48 CFR 52.225-9 - Buy American Act-Construction Materials.

Code of Federal Regulations, 2010 CFR

2010-10-01

... subcontractor for incorporation into the building or work. The term also includes an item brought to the site preassembled from articles, materials, or supplies. However, emergency life safety systems, such as emergency... building or work and that are produced as complete systems, are evaluated as a single and distinct...

Field demonstration of on-site analytical methods for TNT and RDX in ground water

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

Craig, H.; Ferguson, G.; Markos, A.

1996-12-31

A field demonstration was conducted to assess the performance of eight commercially-available and emerging colorimetric, immunoassay, and biosensor on-site analytical methods for explosives 2,4,6-trinitrotoluene (TNT) and hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) in ground water and leachate at the Umatilla Army Depot Activity, Hermiston, Oregon and US Naval Submarine Base, Bangor, Washington, Superfund sites. Ground water samples were analyzed by each of the on-site methods and results compared to laboratory analysis using high performance liquid chromatography (HPLC) with EPA SW-846 Method 8330. The commercial methods evaluated include the EnSys, Inc., TNT and RDX colorimetric test kits (EPA SW-846 Methods 8515 and 8510) with amore » solid phase extraction (SPE) step, the DTECH/EM Science TNT and RDX immunoassay test kits (EPA SW-846 Methods 4050 and 4051), and the Ohmicron TNT immunoassay test kit. The emerging methods tested include the antibody-based Naval Research Laboratory (NRL) Continuous Flow Immunosensor (CFI) for TNT and RDX, and the Fiber Optic Biosensor (FOB) for TNT. Accuracy of the on-site methods were evaluated using linear regression analysis and relative percent difference (RPD) comparison criteria. Over the range of conditions tested, the colorimetric methods for TNT and RDX showed the highest accuracy of the emerging methods for TNT and RDX. The colorimetric method was selected for routine ground water monitoring at the Umatilla site, and further field testing on the NRL CFI and FOB biosensors will continue at both Superfund sites.« less

Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration.

PubMed

Burkhart, Lisa; Sohn, Min-Woong; Jordan, Neil; Tarlov, Elizabeth; Gampetro, Pamela; LaVela, Sherri L

2016-01-01

The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement. This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease. Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site. Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.

CONTROL TECHNOLOGY EXTRACTION OF MERCURY FROM GROUNDWATER IMMOBILIZED ALGAE

EPA Science Inventory

Bio-Recovery Systems, Inc. conducted a project under the Emerging Technology portion of the United States Environmental Protection Agency (EPAs) Superfund Innovative Technology Evaluation (SITE) Program to evaluate the ability of immobilized algae to adsorb mercury from contamina...

Designing Multimedia for the Hypertext Markup Language.

ERIC Educational Resources Information Center

Schwier, Richard A.; Misanchuk, Earl R.

Dynamic discussions have begun to emerge concerning style of presentation on world wide web sites. Some hypertext markup language (HTML) designers seek an intimate and chatty ambience, while others want to project a more professional image. Evaluators see many sites as overdecorated and indecipherable. This paper offers suggestions on selecting…

Assessing the Usability of University Websites: An Empirical Study on Namik Kemal University

ERIC Educational Resources Information Center

Mentes, S. Ahmet; Turan, Aykut H.

2012-01-01

Web sites are emerging as a key component of an organization's survival in our ever globalizing competitive world. Usability of a web site has assumed a great deal of importance in terms of satisfying web site users' needs and expectations. The aim of the study is to evaluate and to explore the usability level of Namik Kemal University (NKU)…

EPA'S SUPERFUND INNOVATIVE TECHNOLOGY EVALUATION (SITE) PROGRAM

EPA Science Inventory

In 1986, the U.S. Environmental Protection Agen- cy`s Offices of Solid Waste and Emergency Response (OSWER), and the Office of Research and Develop- ment (ORD) established a technology research, dem- onstration, and evaluation program to promote the development and use of alterna...

TEST KIT FOR FIELD EVALUATION OF THE CHEMICAL RESISTANCE OF PROTECTIVE CLOTHING

EPA Science Inventory

Personnel involved in emergency response and hazardous waste site activities often have the need to reach on-scene decisions regarding the effectiveness and limitations of chemical protective clothing. Three gravimetric techniques were evaluated as means for providing essential i...

Evidence-based support for the all-hazards approach to emergency preparedness

PubMed Central

2012-01-01

Background During the last decade there has been a need to respond and recover from various types of emergencies including mass casualty events (MCEs), mass toxicological/chemical events (MTEs), and biological events (pandemics and bio-terror agents). Effective emergency preparedness is more likely to be achieved if an all-hazards response plan is adopted. Objectives To investigate if there is a relationship among hospitals' preparedness for various emergency scenarios, and whether components of one emergency scenario correlate with preparedness for other emergency scenarios. Methods Emergency preparedness levels of all acute-care hospitals for MCEs, MTEs, and biological events were evaluated, utilizing a structured evaluation tool based on measurable parameters. Evaluations were made by professional experts in two phases: evaluation of standard operating procedures (SOPs) followed by a site visit. Relationships among total preparedness and different components' scores for various types of emergencies were analyzed. Results Significant relationships were found among preparedness for different emergencies. Standard Operating Procedures (SOPs) for biological events correlated with preparedness for all investigated emergency scenarios. Strong correlations were found between training and drills with preparedness for all investigated emergency scenarios. Conclusions Fundamental critical building blocks such as SOPs, training, and drill programs improve preparedness for different emergencies including MCEs, MTEs, and biological events, more than other building blocks, such as equipment or knowledge of personnel. SOPs are especially important in unfamiliar emergency scenarios. The findings support the adoption of an all-hazards approach to emergency preparedness. PMID:23098065

Prevention of EP Migratory Contamination in a Cluster Randomized Trial to Increase tPA Use in Stroke (The INSTINCT Trial)

PubMed Central

Weston, Victoria C.; Meurer, William J.; Frederiksen, Shirley M.; Fox, Allison K.; Scott, Phillip A.

2016-01-01

Objectives Cluster randomized trials (CRTs) are increasingly utilized to evaluate quality improvement interventions aimed at healthcare providers. In trials testing emergency department interventions, migration of emergency physicians (EPs) between hospitals is an important concern, as contamination may affect both internal and external validity. We hypothesized that geographically isolating emergency departments would prevent migratory contamination in a CRT designed to increase ED delivery of tPA in stroke (The INSTINCT Trial). Methods INSTINCT was a prospective, cluster randomized, controlled trial. 24 Michigan community hospitals were randomly selected in matched pairs for study. Contamination was defined at the cluster level, with substantial contamination defined a priori as >10% of EPs affected. Non-adherence, total crossover (contamination + non-adherence), migration distance and characteristics were determined. Results 307 emergency physicians were identified at all sites. Overall, 7 (2.3%) changed study sites. 1 moved between control sites, leaving 6 (2.0%) total crossovers. Of these, 2 (0.7%) moved from intervention to control (contamination) and 4 (1.3%) moved from control to intervention (non-adherence). Contamination was observed in 2 of 12 control sites, with 17% and 9% contamination of the total site EP workforce at follow-up, respectively. Average migration distance was 42 miles for all EPs moving in the study and 35 miles for EPs moving from intervention to control sites. Conclusion The mobile nature of emergency physicians should be considered in the design of quality improvement CRTs. Increased reporting of contamination in CRTs is encouraged to clarify thresholds and facilitate CRT design. PMID:25440230

OBSERVATIONAL STUDY OF FINAL CLEANING AND AHERA CLEARANCE SAMPLING AT ASBESTOS-ABATEMENT SITES IN NEW JERSEY

EPA Science Inventory

A study was conducted during the summer of 1988 to document final cleaning procedures and evaluate Asbestos Hazard Emergency Response Act (AHERA) clearance air sampling practices used at 20 asbestos-abatement sites in New Jersey. Each abatement took place in a school building and...

Contaminants of emerging concern in a mixed land use watershed: A two year study of occurrence and seasonal variation

USDA-ARS?s Scientific Manuscript database

The occurrence and variation of twenty-six contaminants of emerging concern (CECs) were evaluated in water samples collected from four stream sites over two years in the Zumbro River watershed, Minnesota, U.S.A. Selected CECs included pharmaceuticals and personal care products (PPCPs), pesticides, v...

Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

ERIC Educational Resources Information Center

Asarnow, Joan Rosenbaum; Baraff, Larry J.; Berk, Michele; Grob, Charles; Devich-Navarro, Mona; Suddath, Robert; Piacentini, John; Tang, Lingqi

2008-01-01

The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing…

The eMERGE Network: a consortium of biorepositories linked to electronic medical records data for conducting genomic studies.

PubMed

McCarty, Catherine A; Chisholm, Rex L; Chute, Christopher G; Kullo, Iftikhar J; Jarvik, Gail P; Larson, Eric B; Li, Rongling; Masys, Daniel R; Ritchie, Marylyn D; Roden, Dan M; Struewing, Jeffery P; Wolf, Wendy A

2011-01-26

The eMERGE (electronic MEdical Records and GEnomics) Network is an NHGRI-supported consortium of five institutions to explore the utility of DNA repositories coupled to Electronic Medical Record (EMR) systems for advancing discovery in genome science. eMERGE also includes a special emphasis on the ethical, legal and social issues related to these endeavors. The five sites are supported by an Administrative Coordinating Center. Setting of network goals is initiated by working groups: (1) Genomics, (2) Informatics, and (3) Consent & Community Consultation, which also includes active participation by investigators outside the eMERGE funded sites, and (4) Return of Results Oversight Committee. The Steering Committee, comprised of site PIs and representatives and NHGRI staff, meet three times per year, once per year with the External Scientific Panel. The primary site-specific phenotypes for which samples have undergone genome-wide association study (GWAS) genotyping are cataract and HDL, dementia, electrocardiographic QRS duration, peripheral arterial disease, and type 2 diabetes. A GWAS is also being undertaken for resistant hypertension in ≈ 2,000 additional samples identified across the network sites, to be added to data available for samples already genotyped. Funded by ARRA supplements, secondary phenotypes have been added at all sites to leverage the genotyping data, and hypothyroidism is being analyzed as a cross-network phenotype. Results are being posted in dbGaP. Other key eMERGE activities include evaluation of the issues associated with cross-site deployment of common algorithms to identify cases and controls in EMRs, data privacy of genomic and clinically-derived data, developing approaches for large-scale meta-analysis of GWAS data across five sites, and a community consultation and consent initiative at each site. Plans are underway to expand the network in diversity of populations and incorporation of GWAS findings into clinical care. By combining advanced clinical informatics, genome science, and community consultation, eMERGE represents a first step in the development of data-driven approaches to incorporate genomic information into routine healthcare delivery.

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

PubMed

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

2014-09-01

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

Effects of fine sediment, hyporheic flow, and spawning site characteristics on survival and development of bull trout embryos

USGS Publications Warehouse

Bowerman, Tracy; Neilson, Bethany; Budy, Phaedra

2014-01-01

Successful spawning is imperative for the persistence of salmonid populations, but relatively little research has been conducted to evaluate factors affecting early life-stage survival for bull trout (Salvelinus confluentus), a threatened char. We conducted a field experiment to assess the relationship between site-specific environmental factors and bull trout embryo survival and fry emergence timing. Survival from egg to hatch was negatively related to percent fine sediment (<1 mm) in the redd and positively related to the strength of downwelling at spawning sites. Survival of eggs to fry emergence was also negatively related to fine sediment, and the best statistical models included additional variables that described the rate of downwelling and intragravel flow within the incubation environment. Fry emerged at an earlier stage in development from redds with high percentages of fine sediment. Increased hydraulic conductivity via redd construction and selection of spawning sites with strong downwelling appear to enhance hyporheic flow rates and bull trout egg survival, but early life-stage success may ultimately be limited by intrusion of fine sediment into the incubation environment.

Supplementing seed banks to rehabilitate disturbed Mojave Desert shrublands: where do all the seeds go?

USGS Publications Warehouse

DeFalco, Lesley A.; Esque, Todd C.; Nicklas, Melissa B.; Kane, Jeffrey M.

2012-01-01

Revegetation of degraded arid lands often involves supplementing impoverished seed banks and improving the seedbed, yet these approaches frequently fail. To understand these failures, we tracked the fates of seeds for six shrub species that were broadcast across two contrasting surface disturbances common to the Mojave Desert—sites compacted by concentrated vehicle use and trenched sites where topsoil and subsurface soils were mixed. We evaluated seedbed treatments that enhance soil-seed contact (tackifier) and create surface roughness while reducing soil bulk density (harrowing). We also explored whether seed harvesting by granivores and seedling suppression by non-native annuals influence the success of broadcast seeding in revegetating degraded shrublands. Ten weeks after treatments, seeds readily moved off of experimental plots in untreated compacted sites, but seed movements were reduced 32% by tackifier and 55% through harrowing. Harrowing promoted seedling emergence in compacted sites, particularly for the early-colonizing species Encelia farinosa, but tackifier was largely ineffective. The inherent surface roughness of trenched sites retained three times the number of seeds than compacted sites, but soil mixing during trench development likely altered the suitability of the seedbed thus resulting in poor seedling emergence. Non-native annuals had little influence on seed fates during our study. In contrast, the prevalence of harvester ants increased seed removal on compacted sites, whereas rodent activity influenced removal on trenched sites. Future success of broadcast seeding in arid lands depends on evaluating disturbance characteristics prior to seeding and selecting appropriate species and seasons for application.

The Emergency Landing Planner Experiment

NASA Technical Reports Server (NTRS)

Meuleau, Nocolas F.; Neukom, Christian; Plaunt, Christian John; Smith, David E.; Smith, Tristan B.

2011-01-01

In previous work, we described an Emergency Landing Planner (ELP) designed to assist pilots in choosing the best emergency landing site when damage or failures occur in an aircraft. In this paper, we briefly describe the system, but focus on the integration of this system into the cockpit of a 6 DOF full-motion simulator and a study designed to evaluate the ELP. We discuss the results of this study, the lessons learned, and some of the issues involved in advancing this work further.

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

PubMed

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

2011-02-01

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

Habitat segregation of Ambystoma gracile and Ambystoma macrodactylum in mountain ponds, Mount Rainer National Park, Washington, USA

USGS Publications Warehouse

Hoffman, Robert L.; Larson, Gary L.; Brokes, Brendan J.

2003-01-01

Ambystoma gracile (Baird) and Ambystoma macrodactylum Baird are common salamander species occupying key trophic positions in mountain ponds and lakes of Mount Rainier National Park (MORA). Based on amphibian surveys conducted in ponds and lakes in the northeast quadrant of MORA during the summers of 1993a??1995, 20 sites were resampled in 1996 to document and evaluate distributions of the two species relative to site habitat characteristics. Distributions of larvae were assessed either by nearshore snorkel or visual encounter surveys of each study site. Twelve environmental variables representing pond and lake physical characteristics, water quality, and nutrient concentrations were measured. The occurrences at each site of three major habitat components (i.e., pond bottom firmness, coarse woody debris, and emergent/aquatic vegetation) were qualitatively estimated. Allotopic distributions of larval populations of both species were related to site elevation, maximum depth, organic content of bottom substrates, and surface area. Ambystoma gracile sites were larger, deeper, lower in elevation, had flocculent sediment higher in organic content, abundant coarse woody debris, and limited emergent/aquatic vegetation relative to A. macrodactylum sites. Ambystoma macrodactylum sites were smaller, shallower, higher in elevation, had firm sediments low in organic content, and had a greater occurrence of emergent/aquatic vegetation than did A. gracile sites. Two sites supported syntopic populations and exhibited many of the habitat characteristics observed at sites inhabited by each species. The distribution of each species in MORA was related to the interconnection between habitat characteristics of ponds and lakes and species life-history patterns and possibly interspecific interactions.

An evaluation of remote sensing technologies for the detection of fugitive contamination at selected Superfund hazardous waste sites in Pennsylvania

USGS Publications Warehouse

Slonecker, E. Terrence; Fisher, Gary B.

2014-01-01

This evaluation was conducted to assess the potential for using both traditional remote sensing, such as aerial imagery, and emerging remote sensing technology, such as hyperspectral imaging, as tools for postclosure monitoring of selected hazardous waste sites. Sixteen deleted Superfund (SF) National Priorities List (NPL) sites in Pennsylvania were imaged with a Civil Air Patrol (CAP) Airborne Real-Time Cueing Hyperspectral Enhanced Reconnaissance (ARCHER) sensor between 2009 and 2012. Deleted sites are those sites that have been remediated and removed from the NPL. The imagery was processed to radiance and atmospherically corrected to relative reflectance with standard software routines using the Environment for Visualizing Imagery (ENVI, ITT–VIS, Boulder, Colorado) software. Standard routines for anomaly detection, endmember collection, vegetation stress, and spectral analysis were applied.

SUPERFUND INNOVATIVE TECHNOLOGY EVALUATION - TECHNOLOGY PROFILES

EPA Science Inventory

This document is intended as a reference guide for EPA Regional decision makers and others interested in technologies in the SITE Demonstration and Emerging Technologies programs. The Technologies are described in technology profiles, presented in alphabetical order by developer ...

Site Selection and Resource Allocation of Oil Spill Emergency Base for Offshore Oil Facilities

NASA Astrophysics Data System (ADS)

Li, Yunbin; Liu, Jingxian; Wei, Lei; Wu, Weihuang

2018-02-01

Based on the analysis of the historical data about oil spill accidents in the Bohai Sea, this paper discretizes oil spilled source into a limited number of spill points. According to the probability of oil spill risk, the demand for salvage forces at each oil spill point is evaluated. Aiming at the specific location of the rescue base around the Bohai Sea, a cost-benefit analysis is conducted to determine the total cost of disasters for each rescue base. Based on the relationship between the oil spill point and the rescue site, a multi-objective optimization location model for the oil spill rescue base in the Bohai Sea region is established. And the genetic algorithm is used to solve the optimization problem, and determine the emergency rescue base optimization program and emergency resources allocation ratio.

Supplementing seed banks to rehabilitate disturbed Mojave Desert shrublands: Where do all the seeds go?

USGS Publications Warehouse

DeFalco, L.A.; Esque, T.C.; Nicklas, M.B.; Kane, J.M.

2012-01-01

Revegetation of degraded arid lands often involves supplementing impoverished seed banks and improving the seedbed, yet these approaches frequently fail. To understand these failures, we tracked the fates of seeds for six shrub species that were broadcast across two contrasting surface disturbances common to the Mojave Desert-sites compacted by concentrated vehicle use and trenched sites where topsoil and subsurface soils were mixed. We evaluated seedbed treatments that enhance soil-seed contact (tackifier) and create surface roughness while reducing soil bulk density (harrowing). We also explored whether seed harvesting by granivores and seedling suppression by non-native annuals influence the success of broadcast seeding in revegetating degraded shrublands. Ten weeks after treatments, seeds readily moved off of experimental plots in untreated compacted sites, but seed movements were reduced 32% by tackifier and 55% through harrowing. Harrowing promoted seedling emergence in compacted sites, particularly for the early-colonizing species Encelia farinosa, but tackifier was largely ineffective. The inherent surface roughness of trenched sites retained three times the number of seeds than compacted sites, but soil mixing during trench development likely altered the suitability of the seedbed thus resulting in poor seedling emergence. Non-native annuals had little influence on seed fates during our study. In contrast, the prevalence of harvester ants increased seed removal on compacted sites, whereas rodent activity influenced removal on trenched sites. Future success of broadcast seeding in arid lands depends on evaluating disturbance characteristics prior to seeding and selecting appropriate species and seasons for application. ?? 2010 Society for Ecological Restoration International.

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.

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.

An evaluation of traditional and emerging remote sensing technologies for the detection of fugitive contamination at selected Superfund hazardous waste sites

USGS Publications Warehouse

Slonecker, E. Terrence; Fisher, Gary B.

2011-01-01

This report represents a remote sensing research effort conducted by the U.S. Geological Survey in cooperation with the U.S. Environmental Protection Agency (EPA) for the EPA Office of Inspector General. The objective of this investigation was to explore the efficacy of remote sensing as a technology for postclosure monitoring of hazardous waste sites as defined under the Comprehensive Environmental Response Compensation and Liability Act of 1980 (Public Law 96-510, 42 U.S.C. §9601 et seq.), also known as \\"Superfund.\\" Five delisted Superfund sites in Maryland and Virginia were imaged with a hyperspectral sensor and visited for collection of soil, water, and spectral samples and inspection of general site conditions. This report evaluates traditional and hyperspectral imagery and field spectroscopic measurement techniques in the characterization and analysis of fugitive (anthropogenic, uncontrolled) contamination at previously remediated hazardous waste disposal sites.

Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency.

PubMed

Saleh, Fareed; Breslin, Kristen; Mullan, Paul C; Tillett, Zachary; Chamberlain, James M

2017-10-31

The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency. We obtained productivity data based on billing records measured in emergency relative value units for (1) both evaluation and management of visits and (2) procedures for 16 pediatric emergency medicine providers with more than 750 hours worked per year. Eligible shifts were in an urban, academic pediatric emergency department (ED) with 2 sites: a tertiary care main campus and a satellite community site. We used multivariable linear regression to adjust for the impact of shift and pediatric ED characteristics on individual-provider efficiency and then removed variables from the model with minimal effect on productivity. There were 2998 eligible shifts for the 16 providers during a 3-year period. The resulting model included 4 variables when looking at both ED sites combined. These variables include the following: (1) number of procedures billed by provider, (2) season of the year, (3) shift start time, and (4) day of week. Results were improved when we separately modeled each ED location. A 3-variable model using procedures billed by provider, shift start time, and season explained 23% of the variation in provider efficiency at the academic ED site. A 3-variable model using procedures billed by provider, patient arrivals per hour, and shift start time explained 45% of the variation in provider efficiency at the satellite ED site. Several nonprovider factors affect provider efficiency. These factors should be considered when designing productivity-based incentives.

Left-right asymmetries and shape analysis on Ceroglossus chilensis (Coleoptera: Carabidae)

NASA Astrophysics Data System (ADS)

Bravi, Raffaella; Benítez, Hugo A.

2013-10-01

Bilateral symmetry is widespread in animal kingdom, however most animal can deviate from expected symmetry and manifest some kind of asymmetries. Fluctuating asymmetry is considered as a tool for valuating developmental instability, whereas directional asymmetry is inherited and could be used for evaluating evolutionary development. We use the method of geometric morphometrics to analyze left/right asymmetries in the whole body, in two sites and totally six populations of Ceroglossus chilensis with the aim to infer and explain morphological disparities between populations and sexes in this species. In all individuals analyzed we found both fluctuating asymmetry and directional asymmetry for size and shape variation components, and a high sexual dimorphism. Moreover a high morphological variability between the two sites emerged as well. Differences in diet could influence the expression of morphological variation and simultaneously affect body sides, and therefore contribute to the symmetric component of variation. Moreover differences emerged between two sites could be a consequence of isolation and fragmentation, rather than a response to local environmental differences between sampling sites.

International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents.

PubMed

Strapazzon, Giacomo; Reisten, Oliver; Argenone, Fabien; Zafren, Ken; Zen-Ruffinen, Greg; Larsen, Gordon L; Soteras, Inigo

2018-06-01

Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

EMERGING TECHNOLOGY SUMMARY: ELECTRO-PURE ALTERNATING CURRENT ELECTROCOAGULATION

EPA Science Inventory

The Superfund Innovative Technology Evaluation (SITE) Program was authorized as part of the 1986 amendments to the Superfund legislation. It represents a joint effort between the U.S. Environmental Protection Agency’s (EPA) Office of Research and Development and Office of Solid W...

Evaluation of emergency drug releases from the Centers for Disease Control and Prevention Quarantine Stations

PubMed Central

Roohi, Shahrokh; Grinnell, Margaret; Sandoval, Michelle; Cohen, Nicole J.; Crocker, Kimberly; Allen, Christopher; Dougherty, Cindy; Jolly, Julian; Pesik, Nicki

2018-01-01

The Centers for Disease Control and Prevention (CDC) Quarantine Stations distribute select lifesaving drug products that are not commercially available or are in limited supply in the United States for emergency treatment of certain health conditions. Following a retrospective analysis of shipment records, the authors estimated an average of 6.66 hours saved per shipment when drug products were distributed from quarantine stations compared to a hypothetical centralized site from CDC headquarters in Atlanta, GA. This evaluation supports the continued use of a decentralized model which leverages CDC's regional presence and maximizes efficiency in the distribution of lifesaving drugs. PMID:25779896

Evaluation of emergency drug releases from the Centers for Disease Control and Prevention Quarantine Stations.

PubMed

Roohi, Shahrokh; Grinnell, Margaret; Sandoval, Michelle; Cohen, Nicole J; Crocker, Kimberly; Allen, Christopher; Dougherty, Cindy; Jolly, Julian; Pesik, Nicki

2015-01-01

The Centers for Disease Control and Prevention (CDC) Quarantine Stations distribute select lifesaving drug products that are not commercially available or are in limited supply in the United States for emergency treatment of certain health conditions. Following a retrospective analysis of shipment records, the authors estimated an average of 6.66 hours saved per shipment when drug products were distributed from quarantine stations compared to a hypothetical centralized site from CDC headquarters in Atlanta, GA. This evaluation supports the continued use of a decentralized model which leverages CDC's regional presence and maximizes efficiency in the distribution of lifesaving drugs.

Emergence of Secondary Trigger Sites after Primary Migraine Surgery.

PubMed

Punjabi, Ayesha; Brown, Matthew; Guyuron, Bahman

2016-04-01

Surgical decompression of a migraine headache may unmask headaches originating from secondary sites. A retrospective chart review investigated the incidence and characteristics of secondary trigger sites to identify clinical patterns that could aid in predicting and perhaps reducing postoperative migraines. One hundred eighty-five charts for migraine patients who underwent surgery at the senior author's (B.G.) practice were reviewed. Sites from which migraine headaches initiated or occurred independently were considered primary. The sites that were not active at the time of preoperative evaluation but became active after surgery were considered secondary. Bivariate analysis was performed to characterize postoperative migraines. Of 185 patients, 33 (17.8 percent) developed secondary migraine headache trigger sites. Of patients with primary site I (frontal) symptoms, 20.83 percent had site III (septonasal) symptoms unmasked after surgery (versus 7 percent for patients with other primary sites; p = 0.04). Of the patients with site II (temporal) migraines, 17.14 percent had secondary frontal symptoms (versus 5.68 percent; p = 0.04). Primary site II symptoms predicted postoperative site IV (occipital) symptoms (11.43 versus 1.1 percent; p = 0.008), and primary occipital symptoms predicted postoperative temporal symptoms (11.1 versus 2.33 percent; p = 0.04). The authors observed that 17.8 percent of patients develop postoperative migraine headache triggers that are not reported during the initial assessment. Knowledge of secondary migraine emergence patterns, and the presence of some preoperative symptoms, can aid in predicting the migraines that will arise from a new site postoperatively. Therapeutic, IV.

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

PubMed

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

2012-07-01

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

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

PubMed

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

2017-08-01

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

Combining ecosystem services assessment with structured decision making to support ecological restoration planning.

PubMed

Martin, David M; Mazzotta, Marisa; Bousquin, Justin

2018-04-10

Accounting for ecosystem services in environmental decision making is an emerging research topic. Modern frameworks for ecosystem services assessment emphasize evaluating the social benefits of ecosystems, in terms of who benefits and by how much, to aid in comparing multiple courses of action. Structured methods that use decision analytic-approaches are emerging for the practice of ecological restoration. In this article, we combine ecosystem services assessment with structured decision making to estimate and evaluate measures of the potential benefits of ecological restoration with a case study in the Woonasquatucket River watershed, Rhode Island, USA. We partnered with a local watershed management organization to analyze dozens of candidate wetland restoration sites for their abilities to supply five ecosystem services-flood water retention, scenic landscapes, learning opportunities, recreational opportunities, and birds. We developed 22 benefit indicators related to the ecosystem services as well as indicators for social equity and reliability that benefits will sustain in the future. We applied conceptual modeling and spatial analysis to estimate indicator values for each candidate restoration site. Lastly, we developed a decision support tool to score and aggregate the values for the organization to screen the restoration sites. Results show that restoration sites in urban areas can provide greater social benefits than sites in less urban areas. Our research approach is general and can be used to investigate other restoration planning studies that perform ecosystem services assessment and fit into a decision-making process.

Christmas Valley Renewable Energy Assessment

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

Del Mar, Robert

In partnership with the Oregon Military Department, the Department of Energy used the award to assess and evaluate renewable resources in a 2,622-acre location in Lake County, central Oregon, leading to future development of up to 200 MW of solar electricity. In partnership with the Oregon Military Department, the Department of Energy used the award to assess and evaluate renewable resources in a 2,622-acre location in Lake County, central Oregon, leading to future development of up to 200 MW of solar electricity. The Oregon Military Department (Military) acquired a large parcel of land located in south central Oregon. The landmore » was previously owned by the US Air Force and developed for an Over-the-Horizon Backscatter Radar Transmitter Facility, located about 10 miles east of the town of Christmas Valley. The Military is investigating a number of uses for the site, including Research and Development (R&D) laboratory, emergency response, military operations, developing renewable energy and related educational programs. One of the key potential uses would be for a large scale solar photovoltaic power plant. This is an attractive use because the site has excellent solar exposure; an existing strong electrical interconnection to the power grid; and a secure location at a moderate cost per acre. The project objectives include: 1. Site evaluation 2. Research and Development (R&D) facility analysis 3. Utility interconnection studies and agreements 4. Additional on-site renewable energy resources analysis 5. Community education, outreach and mitigation 6. Renewable energy and emergency readiness training program for veterans« less

Impact of chiropractic services at an on-site health center.

PubMed

Kindermann, Sylvia L; Hou, Qingjiang; Miller, Ross M

2014-09-01

To compare the influence of employer-sponsored, on-site chiropractic care against community-obtained care on health care utilization. This was a retrospective claims analysis of members of a single employee health plan receiving chiropractic care on-site or off-site from 2010 to 2012. Utilization differences were evaluated by having 1 health care event or more, including radiology or clinical visits. There were 876 on-site and 759 off-site participants. The off-site group received more radiology services overall (55.5% vs 38.2%; P < 0.001) including magnetic resonance imaging, ultrasound, and radiograph (all P < 0.0001); had higher outpatient (P < 0.0001) and emergency department (P = 0.022) utilization; and demonstrated greater use of chiropractic care and physical therapy (both P < 0.0001). Compared with off-site care, on-site chiropractic services are associated with lower health care utilization. These results support the value of chiropractic services offered at on-site health centers.

Detection limits of tidal-wetland sequences to identify variable rupture modes of megathrust earthquakes

NASA Astrophysics Data System (ADS)

Shennan, Ian; Garrett, Ed; Barlow, Natasha

2016-10-01

Recent paleoseismological studies question whether segment boundaries identified for 20th and 21st century great, >M8, earthquakes persist through multiple earthquake cycles or whether smaller segments with different boundaries rupture and cause significant hazards. The smaller segments may include some currently slipping rather than locked. In this review, we outline general principles regarding indicators of relative sea-level change in tidal wetlands and the conditions in which paleoseismic indicators must be distinct from those resulting from non-seismic processes. We present new evidence from sites across southcentral Alaska to illustrate different detection limits of paleoseismic indicators and consider alternative interpretations for marsh submergence and emergence. We compare predictions of coseismic uplift and subsidence derived from geophysical models of earthquakes with different rupture modes. The spatial patterns of agreement and misfits between model predictions and quantitative reconstructions of coseismic submergence and emergence suggest that no earthquake within the last 4000 years had a pattern of rupture the same as the Mw 9.2 Alaska earthquake in 1964. From the Alaska examples and research from other subduction zones we suggest that If we want to understand whether a megathrust ruptures in segments of variable length in different earthquakes, we need to be site-specific as to what sort of geological-based criteria eliminate the possibility of a particular rupture mode in different earthquakes. We conclude that coastal paleoseismological studies benefit from a methodological framework that employs rigorous evaluation of five essential criteria and a sixth which may be very robust but only occur at some sites: 1 - lateral extent of peat-mud or mud-peat couplets with sharp contacts; 2 - suddenness of submergence or emergence, and replicated within each site; 3 - amount of vertical motion, quantified with 95% error terms and replicated within each site; 4 - syncroneity of submergence and emergence based on statistical age modelling; 5 - spatial pattern of submergence and emergence; 6 - possible additional evidence, such as evidence of a tsunami or liquefaction concurrent with submergence or emergence. We suggest that it is possible to consider detection limits as low as 0.1-0.2 m coseismic vertical change.

Pre-Feasibility Analysis of Pellet Manufacturing on the Former Loring Air Force Base Site. A Study Prepared in Partnership with the Environmental Protection Agency for the RE-Powering America's Land Initiative: Siting Renewable Energy on Potentially Contaminated Land and Mine Sites

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

Hunsberger, R.; Mosey, G.

2014-04-01

The U.S. Environmental Protection Agency (EPA) Office of Solid Waste and Emergency Response, in accordance with the RE-Powering America's Lands initiative, engaged the U.S. Department of Energy's (DOE) National Renewable Energy Laboratory (NREL) to conduct feasibility studies to assess the viability of developing renewable energy generating facilities on contaminated sites. This site, in Limestone, Maine -- formerly the location of the Loring Air Force Base but now owned by the Aroostook Band of Micmac -- was selected for the potential to produce heating pellets from woody feedstock. Biomass was chosen as the renewable energy resource to evaluate based on abundantmore » woody-biomass resources available in the area. NREL also evaluates potential savings from converting existing Micmac property from oil-fired heating to pellet heating.« less

EPA RE-Powering Mapper Feasibility Studies

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. As part of the RE-Powering America's Land Initiative, the EPA and the U.S. Department of Energy's National Renewable Energy Laboratory (NREL) evaluated the feasibility of developing renewable energy production on Superfund, brownfields, and former landfill or mining sites. These reports pair EPA's expertise on contaminated sites with the renewable energy expertise of NREL.

Outcomes of nonemergent percutaneous coronary intervention with and without on-site surgical backup: a meta-analysis.

PubMed

Singh, Param Puneet; Singh, Mukesh; Bedi, Updesh Singh; Adigopula, Sasikanth; Singh, Sarabjeet; Kodumuri, Vamsi; Molnar, Janos; Ahmed, Aziz; Arora, Rohit; Khosla, Sandeep

2011-01-01

Despite major advances in percutaneous coronary intervention (PCI) techniques, the current guidelines recommend against elective PCI at hospitals without on-site cardiac surgery backup. Nonetheless, an increasing number of hospitals without on-site cardiac surgery in the United States have developed programs for elective PCI. Studies evaluating outcome in this setting have yielded mixed results, leaving the question unanswered. Hence, a meta-analysis comparing outcomes of nonemergent PCI in hospitals with and without on-site surgical backup was performed. A systematic review of literature identified four studies involving 6817 patients. Three clinical end points were extracted from each study and included in-hospital death, myocardial infarction, and the need for emergency coronary artery bypass grafting. The studies were homogenous for each outcome studied. Therefore, the combined relative risks (RRs) across all the studies and the 95% confidence intervals (CIs) were computed using the Mantel-Haenszel fixed-effect model. A two-sided alpha error less than 0.05 was considered to be statistically significant. Compared with facilities with on-site surgical backup, the risk of in-hospital death (RR, 2.7; CI, 0.6-12.9; P = 0.18), nonfatal myocardial infarction (RR, 1.3; CI, 0.7- 2.2; P = 0.29), and need of emergent coronary artery bypass grafting (RR, 0.46; CI, 0.06- 3.1; P = 0.43) was similar in those lacking on-site surgical backup. The present meta-analysis suggests that there is no difference in the outcome with regard to risk of nonfatal myocardial infarction, need for emergency coronary artery bypass grafting, and the risk of death in patients undergoing elective PCI in hospitals with and without on-site cardiac surgery backup.

Revegetation practices on the Santa Rita Experimental Range

Treesearch

Bruce D. Munda; Mark J. Pater

2003-01-01

This paper discusses the revegetation activites on the Santa Rita Experimental Range since 1903. Revegetation research includes experiments to evaluate adaptation, seedbed preparation, and sowing methods. We also discuss criteria used to determine if a site has the potential for a successful revegetation. Successful revegetation was initially based on plant emergence...

Evaluation of small sensor technology for criteria air pollutants at ground-based sites and a citizen science network

EPA Science Inventory

A number of small sensor technologies for the measurement of NOz, O: and other criteriapollutants have recently emerged. There is a growing interest in understanding the capability ofsensor technology in accurately measuring ambient concentrations of gas-phase criteriapollutants....

BABCOCK & WILCOX CYCLONE VITRIFICATION TECHNOLOGY FOR CONTAMINATED SOIL

EPA Science Inventory

The Babcock & Wilcox 6 million Btu/hr pilot cyclone furnace was successfully used in a 2-yr Superfund Innovative Technology Evaluation (SITE) Emerging Technology project to melt and vitrify an EPA Synthetic Soil Matrix (SSM) spiked with 7,000 ppm lead, 1,000 ppm cadmium, and 1,5...

A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments

PubMed Central

Stiell, Ian G.; Clement, Catherine M.; Grimshaw, Jeremy M.; Brison, Robert J.; Rowe, Brian H.; Lee, Jacques S.; Shah, Amit; Brehaut, Jamie; Holroyd, Brian R.; Schull, Michael J.; McKnight, R. Douglas; Eisenhauer, Mary A.; Dreyer, Jonathan; Letovsky, Eric; Rutledge, Tim; MacPhail, Iain; Ross, Scott; Perry, Jeffrey J.; Ip, Urbain; Lesiuk, Howard; Bennett, Carol; Wells, George A.

2010-01-01

Background The Canadian CT Head Rule was developed to allow physicians to be more selective when ordering computed tomography (CT) imaging for patients with minor head injury. We sought to evaluate the effectiveness of implementing this validated decision rule at multiple emergency departments. Methods We conducted a matched-pair cluster-randomized trial that compared the outcomes of 4531 patients with minor head injury during two 12-month periods (before and after) at hospital emergency departments in Canada, six of which were randomly allocated as intervention sites and six as control sites. At the intervention sites, active strategies, including education, changes to policy and real-time reminders on radiologic requisitions were used to implement the Canadian CT Head Rule. The main outcome measure was referral for CT scan of the head. Results Baseline characteristics of patients were similar when comparing control to intervention sites. At the intervention sites, the proportion of patients referred for CT imaging increased from the “before” period (62.8%) to the “after” period (76.2%) (difference +13.3%, 95% CI 9.7%–17.0%). At the control sites, the proportion of CT imaging usage also increased, from 67.5% to 74.1% (difference +6.7%, 95% CI 2.6%–10.8%). The change in mean imaging rates from the “before” period to the “after” period for intervention versus control hospitals was not significant (p = 0.16). There were no missed brain injuries or adverse outcomes. Interpretation Our knowledge–translation-based trial of the Canadian CT Head Rule did not reduce rates of CT imaging in Canadian emergency departments. Future studies should identify strategies to deal with barriers to implementation of this decision rule and explore more effective approaches to knowledge translation. (ClinicalTrials.gov trial register no. NCT00993252) PMID:20732978

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

PubMed

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

2018-01-28

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

Assessing emergency planning zone for new nuclear power plant considering risk of extreme external events

NASA Astrophysics Data System (ADS)

Alzbutas, Robertas

2015-04-01

In general, the Emergency Planning Zones (EPZ) are defined as well as plant site and arrangement structures are designed to minimize the potential for natural and manmade hazards external to the plant from affecting the plant safety related functions, which can affect nearby population and environment. This may include consideration of extreme winds, fires, flooding, aircraft crash, seismic activity, etc. Thus the design basis for plant and site is deeply related to the effects of any postulated external events and the limitation of the plant capability to cope with accidents i.e. perform safety functions. It has been observed that the Probabilistic Safety Assessment (PSA) methodologies to deal with EPZ and extreme external events have not reached the same level of maturity as for severe internal events. The design basis for any plant and site is deeply related to the effects of any postulated external events and the limitation of the plant capability to cope with accidents i.e. perform safety functions. As a prime example of an advanced reactor and new Nuclear Power Plant (NPP) with enhanced safety, the International Reactor Innovative and Secure (IRIS) and Site selection for New NPP in Lithuania had been considered in this work. In the used Safety-by-Design™ approach, the PSA played obviously a key role; therefore a Preliminary IRIS PSA had been developed along with the design. For the design and pre-licensing process of IRIS the external events analysis included both qualitative evaluation and quantitative assessment. As a result of preliminary qualitative analyses, the external events that were chosen for more detailed quantitative scoping evaluation were high winds and tornadoes, aircraft crash, and seismic events. For the site selection in Lithuania a detail site evaluation process was performed and related to the EPZ and risk zoning considerations. In general, applying the quantitative assessment, bounding site characteristics could be used in order to optimize potential redefinition or future restrictions on plant siting and risk zoning. It must be noticed that the use of existing regulations and installations as the basis for this redefinition will not in any way impact the high degree of conservatism inherent in current regulations. Moreover, the remapping process makes this methodology partially independent from the uncertainties still affecting probabilistic techniques. Notwithstanding these considerations, it is still expected that applying this methodology to advanced plant designs with improved safety features will allow significant changes in the emergency planning requirements, and specifically the size of the EPZ. In particular, in the case of IRIS it is expected that taking full credit of the Safety-by-Design™ approach of the IRIS reactor will allow a dramatic changes in the EPZ, while still maintaining a level of protection to the public fully consistent with existing regulations.

