridor, wheezing, and respiratory failure. Online modules were developed for continued spaced education. Knowledge gained from the interventions was measured by precurricular and postcurricular testing and compared with paired t tests. A linear mixed regression model was used to investigate covariates of interest. Sixty-two learners attended the workshop. Fifty-nine learners completed both precurricular and postcurricular testing. The mean increase between pretest and posttest scores was 12.1% (95% confidence interval, 9.4, 14.8; P < 0.001). Type of licensure (private emergency medical technician vs registered nurse) and number of years experience had no association with the level of knowledge gained. Learners who had greater than 1 year of pediatric transport experience scored higher on their pretests. There was no significant retention shown by those who participated in spaced education. The curriculum was associated with a short term increased knowledge regarding pediatric respiratory distress and failure for emergency helicopter transport providers and could be used as an alternative model to develop standardized ongoing medical education in pediatrics. Further work is needed to achieve knowledge retention in this learner population.

Newborn screening by tandem mass spectrometry: ethical and social issues.

PubMed

Avard, Denise; Vallance, Hilary; Greenberg, Cheryl; Potter, Beth

2007-01-01

Emerging technologies like Tandem Mass Spectrometry (TMS) enable multiple tests on a single blood sample and allow the expansion of Newborn Screening (NBS) to include various metabolic diseases. Introducing TMS for NBS raises important social and ethical questions: what are the criteria for adding disorders to screening panels? What evidence justifies expansion of screening? How can equity in NBS access and standards be ensured? How can policy standards be set, given the multiplicity of stakeholders? To address emerging issues, policy-makers, patient advocates, clinicians and researchers had a workshop during the 2005 Garrod Symposium. The participants received a summary of the discussion and understood the workshop's goal was to provide a basis for further discussion. This article contributes to this ongoing discussion. Several proposed recommendations assert the centrality of including social and ethical issues in the assessment of whether or not to introduce TMS. The article outlines five key recommendations for advancing the NBS agenda: national public health leadership; transparency; increased national consistency in NBS strategy, including minimum standards; collaboration between the federal and provincial/territorial governments and diverse stakeholders; and supporting research and/or programs based on effectiveness, which integrate ethical and social issues into assessment.

Mission Systems Open Architecture Science and Technology (MOAST) program

NASA Astrophysics Data System (ADS)

Littlejohn, Kenneth; Rajabian-Schwart, Vahid; Kovach, Nicholas; Satterthwaite, Charles P.

2017-04-01

The Mission Systems Open Architecture Science and Technology (MOAST) program is an AFRL effort that is developing and demonstrating Open System Architecture (OSA) component prototypes, along with methods and tools, to strategically evolve current OSA standards and technical approaches, promote affordable capability evolution, reduce integration risk, and address emerging challenges [1]. Within the context of open architectures, the program is conducting advanced research and concept development in the following areas: (1) Evolution of standards; (2) Cyber-Resiliency; (3) Emerging Concepts and Technologies; (4) Risk Reduction Studies and Experimentation; and (5) Advanced Technology Demonstrations. Current research includes the development of methods, tools, and techniques to characterize the performance of OMS data interconnection methods for representative mission system applications. Of particular interest are the OMS Critical Abstraction Layer (CAL), the Avionics Service Bus (ASB), and the Bulk Data Transfer interconnects, as well as to develop and demonstrate cybersecurity countermeasures techniques to detect and mitigate cyberattacks against open architecture based mission systems and ensure continued mission operations. Focus is on cybersecurity techniques that augment traditional cybersecurity controls and those currently defined within the Open Mission System and UCI standards. AFRL is also developing code generation tools and simulation tools to support evaluation and experimentation of OSA-compliant implementations.

46 CFR 112.55-5 - Emergency lighting loads.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND POWER SYSTEMS Storage Battery Installation § 112.55-5 Emergency lighting loads. When supplying emergency lighting loads, the storage battery initial voltage must not exceed the standard system voltage by...

46 CFR 112.55-5 - Emergency lighting loads.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND POWER SYSTEMS Storage Battery Installation § 112.55-5 Emergency lighting loads. When supplying emergency lighting loads, the storage battery initial voltage must not exceed the standard system voltage by...

46 CFR 112.55-5 - Emergency lighting loads.

Code of Federal Regulations, 2013 CFR

2013-10-01

... AND POWER SYSTEMS Storage Battery Installation § 112.55-5 Emergency lighting loads. When supplying emergency lighting loads, the storage battery initial voltage must not exceed the standard system voltage by...

46 CFR 112.55-5 - Emergency lighting loads.

Code of Federal Regulations, 2014 CFR

2014-10-01

... AND POWER SYSTEMS Storage Battery Installation § 112.55-5 Emergency lighting loads. When supplying emergency lighting loads, the storage battery initial voltage must not exceed the standard system voltage by...

46 CFR 112.55-5 - Emergency lighting loads.

Code of Federal Regulations, 2012 CFR

2012-10-01

... AND POWER SYSTEMS Storage Battery Installation § 112.55-5 Emergency lighting loads. When supplying emergency lighting loads, the storage battery initial voltage must not exceed the standard system voltage by...

Machine-Learning-Based Electronic Triage More Accurately Differentiates Patients With Respect to Clinical Outcomes Compared With the Emergency Severity Index.

PubMed

Levin, Scott; Toerper, Matthew; Hamrock, Eric; Hinson, Jeremiah S; Barnes, Sean; Gardner, Heather; Dugas, Andrea; Linton, Bob; Kirsch, Tom; Kelen, Gabor

2018-05-01

Standards for emergency department (ED) triage in the United States rely heavily on subjective assessment and are limited in their ability to risk-stratify patients. This study seeks to evaluate an electronic triage system (e-triage) based on machine learning that predicts likelihood of acute outcomes enabling improved patient differentiation. A multisite, retrospective, cross-sectional study of 172,726 ED visits from urban and community EDs was conducted. E-triage is composed of a random forest model applied to triage data (vital signs, chief complaint, and active medical history) that predicts the need for critical care, an emergency procedure, and inpatient hospitalization in parallel and translates risk to triage level designations. Predicted outcomes and secondary outcomes of elevated troponin and lactate levels were evaluated and compared with the Emergency Severity Index (ESI). E-triage predictions had an area under the curve ranging from 0.73 to 0.92 and demonstrated equivalent or improved identification of clinical patient outcomes compared with ESI at both EDs. E-triage provided rationale for risk-based differentiation of the more than 65% of ED visits triaged to ESI level 3. Matching the ESI patient distribution for comparisons, e-triage identified more than 10% (14,326 patients) of ESI level 3 patients requiring up triage who had substantially increased risk of critical care or emergency procedure (1.7% ESI level 3 versus 6.2% up triaged) and hospitalization (18.9% versus 45.4%) across EDs. E-triage more accurately classifies ESI level 3 patients and highlights opportunities to use predictive analytics to support triage decisionmaking. Further prospective validation is needed. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The age of permanent tooth emergence in children of different ethnic origin in the Auckland region: a cross-sectional study.

PubMed

Kanagaratnam, Sathananthan; Schluter, Philip J

2012-06-01

To report robust and contemporary estimates of permanent teeth emergence ages in children of Māori, Pasifika, Chinese, Indian and European ethnic origin in the Auckland region. A stratified, two-stage cross-sectional study. Strata were defined by school decile status. Schools defined the first-stage sampling unit, and students the second stage. Invitations and consent forms were distributed to eligible participants at school for completion at home. Participants were examined at school-based clinics or in a mobile clinic. PARTICIPANTS/MATERIALS, AND METHODS: Children aged between 5 and 13 years enrolled within the Auckland Regional Dental Service. Schools were randomly selected and then all students within selected schools were invited to participate. Eligible participants completing a consent form had an additional tooth assessment that complemented their routine dental examination. A generalised gamma failure-time model was employed to estimate permanent tooth eruption ages. Visually based assessment of permanent tooth emergence. Overall, 3,466 children participated. Differences in median permanent tooth emergence ages were seen among ethnic groups and sexes (P < or = 0.01). Pasifika children had earlier median eruption time than sex-matched Māori children, who (in turn) were more advanced than sex-matched European children. Median eruption age occurred earlier in girls than boys for all permanent teeth. Despite known demographic, geographic and ethnic differences, estimates of permanent teeth emergence timing widely used in New Zealand are based on historical overseas populations. The presented estimates provide new standards and may be more appropriate for dental therapists and dentists when assessing permanent teeth emergence in New Zealand children.

Current global standards for chemical protective clothing: how to choose the right protection for the right job?

PubMed Central

VAN WELY, Eric

2017-01-01

The first standards for chemical protective clothing (CPC) emerged mid to late 1980’s and have evolved since as most standards are revisited every 5 yr. Over the past years, we have also seen a strengthening of the chemical and worker protection legislation around the globe (various forms of REACH) but also protection of workers. The most prevalent standards originate under the auspices of the International Standards Organisation (ISO), European Committee for Standardisation (CEN) or under various US standards organisations (e.g. NFPA, ASTM). Protective clothing against hazardous materials is required in many of the professional and non-professional activities of everyday life. Effective and adequate protection is important in many scenarios from household (e.g. cleaning agents, peroxides, acids and bases, paints), to agricultural (e.g. fuel, pesticides), to medical (e.g. pharmaceuticals and active ingredients), to industrial production (e.g. petro-chemicals, chemicals, paints, adhesive and coatings) but also manufacturing of many products (e.g. light bulbs, cars, semi-conductors), during various emergency activities (e.g. boat, rail or road accidents as well as fire-fighting in an urban and industrial setting), and finally, military operations or response to incidents of terrorism. Nevertheless, CPC must remain the last line of defence whenever possible through a preference for less hazardous chemicals, less dangerous processes and handling operations, and by engineering controls to reduce and minimise human contact with the chemicals. This article provides information about the selection, use, care and maintenance (SUCAM) of protective clothing against chemical and microbiological hazards. PMID:29046493

Current global standards for chemical protective clothing: how to choose the right protection for the right job?

PubMed

VAN Wely, Eric

2017-12-07

The first standards for chemical protective clothing (CPC) emerged mid to late 1980's and have evolved since as most standards are revisited every 5 yr. Over the past years, we have also seen a strengthening of the chemical and worker protection legislation around the globe (various forms of REACH) but also protection of workers. The most prevalent standards originate under the auspices of the International Standards Organisation (ISO), European Committee for Standardisation (CEN) or under various US standards organisations (e.g. NFPA, ASTM). Protective clothing against hazardous materials is required in many of the professional and non-professional activities of everyday life. Effective and adequate protection is important in many scenarios from household (e.g. cleaning agents, peroxides, acids and bases, paints), to agricultural (e.g. fuel, pesticides), to medical (e.g. pharmaceuticals and active ingredients), to industrial production (e.g. petro-chemicals, chemicals, paints, adhesive and coatings) but also manufacturing of many products (e.g. light bulbs, cars, semi-conductors), during various emergency activities (e.g. boat, rail or road accidents as well as fire-fighting in an urban and industrial setting), and finally, military operations or response to incidents of terrorism. Nevertheless, CPC must remain the last line of defence whenever possible through a preference for less hazardous chemicals, less dangerous processes and handling operations, and by engineering controls to reduce and minimise human contact with the chemicals. This article provides information about the selection, use, care and maintenance (SUCAM) of protective clothing against chemical and microbiological hazards.

29 CFR 1926.35 - Employee emergency action plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 8 2012-07-01 2012-07-01 false Employee emergency action plans. 1926.35 Section 1926.35... Provisions § 1926.35 Employee emergency action plans. (a) Scope and application. This section applies to all emergency action plans required by a particular OSHA standard. The emergency action plan shall be in writing...

29 CFR 1926.35 - Employee emergency action plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 8 2011-07-01 2011-07-01 false Employee emergency action plans. 1926.35 Section 1926.35... Provisions § 1926.35 Employee emergency action plans. (a) Scope and application. This section applies to all emergency action plans required by a particular OSHA standard. The emergency action plan shall be in writing...

29 CFR 1926.35 - Employee emergency action plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 8 2013-07-01 2013-07-01 false Employee emergency action plans. 1926.35 Section 1926.35... Provisions § 1926.35 Employee emergency action plans. (a) Scope and application. This section applies to all emergency action plans required by a particular OSHA standard. The emergency action plan shall be in writing...

29 CFR 1926.35 - Employee emergency action plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 8 2014-07-01 2014-07-01 false Employee emergency action plans. 1926.35 Section 1926.35... Provisions § 1926.35 Employee emergency action plans. (a) Scope and application. This section applies to all emergency action plans required by a particular OSHA standard. The emergency action plan shall be in writing...

Overview of innovative remediation of emerging contaminants

NASA Astrophysics Data System (ADS)

Keller, A. A.; Adeleye, A. S.; Huang, Y.; Garner, K.

2015-12-01

The application of nanotechnology in drinking water treatment and pollution cleanup is promising, as demonstrated by a number of field-based (pilot and full scale) and bench scale studies. A number of reviews exist for these nanotechnology-based applications; but to better illustrate its importance and guide its development, a direct comparison between traditional treatment technologies and emerging approaches using nanotechnology is needed. In this review, the performances of traditional technologies and nanotechnology for water treatment and environmental remediation were compared with the goal of providing an up-to-date reference on the state of treatment techniques for researchers, industry, and policy makers. Pollutants were categorized into broad classes, and the most cost-effective techniques (traditional and nanotechnology-based) in each category reported in the literature were compared. Where information was available, cost and environmental implications of both technologies were also compared. Traditional treatment technologies were found to currently offer the most cost-effective choices for removal of several common pollutants from drinking water and polluted sites. Nano-based techniques may however become important in complicated remediation conditions and meeting increasingly stringent water quality standards, especially in removal of emerging pollutants and low levels of contaminants. We also discuss challenges facing environmental application of nanotechnology were also discussed and potential solutions.

How galectin-3 changes acute heart failure decision making in the emergency department.

PubMed

Peacock, W Frank

2014-10-01

When considering the appropriate disposition plan in a patient presenting to the emergency department (ED) with acute heart failure (HF), the range of options includes discharge home to intensive care unit (ICU) admission. Unfortunately, there are few objective measures to insure optimal choices, and the currently available science is scant at best. The consequences of a lack of a standardized approach are nowhere more evident than as demonstrated by the worldwide 90-day heart failure rehospitalization rate that exceeds 25%. New strategies to address this important gap in clinical care are sorely needed. The measurement of galectin-3 may represent a new alternative to the historical standard of gestalt-based clinical disposition decisions. Elevated galectin-3 can identify patients at very high risk for short-term adverse outcomes, while low levels identify a population with essentially no 90-day revisits. This prospective objective measure of illness severity may aid in clinical decision making and thus represent a future where rehospitalization after HF is an unusual event.

Creating Safer Campuses through Implementation of Threat-Assessment Teams: Are They Enough?

ERIC Educational Resources Information Center

Toppe, Michele L.

2017-01-01

According to higher education policy experts, "Campus threat assessment is not merely a recommendation, but an emerging standard of care." However, despite evidence of the emergence of this standard and the consistency of recommendations that comport with those made by the Virginia Tech Review Panel, college campuses continue to vary…

Application of LC/MS/MS Techniques to Development of US EPA Standardized Methods for Chemicals of Emerging Concern

EPA Science Inventory

This presentation will describe the U.S. EPA’s drinking water and ambient water method development program in relation to the process employed and the typical challenges encountered in developing standardized LC/MS/MS methods for chemicals of emerging concern. The EPA&rsquo...

Data Friction Meets Social Friction: Challenges for standardization in emerging fields of geoscience

NASA Astrophysics Data System (ADS)

Darch, P. T.

2017-12-01

Many interdisciplinary endeavors in the geosciences occur in emergent scientific fields. These fields are often characterized by heterogeneity of methods for production and collection of data, and by data scarcity. This paper presents findings about processes of methods standardization from a long-term case study of an emergent, data-scarce field, the deep subseafloor biosphere. Researchers come from many physical and life science backgrounds to study interactions between microbial life in the seafloor and the physical environment they inhabit. Standardization of methods for collecting data promises multiple benefits to this field, including: Addressing data scarcity through enabling greater data reuse and promoting better interoperability with large scale infrastructures; Fostering stronger collaborative links between researchers distributed across institutions and backgrounds. Ongoing standardization efforts in the field do not only involve scientific judgments about which among a range of methods is most efficient, least biased, or most reliable. Instead, these efforts also encounter multiple difficult social challenges, including: Lack of agreed upon criteria about how to judge competing methods: should efficiency, bias, or reliability take priority?; Lack of resources to carry out the work necessary to determine standards, particularly acute in emergent fields; Concerns that standardization is premature in such a new field, foreclosing the possibility of better methods being developed in the future; Concerns that standardization could prematurely shut down important scientific debates; Concerns among some researchers that their own work may become obsolete should the methods chosen as standard be different from their own. The success of these standardization efforts will depend on addressing both scientific and social dimensions, to ensure widespread acceptance among researchers in the field.

Emerging therapies for Clostridium difficile infections.

PubMed

McFarland, Lynne V

2011-09-01

Clostridium difficile infection (CDI) is the leading identifiable gastrointestinal disease in healthcare institutions, but the response rates to the two standard therapies for CDI are declining and so innovative therapies are being developed for CDI. The purpose of this paper is to review the data on the efficacy and safety of emerging therapies for CDI and assess their potential for effectiveness based on the clinical phase of development and marketing challenges. Emerging therapies for CDI are reviewed including new antibiotics, peptides, immune regulators, probiotics and toxin binders. PubMed, Medline and Google Scholar and online clinical trial registers are searched from 1976 to 2010 for articles unrestricted by language. Secondary searches by author, manufacturing companies and FDA websites are also performed. Of the emerging therapies for CDI, several may ultimately reduce the incidence of CDI and the economic burden of this disease on the healthcare system. Several emerging treatments (fidaxomicin, rifaximin and mAbs) show the most promise, although only one is currently being actively developed. Use of other clostridial strains, probiotic strains and immune enhancers have great potential as therapies, but require further development.

Gravitational Field as a Pressure Force from Logarithmic Lagrangians and Non-Standard Hamiltonians: The Case of Stellar Halo of Milky Way

NASA Astrophysics Data System (ADS)

El-Nabulsi, Rami Ahmad

2018-03-01

Recently, the notion of non-standard Lagrangians was discussed widely in literature in an attempt to explore the inverse variational problem of nonlinear differential equations. Different forms of non-standard Lagrangians were introduced in literature and have revealed nice mathematical and physical properties. One interesting form related to the inverse variational problem is the logarithmic Lagrangian, which has a number of motivating features related to the Liénard-type and Emden nonlinear differential equations. Such types of Lagrangians lead to nonlinear dynamics based on non-standard Hamiltonians. In this communication, we show that some new dynamical properties are obtained in stellar dynamics if standard Lagrangians are replaced by Logarithmic Lagrangians and their corresponding non-standard Hamiltonians. One interesting consequence concerns the emergence of an extra pressure term, which is related to the gravitational field suggesting that gravitation may act as a pressure in a strong gravitational field. The case of the stellar halo of the Milky Way is considered.

TU-D-201-07: Severity Indication in High Dose Rate Brachytherapy Emergency Response Procedure

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

Li, K; Rustad, F

Purpose: Understanding the corresponding dose to different staff during the High Dose Rate (HDR) Brachytherapy emergency response procedure could help to develop a strategy in efficiency and effective action. In this study, the variation and risk analysis methodology was developed to simulation the HDR emergency response procedure based on severity indicator. Methods: A GammaMedplus iX HDR unit from Varian Medical System was used for this simulation. The emergency response procedure was decomposed based on risk management methods. Severity indexes were used to identify the impact of a risk occurrence on the step including dose to patient and dose to operationmore » staff by varying the time, HDR source activity, distance from the source to patient and staff and the actions. These actions in 7 steps were to press the interrupt button, press emergency shutoff switch, press emergency button on the afterloader keypad, turn emergency hand-crank, remove applicator from the patient, disconnect transfer tube and move afterloader from the patient, and execute emergency surgical recovery. Results: Given the accumulated time in second at the assumed 7 steps were 15, 5, 30, 15, 180, 120, 1800, and the dose rate of HDR source is 10 Ci, the accumulated dose in cGy to patient at 1cm distance were 188, 250, 625, 813, 3063, 4563 and 27063, and the accumulated exposure in rem to operator at outside the vault, 1m and 10cm distance were 0.0, 0.0, 0.1, 0.1, 22.6, 37.6 and 262.6. The variation was determined by the operators in action at different time and distance from the HDR source. Conclusion: The time and dose were estimated for a HDR unit emergency response procedure. It provided information in making optimal decision during the emergency procedure. Further investigation would be to optimize and standardize the responses for other emergency procedure by time-spatial-dose severity function.« less

Adherence to Standards for Reporting Diagnostic Accuracy in Emergency Medicine Research.

PubMed

Gallo, Lucas; Hua, Nadia; Mercuri, Mathew; Silveira, Angela; Worster, Andrew

2017-08-01

Diagnostic tests are used frequently in the emergency department (ED) to guide clinical decision making and, hence, influence clinical outcomes. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria were developed to ensure that diagnostic test studies are performed and reported to best inform clinical decision making in the ED. The objective was to determine the extent to which diagnostic studies published in emergency medicine journals adhered to STARD 2003 criteria. Diagnostic studies published in eight MEDLINE-listed, peer-reviewed, emergency medicine journals over a 5-year period were reviewed for compliance to STARD criteria. A total of 12,649 articles were screened and 114 studies were included in our study. Twenty percent of these were randomly selected for assessment using STARD 2003 criteria. Adherence to STARD 2003 reporting standards for each criteria ranged from 8.7% adherence (criteria-reporting adverse events from performing index test or reference standard) to 100% (multiple criteria). Just over half of STARD criteria are reported in more than 80% studies. As poorly reported studies may negatively impact their clinical usefulness, it is essential that studies of diagnostic test accuracy be performed and reported adequately. Future studies should assess whether studies have improved compliance with the STARD 2015 criteria amendment. © 2017 by the Society for Academic Emergency Medicine.

Emergency Medical Services Program Guide.

ERIC Educational Resources Information Center

Georgia Univ., Athens. Dept. of Vocational Education.

This program guide contains the standard emergency medical services curriculum for technical institutes in Georgia. The curriculum encompasses the minimum competencies required for entry-level workers in the emergency medical services field, and includes job skills in six emergency medical services divisions outlined in the national curriculum:…

Establishment of a multidisciplinary concussion program: impact of standardization on patient care and resource utilization.

PubMed

Wilkins, Sara Anne; Shannon, Chevis N; Brown, Steven T; Vance, E Haley; Ferguson, Drew; Gran, Kimberly; Crowther, Marshall; Wellons, John C; Johnston, James M

2014-01-01

Recent legislation and media coverage have heightened awareness of concussion in youth sports. Previous work by the authors' group defined significant variation of care in management of children with concussion. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center. This retrospective study included all patients younger than 18 years of age evaluated for sports-related concussion between January 1, 2007, and December 31, 2011. Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 (SCAT2) scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care. Five hundred eighty-nine patients were identified, including 270 before standardization (2007-2011) and 319 after standardization (2011-2012). Statistically significant differences (p < 0.0001) were observed between the 2 groups for multiple variables: there were more girls, more first-time concussions, fewer initial presentations to the emergency department, more consistent administration of the SCAT2, and more consistent supervision of return to play and return to think after adoption of the protocol. A combination of increased public awareness and legislation has led to a 5-fold increase in the number of youth athletes presenting for concussion evaluation at the authors' center. Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population.

An initiative to provide emergency healthcare for older people in the community: the impact on carers.

PubMed

Knowles, E; Mason, S; Colwell, B

2011-04-01

The increase in the size and age of the UK older population has had a major effect on emergency services. Many older people will visit the emergency department but not necessarily require significant clinical intervention. The Paramedic Practitioner in Older People's Support (PPOPS) scheme was set up to provide community-based clinical assessment of older patients contacting the emergency services with minor acute conditions as an alternative approach to emergency department transfer. Patient carers were followed-up to evaluate the impact of this scheme when compared with standard transfer to the emergency department. Postal questionnaires, including items on the level of care provided, satisfaction with care received and carer impact, were administered to 561 carers. The overall response rate was 71.5% (401/561). The carers were predominantly female, approximately 60 years of age and family members, with more than three-quarters providing some form of physical care before the patient episode. Overall, carers did report an increase in the level of care provided before episode, significantly more so in the emergency department group (p=0.003). These increases related to more input needed in supporting physical activities. The carers in the PPOPS group were more likely to report greater satisfaction with their impression of care and staff attitude and would prefer treatment at home for the patient than those in the emergency department group (p<0.001). A minor health event does impact on the life of a carer. However, community-based schemes, such as PPOPS, do not increase the burden on carers and have high levels of satisfaction among this important group of the community.

A first response bag with standardized contents for medical emergencies on cruise ships.