Prevention of emergency physician migratory contamination in a cluster randomized trial to increase tissue plasminogen activator use in stroke (the INSTINCT trial).

PubMed

Weston, Victoria C; Meurer, William J; Frederiksen, Shirley M; Fox, Allison K; Scott, Phillip A

2014-12-01

Cluster randomized trials (CRTs) are increasingly used to evaluate quality improvement interventions aimed at health care providers. In trials testing emergency department (ED) interventions, migration of emergency physicians (EPs) between hospitals is an important concern, as contamination may affect both internal and external validity. We hypothesized that geographically isolating EDs would prevent migratory contamination in a CRT designed to increase ED delivery of tissue plasminogen activator (tPA) in stroke (the INSTINCT trial). INSTINCT was a prospective, cluster randomized, controlled trial. Twenty-four Michigan community hospitals were randomly selected in matched pairs for study. Contamination was defined at the cluster level, with substantial contamination defined a priori as greater than 10% of EPs affected. Nonadherence, total crossover (contamination+nonadherence), migration distance, and characteristics were determined. Three hundred seven EPs were identified at all sites. Overall, 7 (2.3%) changed study sites. One moved between control sites, leaving 6 (2.0%) total crossovers. Of these, 2 (0.7%) moved from intervention to control (contamination); and 4 (1.3%) moved from control to intervention (nonadherence). Contamination was observed in 2 of 12 control sites, with 17% and 9% contamination of the total site EP workforce at follow-up, respectively. Average migration distance was 42 miles for all EPs moving in the study and 35 miles for EPs moving from intervention to control sites. The mobile nature of EPs should be considered in the design of quality improvement CRTs. Increased reporting of contamination in CRTs is encouraged to clarify thresholds and facilitate CRT design. Copyright © 2014 Elsevier Inc. All rights reserved.

Statistical analysis of stream water-quality data and sampling network design near Oklahoma City, central Oklahoma, 1977-1999

USGS Publications Warehouse

Brigham, Mark E.; Payne, Gregory A.; Andrews, William J.; Abbott, Marvin M.

2002-01-01

The sampling network was evaluated with respect to areal coverage, sampling frequency, and analytical schedules. Areal coverage could be expanded to include one additional watershed that is not part of the current network. A new sampling site on the North Canadian River might be useful because of expanding urbanization west of the city, but sampling at some other sites could be discontinued or reduced based on comparisons of data between the sites. Additional real-time or periodic monitoring for dissolved oxygen may be useful to prevent anoxic conditions in pools behind new low-water dams. The sampling schedules, both monthly and quarterly, are adequate to evaluate trends, but additional sampling during flow extremes may be needed to quantify loads and evaluate water-quality during flow extremes. Emerging water-quality issues may require sampling for volatile organic compounds, sulfide, total phosphorus, chlorophyll-a, Esherichia coli, and enterococci, as well as use of more sensitive laboratory analytical methods for determination of cadmium, mercury, lead, and silver.

Effect of emamectin benzoate on mortality, proboscis extension, gustation and reproduction of the corn earworm, Helicoverpa zea

USDA-ARS?s Scientific Manuscript database

Newly emerged bollworm adults, Helicoverpa zea (Boddie) require carbohydrate source from plant exudates and nectars for reproduction. Adults actively seek such feeding sites upon eclosion in their natural habitat. We wanted to evaluate this nocturnal behavior of the bollworm for potential use as a p...

SITE EMERGING TECHNOLOGY SUMMARY: INTEGRATION OF PHOTOCATALYTIC OXIDATION WITH AIR STRIPPING OF CONTAMINATED AQUIFERS

EPA Science Inventory

In a recently completed test program, bench-scale laboratory studies at Arizona State University (ASU) in Tempe, AZ, and pilot-scale studies in a simulated field test situation at Zentox Corp in Ocala, FL, were performed to evaluate the integration of gas-solid ultraviolet (UV) p...

75 FR 75 - Special Conditions: Boeing Model 787-8 Airplane; Overhead Crew Rest Compartment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

..., explain the reason for any recommended change, and include supporting data. We ask that you send us two...-site operational evaluation. Any changes to the approved OCR compartment configuration that affect crewmember emergency egress or any other procedures affecting safety of the occupying crewmembers or related...

Thermodynamics of Strecker synthesis in hydrothermal systems

NASA Technical Reports Server (NTRS)

Schulte, Mitchell; Shock, Everett

1995-01-01

Submarine hydrothermal systems on the early Earth may have been the sites from which life emerged. The potential for Strecker synthesis to produce biomolecules (amino and hydroxy acids) from starting compounds (ketones, aldehydes, HCN and ammonia) in such environments is evaluated quantitatively using thermodynamic data and parameters for the revised Helgeson-Kirkham-Flowers (HKF) equation of state. Although there is an overwhelming thermodynamic drive to form biomolecules by the Strecker synthesis at hydrothermal conditions, the availability and concentration of starting compounds limit the efficiency and productivity of Strecker reactions. Mechanisms for concentrating reactant compounds could help overcome this problem, but other mechanisms for production of biomolecules may have been required to produce the required compounds on the early Earth. Geochemical constraints imposed by hydrothermal systems provide important clues for determining the potential of these and other systems as sites for the emergence of life.

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

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

Not Available

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

Open space suitability analysis for emergency shelter after an earthquake

NASA Astrophysics Data System (ADS)

Anhorn, J.; Khazai, B.

2014-06-01

In an emergency situation shelter space is crucial for people affected by natural hazards. Emergency planners in disaster relief and mass care can greatly benefit from a sound methodology that identifies suitable shelter areas and sites where shelter services need to be improved. A methodology to rank suitability of open spaces for contingency planning and placement of shelter in the immediate aftermath of a disaster is introduced. The Open Space Suitability Index (OSSI) uses the combination of two different measures: a qualitative evaluation criterion for the suitability and manageability of open spaces to be used as shelter sites, and a second quantitative criterion using a capacitated accessibility analysis based on network analysis. For the qualitative assessment, implementation issues, environmental considerations, and basic utility supply are the main categories to rank candidate shelter sites. Geographic Information System (GIS) is used to reveal spatial patterns of shelter demand. Advantages and limitations of this method are discussed on the basis of a case study in Kathmandu Metropolitan City (KMC). According to the results, out of 410 open spaces under investigation, 12.2% have to be considered not suitable (Category D and E) while 10.7% are Category A and 17.6% are Category B. Almost two third (59.5%) are fairly suitable (Category C).

Open space suitability analysis for emergency shelter after an earthquake

NASA Astrophysics Data System (ADS)

Anhorn, J.; Khazai, B.

2015-04-01

In an emergency situation shelter space is crucial for people affected by natural hazards. Emergency planners in disaster relief and mass care can greatly benefit from a sound methodology that identifies suitable shelter areas and sites where shelter services need to be improved. A methodology to rank suitability of open spaces for contingency planning and placement of shelter in the immediate aftermath of a disaster is introduced. The Open Space Suitability Index uses the combination of two different measures: a qualitative evaluation criterion for the suitability and manageability of open spaces to be used as shelter sites and another quantitative criterion using a capacitated accessibility analysis based on network analysis. For the qualitative assessment implementation issues, environmental considerations and basic utility supply are the main categories to rank candidate shelter sites. A geographic information system is used to reveal spatial patterns of shelter demand. Advantages and limitations of this method are discussed on the basis of an earthquake hazard case study in the Kathmandu Metropolitan City. According to the results, out of 410 open spaces under investigation, 12.2% have to be considered not suitable (Category D and E) while 10.7% are Category A and 17.6% are Category B. Almost two-thirds (59.55%) are fairly suitable (Category C).

Data collected to support monitoring of constructed emergent sandbar habitat on the Missouri River downstream from Gavins Point Dam, South Dakota and Nebraska, 2004-06

USGS Publications Warehouse

Thompson, Ryan F.; Johnson, Michaela R.; Andersen, Michael J.

2007-01-01

The U.S. Army Corps of Engineers has constructed emergent sandbar habitat on sections of the Missouri River bordering South Dakota and Nebraska downstream from Gavins Point Dam to create and enhance habitat for threatened and endangered bird species. Two areas near river miles 761.3 and 769.8 were selected for construction of emergent sandbar habitat. Pre- and postconstruction data were collected by the U.S. Geological Survey, in cooperation with the U.S. Army Corps of Engineers, to evaluate the success of the habitat management techniques. Data collected include pre- and postconstruction channel-geometry data (bathymetric and topographic) for areas upstream from, downstream from, and within each construction site. Water-velocity data were collected for selected parts of the site near river mile 769.8. Instruments and methods used in data collection, as well as quality-assurance and quality-control measures, are described. Geospatial channel-geometry data are presented for transects of the river channel as cross sections and as geographical information system shapefiles. Geospatial land-surface elevation data are provided for part of each site in the form of a color-shaded relief map. Geospatial water-velocity data also are provided as color-shaded maps and geographical information system shapefiles.

Targeting smooth emergence: the effect site concentration of remifentanil for preventing cough during emergence during propofol-remifentanil anaesthesia for thyroid surgery.

PubMed

Lee, B; Lee, J-R; Na, S

2009-06-01

The administration of short-acting opioids can be a reliable and safe method to prevent coughing during emergence from anaesthesia but the proper dose or effect site concentration of remifentanil for this purpose has not been reported. We therefore investigated the effect site concentration (Ce) of remifentanil for preventing cough during emergence from anaesthesia with propofol-remifentanil target-controlled infusion. Twenty-three ASA I-II grade female patients, aged 23-66 yr undergoing elective thyroidectomy were enrolled in this study. EC(50) and EC(95) of remifentanil for preventing cough were determined using Dixon's up-and-down method and probit analysis. Propofol effect site concentration at extubation, mean arterial pressure, and heart rate (HR) were compared in patients with smooth emergence and without smooth emergence. Three out of 11 patients with remifentanil Ce of 1.5 ng ml(-1) and all seven patients with Ce of 2.0 ng ml(-1) did not cough during emergence; the EC(50) of remifentanil that suppressed coughing was 1.46 ng ml(-1) by Dixon's up-and-down method, and EC(95) was 2.14 ng ml(-1) by probit analysis. Effect site concentration of propofol at awakening was similar in patients with a smooth emergence and those without smooth emergence, but HR and arterial pressure were higher in those who coughed during emergence. Clinically significant hypoventilation was not seen in any patient. We found that the EC(95) of effect site concentration of remifentanil to suppress coughing at emergence from anaesthesia was 2.14 ng ml(-1). Maintaining an established Ce of remifentanil is a reliable method of abolishing cough and thereby targeting smooth emergence from anaesthesia.

SU-E-J-92: On-Line Cone Beam CT Based Planning for Emergency and Palliative Radiation Therapy

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

Held, M; Morin, O; Pouliot, J

2014-06-01

Purpose: To evaluate and develop the feasibility of on-line cone beam CT based planning for emergency and palliative radiotherapy treatments. Methods: Subsequent to phantom studies, a case library of 28 clinical megavoltage cone beam CT (MVCBCT) was built to assess dose-planning accuracies on MVCBCT for all anatomical sites. A simple emergency treatment plan was created on the MVCBCT and copied to its reference CT. The agreement between the dose distributions of each image pair was evaluated by the mean dose difference of the dose volume and the gamma index of the central 2D axial plane. An array of popular urgentmore » and palliative cases was also evaluated for imaging component clearance and field-of-view. Results: The treatment cases were categorized into four groups (head and neck, thorax/spine, pelvis and extremities). Dose distributions for head and neck treatments were predicted accurately in all cases with a gamma index of >95% for 2% and 2 mm criteria. Thoracic spine treatments had a gamma index as low as 60% indicating a need for better uniformity correction and tissue density calibration. Small anatomy changes between CT and MVCBCT could contribute to local errors. Pelvis and sacral spine treatment cases had a gamma index between 90% and 98% for 3%/3 mm criteria. The limited FOV became an issue for large pelvis patients. Imaging clearance was difficult for cases where the tumor was positioned far off midline. Conclusion: The MVCBCT based dose planning and delivery approach is feasible in many treatment cases. Dose distributions for head and neck patients are unrestrictedly predictable. Some FOV restrictions apply to other treatment sites. Lung tissue is most challenging for accurate dose calculations given the current imaging filters and corrections. Additional clinical cases for extremities need to be included in the study to assess the full range of site-specific planning accuracies. This work is supported by Siemens.« less

Where to go? Strategic modelling of access to emergency shelters in Mozambique.

PubMed

Gall, Melanie

2004-03-01

This paper, through spatial-analysis techniques, examines the accessibility of emergency shelters for vulnerable populations, and outlines the benefits of an extended and permanently established shelter network in central Mozambique. The raster-based modelling approach considers data on land cover, locations of accommodation centres in 2000, settlements and infrastructure. The shelter analysis is a two-step process determining access for vulnerable communities first, followed by a suitability analysis for additional emergency shelter sites. The results indicate the need for both retrofitting existing infrastructure (schools, health posts) to function as shelters during an emergency, and constructing new facilities - at best multi-purpose facilities that can serve as social infrastructure and shelter. Besides assessing the current situation in terms of availability and accessibility of emergency shelters, this paper provides an example of evaluating the effectiveness of humanitarian assistance without conventional mechanisms like food tonnage and number of beneficiaries.

American Society for Therapeutic Radiology and Oncology (ASTRO) Emerging Technology Committee report on electronic brachytherapy.

PubMed

Park, Catherine C; Yom, Sue S; Podgorsak, Matthew B; Harris, Eleanor; Price, Robert A; Bevan, Alison; Pouliot, Jean; Konski, Andre A; Wallner, Paul E

2010-03-15

The development of novel technologies for the safe and effective delivery of radiation is critical to advancing the field of radiation oncology. The Emerging Technology Committee of the American Society for Therapeutic Radiology and Oncology appointed a Task Group within its Evaluation Subcommittee to evaluate new electronic brachytherapy methods that are being developed for, or are already in, clinical use. The Task Group evaluated two devices, the Axxent Electronic Brachytherapy System by Xoft, Inc. (Fremont, CA), and the Intrabeam Photon Radiosurgery Device by Carl Zeiss Surgical (Oberkochen, Germany). These devices are designed to deliver electronically generated radiation, and because of their relatively low energy output, they do not fall under existing regulatory scrutiny of radioactive sources that are used for conventional radioisotope brachytherapy. This report provides a descriptive overview of the technologies, current and future projected applications, comparison of competing technologies, potential impact, and potential safety issues. The full Emerging Technology Committee report is available on the American Society for Therapeutic Radiology and Oncology Web site. Copyright 2010. Published by Elsevier Inc.

American Society for Therapeutic Radiology and Oncology (ASTRO) Emerging Technology Committee Report on Electronic Brachytherapy

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

Park, Catherine C., E-mail: cpark@radonc.ucsf.ed; Yom, Sue S.; Podgorsak, Matthew B.

The development of novel technologies for the safe and effective delivery of radiation is critical to advancing the field of radiation oncology. The Emerging Technology Committee of the American Society for Therapeutic Radiology and Oncology appointed a Task Group within its Evaluation Subcommittee to evaluate new electronic brachytherapy methods that are being developed for, or are already in, clinical use. The Task Group evaluated two devices, the Axxent Electronic Brachytherapy System by Xoft, Inc. (Fremont, CA), and the Intrabeam Photon Radiosurgery Device by Carl Zeiss Surgical (Oberkochen, Germany). These devices are designed to deliver electronically generated radiation, and because ofmore » their relatively low energy output, they do not fall under existing regulatory scrutiny of radioactive sources that are used for conventional radioisotope brachytherapy. This report provides a descriptive overview of the technologies, current and future projected applications, comparison of competing technologies, potential impact, and potential safety issues. The full Emerging Technology Committee report is available on the American Society for Therapeutic Radiology and Oncology Web site.« less

Emergency Immigration Education Act Programs: Summer E.S.L. Welcome Plus Program for Students of Limited English Proficiency (LEP), Summer Bilingual Program, and Project Omega. OREA Report.

ERIC Educational Resources Information Center

Duque, Diana L.

This report presents findings of the evaluation by the New York City public school system's Office of Research, Evaluation, and Assessment of three programs (Summer E.S.L. Welcome Plus, Summer Bilingual, and Project Omega) for immigrant students. The Summer E.S.L. (English as a Second Language) Welcome Plus program operated at 19 sites in New York…

National Program for Inspection of Non-Federal Dams. Farm Brook Site 2A Dam (CT 01546), Connecticut Coastal Basin, Hamden, Connecticut. Phase I Inspection Report.

DTIC Science & Technology

1981-09-01

01546 NAME OF DAM: Farm Brook Site 2A Darn TO4N: Hamden COUNTY AND STATE: New Haven County, Connecticut STREAM: Wilmot Brook *DATE OF INSPECTION...few lives. Therefore, an emergency operation plan, including a downstream warning system should be prepared and implemented. It is recommended that...3.2 Evaluation 3-4 4. OPERATIONAL & MAINTENANCE PROCEDURES - 4.1 Operational Procedures 4-1 a. General b. Description of any Warning System in Effect

Development, Evaluation and Implementation of Chief Complaint Groupings to Activate Data Collection: A Multi-Center Study of Clinical Decision Support for Children with Head Trauma.

PubMed

Deakyne, S J; Bajaj, L; Hoffman, J; Alessandrini, E; Ballard, D W; Norris, R; Tzimenatos, L; Swietlik, M; Tham, E; Grundmeier, R W; Kuppermann, N; Dayan, P S

2015-01-01

Overuse of cranial computed tomography scans in children with blunt head trauma unnecessarily exposes them to radiation. The Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma prediction rules identify children who do not require a computed tomography scan. Electronic health record (EHR) based clinical decision support (CDS) may effectively implement these rules but must only be provided for appropriate patients in order to minimize excessive alerts. To develop, implement and evaluate site-specific groupings of chief complaints (CC) that accurately identify children with head trauma, in order to activate data collection in an EHR. As part of a 13 site clinical trial comparing cranial computed tomography use before and after implementation of CDS, four PECARN sites centrally developed and locally implemented CC groupings to trigger a clinical trial alert (CTA) to facilitate the completion of an emergency department head trauma data collection template. We tested and chose CC groupings to attain high sensitivity while maintaining at least moderate specificity. Due to variability in CCs available, identical groupings across sites were not possible. We noted substantial variability in the sensitivity and specificity of seemingly similar CC groupings between sites. The implemented CC groupings had sensitivities greater than 90% with specificities between 75-89%. During the trial, formal testing and provider feedback led to tailoring of the CC groupings at some sites. CC groupings can be successfully developed and implemented across multiple sites to accurately identify patients who should have a CTA triggered to facilitate EHR data collection. However, CC groupings will necessarily vary in order to attain high sensitivity and moderate-to-high specificity. In future trials, the balance between sensitivity and specificity should be considered based on the nature of the clinical condition, including prevalence and morbidity, in addition to the goals of the intervention being considered.

Security concept in 'MyAngelWeb' a website for the individual patient at risk of emergency.

PubMed

Pinciroli, F; Nahaissi, D; Boschini, M; Ferrari, R; Meloni, G; Camnasio, M; Spaggiari, P; Carnerone, G

2000-11-01

We describe the Security Plan for the 'MyAngelWeb' service. The different actors involved in the service are subject to different security procedures. The core of the security system is implemented at the host site by means of a DBMS and standard Information Technology tools. Hardware requirements for sustainable security are needed at the web-site construction sites. They are not needed at the emergency physician's site. At the emergency physician's site, a two-way authentication system (password and test phrase method) is implemented.

Security concept in 'MyAngelWeb((R))' a website for the individual patient at risk of emergency.

PubMed

Pinciroli; Nahaissi; Boschini; Ferrari; Meloni; Camnasio; Spaggiari; Carnerone

2000-11-01

We describe the Security Plan for the 'MyAngelWeb' service. The different actors involved in the service are subject to different security procedures. The core of the security system is implemented at the host site by means of a DBMS and standard Information Technology tools. Hardware requirements for sustainable security are needed at the web-site construction sites. They are not needed at the emergency physician's site. At the emergency physician's site, a two-way authentication system (password and test phrase method) is implemented.

Real-time analysis application for identifying bursty local areas related to emergency topics.

PubMed

Sakai, Tatsuhiro; Tamura, Keiichi

2015-01-01

Since social media started getting more attention from users on the Internet, social media has been one of the most important information source in the world. Especially, with the increasing popularity of social media, data posted on social media sites are rapidly becoming collective intelligence, which is a term used to refer to new media that is displacing traditional media. In this paper, we focus on geotagged tweets on the Twitter site. These geotagged tweets are referred to as georeferenced documents because they include not only a short text message, but also the documents' posting time and location. Many researchers have been tackling the development of new data mining techniques for georeferenced documents to identify and analyze emergency topics, such as natural disasters, weather, diseases, and other incidents. In particular, the utilization of geotagged tweets to identify and analyze natural disasters has received much attention from administrative agencies recently because some case studies have achieved compelling results. In this paper, we propose a novel real-time analysis application for identifying bursty local areas related to emergency topics. The aim of our new application is to provide new platforms that can identify and analyze the localities of emergency topics. The proposed application is composed of three core computational intelligence techniques: the Naive Bayes classifier technique, the spatiotemporal clustering technique, and the burst detection technique. Moreover, we have implemented two types of application interface: a Web application interface and an android application interface. To evaluate the proposed application, we have implemented a real-time weather observation system embedded the proposed application. we used actual crawling geotagged tweets posted on the Twitter site. The weather observation system successfully detected bursty local areas related to observed emergency weather topics.

Emergency preparedness among people living near US army chemical weapons sites after September 11, 2001.

PubMed

Williams, Bryan L; Magsumbol, Melina S

2007-09-01

We examined trust in the army and perceptions of emergency preparedness among residents living near the Anniston, Ala, and Richmond, Ky, US Army chemical weapons stockpile sites shortly after September 11, 2001. Residents (n = 655) living near the 2 sites who participated in a cross-sectional population were relatively unprepared in the event of a chemical emergency. The events of September 11 gave rise to concerns regarding the security of stored chemical weapons and the sites' vulnerability to terrorist attacks. Although residents expressed trust in the army to manage chemical weapons safely, only a few expressed a desire to actively participate in site decisions. Compliance with procedures during emergencies could be seriously limited, putting residents in these sites at higher levels of risk of exposure to chemical hazards than nonresidents.

Developing on-site paper colorimetric monitoring technique for quick evaluating copper ion concentration in mineral wastewater

NASA Astrophysics Data System (ADS)

Liu, Guokun; Peng, Jingji; Zheng, Hong; Yuan, Dongxing

2018-05-01

With the reinforce of the copper mining, the on-site monitoring of the accompanied effluent discharge is highly demanded for the emergency response to minimize the negative effect of the effluent on the surrounding ecosystem. On the basis of the specific interaction between Cu2+ and L-Cysteine (L-Cys), which was modified on gold nanoparticles (Au NPs), and the aggregation dependent surface plasmon resonance (SPR) of Au NPs, we developed an easy-on-going paper colorimetric method for the quick evaluating the copper ion concentration in the waste water excreted from the copper mine. The color change of L-Cys modified Au NPs (L-Cys-Au NPs)immobilized on a filter paper was very sensitive to the Cu2+ concentration and free of interference from other metal ions typically in waste water. The proposed paper colorimetry has the LOD of 0.09 mg/L and the linear range of 0.1-10 mg/L, respectively, with the RSD (n = 5) was 6.6% for 1 mg/L Cu2+ and 3.5% for 5 mg/L Cu2+. The quantitative analysis results for the mineral wastewater is in good agreement the China National Environmental Protection Standards HJ485-2009, which indicates the current method could be developed to the on-site detection technique for the emergency response in monitoring Cu2+ in industrial wastewater or polluted water.

DEVELOPMENT OF EMERGING TECHNOLOGIES WITHIN THE SITE PROGRAM

EPA Science Inventory

The Site Program is formed by five research programs: the Demonstration Program, the Emerging Technology Program, the Measurement and Monitoring Technology Development Program, the Innovative Technology Program, and the Technology Transfer Program. The Emerging Technology (ET) P...

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.

Reconstruction of the Radiation Emergency Medical System From the Acute to the Sub-acute Phases After the Fukushima Nuclear Power Plant Crisis

PubMed Central

OJINO, Mayo; ISHII, Masami

2014-01-01

The radiation emergency medical system in Japan ceased to function as a result of the accident at the Fukushima Daiichi Nuclear Power Plant, which has commonly become known as the “Fukushima Accident.” In this paper, we review the reconstruction processes of the radiation emergency medical system in order of events and examine the ongoing challenges to overcoming deficiencies and reinforcing the system by reviewing relevant literature, including the official documents of the investigation committees of the National Diet of Japan, the Japanese government, and the Tokyo Electric Power Company, as well as technical papers written by the doctors involved in radiation emergency medical activities in Fukushima. Our review has revealed that the reconstruction was achieved in 6 stages from March 11 to July 1, 2011: (1) Re-establishment of an off-site center (March 13), (2) Re-establishment of a secondary radiation emergency hospital (March 14), (3) Reconstruction of the initial response system for radiation emergency care (April 2), (4) Reinforcement of the off-site center and stationing of disaster medical advisors at the off-site center (April 4), (5) Reinforcement of the medical care system and an increase in the number of hospitals for non-contaminated patients (From April 2 to June 23), and (6) Enhancement of the medical care system in the Fukushima Nuclear Power Plant and the construction of a new medical care system, involving both industrial medicine and emergency medicine (July 1). Medical resources such as voluntary efforts, academic societies, a local community medical system and university hospitals involved in medical care activities on 6 stages originally had not planned. In the future, radiation emergency medical systems should be evaluated with these 6 stages as a basis, in order to reinforce and enrich both the existing and backup systems so that minimal harm will come to nuclear power plant workers or evacuees and that they will receive proper care. This will involve creating a network of medical resources becoming involved across the country. PMID:25237278

Reconstruction of the Radiation Emergency Medical System From the Acute to the Sub-acute Phases After the Fukushima Nuclear Power Plant Crisis.

PubMed

Ojino, Mayo; Ishii, Masami

2014-02-01

The radiation emergency medical system in Japan ceased to function as a result of the accident at the Fukushima Daiichi Nuclear Power Plant, which has commonly become known as the "Fukushima Accident." In this paper, we review the reconstruction processes of the radiation emergency medical system in order of events and examine the ongoing challenges to overcoming deficiencies and reinforcing the system by reviewing relevant literature, including the official documents of the investigation committees of the National Diet of Japan, the Japanese government, and the Tokyo Electric Power Company, as well as technical papers written by the doctors involved in radiation emergency medical activities in Fukushima. Our review has revealed that the reconstruction was achieved in 6 stages from March 11 to July 1, 2011: (1) Re-establishment of an off-site center (March 13), (2) Re-establishment of a secondary radiation emergency hospital (March 14), (3) Reconstruction of the initial response system for radiation emergency care (April 2), (4) Reinforcement of the off-site center and stationing of disaster medical advisors at the off-site center (April 4), (5) Reinforcement of the medical care system and an increase in the number of hospitals for non-contaminated patients (From April 2 to June 23), and (6) Enhancement of the medical care system in the Fukushima Nuclear Power Plant and the construction of a new medical care system, involving both industrial medicine and emergency medicine (July 1). Medical resources such as voluntary efforts, academic societies, a local community medical system and university hospitals involved in medical care activities on 6 stages originally had not planned. In the future, radiation emergency medical systems should be evaluated with these 6 stages as a basis, in order to reinforce and enrich both the existing and backup systems so that minimal harm will come to nuclear power plant workers or evacuees and that they will receive proper care. This will involve creating a network of medical resources becoming involved across the country.

Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial.

PubMed

Jabbour, Mona; Curran, Janet; Scott, Shannon D; Guttman, Astrid; Rotter, Thomas; Ducharme, Francine M; Lougheed, M Diane; McNaughton-Filion, M Louise; Newton, Amanda; Shafir, Mark; Paprica, Alison; Klassen, Terry; Taljaard, Monica; Grimshaw, Jeremy; Johnson, David W

2013-05-22

The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for 'point of care' management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma--the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis--the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. ClinicalTrials.gov: NCT01815710.

Kauai Test Facility hazards assessment document

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

Swihart, A

1995-05-01

The Department of Energy Order 55003A requires facility-specific hazards assessment be prepared, maintained, and used for emergency planning purposes. This hazards assessment document describes the chemical and radiological hazards associated with the Kauai Test Facility, Barking Sands, Kauai, Hawaii. The Kauai Test Facility`s chemical and radiological inventories were screened according to potential airborne impact to onsite and offsite individuals. The air dispersion model, ALOHA, estimated pollutant concentrations downwind from the source of a release, taking into consideration the toxicological and physical characteristics of the release site, the atmospheric conditions, and the circumstances of the release. The greatest distance to themore » Early Severe Health Effects threshold is 4.2 kilometers. The highest emergency classification is a General Emergency at the {open_quotes}Main Complex{close_quotes} and a Site Area Emergency at the Kokole Point Launch Site. The Emergency Planning Zone for the {open_quotes}Main Complex{close_quotes} is 5 kilometers. The Emergency Planning Zone for the Kokole Point Launch Site is the Pacific Missile Range Facility`s site boundary.« less

Spatiotemporal Variation in Environmental Vibrio cholerae in an Estuary in Southern Coastal Ecuador.

PubMed

Ryan, Sadie J; Stewart-Ibarra, Anna M; Ordóñez-Enireb, Eunice; Chu, Winnie; Finkelstein, Julia L; King, Christine A; Escobar, Luis E; Lupone, Christina; Heras, Froilan; Tauzer, Erica; Waggoner, Egan; James, Tyler G; Cárdenas, Washington B; Polhemus, Mark

2018-03-10

Cholera emergence is strongly linked to local environmental and ecological context. The 1991-2004 pandemic emerged in Perú and spread north into Ecuador's El Oro province, making this a key site for potential re-emergence. Machala, El Oro, is a port city of 250,000 inhabitants, near the Peruvian border. Many livelihoods depend on the estuarine system, from fishing for subsistence and trade, to domestic water use. In 2014, we conducted biweekly sampling for 10 months in five estuarine locations, across a gradient of human use, and ranging from inland to ocean. We measured water-specific environmental variables implicated in cholera growth and persistence: pH, temperature, salinity, and algal concentration, and evaluated samples in five months for pathogenic and non-pathogenic Vibrio cholerae , by polymerase chain reaction (PCR). We found environmental persistence of pandemic strains O1 and O139, but no evidence for toxigenic strains. Vibrio cholerae presence was coupled to algal and salinity concentration, and sites exhibited considerable seasonal and spatial heterogeneity. This study indicates that environmental conditions in Machala are optimal for cholera re-emergence, with risk peaking during September, and higher risk near urban periphery low-income communities. This highlights a need for surveillance of this coupled cholera-estuarine system to anticipate potential future cholera outbreaks.

Spatiotemporal Variation in Environmental Vibrio cholerae in an Estuary in Southern Coastal Ecuador

PubMed Central

Stewart-Ibarra, Anna M.; Ordóñez-Enireb, Eunice; Chu, Winnie; Finkelstein, Julia L.; King, Christine A.; Escobar, Luis E.; Lupone, Christina; Heras, Froilan; Tauzer, Erica; Waggoner, Egan; Polhemus, Mark

2018-01-01

Cholera emergence is strongly linked to local environmental and ecological context. The 1991–2004 pandemic emerged in Perú and spread north into Ecuador’s El Oro province, making this a key site for potential re-emergence. Machala, El Oro, is a port city of 250,000 inhabitants, near the Peruvian border. Many livelihoods depend on the estuarine system, from fishing for subsistence and trade, to domestic water use. In 2014, we conducted biweekly sampling for 10 months in five estuarine locations, across a gradient of human use, and ranging from inland to ocean. We measured water-specific environmental variables implicated in cholera growth and persistence: pH, temperature, salinity, and algal concentration, and evaluated samples in five months for pathogenic and non-pathogenic Vibrio cholerae, by polymerase chain reaction (PCR). We found environmental persistence of pandemic strains O1 and O139, but no evidence for toxigenic strains. Vibrio cholerae presence was coupled to algal and salinity concentration, and sites exhibited considerable seasonal and spatial heterogeneity. This study indicates that environmental conditions in Machala are optimal for cholera re-emergence, with risk peaking during September, and higher risk near urban periphery low-income communities. This highlights a need for surveillance of this coupled cholera–estuarine system to anticipate potential future cholera outbreaks. PMID:29534431

The 2009 L'Aquila earthquake sequence: technical and scientific activities during the emergency and post-emergency phases

NASA Astrophysics Data System (ADS)

Cardinali, Mauro

2010-05-01

The Central Apennines of Italy is an area characterized by significant seismic activity. In this area, individual earthquakes and prolonged seismic sequences produce a variety of ground effects, including landslides. The L'Aquila area, in the Abruzzo Region, was affected by an earthquake sequence that started on December 2008, and continued for several months. The main shock occurred on April 6, 2009, with local magnitude m = 6.3, and was followed by two separate earthquakes on April 7 and April 9, each with a local magnitude m > 5.0. The main shocks caused 308 fatalities, injured more than 1500 people, and left in excess of 65,000 people homeless. Damage to the cultural heritage was also severe, with tens of churches and historical buildings severely damaged or destroyed. The main shocks and some of the most severe aftershocks triggered landslides, chiefly rock falls and minor rock slides that caused damage to towns, individual houses, and the transportation network. Beginning in the immediate aftermath of the event, and continuing during the emergency and post-emergency phases, we assisted the Italian national Department for Civil Protection in the evaluation of local landslide and hydrological risk conditions. Technical and scientific activities focused on: (i) mapping the location, type, and severity of the main ground effects produced by the earthquake shaking, (ii) evaluating and selecting sites for potential new settlements and individual buildings, including a preliminary assessment of the local geomorphological and hydrological conditions; (iii) evaluating rock fall hazard at individual sites, (iv) monitoring slope and ground deformations, and (v) designing and implementing a prototype system for the forecast of the possible occurrence of rainfall-induced landslides. To execute these activates, we exploited a wide range of methods, techniques, and technologies, and we performed repeated field surveys, the interpretation of ground and aerial photographs taken at different times, the analysis and processing of optical and SAR satellite images, and the statistical analysis of rainfall measurements and quantitative weather forecasts.

RNA transcriptional biosignature analysis for identifying febrile infants with serious bacterial infections in the emergency department: a feasibility study.

PubMed

Mahajan, Prashant; Kuppermann, Nathan; Suarez, Nicolas; Mejias, Asuncion; Casper, Charlie; Dean, J Michael; Ramilo, Octavio

2015-01-01

To develop the infrastructure and demonstrate the feasibility of conducting microarray-based RNA transcriptional profile analyses for the diagnosis of serious bacterial infections in febrile infants 60 days and younger in a multicenter pediatric emergency research network. We designed a prospective multicenter cohort study with the aim of enrolling more than 4000 febrile infants 60 days and younger. To ensure success of conducting complex genomic studies in emergency department (ED) settings, we established an infrastructure within the Pediatric Emergency Care Applied Research Network, including 21 sites, to evaluate RNA transcriptional profiles in young febrile infants. We developed a comprehensive manual of operations and trained site investigators to obtain and process blood samples for RNA extraction and genomic analyses. We created standard operating procedures for blood sample collection, processing, storage, shipping, and analyses. We planned to prospectively identify, enroll, and collect 1 mL blood samples for genomic analyses from eligible patients to identify logistical issues with study procedures. Finally, we planned to batch blood samples and determined RNA quantity and quality at the central microarray laboratory and organized data analysis with the Pediatric Emergency Care Applied Research Network data coordinating center. Below we report on establishment of the infrastructure and the feasibility success in the first year based on the enrollment of a limited number of patients. We successfully established the infrastructure at 21 EDs. Over the first 5 months we enrolled 79% (74 of 94) of eligible febrile infants. We were able to obtain and ship 1 mL of blood from 74% (55 of 74) of enrolled participants, with at least 1 sample per participating ED. The 55 samples were shipped and evaluated at the microarray laboratory, and 95% (52 of 55) of blood samples were of adequate quality and contained sufficient RNA for expression analysis. It is possible to create a robust infrastructure to conduct genomic studies in young febrile infants in the context of a multicenter pediatric ED research setting. The sufficient quantity and high quality of RNA obtained suggests that whole blood transcriptional profile analysis for the diagnostic evaluation of young febrile infants can be successfully performed in this setting.

Supporting Heart Failure Patient Transitions From Acute to Community Care With Home Telemonitoring Technology: A Protocol for a Provincial Randomized Controlled Trial (TEC4Home)

PubMed Central

2016-01-01

Background Seniors with chronic diseases such as heart failure have complex care needs. They are vulnerable to their condition deteriorating and, without timely intervention, may require multiple emergency department visits and/or repeated hospitalizations. Upon discharge, the transition from the emergency department to home can be a vulnerable time for recovering patients with disruptions in the continuity of care. Remote monitoring of heart failure patients using home telemonitoring, coupled with clear communication protocols between health care professionals, can be effective in increasing the safety and quality of care for seniors with heart failure discharged from the emergency department. Objective The aim of the Telehealth for Emergency-Community Continuity of Care Connectivity via Home Telemonitoring (TEC4Home) study is to generate evidence through a programmatic evaluation and a clinical trial to determine how home telemonitoring may improve care and increase patient safety during the transition of care and determine how it is best implemented to support patients with heart failure within this context. Methods This 4-year project consists of 3 studies to comprehensively evaluate the outcomes and effectiveness of TEC4Home. Study 1 is a feasibility study with 90 patients recruited from 2 emergency department sites to test implementation and evaluation procedures. Findings from the feasibility study will be used to refine protocols for the larger trial. Study 2 is a cluster randomized controlled trial that will include 30 emergency department sites and 900 patients across British Columbia. The primary outcome of the randomized controlled trial will be emergency department revisits and hospital readmission rates. Secondary outcomes include health care resource utilization/costs, communication between members of the care team, and patient quality of life. Study 3 will run concurrently to study 2 and test the effectiveness of predictive analytic software to detect patient deterioration sooner. Results It is hypothesized that TEC4Home will be a cost-effective strategy to decrease 90-day emergency department revisits and hospital admission rates and improve comfort and quality of life for seniors with heart failure. The results from this project will also help establish an innovation pathway for rapid and rigorous introduction of innovation into the health system. Conclusions While there is some evidence about the effectiveness of home telemonitoring for some patients and conditions, the TEC4Home project will be one of the first protocols that implements and evaluates the technology for patients with heart failure as they transition from the emergency department to home care. The results from this research are expected to inform the full scale and spread of the home monitoring approach throughout British Columbia and Canada and to other chronic diseases. ClinicalTrial ClinicalTrials.gov NCT02821065; https://clinicaltrials.gov/ct2/show/NCT02821065 (Archived by WebCite at http://www.webcitation.org/6ml2iwKax) PMID:27977002

Advanced Atmospheric Modeling for Emergency Response.

NASA Astrophysics Data System (ADS)

Fast, Jerome D.; O'Steen, B. Lance; Addis, Robert P.

1995-03-01

Atmospheric transport and diffusion models are an important part of emergency response systems for industrial facilities that have the potential to release significant quantities of toxic or radioactive material into the atmosphere. An advanced atmospheric transport and diffusion modeling system for emergency response and environmental applications, based upon a three-dimensional mesoscale model, has been developed for the U.S. Department of Energy's Savannah River Site so that complex, time-dependent flow fields not explicitly measured can be routinely simulated. To overcome some of the current computational demands of mesoscale models, two operational procedures for the advanced atmospheric transport and diffusion modeling system are described including 1) a semiprognostic calculation to produce high-resolution wind fields for local pollutant transport in the vicinity of the Savannah River Site and 2) a fully prognostic calculation to produce a regional wind field encompassing the southeastern United States for larger-scale pollutant problems. Local and regional observations and large-scale model output are used by the mesoscale model for the initial conditions, lateral boundary conditions, and four-dimensional data assimilation procedure. This paper describes the current status of the modeling system and presents two case studies demonstrating the capabilities of both modes of operation. While the results from the case studies shown in this paper are preliminary and certainly not definitive, they do suggest that the mesoscale model has the potential for improving the prognostic capabilities of atmospheric modeling for emergency response at the Savannah River Site. Long-term model evaluation will be required to determine under what conditions significant forecast errors exist.