PubMed

Dahl, Eilif; Diskin, Art; Giusti, Angela C; Bilé, Anne; Williams, Steve

2010-01-01

There are no international rules regarding which medical supplies to bring when the nurseon- duty is called to emergencies outside a cruise ship's infirmary. Ideally, one First Response Bag should contain all that is needed to manage the initial 10-15 minutes of any medical emergency until the patient can be safely transported to the ship's infirmary. Royal Caribbean Cruises Ltd recently decided to establish a fleet-wide standardized First Response Bag for initial management of cardiac and other emergencies encountered by the nurse-on-duty outside the ship's infirmary. A prototype First Response Bag was tried out on one ship. A PowerPoint presentation of the bag with its contents was then circulated by e-mail to all 33 infirmaries of the fleet, and comments from all 181 medical staff members were invited. All responses were discussed fleet-wide for consensus. Responses from 18 ships triggered eager discussions. The resulting First Response Bag was considered by all an improvement compared to the solutions practiced previously on most ships of the fleet. The bag is a lightweight combined roller and backpack with 12 compartments, and it has well-organized, easily accessible, fleet-wide standardized minimal supplies. It contains what is needed to manage the initial phase of a cardiac arrest and other emergencies. This initiative may inspire other companies in standardization efforts and trigger cruise industry-wide cooperation'with the ultimate goal of an internationally accepted first response bag standard.

Acceptability of the flipped classroom approach for in-house teaching in emergency medicine.

PubMed

Tan, Eunicia; Brainard, Andrew; Larkin, Gregory L

2015-10-01

To evaluate the relative acceptability of the flipped classroom approach compared with traditional didactics for in-house teaching in emergency medicine. Our department changed its learning model from a 'standard' lecture-based model to a 'flipped classroom' model. The 'flipped classroom' included provided pre-session learning objectives and resources before each 2 h weekly session. In-session activities emphasised active learning strategies and knowledge application. Feedback was sought from all medical staff regarding the acceptability of the new approach using an online anonymous cross-sectional qualitative survey. Feedback was received from 49/57 (86%) medical staff. Ninety-eight per cent (48/49) of respondents preferred the flipped classroom over the traditional approach. Aspects of the flipped classroom learners liked most included case-based discussion, interaction with peers, application of knowledge, self-directed learning and small-group learning. Barriers to pre-session learning include work commitments, 'life', perceived lack of time, family commitments, exam preparation and high volume of learning materials. Reported motivational factors promoting pre-session learning include formal assessment, participation requirements, more time, less material, more clinical relevance and/or more interesting material. Case studies and 'hands-on' activities were perceived to be the most useful in-session activities. The flipped classroom shows promise as an acceptable approach to in-house emergency medicine teaching. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

State Regulation Of Freestanding Emergency Departments Varies Widely, Affecting Location, Growth, And Services Provided.

PubMed

Gutierrez, Catherine; Lindor, Rachel A; Baker, Olesya; Cutler, David; Schuur, Jeremiah D

2016-10-01

Freestanding emergency departments (EDs), which offer emergency medical care at sites separate from hospitals, are a rapidly growing alternative to traditional hospital-based EDs. We evaluated state regulations of freestanding EDs and describe their effect on the EDs' location, staffing, and services. As of December 2015, thirty-two states collectively had 400 freestanding EDs. Twenty-one states had regulations that allowed freestanding EDs, and twenty-nine states did not have regulations that applied specifically to such EDs (one state had hospital regulations that precluded them). State policies regarding freestanding EDs varied widely, with no standard requirements for location, staffing patterns, or clinical capabilities. States requiring freestanding EDs to have a certificate of need had fewer of such EDs per capita than states without such a requirement. For patients to better understand the capabilities and costs of freestanding EDs and to be able to choose the most appropriate site of emergency care, consistent state regulation of freestanding EDs is needed. Project HOPE—The People-to-People Health Foundation, Inc.

Emergency department visual urinalysis versus laboratory urinalysis.

PubMed

Worrall, James C

2009-11-01

The primary objective of this study was to compare the results of nurse-performed urinalysis (NPU) interpreted visually in the emergency department (ED) with laboratory performed urinalysis (LPU) interpreted by reflectance photometry. This was a prospective observational study based on a convenience sample from my emergency practice. Emergency nurses, who were unaware of the study, performed usual dipstick analysis before sending the same urine sample to the laboratory for testing. Of 140 urinalyses performed during the study period, 124 were suitable for analysis. When compared with the reference standard LPU, the NPU had an overall sensitivity of 100% (95% confidence interval [CI] 95%-100%) and a specificity of 49% (95% CI 33%-65%) for the presence of any 1 of blood, leukocyte esterase, nitrites, protein, glucose or ketones in the urine. Of 20 falsely positive NPUs, 18 were a result of the nurse recording 1 or more components as "trace" positive. Although NPU does not yield identical results to LPU, a negative LPU is expected when the initial NPU in the ED is negative.

Prudent layperson definition of an emergent pediatric medical condition.

PubMed

Huang, Craig J; Poirier, Michael P; Cantwell, John R; Ermis, Peter R; Isaacman, Daniel J

2006-03-01

This study was designed to assess how well parents rated pediatric medical conditions based on their perceived degree of urgency so as to determine if the "Prudent Layperson Standard'' is reasonable. A self-administered, supervised survey was given to a convenience sample of 340 caregivers in the emergency department of an urban children's hospital. Respondents were asked to rank the urgency of 15 scenarios. A caregiver response within 1 point of the physician score was considered concordant with medical opinion. A 2-week-old infant with a rectal temperature of 103.7 degrees F was the only emergent scenario underestimated by caregivers. A 1 1/2-yr-old child with an upper respiratory tract infection, a 7-year-old child with ringworm, an 8-month-old infant with a simple forehead contusion, and a 4-year-old child with conjunctivitis were the non-urgent scenarios overestimated by caregivers. Laypeople are able to identify cases constructed to represent obvious pediatric medical emergencies. Several patient subgroups frequently overestimate medical urgency.

International recommendations for outpatient palliative care and prehospital palliative emergencies – a prospective questionnaire-based investigation

PubMed Central

2013-01-01

Background To determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts. Methods One hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical . Results The total response rate was 61% (n = 92 experts). Survey responses were obtained from 35 different countries. The following standards in the treatment of palliative emergencies were recommended: (1) early integration of “Palliative Care Teams” (PCTs) and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, drug boxes, and “Do not attempt resuscitation” orders and (4) emergency medical training (physicians and paramedics). Conclusions This study detected structurally and nationally differences in outpatient palliative care regarding the treatment of palliative emergencies. Accordingly, these differences should be discussed and adapted to the respective specifications of individual single countries. A single established outpatient palliative emergency medical care concept may be the basis for an overall out-of-hospital palliative care system. PMID:23432905

Assessing Data Quality in Emergent Domains of Earth Sciences

NASA Astrophysics Data System (ADS)

Darch, P. T.; Borgman, C.

2016-12-01

As earth scientists seek to study known phenomena in new ways, and to study new phenomena, they often develop new technologies and new methods such as embedded network sensing, or reapply extant technologies, such as seafloor drilling. Emergent domains are often highly multidisciplinary as researchers from many backgrounds converge on new research questions. They may adapt existing methods, or develop methods de novo. As a result, emerging domains tend to be methodologically heterogeneous. As these domains mature, pressure to standardize methods increases. Standardization promotes trust, reliability, accuracy, and reproducibility, and simplifies data management. However, for standardization to occur, researchers must be able to assess which of the competing methods produces the highest quality data. The exploratory nature of emerging domains discourages standardization. Because competing methods originate in different disciplinary backgrounds, their scientific credibility is difficult to compare. Instead of direct comparison, researchers attempt to conduct meta-analyses. Scientists compare datasets produced by different methods to assess their consistency and efficiency. This paper presents findings from a long-term qualitative case study of research on the deep subseafloor biosphere, an emergent domain. A diverse community converged on the study of microbes in the seafloor and those microbes' interactions with the physical environments they inhabit. Data on this problem are scarce, leading to calls for standardization as a means to acquire and analyze greater volumes of data. Lacking consistent methods, scientists attempted to conduct meta-analyses to determine the most promising methods on which to standardize. Among the factors that inhibited meta-analyses were disparate approaches to metadata and to curating data. Datasets may be deposited in a variety of databases or kept on individual scientists' servers. Associated metadata may be inconsistent or hard to interpret. Incentive structures, including prospects for journal publication, often favor new data over reanalyzing extant datasets. Assessing data quality in emergent domains is extremely difficult and will require adaptations in infrastructure, culture, and incentives.

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study

PubMed Central

Layani, Géraldine; Fleet, Richard; Dallaire, Renée; Tounkara, Fatoumata K.; Poitras, Julien; Archambault, Patrick; Chauny, Jean-Marc; Ouimet, Mathieu; Gauthier, Josée; Dupuis, Gilles; Tanguay, Alain; Lévesque, Jean-Frédéric; Simard-Racine, Geneviève; Haggerty, Jeannie; Légaré, France

2016-01-01

Background: Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. Methods: We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013. Results: Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators. Interpretation: Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments. PMID:27730103

46 CFR 154.1020 - Emergency power.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 5 2010-10-01 2010-10-01 false Emergency power. 154.1020 Section 154.1020 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS... § 154.1020 Emergency power. The emergency generator must be designed to allow operation at the final...

46 CFR 154.1020 - Emergency power.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 5 2011-10-01 2011-10-01 false Emergency power. 154.1020 Section 154.1020 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS... § 154.1020 Emergency power. The emergency generator must be designed to allow operation at the final...

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.

An Audit of Emergency Department Accreditation Based on Joint Commission International Standards (JCI).

PubMed

Hashemi, Behrooz; Motamedi, Maryam; Etemad, Mania; Rahmati, Farhad; Forouzanfar, Mohammad Mehdi; Kaghazchi, Fatemeh

2014-01-01

Despite thousands of years from creation of medical knowledge, it not much passes from founding the health care systems. Accreditation is an effective mechanism for performance evaluation, quality enhancement, and the safety of health care systems. This study was conducted to assess the results of emergency department (ED) accreditation in Shohadaye Tajrish Hospital, Tehran, Iran, 2013 in terms of domesticated standards of joint commission international (JCI) standards. This cohort study with a four-month follow up was conducted in the ED of Shohadaye Tajrish Hospital in 2013. The standard evaluation checklist of Iran hospitals (based on JCI standards) included 24 heading and 337 subheading was used for this purpose. The effective possible causes of weak spots were found and their solutions considered. After correction, assessment of accreditation were repeated again. Finally, the achieved results of two periods were analyzed using SPSS version 20. Quality improvement, admission in department and patient assessment, competency and capability test for staffs, collection and analysis of data, training of patients, and facilities had the score of below 50%. The mean of total score for accreditation in ED in the first period was 60.4±30.15 percent and in the second period 68.9±22.9 (p=0.005). Strategic plans, head of department, head nurse, resident physician, responsible nurse for the shift, and personnel file achieved the score of 100%. Of total headings below 50% in the first period just in two cases, collection and analysis of data with growth of 40% as well as competency and capability test for staffs with growth of 17%, were reached to more than 50%. Based on findings of the present study, the ED of Shohadaye Tajrish hospital reached the score of below 50% in six heading of quality improvement, admission in department and patient assessment, competency and capability test for staffs, collection and analysis of data, training of patients, and facilities. While, the given score in strategic plans, head of department, head nurse, resident physician, responsible nurse for the shifts, and personnel file was 100%.

A scalable healthcare information system based on a service-oriented architecture.

PubMed

Yang, Tzu-Hsiang; Sun, Yeali S; Lai, Feipei

2011-06-01

Many existing healthcare information systems are composed of a number of heterogeneous systems and face the important issue of system scalability. This paper first describes the comprehensive healthcare information systems used in National Taiwan University Hospital (NTUH) and then presents a service-oriented architecture (SOA)-based healthcare information system (HIS) based on the service standard HL7. The proposed architecture focuses on system scalability, in terms of both hardware and software. Moreover, we describe how scalability is implemented in rightsizing, service groups, databases, and hardware scalability. Although SOA-based systems sometimes display poor performance, through a performance evaluation of our HIS based on SOA, the average response time for outpatient, inpatient, and emergency HL7Central systems are 0.035, 0.04, and 0.036 s, respectively. The outpatient, inpatient, and emergency WebUI average response times are 0.79, 1.25, and 0.82 s. The scalability of the rightsizing project and our evaluation results show that the SOA HIS we propose provides evidence that SOA can provide system scalability and sustainability in a highly demanding healthcare information system.

Applying emerging digital video interface standards to airborne avionics sensor and digital map integrations: benefits outweigh the initial costs

NASA Astrophysics Data System (ADS)

Kuehl, C. Stephen

1996-06-01

Video signal system performance can be compromised in a military aircraft cockpit management system (CMS) with the tailoring of vintage Electronics Industries Association (EIA) RS170 and RS343A video interface standards. Video analog interfaces degrade when induced system noise is present. Further signal degradation has been traditionally associated with signal data conversions between avionics sensor outputs and the cockpit display system. If the CMS engineering process is not carefully applied during the avionics video and computing architecture development, extensive and costly redesign will occur when visual sensor technology upgrades are incorporated. Close monitoring and technical involvement in video standards groups provides the knowledge-base necessary for avionic systems engineering organizations to architect adaptable and extendible cockpit management systems. With the Federal Communications Commission (FCC) in the process of adopting the Digital HDTV Grand Alliance System standard proposed by the Advanced Television Systems Committee (ATSC), the entertainment and telecommunications industries are adopting and supporting the emergence of new serial/parallel digital video interfaces and data compression standards that will drastically alter present NTSC-M video processing architectures. The re-engineering of the U.S. Broadcasting system must initially preserve the electronic equipment wiring networks within broadcast facilities to make the transition to HDTV affordable. International committee activities in technical forums like ITU-R (former CCIR), ANSI/SMPTE, IEEE, and ISO/IEC are establishing global consensus on video signal parameterizations that support a smooth transition from existing analog based broadcasting facilities to fully digital computerized systems. An opportunity exists for implementing these new video interface standards over existing video coax/triax cabling in military aircraft cockpit management systems. Reductions in signal conversion processing steps, major improvement in video noise reduction, and an added capability to pass audio/embedded digital data within the digital video signal stream are the significant performance increases associated with the incorporation of digital video interface standards. By analyzing the historical progression of military CMS developments, establishing a systems engineering process for CMS design, tracing the commercial evolution of video signal standardization, adopting commercial video signal terminology/definitions, and comparing/contrasting CMS architecture modifications using digital video interfaces; this paper provides a technical explanation on how a systems engineering process approach to video interface standardization can result in extendible and affordable cockpit management systems.

Information-Flow-Based Access Control for Web Browsers

NASA Astrophysics Data System (ADS)

Yoshihama, Sachiko; Tateishi, Takaaki; Tabuchi, Naoshi; Matsumoto, Tsutomu

The emergence of Web 2.0 technologies such as Ajax and Mashup has revealed the weakness of the same-origin policy[1], the current de facto standard for the Web browser security model. We propose a new browser security model to allow fine-grained access control in the client-side Web applications for secure mashup and user-generated contents. We propose a browser security model that is based on information-flow-based access control (IBAC) to overcome the dynamic nature of the client-side Web applications and to accurately determine the privilege of scripts in the event-driven programming model.

Historical development and current status of emergency nursing in Turkey.

PubMed

Selimen, Deniz; Gürkan, Aysel

2009-09-01

As the demand for high quality Accident and Emergency Departments and nursing staff increases throughout Turkey, the need for more specialized emergency nurse training has also increased. Although there have been a number of positive developments regarding emergency nursing standards, the general quality of emergency nurse training needs to be improved and job definitions amended to better reflect the specialist duties of emergency nurses.

[An online emergency physician survey - demography, education and experience of German emergency physicians].

PubMed

Ilper, H; Kunz, T; Walcher, F; Zacharowski, K; Byhahn, C

2013-04-01

German emergency patients are treated by (emergency) physicians (EP). The entry level to emergency medicine differs. Manual skills experience (e. g. tracheal intubation) and knowledge of guidelines are minimum requirements. It is currently unclear who works as an EP and what medical experience he or she has. The anonymous survey was online from 10/15/2010 to 11/16/2011 and distribution was supported by leading physicians informing society members. Online networks informed independent physicians. 2091 EP took part, 1991 datasets were evaluated, 100 datasets were excluded. All results are shown as mean ± standard deviation and range (minimum - maximum). Mean age of the EP was 42 ± 8 years (26-71 years), 80 % (n = 1604) were male, 20 % (n = 387) were female. Participants finished medical school in 1997 ± 8 years (1964-2010). Base specialty during rotation was anesthesiology 59 %, internal medicine 32 %, surgery 26 %, trauma surgery/orthopedics 21 %, others 16 %. Consultants were 75 %. Main income source was answered as "hospital physician" by 77 %, "resident doctor" by 15 %, "professional emergency physician" by 7 %. The participants use a widespread chance for CME (Continuing Medical Education). The participants appear experienced in medicine and emergency medicine. They use a widespread chance for CME. Most of the participants work in anaesthesiology. © Georg Thieme Verlag KG Stuttgart · New York.

29 CFR 1990.152 - Model emergency temporary standard pursuant to section 6(c) of the Act.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (insert section number of standard) (a) Scope and application—(1) General. This section applies to all... Occupational Safety and Health, U.S. Department of Health, Education and Welfare, or designee. Emergency means... appropriate exposure limit representing a level that can be complied with immediately) as an eight (8)-hour...

29 CFR 1990.152 - Model emergency temporary standard pursuant to section 6(c) of the Act.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (insert section number of standard) (a) Scope and application—(1) General. This section applies to all... Occupational Safety and Health, U.S. Department of Health, Education and Welfare, or designee. Emergency means... appropriate exposure limit representing a level that can be complied with immediately) as an eight (8)-hour...

29 CFR 1990.152 - Model emergency temporary standard pursuant to section 6(c) of the Act.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (insert section number of standard) (a) Scope and application—(1) General. This section applies to all... Occupational Safety and Health, U.S. Department of Health, Education and Welfare, or designee. Emergency means... appropriate exposure limit representing a level that can be complied with immediately) as an eight (8)-hour...

29 CFR 1990.152 - Model emergency temporary standard pursuant to section 6(c) of the Act.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (insert section number of standard) (a) Scope and application—(1) General. This section applies to all... Occupational Safety and Health, U.S. Department of Health, Education and Welfare, or designee. Emergency means... appropriate exposure limit representing a level that can be complied with immediately) as an eight (8)-hour...

29 CFR 1990.152 - Model emergency temporary standard pursuant to section 6(c) of the Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (insert section number of standard) (a) Scope and application—(1) General. This section applies to all... Occupational Safety and Health, U.S. Department of Health, Education and Welfare, or designee. Emergency means... appropriate exposure limit representing a level that can be complied with immediately) as an eight (8)-hour...

14 CFR Appendix J to Part 25 - Emergency Evacuation

Code of Federal Regulations, 2010 CFR

2010-01-01

... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Pt. 25, App. J Appendix J to Part 25—Emergency Evacuation...-candles prior to the activation of the airplane emergency lighting system. The source(s) of the initial... airplane emergency lighting system. (b) The airplane must be in a normal attitude with landing gear...

Facilitating emergency hospital evacuation through uniform discharge criteria.

PubMed

Sandra, Keret; Meital, Nahari; Ofer, Merin; Limor, Aharonson-Daniel; Sara, Goldberg; Bruria, Adini

2017-05-01

Though hospitals' operational continuity is crucial, full institutional evacuation may at times be unavoidable. The study's objective was to establish criteria for discharge of patients during complete emergency evacuation and compare scope of patients suitable for discharge pre/post implementation of criteria. Standards for patient discharge during an evacuation were developed based on literature and disaster managers. The standards were reviewed in a two-round Delphi process. All hospitals in Israel were requested to identify inpatients' that could be released home during institutional evacuation. Potential discharges were compared in 2013-2014, before and after formulation of discharge criteria. Consensus exceeding 80% was obtained for four out of five criteria after two Delphi cycles. Average projected discharge rate before and after formulation of criteria was 34.2% and 42.9%, respectively (p<0.001). Variance in potential dischargeable patients was 31-fold less in 2014 than in 2013 (MST=8,452 versus MST=264,366, respectively; p<0.001). Differences were found between small, medium and large hospitals in mean rate of dischargeable patients: 52.1%, 41.5% and 42.2%, respectively (p=0.001). The study's findings enable to forecast the extent of patients that may be released home during full emergency evacuation of a hospital; thereby facilitating preparedness of contingency plans. Copyright © 2016 Elsevier Inc. All rights reserved.

The resistance mechanisms and treatment strategies for EGFR-mutant advanced non-small-cell lung cancer

PubMed Central

Zhong, Wen-Zhao; Zhou, Qing; Wu, Yi-Long

2017-01-01

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) have been established as the standard therapy for EGFR-sensitizing mutant advanced non-small-cell lung cancer (NSCLC). However, patients ultimately develop resistance to these drugs. There are several mechanisms of both primary and secondary resistance to EGFR-TKIs. The primary resistance mechanisms include point mutations in exon 18, deletions or insertions in exon 19, insertions, duplications and point mutations in exon 20 and point mutation in exon 21 of EGFR gene. Secondary resistance to EGFR-TKIs is due to emergence of T790M mutation, activation of alternative signaling pathways, bypassing downstream signaling pathways and histological transformation. Strategies to overcome these intrinsic and acquired resistance mechanisms are complex. With the development of the precision medicine for advanced NSCLC, available systemic and local treatment options have expanded, requiring new clinical algorithms that take into account resistance mechanism. Though combination therapy is emerging as the standard of to overcome resistance mechanisms. Personalized treatment modalities based on molecular diagnosis and monitoring is essential for disease management. Emerging data from the ongoing clinical trials on combination therapy of third generation TKIs and antibodies in EGFR mutant NSCLC are promising for better survival outcomes. PMID:29050366

Point-of-care ultrasonography by pediatric emergency physicians. Policy statement.

PubMed

Marin, Jennifer R; Lewiss, Resa E

2015-04-01

Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. Pediatric emergency medicine fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for pediatric emergency physicians.

Value of the Cosmological Constant in Emergent Quantum Gravity

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

Hogan, Craig

It is suggested that the exact value of the cosmological constant could be derived from first principles, based on entanglement of the Standard Model field vacuum with emergent holographic quantum geometry. For the observed value of the cosmological constant, geometrical information is shown to agree closely with the spatial information density of the QCD vacuum, estimated in a free-field approximation. The comparison is motivated by a model of exotic rotational fluctuations in the inertial frame that can be precisely tested in laboratory experiments. Cosmic acceleration in this model is always positive, but fluctuates with characteristic coherence lengthmore » $$\\approx 100$$km and bandwidth $$\\approx 3000$$ Hz.« less

Responding to the deaf in disasters: establishing the need for systematic training for state-level emergency management agencies and community organizations

PubMed Central

2013-01-01

Background Deaf and hard-of-hearing (Deaf/HH) individuals have been underserved before and during emergencies. This paper will assess Deaf/HH related emergency preparedness training needs for state emergency management agencies and deaf-serving community-based organizations (CBOs). Methods Four approaches were used: 1) a literature review; 2) results from 50 key informant (KI) interviews from state and territorial-level emergency management and public health agencies; 3) results from 14 KI interviews with deaf-serving CBOs in the San Francisco Bay Area; and 4) a pilot program evaluation of an emergency responder training serving the Deaf/HH in one urban community. Results Results from literature review and state and territorial level KIs indicate that there is a substantive gap in emergency preparedness training on serving Deaf/HH provided by state agencies. In addition, local KI interviews with 14 deaf-serving CBOs found gaps in training within deaf-serving CBOs. These gaps have implications for preparing for and responding to all-hazards emergencies including weather-related or earthquake-related natural disasters, terrorist attacks, and nuclear-chemical disasters. Conclusion Emergency preparedness trainings specific to responding to or promoting preparedness of the Deaf/HH is rare, even for state agency personnel, and frequently lack standardization, evaluation, or institutionalization in emergency management infrastructure. This has significant policy and research implications. Similarly, CBOs are not adequately trained to serve the needs of their constituents. PMID:23497178

Emergency cesarean section and the 30-minute rule: definitions.

PubMed

Schauberger, Charles W; Chauhan, Suneet P

2009-03-01

We explored the role that lack of a standard definition and heterogeneity in patient selection criteria in the literature might have on the apparent inability to routinely begin an emergency cesarean section in less than 30 minutes. A review of the literature on emergency cesarean delivery was performed. Although there are some similarities in definitions and the criteria used for patient selection in multiple studies, the variability in the definitions could be responsible for some of the apparent timeliness performance deficiency in the literature. A standard definition and directions for future research are suggested.

ACR Imaging IT Reference Guide: Image Sharing: Evolving Solutions in the Age of Interoperability

PubMed Central

Erickson, Bradley J.; Choy, Garry

2014-01-01

Interoperability is a major focus of the quickly evolving world of Health Information Technology. Easy, yet secure and confidential exchange of imaging exams and the associated reports must be a part of the solutions that are implemented. The availability of historical exams is essential in providing a quality interpretation and reducing inappropriate utilization of imaging services. Today exchange of imaging exams is most often achieved via a CD. We describe the virtues of this solution as well as challenges that have surfaced. Internet and cloud based technologies employed for many consumer services can provide a better solution. Vendors are making these solutions available. Standards for internet based exchange are emerging. Just as Radiology converged on DICOM as a standard to store and view images we need a common exchange standard. We will review the existing standards, and how they are organized into useful workflows through Integrating the Healthcare Enterprise (IHE) profiles. IHE and standards development processes are discussed. Healthcare and the domain of Radiology must stay current with quickly evolving internet standards. The successful use of the “cloud” will depend upon both the technologies we discuss and the policies put into place around these technologies. We discuss both aspects. The Radiology community must lead the way and provide a solution that works for radiologists and clinicians in the Electronic Medical Record (EMR). Lastly we describe the features we believe radiologists should consider when considering adding internet based exchange solutions to their practice. PMID:25467903

Soil sampling and analytical strategies for mapping fallout in nuclear emergencies based on the Fukushima Dai-ichi Nuclear Power Plant accident.

PubMed

Onda, Yuichi; Kato, Hiroaki; Hoshi, Masaharu; Takahashi, Yoshio; Nguyen, Minh-Long

2015-01-01

The Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident resulted in extensive radioactive contamination of the environment via deposited radionuclides such as radiocesium and (131)I. Evaluating the extent and level of environmental contamination is critical to protecting citizens in affected areas and to planning decontamination efforts. However, a standardized soil sampling protocol is needed in such emergencies to facilitate the collection of large, tractable samples for measuring gamma-emitting radionuclides. In this study, we developed an emergency soil sampling protocol based on preliminary sampling from the FDNPP accident-affected area. We also present the results of a preliminary experiment aimed to evaluate the influence of various procedures (e.g., mixing, number of samples) on measured radioactivity. Results show that sample mixing strongly affects measured radioactivity in soil samples. Furthermore, for homogenization, shaking the plastic sample container at least 150 times or disaggregating soil by hand-rolling in a disposable plastic bag is required. Finally, we determined that five soil samples within a 3 m × 3-m area are the minimum number required for reducing measurement uncertainty in the emergency soil sampling protocol proposed here. Copyright © 2014 Elsevier Ltd. All rights reserved.

International standards in mitigating trade risks.

PubMed

Thiermann, A B

2011-04-01

This paper describes the role of the World Organisation for Animal Health (OIE), as a science-based and democratic standard-setting organisation that provides guidance on preventing the spread of animal diseases, including zoonoses, in international trade. The World Trade Organization is identified as the international institution with the legal power to encourage adherence to international standards and mediate trade disputes. The importance of assuring good governance and the credibility of national Veterinary Services through a process of official certification is identified as an essential component in the safety of trade. Private-public partnerships and the evolution of responsibilities are also identified as essential for the implementation of health guarantees such as compartmentalisation. The rapid emergence of private standards is described as a potential complement to the implementation of sanitary standards, as long as they are applied globally and in support of the OIE standards. Ultimately, the biggest challenge is for the international community to create the incentives and generate the political will for fair trade and for the universal recognition and application of the established international sanitary standards.

Crisis Reliability Indicators Supporting Emergency Services (CRISES): A Framework for Developing Performance Measures for Behavioral Health Crisis and Psychiatric Emergency Programs.

PubMed

Balfour, Margaret E; Tanner, Kathleen; Jurica, Paul J; Rhoads, Richard; Carson, Chris A

2016-01-01

Crisis and emergency psychiatric services are an integral part of the healthcare system, yet there are no standardized measures for programs providing these services. We developed the Crisis Reliability Indicators Supporting Emergency Services (CRISES) framework to create measures that inform internal performance improvement initiatives and allow comparison across programs. The framework consists of two components-the CRISES domains (timely, safe, accessible, least-restrictive, effective, consumer/family centered, and partnership) and the measures supporting each domain. The CRISES framework provides a foundation for development of standardized measures for the crisis field. This will become increasingly important as pay-for-performance initiatives expand with healthcare reform.

Evolution of European Union legislation on emergency research.

PubMed

Mentzelopoulos, Spyros D; Mantzanas, Michail; van Belle, Gerald; Nichol, Graham

2015-06-01

Emergency research is necessary to prevent exposure of patients to unvalidated clinical practice (nonmaleficence), and to improve the dismal prognosis of disorders requiring emergent treatment such as cardiac arrest (beneficence). Regulations that govern clinical research should conform to bioethical principles of respect for nonmaleficence, beneficence, autonomy, and justice. Our objectives are to review the evolution of European Union (EU) legislation on emergency research, and to identify potentially remaining problems. EU legislative sources on clinical research and medical literature describing the impact of EU Regulations on emergency research. Article 5 of EU Directive 2001/20/EC required consent before enrolment in a research study to ensure the autonomy of potentially incapacitated research subjects. However, obtaining such consent is often impossible in emergency situations. Directive 2001/20/EC was criticized for potentially preventing emergency research. Several EU Member States addressed this problem by permitting deferred consent. International ethical guidelines supporting deferred consent were also cited by Good Clinical Practice Directive 2005/28/EC. However, Directive 2001/20/EC was not revised to achieve harmonization of EU emergency research, thus resulting in ongoing "ambiguity" as regards to emergency research legitimacy. This will be definitively addressed by applying EU Regulation No. 536/2014 and repealing Directive 2001/20/EC. The new EU Regulation permits using deferred consent under clearly specified conditions, and may foster emergency research that evaluates interventions posing minimal risk relative to standard practice. Legislation related to emergency research in Europe has evolved to increase concordance with bioethical principles so as to increase evidence-based improvements in emergency care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Emerging contaminants: Presentations at the 2009 Toxicology and Risk Assessment Conference

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

Murnyak, George, E-mail: George.murnyak@us.army.mil; Vandenberg, John, E-mail: Vandenberg.John@epamail.epa.gov; Yaroschak, Paul J., E-mail: Paul.Yaroschak@osd.mil

2011-07-15

A session entitled 'Emerging Contaminants' was held in April 2009 in Cincinnati, OH at the 2009 Toxicology and Risk Assessment Conference. The purpose of the session was to share information on both programmatic and technical aspects associated with emerging contaminants. Emerging contaminants are chemicals or materials that are characterized by a perceived or real threat to human health or environment, a lack of published health standards or an evolving standard. A contaminant may also be 'emerging' because of the discovery of a new source, a new pathway to humans, or a new detection method or technology. The session included fivemore » speakers representing the Department of Defense (DoD), the Environmental Protection Agency (EPA), and each of the military services. The DoD created the Emerging Contaminant Directorate to proactively address environmental, health, and safety concerns associated with emerging contaminants. This session described the scan-watch-action list process, impact assessment methodology, and integrated risk management concept that DoD has implemented to manage emerging contaminants. EPA presented emerging trends in health risk assessment. Researchers made technical presentations on the status of some emerging contaminates in the assessment process (i.e. manganese, RDX, and naphthalene).« less

The advent of clinical standards for professional liability.

PubMed

Holzer, J F

1990-02-01

The development of clinically based written standards to reduce the frequency and severity of medical malpractice loss appears to be gaining in popularity among provider specialty groups and professional liability underwriters. To date, such standards have addressed problems in specialties such as obstetrics and anesthesia where dollar losses associated with malpractice claims have been high. Guidelines can be developed and used by providers on a purely voluntary basis or mandated on an involuntary basis by third parties such as malpractice insurance companies or legislators. Because the advent of risk-control standards is a relatively new phenomenon, formal scientific studies on the long-term benefits of such guidelines have not yet been published. However, it appears that sharp reductions of malpractice losses in specialties such as anesthesia have coincided with the implementation of formal written standards specifically designed for liability control. This has led some liability insurance carriers to decrease premiums associated with specialists following such standards. Many providers are understandably concerned about the potential use of written standards by plaintiff attorneys in medical malpractice suits. Although it is possible that such policies and guidelines could be admitted into evidence to show that a provider breached the legal duty or standard of care owed to a patient, it is uncertain whether these risk-control standards could ultimately pass the evidentiary rules of relevancy or materiality in a given lawsuit. It is clear, however, that the consensus-based process of creating clinical standards and guidelines specifically for controlling professional liability losses is itself a powerful and emerging standard for health care risk management programs.

Development of Hospital-based Data Sets as a Vehicle for Implementation of a National Electronic Health Record

PubMed Central

Keikha, Leila; Farajollah, Seyede Sedigheh Seied; Safdari, Reza; Ghazisaeedi, Marjan; Mohammadzadeh, Niloofar

2018-01-01

Background In developing countries such as Iran, international standards offer good sources to survey and use for appropriate planning in the domain of electronic health records (EHRs). Therefore, in this study, HL7 and ASTM standards were considered as the main sources from which to extract EHR data. Objective The objective of this study was to propose a hospital data set for a national EHR consisting of data classes and data elements by adjusting data sets extracted from the standards and paper-based records. Method This comparative study was carried out in 2017 by studying the contents of the paper-based records approved by the health ministry in Iran and the international ASTM and HL7 standards in order to extract a minimum hospital data set for a national EHR. Results As a result of studying the standards and paper-based records, a total of 526 data elements in 174 classes were extracted. An examination of the data indicated that the highest number of extracted data came from the free text elements, both in the paper-based records and in the standards related to the administrative data. The major sources of data extracted from ASTM and HL7 were the E1384 and Hl7V.x standards, respectively. In the paper-based records, data were extracted from 19 forms sporadically. Discussion By declaring the confidentiality of information, the ASTM standards acknowledge the issue of confidentiality of information as one of the main challenges of EHR development, and propose new types of admission, such as teleconference, tele-video, and home visit, which are inevitable with the advent of new technology for providing healthcare and treating diseases. Data related to finance and insurance, which were scattered in different categories by three organizations, emerged as the financial category. Documenting the role and responsibility of the provider by adding the authenticator/signature data element was deemed essential. Conclusion Not only using well-defined and standardized data, but also adapting EHR systems to the local facilities and the existing social and cultural conditions, will facilitate the development of structured data sets. PMID:29618962

Development of Hospital-based Data Sets as a Vehicle for Implementation of a National Electronic Health Record.

PubMed

Keikha, Leila; Farajollah, Seyede Sedigheh Seied; Safdari, Reza; Ghazisaeedi, Marjan; Mohammadzadeh, Niloofar

2018-01-01

In developing countries such as Iran, international standards offer good sources to survey and use for appropriate planning in the domain of electronic health records (EHRs). Therefore, in this study, HL7 and ASTM standards were considered as the main sources from which to extract EHR data. The objective of this study was to propose a hospital data set for a national EHR consisting of data classes and data elements by adjusting data sets extracted from the standards and paper-based records. This comparative study was carried out in 2017 by studying the contents of the paper-based records approved by the health ministry in Iran and the international ASTM and HL7 standards in order to extract a minimum hospital data set for a national EHR. As a result of studying the standards and paper-based records, a total of 526 data elements in 174 classes were extracted. An examination of the data indicated that the highest number of extracted data came from the free text elements, both in the paper-based records and in the standards related to the administrative data. The major sources of data extracted from ASTM and HL7 were the E1384 and Hl7V.x standards, respectively. In the paper-based records, data were extracted from 19 forms sporadically. By declaring the confidentiality of information, the ASTM standards acknowledge the issue of confidentiality of information as one of the main challenges of EHR development, and propose new types of admission, such as teleconference, tele-video, and home visit, which are inevitable with the advent of new technology for providing healthcare and treating diseases. Data related to finance and insurance, which were scattered in different categories by three organizations, emerged as the financial category. Documenting the role and responsibility of the provider by adding the authenticator/signature data element was deemed essential. Not only using well-defined and standardized data, but also adapting EHR systems to the local facilities and the existing social and cultural conditions, will facilitate the development of structured data sets.

Market Structure, Financial Dependence and Industrial Growth: Evidence from the Banking Industry in Emerging Asian Economies.

PubMed

Khan, Habib Hussain; Ahmad, Rubi Binit; Gee, Chan Sok

2016-01-01

In this study, we examine the role of market structure for growth in financially dependent industries from 10 emerging Asian economies over the period of 1995-2011. Our approach departs from existing studies in that we apply four alternative measures of market structure based on structural and non-structural approaches and compare their outcomes. Results indicate that higher bank concentration may slow down the growth of financially dependent industries. Bank competition on the other hand, allows financially dependent industries to grow faster. These findings are consistent across a number of sensitivity checks such as alternative measures of financial dependence, institutional factors (including property rights, quality of accounting standards and bank ownership), and endogeneity consideration. In sum, our study suggests that financially dependent industries grow more in more competitive/less concentrated banking systems. Therefore, regulatory authorities need to be careful while pursuing a consolidation policy for banking sector in emerging Asian economies.

Emergency Medical Services Instructor Training Program of the National Standard Curriculum Revised

DOT National Transportation Integrated Search

1996-05-01

In 1986, the National Highway Traffic Safety Administration (NHTSA) developed the first edition of the "Emergency Medical Services Instructor Training Program" to teach instructor skills to Emergency Medical Services (EMS) experts. In 1990, NHTSA rev...

49 CFR 238.125 - Marking and instructions for emergency egress and rescue access.

Code of Federal Regulations, 2014 CFR

2014-10-01

... and rescue access. On or after January 28, 2015, emergency signage and markings shall be provided for..., “Standard for Emergency Signage for Egress/Access of Passenger Rail Equipment,” Authorized October 7, 2007...

River Basin Standards Interoperability Pilot

NASA Astrophysics Data System (ADS)

Pesquer, Lluís; Masó, Joan; Stasch, Christoph

2016-04-01

There is a lot of water information and tools in Europe to be applied in the river basin management but fragmentation and a lack of coordination between countries still exists. The European Commission and the member states have financed several research and innovation projects in support of the Water Framework Directive. Only a few of them are using the recently emerging hydrological standards, such as the OGC WaterML 2.0. WaterInnEU is a Horizon 2020 project focused on creating a marketplace to enhance the exploitation of EU funded ICT models, tools, protocols and policy briefs related to water and to establish suitable conditions for new market opportunities based on these offerings. One of WaterInnEU's main goals is to assess the level of standardization and interoperability of these outcomes as a mechanism to integrate ICT-based tools, incorporate open data platforms and generate a palette of interchangeable components that are able to use the water data emerging from the recently proposed open data sharing processes and data models stimulated by initiatives such as the INSPIRE directive. As part of the standardization and interoperability activities in the project, the authors are designing an experiment (RIBASE, the present work) to demonstrate how current ICT-based tools and water data can work in combination with geospatial web services in the Scheldt river basin. The main structure of this experiment, that is the core of the present work, is composed by the following steps: - Extraction of information from river gauges data in OGC WaterML 2.0 format using SOS services (preferably compliant to the OGC SOS 2.0 Hydrology Profile Best Practice). - Model floods using a WPS 2.0, WaterML 2.0 data and weather forecast models as input. - Evaluation of the applicability of Sensor Notification Services in water emergencies. - Open distribution of the input and output data as OGC web services WaterML, / WCS / WFS and with visualization utilities: WMS. The architecture tests the combination of Gauge data in a WPS that is triggered by a meteorological alert. The data is translated into OGC WaterML 2.0 time series data format and will be ingested in a SOS 2.0. SOS data is visualized in a SOS Client that is able to handle time series. The meteorological forecast data (with the supervision of an operator manipulating the WPS user interface) ingests with WaterML 2.0 time series and terrain data is input for a flooding modelling algorithm. The WPS is able to produce flooding datasets in the form of coverages that is offered to clients via a WCS 2.0 service or a WMS 1.3 service, and downloaded and visualized by the respective clients. The WPS triggers a notification or an alert that will be monitored from an emergency control response service. Acronyms AS: Alert Service ES: Event Service ICT: Information and Communication Technology NS: Notification Service OGC: Open Geospatial Consortium RIBASE: River Basin Standards Interoperability Pilot SOS: Sensor Observation Service WaterML: Water Markup Language WCS: Web Coverage Service WMS: Web Map Service WPS: Web Processing Service

Virtue in emergency medicine.

PubMed

Larkin, Gregory Luke; Iserson, Kenneth; Kassutto, Zach; Freas, Glenn; Delaney, Kathy; Krimm, John; Schmidt, Terri; Simon, Jeremy; Calkins, Anne; Adams, James

2009-01-01

At a time in which the integrity of the medical profession is perceptibly challenged, emergency physicians (EPs) have an opportunity to reaffirm their commitment to both their patients and their practice through acceptance of a virtue-based ethic. The virtue-based ethic transcends legalistic rule following and the blind application of principles. Instead, virtue honors the humanity of patients and the high standards of the profession. Recognizing historical roots that are relevant to the modern context, this article describes 10 core virtues important for EPs. In addition to the long-recognized virtues of prudence, courage, temperance, and justice, 6 additional virtues are offered unconditional positive regard, charity, compassion, trustworthiness, vigilance, and agility. These virtues might serve as ideals to which all EPs can strive. Through these, the honor of the profession will be maintained, the trust of patients will be preserved, and the integrity of the specialty will be promoted.

Research on sudden environmental pollution public service platform construction based on WebGIS

NASA Astrophysics Data System (ADS)

Bi, T. P.; Gao, D. Y.; Zhong, X. Y.

2016-08-01

In order to actualize the social sharing and service of the emergency-response information for sudden pollution accidents, the public can share the risk source information service, dangerous goods control technology service and so on, The SQL Server and ArcSDE software are used to establish a spatial database to restore all kinds of information including risk sources, hazardous chemicals and handling methods in case of accidents. Combined with Chinese atmospheric environmental assessment standards, the SCREEN3 atmospheric dispersion model and one-dimensional liquid diffusion model are established to realize the query of related information and the display of the diffusion effect under B/S structure. Based on the WebGIS technology, C#.Net language is used to develop the sudden environmental pollution public service platform. As a result, the public service platform can make risk assessments and provide the best emergency processing services.

Use of xylazine hydrochloride-ketamine hydrochloride for immobilization of wild leopards (Panthera pardus fusca) in emergency situations.

PubMed

Belsare, Aniruddha V; Athreya, Vidya R

2010-06-01

In India, leopards (Panthera pardus fusca) inhabit human-dominated landscapes, resulting in encounters that require interventions to prevent harm to people, as well as the leopards. Immobilization is a prerequisite for any such intervention. Such emergency field immobilizations have to be carried out with limited tools, often amidst large uncontrollable crowds. An effective and practicable approach is discussed, based on 55 wild leopard immobilizations undertaken between January 2003 and April 2008. A xylazine hydrochloride (1.4 +/- 0.3 mg/kg)--ketamine hydrochloride (5 +/- 2 mg/kg) mixture was used for immobilization of leopards, based on estimated body weight. When weight could not be estimated, a standard initial dose of 50 mg of xylazine--150 mg of ketamine was used. Supplemental doses (50-75 mg) of only ketamine were used as required. No life-threatening adverse effects of immobilization were documented for at least 1 mo postimmobilization.

Investigating Attitudes towards an Emerging Standard of English: Evaluations of Newscasters' Accents in Trinidad

ERIC Educational Resources Information Center

Deuber, Dagmar; Leung, Glenda-Alicia

2013-01-01

This paper addresses the issue of the emergence of new standards of English in the postcolonial world by means of a language attitude study conducted in the Caribbean island of Trinidad that involved rating the accents of newscasters. Accents represented in the clips played to respondents comprised various local as well as non-local ones. The…

40 CFR Table 5 to Subpart IIIi of... - Labeling and Recordkeeping Requirements for New Stationary Emergency Engines

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Labeling and Recordkeeping Requirements for New Stationary Emergency Engines 5 Table 5 to Subpart IIII of Part 60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance fo...

40 CFR Table 5 to Subpart IIIi of... - Labeling and Recordkeeping Requirements for New Stationary Emergency Engines

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 6 2011-07-01 2011-07-01 false Labeling and Recordkeeping Requirements for New Stationary Emergency Engines 5 Table 5 to Subpart IIII of Part 60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance fo...

40 CFR Table 5 to Subpart IIIi of... - Labeling and Recordkeeping Requirements for New Stationary Emergency Engines

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 7 2014-07-01 2014-07-01 false Labeling and Recordkeeping Requirements for New Stationary Emergency Engines 5 Table 5 to Subpart IIII of Part 60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance fo...

40 CFR Table 5 to Subpart IIIi of... - Labeling and Recordkeeping Requirements for New Stationary Emergency Engines

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 7 2013-07-01 2013-07-01 false Labeling and Recordkeeping Requirements for New Stationary Emergency Engines 5 Table 5 to Subpart IIII of Part 60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance fo...

40 CFR Table 5 to Subpart IIIi of... - Labeling and Recordkeeping Requirements for New Stationary Emergency Engines

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 7 2012-07-01 2012-07-01 false Labeling and Recordkeeping Requirements for New Stationary Emergency Engines 5 Table 5 to Subpart IIII of Part 60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance fo...

Significant acceleration of emergency response using smartphone geolocation data and a worldwide emergency call support system.

PubMed

Weinlich, Michael; Kurz, Peter; Blau, Melissa B; Walcher, Felix; Piatek, Stefan

2018-01-01

When patients are disorientated or experience language barriers, it is impossible to activate the emergency response system. In these cases, the delay for receiving appropriate help can extend to several hours. A worldwide emergency call support system (ECSS), including geolocation of modern smartphones (GPS, WLAN and LBS), was established referring to E911 and eCall systems. The system was tested for relevance in quickly forwarding abroad emergency calls to emergency medical services (EMS). To verify that geolocation data from smartphones are exact enough to be used for emergency cases, the accuracy of GPS (global positioning system), Wi-Fi (wireless LAN network) and LBS (location based system) was tested in eleven different countries and compared to actual location. The main objective was analyzed by simulation of emergencies in different countries. The time delay in receiving help in unsuccessful emergency call cases by using the worldwide emergency call support system (ECSS) was measured. GPS is the gold standard to locate patients with an average accuracy of 2.0 ± 3.3 m. Wi-Fi can be used within buildings with an accuracy of 7.0 ± 24.1 m. Using ECSS, the emergency call leads to a successful activation of EMS in 22.8 ± 10.8 min (Median 21 min). The use of a simple app with one button to touch did never cause any delay. The worldwide emergency call support system (ECSS) significantly improves the emergency response in cases of disorientated patients or language barriers. Under circumstances without ECSS, help can be delayed by 2 or more hours and might have relevant lifesaving effects. This is the first time that Wi-Fi geolocation could prove to be a useful improvement in emergencies to enhance GPS, especially within or close to buildings.

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.

40 CFR 267.57 - What must the emergency coordinator do after an emergency?

Code of Federal Regulations, 2014 CFR

2014-07-01

... OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.57 What must the..., or any other material that results from a release, fire, or explosion at the facility. (b) The... completed. (2) All emergency equipment listed in the contingency plan is cleaned and fit for its intended...

40 CFR 267.57 - What must the emergency coordinator do after an emergency?

Code of Federal Regulations, 2012 CFR

2012-07-01

... OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.57 What must the..., or any other material that results from a release, fire, or explosion at the facility. (b) The... completed. (2) All emergency equipment listed in the contingency plan is cleaned and fit for its intended...

40 CFR 267.57 - What must the emergency coordinator do after an emergency?

Code of Federal Regulations, 2013 CFR

2013-07-01

... OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.57 What must the..., or any other material that results from a release, fire, or explosion at the facility. (b) The... completed. (2) All emergency equipment listed in the contingency plan is cleaned and fit for its intended...

40 CFR 267.57 - What must the emergency coordinator do after an emergency?

Code of Federal Regulations, 2011 CFR

2011-07-01

... OPERATING UNDER A STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.57 What must the..., or any other material that results from a release, fire, or explosion at the facility. (b) The... completed. (2) All emergency equipment listed in the contingency plan is cleaned and fit for its intended...

The effect of paramedic training on pre-hospital trauma care (EPPTC-study): a study protocol for a prospective semi-qualitative observational trial

PubMed Central

2014-01-01

Background Accidents are the leading cause of death in adults prior to middle age. The care of severely injured patients is an interdisciplinary challenge. Limited evidence is available concerning pre-hospital trauma care training programs and the advantage of such programs for trauma patients. The effect on trauma care procedures or on the safety of emergency crews on the scene is limited; however, there is a high level of experience and expert opinion. Methods I – Video-recorded case studies are the basis of an assessment tool and checklist being developed to verify the results of programs to train participants in the care of seriously injured patients, also known as “objective structured clinical examination” (OSCE). The timing, completeness and quality of the individual measures are assessed using appropriate scales. The evaluation of team communication and interaction will be analyzed with qualitative methods and quantified and verified by existing instruments (e.g. the Clinical Team Scale). The developed assessment tool is validated by several experts in the fields of trauma care, trauma research and medical education. II a) In a German emergency medical service, the subjective assessment of paramedics of their pre-hospital care of trauma patients is evaluated at three time points, namely before, immediately after and one year after training. b) The effect of a standardized course concept on the quality of documentation in actual field operations is determined based on three items relevant to patient safety before and after the course. c) The assessment tool will be used to assess the effect of a standardized course concept on procedures and team communication in pre-hospital trauma care using scenario-based case studies. Discussion This study explores the effect of training on paramedics. After successful study completion, further multicenter studies are conceivable, which would evaluate emergency-physician staffed teams. The influence on the patients and prehospital measures should be assessed based on a retrospective analysis of the emergency room data. Trials registration German Clinical Trials Register, ID DRKS00004713. PMID:24528532

Reliability of Smartphone-Based Instant Messaging Application for Diagnosis, Classification, and Decision-making in Pediatric Orthopedic Trauma.