Prehospital Emergencies in Illegal Gold Mining Sites in French Guiana.

PubMed

Egmann, Gérald; Tattevin, Pierre; Palancade, Renaud; Nacher, Matthieu

2018-03-01

Illegal gold mining is flourishing in French Guiana, existing outside the law due to both the high cost of gold mining permits and the challenges of law enforcement within the Amazon forest. We report the characteristics of, and the medical responses to, medical emergencies in illegal gold mining sites. We performed a retrospective study of all medical emergencies reported from illegal gold mining sites to the centralized call office of SAMU 973 from 1998 through 2000 and from 2008 through 2010. According to the national health care system, any medical emergency within the territory is handled by the prehospital emergency medical service (SAMU 973), irrespective of the patients' legal status. Data were extracted from the SAMU 973 notebook registry (1998-2000) or the SAMU 973 computerized database (2008-2010) and werre collected using a standardized questionnaire. Of 71,932 calls for medical emergencies in French Guiana during the study periods, 340 (0.5%) originated from illegal gold mining sites. Of these, 196 (58%) led to medical evacuation by helicopter, whereas the overall rate of evacuation by helicopter after placing a call to SAMU 973 was only 4% (3020/71,932; P<0.0001 for comparison with illegal gold mining sites). Medical emergencies were classified as illness (48%, mostly infectious), trauma (44%, mostly weapon wounds), and miscellaneous (8%). Medical emergencies at illegal gold mining sites in the Amazon forest mostly include infectious diseases, followed by trauma, and often require medical evacuation by helicopter. Our study suggests that implementation of preventive medicine within gold mining sites, irrespective of their legal status, could be cost-effective and reduce morbidity. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Evaluating the Use of Existing Data Sources, Probabilistic Linkage, and Multiple Imputation to Build Population-based Injury Databases Across Phases of Trauma Care

PubMed Central

Newgard, Craig; Malveau, Susan; Staudenmayer, Kristan; Wang, N. Ewen; Hsia, Renee Y.; Mann, N. Clay; Holmes, James F.; Kuppermann, Nathan; Haukoos, Jason S.; Bulger, Eileen M.; Dai, Mengtao; Cook, Lawrence J.

2012-01-01

Objectives The objective was to evaluate the process of using existing data sources, probabilistic linkage, and multiple imputation to create large population-based injury databases matched to outcomes. Methods This was a retrospective cohort study of injured children and adults transported by 94 emergency medical systems (EMS) agencies to 122 hospitals in seven regions of the western United States over a 36-month period (2006 to 2008). All injured patients evaluated by EMS personnel within specific geographic catchment areas were included, regardless of field disposition or outcome. The authors performed probabilistic linkage of EMS records to four hospital and postdischarge data sources (emergency department [ED] data, patient discharge data, trauma registries, and vital statistics files) and then handled missing values using multiple imputation. The authors compare and evaluate matched records, match rates (proportion of matches among eligible patients), and injury outcomes within and across sites. Results There were 381,719 injured patients evaluated by EMS personnel in the seven regions. Among transported patients, match rates ranged from 14.9% to 87.5% and were directly affected by the availability of hospital data sources and proportion of missing values for key linkage variables. For vital statistics records (1-year mortality), estimated match rates ranged from 88.0% to 98.7%. Use of multiple imputation (compared to complete case analysis) reduced bias for injury outcomes, although sample size, percentage missing, type of variable, and combined-site versus single-site imputation models all affected the resulting estimates and variance. Conclusions This project demonstrates the feasibility and describes the process of constructing population-based injury databases across multiple phases of care using existing data sources and commonly available analytic methods. Attention to key linkage variables and decisions for handling missing values can be used to increase match rates between data sources, minimize bias, and preserve sampling design. PMID:22506952

Emergent Family Support Practices in a Context of Policy Churn: An Example from the Children's Fund

ERIC Educational Resources Information Center

Warren, Simon; Apostolov, Apostol; Broughton, Kevin; Evans, Ruth; MacNab, Natasha; Smith, Penny

2006-01-01

What might family support services look like in the reconfigured children and family services after the Children Act? This is the question this article attempts to explore by drawing on evidence from the National Evaluation of the Children's Fund in England. The article describes common features in two case-study sites that might indicate the…

LiveWall Operational Evaluation: Seattle Law Enforcement Pilot

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

Barr, Jonathan L.; Burtner, Edwin R.; Stein, Steven L.

2013-10-01

The LiveWall concept envisioned as an outgrowth of the Precision Information Environment (PIE) project allows communications between separate groups using interactive video, audio, and a shared desktop environment; this allows everyone to participate and collaborate in real time, regardless of location. The LiveWall concept provides a virtual window to other locations, where all parties can interact and collaboratively work with each other. This functionality is intended to improve multi-site coordination amongst emergency operations centers (EOC), field operations sites and across organizations and jurisdictions to accommodate communications during routine and emergency events. For the initial LiveWall operational evaluation PNNL partnered withmore » the Seattle Police Department (SPD). This partnership allowed for the creation of an excellent LiveWall test bed specific to law enforcement. This partnership made it possible to test the LiveWall concept with scenarios involving the many facets of the law enforcement work done by SPD. PNNL and SPD agreed that integrating the systems into operations for a real event would be the best test of the technology and give SPD staff greater visibility into the functionality and benefits offered by the LiveWall concept.« less

Differences between orthopaedic evaluation and radiological reports of conventional radiographs in patients with minor trauma admitted to the emergency department.

PubMed

Catapano, Michele; Albano, Domenico; Pozzi, Grazia; Accetta, Riccardo; Memoria, Sergio; Pregliasco, Fabrizio; Messina, Carmelo; Sconfienza, Luca Maria

2017-11-01

During night and on weekends, in our emergency department there is no radiologist on duty or on call: thus, X-ray examinations (XR) are evaluated by the orthopaedic surgeon on duty and reported the following morning/monday by radiologists. The aim of our study was to examine the discrepancy rate between orthopaedists and radiologists in the interpretation of imaging examinations performed on patients in our tertiary level orthopaedic institution and the consequences of delayed diagnosis in terms of patient management and therapeutic strategy. We retrospectively reviewed all cases of discrepancy between orthopaedists and radiologists, which were categorized according to anatomical location of injury, initial diagnosis and treatment, change in diagnosis and treatment. We used the Chi square test to compare the frequencies of discrepancies between patients ≤14 and >14years of age. From January to December 2016, 19,512 patients admitted to our emergency department performed at least an imaging examination; among these patients, 13,561 underwent XR in absence of an attending radiologist. A discrepant diagnosis was found in 337/13,561 (2.5%; 184 males; mean age: 36.7±23.7, range 2-95); 151/337 (45%) discrepancies were encountered in the lower limbs, with ankle being the most common site of misdiagnosis (64/151), and 103/337 (30%) in the upper limbs, with the elbow being the most frequent site in this district (35/103). We found 293/337 false negatives (87%) and 44/337 false positives (13%), with 134 and 13 patients needing treatment change, respectively. We found 85/337 discrepancies (25%) in patients ≤14 years of age, and 252/337 (75%) in those >14years. The distribution of discrepancies per anatomic district was significantly different (P<0.001) in these two groups of patients. A low rate of discrepancy between orthopaedists and radiologists in evaluating images of patients admitted to our emergency department was found, although treatment change occurred in about half of cases. A thorough and accurate clinical evaluation is crucial to provide a correct treatment and prognosis. Copyright © 2017 Elsevier Ltd. All rights reserved.

Workflow in clinical trial sites & its association with near miss events for data quality: ethnographic, workflow & systems simulation.

PubMed

de Carvalho, Elias Cesar Araujo; Batilana, Adelia Portero; Claudino, Wederson; Reis, Luiz Fernando Lima; Schmerling, Rafael A; Shah, Jatin; Pietrobon, Ricardo

2012-01-01

With the exponential expansion of clinical trials conducted in (Brazil, Russia, India, and China) and VISTA (Vietnam, Indonesia, South Africa, Turkey, and Argentina) countries, corresponding gains in cost and enrolment efficiency quickly outpace the consonant metrics in traditional countries in North America and European Union. However, questions still remain regarding the quality of data being collected in these countries. We used ethnographic, mapping and computer simulation studies to identify/address areas of threat to near miss events for data quality in two cancer trial sites in Brazil. Two sites in Sao Paolo and Rio Janeiro were evaluated using ethnographic observations of workflow during subject enrolment and data collection. Emerging themes related to threats to near miss events for data quality were derived from observations. They were then transformed into workflows using UML-AD and modeled using System Dynamics. 139 tasks were observed and mapped through the ethnographic study. The UML-AD detected four major activities in the workflow evaluation of potential research subjects prior to signature of informed consent, visit to obtain subject́s informed consent, regular data collection sessions following study protocol and closure of study protocol for a given project. Field observations pointed to three major emerging themes: (a) lack of standardized process for data registration at source document, (b) multiplicity of data repositories and (c) scarcity of decision support systems at the point of research intervention. Simulation with policy model demonstrates a reduction of the rework problem. Patterns of threats to data quality at the two sites were similar to the threats reported in the literature for American sites. The clinical trial site managers need to reorganize staff workflow by using information technology more efficiently, establish new standard procedures and manage professionals to reduce near miss events and save time/cost. Clinical trial sponsors should improve relevant support systems.

Workflow in Clinical Trial Sites & Its Association with Near Miss Events for Data Quality: Ethnographic, Workflow & Systems Simulation

PubMed Central

Araujo de Carvalho, Elias Cesar; Batilana, Adelia Portero; Claudino, Wederson; Lima Reis, Luiz Fernando; Schmerling, Rafael A.; Shah, Jatin; Pietrobon, Ricardo

2012-01-01

Background With the exponential expansion of clinical trials conducted in (Brazil, Russia, India, and China) and VISTA (Vietnam, Indonesia, South Africa, Turkey, and Argentina) countries, corresponding gains in cost and enrolment efficiency quickly outpace the consonant metrics in traditional countries in North America and European Union. However, questions still remain regarding the quality of data being collected in these countries. We used ethnographic, mapping and computer simulation studies to identify/address areas of threat to near miss events for data quality in two cancer trial sites in Brazil. Methodology/Principal Findings Two sites in Sao Paolo and Rio Janeiro were evaluated using ethnographic observations of workflow during subject enrolment and data collection. Emerging themes related to threats to near miss events for data quality were derived from observations. They were then transformed into workflows using UML-AD and modeled using System Dynamics. 139 tasks were observed and mapped through the ethnographic study. The UML-AD detected four major activities in the workflow evaluation of potential research subjects prior to signature of informed consent, visit to obtain subject́s informed consent, regular data collection sessions following study protocol and closure of study protocol for a given project. Field observations pointed to three major emerging themes: (a) lack of standardized process for data registration at source document, (b) multiplicity of data repositories and (c) scarcity of decision support systems at the point of research intervention. Simulation with policy model demonstrates a reduction of the rework problem. Conclusions/Significance Patterns of threats to data quality at the two sites were similar to the threats reported in the literature for American sites. The clinical trial site managers need to reorganize staff workflow by using information technology more efficiently, establish new standard procedures and manage professionals to reduce near miss events and save time/cost. Clinical trial sponsors should improve relevant support systems. PMID:22768105

EPA RE-Powering Mapper: Alternative Energy Potential at Cleanup Sites

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management??s (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

Emergency Preparedness Among People Living Near US Army Chemical Weapons Sites After September 11, 2001

PubMed Central

Williams, Bryan L.; Magsumbol, Melina S.

2007-01-01

We examined trust in the army and perceptions of emergency preparedness among residents living near the Anniston, Ala, and Richmond, Ky, US Army chemical weapons stockpile sites shortly after September 11, 2001. Residents (n = 655) living near the 2 sites who participated in a cross-sectional population were relatively unprepared in the event of a chemical emergency. The events of September 11 gave rise to concerns regarding the security of stored chemical weapons and the sites’ vulnerability to terrorist attacks. Although residents expressed trust in the army to manage chemical weapons safely, only a few expressed a desire to actively participate in site decisions. Compliance with procedures during emergencies could be seriously limited, putting residents in these sites at higher levels of risk of exposure to chemical hazards than nonresidents. PMID:17666684

[Analysis on on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou].

PubMed

Wang, X G; Jin, R H; Liu, F P; Han, C M

2017-10-20

Objective: To investigate the situations of on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou, so as to provide more data support for emergency medical rescues of the similar incidents of massive casualty. Methods: Two medical workers with a certain clinical experience were sent to Hangzhou 120 emergency medical centers to collect data of the on-site rescue on 21st July, 2017, including ambulance call-outs, on-site command and traffic conditions, and on-site triage and evacuation of the victims. They were then sent to the hospitals receiving the victims to investigate the situations of these victims including the general information (such as gender, age, admitted hospitals, and number of admission, discharge, and transferring in the first two weeks after the accident) and injury assessment [such as injury position and type, injury severity evaluation by New Injury Severity Scoring (NISS), and burn severity evaluation for victims with burns]. Results: (1) A total of 15 ambulances reached the accident site for rescue. The traffic and transportation were jammed and interrupted after this accident. On-site triage and distribution were disorderly conducted. (2) Clinical data of 53 victims were collected, including 24 males and 29 females, with the age of 8 to 70 (34±14) years old. They were sent into 6 hospitals in Hangzhou. Two victims died on the day of accident. Up to two weeks after this accident, 28 (52.8%) victims were discharged from the hospitals and received follow-up in outpatient department. Five victims with severe injuries were transferred to the other hospitals. (3) Based on the results of NISS, the injury severities were mild in 29 (54.7%) cases, moderate in 9 (17.0%) cases, serious in 3 (5.7%) cases, and severe in 12 (22.6%) cases. Those 2 dead victims were classified into the severe category due to the highest NISS score of 75. For all of the victims, skin and soft tissue defects were most common. Six (11.3%) victims were combined with burns. According to the classification of burn severity, there were one case of mild, one case of serious, and 4 cases of severe. Conclusions: The gas explosion accident in Hangzhou caused massive casualties with complex injuries. The local emergency medical rescue responded quickly, but during the rescue process, lots of aspects should be further improved.

Assessments of Ali, Dome A, and Summit Camp for mm-wave Observations Using MERRA-2 Reanalysis

DOE PAGES

Kuo, Chao -Lin

2017-10-10

NASA's latest MERRA-2 reanalysis of the modern satellite measurements has made atmospheric data easily accessible with unprecedented uniformity, fidelity, and completeness. In this paper, these data are used to evaluate five sites for millimeter-wave (mm-wave) observations. These include two established sites (South Pole and Chajnantor, Atacama), and three new sites (Ali in Tibet, Dome A in Antarctica, and Summit Camp in Greenland). Atmospheric properties including precipitable water vapor (PWV), sky brightness temperature fluctuations, and ice and liquid water paths are derived and compared. Dome A emerges to be the best among those evaluated, with PWV and fluctuations smaller than themore » second-best site, South Pole, by more than a factor of 2. It is found that the higher site in Ali (6100 m) is on par with Cerro Chajnantor (5612 m) in terms of transmission and stability. The lower site in Ali (5250 m) planned for the first stage of observations at 90/150 GHz provides conditions comparable to those on the Chajnantor Plateau. These analyses confirm Ali to be an excellent mm-wave site in the Northern Hemisphere that will complement well-established Southern sites. According to MERRA-2 data, the observing conditions at Summit Camp are also comparable to Cerro Chajnantor. Furthermore, it is more affected by the presence of liquid water clouds.« less

Comparative evaluation of leachate pollution index of MSW landfill site of Kolkata with other metropolitan cities of India.

PubMed

Motling, Sanjay; Dutta, Amit; Mukherjee, S N; Kumar, Sunil

2013-07-01

The uncontrolled tipping of mixed urban solid waste in landfill site causes serious negative impacts on the environment. The major issue in this context is the generation of leachate which possesses potential of polluting freshwater ecosystem including groundwater besides associated health hazards and depletion of soil fertility. In this context, a pseudo computation quantitative tool, known as leachate pollution index (LPI), has been developed by some researchers for scaling pollution potential of landfill site owing to emergence of leachate. This paper. deals with the assessment of leachate quality of existing landfill site of Kolkata situated at Dhapa waste dumping ground through evaluation of the LPI from experimental analysis of leachate. The leachate was collected from this site in different seasons. 18 parameters were tested with real leachate samples in the Environmental Engineering Laboratory of Civil Engineering Department of Jadavpur University Kolkata. The results exhibited a very high value of organic pollutants in the leachate with COD as 21,129 mg/L and also values of TDS, Fe2+, Cr, Zn, chloride and ammonical nitrogen. The LPI value of Kolkata landfill site at Dhapa was estimated and also compared with leachate quality data of other metropolitan cities viz. Mumbai, Delhi, Chennai as available in literatures. It is found that LPI of the Kolkata landfill site is highest compared to all other landfill sites of other metropolitan cities in India.

Assessments of Ali, Dome A, and Summit Camp for mm-wave Observations Using MERRA-2 Reanalysis

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

Kuo, Chao -Lin

NASA's latest MERRA-2 reanalysis of the modern satellite measurements has made atmospheric data easily accessible with unprecedented uniformity, fidelity, and completeness. In this paper, these data are used to evaluate five sites for millimeter-wave (mm-wave) observations. These include two established sites (South Pole and Chajnantor, Atacama), and three new sites (Ali in Tibet, Dome A in Antarctica, and Summit Camp in Greenland). Atmospheric properties including precipitable water vapor (PWV), sky brightness temperature fluctuations, and ice and liquid water paths are derived and compared. Dome A emerges to be the best among those evaluated, with PWV and fluctuations smaller than themore » second-best site, South Pole, by more than a factor of 2. It is found that the higher site in Ali (6100 m) is on par with Cerro Chajnantor (5612 m) in terms of transmission and stability. The lower site in Ali (5250 m) planned for the first stage of observations at 90/150 GHz provides conditions comparable to those on the Chajnantor Plateau. These analyses confirm Ali to be an excellent mm-wave site in the Northern Hemisphere that will complement well-established Southern sites. According to MERRA-2 data, the observing conditions at Summit Camp are also comparable to Cerro Chajnantor. Furthermore, it is more affected by the presence of liquid water clouds.« less

Assessments of Ali, Dome A, and Summit Camp for mm-wave Observations Using MERRA-2 Reanalysis

NASA Astrophysics Data System (ADS)

Kuo, Chao-Lin

2017-10-01

NASA’s latest MERRA-2 reanalysis of the modern satellite measurements has made atmospheric data easily accessible with unprecedented uniformity, fidelity, and completeness. In this paper, these data are used to evaluate five sites for millimeter-wave (mm-wave) observations. These include two established sites (South Pole and Chajnantor, Atacama), and three new sites (Ali in Tibet, Dome A in Antarctica, and Summit Camp in Greenland). Atmospheric properties including precipitable water vapor (PWV), sky brightness temperature fluctuations, and ice and liquid water paths are derived and compared. Dome A emerges to be the best among those evaluated, with PWV and fluctuations smaller than the second-best site, South Pole, by more than a factor of 2. It is found that the higher site in Ali (6100 m) is on par with Cerro Chajnantor (5612 m) in terms of transmission and stability. The lower site in Ali (5250 m) planned for the first stage of observations at 90/150 GHz provides conditions comparable to those on the Chajnantor Plateau. These analyses confirm Ali to be an excellent mm-wave site in the Northern Hemisphere that will complement well-established Southern sites. According to MERRA-2 data, the observing conditions at Summit Camp are also comparable to Cerro Chajnantor. However, it is more affected by the presence of liquid water clouds.