PubMed

Stahl, Ido; Katsman, Alexander; Zaidman, Michael; Keshet, Doron; Sigal, Amit; Eidelman, Mark

2017-07-11

Smartphones have the ability to capture and send images, and their use has become common in the emergency setting for transmitting radiographic images with the intent to consult an off-site specialist. Our objective was to evaluate the reliability of smartphone-based instant messaging applications for the evaluation of various pediatric limb traumas, as compared with the standard method of viewing images of a workstation-based picture archiving and communication system (PACS). X-ray images of 73 representative cases of pediatric limb trauma were captured and transmitted to 5 pediatric orthopedic surgeons by the Whatsapp instant messaging application on an iPhone 6 smartphone. Evaluators were asked to diagnose, classify, and determine the course of treatment for each case over their personal smartphones. Following a 4-week interval, revaluation was conducted using the PACS. Intraobserver agreement was calculated for overall agreement and per fracture site. The overall results indicate "near perfect agreement" between interpretations of the radiographs on smartphones compared with computer-based PACS, with κ of 0.84, 0.82, and 0.89 for diagnosis, classification, and treatment planning, respectively. Looking at the results per fracture site, we also found substantial to near perfect agreement. Smartphone-based instant messaging applications are reliable for evaluation of a wide range of pediatric limb fractures. This method of obtaining an expert opinion from the off-site specialist is immediately accessible and inexpensive, making smartphones a powerful tool for doctors in the emergency department, primary care clinics, or remote medical centers, enabling timely and appropriate treatment for the injured child. This method is not a substitution for evaluation of the images in the standard method over computer-based PACS, which should be performed before final decision-making.

The quality of free antenatal and delivery services in Northern Sierra Leone.

PubMed

Koroma, Manso M; Kamara, Samuel S; Bangura, Evelyn A; Kamara, Mohamed A; Lokossou, Virgil; Keita, Namoudou

2017-07-12

The number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone. A cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities. The quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care. The health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.

ANZSoilML: An Australian - New Zealand standard for exchange of soil data

NASA Astrophysics Data System (ADS)

Simons, Bruce; Wilson, Peter; Ritchie, Alistair; Cox, Simon

2013-04-01

The Australian-New Zealand soil information exchange standard (ANZSoilML) is a GML-based standard designed to allow the discovery, query and delivery of soil and landscape data via standard Open Geospatial Consortium (OGC) Web Feature Services. ANZSoilML modifies the Australian soil exchange standard (OzSoilML), which is based on the Australian Soil Information Transfer and Evaluation System (SITES) database design and exchange protocols, to meet the New Zealand National Soils Database requirements. The most significant change was the removal of the lists of CodeList terms in OzSoilML, which were based on the field methods specified in the 'Australian Soil and Land Survey Field Handbook'. These were replaced with empty CodeLists as placeholders to external vocabularies to allow the use of New Zealand vocabularies without violating the data model. Testing of the use of these separately governed Australian and New Zealand vocabularies has commenced. ANZSoilML attempts to accommodate the proposed International Organization for Standardization ISO/DIS 28258 standard for soil quality. For the most part, ANZSoilML is consistent with the ISO model, although major differences arise as a result of: • The need to specify the properties appropriate for each feature type; • The inclusion of soil-related 'Landscape' features; • Allowing the mapping of soil surfaces, bodies, layers and horizons, independent of the soil profile; • Allowing specifying the relationships between the various soil features; • Specifying soil horizons as specialisations of soil layers; • Removing duplication of features provided by the ISO Observation & Measurements standard. The International Union of Soil Sciences (IUSS) Working Group on Soil Information Standards (WG-SIS) aims to develop, promote and maintain a standard to facilitate the exchange of soils data and information. Developing an international exchange standard that is compatible with existing and emerging national and regional standards is a considerable challenge. ANZSoilML is proposed as a profile of the more generalised SoilML model being progressed through the IUSS Working Group.

Experimental GMPLS-Based Provisioning for Future All-Optical DPRing-Based MAN

NASA Astrophysics Data System (ADS)

Mu�oz, Ra�l; V�ctor Mart�nez Rivera, Ricardo; Sorribes, Jordi; Junyent Giralt, Gabriel

2005-10-01

Given the abundance and strategic importance of ring fiber plants in metropolitan area networks (MANs), and the accelerating growth of Internet traffic, it is crucial to extend the existing Internet protocol (IP)-based generalized multiprotocol label switching (GMPLS) framework to provision dynamic wavelength division multiplexing (WDM) optical rings. Nevertheless, the emerging GMPLS-based lightpath provisioning does not cover the intricacies of optical rings. No GMPLS standard exists for optical add-drop multiplexer (OADM) rings, relying instead upon proprietary static solution. The objective of this paper is to propose and evaluate novel GMPLS-based lightpath signaling and wavelength reservation schemes specifically designed for dedicated protection ring (DPRing)-based MANs. Performance evaluation has been carried out in a GMPLS-based testbed named ADRENALINE.

49 CFR 239.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF TRANSPORTATION PASSENGER TRAIN EMERGENCY PREPAREDNESS General § 239.1 Purpose and scope. (a... manage passenger train emergencies. (b) This part prescribes minimum Federal safety standards for the preparation, adoption, and implementation of emergency preparedness plans by railroads connected with the...

Mental and social health during and after acute emergencies: emerging consensus?

PubMed Central

van Ommeren, Mark; Saxena, Shekhar; Saraceno, Benedetto

2005-01-01

Mental health care programmes during and after acute emergencies in resource-poor countries have been considered controversial. There is no agreement on the public health value of the post-traumatic stress disorder concept and no agreement on the appropriateness of vertical (separate) trauma-focused services. A range of social and mental health intervention strategies and principles seem, however, to have the broad support of expert opinion. Despite continuing debate, there is emerging agreement on what entails good public health practice in respect of mental health. In terms of early interventions, this agreement is exemplified by the recent inclusion of a "mental and social aspects of health" standard in the Sphere handbook's revision on minimal standards in disaster response. This affirmation of emerging agreement is important and should give clear messages to health planners. PMID:15682252

Overall ED efficiency is associated with decreased time to percutaneous coronary intervention for ST-segment elevation myocardial infarction.

PubMed

Jones, Christopher W; Sonnad, Seema S; Augustine, James J; Reese, Charles L

2014-10-01

Performance of percutaneous coronary intervention (PCI) within 90 minutes of hospital arrival for ST-segment elevation myocardial infarction patients is a commonly cited clinical quality measure. The Centers for Medicare and Medicaid Services use this measure to adjust hospital reimbursement via the Value-Based Purchasing Program. This study investigated the relationship between hospital performance on this quality measure and emergency department (ED) operational efficiency. Hospital-level data from Centers for Medicare and Medicaid Services on PCI quality measure performance was linked to information on operational performance from 272 US EDs obtained from the Emergency Department Benchmarking Alliance annual operations survey. Standard metrics of ED size, acuity, and efficiency were compared across hospitals grouped by performance on the door-to-balloon time quality measure. Mean hospital performance on the 90-minute arrival to PCI measure was 94.0% (range, 42-100). Among hospitals failing to achieve the door-to-balloon time performance standard, median ED length of stay was 209 minutes, compared with 173 minutes among those hospitals meeting the benchmark standard (P < .001). Similarly, median time from ED patient arrival to physician evaluation was 39 minutes for hospitals below the performance standard and 23 minutes for hospitals at the benchmark standard (P < .001). Markers of ED size and acuity, including annual patient volume, admission rate, and the percentage of patients arriving via ambulance did not vary with door-to-balloon time. Better performance on measures associated with ED efficiency is associated with more timely PCI performance. Copyright © 2014 Elsevier Inc. All rights reserved.

Orthopaedic surgery in natural disaster and conflict settings: how can quality care be ensured?

PubMed

Alvarado, Oscar; Trelles, Miguel; Tayler-Smith, Katie; Joseph, Holdine; Gesline, Rodné; Wilna, Thélusma Eli; Mohammad Omar, Mohammad Karim; Faiz Mohammad, Niaz Mohammad; Muhima Mastaki, John; Chingumwa Buhu, Richard; Caluwaerts, An; Dominguez, Lynette

2015-10-01

Médecins sans Frontières (MSF) is one of the main providers of orthopaedic surgery in natural disaster and conflict settings and strictly imposes a minimum set of context-specific standards before any surgery can be performed. Based on MSF's experience of performing orthopaedic surgery in a number of such settings, we describe: (a) whether it was possible to implement the minimum standards for one of the more rigorous orthopaedic procedures--internal fixation--and when possible, the time frame, (b) the volume and type of interventions performed and (c) the intra-operative mortality rates and postoperative infection rates. We conducted a retrospective review of routine programme data collected between 2007 and 2014 from three MSF emergency surgical interventions in Haiti (following the 2010 earthquake) and three ongoing MSF projects in Kunduz (Afghanistan), Masisi (Democratic Republic of the Congo) and Tabarre (Haiti). The minimum standards for internal fixation were achieved in one emergency intervention site in Haiti, and in Kunduz and Tabarre, taking up to 18 months to implement in Kunduz. All sites achieved the minimum standards to perform amputations, reductions and external fixations, with a total of 9,409 orthopaedic procedures performed during the study period. Intraoperative mortality rates ranged from 0.6 to 1.9 % and postoperative infection rates from 2.4 to 3.5 %. In settings affected by natural disaster or conflict, a high volume and wide repertoire of orthopaedic surgical procedures can be performed with good outcomes when minimum standards are in place. More demanding procedures like internal fixation may not always be feasible.

EarthServer: Use of Rasdaman as a data store for use in visualisation of complex EO data

NASA Astrophysics Data System (ADS)

Clements, Oliver; Walker, Peter; Grant, Mike

2013-04-01

The European Commission FP7 project EarthServer is establishing open access and ad-hoc analytics on extreme-size Earth Science data, based on and extending cutting-edge Array Database technology. EarthServer is built around the Rasdaman Raster Data Manager which extends standard relational database systems with the ability to store and retrieve multi-dimensional raster data of unlimited size through an SQL style query language. Rasdaman facilitates visualisation of data by providing several Open Geospatial Consortium (OGC) standard interfaces through its web services wrapper, Petascope. These include the well established standards, Web Coverage Service (WCS) and Web Map Service (WMS) as well as the emerging standard, Web Coverage Processing Service (WCPS). The WCPS standard allows the running of ad-hoc queries on the data stored within Rasdaman, creating an infrastructure where users are not restricted by bandwidth when manipulating or querying huge datasets. Here we will show that the use of EarthServer technologies and infrastructure allows access and visualisation of massive scale data through a web client with only marginal bandwidth use as opposed to the current mechanism of copying huge amounts of data to create visualisations locally. For example if a user wanted to generate a plot of global average chlorophyll for a complete decade time series they would only have to download the result instead of Terabytes of data. Firstly we will present a brief overview of the capabilities of Rasdaman and the WCPS query language to introduce the ways in which it is used in a visualisation tool chain. We will show that there are several ways in which WCPS can be utilised to create both standard and novel web based visualisations. An example of a standard visualisation is the production of traditional 2d plots, allowing users the ability to plot data products easily. However, the query language allows the creation of novel/custom products, which can then immediately be plotted with the same system. For more complex multi-spectral data, WCPS allows the user to explore novel combinations of bands in standard band-ratio algorithms through a web browser with dynamic updating of the resultant image. To visualise very large datasets Rasdaman has the capability to dynamically scale a dataset or query result so that it can be appraised quickly for use in later unscaled queries. All of these techniques are accessible through a web based GIS interface increasing the number of potential users of the system. Lastly we will show the advances in dynamic web based 3D visualisations being explored within the EarthServer project. By utilising the emerging declarative 3D web standard X3DOM as a tool to visualise the results of WCPS queries we introduce several possible benefits, including quick appraisal of data for outliers or anomalous data points and visualisation of the uncertainty of data alongside the actual data values.

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.

Strongly interacting dynamics beyond the standard model on a space-time lattice.

PubMed

Lucini, Biagio

2010-08-13

Strong theoretical arguments suggest that the Higgs sector of the standard model of electroweak interactions is an effective low-energy theory, with a more fundamental theory expected to emerge at an energy scale of the order of a teraelectronvolt. One possibility is that the more fundamental theory is strongly interacting and the Higgs sector is given by the low-energy dynamics of the underlying theory. I review recent works aimed at determining observable quantities by numerical simulations of strongly interacting theories proposed in the literature to explain the electroweak symmetry-breaking mechanism. These investigations are based on Monte Carlo simulations of the theory formulated on a space-time lattice. I focus on the so-called minimal walking technicolour scenario, an SU(2) gauge theory with two flavours of fermions in the adjoint representation. The emerging picture is that this theory has an infrared fixed point that dominates the large-distance physics. I shall discuss the first numerical determinations of quantities of phenomenological interest for this theory and analyse future directions of quantitative studies of strongly interacting theories beyond the standard model with lattice techniques. In particular, I report on a finite size scaling determination of the chiral condensate anomalous dimension gamma, for which 0.05 < or = gamma < or = 0.25.

[Investigation into the capacity for risk identification, assessment, and mitigation in managing public health emergencies in China].

PubMed

Hu, Guo-qing; Rao, Ke-qin; Sun, Zhen-qiu

2007-08-01

To investigate the capacity for risk identification, assessment, and mitigation in public health emergency management in China. Four provinces were randomly selected using stratified sampling. All the municipalities under these four provinces were assessed using the 3rd subscale (Risk Identification, Risk Assessment, and Risk Mitigation) of Preparedness and Response Capacity Questionnaire for Public Health Emergencies Used in Provincial or Municipal Governments, which was developed by the Center for Health Statistics and Information, Ministry of Health of the People's Republic of China. Sixty of 66 questionnaires (90.91%) were collected. Among 60 investigated municipalities, 35 (58%) identified the potential public health emergencies, 17 (28%) assessed the risks for the identified emergencies, and 5 (8%) conducted risk assessments for the locally accident-prone factories, mines, corporations, and big establishments, 6 (10%) identified the priorities in public health emergency management based on risk assessment, 6 (10%) developed special prevention strategies for main public health emergencies, 3 (5%) assessed the vulnerability of local residents to public health emergencies, and 34 (57%) assessed or were assessing the preparedness and response capacity for public health emergencies in the past 2 years. The mean of standard total score for risk identification, assessment, and mitigation was 24.05 (95% CI: 18.32, 29.77). Risk identification, assessment, and mitigation still require further improvement in China, and both the central and local authorities should implement more effective and efficient measures.

The evolution of internet-based map server applications in the United States Department of Agriculture, Veterinary Services.

PubMed

Maroney, Susan A; McCool, Mary Jane; Geter, Kenneth D; James, Angela M

2007-01-01

The internet is used increasingly as an effective means of disseminating information. For the past five years, the United States Department of Agriculture (USDA) Veterinary Services (VS) has published animal health information in internet-based map server applications, each oriented to a specific surveillance or outbreak response need. Using internet-based technology allows users to create dynamic, customised maps and perform basic spatial analysis without the need to buy or learn desktop geographic information systems (GIS) software. At the same time, access can be restricted to authorised users. The VS internet mapping applications to date are as follows: Equine Infectious Anemia Testing 1972-2005, National Tick Survey tick distribution maps, the Emergency Management Response System-Mapping Module for disease investigations and emergency outbreaks, and the Scrapie mapping module to assist with the control and eradication of this disease. These services were created using Environmental Systems Research Institute (ESRI)'s internet map server technology (ArcIMS). Other leading technologies for spatial data dissemination are ArcGIS Server, ArcEngine, and ArcWeb Services. VS is prototyping applications using these technologies, including the VS Atlas of Animal Health Information using ArcGIS Server technology and the Map Kiosk using ArcEngine for automating standard map production in the case of an emergency.

Accessibility and distribution of the Norwegian National Air Emergency Service: 1988-1998.

PubMed

Heggestad, Torhild; Børsheim, Knut Yngve

2002-01-01

To evaluate the accessibility and distribution of the Norwegian National Air Emergency Service in the 10-year period from 1988 to 1998. The primary material was annual standardized activity data that included all helicopter missions. A multivariate model of determinants for use of the helicopter service was computed by linear regression. Accessibility was measured as the percentage of the population reached in different flying times, and we evaluated the service using a simulation of alternative locations for the helicopter bases. The helicopter service (HEMS) has short access times, with a mean reaction time of 8 minutes and a mean response time of 26 minutes for acute missions. Nearly all patients (98%) are reached within 1 hour. A simulation that tested alternative locations of the helicopter bases compared with current locations showed no increase in accessibility. The use of the service shows large regional differences. Multivariate analyses showed that the distances of the patients from the nearest helicopter base and the nearest hospital are significant determinants for the use of HEMS. Establishment of a national service has given the Norwegian population better access to highly qualified prehospital emergency services. Furthermore, the HEMS has a compensating effect in adjusting for differences in traveling distances to a hospital. Safety, cost-containment, and gatekeeper functions remain challenges.

Emergency contraception.

PubMed

Conard, Lee Ann E; Gold, Melanie A

2005-10-01

Emergency contraception is increasing in use and has become a universal standard of care in the United States. This article reviews available forms of emergency contraception, their indications, contraindications, adverse effects and efficacy at preventing pregnancy. This article describes the mechanism of action of different forms of emergency contraception and provides recommendations on when to start or restart an ongoing method of contraceptive after emergency contraception use. Literature on the impact of the advance provision of emergency contraception on contracepting behaviors is reviewed, and behavior change counseling related to emergency contraception is described.

Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions.

PubMed

Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S; Haji-Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M

The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016. We performed a Lean-based multidisciplinary initiative beginning with a rapid process improvement workshop to evaluate current processes, identify root causes of delays, and develop countermeasures. Frontline staff developed standard work for each phase of the ED stay. Units developed a daily management system to reinforce, evaluate, and refine standard work. The primary outcome was the change in ED LOS for medicine admissions pre- and postintervention. ED LOS at the intervention site was compared with other similar VA facilities as controls over the same time period using a difference-in-differences approach. ED LOS for medicine admissions reduced 26.4%, from 8.7 to 6.4 hours. Difference-in-differences analysis showed that ED LOS for combined medicine and surgical admissions decreased from 6.7 to 6.0 hours (-0.7 hours, P = .003) at the intervention site compared with no change (5.6 hours, P = .2) at the control sites. We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.

Emergency department presentations for atrial fibrillation and flutter in Alberta: a large population-based study.

PubMed

Rosychuk, Rhonda J; Graham, Michelle M; Holroyd, Brian R; Rowe, Brian H

2017-01-10

Atrial fibrillation or flutter (AFF) are not infrequent presenting problems in Emergency Departments (ED); however, little is known of the pattern of these presentations. This study provides a description of AFF presentations and outcomes after ED discharge in Alberta. Provincial administrative databases were used to obtain all primary ED encounters for AFF during 1999 to 2011 for patients aged >35 years. Data extracted included demographics, ED visit timing, and subsequent visits to non-ED settings. Analysis included summaries and standardized rates. During the study period, there were 63,398 ED AFF visits from 32,104 distinct adults. Median ages for females and males were 75 and 67 years, respectively; more men (52%) and patients > 65 presented. Overall, the standardized rates remained similar (2.8 per 1,000 over the study period). Specific populations of human services recipients and First Nations had higher ED visit rates for AFF than other groups. Predictable daily, weekly, and monthly trends were observed. The ED visits were followed by numerous subsequent visits in non-ED settings; however, First Nations and women had lower rates of specialist follow-up. Annually, over 5,000 ED presentations of patients experiencing AFF occur in Alberta and admissions proportions are declining. While presentation rates across the province are stable, follow-up with physicians, consultation with cardiologists and health outcomes vary based on socio-economic, age, sex, and First Nations status. Further research is required to understand the causes and consequences of these inequalities and to standardize care.

Improving cancer patient emergency room utilization: A New Jersey state assessment.

PubMed

Scholer, Anthony J; Mahmoud, Omar M; Ghosh, Debopyria; Schwartzman, Jacob; Farooq, Mohammed; Cabrera, Javier; Wieder, Robert; Adam, Nabil R; Chokshi, Ravi J

2017-12-01

Due to its increasing incidence and its major contribution to healthcare costs, cancer is a major public health problem in the United States. The impact across different services is not well documented and utilization of emergency departments (ED) by cancer patients is not well characterized. The aim of our study was to identify factors that can be addressed to improve the appropriate delivery of quality cancer care thereby reducing ED utilization, decreasing hospitalizations and reducing the related healthcare costs. The New Jersey State Inpatient and Emergency Department Databases were used to identify the primary outcome variables; patient disposition and readmission rates. The independent variables were demographics, payer and clinical characteristics. Multivariable unconditional logistic regression models using clinical and demographic data were used to predict hospital admission or emergency department return. A total of 37,080 emergency department visits were cancer related with the most common diagnosis attributed to lung cancer (30.0%) and the most common presentation was pain. The disposition of patients who visit the ED due to cancer related issues is significantly affected by the factors of race (African American OR=0.6, p value=0.02 and Hispanic OR=0.5, p value=0.02, respectively), age aged 65 to 75years (SNF/ICF OR 2.35, p value=0.00 and Home Healthcare Service OR 5.15, p value=0.01, respectively), number of diagnoses (OR 1.26, p value=0.00), insurance payer (SNF/ICF OR 2.2, p value=0.02 and Home Healthcare Services OR 2.85, p value=0.07, respectively) and type of cancer (breast OR 0.54, p value=0.01, prostate OR 0.56, p value=0.01, uterine OR 0.37, p value=0.02, and other OR 0.62, p value=0.05, respectively). In addition, comorbidities increased the likelihood of death, being transferred to SNF/ICF, or utilization of home healthcare services (OR 1.6, p value=0.00, OR 1.18, p value=0.00, and OR 1.16, p value=0.04, respectively). Readmission is significantly affected by race (American Americans OR 0.41, standard error 0.08, p value=0.001 and Hispanics OR 0.29, standard error 0.11, p value=0.01, respectively), income (Quartile 2 OR 0.98, standard error 0.14, p value 0.01, Quartile 3 OR 1.07, standard error 0.13, p value 0.01, and Quartile 4 OR 0.88, standard error 0.12, p value 0.01, respectively), and type of cancer (prostate OR 0.25, standard error 0.09, p value=0.001). Web based symptom questionnaires, patient navigators, end of life nursing and clinical cancer pathways can identify, guide and prompt early initiation of treat before progression of symptoms in cancer patients most likely to visit the ED. Thus, improving cancer patient satisfaction, outcomes and reduce health care costs. Published by Elsevier Ltd.

Paediatric emergency and acute care in resource poor settings.

PubMed

Duke, Trevor; Cheema, Baljit

2016-02-01

Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little. © 2016 The Authors. Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

14 CFR 25.1362 - Electrical supplies for emergency conditions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Equipment Electrical Systems and Equipment § 25.1362 Electrical supplies for emergency conditions. A suitable electrical supply must be... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Electrical supplies for emergency...

29 CFR 1953.5 - Special provisions for standards changes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of its intent to retain the existing State standard to OSHA within 6 months of the Federal..., in the case of standards applicable to products used or distributed in interstate commerce where... standards. (1) Immediately upon publication of an emergency temporary standard in the Federal Register, OSHA...

Healthcare provider perceptions of clinical prediction rules

PubMed Central

Richardson, Safiya; Khan, Sundas; McCullagh, Lauren; Kline, Myriam; Mann, Devin; McGinn, Thomas

2015-01-01

Objectives To examine internal medicine and emergency medicine healthcare provider perceptions of usefulness of specific clinical prediction rules. Setting The study took place in two academic medical centres. A web-based survey was distributed and completed by participants between 1 January and 31 May 2013. Participants Medical doctors, doctors of osteopathy or nurse practitioners employed in the internal medicine or emergency medicine departments at either institution. Primary and secondary outcome measures The primary outcome was to identify the clinical prediction rules perceived as most useful by healthcare providers specialising in internal medicine and emergency medicine. Secondary outcomes included comparing usefulness scores of specific clinical prediction rules based on provider specialty, and evaluating associations between usefulness scores and perceived characteristics of these clinical prediction rules. Results Of the 401 healthcare providers asked to participate, a total of 263 (66%), completed the survey. The CHADS2 score was chosen by most internal medicine providers (72%), and Pulmonary Embolism Rule-Out Criteria (PERC) score by most emergency medicine providers (45%), as one of the top three most useful from a list of 24 clinical prediction rules. Emergency medicine providers rated their top three significantly more positively, compared with internal medicine providers, as having a better fit into their workflow (p=0.004), helping more with decision-making (p=0.037), better fitting into their thought process when diagnosing patients (p=0.001) and overall, on a 10-point scale, more useful (p=0.009). For all providers, the perceived qualities of useful at point of care, helps with decision making, saves time diagnosing, fits into thought process, and should be the standard of clinical care correlated highly (≥0.65) with overall 10-point usefulness scores. Conclusions Healthcare providers describe clear preferences for certain clinical prediction rules, based on medical specialty. PMID:26338684

Radio System for Locating Emergency Workers

NASA Technical Reports Server (NTRS)

Larson, William; Medelius, Pedro; Starr, Stan; Bedette, Guy; Taylor, John; Moerk, Steve

2003-01-01

A system based on low-power radio transponders and associated analog and digital electronic circuitry has been developed for locating firefighters and other emergency workers deployed in a building or other structure. The system has obvious potential for saving lives and reducing the risk of injuries. The system includes (1) a central station equipped with a computer and a transceiver; (2) active radio-frequency (RF) identification tags, each placed in a different room or region of the structure; and (3) transponder units worn by the emergency workers. The RF identification tags can be installed in a new building as built-in components of standard fire-detection devices or ground-fault electrical outlets or can be attached to such devices in a previously constructed building, without need for rewiring the building. Each RF identification tag contains information that uniquely identifies it. When each tag is installed, information on its location and identity are reported to, and stored at, the central station. In an emergency, if a building has not been prewired with RF identification tags, leading emergency workers could drop sequentially numbered portable tags in the rooms of the building, reporting the tag numbers and locations by radio to the central station as they proceed.

Medical emergencies on board commercial airlines: is documentation as expected?

PubMed Central

2012-01-01

Introduction The purpose of this study was to perform a descriptive, content-based analysis on the different forms of documentation for in-flight medical emergencies that are currently provided in the emergency medical kits on board commercial airlines. Methods Passenger airlines in the World Airline Directory were contacted between March and May 2011. For each participating airline, sample in-flight medical emergency documentation forms were obtained. All items in the sample documentation forms were subjected to a descriptive analysis and compared to a sample "medical incident report" form published by the International Air Transport Association (IATA). Results A total of 1,318 airlines were contacted. Ten airlines agreed to participate in the study and provided a copy of their documentation forms. A descriptive analysis revealed a total of 199 different items, which were summarized into five sub-categories: non-medical data (63), signs and symptoms (68), diagnosis (26), treatment (22) and outcome (20). Conclusions The data in this study illustrate a large variation in the documentation of in-flight medical emergencies by different airlines. A higher degree of standardization is preferable to increase the data quality in epidemiologic aeromedical research in the future. PMID:22397530

40 CFR 267.55 - What is the role of the emergency coordinator?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 26 2010-07-01 2010-07-01 false What is the role of the emergency... STANDARDIZED PERMIT Contingency Plan and Emergency Procedures § 267.55 What is the role of the emergency... familiar with all aspects of the facility's contingency plan, all operations and activities at the facility...

International Human Rights and the Mistreatment of Women During Childbirth

PubMed Central

Zampas, Christina; Vogel, Joshua P.; Bohren, Meghan A.; Roseman, Mindy; Erdman, Joanna N.

2016-01-01

Abstract International human rights bodies have played a critical role in codifying, setting standards, and monitoring human rights violations in the context of sexual and reproductive health and rights. In recent years, these institutions have developed and applied human rights standards in the more particular context of maternal mortality and morbidity, and have increasingly recognized a critical human rights issue in the provision and experience of care during and after pregnancy, including during childbirth. However, the international human rights standards on mistreatment during facility-based childbirth remain, in an early stage of development, focused largely on a discrete subset of experiences, such as forced sterilization and lack of access to emergency obstetric care. As a consequence, the range of mistreatment that women may experience has not been adequately addressed or analyzed under international human rights law. Identifying human rights norms and standards related to the full range of documented mistreatment is thus a first step towards addressing violations of human rights during facility-based childbirth, ensuring respectful and humane treatment, and developing a program of work to improve the overall quality of maternal care. This article reviews international human rights standards related to the mistreatment of women during childbirth in facility settings under regional and international human rights law and lays out an agenda for further research and action. PMID:28559681

International Human Rights and the Mistreatment of Women During Childbirth.

PubMed

Khosla, Rajat; Zampas, Christina; Vogel, Joshua P; Bohren, Meghan A; Roseman, Mindy; Erdman, Joanna N

2016-12-01

International human rights bodies have played a critical role in codifying, setting standards, and monitoring human rights violations in the context of sexual and reproductive health and rights. In recent years, these institutions have developed and applied human rights standards in the more particular context of maternal mortality and morbidity, and have increasingly recognized a critical human rights issue in the provision and experience of care during and after pregnancy, including during childbirth. However, the international human rights standards on mistreatment during facility-based childbirth remain, in an early stage of development, focused largely on a discrete subset of experiences, such as forced sterilization and lack of access to emergency obstetric care. As a consequence, the range of mistreatment that women may experience has not been adequately addressed or analyzed under international human rights law. Identifying human rights norms and standards related to the full range of documented mistreatment is thus a first step towards addressing violations of human rights during facility-based childbirth, ensuring respectful and humane treatment, and developing a program of work to improve the overall quality of maternal care. This article reviews international human rights standards related to the mistreatment of women during childbirth in facility settings under regional and international human rights law and lays out an agenda for further research and action.

TEMORA 1: A new zircon standard for Phanerozoic U-Pb geochronology

USGS Publications Warehouse

Black, L.P.; Kamo, S.L.; Allen, C.M.; Aleinikoff, J.N.; Davis, D.W.; Korsch, R.J.; Foudoulis, C.

2003-01-01

The role of the standard is critical to the derivation of reliable U-Pb zircon ages by micro-beam analysis. For maximum reliability, it is critically important that the utilised standard be homogeneous at all scales of analysis. It is equally important that the standard has been precisely and accurately dated by an independent technique. This study reports the emergence of a new zircon standard that meets those criteria, as demonstrated by Sensitive High Resolution Ion MicroProbe (SHRIMP), isotope dilution thermal ionisation mass-spectrometry (IDTIMS) and excimer laser ablation- inductively coupled plasma-mass-spectrometry (ELA-ICP-MS) documentation. The TEMORA 1 zircon standard derives from the Middledale Gabbroic Diorite, a high-level mafic stock within the Palaeozoic Lachlan Orogen of eastern Australia. Its 206Pb/238U IDTIMS age has been determined to be 416.75??0.24 Ma (95% confidence limits), based on measurement errors alone. Spike-calibration uncertainty limits the accuracy to 416.8??1.1 Ma for U-Pb intercomparisons between different laboratories that do not use a common spike. ?? 2003 Published by Elsevier Science B.V. All rights reserved.

Patient-reported outcomes in child and adolescent mental health services (CAMHS): use of idiographic and standardized measures.

PubMed

Wolpert, Miranda; Ford, Tamsin; Trustam, Emma; Law, Duncan; Deighton, Jessica; Flannery, Halina; Fugard, Andrew J B; Fugard, Rew J B

2012-04-01

There is increasing emphasis on use of patient-reported outcome measures (PROMs) in mental health but little research on the best approach, especially where there are multiple perspectives. To present emerging findings from both standardized and idiographic child-, parent- and clinician-rated outcomes in child and adolescent mental health services (CAMHS) and consider their correlations. Outcomes were collected in CAMHS across the UK. These comprised idiographic measures (goal-based outcomes) and standardized measures (practitioner-rated Children's Global Assessment Scale; child- and parent-rated Strengths and Difficulties Questionnaire). There was reliable positive change from the beginning of treatment to later follow-up according to all informants. Standardized clinician function report was correlated with standardized child difficulty report (r  =  - 0.26), standardized parent report (r  =  - 0.28) and idiographic joint client-determined goals (r  =  0.38) in the expected directions. These results suggest that routine outcome monitoring is feasible, and suggest the possibility of using jointly agreed idiographic measures alongside particular perspectives on outcome as part of a PROMs approach.

Survey of the current state of emergency care in Chennai, India

PubMed Central

Khadpe, Jay; Thangalvadi, Tausif; Rajavelu, Parivalavan; Sinert, Richard

2011-01-01

BACKGROUND: On July 21, 2009, the Medical Council of India officially recognized the specialty of emergency medicine in India. The city of Chennai with over six and a half million people is the fourth largest on the subcontinent and has already been a prominent city of interest in the specialty's development. However, there is no standardization of the resources found in the city's emergency departments. This study was to survey the equipment, training, and certification of Chennai area emergency departments and their staff. METHODS: We conducted a cross-sectional survey of emergency department staff from 38 Chennai area hospitals. The survey instrument contained 44 questions pertaining to hospital demographics, staff training and certification, and ED equipment and supplies. The items on the survey were specifically chosen to represent only the most basic and common resources necessary to practise emergency medicine. RESULTS: The survey found a majority of hospitals are privately operated but there is a wide range in terms of size and volume of patients. A minority of both doctors and nurses are certified in BLS, ACLS, PALS, and ATLS. While almost all departments surveyed had the basic code medications, a number of basic equipment items were lacking from a large percentage of the EDs surveyed. CONCLUSION: The newly established EP community in Chennai will have the responsibility to establish standards for both training and resources so that the specialty may grow and provide a higher standard of emergency care moving into the future. PMID:25215004

Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial

PubMed Central

Peterson, Donna J.; Christiansen, Ann L.; Mahoney, Jane; Laud, Purushottam; Layde, Peter M.

2015-01-01

Objectives. We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect. Methods. We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression. Results. Compared with control communities, standard and enhanced support communities showed significantly higher community-wide reductions (9% and 8%, respectively) in fall injuries from baseline (2007–2008) to follow-up (2010–2011). No significant difference was found between enhanced and standard support communities. Conclusions. Population-based fall prevention interventions can be effective when implemented in community settings. More research is needed to identify the barriers and facilitators that influence the successful adoption and implementation of fall prevention interventions into broad community practice. PMID:25602891

Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial.

PubMed

Guse, Clare E; Peterson, Donna J; Christiansen, Ann L; Mahoney, Jane; Laud, Purushottam; Layde, Peter M

2015-07-01

We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect. We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression. Compared with control communities, standard and enhanced support communities showed significantly higher community-wide reductions (9% and 8%, respectively) in fall injuries from baseline (2007-2008) to follow-up (2010-2011). No significant difference was found between enhanced and standard support communities. Population-based fall prevention interventions can be effective when implemented in community settings. More research is needed to identify the barriers and facilitators that influence the successful adoption and implementation of fall prevention interventions into broad community practice.

A proteomics performance standard to support measurement quality in proteomics.

PubMed

Beasley-Green, Ashley; Bunk, David; Rudnick, Paul; Kilpatrick, Lisa; Phinney, Karen

2012-04-01

The emergence of MS-based proteomic platforms as a prominent technology utilized in biochemical and biomedical research has increased the need for high-quality MS measurements. To address this need, National Institute of Standards and Technology (NIST) reference material (RM) 8323 yeast protein extract is introduced as a proteomics quality control material for benchmarking the preanalytical and analytical performance of proteomics-based experimental workflows. RM 8323 yeast protein extract is based upon the well-characterized eukaryote Saccharomyces cerevisiae and can be utilized in the design and optimization of proteomics-based methodologies from sample preparation to data analysis. To demonstrate its utility as a proteomics quality control material, we coupled LC-MS/MS measurements of RM 8323 with the NIST MS Quality Control (MSQC) performance metrics to quantitatively assess the LC-MS/MS instrumentation parameters that influence measurement accuracy, repeatability, and reproducibility. Due to the complexity of the yeast proteome, we also demonstrate how NIST RM 8323, along with the NIST MSQC performance metrics, can be used in the evaluation and optimization of proteomics-based sample preparation methods. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

32 CFR 103.4 - Policy.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Advocates General of the Military Departments and IG, DoD. (d) Standardized SAPR requirements, terminology... shall receive timely access to comprehensive medical treatment, including emergency care treatment and services, as described in this part and DoDI 6495.02. (j) Emergency care shall consist of emergency medical...

32 CFR 103.4 - Policy.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Advocates General of the Military Departments and IG, DoD. (d) Standardized SAPR requirements, terminology... shall receive timely access to comprehensive medical treatment, including emergency care treatment and services, as described in this part and DoDI 6495.02. (j) Emergency care shall consist of emergency medical...

32 CFR 103.4 - Policy.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Advocates General of the Military Departments and IG, DoD. (d) Standardized SAPR requirements, terminology... shall receive timely access to comprehensive medical treatment, including emergency care treatment and services, as described in this part and DoDI 6495.02. (j) Emergency care shall consist of emergency medical...

44 CFR 75.10 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Applicability. 75.10 Section 75.10 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... PROPERTIES UNDER SELF-INSURANCE PLAN Standards for Exemption § 75.10 Applicability. A State shall be exempt...

47 CFR 76.616 - Operation near certain aeronautical and marine emergency radio frequencies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... emergency radio frequencies. 76.616 Section 76.616 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Technical Standards § 76.616 Operation near certain aeronautical and marine emergency radio frequencies. (a) The transmission...

Self-Identifying Emergency Radio Beacons

NASA Technical Reports Server (NTRS)

Friedman, Morton L.

1987-01-01

Rescue teams aided by knowledge of vehicle in distress. Similar to conventional emergency transmitters except contains additional timing and modulating circuits. Additions to standard emergency transmitter enable transmitter to send rescuers identifying signal in addition to conventional distress signal created by sweep generator. Data generator contains identifying code.

76 FR 39843 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-07

...: National Institute of Standards and Technology (NIST). Title: Usage of Elevators for Occupant Evacuation...- story buildings in the United States during fire emergencies. This research aims to summarize emergency... emergency procedures for multi-story buildings) from existing buildings in the United States, including...

What This Is We Bring Your America: The Co-Construction of an Electronic Picturebook by Special Educators and Their Students According to the Principles of Universal Design for Learning

ERIC Educational Resources Information Center

Fitzgerald, John Francisco

2009-01-01

In 1997, one of the stipulations that Congress inserted into the reauthorization of the Individuals with Disabilities Education Act (IDEA-97) was the mandate that schools must give students with disabilities access to the very same standards-based curriculum as their non-disabled peers. Just as Universal Design emerged as a paradigm in…

Info Based Med Emergency Decision Tools, Rural Mobil Comm

DTIC Science & Technology

2006-10-01

through its ability to deliver and manage a wide variety of environmental sensors – in short, a robotic equivalent of hearing, sight, smell, taste, and...spread of infection . Panasonic Rugged Laptop: At the time of the evaluation, the Panasonic Toughbook was regarded as the industry standard for...a patient’s systolic and diastolic blood pressure, pulse rate, temperature, and oxygen saturation ( SpO2 ). The front of the device contains an LCD

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.

Radiative mixing of the one Higgs boson and emergent self-interacting dark matter

DOE PAGES

Ma, Ernest

2016-03-01

In all scalar extensions of the standard model of particle interactions, the one Higgs boson responsible for electroweak symmetry breaking always mixes with other neutral scalars at tree level unless a symmetry prevents it. One unexplored important option is that the mixing may be radiative, and thus guaranteed to be small. Moreover, two first such examples are discussed. One is based on the soft breaking of the discrete symmetry Z3. The other starts with the non-Abelian discrete symmetry A4which is then softly broken to Z3, and results in the emergence of an interesting dark-matter candidate together with a light mediatormore » for the dark matter to have its own long-range interaction.« less

[Medical doctor in mountain rescue service - a profession's perspective].

PubMed

Putzke, Matthias

2008-01-01

Helicopter emergency services (HEMS) carrying doctors trained in emergency medicine represent a well established system for primary care with increasing professionalism since their implementation in the seventies until now. However, considerable differences persist in Europe concerning the structure as well as integration of the system in the entire organisation of area-wide demands. Based on the particular geographic conditions in the alps which are highly associated with challenges for man and material a dense network of helicopter airbases has been established. Hence, this system accounts for the social, economical and touristic requirements of this region in terms of providing sufficient emergency medical treatment. In addition to statutory and professional provisions qualification requirements for emergency doctors comprehend extensive alpine training. Primarily this provides personal safety as well as security for the entire team and the patient which particularly applies for technical rope rescue. Advanced all-season training is compulsory due to seasonal differences in casualties. Well harmonized training with cross-border validity is not available to-date. Hence, the development of obligatory standard operating procedures should be the major goal of medical associations and societies.

An Assessment of Long-Term Compliance with Performance Standards in Compensatory Mitigation Wetlands.

PubMed

Van den Bosch, Kyle; Matthews, Jeffrey W

2017-04-01

Under the US Clean Water Act, wetland restoration is used to compensate for adverse impacts to wetlands. Following construction, compensation wetlands are monitored for approximately 5 years to determine if they comply with project-specific performance standards. Once a compensation site complies with performance standards, it is assumed that the site will continue to meet standards indefinitely. However, there have been few assessments of long-term compliance. We surveyed, in 2012, 30 compensation sites 8-20 years after restoration to determine whether projects continued to meet performance standards. Additionally, we compared floristic quality of compensation sites to the quality of adjacent natural wetlands to determine whether wetland condition in compensation sites could be predicted based on the condition of nearby wetlands. Compensation sites met, on average, 65% of standards during the final year of monitoring and 53% of standards in 2012, a significant decrease in compliance. Although forested wetlands often failed to meet standards for planted tree survival, the temporal decrease in compliance was driven by increasing dominance by invasive plants in emergent wetlands. The presumption of continued compliance with performance standards after a 5-year monitoring period was not supported. Wetlands restored near better quality natural wetlands achieved and maintained greater floristic quality, suggesting that landscape context was an important determinant of long-term restoration outcomes. Based on our findings, we recommend that compensation wetlands should be monitored for longer time periods, and we suggest that nearby or adjacent natural wetlands provide good examples of reasonably achievable restoration outcomes in a particular landscape.

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

PubMed

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

2012-01-01

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

Hepatorenal revascularization enables EVAR repair on a patient with AAA and an ectopic right renal artery.

PubMed

Lazaris, A M; Moulakakis, K; Mantas, G; Poulou, K; Alexiou, E; Vasdekis, S; Geroulakos, G

2018-06-07

The last thirty years the endovascular repair (EVAR) has become the standard method of treatment of abdominal aortic aneurysms (AAA). Nevertheless, the method has limitations based mainly on the anatomic characteristics of the specific aneurysm. In these cases a combination of endovascular and open techniques can be used. We describe a case of a patient with an infrarenal AAA and an ectopic right renal artery emerging from within the aneurysm sac. The patient was treated with a combination of endovascular and open techniques. In particular, he underwent a hepatorenal revascularization followed by a standard EVAR procedure, with a successful final outcome. For the treatment of AAA disease, the combination of open and endovascular procedures can overcome difficulties where a standard EVAR cannot be an option. Copyright © 2018 Elsevier Inc. All rights reserved.

Molecular diagnosis of bloodstream infections: planning to (physically) reach the bedside.

PubMed

Leggieri, N; Rida, A; François, P; Schrenzel, Jacques

2010-08-01

Faster identification of infecting microorganisms and treatment options is a first-ranking priority in the infectious disease area, in order to prevent inappropriate treatment and overuse of broad-spectrum antibiotics. Standard bacterial identification is intrinsically time-consuming, and very recently there has been a burst in the number of commercially available nonphenotype-based techniques and in the documentation of a possible clinical impact of these techniques. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is now a standard diagnostic procedure on cultures and hold promises on spiked blood. Meanwhile, commercial PCR-based techniques have improved with the use of bacterial DNA enrichment methods, the diversity of amplicon analysis techniques (melting curve analysis, microarrays, gel electrophoresis, sequencing and analysis by mass spectrometry) leading to the ability to challenge bacterial culture as the gold standard for providing earlier diagnosis with a better 'clinical' sensitivity and additional prognostic information. Laboratory practice has already changed with MALDI-TOF MS, but a change in clinical practice, driven by emergent nucleic acid-based techniques, will need the demonstration of real-life applicability as well as robust clinical-impact-oriented studies.

The contested space: The impact of competency-based education and accreditation on dietetic practice in Australia.

PubMed

Ash, Susan; Palermo, Claire; Gallegos, Danielle

2018-05-06

Competency-based Education (CBE) has underpinned the education of dietitians in Australia since the first Competency Standards (CS) were published; however, little is known about how CBE has influenced dietetic practice. The aim of this paper is to explore how a CBE framework and the CS have influenced dietetic practice in Australia since 1990. A qualitative investigation explored concepts of dietetic practice. Data analysed were original interviews previously undertaken with recent graduate dietitians during 1991 (n = 26), 1998 (n = 23) and 2007 (n = 19) and seven guided discussions with dietitians and employers (n = 28) conducted in 2014 to identify themes. The DAA Competency Standards and Accreditation Manuals/Standards since 1990 were also analysed to triangulate the interview data and to investigate how the CS were interpreted. Themes identified from interviews included: (i) communicating for better care, (ii) scientific enquiry for effective practice, (iii) critical thinking and evidence-based practice and (iv) professionalism, which remained core to dietetic practice over time, but leadership, advocacy, business management and entrepreneurial skills have emerged more strongly as the scope of practice has diversified. The landscape in which dietitians' practice showed increasing complexity and clear boundaries separating professional roles were disappearing. The 2015 CS and the 2017 Accreditation Standards highlighted that competency remains a shifting construct and that professional behaviours change depending on economic and political reasons in the play of power. Accreditation policy and current standards have successfully maintained a standard of dietetic practice across a diverse country but have the potential to constrain innovation. © 2018 Dietitians Association of Australia.

Developing a Standard Set of Patient-Centred Outcomes for Inflammatory Bowel Disease-an International, Cross-disciplinary Consensus.

PubMed

Kim, Andrew H; Roberts, Charlotte; Feagan, Brian G; Banerjee, Rupa; Bemelman, Willem; Bodger, Keith; Derieppe, Marc; Dignass, Axel; Driscoll, Richard; Fitzpatrick, Ray; Gaarentstroom-Lunt, Janette; Higgins, Peter D; Kotze, Paulo Gustavo; Meissner, Jillian; O'Connor, Marian; Ran, Zhi-Hua; Siegel, Corey A; Terry, Helen; van Deen, Welmoed K; van der Woude, C Janneke; Weaver, Alandra; Yang, Suk-Kyun; Sands, Bruce E; Vermeire, Séverine; Travis, Simon Pl

2018-03-28

Success in delivering value-based healthcare involves measuring outcomes that matter most to patients. Our aim was to develop a minimum Standard Set of patient-centred outcome measures for inflammatory bowel disease [IBD], for use in different healthcare settings. An international working group [n = 25] representing patients, patient associations, gastroenterologists, surgeons, specialist nurses, IBD registries and patient-reported outcome measure [PROM] methodologists participated in a series of teleconferences incorporating a modified Delphi process. Systematic review of existing literature, registry data, patient focus groups and open review periods were used to reach consensus on a minimum set of standard outcome measures and risk adjustment variables. Similar methodology has been used in 21 other disease areas [www.ichom.org]. A minimum Standard Set of outcomes was developed for patients [aged ≥16] with IBD. Outcome domains included survival and disease control [survival, disease activity/remission, colorectal cancer, anaemia], disutility of care [treatment-related complications], healthcare utilization [IBD-related admissions, emergency room visits] and patient-reported outcomes [including quality of life, nutritional status and impact of fistulae] measured at baseline and at 6 or 12 month intervals. A single PROM [IBD-Control questionnaire] was recommended in the Standard Set and minimum risk adjustment data collected at baseline and annually were included: demographics, basic clinical information and treatment factors. A Standard Set of outcome measures for IBD has been developed based on evidence, patient input and specialist consensus. It provides an international template for meaningful, comparable and easy-to-interpret measures as a step towards achieving value-based healthcare in IBD.

An evolutionary algorithm that constructs recurrent neural networks.

PubMed

Angeline, P J; Saunders, G M; Pollack, J B

1994-01-01

Standard methods for simultaneously inducing the structure and weights of recurrent neural networks limit every task to an assumed class of architectures. Such a simplification is necessary since the interactions between network structure and function are not well understood. Evolutionary computations, which include genetic algorithms and evolutionary programming, are population-based search methods that have shown promise in many similarly complex tasks. This paper argues that genetic algorithms are inappropriate for network acquisition and describes an evolutionary program, called GNARL, that simultaneously acquires both the structure and weights for recurrent networks. GNARL's empirical acquisition method allows for the emergence of complex behaviors and topologies that are potentially excluded by the artificial architectural constraints imposed in standard network induction methods.

Red flag findings in children with headaches: Prevalence and association with emergency department neuroimaging.

PubMed

Tsze, Daniel S; Ochs, Julie B; Gonzalez, Ariana E; Dayan, Peter S

2018-01-01

Background Clinicians appear to obtain emergent neuroimaging for children with headaches based on the presence of red flag findings. However, little data exists regarding the prevalence of these findings in emergency department populations, and whether the identification of red flag findings is associated with potentially unnecessary emergency department neuroimaging. Objectives We aimed to determine the prevalence of red flag findings and their association with neuroimaging in otherwise healthy children presenting with headaches to the emergency department. Our secondary aim was to determine the prevalence of emergent intracranial abnormalities in this population. Methods A prospective cohort study of otherwise healthy children 2-17 years of age presenting to an urban pediatric emergency department with non-traumatic headaches was undertaken. Emergency department physicians completed a standardized form to document headache descriptors and characteristics, associated symptoms, and physical and neurological exam findings. Children who did not receive emergency department neuroimaging received 4-month telephone follow-up. Outcomes included emergency department neuroimaging and the presence of emergent intracranial abnormalities. Results We enrolled 224 patients; 197 (87.9%) had at least one red flag finding on history. Several red flag findings were reported by more than a third of children, including: Headache waking from sleep (34.8%); headache present with or soon after waking (39.7%); or headaches increasing in frequency, duration and severity (40%, 33.1%, and 46.3%). Thirty-three percent of children received emergency department neuroimaging. The prevalence of emergent intracranial abnormalities was 1% (95% CI 0.1, 3.6). Abnormal neurological exam, extreme pain intensity of presenting headache, vomiting, and positional symptoms were independently associated with emergency department neuroimaging. Conclusions Red flag findings are common in children presenting with headaches to the emergency department. The presence of red flag findings is associated with emergency department neuroimaging, although the risk of emergent intracranial abnormalities is low. Many children with headaches may be receiving unnecessary neuroimaging due to the high prevalence of non-specific red flag findings.

Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar: A nationwide observational study.

PubMed

Irfan, Furqan B; Bhutta, Zain Ali; Castren, Maaret; Straney, Lahn; Djarv, Therese; Tariq, Tooba; Thomas, Stephen Hodges; Alinier, Guillaume; Al Shaikh, Loua; Owen, Robert Campbell; Al Suwaidi, Jassim; Shuaib, Ashfaq; Singh, Rajvir; Cameron, Peter Alistair

2016-11-15

Out-of-hospital cardiac arrest (OHCA) studies from the Middle East and Asian region are limited. This study describes the epidemiology, emergency health services, and outcomes of OHCA in Qatar. This was a prospective nationwide population-based observational study on OHCA patients in Qatar according to Utstein style guidelines, from June 2012 to May 2013. Data was collected from various sources; the national emergency medical service, 4 emergency departments, and 8 public hospitals. The annual crude incidence of presumed cardiac OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence was 87.8 per 100,000 population. Of the 447 OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51years (IQR=39-66). Frequently observed nationalities were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Bystander cardiopulmonary resuscitation (CPR) was carried out in 92 (20.6%) OHCA patients. Survival rate was 8.1% (n=36) and multivariable logistic regression indicated that initial shockable rhythm (OR 13.4, 95% CI 5.4-33.3, p=0.001) was associated with higher odds of survival while male gender (OR 0.27, 95% CI 0.1-0.8, p=0.01) and advanced cardiac life support (ACLS) (OR 0.15, 95% CI 0.04-0.5, p=0.02) were associated with lower odds of survival. Standardized incidence and survival rates were comparable to Western countries. Although expatriates comprise more than 80% of the population, Qataris contributed 20% of the total cardiac arrests observed. There are significant opportunities to improve outcomes, including community-based CPR and defibrillation training. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

40 CFR 60.4204 - What emission standards must I meet for non-emergency engines if I am an owner or operator of a...

Code of Federal Regulations, 2010 CFR

2010-07-01

... with a displacement of less than 10 liters per cylinder must comply with the emission standards in... with a displacement of greater than or equal to 10 liters per cylinder and less than 30 liters per... model year and later non-emergency stationary CI ICE with a displacement of less than 30 liters per...

A standard telemental health evaluation model: the time is now.

PubMed

Kramer, Greg M; Shore, Jay H; Mishkind, Matt C; Friedl, Karl E; Poropatich, Ronald K; Gahm, Gregory A

2012-05-01

The telehealth field has advanced historic promises to improve access, cost, and quality of care. However, the extent to which it is delivering on its promises is unclear as the scientific evidence needed to justify success is still emerging. Many have identified the need to advance the scientific knowledge base to better quantify success. One method for advancing that knowledge base is a standard telemental health evaluation model. Telemental health is defined here as the provision of mental health services using live, interactive video-teleconferencing technology. Evaluation in the telemental health field largely consists of descriptive and small pilot studies, is often defined by the individual goals of the specific programs, and is typically focused on only one outcome. The field should adopt new evaluation methods that consider the co-adaptive interaction between users (patients and providers), healthcare costs and savings, and the rapid evolution in communication technologies. Acceptance of a standard evaluation model will improve perceptions of telemental health as an established field, promote development of a sounder empirical base, promote interagency collaboration, and provide a framework for more multidisciplinary research that integrates measuring the impact of the technology and the overall healthcare aspect. We suggest that consideration of a standard model is timely given where telemental health is at in terms of its stage of scientific progress. We will broadly recommend some elements of what such a standard evaluation model might include for telemental health and suggest a way forward for adopting such a model.

75 FR 8180 - Proposed Agency Information Collection Activities; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-23

... Emergency Preparedness. OMB Control Number: 2130-0545. Type of Request: Extension of a currently approved... passenger train emergency regulations set forth in 49 CFR Parts 223 and 239 which require railroads to meet minimum Federal standards for the preparation, adoption, and implementation of emergency preparedness...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 3 2010-10-01 2010-10-01 false Emergency plans. 192.615 Section 192.615... BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Operations § 192.615 Emergency plans. (a) Each operator... notifies the officials; and (4) Plan how the operator and officials can engage in mutual assistance to...

77 FR 153 - Passenger Train Emergency Systems II

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-03

... emergency exits and the path to the nearest exit in the dark. Existing signage inside some passenger... and markings in the dark. Debriefing and Critique FRA is proposing a modification to the existing... standard satisfactorily addresses matters related to emergency signage, exit path marking, and egress...

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.

18O-labeled proteome reference as global internal standards for targeted quantification by selected reaction monitoring-mass spectrometry.

PubMed

Kim, Jong-Seo; Fillmore, Thomas L; Liu, Tao; Robinson, Errol; Hossain, Mahmud; Champion, Boyd L; Moore, Ronald J; Camp, David G; Smith, Richard D; Qian, Wei-Jun

2011-12-01

Selected reaction monitoring (SRM)-MS is an emerging technology for high throughput targeted protein quantification and verification in biomarker discovery studies; however, the cost associated with the application of stable isotope-labeled synthetic peptides as internal standards can be prohibitive for screening a large number of candidate proteins as often required in the preverification phase of discovery studies. Herein we present a proof of concept study using an (18)O-labeled proteome reference as global internal standards (GIS) for SRM-based relative quantification. The (18)O-labeled proteome reference (or GIS) can be readily prepared and contains a heavy isotope ((18)O)-labeled internal standard for every possible tryptic peptide. Our results showed that the percentage of heavy isotope ((18)O) incorporation applying an improved protocol was >99.5% for most peptides investigated. The accuracy, reproducibility, and linear dynamic range of quantification were further assessed based on known ratios of standard proteins spiked into the labeled mouse plasma reference. Reliable quantification was observed with high reproducibility (i.e. coefficient of variance <10%) for analyte concentrations that were set at 100-fold higher or lower than those of the GIS based on the light ((16)O)/heavy ((18)O) peak area ratios. The utility of (18)O-labeled GIS was further illustrated by accurate relative quantification of 45 major human plasma proteins. Moreover, quantification of the concentrations of C-reactive protein and prostate-specific antigen was illustrated by coupling the GIS with standard additions of purified protein standards. Collectively, our results demonstrated that the use of (18)O-labeled proteome reference as GIS provides a convenient, low cost, and effective strategy for relative quantification of a large number of candidate proteins in biological or clinical samples using SRM.

Significant improvement of the quality of bystander first aid using an expert system with a mobile multimedia device.

PubMed

Ertl, Lorenz; Christ, Frank

2007-08-01

Better quality bystander first-aid could improve outcome rates for emergency victims significantly. In this case-control study, we hypothesised that expert knowledge presented step-by-step to untrained helpers using a personal digital assistant (PDA), would improve the quality of bystanders basic life support. We confronted 101 lay-helpers with two standard emergency situations. (1) An unconscious trauma victim with severe bleeding. (2) Cardiopulmonary resuscitation (CPR). Performance was assessed using an Objective Structured Clinical Examination (OSCE). One group was supported by a PDA providing visual and audio instructions, whereas the control group acted only with their current knowledge. The expert system was programmed in HTML-code and displayed on the PDA's Internet browser. The maximum score obtainable was 24 points corresponding to optimal treatment. The control group without the PDA reached 14.8+/-3.5 (mean value+/-standard deviation), whereas the PDA supported group scored significantly higher (21.9+/-2.7, p<0.01). The difference in performance was measurable in all criteria tested and particularly notable in the items: placing in recovery position, airway management and quality of CPR. The PDA based expert system increased the performance of untrained helpers supplying emergency care significantly. Since Internet compatible mobile devices have become widely available, a significant quality improvement in bystander first-aid seems possible.

Getting It Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent.

PubMed

Salmon, Margaret; Landes, Megan; Hunchak, Cheryl; Paluku, Justin; Malemo Kalisya, Luc; Salmon, Christian; Muller, Mundenga Mutendi; Wachira, Benjamin; Mangan, James; Chhaganlal, Kajal; Kalanzi, Joseph; Azazh, Aklilu; Berman, Sara; Zied, El-Sayed; Lamprecht, Hein

2017-02-01

Significant evidence identifies point-of-care ultrasound (PoCUS) as an important diagnostic and therapeutic tool in resource-limited settings. Despite this evidence, local health care providers on the African continent continue to have limited access to and use of ultrasound, even in potentially high-impact fields such as obstetrics and trauma. Dedicated postgraduate emergency medicine residency training programs now exist in 8 countries, yet no current consensus exists in regard to core PoCUS competencies. The current practice of transferring resource-rich PoCUS curricula and delivery methods to resource-limited health systems fails to acknowledge the unique challenges, needs, and disease burdens of recipient systems. As emergency medicine leaders from 8 African countries, we introduce a practical algorithmic approach, based on the local epidemiology and resource constraints, to curriculum development and implementation. We describe an organizational structure composed of nexus learning centers for PoCUS learners and champions on the continent to keep credentialing rigorous and standardized. Finally, we put forth 5 key strategic considerations: to link training programs to hospital systems, to prioritize longitudinal learning models, to share resources to promote health equity, to maximize access, and to develop a regional consensus on training standards and credentialing. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Managing Emergency Situations in VANET Through Heterogeneous Technologies Cooperation.

PubMed

Santamaria, Amilcare Francesco; Tropea, Mauro; Fazio, Peppino; De Rango, Floriano

2018-05-08

Nowadays, the research on vehicular computing enhanced a very huge amount of services and protocols, aimed to vehicles security and comfort. The investigation of the IEEE802.11p, Wireless Access in Vehicular Environments (WAVE) and Dedicated Short Range Communication (DSRC) standards gave to the scientific world the chance to integrate new services, protocols, algorithms and devices inside vehicles. This opportunity attracted the attention of private/public organizations, which spent lot of resources and money to promote vehicular technologies. In this paper, the attention is focused on the design of a new approach for vehicular environments able to gather information during mobile node trips, for advising dangerous or emergency situations by exploiting on-board sensors. It is assumed that each vehicle has an integrated on-board unit composed of several sensors and Global Position System (GPS) device, able to spread alerting messages around the network, regarding warning and dangerous situations/conditions. On-board units, based on the standard communication protocols, share the collected information with the surrounding road-side units, while the sensing platform is able to recognize the environment that vehicles are passing through (obstacles, accidents, emergencies, dangerous situations, etc.). Finally, through the use of the GPS receiver, the exact location of the caught event is determined and spread along the network. In this way, if an accident occurs, the arriving cars will, probably, avoid delay and danger situations.

Managing Emergency Situations in VANET Through Heterogeneous Technologies Cooperation

PubMed Central

Tropea, Mauro; De Rango, Floriano

2018-01-01

Nowadays, the research on vehicular computing enhanced a very huge amount of services and protocols, aimed to vehicles security and comfort. The investigation of the IEEE802.11p, Wireless Access in Vehicular Environments (WAVE) and Dedicated Short Range Communication (DSRC) standards gave to the scientific world the chance to integrate new services, protocols, algorithms and devices inside vehicles. This opportunity attracted the attention of private/public organizations, which spent lot of resources and money to promote vehicular technologies. In this paper, the attention is focused on the design of a new approach for vehicular environments able to gather information during mobile node trips, for advising dangerous or emergency situations by exploiting on-board sensors. It is assumed that each vehicle has an integrated on-board unit composed of several sensors and Global Position System (GPS) device, able to spread alerting messages around the network, regarding warning and dangerous situations/conditions. On-board units, based on the standard communication protocols, share the collected information with the surrounding road-side units, while the sensing platform is able to recognize the environment that vehicles are passing through (obstacles, accidents, emergencies, dangerous situations, etc.). Finally, through the use of the GPS receiver, the exact location of the caught event is determined and spread along the network. In this way, if an accident occurs, the arriving cars will, probably, avoid delay and danger situations. PMID:29738453

Descriptive Metadata: Emerging Standards.

ERIC Educational Resources Information Center

Ahronheim, Judith R.

1998-01-01

Discusses metadata, digital resources, cross-disciplinary activity, and standards. Highlights include Standard Generalized Markup Language (SGML); Extensible Markup Language (XML); Dublin Core; Resource Description Framework (RDF); Text Encoding Initiative (TEI); Encoded Archival Description (EAD); art and cultural-heritage metadata initiatives;…

76 FR 8778 - Construction Standards on Posting Emergency Telephone Numbers and Floor Load Limits; Extension of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-15

...). Two construction standards, ``Medical Services and First Aid'' (Sec. 1926.50), and ``General... the two construction standards, ``Medical Services and First Aid'' paragraph (f) of Sec. 1926.50, and...

The IEEE Software Engineering Standards Process

PubMed Central

Buckley, Fletcher J.

1984-01-01

Software Engineering has emerged as a field in recent years, and those involved increasingly recognize the need for standards. As a result, members of the Institute of Electrical and Electronics Engineers (IEEE) formed a subcommittee to develop these standards. This paper discusses the ongoing standards development, and associated efforts.

Estimates of emergency operating capacity in U.S. manufacturing industries: 1994--2005

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

Belzer, D.B.

1997-02-01

To develop integrated policies for mobilization preparedness, planners require estimates and projections of available productive capacity during national emergency conditions. This report develops projections of national emergency operating capacity (EOC) for 458 US manufacturing industries at the 4-digit Standard Industrial Classification (SIC) level. These measures are intended for use in planning models that are designed to predict the demands for detailed industry sectors that would occur under conditions such as a military mobilization or a major national disaster. This report is part of an ongoing series of studies prepared by the Pacific Northwest National Laboratory to support mobilization planning studiesmore » of the Federal Emergency Planning Agency/US Department of Defense (FEMA/DOD). Earlier sets of EOC estimates were developed in 1985 and 1991. This study presents estimates of EOC through 2005. As in the 1991 study, projections of capacity were based upon extrapolations of equipment capital stocks. The methodology uses time series regression models based on industry data to obtain a response function of industry capital stock to levels of industrial output. The distributed lag coefficients of these response function are then used with projected outputs to extrapolate the 1994 level of EOC. Projections of industrial outputs were taken from the intermediate-term forecast of the US economy prepared by INFORUM (Interindustry Forecasting Model, University of Maryland) in the spring of 1996.« less

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support.

PubMed

Kyriacou, E; Pavlopoulos, S; Berler, A; Neophytou, M; Bourka, A; Georgoulas, A; Anagnostaki, A; Karayiannis, D; Schizas, C; Pattichis, C; Andreou, A; Koutsouris, D

2003-03-24

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol.

dLOGIS: Disaster Logistics Information System

NASA Astrophysics Data System (ADS)

Koesuma, Sorja; Riantana, Rio; Siswanto, Budi; Aji Purnomo, Fendi; Lelono, Sarjoko

2017-11-01

There are three timing of disaster mitigation which is pre-disaster, emergency response and post-disaster. All of those is important in disaster mitigation, but emergency response is important when we are talking about time. Emergency response has limited time when we should give help. Rapid assessment of kind of logistic, the number of survivors, number children and old people, their gender and also for difable person. It should be done in emergency response time. Therefore we make a mobile application for logistics management system. The name of application is dLOGIS, i.e. Disaster Logistics Information System. The application is based on Android system for mobile phone. Otherwise there is also website version. The website version is for maintenance, data input and registration. So the people or government can use it directly when there is a disaster. After login in dLOGIS, there is five main menus. The first main menu shows disaster information, refugees conditions, logistics needed, available logistics stock and already accepted logistics. In the second menu is used for entering survivors data. The field coordinator can enter survivors data based on the rapid assessment in disaster location. The third menu is used for entering kind of logistic. Number and kind of logistics are based on the BNPB needed standard for the survivor. The fourth menu displays the logistics stock available in field coordinator. And the last menu displays the logistics help that already accepted and sent by donation. By using this application when a disaster happened, field coordinator or local government can use maintenance distribution of logistics base on their needs. Also for donor people who will give help to survivor, they can give logistics with the corresponding of survivor needs.

Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department.

PubMed

Sauter, Thomas C; Hautz, Wolf E; Hostettler, Simone; Brodmann-Maeder, Monika; Martinolli, Luca; Lehmann, Beat; Exadaktylos, Aristomenis K; Haider, Dominik G

2016-08-02

Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen's d was calculated as effect size for all statistically significant tests. Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (d z  = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED.

Data Standards for Omics Data: The Basis of Data Sharing and Reuse

PubMed Central

Chervitz, Stephen A.; Deutsch, Eric W.; Field, Dawn; Parkinson, Helen; Quackenbush, John; Rocca-Serra, Phillipe; Sansone, Susanna-Assunta; Stoeckert, Christian J.; Taylor, Chris F.; Taylor, Ronald; Ball, Catherine A.

2014-01-01

To facilitate sharing of Omics data, many groups of scientists have been working to establish the relevant data standards. The main components of data sharing standards are experiment description standards, data exchange standards, terminology standards, and experiment execution standards. Here we provide a survey of existing and emerging standards that are intended to assist the free and open exchange of large-format data. PMID:21370078

Standardized Testing Program for Solid-State Hydrogen Storage Technologies

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

Miller, Michael A.; Page, Richard A.

2012-07-30

In the US and abroad, major research and development initiatives toward establishing a hydrogen-based transportation infrastructure have been undertaken, encompassing key technological challenges in hydrogen production and delivery, fuel cells, and hydrogen storage. However, the principal obstacle to the implementation of a safe, low-pressure hydrogen fueling system for fuel-cell powered vehicles remains storage under conditions of near-ambient temperature and moderate pressure. The choices for viable hydrogen storage systems at the present time are limited to compressed gas storage tanks, cryogenic liquid hydrogen storage tanks, chemical hydrogen storage, and hydrogen absorbed or adsorbed in a solid-state material (a.k.a. solid-state storage). Solid-statemore » hydrogen storage may offer overriding benefits in terms of storage capacity, kinetics and, most importantly, safety.The fervor among the research community to develop novel storage materials had, in many instances, the unfortunate consequence of making erroneous, if not wild, claims on the reported storage capacities achievable in such materials, to the extent that the potential viability of emerging materials was difficult to assess. This problem led to a widespread need to establish a capability to accurately and independently assess the storage behavior of a wide array of different classes of solid-state storage materials, employing qualified methods, thus allowing development efforts to focus on those materials that showed the most promise. However, standard guidelines, dedicated facilities, or certification programs specifically aimed at testing and assessing the performance, safety, and life cycle of these emergent materials had not been established. To address the stated need, the Testing Laboratory for Solid-State Hydrogen Storage Technologies was commissioned as a national-level focal point for evaluating new materials emerging from the designated Materials Centers of Excellence (MCoE) according to established and qualified standards. Working with industry, academia, and the U.S. government, SwRI set out to develop an accepted set of evaluation standards and analytical methodologies. Critical measurements of hydrogen sorption properties in the Laboratory have been based on three analytical capabilities: 1) a high-pressure Sievert-type volumetric analyzer, modified to improve low-temperature isothermal analyses of physisorption materials and permit in situ mass spectroscopic analysis of the sample’s gas space; 2) a static, high-pressure thermogravimetric analyzer employing an advanced magnetic suspension electro-balance, glove-box containment, and capillary interface for in situ mass spectroscopic analysis of the sample’s gas space; and 3) a Laser-induced Thermal Desorption Mass Spectrometer (LTDMS) system for high thermal-resolution desorption and mechanistic analyses. The Laboratory has played an important role in down-selecting materials and systems that have emerged from the MCoEs.« less

Making adaptable systems work for mission operations: A case study

NASA Technical Reports Server (NTRS)

Holder, Barbara E.; Levesque, Michael E.

1993-01-01

The Advanced Multimission Operations System (AMMOS) at NASA's Jet Propulsion Laboratory is based on a highly adaptable multimission ground data system (MGDS) for mission operations. The goal for MGDS is to support current flight project science and engineering personnel and to meet the demands of future missions while reducing associated operations and software development costs. MGDS has become a powerful and flexible mission operations system by using a network of heterogeneous workstations, emerging open system standards, and selecting an adaptable tools-based architecture. Challenges in developing adaptable systems for mission operations and the benefits of this approach are described.

Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.

PubMed

Schnakers, Caroline; Vanhaudenhuyse, Audrey; Giacino, Joseph; Ventura, Manfredi; Boly, Melanie; Majerus, Steve; Moonen, Gustave; Laureys, Steven

2009-07-21

Previously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS). However, no recent studies have investigated the accuracy of this grave clinical diagnosis. In this study, we compared consensus-based diagnoses of VS and MCS to those based on a well-established standardized neurobehavioral rating scale, the JFK Coma Recovery Scale-Revised (CRS-R). We prospectively followed 103 patients (55 +/- 19 years) with mixed etiologies and compared the clinical consensus diagnosis provided by the physician on the basis of the medical staff's daily observations to diagnoses derived from CRS-R assessments performed by research staff. All patients were assigned a diagnosis of 'VS', 'MCS' or 'uncertain diagnosis.' Of the 44 patients diagnosed with VS based on the clinical consensus of the medical team, 18 (41%) were found to be in MCS following standardized assessment with the CRS-R. In the 41 patients with a consensus diagnosis of MCS, 4 (10%) had emerged from MCS, according to the CRS-R. We also found that the majority of patients assigned an uncertain diagnosis by clinical consensus (89%) were in MCS based on CRS-R findings. Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.

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

Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit.

PubMed

Wiler, Jennifer L; Welch, Shari; Pines, Jesse; Schuur, Jeremiah; Jouriles, Nick; Stone-Griffith, Suzanne

2015-05-01

The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers. © 2015 by the Society for Academic Emergency Medicine.

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Means of Egress § 1910.38 Emergency action plans. (a) Application. An... plans. An emergency action plan must be in writing, kept in the workplace, and available to employees... information about the plan or an explanation of their duties under the plan. (d) Employee alarm system. An...

49 CFR 571.217 - Standard No. 217; Bus emergency exits and window retention and release.

Code of Federal Regulations, 2010 CFR

2010-10-01

... shown in Figure 3A for a side emergency exit door, and in figure 3D for a rear emergency exit door. (b... § 571.217 see the List of CFR Sections Affected which appears in the Finding Aids section of the printed...

44 CFR 75.14 - States exempt under this part.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false States exempt under this part. 75.14 Section 75.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... STATE-OWNED PROPERTIES UNDER SELF-INSURANCE PLAN Standards for Exemption § 75.14 States exempt under...

44 CFR 75.12 - Application by a State for exemption.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Application by a State for exemption. 75.12 Section 75.12 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... STATE-OWNED PROPERTIES UNDER SELF-INSURANCE PLAN Standards for Exemption § 75.12 Application by a State...

46 CFR 154.1872 - Cargo emergency jettisoning.

Code of Federal Regulations, 2010 CFR

2010-10-01

... STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Operations § 154.1872 Cargo emergency... piping when being used may be outside of the transverse tank location under § 154.310. (c) The master... ensure that after the emergency jettisoning piping is used it is purged of cargo vapors with inert gas...

44 CFR 208.2 - Definitions of terms used in this part.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Definitions of terms used in this part. 208.2 Section 208.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... defined term unless such capitalization results from the application of standard capitalization or style...

49 CFR 571.217 - Standard No. 217; Bus emergency exits and window retention and release.

Code of Federal Regulations, 2011 CFR

2011-10-01

... shown in Figure 3A for a side emergency exit door, and in figure 3D for a rear emergency exit door. (b... § 571.217 see the List of CFR Sections Affected which appears in the Finding Aids section of the printed...

The ODD protocol: A review and first update

USGS Publications Warehouse

Grimm, Volker; Berger, Uta; DeAngelis, Donald L.; Polhill, J. Gary; Giske, Jarl; Railsback, Steve F.

2010-01-01

The 'ODD' (Overview, Design concepts, and Details) protocol was published in 2006 to standardize the published descriptions of individual-based and agent-based models (ABMs). The primary objectives of ODD are to make model descriptions more understandable and complete, thereby making ABMs less subject to criticism for being irreproducible. We have systematically evaluated existing uses of the ODD protocol and identified, as expected, parts of ODD needing improvement and clarification. Accordingly, we revise the definition of ODD to clarify aspects of the original version and thereby facilitate future standardization of ABM descriptions. We discuss frequently raised critiques in ODD but also two emerging, and unanticipated, benefits: ODD improves the rigorous formulation of models and helps make the theoretical foundations of large models more visible. Although the protocol was designed for ABMs, it can help with documenting any large, complex model, alleviating some general objections against such models.