Detection of helicopter landing sites in unprepared terrain

NASA Astrophysics Data System (ADS)

Peinecke, Niklas

2014-06-01

The primary usefulness of helicopters shows in missions where regular aircraft cannot be used, especially HEMS (Helicopter Emergency Medical Services). This might be due to requirements for landing in unprepared areas without dedicated runway structures, and an extended exibility to y to more than one previously unprepared target. One example of such missions are search and rescue operations. An important task of such a mission is to locate a proper landing spot near the mission target. Usually, the pilot would have to evaluate possible landing sites by himself, which can be time-intensive, fuel-costly, and generally impossible when operating in degraded visual environments. We present a method for pre-selecting a list of possible landing sites. After specifying the intended size, orientation and geometry of the site, a choice of possibilities is presented to the pilot that can be ordered by means of wind direction, terrain constraints like maximal slope and roughness, and proximity to a mission target. The possible choices are calculated automatically either from a pre-existing terrain data base, or from sensor data collected during earlier missions, e.g., by collecting data with radar or laser sensors. Additional data like water-body maps and topological information can be taken into account to avoid landing in dangerous areas under adverse view conditions. In case of an emergency turnaround the list can be re-ordered to present alternative sites to the pilot. We outline the principle algorithm for selecting possible landing sites, and we present examples of calculated lists.

Cytotechnologists and On-Site Evaluation of Adequacy

PubMed Central

Collins, Jennifer A.; Novak, Anna; Ali, Syed Z.

2013-01-01

While fine needle aspiration (FNA) is certainly not a new biopsy technique, recent developments in advanced imaging techniques, molecular testing, and targeted therapies have coincided with a rapid increase in the number of FNA procedures being performed. Concurrently, the demand for on-site evaluation of adequacy (OSEA) has also increased, outstripping the capacity of available cytopathologists at some institutions. Among the several alternatives to cytopathologist-performed OSEA, cytotechnologist-attended OSEA stands out because it preserves the representation of the pathology service at the time of the procedure. Herein, we review the current literature about OSEA and the necessity of cytotechnologists to expand access of this useful pathology service to a broader patient population. We also examine how cytotechnologists are likely to fit into the emerging practice of telecytology. PMID:24255627

Establishing a successful coronary CT angiography program in the emergency department: official writing of the Fellow and Resident Leaders of the Society of Cardiovascular Computed Tomography (FiRST).

PubMed

Maroules, Christopher D; Blaha, Michael J; El-Haddad, Mohamed A; Ferencik, Maros; Cury, Ricardo C

2013-01-01

Coronary CT angiography is an effective, evidence-based strategy for evaluating acute chest pain in the emergency department for patients at low-to-intermediate risk of acute coronary syndrome. Recent multicenter trials have reported that coronary CT angiography is safe, reduces time to diagnosis, facilitates discharge, and may lower overall cost compared with routine care. Herein, we provide a 10-step approach for establishing a successful coronary CT angiography program in the emergency department. The importance of strategic planning and multidisciplinary collaboration is emphasized. Patient selection and preparation guidelines for coronary CT angiography are reviewed with straightforward protocols that can be adapted and modified to clinical sites, depending on available cardiac imaging capabilities. Technical parameters and patient-specific modifications are also highlighted to maximize the likelihood of diagnostic quality examinations. Practical suggestions for quality control, process monitoring, and standardized reporting are reviewed. Finally, the role of a "triple rule-out" protocol is featured in the context of acute chest pain evaluation in the emergency department. Copyright © 2013 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Treatability studies performed in support of an engineering evaluation/cost analysis

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

Myers, J.M.; Mueller, J.P.; Sundquist, J.A.

1995-12-31

The Southern Shipbuilding Corporation (SSC) site is located on 54 acres of wooded land adjacent to Bayou Bonfouca, approximately 1.8 miles downstream of the Bayou Bonfouca National Priorities List (NPL) Superfund site in Slidell, St. Tammany Parish, Louisiana. Two one-acre, impoundments on the SSC site were used to store wastes generated from vessel cleaning. Wastes stored in the impoundments are migrating into Bayou Bonfouca, which empties into Lake Pontchartrain. In addition, the impoundments are frequently invaded by flood waters. The US EPA Emergency Response Branch (EPA-ERB) performed a site investigation which indicated that the majority of the contamination is petroleum-relatedmore » and that the compounds of concern are polycyclic aromatic hydrocarbons (PARs). The wastes are generally contained with the two impoundments and surrounding soils. As part of an Engineering Evaluation/Cost Basis (EE/CA) of potential response action alternatives, four treatability studies were performed. A thermal treatment (incineration) study was performed at the EPA`s Incineration Research Facility (IRF). Biodegradation remedy selection feasibility assessment was conducted on-site. A remedy screening soil washing study was also performed by TAT. A solidification/stabilization (S/S) study was conducted through EPA`s Risk Reduction Engineering Laboratory (RREL) to ascertain if the PAHs could be immobilized within a solid matrix. Experimental objectives, dead methodology and conclusions for these studies are presented as they relate to potential response actions being evaluated at the SSC site.« less

EPA RE-Powering Mapper Region 10

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 4

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Large Scale

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 2

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 6

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 8

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 7

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 5

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 3

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Solar on Landfills

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 9

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Utility Scale

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Screening Shapefile

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Center for Program Analysis (CPA) initiated the RE-Powering America??s Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

EPA RE-Powering Mapper Region 1

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Office of Land and Emergency Management (OLEM) Office of Communications, Partnerships and Analysis (OCPA) initiated the RE-Powering America's Land Initiative to demonstrate the enormous potential that contaminated lands, landfills, and mine sites provide for developing renewable energy in the United States. EPA developed national level site screening criteria in partnership with the U.S. Department of Energy (DOE) National Renewable Energy Laboratory (NREL) for wind, solar, biomass, and geothermal facilities. While the screening criteria demonstrate the potential to reuse contaminated land for renewable energy facilities, the criteria and data are neither designed to identify the best sites for developing renewable energy nor all-inclusive. Therefore, more detailed, site-specific analysis is necessary to identify or prioritize the best sites for developing renewable energy facilities based on the technical and economic potential. Please note that these sites were only pre-screened for renewable energy potential. The sites were not evaluated for land use constraints or current on the ground conditions. Additional research and site-specific analysis are needed to verify viability for renewable energy potential at a given site.

Bioterrorism web site resources for infectious disease clinicians and epidemiologists.

PubMed

Ferguson, Natalie E; Steele, Lynn; Crawford, Carol Y; Huebner, Nathan L; Fonseka, Jamila C; Bonander, Jason C; Kuehnert, Matthew J

2003-06-01

Finding bioterrorism-related information on the World Wide Web can be laborious. We hope to help readers find such information more easily by summarizing essential information in a consistent framework. A panel of 7 Centers for Disease Control and Prevention reviewers identified Web sites and evaluated them for sponsorship, mission, content usefulness, online ease of use, and adherence to commonly accepted quality criteria. Of >100 potential sites identified, 81 were chosen for target content of interest, and 43 were selected for inclusion. The results were classified into general purpose/portal sites; biological agent information; laboratory, infection control, epidemiology, and mental health information; and emergency contact sources, news and updates, event preparedness resources, information for first-responder settings, clinical and public education materials, and research resources. Agents covered included anthrax, smallpox, plague, botulism, tularemia, and viral hemorrhagic fever.

Assessment of injuries sustained in mixed martial arts competition.

PubMed

Scoggin, James F; Brusovanik, Georgiy; Pi, Michael; Izuka, Byron; Pang, Pierre; Tokumura, Seren; Scuderi, Gaetano

2010-05-01

Mixed martial arts (MMA) competitions have gained much popularity, and the sport is watched by many millions annually. Despite ongoing controversy, there have been no objective studies of the injuries sustained in MMA based on on-site evaluation. In the study reported in this article, we attempted to delineate injury patterns for MMA participants. We conducted an observational cohort study of MMA competitions held in Hawaii between 1999 and 2006. The study included 116 bouts, involving 232 "exposures" and 179 male participants between ages 18 and 40. All the fighters were examined by 1 of 4 physicians, both before and after each bout. Fighters were referred to an emergency department when necessary, and follow-up was recommended as needed. Among the 232 exposures were 55 injuries: 28 abrasions and lacerations (6 requiring on-site suturing or referral to an emergency department for suturing), 11 concussions (4 with retrograde amnesia), 5 facial injuries (2 nasal fractures, 1 tympanum rupture, 1 temporomandibular joint sprain, 1 Le Fort fracture), and 11 orthopedic injuries (3 metacarpal injuries, with 1 confirmed fracture; 1 acromioclavicular separation; 1 traumatic olecranon bursitis; 1 elbow subluxation; 1 midfoot sprain; 1 aggravation of elbow medial collateral ligament sprain; 1 elbow lateral collateral ligament strain; 1 trapezius strain; 1 Achilles tendon contusion). We describe the injuries sustained in MMA competition to make comparisons with other sports. We discuss distribution and mechanism of injuries as well as injury incidence based on on-site evaluation in MMA.

NHS Blood Tracking Pilot: City University Evaluation Project

NASA Astrophysics Data System (ADS)

Goddard, Kate; Shabestari, Omid; Adriano, Juan; Kay, Jonathan; Roudsari, Abdul

Automation of healthcare processes is an emergent theme in the drive to increase patient safety. The Mayday Hospital has been chosen as the pilot site for the implementation of the Electronic Clinical Transfusion Management System to track blood from the point of ordering to the final transfusion. The Centre for Health Informatics at City University is carrying out an independent evaluation of the system implementation using a variety of methodologies to both formatively inform the implementation process and summatively provide an account of the lessons learned for future implementations.

Implications of the Emergency Medical Treatment and Labor Act (EMTALA) during public health emergencies and on alternate sites of care.

PubMed

Roszak, Andrew R; Jensen, Frances R; Wild, Richard E; Yeskey, Kevin; Handrigan, Michael T

2009-12-01

Hospitals throughout the country are using innovative strategies to accommodate the surge of patients brought on by the novel H1N1 virus. One strategy has been to help decompress the amount of patients seeking care within emergency departments by using alternate sites of care, such as tents, parking lots, and community centers as triage, staging, and screening areas. As at any other time an individual presents on hospital property, hospitals and providers must be mindful of the requirements of the Emergency Medical Treatment and Labor Act. In this article we review the act and its implications during public health emergencies, with a particular focus on its implications on alternative sites of care.

Laboratory and clinical evaluation of on-site urine drug testing.

PubMed

Beck, Olof; Carlsson, Sten; Tusic, Marinela; Olsson, Robert; Franzen, Lisa; Hulten, Peter

2014-11-01

Products for on-site urine drug testing offer the possibility to perform screening for drugs of abuse directly at the point-of-care. This is a well-established routine in emergency and dependency clinics but further evaluation of performance is needed due to inherent limitations with the available products. Urine drug testing by an on-site product was compared with routine laboratory methods. First, on-site testing was performed at the laboratory in addition to the routine method. Second, the on-site testing was performed at a dependency clinic and urine samples were subsequently sent to the laboratory for additional analytical investigation. The on-site testing products did not perform with assigned cut-off levels. The subjective reading between the presence of a spot (i.e. negative test result) being present or no spot (positive result) was difficult in 3.2% of the cases, and occurred for all parameters. The tests performed more accurately in drug negative samples (specificity 96%) but less accurately for detecting positives (sensitivity 79%). Of all incorrect results by the on-site test the proportion of false negatives was 42%. The overall agreement between on-site and laboratory testing was 95% in the laboratory study and 98% in the clinical study. Although a high degree of agreement was observed between on-site and routine laboratory urine drug testing, the performance of on-site testing was not acceptable due to significant number of false negative results. The limited sensitivity of on-site testing compared to laboratory testing reduces the applicability of these tests.

Can Periodic Cicadas be used as a Biomonitor for Arsenical Pesticide Contamination?

NASA Astrophysics Data System (ADS)

Robinson, G. R.; Sibrell, P. L.; Boughton, C. J.; Yang, L.; Hancock, T. C.

2004-12-01

Widespread use of arsenical pesticides on fruit crops, particularly apple orchards, during the first half of the 20th century is a significant source of arsenic to agricultural soil in the Mid-Atlantic region. Cumulative application rates may be as high as 37 Kg/hectare of arsenic in orchard areas. Brood X 17-year periodic cicadas (Magicicada spp.) emerged at densities up to 30,000 or more individuals per hectare in orchard and forest habitats during May-June, 2004, in Clarke and Frederick Counties, Virginia and in Berkeley and Jefferson Counties, West Virginia. These cicadas were sampled to evaluate the bioavailability of arsenic in orchard and non-orchard reference site soils. Potentially toxic elements, such as arsenic and other heavy metals bind to sulfhydryl groups, and thus may accumulate in keratin-rich tissues, such as cicada nymphal exuviae and adult exoskeletons. These cicadas feed on plant roots underground for 17 years before emerging to molt into their adult form. Adult cicadas have very limited dispersal, rarely traveling more than 50 m in a flight. As such, their body and exoskeleton keratin has potential value as a biomonitor for arsenic and other metals that is spatially referenced to local conditions for the duration of time the nymphs live in the soil. This study addresses the following research questions: (1) do the soils in and adjacent to orchard sites where arsenical pesticide was used contain elevated concentrations of arsenic and other metals relative to likely background conditions?; (2) can periodic cicadas be used as an easily sampled biomonitor measuring bioavailability of pesticide residues in soils?; and (3) do the concentration levels of arsenical pesticide residues in periodic cicadas emerging from contaminated orchard sites pose a dietary threat to birds and other wildlife that preferentially feed upon cicadas during emergence events?

Periorbital and Intraorbital Studies of the Terminal Branches of the Ophthalmic Artery for Periorbital and Glabellar Filler Placements.

PubMed

Tansatit, Tanvaa; Apinuntrum, Prawit; Phetudom, Thavorn

2017-06-01

Filler injections for sunken upper eyelid correction and glabellar augmentation at the orbitoglabellar region need to be performed correctly. Precise knowledge of the emerging sites of all terminal branches of the ophthalmic artery is essential for these procedures to be conducted safely. The terminal branches of the ophthalmic artery were studied in both periorbital and intraorbital dissections. The aim of this study was to verify the critical positions of the emerging sites at the orbital septum that may act as potential retrograde channels for filler emboli. In the 40 eyes examined, the branches of the ophthalmic artery were found to emerge from four different sites. Two substantial emerging sites were situated on both sides of the trochlea of the superior oblique muscle. These sites were located at the superior part of the medial orbital rim (SMOR) and are alternatively named as the epitrochlear and the subtrochlear emerging sites. The other two sites can be regarded as accessory emerging sites due to the comparably smaller artery. Dissection of the intraorbital region revealed small periosteal branches of the infraorbital artery which coursed anteriorly on the orbital floor to form anastomoses with the lacrimal artery. In other areas of the orbital floor, no branches extended from the infraorbital artery. In front of the lacrimal gland, very minute branches descended and coursed along both margins of the superior tarsus but did not course outside the lateral orbital rim. A danger zone was located at the SMOR, where the ophthalmic branches emerge to form anastomotic channels. Compression at the trochlea guarantees safe injection of filler, reducing the risk of complication. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

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

Koike, Yuya, E-mail: r06118@hotmail.co.jp; Nishimura, Jun-ichi, E-mail: jun-ichi-n@nifty.com; Hase, Soichiro, E-mail: haseman@hotmail.co.jp

PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasationmore » of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.« less

$250,000 Emergency Action Memo from Steve Spurlin, EPA Region 4 to Addressees. Documenting the Decision to Initiate Emergency Response Actions at the Site

EPA Pesticide Factsheets

Contains July 18, 2007 memo about the decision to initiate emergency response actions for the American Drum & Pallet Site·tocated in Memphis, Shelby County, Tennessee. Region ID: 04 DocID: 10517021, DocDate: 07-18-2007

Better data, better planning: the College of Emergency Medicine sentinel sites project.

PubMed

Moulton, Chris; Mann, Clifford; Tempest, Michelle

2014-11-01

This article describes the College of Emergency Medicine's initial attempt to gather high quality data from its own 'sentinel sites' rather than relying on more comprehensive national data of dubious quality. Such information is essential to inform and guide the planning of urgent and emergency care services in the future.

Accidental Release of Chlorine from a Storage Facility and an On-Site Emergency Mock Drill: A Case Study

PubMed Central

Soman, Ambalathumpara Raman; Sundararaj, Gopalswamy

2015-01-01

In the current industrial scenario there is a serious need for formulating strategies to handle hazardous substances in the safest way. Manufacture, storage, and use of hazardous substances pose a serious risk to industry, people, and the environment. Accidental release of toxic chemicals can lead to emergencies. An emergency response plan (ERP) is inevitable to minimize the adverse effects of such releases. The on-site emergency plan is an integral component of any process safety and risk management system. This paper deals with an on-site emergency response plan for a chlorine manufacturing industry. It was developed on the basis of a previous study on chlorine release and a full scale mock drill has been conducted for testing the plan. Results indicated that properly trained personnel can effectively handle each level of incidents occurring in the process plant. As an extensive guideline to the district level government authorities for off-site emergency planning, risk zone has also been estimated with reference to a chlorine exposure threshold of 3 ppm. PMID:26171416

Social Media in School Emergency Management: Using New Media Technology to Improve Emergency Management Communications

ERIC Educational Resources Information Center

Stephens, Kim

2011-01-01

Social Media is the use of social networking sites, messaging sites, texting, and other web-based or mobile technologies to support social interaction. Facebook is by far the most widely used social networking site. Twitter is by far the most widely used messaging site. The goals of this presentation are: (1) To provide an understanding of the…

Big maggots dig deeper: size-dependent larval dispersal in flies.

PubMed

Davis, Jeremy M; Coogan, Laura E; Papaj, Daniel R

2015-09-01

The ability of individual animals to select habitats optimal for development and survival can be constrained by the costs of moving through the environment. Animals that seek overwintering sites underground, for example, may be constrained by the energy required to burrow into the soil. We conducted field and laboratory studies to determine the relationship between individual size and overwintering site selection in the tephritid flies, Rhagoletis juglandis and Rhagoletis suavis. We also explored the effect of site selection on pupal mortality, parasitism, and the ability to emerge from overwintering sites after eclosion. In both species, and in both lab and field tests, larger pupae were found at deeper soil depths. In addition, marginally non-significant trends indicated pupae in deeper sites were 48% more likely to survive the overwintering period. Finally, larger individuals were more likely to eclose and emerge from the soil at a given depth, but flies in deep overwintering sites were less likely to emerge from those sites than flies in shallow sites. Our data indicate that overwintering site selection represents a trade-off between avoiding predators and parasites that occur at shallow sites, and the energetic and mortality costs of burrowing to, overwintering in, and emerging from, deeper sites. The size-dependent overwintering site selection demonstrated here has implications for population dynamics and pest control strategies. Some fly control measures, such as the introduction of parasites or predators, will be mitigated when the deepest and least accessible overwintering pupae represent a disproportionately large amount of the population's reproductive capacity.

Assessment of general health of fishes collected at selected sites in the Great Lakes Basin In 2012

USGS Publications Warehouse

Mazik, Patricia M.; Braham, Ryan P.; Hahn, Cassidy M.; Blazer, Vicki

2015-01-01

The U. S. Fish and Wildlife Service received funding through the Great Lakes Restoration Initiative (GLRI) for an Early Warning Program to detect and identify emerging contaminants and to evaluate the effects of these contaminants on fish and wildlife. The U.S. Geological Survey (WV Cooperative Fish and Wildlife Research Unit and National Fish Health Research Laboratory, Leetown Science Center) developed and implemented a biological effects monitoring protocol to assist in this program. Fish collections and measurements of biomarkers of exposure in Fall 2010 and Spring 2011 occurred at individual sites within select Areas of Concern (AOCs). They provided an assessment of the utility of the suite of biomarkers and also identified sites for more in-depth analyses. Selected areas are characterized as areas with known emerging contaminants, sensitive or listed species, areas downstream from municipal wastewater discharges or receiving waters for industrial facilities, and/or areas susceptible to agricultural or urban contamination, or harbors or ports. The results of the 2010- 2011 studies were summarized in Blazer et al. 2014 a, b, c; Braham et al. in review and Blazer et al. in review.

Primary Care Emergency Preparedness Network, New York City, 2015: Comparison of Member and Nonmember Sites

PubMed Central

Jean, Marc C.; Chen, Bei; Molinari, Noelle-Angelique M.; LeBlanc, Tanya T.

2017-01-01

Objectives. To assess whether Primary Care Emergency Preparedness Network member sites reported indicators of preparedness for public health emergencies compared with nonmember sites. The network—a collaboration between government and New York City primary care associations—offers technical assistance to primary care sites to improve disaster preparedness and response. Methods. In 2015, we administered an online questionnaire to sites regarding facility characteristics and preparedness indicators. We estimated differences between members and nonmembers with natural logarithm–linked binomial models. Open-ended assessments identified preparedness gaps. Results. One hundred seven sites completed the survey (23.3% response rate); 47 (43.9%) were nonmembers and 60 (56.1%) were members. Members were more likely to have completed hazard vulnerability analysis (risk ratio [RR] = 1.94; 95% confidence interval [CI] = 1.28, 2.93), to have identified essential services for continuity of operations (RR = 1.39; 95% CI = 1.03, 1.86), to have memoranda of understanding with external partners (RR = 2.49; 95% CI = 1.42, 4.36), and to have completed point-of-dispensing training (RR = 4.23; 95% CI = 1.76, 10.14). Identified preparedness gaps were improved communication, resource availability, and train-the-trainer programs. Public Health Implications. Primary Care Emergency Preparedness Network membership is associated with improved public health emergency preparedness among primary care sites. PMID:28892448

Supporting Heart Failure Patient Transitions From Acute to Community Care With Home Telemonitoring Technology: A Protocol for a Provincial Randomized Controlled Trial (TEC4Home).

PubMed

2016-12-18

Seniors with chronic diseases such as heart failure have complex care needs. They are vulnerable to their condition deteriorating and, without timely intervention, may require multiple emergency department visits and/or repeated hospitalizations. Upon discharge, the transition from the emergency department to home can be a vulnerable time for recovering patients with disruptions in the continuity of care. Remote monitoring of heart failure patients using home telemonitoring, coupled with clear communication protocols between health care professionals, can be effective in increasing the safety and quality of care for seniors with heart failure discharged from the emergency department. The aim of the Telehealth for Emergency-Community Continuity of Care Connectivity via Home Telemonitoring (TEC4Home) study is to generate evidence through a programmatic evaluation and a clinical trial to determine how home telemonitoring may improve care and increase patient safety during the transition of care and determine how it is best implemented to support patients with heart failure within this context. This 4-year project consists of 3 studies to comprehensively evaluate the outcomes and effectiveness of TEC4Home. Study 1 is a feasibility study with 90 patients recruited from 2 emergency department sites to test implementation and evaluation procedures. Findings from the feasibility study will be used to refine protocols for the larger trial. Study 2 is a cluster randomized controlled trial that will include 30 emergency department sites and 900 patients across British Columbia. The primary outcome of the randomized controlled trial will be emergency department revisits and hospital readmission rates. Secondary outcomes include health care resource utilization/costs, communication between members of the care team, and patient quality of life. Study 3 will run concurrently to study 2 and test the effectiveness of predictive analytic software to detect patient deterioration sooner. It is hypothesized that TEC4Home will be a cost-effective strategy to decrease 90-day emergency department revisits and hospital admission rates and improve comfort and quality of life for seniors with heart failure. The results from this project will also help establish an innovation pathway for rapid and rigorous introduction of innovation into the health system. While there is some evidence about the effectiveness of home telemonitoring for some patients and conditions, the TEC4Home project will be one of the first protocols that implements and evaluates the technology for patients with heart failure as they transition from the emergency department to home care. The results from this research are expected to inform the full scale and spread of the home monitoring approach throughout British Columbia and Canada and to other chronic diseases. ClinicalTrials.gov NCT02821065; https://clinicaltrials.gov/ct2/show/NCT02821065 (Archived by WebCite at http://www.webcitation.org/6ml2iwKax). ©TEC4Home Healthcare Innovation Community. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 18.12.2016.

Persistent and emerging micro-organic contaminants in Chalk groundwater of England and France.

PubMed

Lapworth, D J; Baran, N; Stuart, M E; Manamsa, K; Talbot, J

2015-08-01

The Chalk aquifer of Northern Europe is an internationally important source of drinking water and sustains baseflow for surface water ecosystems. The areal distribution of microorganic (MO) contaminants, particularly non-regulated emerging MOs, in this aquifer is poorly understood. This study presents results from a reconnaissance survey of MOs in Chalk groundwater, including pharmaceuticals, personal care products and pesticides and their transformation products, conducted across the major Chalk aquifers of England and France. Data from a total of 345 sites collected during 2011 were included in this study to provide a representative baseline assessment of MO occurrence in groundwater. A suite of 42 MOs were analysed for at each site including industrial compounds (n=16), pesticides (n=14) and pharmaceuticals, personal care and lifestyle products (n=12). Occurrence data is evaluated in relation to land use, aquifer exposure, well depth and depth to groundwater to provide an understanding of vulnerable groundwater settings. Copyright © 2015 Natural Environment Research Council. Published by Elsevier Ltd.. All rights reserved.

Coexistence of Velocity Renormalization and Ferrimagnetic Fluctuation in the Organic Dirac Electron System α-(BEDT-TTF)2I3

NASA Astrophysics Data System (ADS)

Matsuno, Genki; Kobayashi, Akito

2018-05-01

We evaluate the uniform spin susceptibility in an extended Hubbard model describing α-(BEDT-TTF)2I3. Employing the Fock-type self-energy with the long-range Coulomb interaction and the random phase approximation with the on-site Coulomb interaction, it is clarified that the characteristic energy scales at which ferrimagnetic fluctuation and velocity renormalization emerge are different. This is why these phenomena coexist while the ferrimagnetic fluctuation is disturbed by the velocity renormalization. In addition, it is found that screening effect to the self-energy is irrelevant in the presence of a strong on-site Coulomb interaction U.

A case of thoracic splenosis in a post-splenectomy patient following abdominal trauma: Hello Howell-Jolly.

PubMed

Viviers, Petrus J

2014-08-01

Seeding of splenic tissue to extra-abdominal sites is a relatively infrequent consequence of open abdominal trauma. Immunological function of these small foci of ectopic splenic tissue is unknown and their use in determining the splenic function may be limited. In this case report, a patient is described who had previously undergone an emergency splenectomy. The absence of Howell-Jolly bodies on the blood smear in a patient who had previously undergone surgical splenectomy raised the suspicion of splenosis. The immunological features as well as non-invasive evaluation of these ill-defined splenic tissue sites are discussed.

User's Guide for MetView: A Meteorological Display and Assessment Tool

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

Glantz, Clifford S.; Pelton, Mitchell A.; Allwine, K Jerry

2000-09-27

MetView Version 2.0 is an easy-to-use model for accessing, viewing, and analyzing meteorological data. MetView provides both graphical and numerical displays of data. It can accommodate data from an extensive meteorological monitoring network that includes near-surface monitoring locations, instrumented towers, sodars, and meteorologist observations. MetView is used operationally for both routine, emergency response, and research applications at the U.S. Department of Energy's Hanford Site. At the Site's Emergency Operations Center, MetView aids in the access, visualization, and interpretation of real-time meteorological data. Historical data can also be accessed and displayed. Emergency response personnel at the Emergency Operations Center use MetViewmore » products in the formulation of protective action recommendations and other decisions. In the initial stage of an emergency, MetView can be operated using a very simple, five-step procedure. This first-responder procedure allows non-technical staff to rapidly generate meteorological products and disseminate key information. After first-responder information products are produced, the Emergency Operations Center's technical staff can conduct more sophisticated analyses using the model. This may include examining the vertical variation in winds, assessing recent changes in atmospheric conditions, evaluating atmospheric mixing rates, and forecasting changes in meteorological conditions. This user's guide provides easy-to-follow instructions for both first-responder and routine operation of the model. Examples, with explanations, are provided for each type of MetView output display. Information is provided on the naming convention, format, and contents of each type of meteorological data file used by the model area. This user's guide serves as a ready reference for experienced MetView users and a training manual for new users.« less

A Participatory Evaluation of the Use of Social Networking Tools in a High School Math Class

ERIC Educational Resources Information Center

Wormald, Randy J.

2012-01-01

As we move into the 21st century, the needs of our students are more variable than ever. There has been a proliferation of social networking usage in society yet there has been little use of those emerging tools in schools as a means to enhance student learning. It is a common practice in school districts to block social networking sites and…

Community-based health care for indigenous women in Mexico: a qualitative evaluation

PubMed Central

2014-01-01

Introduction Indigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the “Casa de la Mujer Indígena”, a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives. Methods The study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis. Results Few similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies. Conclusions The model’s cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user’s input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care. PMID:24393517

Community-based health care for indigenous women in Mexico: a qualitative evaluation.

PubMed

Pelcastre-Villafuerte, Blanca; Ruiz, Myriam; Meneses, Sergio; Amaya, Claudia; Márquez, Margarita; Taboada, Arianna; Careaga, Katherine

2014-01-06

Indigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the "Casa de la Mujer Indígena", a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives. The study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis. Few similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies. The model's cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user's input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care.

Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial

PubMed Central

2013-01-01

Background The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. Design/methods We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. Discussion This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. Trial registration ClinicalTrials.gov: NCT01815710 PMID:23692634

Seedling ecology and restoration of blackbrush (Coleogyne ramosissima) in the Mojave Desert, United States

USGS Publications Warehouse

Jones, Lisa C.; Schwinning, Susanne; Esque, Todd C.

2014-01-01

Increases in fire frequency are disrupting many ecological communities not historically subjected to fire. In the southwestern United States, the blackbrush (Coleogyne ramosissima) community is among the most threatened, often replaced by invasive annual grasses after fire. This long-lived shrub is vulnerable because it recruits sporadically, partially due to mast seeding and the absence of a seed bank. The goal of this study was to evaluate if shrub restoration can be enhanced by identifying and ameliorating recruitment limitations. Specifically, we tested the effect of encapsulating seeds in predation-deterring “seed balls.” We also tested the effects of nurse plants and mammalian exclusion cages on seedling emergence, growth, and survivorship. These experiments were conducted in a full-factorial design across three sites differing in elevation. Over 2 years, 13% of all planted seeds emerged and the effect of seed balls was overwhelmingly negative because of low emergence. Nurse plants had overall positive effects at Low Elevation, but negative effects at Mid- and High Elevation. Emergence and survival were highest in caged plots everywhere, and effect sizes increased with elevation. Interactions between the cage and the nurse plant treatments indicated that nurse plants tended to attract mammalian predators, lowering emergence and seedling survivorship, particularly at higher elevations. Findings conform to the stress-gradient hypothesis in that interactions among seedlings and mature plants shifted from facilitation to competition as environmental stress decreased with increasing elevation, suggesting that they are transferable to ecologically similar communities elsewhere. Knowledge of site-specific recruitment limitations can help minimize ineffective restoration efforts.

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

PubMed

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

2004-07-01

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

Phenology of stable fly (Diptera: Muscidae) larvae in round bale hay feeding sites in Eastern Nebraska

USDA-ARS?s Scientific Manuscript database

The temporal and spatial patterns of adult stable fly, Stomoxys calcitrans (L.), emergence from six sites where large round baled hay had been provided to pastured cattle as winter feed were studied using emergence traps. The substrate at these sites, consisting of waste hay mixed with bovine manure...

Online and Offline Social Networks: Use of Social Networking Sites by Emerging Adults

ERIC Educational Resources Information Center

Subrahmanyam, Kaveri; Reich, Stephanie M.; Waechter, Natalia; Espinoza, Guadalupe

2008-01-01

Social networking sites (e.g., MySpace and Facebook) are popular online communication forms among adolescents and emerging adults. Yet little is known about young people's activities on these sites and how their networks of "friends" relate to their other online (e.g., instant messaging) and offline networks. In this study, college students…

The effect of Transition to Specialty Practice Programs on Australian emergency nurses' professional development, recruitment and retention.

PubMed

Morphet, Julia; Kent, Bridie; Plummer, Virginia; Considine, Julie

2015-11-01

To date, emergency nursing Transition to Specialty Practice Program (TSPP) evaluations have been single-site observational studies. The aim of this paper was to examine the professional development, recruitment and retention outcomes of Australian emergency nursing TSPPs. An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Unit Managers and Nurse Educators. Survey data from EDs with TSPPs and EDs without TSPPs were compared. Qualitative data were analysed using content analysis. Data were collected from 118 EDs, and 13 interviews. TSPPs were offered in 72.1% of EDs. EDs with TSPPs had higher proportions of nurses with postgraduate qualifications (Mdn 28.3% vs. 22.1%, p=0.45) and Clinical Specialists (Mdn 16.4% vs. 6.3%, p=0.04). The median proportion of currently rostered nurses with TSPP completion was 34.2% in EDs with TSPPs introduced in 2000-2005 indicating ED high levels of retention. Emergency nursing TSPPs have had a positive effect on nursing professional development, recruitment and retention. To ensure consistency in outcomes and optimise reliability of emergency nursing skills and knowledge, a national emergency nursing TSPP framework is needed. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Homeland Security and Defense Applications

ScienceCinema

None

2018-01-16

Homeland Security and Defense Applications personnel are the best in the world at detecting and locating dirty bombs, loose nukes, and other radiological sources. The site trains the Nation's emergency responders, who would be among the first to confront a radiological or nuclear emergency. Homeland Security and Defense Applications highly training personnel, characterize the threat environment, produce specialized radiological nuclear detection equipment, train personnel on the equipment and its uses, test and evaluate the equipment, and develop different kinds of high-tech equipment to defeat terrorists. In New York City for example, NNSS scientists assisted in characterizing the radiological nuclear environment after 9/11, and produced specialized radiological nuclear equipment to assist local officials in their Homeland Security efforts.

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

None

Homeland Security and Defense Applications personnel are the best in the world at detecting and locating dirty bombs, loose nukes, and other radiological sources. The site trains the Nation's emergency responders, who would be among the first to confront a radiological or nuclear emergency. Homeland Security and Defense Applications highly training personnel, characterize the threat environment, produce specialized radiological nuclear detection equipment, train personnel on the equipment and its uses, test and evaluate the equipment, and develop different kinds of high-tech equipment to defeat terrorists. In New York City for example, NNSS scientists assisted in characterizing the radiological nuclear environmentmore » after 9/11, and produced specialized radiological nuclear equipment to assist local officials in their Homeland Security efforts.« less

Management of Acute Exacerbation of Asthma and Chronic Obstructive Pulmonary Disease in the Emergency Department.

PubMed

Suau, Salvador J; DeBlieux, Peter M C

2016-02-01

Acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD are chronic, debilitating disease processes that have been differentiated traditionally by the presence or absence of reversible airflow obstruction. Asthma and COPD exacerbations impose an enormous economic burden on the US health care budget. In daily clinical practice, it is difficult to differentiate these 2 obstructive processes based on their symptoms, and on their nearly identical acute treatment strategies; major differences are important when discussing anatomic sites involved, long-term prognosis, and the nature of inflammatory markers. Copyright © 2016 Elsevier Inc. All rights reserved.

Are Schools Prepared for Emergencies?: A Baseline Assessment of Emergency Preparedness at School Sites in Three Los Angeles County School Districts

ERIC Educational Resources Information Center

Kano, Megumi; Ramirez, Marizen; Ybarra, William J.; Frias, Gus; Bourque, Linda B.

2007-01-01

A survey of emergency preparedness was conducted in three public school districts in urban areas of Los Angeles County. Eighty-three school sites were surveyed using self-administered questionnaires. Although designated respondents generally felt that their schools were well prepared, the survey also revealed the need for improvements in written…

De novo active sites for resurrected Precambrian enzymes

NASA Astrophysics Data System (ADS)

Risso, Valeria A.; Martinez-Rodriguez, Sergio; Candel, Adela M.; Krüger, Dennis M.; Pantoja-Uceda, David; Ortega-Muñoz, Mariano; Santoyo-Gonzalez, Francisco; Gaucher, Eric A.; Kamerlin, Shina C. L.; Bruix, Marta; Gavira, Jose A.; Sanchez-Ruiz, Jose M.

2017-07-01

Protein engineering studies often suggest the emergence of completely new enzyme functionalities to be highly improbable. However, enzymes likely catalysed many different reactions already in the last universal common ancestor. Mechanisms for the emergence of completely new active sites must therefore either plausibly exist or at least have existed at the primordial protein stage. Here, we use resurrected Precambrian proteins as scaffolds for protein engineering and demonstrate that a new active site can be generated through a single hydrophobic-to-ionizable amino acid replacement that generates a partially buried group with perturbed physico-chemical properties. We provide experimental and computational evidence that conformational flexibility can assist the emergence and subsequent evolution of new active sites by improving substrate and transition-state binding, through the sampling of many potentially productive conformations. Our results suggest a mechanism for the emergence of primordial enzymes and highlight the potential of ancestral reconstruction as a tool for protein engineering.

Indirect effects of an invasive annual grass on seed fates of two native perennial grass species.

PubMed

Meyer, Susan E; Merrill, Katherine T; Allen, Phil S; Beckstead, Julie; Norte, Anna S

2014-04-01

Invasive plants exhibit both direct and indirect negative effects on recruitment of natives following invasion. We examined indirect effects of the invader Bromus tectorum (cheatgrass) on seed fates of two native grass species, Elymus elymoides and Pseudoroegneria spicata, by removing B. tectorum and by adding inoculum of the shared seed pathogen Pyrenophora semeniperda in factorial experiments at xeric and mesic field sites. We also included a supplemental watering treatment to increase emergence and also the potential for pathogen escape. We recorded emergence and survival of native seedlings and also determined the fate of unemerged seeds. At the xeric site, Pyrenophora-caused mortality was high (34%), and effects of other pathogens and failed emergence of germinants were smaller. Cheatgrass removal negatively affected both emergence (35 vs. 25%) and spring survival (69 vs. 42%). Pyrenophora-caused seed mortality increased with inoculum augmentation for both species (22 vs. 47% overall), but emergence was negatively impacted only for P. spicata (20 vs. 34%). At the mesic site, Pyrenophora-caused mortality was low (6%). Cheatgrass removal doubled emergence (26 vs. 14%). Seed mortality increased significantly with inoculum augmentation for P. spicata (12 vs. 5%) but not E. elymoides, while emergence was not significantly affected in either species. A large fraction of seeds produced germinants that failed to emerge (37%), while another large fraction (35%) was killed by other pathogens. We conclude that facilitation by cheatgrass at the xeric site but interference at the mesic site was probably mediated through litter effects that could be ameliorative or suppressive. Apparent competition between cheatgrass and native grasses could occur through Pyrenophora, especially in a xeric environment, but effects were weak or absent at emergence. This was probably because Pyrenophora attacks the same slow-germinating fraction that is subject to pre-emergence mortality from other causes, including attack by other pathogens such as Fusarium.

Docking modes of BB-3497 into the PDF active site--a comparison of the pure MM and QM/MM based docking strategies.

PubMed

Kumari, Tripti; Issar, Upasana; Kakkar, Rita

2014-01-01

Peptide deformylase (PDF) has emerged as an important antibacterial drug target. Considerable effort is being directed toward developing peptidic and non-peptidic inhibitors for this metalloprotein. In this work, the known peptidic inhibitor BB-3497 and its various ionization and tautomeric states are evaluated for their inhibition efficiency against PDF using a molecular mechanics (MM) approach as well as a mixed quantum mechanics/molecular mechanics (QM/MM) approach, with an aim to understand the interactions in the binding site. The evaluated Gibbs energies of binding with the mixed QM/MM approach are shown to have the best predictive power. The experimental pose is found to have the most negative Gibbs energy of binding, and also the smallest strain energy. A quantum mechanical evaluation of the active site reveals the requirement of strong chelation by the ligand with the metal ion. The investigated ligand chelates the metal ion through the two oxygens of its reverse hydroxamate moiety, particularly the N-O(-) oxygen, forming strong covalent bonds with the metal ion, which is penta-coordinated. In the uninhibited state, the metal ion is tetrahedrally coordinated, and hence chelation with the inhibitor is associated with an increase of the metal ion coordination. Thus, the strong binding of the ligand at the binding site is accounted for.

Assessing the success of the WomanKind program: an integrated model of 24-hour health care response to domestic violence.

PubMed

Short, Lynn M; Hadley, Susan M; Bates, Bonnie

2002-01-01

The WomanKind program, a non-profit health care based program for for victims of domestic/intimate partner violence (IPV), seeks to enable and motivate health care providers to identify victims of such violence and refer them to WomanKind's in-house services. An evaluation designed to assess client referral to WomanKind services and the impact of health care provider training was carried out. Data were collected at three intervals over a 2-year period at 3 intervention and 2 comparison hospitals located in Minneapolis, MN. The focus of data collection efforts was to assess the providers' knowledge, attitudes, beliefs, and behaviors (KABB) concerning identification and referral of victims of IPV. Hospital staff and volunteer advocate training programs also were evaluated. Chart reviews were conducted and client referrals assessed. Providers at WomanKind hospitals demonstrated significantly higher knowledge, attitudes, beliefs and behaviors than those at comparison hospitals throughout the study. During the data collection period, 1719 IPV victims were identified and referred to the WomanKind program, while only 27 IPV victims were referred to trained social workers at the comparison hospitals. Chart reviews indicated that emergency staff at the intervention sites provide documentation of IPV in patient records twice as frequently as emergency staff at the comparison sites. This research underscores the efficacy of a well-structured, multidisciplinary effort to deliver services to IPV victims. The results demonstrate that specialized training and on-site client services create a significant positive impact on the KABB of health care providers.