Hospital-Based Acute Care After Total Hip and Knee Arthroplasty: Implications for Quality Measurement.

PubMed

Trimba, Roman; Laughlin, Richard T; Krishnamurthy, Anil; Ross, Joseph S; Fox, Justin P

2016-03-01

Although hospital readmissions are being adopted as a quality measure after total hip or knee arthroplasty, they may fail accurately capture the patient's postdischarge experience. We studied 272,853 discharges from 517 hospitals to determine hospital emergency department (ED) visit and readmission rates. The hospital-level, 30-day, risk-standardized ED visit (median = 5.6% [2.4%-13.7%]) and hospital readmission (5.0% [2.6%-9.2%]) rates were similar and varied widely. A hospital's risk-standardized ED visit rate did not correlate with its readmission rate (r = -0.03, P = .50). If ED visits were included in a broader "readmission" measure, 246 (47.6%) hospitals would change perceived performance groups. Including ED visits in a broader, hospital-based, acute care measure may be warranted to better describe postdischarge health care utilization. Copyright © 2016 Elsevier Inc. All rights reserved.

A UML profile for the OBO relation ontology.

PubMed

Guardia, Gabriela D A; Vêncio, Ricardo Z N; de Farias, Cléver R G

2012-01-01

Ontologies have increasingly been used in the biomedical domain, which has prompted the emergence of different initiatives to facilitate their development and integration. The Open Biological and Biomedical Ontologies (OBO) Foundry consortium provides a repository of life-science ontologies, which are developed according to a set of shared principles. This consortium has developed an ontology called OBO Relation Ontology aiming at standardizing the different types of biological entity classes and associated relationships. Since ontologies are primarily intended to be used by humans, the use of graphical notations for ontology development facilitates the capture, comprehension and communication of knowledge between its users. However, OBO Foundry ontologies are captured and represented basically using text-based notations. The Unified Modeling Language (UML) provides a standard and widely-used graphical notation for modeling computer systems. UML provides a well-defined set of modeling elements, which can be extended using a built-in extension mechanism named Profile. Thus, this work aims at developing a UML profile for the OBO Relation Ontology to provide a domain-specific set of modeling elements that can be used to create standard UML-based ontologies in the biomedical domain.

Near-infrared fluorescence image quality test methods for standardized performance evaluation

NASA Astrophysics Data System (ADS)

Kanniyappan, Udayakumar; Wang, Bohan; Yang, Charles; Ghassemi, Pejhman; Wang, Quanzeng; Chen, Yu; Pfefer, Joshua

2017-03-01

Near-infrared fluorescence (NIRF) imaging has gained much attention as a clinical method for enhancing visualization of cancers, perfusion and biological structures in surgical applications where a fluorescent dye is monitored by an imaging system. In order to address the emerging need for standardization of this innovative technology, it is necessary to develop and validate test methods suitable for objective, quantitative assessment of device performance. Towards this goal, we develop target-based test methods and investigate best practices for key NIRF imaging system performance characteristics including spatial resolution, depth of field and sensitivity. Characterization of fluorescence properties was performed by generating excitation-emission matrix properties of indocyanine green and quantum dots in biological solutions and matrix materials. A turbid, fluorophore-doped target was used, along with a resolution target for assessing image sharpness. Multi-well plates filled with either liquid or solid targets were generated to explore best practices for evaluating detection sensitivity. Overall, our results demonstrate the utility of objective, quantitative, target-based testing approaches as well as the need to consider a wide range of factors in establishing standardized approaches for NIRF imaging system performance.

75 FR 34452 - Center for Drug Evaluation and Research Data Standards Plan; Availability for Comment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-17

... identifies key objectives for a data standards program at CDER, processes to be developed to ensure... public health mission. At present, the lack of standardized data affects CDER's review processes by...-emerging issues. Standardization of data submissions, a requirement for electronic submissions, and a...

Ethical standards for mental health and psychosocial support research in emergencies: review of literature and current debates.

PubMed

Chiumento, Anna; Rahman, Atif; Frith, Lucy; Snider, Leslie; Tol, Wietse A

2017-02-08

Research in emergencies is needed to understand the prevalence of mental health and psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and psychosocial support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies. Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.

Status of emerging standards for removable computer storage media and related contributions of NIST

NASA Technical Reports Server (NTRS)

Podio, Fernando L.

1992-01-01

Standards for removable computer storage media are needed so that users may reliably interchange data both within and among various computer installations. Furthermore, media interchange standards support competition in industry and prevent sole-source lock-in. NIST participates in magnetic tape and optical disk standards development through Technical Committees X3B5, Digital Magnetic Tapes, X3B11, Optical Digital Data Disk, and the Joint Technical Commission on Data Permanence. NIST also participates in other relevant national and international standards committees for removable computer storage media. Industry standards for digital magnetic tapes require the use of Standard Reference Materials (SRM's) developed and maintained by NIST. In addition, NIST has been studying care and handling procedures required for digital magnetic tapes. NIST has developed a methodology for determining the life expectancy of optical disks. NIST is developing care and handling procedures for optical digital data disks and is involved in a program to investigate error reporting capabilities of optical disk drives. This presentation reflects the status of emerging magnetic tape and optical disk standards, as well as NIST's contributions in support of these standards.

Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine.

PubMed

Balhara, Kamna S; Peterson, Susan M; Elabd, Mohamed Moheb; Regan, Linda; Anton, Xavier; Al-Natour, Basil Ali; Hsieh, Yu-Hsiang; Scheulen, James; Stewart de Ramirez, Sarah A

2018-04-01

Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p < 0.001), and all in English. Handoff was streamlined from 7 possible pathways to 3. Most post-intervention survey respondents reported improved workflow (77.8%) and safety (83.3%); none reported patient harm. Respondents and observers noted reduced inefficiency (p < 0.05). Our standardized tool increased face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

PubMed

Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

2015-01-01

Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Pocket-sized versus standard ultrasound machines in abdominal imaging.

PubMed

Tse, K H; Luk, W H; Lam, M C

2014-06-01

The pocket-sized ultrasound machine has emerged as an invaluable tool for quick assessment in emergency and general practice settings. It is suitable for instant and quick assessment in cardiac imaging. However, its applicability in the imaging of other body parts has yet to be established. In this pictorial review, we compared the performance of the pocketsized ultrasound machine against the standard ultrasound machine for its image quality in common abdominal pathology.

Optimization of Simulation-Based Training Systems: Model Description, Implementation, and Evaluation

DTIC Science & Technology

1990-06-01

Taskcs01 for Instructional _______Cue ______ 0__ Fq’o~eturesResponse 1A I Analyze Tasks %Requirements 018 TaskfrFieiy0-m Learning fo ielt asl... academic instruction on aircraft systems, emergency procedures, and tactics. Although some Army aviators enter the AH-I AQC immediately after completing...from low to high fidelity, and (d) tasks could not be trained to standard using academic training only. The tasks that were chosen are enumerated in

The Physics of Imaging with Remote Sensors : Photon State Space & Radiative Transfer

NASA Technical Reports Server (NTRS)

Davis, Anthony B.

2012-01-01

Standard (mono-pixel/steady-source) retrieval methodology is reaching its fundamental limit with access to multi-angle/multi-spectral photo- polarimetry. Next... Two emerging new classes of retrieval algorithm worth nurturing: multi-pixel time-domain Wave-radiometry transition regimes, and more... Cross-fertilization with bio-medical imaging. Physics-based remote sensing: - What is "photon state space?" - What is "radiative transfer?" - Is "the end" in sight? Two wide-open frontiers! center dot Examples (with variations.

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

PubMed

Travers, Debbie A; Haas, Stephanie W

2004-11-01

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

International Standards for Genomes, Transcriptomes, and Metagenomes

PubMed Central

Mason, Christopher E.; Afshinnekoo, Ebrahim; Tighe, Scott; Wu, Shixiu; Levy, Shawn

2017-01-01

Challenges and biases in preparing, characterizing, and sequencing DNA and RNA can have significant impacts on research in genomics across all kingdoms of life, including experiments in single-cells, RNA profiling, and metagenomics (across multiple genomes). Technical artifacts and contamination can arise at each point of sample manipulation, extraction, sequencing, and analysis. Thus, the measurement and benchmarking of these potential sources of error are of paramount importance as next-generation sequencing (NGS) projects become more global and ubiquitous. Fortunately, a variety of methods, standards, and technologies have recently emerged that improve measurements in genomics and sequencing, from the initial input material to the computational pipelines that process and annotate the data. Here we review current standards and their applications in genomics, including whole genomes, transcriptomes, mixed genomic samples (metagenomes), and the modified bases within each (epigenomes and epitranscriptomes). These standards, tools, and metrics are critical for quantifying the accuracy of NGS methods, which will be essential for robust approaches in clinical genomics and precision medicine. PMID:28337071

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.

An Interoperable Architecture for Air Pollution Early Warning System Based on Sensor Web

NASA Astrophysics Data System (ADS)

Samadzadegan, F.; Zahmatkesh, H.; Saber, M.; Ghazi khanlou, H. J.

2013-09-01

Environmental monitoring systems deal with time-sensitive issues which require quick responses in emergency situations. Handling the sensor observations in near real-time and obtaining valuable information is challenging issues in these systems from a technical and scientific point of view. The ever-increasing population growth in urban areas has caused certain problems in developing countries, which has direct or indirect impact on human life. One of applicable solution for controlling and managing air quality by considering real time and update air quality information gathered by spatially distributed sensors in mega cities, using sensor web technology for developing monitoring and early warning systems. Urban air quality monitoring systems using functionalities of geospatial information system as a platform for analysing, processing, and visualization of data in combination with Sensor Web for supporting decision support systems in disaster management and emergency situations. This system uses Sensor Web Enablement (SWE) framework of the Open Geospatial Consortium (OGC), which offers a standard framework that allows the integration of sensors and sensor data into spatial data infrastructures. SWE framework introduces standards for services to access sensor data and discover events from sensor data streams as well as definition set of standards for the description of sensors and the encoding of measurements. The presented system provides capabilities to collect, transfer, share, process air quality sensor data and disseminate air quality status in real-time. It is possible to overcome interoperability challenges by using standard framework. In a routine scenario, air quality data measured by in-situ sensors are communicated to central station where data is analysed and processed. The extracted air quality status is processed for discovering emergency situations, and if necessary air quality reports are sent to the authorities. This research proposed an architecture to represent how integrate air quality sensor data stream into geospatial data infrastructure to present an interoperable air quality monitoring system for supporting disaster management systems by real time information. Developed system tested on Tehran air pollution sensors for calculating Air Quality Index (AQI) for CO pollutant and subsequently notifying registered users in emergency cases by sending warning E-mails. Air quality monitoring portal used to retrieving and visualize sensor observation through interoperable framework. This system provides capabilities to retrieve SOS observation using WPS in a cascaded service chaining pattern for monitoring trend of timely sensor observation.

Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience

PubMed Central

Sullivan, Marlysa B.; Erb, Matt; Schmalzl, Laura; Moonaz, Steffany; Noggle Taylor, Jessica; Porges, Stephen W.

2018-01-01

Yoga therapy is a newly emerging, self-regulating complementary and integrative healthcare (CIH) practice. It is growing in its professionalization, recognition and utilization with a demonstrated commitment to setting practice standards, educational and accreditation standards, and promoting research to support its efficacy for various populations and conditions. However, heterogeneity of practice, poor reporting standards, and lack of a broadly accepted understanding of the neurophysiological mechanisms involved in yoga therapy limits the structuring of testable hypotheses and clinical applications. Current proposed frameworks of yoga-based practices focus on the integration of bottom-up neurophysiological and top-down neurocognitive mechanisms. In addition, it has been proposed that phenomenology and first person ethical inquiry can provide a lens through which yoga therapy is viewed as a process that contributes towards eudaimonic well-being in the experience of pain, illness or disability. In this article we build on these frameworks, and propose a model of yoga therapy that converges with Polyvagal Theory (PVT). PVT links the evolution of the autonomic nervous system to the emergence of prosocial behaviors and posits that the neural platforms supporting social behavior are involved in maintaining health, growth and restoration. This explanatory model which connects neurophysiological patterns of autonomic regulation and expression of emotional and social behavior, is increasingly utilized as a framework for understanding human behavior, stress and illness. Specifically, we describe how PVT can be conceptualized as a neurophysiological counterpart to the yogic concept of the gunas, or qualities of nature. Similar to the neural platforms described in PVT, the gunas provide the foundation from which behavioral, emotional and physical attributes emerge. We describe how these two different yet analogous frameworks—one based in neurophysiology and the other in an ancient wisdom tradition—highlight yoga therapy’s promotion of physical, mental and social wellbeing for self-regulation and resilience. This parallel between the neural platforms of PVT and the gunas of yoga is instrumental in creating a translational framework for yoga therapy to align with its philosophical foundations. Consequently, yoga therapy can operate as a distinct practice rather than fitting into an outside model for its utilization in research and clinical contexts. PMID:29535617

ESIP's Emerging Provenance and Context Content Standard Use Cases: Developing Examples and Models for Data Stewardship

NASA Astrophysics Data System (ADS)

Ramdeen, S.; Hills, D. J.

2013-12-01

Earth science data collections range from individual researchers' private collections to large-scale data warehouses, from computer-generated data to field or lab based observations. These collections require stewardship. Fundamentally, stewardship ensures long term preservation and the provision of access to the user community. In particular, stewardship includes capturing appropriate metadata and documentation--and thus the context of the data's creation and any changes they underwent over time --to enable data reuse. But scientists and science data managers must translate these ideas into practice. How does one balance the needs of current and (projected) future stakeholders? In 2011, the Data Stewardship Committee (DSC) of the Federation of Earth Science Information Partners (ESIP) began developing the Provenance and Context Content Standard (PCCS). As an emerging standard, PCCS provides a framework for 'what' must be captured or preserved as opposed to describing only 'how' it should be done. Originally based on the experiences of NASA and NOAA researchers within ESIP, the standard currently provides data managers with content items aligned to eight key categories. While the categories and content items are based on data life cycles of remote sensing missions, they can be generalized to cover a broader set of activities, for example, preservation of physical objects. These categories will include the information needed to ensure the long-term understandability and usability of earth science data products. In addition to the PCCS, the DSC is developing a series of use cases based on the perspectives of the data archiver, data user, and the data consumer that will connect theory and practice. These cases will act as specifications for developing PCCS-based systems. They will also provide for examination of the categories and content items covered in the PCCS to determine if any additions are needed to cover the various use cases, and also provide rationale and indicate priorities for preservation. Though the use cases currently focus on two areas, 'creating' a data set and 'using' a data set, the use cases will eventually cover the full data lifecycle. Currently developing a template to be used in future use case creation, the DSC is also preparing and testing more use case scenarios. This presentation will introduce the ESIP use cases based on the PCCS. It will at once expand stakeholder participation and show the application of these materials beyond the ESIP community in which they were developed. More information about the ESIP use case activities can be found on the DSC wiki - http://wiki.esipfed.org/index.php/Preservation_Use_Case_Activity.

Biopolymers for Antitumor Implantable Drug Delivery Systems: Recent Advances and Future Outlook.

PubMed

Talebian, Sepehr; Foroughi, Javad; Wade, Samantha J; Vine, Kara L; Dolatshahi-Pirouz, Alireza; Mehrali, Mehdi; Conde, João; Wallace, Gordon G

2018-05-13

In spite of remarkable improvements in cancer treatments and survivorship, cancer still remains as one of the major causes of death worldwide. Although current standards of care provide encouraging results, they still cause severe systemic toxicity and also fail in preventing recurrence of the disease. In order to address these issues, biomaterial-based implantable drug delivery systems (DDSs) have emerged as promising therapeutic platforms, which allow local administration of drugs directly to the tumor site. Owing to the unique properties of biopolymers, they have been used in a variety of ways to institute biodegradable implantable DDSs that exert precise spatiotemporal control over the release of therapeutic drug. Here, the most recent advances in biopolymer-based DDSs for suppressing tumor growth and preventing tumor recurrence are reviewed. Novel emerging biopolymers as well as cutting-edge polymeric microdevices deployed as implantable antitumor DDSs are discussed. Finally, a review of a new therapeutic modality within the field, which is based on implantable biopolymeric DDSs, is given. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Application of recombinant hemagglutinin proteins as alternative antigen standards for pandemic influenza vaccines.

PubMed

Choi, Yejin; Kwon, Seong Yi; Oh, Ho Jung; Shim, Sunbo; Chang, Seokkee; Chung, Hye Joo; Kim, Do Keun; Park, Younsang; Lee, Younghee

2017-09-01

The single radial immunodiffusion (SRID) assay, used to quantify hemagglutinin (HA) in influenza vaccines, requires reference reagents; however, because centralized production of reference reagents may slow the emergency deployment of vaccines, alternatives are needed. We investigated the production of HA proteins using recombinant DNA technology, rather than a traditional egg-based production process. The HA proteins were then used in an SRID assay as a reference antigen. We found that HA can be quantified in both egg-based and cell-based influenza vaccines when recombinant HAs (rHAs) are used as the reference antigen. Furthermore, we confirmed that rHAs obtained from strains with pandemic potential, such as H5N1, H7N3, H7N9, and H9N2 strains, can be utilized in the SRID assay. The rHA production process takes just one month, in contrast to the traditional process that takes three to four months. The use of rHAs may reduce the time required to produce reference reagents and facilitate timely introduction of vaccines during emergencies.

Forecast Based Financing for Managing Weather and Climate Risks to Reduce Potential Disaster Impacts

NASA Astrophysics Data System (ADS)

Arrighi, J.

2017-12-01

There is a critical window of time to reduce potential impacts of a disaster after a forecast for heightened risk is issued and before an extreme event occurs. The concept of Forecast-based Financing focuses on this window of opportunity. Through advanced preparation during system set-up, tailored methodologies are used to 1) analyze a range of potential extreme event forecasts, 2) identify emergency preparedness measures that can be taken when factoring in forecast lead time and inherent uncertainty and 3) develop standard operating procedures that are agreed on and tied to guaranteed funding sources to facilitate emergency measures led by the Red Cross or government actors when preparedness measures are triggered. This presentation will focus on a broad overview of the current state of theory and approaches used in developing a forecast-based financing systems - with a specific focus on hydrologic events, case studies of success and challenges in various contexts where this approach is being piloted, as well as what is on the horizon to be further explored and developed from a research perspective as the application of this approach continues to expand.

Clustering of Emerging Flux

NASA Technical Reports Server (NTRS)

Ruzmaikin, A.

1997-01-01

Observations show that newly emerging flux tends to appear on the Solar surface at sites where there is flux already. This results in clustering of solar activity. Standard dynamo theories do not predict this effect.

Competency in managing cardiac arrest: A scenario-based evaluation of dental students.

PubMed

Breuer, Georg; Knipfer, Christian; Huber, Tobias; Huettl, Stephan; Shams, Nima; Knipfer, Kristin; Neukam, Friedrich Wilhelm; Schuettler, Juergen; Stelzle, Florian

2016-01-01

Advanced Cardiovascular Life Support (ACLS) in life-threatening situations is perceived as a basic skill for dental professionals. However, medical emergency training in dental schools is often not standardized. The dental students' knowledge transfer to an ACLS setting thus remains questionable. The aim of the study was to evaluate dental pre-doctorate students' practical competence in ACLS in a standardized manner to enable the curriculum to be adapted to meet their particular needs. Thirty dental students (age 25.47 ± 1.81; 16 male/14 female) in their last year of dental studies were randomly assigned to 15 teams. Students' ability to successfully manage ACLS was assessed by a scenario-based approach (training module: Laerdal® ALS Skillmaster). Competence was assessed by means of (a) an observation chart, (b) video analysis and (c) training module analysis (Laerdal HeartSim®4000; Version 1.4). The evaluation was conducted by a trained anesthesiologist with regard to the 2010 guidelines of the European Resuscitation Council (ERC). Only five teams (33.3%) checked for all three vital functions (response, breathing and circulation). All teams initiated cardiopulmonary resuscitation (CPR). Only 54.12% of the compressions performed during CPR were sufficient. Four teams stopped the CPR after initiation. In total, 93% of the teams used the equipment for bag-valve-mask ventilation and 53.3% used the AED (Automated external defibrillator). ACLS training on a regular basis is necessary and, consistent with a close link between dentistry and medicine, should be a standardized part of the medical emergency curriculum for dental students with a specific focus on the deficiencies revealed in this study.

Ozone's Threat Hits Back Mexico City

NASA Astrophysics Data System (ADS)

Velasco, E.; Retama, A.; Guzman, D.

2016-12-01

Last March the Mexican authorities activated after 13 years the environmental alarm when ozone (O3) reached 210 ppb. The emergency measures created confusion among the public, who had lost memory of previous air quality crisis. Despite Mexico City has experienced a significant progress towards achieving cleaner air during the last 20 years, a recent relaxation in traffic regulations and meteorology favorable for photochemical activity triggered this new episode. All criteria pollutants of primary origin have been controlled and are in compliance with the Mexican Air Quality Standards. However, O3 and fine particles still exceed the standard threshold concentrations. For instance, 49-64% of the days have exceeded the 1-hour O3 standard of 95 ppb during the last 5 years. The current control policies, which responded to the integration of air quality information by authorities and scientists, have apparently started to lose effectiveness. Although precursor gases, such as alkanes and aromatics have shown an important decrease, reactive olefins have gained importance. The increase of motor-vehicles in recent years seems to fuel again the atmosphere's reactivity. This paper analyses the effectiveness of the emergency measures during the crisis based on the knowledge obtained from previous large field studies and the comprehensive data collected by the local air quality monitoring network. It is 10 years from MILAGRO, the last interdisciplinary study that examined the air pollution of the most populous city in North America. We call for a new collaborative research initiative based on a major field measurement campaign with the target of revealing new insights into the meteorology, emission of primary pollutants and precursor gases, photochemical production and formation of secondary particles in the atmosphere of Mexico City to improve its air quality, as well as of similar cities in the developing world.

DNA origami-based standards for quantitative fluorescence microscopy.

PubMed

Schmied, Jürgen J; Raab, Mario; Forthmann, Carsten; Pibiri, Enrico; Wünsch, Bettina; Dammeyer, Thorben; Tinnefeld, Philip

2014-01-01

Validating and testing a fluorescence microscope or a microscopy method requires defined samples that can be used as standards. DNA origami is a new tool that provides a framework to place defined numbers of small molecules such as fluorescent dyes or proteins in a programmed geometry with nanometer precision. The flexibility and versatility in the design of DNA origami microscopy standards makes them ideally suited for the broad variety of emerging super-resolution microscopy methods. As DNA origami structures are durable and portable, they can become a universally available specimen to check the everyday functionality of a microscope. The standards are immobilized on a glass slide, and they can be imaged without further preparation and can be stored for up to 6 months. We describe a detailed protocol for the design, production and use of DNA origami microscopy standards, and we introduce a DNA origami rectangle, bundles and a nanopillar as fluorescent nanoscopic rulers. The protocol provides procedures for the design and realization of fluorescent marks on DNA origami structures, their production and purification, quality control, handling, immobilization, measurement and data analysis. The procedure can be completed in 1-2 d.

Market Structure, Financial Dependence and Industrial Growth: Evidence from the Banking Industry in Emerging Asian Economies

PubMed Central

Khan, Habib Hussain; Ahmad, Rubi Binit; Gee, Chan Sok

2016-01-01

In this study, we examine the role of market structure for growth in financially dependent industries from 10 emerging Asian economies over the period of 1995–2011. Our approach departs from existing studies in that we apply four alternative measures of market structure based on structural and non-structural approaches and compare their outcomes. Results indicate that higher bank concentration may slow down the growth of financially dependent industries. Bank competition on the other hand, allows financially dependent industries to grow faster. These findings are consistent across a number of sensitivity checks such as alternative measures of financial dependence, institutional factors (including property rights, quality of accounting standards and bank ownership), and endogeneity consideration. In sum, our study suggests that financially dependent industries grow more in more competitive/less concentrated banking systems. Therefore, regulatory authorities need to be careful while pursuing a consolidation policy for banking sector in emerging Asian economies. PMID:27490847

Novel technologies for reverse osmosis concentrate treatment: a review.

PubMed

Joo, Sung Hee; Tansel, Berrin

2015-03-01

Global water shortages due to droughts and population growth have created increasing interest in water reuse and recycling and, concomitantly, development of effective water treatment processes. Pressured membrane processes, in particular reverse osmosis, have been adopted in water treatment industries and utilities despite the relatively high operational cost and energy consumption. However, emerging contaminants are present in reverse osmosis concentrate in higher concentrations than in the feed water, and have created challenges for treatment of the concentrate. Further, standards and guidelines for assessment and treatment of newly identified contaminants are currently lacking. Research is needed regarding the treatment and disposal of emerging contaminants of concern in reverse osmosis concentrate, in order to develop cost-effective methods for minimizing potential impacts on public health and the environment. This paper reviews treatment options for concentrate from membrane processes. Barriers to emerging treatment options are discussed and novel treatment processes are evaluated based on a literature review. Copyright © 2014 Elsevier Ltd. All rights reserved.

Haemostatic monitoring during postpartum haemorrhage and implications for management

PubMed Central

Solomon, C.; Collis, R. E.; Collins, P. W.

2012-01-01

Summary Postpartum haemorrhage (PPH) is a major risk factor for maternal morbidity and mortality. PPH has numerous causative factors, which makes its occurrence and severity difficult to predict. Underlying haemostatic imbalances such as consumptive and dilutional coagulopathies may develop during PPH, and can exacerbate bleeding and lead to progression to severe PPH. Monitoring coagulation status in patients with PPH may be crucial for effective haemostatic management, goal-directed therapy, and improved outcomes. However, current PPH management guidelines do not account for the altered baseline coagulation status observed in pregnant patients, and the appropriate transfusion triggers to use in PPH are unknown, due to a lack of high-quality studies specific to this area. In this review, we consider the evidence for the use of standard laboratory-based coagulation tests and point-of-care viscoelastic coagulation monitoring in PPH. Many laboratory-based tests are unsuitable for emergency use due to their long turnaround times, so have limited value for the management of PPH. Emerging evidence suggests that viscoelastic monitoring, using thrombelastography- or thromboelastometry-based tests, may be useful for rapid assessment and for guiding haemostatic therapy during PPH. However, further studies are needed to define the ranges of reference values that should be considered ‘normal’ in this setting. Improving awareness of the correct application and interpretation of viscoelastic coagulation monitoring techniques may be critical in realizing their emergency diagnostic potential. PMID:23075633

Biomimicry of volatile-based microbial control for managing emerging fungal pathogens.

PubMed

Gabriel, K T; Joseph Sexton, D; Cornelison, C T

2018-05-01

Volatile organic compounds (VOCs) are known to be produced by a wide range of micro-organisms and for a number of purposes. Volatile-based microbial inhibition in environments such as soil is well-founded, with numerous antimicrobial VOCs having been identified. Inhibitory VOCs are of interest as microbial control agents, as low concentrations of gaseous VOCs can elicit significant antimicrobial effects. Volatile organic compounds are organic chemicals typically characterized as having low molecular weight, low solubility in water, and high vapour pressure. Consequently, VOCs readily evaporate to the gaseous phase at standard temperature and pressure. This contact-independent antagonism presents unique advantages over traditional, contact-dependent microbial control methods, including increased surface exposure and reduced environmental persistence. This approach has been the focus of our recent research, with positive results suggesting it may be particularly promising for the management of emerging fungal pathogens, such as the causative agents of white-nose syndrome of bats and snake fungal disease, which are difficult or impossible to treat using traditional approaches. Here, we review the history of volatile-based microbial control, discuss recent progress in formulations that mimic naturally antagonistic VOCs, outline the development of a novel treatment device, and highlight areas where further work is needed to successfully deploy VOCs against existing and emerging fungal pathogens. © 2017 The Society for Applied Microbiology.

Does the Concept of the "Flipped Classroom" Extend to the Emergency Medicine Clinical Clerkship?

PubMed

Heitz, Corey; Prusakowski, Melanie; Willis, George; Franck, Christopher

2015-11-01

Linking educational objectives and clinical learning during clerkships can be difficult. Clinical shifts during emergency medicine (EM) clerkships provide a wide variety of experiences, some of which may not be relevant to recommended educational objectives. Students can be directed to standardize their clinical experiences, and this improves performance on examinations. We hypothesized that applying a "flipped classroom" model to the clinical clerkship would improve performance on multiple-choice testing when compared to standard learning. Students at two institutions were randomized to complete two of four selected EM clerkship topics in a "flipped fashion," and two others in a standard fashion. For flipped topics, students were directed to complete chief complaint-based asynchronous modules prior to a shift, during which they were directed to focus on the chief complaint. For the other two topics, modules were to be performed at the students' discretion, and shifts would not have a theme. At the end of the four-week clerkship, a 40-question multiple-choice examination was administered with 10 questions per topic. We compared performance on flipped topics with those performed in standard fashion. Students were surveyed on perceived effectiveness, ability to follow the protocol, and willingness of preceptors to allow a chief-complaint focus. Sixty-nine students participated; examination scores for 56 were available for analysis. For the primary outcome, no difference was seen between the flipped method and standard (p=0.494.) A mixed model approach showed no effect of flipped status, protocol adherence, or site of rotation on the primary outcome of exam scores. Students rated the concept of the flipped clerkship highly (3.48/5). Almost one third (31.1%) of students stated that they were unable to adhere to the protocol. Preparation for a clinical shift with pre-assigned, web-based learning modules followed by an attempt at chief-complaint-focused learning during a shift did not result in improvements in performance on a multiple-choice assessment of knowledge; however, one third of participants did not adhere strictly to the protocol. Future investigations should ensure performance of pre-assigned learning as well as clinical experiences, and consider alternate measures of knowledge.

29 CFR 1910.120 - Hazardous waste operations and emergency response.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 5 2014-07-01 2014-07-01 false Hazardous waste operations and emergency response. 1910.120 Section 1910.120 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Hazardous Materials § 1910.120 Hazardous waste operations and emergency...

29 CFR 1910.120 - Hazardous waste operations and emergency response.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 5 2012-07-01 2012-07-01 false Hazardous waste operations and emergency response. 1910.120 Section 1910.120 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Hazardous Materials § 1910.120 Hazardous waste operations and emergency...

29 CFR 1910.120 - Hazardous waste operations and emergency response.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 5 2013-07-01 2013-07-01 false Hazardous waste operations and emergency response. 1910.120 Section 1910.120 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Hazardous Materials § 1910.120 Hazardous waste operations and emergency...

Basic Training Program for Emergency Medical Technician Ambulance: Course Guide.

ERIC Educational Resources Information Center

Fucigna, Joseph T.; And Others

In an effort to upgrade or further develop the skills levels of all individuals involved in the emergency medical care service, this training program was developed for the National Highway Safety Bureau. This specific course is an attempt to organize, conduct, and standardize a basic training course for emergency medical technicians (EMTs). The…

Emergency Management Standards for NCAA Division I-A Football Stadia

ERIC Educational Resources Information Center

Hoogstra, Joshua R.

2012-01-01

In the best of times, emergency managers of athletic event venues struggle with the responsibilities of venue security. The possibility of terrorist threats exacerbates the situation, especially when security threats can involve a critical mass of spectators at an event. Emergency managers at the National Collegiate Athletic Association (NCAA)…

49 CFR 195.264 - Impoundment, protection against entry, normal/emergency venting or pressure/vacuum relief for...

Code of Federal Regulations, 2010 CFR

2010-10-01

... devices must be provided for each low-pressure and high-pressure breakout tank. (e) For normal/emergency... and vacuum-relieving devices installed on high pressure tanks built to API Standard 2510 (incorporated.../emergency venting or pressure/vacuum relief for aboveground breakout tanks. 195.264 Section 195.264...

Emergency medical equipment storage: benefits of visual cues tested in field and simulated settings.

PubMed

Grundgeiger, Tobias; Harris, Bonnie; Ford, Nicholas; Abbey, Michael; Sanderson, Penelope M; Venkatesh, Balasubramanian

2014-08-01

We tested the effectiveness of an illustrated divider ("the divider") for bedside emergency equipment drawers in an intensive care unit (ICU). In Study I, we assessed whether the divider increases completeness and standardizes the locations of emergency equipment within the drawer. In Study 2, we investigated whether the divider decreases nurses' restocking and retrieval times and decreases their workload. Easy access to fully stocked emergency equipment is important during emergencies. However, inefficient equipment storage and cognitively demanding work settings might mean that drawers are incompletely stocked and access to items is slow. A pre-post-post study investigated drawer completeness and item locations before and after the introduction of the divider to 30 ICU drawers. A subsequent experiment measured item restocking time, item retrieval time, and subjective workload for nurses. At 2 weeks and 10 weeks after the divider was introduced, the completeness of the drawer increased significantly compared with before the divider was introduced. The divider decreased the variability of the locations of the 17 items in the drawer to 16% of its original value. Study 2 showed that restocking times but not retrieval times were significantly faster with the divider present For both tasks, nurses rated their workload lower with the divider. The divider improved the standardization and completeness of emergency equipment. In addition, restocking times and workload were decreased with the divider. Redesigning storage for certain equipment using human factors design principles can help to speed and standardize restocking and ease access to equipment.

European Patient Summary Guideline: Focus on Greece.

PubMed

Berler, Alexander; Tagaris, Anastassios; Chronaki, Catherine

2016-01-01

The European Patient Summary (PS) guideline specifies a minimal dataset of essential and important information for unplanned or emergency care initially defined in the epSOS project with aim to improve patients' safety and quality of Care. The eHealth Network of European Union (EU) Member State (MS) representatives established under Article 14 of the EU directive 2011/24 on patient rights to cross-border healthcare adopted PS guideline in November 2013 and since then the guideline has been part of MS strategic eHealth implementation plans, standardization efforts, and concrete regional, national, European and international projects. This paper reviews implementation efforts for the implementation of an operational patient summary service in Greece drawing on challenges and lessons learned for sustainable standards-based large scale eHealth deployment in Europe and abroad, as well as the reuse of best practices from international standards and integration profiles.

Science Teacher Efficacy and Extrinsic Factors Toward Professional Development Using Video Games in a Design-Based Research Model: The Next Generation of STEM Learning

NASA Astrophysics Data System (ADS)

Annetta, Leonard A.; Frazier, Wendy M.; Folta, Elizabeth; Holmes, Shawn; Lamb, Richard; Cheng, Meng-Tzu

2013-02-01

Designed-based research principles guided the study of 51 secondary-science teachers in the second year of a 3-year professional development project. The project entailed the creation of student-centered, inquiry-based, science, video games. A professional development model appropriate for infusing innovative technologies into standards-based curricula was employed to determine how science teacher's attitudes and efficacy where impacted while designing science-based video games. The study's mixed-method design ascertained teacher efficacy on five factors (General computer use, Science Learning, Inquiry Teaching and Learning, Synchronous chat/text, and Playing Video Games) related to technology and gaming using a web-based survey). Qualitative data in the form of online blog posts was gathered during the project to assist in the triangulation and assessment of teacher efficacy. Data analyses consisted of an Analysis of Variance and serial coding of teacher reflective responses. Results indicated participants who used computers daily have higher efficacy while using inquiry-based teaching methods and science teaching and learning. Additional emergent findings revealed possible motivating factors for efficacy. This professional development project was focused on inquiry as a pedagogical strategy, standard-based science learning as means to develop content knowledge, and creating video games as technological knowledge. The project was consistent with the Technological Pedagogical Content Knowledge (TPCK) framework where overlapping circles of the three components indicates development of an integrated understanding of the suggested relationships. Findings provide suggestions for development of standards-based science education software, its integration into the curriculum and, strategies for implementing technology into teaching practices.

A computational framework for converting textual clinical diagnostic criteria into the quality data model.

PubMed

Hong, Na; Li, Dingcheng; Yu, Yue; Xiu, Qiongying; Liu, Hongfang; Jiang, Guoqian

2016-10-01

Constructing standard and computable clinical diagnostic criteria is an important but challenging research field in the clinical informatics community. The Quality Data Model (QDM) is emerging as a promising information model for standardizing clinical diagnostic criteria. To develop and evaluate automated methods for converting textual clinical diagnostic criteria in a structured format using QDM. We used a clinical Natural Language Processing (NLP) tool known as cTAKES to detect sentences and annotate events in diagnostic criteria. We developed a rule-based approach for assigning the QDM datatype(s) to an individual criterion, whereas we invoked a machine learning algorithm based on the Conditional Random Fields (CRFs) for annotating attributes belonging to each particular QDM datatype. We manually developed an annotated corpus as the gold standard and used standard measures (precision, recall and f-measure) for the performance evaluation. We harvested 267 individual criteria with the datatypes of Symptom and Laboratory Test from 63 textual diagnostic criteria. We manually annotated attributes and values in 142 individual Laboratory Test criteria. The average performance of our rule-based approach was 0.84 of precision, 0.86 of recall, and 0.85 of f-measure; the performance of CRFs-based classification was 0.95 of precision, 0.88 of recall and 0.91 of f-measure. We also implemented a web-based tool that automatically translates textual Laboratory Test criteria into the QDM XML template format. The results indicated that our approaches leveraging cTAKES and CRFs are effective in facilitating diagnostic criteria annotation and classification. Our NLP-based computational framework is a feasible and useful solution in developing diagnostic criteria representation and computerization. Copyright © 2016 Elsevier Inc. All rights reserved.

Nanotechnology: Emerging Developments and Early Detection of Cancer. A Two-Day Workshop Sponsored by the National Cancer Institute and the National Institute of Standards and Technology, August 30–31 2001, on the National Institute of Standards and Technology Campus, Gaithersburg, MD, USA

PubMed Central

Zullo, Steven J.; Srivastava, Sudhir; Looney, J. Patrick; Barker, Peter E.

2002-01-01

A recent meeting jointly sponsored by the National Cancer Institute (NCI) and National Institute of Standards and Technology (NIST) brought together researchers active in nanotechnology and cancer molecular biology to discuss and evaluate the interface between disciplines. Emerging areas where nanotechnologies may impact cancer prevention and early cancer detection were elaborated by key researchers who catalyzed interdisciplinary dialogue aimed at fostering cross-discipline communications and future collaboration. PMID:12590168

Vehicular crash data used to rank intersections by injury crash frequency and severity.

PubMed

Liu, Yi; Li, Zongzhi; Liu, Jingxian; Patel, Harshingar

2016-09-01

This article contains data on research conducted in "A double standard model for allocating limited emergency medical service vehicle resources ensuring service reliability" (Liu et al., 2016) [1]. The crash counts were sorted out from comprehensive crash records of over one thousand major signalized intersections in the city of Chicago from 2004 to 2010. For each intersection, vehicular crashes were counted by crash severity levels, including fatal, injury Types A, B, and C for major, moderate, and minor injury levels, property damage only (PDO), and unknown. The crash data was further used to rank intersections by equivalent injury crash frequency. The top 200 intersections with the highest number of crash occurrences identified based on crash frequency- and severity-based scenarios are shared in this brief. The provided data would be a valuable source for research in urban traffic safety analysis and could also be utilized to examine the effectiveness of traffic safety improvement planning and programming, intersection design enhancement, incident and emergency management, and law enforcement strategies.

Observations from Ground Zero at the World Trade Center in New York City, Part II: Theoretical and clinical considerations.

PubMed

Acosta, Judith K; Levenson, Richard L

2002-01-01

Part I of this series discussed our observations of Ground Zero of the World Trade Center (WTC) immediately after the attack on September 11, 2001, as well as the stress-response of police officers on site. This paper offers a variety of clinical techniques for emergency mental health practitioners and first responders for use with victims of critical incidents. The suggested interventions are based on the theory and clinical practice of Emergency Medical Hypnosis, Neuro-Linguistic Programming, and Ericksonian Psychotherapy. Specific examples of how they were applied with police personnel following the World Trade Center attack are provided along with specific clinical guidelines. These interventions are designed to augment and enhance standard CISM, mental health, and medical practice in the field.

Engineering of Nanoscale Contrast Agents for Optical Coherence Tomography.

PubMed

Gordon, Andrew Y; Jayagopal, Ashwath

2014-01-30

Optical coherence tomography has emerged as valuable imaging modalityin ophthalmology and other fields by enabling high-resolution three-dimensional imaging of tissue. In this paper, we review recent progress in the field of contrast-enhanced optical coherence tomography (OCT). We discuss exogenous and endogenous sources of OCT contrast, focusing on their use with standard OCT systems as well as emerging OCT-based imaging modalities. We include advances in the processing of OCT data that generate improved tissue contrast, including spectroscopic OCT (SOCT), as well as work utilizing secondary light sources and/or detection mechanisms to create and detect enhanced contrast, including photothermal OCT (PTOCT) and photoacoustic OCT (PAOCT). Finally, we conclude with a discussion of the translational potential of these developments as well as barriers to their clinical use.

Managing Environmental Liabilities using Full Lifecycle Accounting

DTIC Science & Technology

2009-05-01

aniJtl’lnut, ... Ill ld II d»INi"’ Ill £¢ttl> I .. IN F<£~DIO:L 11Contains Enfos Confidential and Proprietary Information EMERGING “ FAIR VALUE MEASUREMENT... Fair value measurement, also known as “mark-to-market”, has emerged as the favored measurement principle under U.S. and international financial...reporting standards over the past decade. In recent years, the FASB has adopted numerous standards requiring fair value measurement of liabilities

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.

Clinical audit of emergency unit before and after establishment of the emergency medicine department.

PubMed

Amini, Afshin; Dindoost, Payam; Moghimi, Mehrdad; Kariman, Hamid; Shahrami, Ali; Dolatabadi, Ali Arhami; Ali-Mohammadi, Hossein; Alavai-Moghaddam, Mostafa; Derakhshanfar, Hojjat; Hatamabadi, HamidReza; Heidari, Kamran; Alamdari, Shahram; Meibodi, Mohammad Kalantar; Shojaee, Majid; Foroozanfar, Mohammad Mehdi; Hashemi, Behrooz; Sabzeghaba, Anita; Kabir, Ali

2012-02-01

To assess the deficiencies and potential areas through a medical audit of the emergency departments, in six general hospitals affiliated to Shahid Beheshti University of Medical Sciences at Tehran, Iran, after preparing specific wards-based international standards. A checklist was completed for all hospitals which met our eligibility criteria mainly observation and interviews with head nurses and managers of the emergency medicine unit of the hospitals before (2003) and after (2008) the establishment of emergency departments there. Domains studied included staffing, education and continuing professional development (CPD), facility (design), equipment, ancillary services, medical records, manuals and references, research, administration, pre-hospital care, information systems, disaster planning, bench-marking and hospital accreditation. Education and CPD (p = 0.042), design and facility (p = 0.027), equipment (p = 0.028), and disaster (p = 0.026) had significantly improved after the establishment of emergency departments. Nearly all domains showed a positive change though it was non-significant in a few. In terms of observation, better improvement was seen in disaster, security, design, and research. According to the score for each domain compared to what it was in the earlier phase, better improvement was observed in hospital accreditation, information systems, security, disaster planning, and research. Security, disaster planning, research, design and facility had improved in hospitals that wave studied, while equipment, records, ancillary services, administration and bench-marking had the lowest improvement even after the establishment of emergency department, and, hence, needed specific attention.

Nonneurologic emergencies in boxing.

PubMed

Coletta, Domenic F

2009-10-01

Professional boxing has done an admirable job in promoting safety standards in its particular sport. However, injuries occur during the normal course of competition and, unfortunately, an occasional life-threatening emergency may arise. Although most common medical emergencies in boxing are injuries from closed head trauma, in this article those infrequent but potentially catastrophic nonneurologic conditions are reviewed along with some less serious emergencies that the physician must be prepared to address.

Survival of the hospital emergency department: strategic alternatives for the future.

PubMed

Widra, L S; Fottler, M D

1988-01-01

Diverse and pervasive environmental forces are reshaping hospital emergency services as hospitals strive to respond to consumer preferences related to cost and convenience. Complacency can no longer serve as a standard operating procedure for hospital emergency departments competing against lower-priced, consumer-oriented, free-standing facilities. Strategic alternatives, a five-step strategy for survival and growth, and a projection of future models of hospital emergency services are examined.

Recent Trends in Information Literacy and Instruction.

ERIC Educational Resources Information Center

Arp, Lori, Ed.; Woodard, Beth S., Ed.

2002-01-01

Discusses recent trends in information literacy and instruction. Topics include the emergence of standards and guidelines; standards in elementary and secondary schools; accreditation standards, certification, and mandates; defining what librarians do, particularly as teachers; plagiarism, copyright, and ethical behavior; and the impact of…

A Longitudinal Emergency Medical Services Track in Emergency Medicine Residency.

PubMed

Adams, Daniel; Bischof, Jason; Larrimore, Ashley; Krebs, William; King, Andrew

2017-03-30

Emergency medicine residency programs offer Emergency Medical Services (EMS) curricula to address Accreditation Council for Graduate Medical Education (ACGME) milestones. While some programs offer advanced clinical tracks in EMS, no standard curriculum exists. We sought to establish a well-defined EMS curriculum to allow interested residents to develop advanced clinical skills and scholarship within this subspecialty. Core EMS fellowship trained faculty were recruited to help develop the curriculum. Building on ACGME graduation requirements and milestones, important elements of EMS fellowship training were incorporated into the curriculum to develop the final document. The final curriculum focuses on scholarly activities relating to the four core areas of EMS identified by The American Board of Emergency Medicine and serves as an intermediary between ACGME graduation requirements for education in EMS and fellowship level training. Standardization of the EMS scholarly track can provide residents with the potential to obtain competency beyond ACGME requirements and prepare them for success in fellowship training and/or leadership within EMS on graduation.

A Longitudinal Emergency Medical Services Track in Emergency Medicine Residency

PubMed Central

Bischof, Jason; Larrimore, Ashley; Krebs, William; King, Andrew

2017-01-01

Emergency medicine residency programs offer Emergency Medical Services (EMS) curricula to address Accreditation Council for Graduate Medical Education (ACGME) milestones. While some programs offer advanced clinical tracks in EMS, no standard curriculum exists. We sought to establish a well-defined EMS curriculum to allow interested residents to develop advanced clinical skills and scholarship within this subspecialty. Core EMS fellowship trained faculty were recruited to help develop the curriculum. Building on ACGME graduation requirements and milestones, important elements of EMS fellowship training were incorporated into the curriculum to develop the final document. The final curriculum focuses on scholarly activities relating to the four core areas of EMS identified by The American Board of Emergency Medicine and serves as an intermediary between ACGME graduation requirements for education in EMS and fellowship level training. Standardization of the EMS scholarly track can provide residents with the potential to obtain competency beyond ACGME requirements and prepare them for success in fellowship training and/or leadership within EMS on graduation. PMID:28465874

Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool.

PubMed

Gonzalo, Jed D; Yang, Julius J; Stuckey, Heather L; Fischer, Christopher M; Sanchez, Leon D; Herzig, Shoshana J

2014-08-01

To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period. Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation. University-based, tertiary-care hospital. Internal medicine resident physicians admitting patients from the emergency department. An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers. (i) Incidence of reported near misses/adverse events, (ii) communication of key clinical information and quality of verbal communication and (iii) characterization of near misses/adverse events. Seventy-eight of 80 surveys (98%) and 1058 of 1388 surveys (76%) were completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related to perceived sufficiency/accuracy of diagnosis, treatment or disposition, and information quality. The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Calibrating emergent phenomena in stock markets with agent based models

PubMed Central

Sornette, Didier

2018-01-01

Since the 2008 financial crisis, agent-based models (ABMs), which account for out-of-equilibrium dynamics, heterogeneous preferences, time horizons and strategies, have often been envisioned as the new frontier that could revolutionise and displace the more standard models and tools in economics. However, their adoption and generalisation is drastically hindered by the absence of general reliable operational calibration methods. Here, we start with a different calibration angle that qualifies an ABM for its ability to achieve abnormal trading performance with respect to the buy-and-hold strategy when fed with real financial data. Starting from the common definition of standard minority and majority agents with binary strategies, we prove their equivalence to optimal decision trees. This efficient representation allows us to exhaustively test all meaningful single agent models for their potential anomalous investment performance, which we apply to the NASDAQ Composite index over the last 20 years. We uncover large significant predictive power, with anomalous Sharpe ratio and directional accuracy, in particular during the dotcom bubble and crash and the 2008 financial crisis. A principal component analysis reveals transient convergence between the anomalous minority and majority models. A novel combination of the optimal single-agent models of both classes into a two-agents model leads to remarkable superior investment performance, especially during the periods of bubbles and crashes. Our design opens the field of ABMs to construct novel types of advanced warning systems of market crises, based on the emergent collective intelligence of ABMs built on carefully designed optimal decision trees that can be reversed engineered from real financial data. PMID:29499049

Calibrating emergent phenomena in stock markets with agent based models.

PubMed

Fievet, Lucas; Sornette, Didier

2018-01-01

Since the 2008 financial crisis, agent-based models (ABMs), which account for out-of-equilibrium dynamics, heterogeneous preferences, time horizons and strategies, have often been envisioned as the new frontier that could revolutionise and displace the more standard models and tools in economics. However, their adoption and generalisation is drastically hindered by the absence of general reliable operational calibration methods. Here, we start with a different calibration angle that qualifies an ABM for its ability to achieve abnormal trading performance with respect to the buy-and-hold strategy when fed with real financial data. Starting from the common definition of standard minority and majority agents with binary strategies, we prove their equivalence to optimal decision trees. This efficient representation allows us to exhaustively test all meaningful single agent models for their potential anomalous investment performance, which we apply to the NASDAQ Composite index over the last 20 years. We uncover large significant predictive power, with anomalous Sharpe ratio and directional accuracy, in particular during the dotcom bubble and crash and the 2008 financial crisis. A principal component analysis reveals transient convergence between the anomalous minority and majority models. A novel combination of the optimal single-agent models of both classes into a two-agents model leads to remarkable superior investment performance, especially during the periods of bubbles and crashes. Our design opens the field of ABMs to construct novel types of advanced warning systems of market crises, based on the emergent collective intelligence of ABMs built on carefully designed optimal decision trees that can be reversed engineered from real financial data.