Evaluation of the ERP dispersion model using Darlington tracer-study data. Report No. 90-200-K

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

Wright, S.C.

1990-01-01

In this study, site-boundary atmospheric dilution factors calculated by the atmospheric dispersion model used in the ERP (Emergency Response Planning) computer code were compared to data collected during the Darlington tracer study. The purpose of this comparison was to obtain estimates of model uncertainty under a variety of conditions. This report provides background on ERP, the ERP dispersion model and the Darlington tracer study. Model evaluation techniques are discussed briefly, and the results of the comparison of model calculations with the field data are presented and reviewed.

Site safety plan for Lawrence Livermore National Laboratory CERCLA investigations at site 300. Revision 2

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

Kilmer, J.

Various Department of Energy Orders incorporate by reference, health and safety regulations promulgated by the Occupational Safety and Health Administration (OSHA). One of the OSHA regulations, 29 CFR 1910.120, Hazardous Waste Operations and Emergency Response, requires that site safety plans are written for activities such as those covered by work plans for Site 300 environmental investigations. Based upon available data, this Site Safety Plan (Plan) for environmental restoration has been prepared specifically for the Lawrence Livermore National Laboratory Site 300, located approximately 15 miles east of Livermore, California. As additional facts, monitoring data, or analytical data on hazards are provided,more » this Plan may need to be modified. It is the responsibility of the Environmental Restoration Program and Division (ERD) Site Safety Officer (SSO), with the assistance of Hazards Control, to evaluate data which may impact health and safety during these activities and to modify the Plan as appropriate. This Plan is not `cast-in-concrete.` The SSO shall have the authority, with the concurrence of Hazards Control, to institute any change to maintain health and safety protection for workers at Site 300.« less

Evaluation of toxicity to the amphipod, Hyalella azteca, and to the midge, Chironomus dilutus; and bioaccumulation by the oligochaete, Lumbriculus variegatus, with exposure to PCB-contaminated sediments from Anniston, Alabama

USGS Publications Warehouse

Ingersoll, Christopher G.; Steevens, Jeffery A.; MacDonald, Donald D.; Brumbaugh, William G.; Coady, Matthew R.; Farrar, J. Daniel; Lotufo, Guilherme R.; Kemble, Nile E.; Kunz, James L.; Stanley, Jacob K.; Sinclair, Jesse A.; Ingersoll, Christopher G.; Steevens, Jeffery A.; MacDonald, Donald D.

2014-01-01

The U.S. Environmental Protection Agency (USEPA) requested that as part of the remedial investigation for the Anniston, Alabama Polychlorinated Biphenyl (PCB) Site (Anniston PCB Site), that Pharmacia Corporation and Solutia Inc. (P/S) perform long-term reproduction toxicity tests with the amphipod, Hyalella azteca, and the midge, Chironomus dilutus, and bioaccumulation tests with the oligochaete, Lumbriculus variegatus, using sediment samples collected from reference locations and from Operable Unit 4 of the Anniston PCB Site. The sediment toxicity testing and sediment bioaccumulation results will be used by ARCADIS U.S., Inc. (ARCADIS) as part of a weight-of-evidence assessment to evaluate risks and establish sediment remediation goals for contaminants to sediment-dwelling organisms inhabiting the Anniston PCB Site. The goal of this study was to characterize relations between sediment chemistry and sediment toxicity and relations between sediment chemistry and sediment bioaccumulation in samples of sediments collected from the Anniston PCB Site. A total of 32 samples were evaluated from six test sites and one reference site to provide a wide range in concentrations of chemicals of potential concern (COPCs) including PCBs in samples of whole sediment. The goal of this study was not to determine the extent of sediment contamination across the Anniston PCB Site. Hence, the test sites or samples collected from within a test site were not selected to represent the spatial extent of sediment contamination across the Anniston PCB Site. Sediment chemistry, pore-water chemistry, and sediment toxicity data were generated for 26 sediment samples from the Anniston PCB Site. All of the samples were evaluated to determine if they qualified as reference sediment samples. Those samples that met the chemical selection criteria and biological selection criteria were identified as reference samples and used to develop the reference envelope for each toxicity test endpoint. Physical characterization of samples of whole sediment included analyses of grain size, TOC, and nutrients. Organic chemical characterization of samples of whole sediment included PCB homologs and select (13) PCB congeners, parent and alkylated polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides, and polychlorinated dibenzo-p-dioxins; and dibenzofurans. The PCB aroclors analyzed included 1016, 1221, 1232, 1242, 1248, 1254, 1260, 1262 and 1268. Analyses of whole sediment also included total metals, simultaneously extracted metals, and acid volatile sulfide. Chemical characterization of samples of pore water isolated from samples of whole sediment at the start of the sediment toxicity exposures or at the start of the sediment bioaccumulation exposures included metals, major cations, major anions, dissolved organic carbon, and additional water-quality characteristics. Concentrations of metals or PCBs in pore water during the sediment toxicity exposures or during sediment bioaccumulation exposures also were determined using peeper samples (for metals) or solid-phase microextraction (SPME) samplers (for PCBs). The bioavailability and bioaccumulation of PCBs in 14 sediment samples were investigated using SPME passive samplers and the 28-d L. variegatus whole-sediment bioaccumulation exposures In general the accumulation of PCBs consistently was predicted through the use of organic carbon normalization and equilibrium partitioning. In these sediments, PCB homologs were accumulated differently based on bioavailability and potential to accumulate in oligochaetes. As part of this assessment homolog specific biota sediment accumulation factor values were developed that could be applied across the larger site to predict tissue levels of PCBs. The whole-sediment toxicity tests done with H. azteca and C. dilutus met the established ASTM and USEPA test acceptability criteria. The most responsive H. azteca endpoints were day 42 survival normalized young per female and day 28 biomass and that the most responsive C. dilutus endpoints were adult biomass and percent adult emergence. Overall, between the two species, the most responsive endpoint assessed for these two species was H. azteca survival-normalized young per female (67 percent of the samples classified as toxic). Concentration-response models (CRMs) and site-specific sediment toxicity thresholds (TTs) were generated with matching sediment chemistry and sediment toxicity data. Sediment chemistry, pore-water chemistry, and sediment toxicity data were evaluated for as many as 26 sediment samples from the Anniston PCB Site. The reference-envelope approach was used to identify the sediment samples that were toxic to benthic invertebrates. This procedure involved identification of reference sediment samples, normalizing the toxicity data to reflect control responses, developing a reference envelope for each toxicity test endpoint, and designating each sediment sample as toxic or not toxic for each toxicity test endpoint, for each species, and for all species combined. These results demonstrated percent emergence of adult C. dilutus, biomass of adult C. dilutus, and reproduction of H. azteca normalized to percent survival were among the most responsive endpoints that were evaluated. Therefore, these endpoints were selected for CRM development. The site-specific TTs for whole sediment provide a reliable basis for identifying toxic and not toxic sediment samples in the Anniston PCB Site (that is, for correctly classifying the sediment samples used to derive the TTs as toxic or not toxic, for the endpoint used to derive the TTs). Among the 69 TTs for sediment, the TTLRs for total PCB homologs [499 to 1,870 micrograms per kilogram dry weight (μg/kg DW)] and for lead [(9.48 to 10.3 milligrams per kilogram (mg/kg) DW] based on reproduction of H. azteca or based on emergence or biomass of adult C. dilutus, were the most reliable. Such TTs had low rates of false negative errors (that is, only 0 to 11 percent of the samples below the TT were toxic to benthic invertebrates), low rates of false positive errors (only 0 to 6 percent of the samples greater than the TT were not toxic to benthic invertebrates), and high rates of correct classification (that is, 92 to 96 percent). The site-specific TTs for PCBs and other COPCs derived in this study also were compared to empirically based sediment quality guidelines (SQGs), to equilibrium-partitioning based SQGs, and to the results of spiked-sediment toxicity tests. The results of this evaluation indicated that the site-specific sediment TTs for PCBs were comparable to the consensus-based SQGs that were derived for PCBs. In addition, the site-specific sediment TTs for PCBs are well within the range of SQGs derived using the equilibrium partitioning approach. The site-specific sediment TTs for PCBs also are consistent with the results of chronic TTs that have been estimated for benthic invertebrates using the results of spiked-sediment toxicity tests. As the site-specific sediment TTs for PCBs are consistent with empirically based SQGs, equilibrium-partitioning based SQGs, and results of sediment-spiking studies, these site- specific sediment TTs likely represent the concentrations of PCBs that are sufficient to cause toxicity to benthic invertebrates (as opposed to simply being correlated with adverse effects on the survival, weight, or reproduction of benthic invertebrates). Importantly, such site-specific sediment TTs have been demonstrated to accurately classify sediment samples as toxic or not toxic to benthic invertebrates at the Anniston PCB Site. In contrast, the TTs for metals, PAHs, and organochlorine pesticides were generally lower than consensus-based SQGs (that is, probable effect concentrations), and LC50s (median lethal effect concentrations) generated in spiked-sediment toxicity tests, indicating that these COPCs are likely not the main contributors to the observed toxicity of the site sediments evaluated in this study. The reproduction endpoint for H. azteca provided lower TTs compared to the day 28 biomass endpoint for H. azteca and the emergence or biomass endpoints for adult C. dilutus provided lower TTs compared to the day 13 biomass endpoint for C. dilutus.

Enhanced, Partially Redundant Emergency Notification System

NASA Technical Reports Server (NTRS)

Pounds, Clark D.

2005-01-01

The Johnson Space Center Emergency Notification System (JENS) software utilizes pre-existing computation and communication infrastructure to augment a prior variable-tone, siren-based, outdoor alarm system, in order to enhance the ability to give notice of emergencies to employees working in multiple buildings. The JENS software includes a component that implements an administrative Web site. Administrators can grant and deny access to the administrative site and to an originator Web site that enables authorized individuals to quickly compose and issue alarms. The originator site also facilitates maintenance and review of alarms already issued. A custom client/server application program enables an originator to notify every user who is logged in on a Microsoft Windows-based desktop computer by means of a pop-up message that interrupts, but does not disrupt, the user s work. Alternatively or in addition, the originator can send an alarm message to recipients on an e-mail distribution list and/or can post the notice on an internal Web site. An alarm message can consist of (1) text describing the emergency and suggesting a course of action and (2) a replica of the corresponding audible outdoor alarm.

Hazardous Materials Management and Emergency Response training Center needs assessment

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

McGinnis, K.A.; Bolton, P.A.; Robinson, R.K.

1993-09-01

For the Hanford Site to provide high-quality training using simulated job-site situations to prepare the 4,000 Site workers and 500 emergency responders for known and unknown hazards a Hazardous Materials Management and Emergency Response Training Center is needed. The center will focus on providing classroom lecture as well as hands-on, realistic training. The establishment of the center will create a partnership among the US Department of Energy; its contractors; labor; local, state, and tribal governments; and Xavier and Tulane Universities of Louisiana. This report presents the background, history, need, benefits, and associated costs of the proposed center.

Social media best practices in emergency management.

PubMed

Siskey, Ashley; Islam, Tanveer

2016-01-01

Social media platforms have become popular as means of communications in emergency management. Many people use social media sites such as Facebook and Twitter on a daily basis including during disaster events. Emergency management agencies (EMAs) need to recognize the value of not only having a presence on social media but also actively engaging stakeholders and the public on these sites. However, identifying best practices for the use of social media in emergency management is still in its infancy. The objective of this article is to begin to create or further define best practices for emergency managers to use social media sites particularly Facebook and Twitter in four key areas: 1) implementation, 2) education, 3) collaboration, and 4) communication. A list of recommendations of best practices is formulated for each key area and results from a nationwide survey on the use of social media by county EMAs are discussed in this article.

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

PubMed

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

2018-01-30

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

Applying Multi-Criteria Decision Analysis (MCDA) Simple Scoring as an Evidence-based HTA Methodology for Evaluating Off-Patent Pharmaceuticals (OPPs) in Emerging Markets.

PubMed

Brixner, Diana; Maniadakis, Nikos; Kaló, Zoltán; Hu, Shanlian; Shen, Jie; Wijaya, Kalman

2017-09-01

Off-patent pharmaceuticals (OPPs) represent more than 60% of the pharmaceutical market in many emerging countries, where they are frequently evaluated primarily on cost rather than with health technology assessment. OPPs are assumed to be identical to the originators. Branded and unbranded generic versions can, however, vary from the originator in active pharmaceutical ingredients, dosage, consistency formulation, excipients, manufacturing processes, and distribution, for example. These variables can alter the efficacy and safety of the product, negatively impacting both the anticipated cost savings and the population's health. In addition, many health care systems lack the resources or expertise to evaluate such products, and current assessment methods can be complex and difficult to adapt to a health system's needs. Multicriteria decision analysis (MCDA) simple scoring is an evidence-based health technology assessment methodology for evaluating OPPs, especially in emerging countries in which resources are limited but decision makers still must balance affordability with factors such as drug safety, level interchangeability, manufacturing site and active pharmaceutical ingredient quality, supply track record, and real-life outcomes. MCDA simple scoring can be applied to pharmaceutical pricing, reimbursement, formulary listing, and drug procurement. In November 2015, a workshop was held at the International Society for Pharmacoeconomics and Outcomes Research Annual Meeting in Milan to refine and prioritize criteria that can be used in MCDA simple scoring for OPPs, resulting in an example MCDA process and 22 prioritized criteria that health care systems in emerging countries can easily adapt to their own decision-making processes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Qualitative data collection and analysis methods: the INSTINCT trial.

PubMed

Meurer, William J; Frederiksen, Shirley M; Majersik, Jennifer J; Zhang, Lingling; Sandretto, Annette; Scott, Phillip A

2007-11-01

Patient care practices often lag behind current scientific evidence and professional guidelines. The failure of such knowledge translation (KT) efforts may reflect inadequate assessment and management of specific barriers confronting both physicians and patients at the point of treatment level. Effective KT in this setting may benefit from the use of qualitative methods to identify and overcome these barriers. Qualitative methodology allows in-depth exploration of the barriers involved in adopting practice change and has been infrequently used in emergency medicine research. The authors describe the methodology for qualitative analysis within the INcreasing Stroke Treatment through INteractive behavioral Change Tactics (INSTINCT) trial. This includes processes for valid data collection and reliable analysis of the textual data from focus group and interview transcripts. INSTINCT is a 24-hospital, randomized, controlled study that is designed to evaluate a system-based barrier assessment and interactive educational intervention to increase appropriate tissue plasminogen activator (tPA) use in ischemic stroke. Intervention hospitals undergo baseline barrier assessment using both qualitative as well as quantitative (survey) techniques. Investigators obtain data on local barriers to tPA use, as well as information on local attitudes, knowledge, and beliefs regarding acute stroke treatment. Targeted groups at each site include emergency physicians, emergency nurses, neurologists, radiologists, and hospital administrators. Transcript analysis using NVivo7 with a predefined barrier taxonomy is described. This will provide both qualitative insight on thrombolytic use and importance of specific barrier types for each site. The qualitative findings subsequently direct the form of professional education efforts and system interventions at treatment sites.

Emergencies and Emergency Permits for Ocean Dumping

EPA Pesticide Factsheets

Emergency permits under the MPRSA are issued if disposed material poses a threat to human health. Information is provided on emergency permit examples and disposal sites. Emergencies to safeguard life at sea does not require an ocean dumping permit.

Angiographic evaluation and management of acute gastrointestinal hemorrhage

PubMed Central

Walker, T Gregory; Salazar, Gloria M; Waltman, Arthur C

2012-01-01

Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment, there are still a significant number of patients who require emergency angiography and transcatheter treatment. Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography. Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding, as determined by the available clinical, endoscopic and imaging data. If a hemorrhage source is identified, superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications. This is now well-recognized as a viable and safe alternative to emergency surgery. In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding. One must be aware of the various side effects and potential complications associated with this treatment, however, and recognize the high re-bleeding rate. In this article we review the current role of angiography, transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage. PMID:22468082

Situational Awareness Applied to Geology Field Mapping using Integration of Semantic Data and Visualization Techniques

NASA Astrophysics Data System (ADS)

Houser, P. I. Q.

2017-12-01

21st century earth science is data-intensive, characterized by heterogeneous, sometimes voluminous collections representing phenomena at different scales collected for different purposes and managed in disparate ways. However, much of the earth's surface still requires boots-on-the-ground, in-person fieldwork in order to detect the subtle variations from which humans can infer complex structures and patterns. Nevertheless, field experiences can and should be enabled and enhanced by a variety of emerging technologies. The goal of the proposed research project is to pilot test emerging data integration, semantic and visualization technologies for evaluation of their potential usefulness in the field sciences, particularly in the context of field geology. The proposed project will investigate new techniques for data management and integration enabled by semantic web technologies, along with new techniques for augmented reality that can operate on such integrated data to enable in situ visualization in the field. The research objectives include: Develop new technical infrastructure that applies target technologies to field geology; Test, evaluate, and assess the technical infrastructure in a pilot field site; Evaluate the capabilities of the systems for supporting and augmenting field science; and Assess the generality of the system for implementation in new and different types of field sites. Our hypothesis is that these technologies will enable what we call "field science situational awareness" - a cognitive state formerly attained only through long experience in the field - that is highly desirable but difficult to achieve in time- and resource-limited settings. Expected outcomes include elucidation of how, and in what ways, these technologies are beneficial in the field; enumeration of the steps and requirements to implement these systems; and cost/benefit analyses that evaluate under what conditions the investments of time and resources are advisable to construct such system.

Genital and Extragenital Gonorrhea and Chlamydia in Children and Adolescents Evaluated for Sexual Abuse.

PubMed

Kellogg, Nancy D; Melville, John D; Lukefahr, James L; Nienow, Shalon M; Russell, Edward L

2017-01-09

The aim of this study was to describe the use of a nucleic acid amplification test in detecting genital and extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in children and adolescents assessed for sexual abuse/assault. The charts of children aged 0 to 17 years, consecutively evaluated for sexual victimization, in emergency department and outpatient settings were reviewed. Data extracted included age, sex, type of sexual contact, anogenital findings, previous sexual contact, toxicology results, and sites tested for NG and CT. Of the 1319 patients who were tested, 579 were tested at more than 1 site, and 120 had at least 1 infected site. Chlamydia trachomatis was identified in 104 patients, and NG was found in 33. In bivariate analysis, a positive test was associated with female sex, age older than 11 years, previous sexual contact, acute or healed genital injury, drug/alcohol intoxication, and examination within 72 hours of sexual contact. Fifty-one patients had positive anal tests, and 24 had positive oral tests. More than 75% of patients with positive extragenital tests had additional positive tests or anogenital injury. Most with a positive anal (59%) or oral (77%) test did not report that the assailant's genitals came into contact with that site. Positive tests for NG and CT in patients evaluated for sexual victimization may represent infection from sexual contact, contiguous spread of infection, or the presence of infected assailant secretions. Relying on patient reports of symptoms, or types of sexual contact, to determine need for testing may miss NG and CT infections in patients evaluated for sexual victimization.

Clinical Decision Support for a Multicenter Trial of Pediatric Head Trauma

PubMed Central

Swietlik, Marguerite; Deakyne, Sara; Hoffman, Jeffrey M.; Grundmeier, Robert W.; Paterno, Marilyn D.; Rocha, Beatriz H.; Schaeffer, Molly H; Pabbathi, Deepika; Alessandrini, Evaline; Ballard, Dustin; Goldberg, Howard S.; Kuppermann, Nathan; Dayan, Peter S.

2016-01-01

Summary Introduction For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinically-important traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial. Methods Thirteen EDs participated in this trial. The 10 sites receiving the CDS intervention used the Epic® EHR. All sites implementing EHR-based CDS built the rules by using the vendor’s CDS engine. Based on a sociotechnical analysis, we designed the CDS so that recommendations could be displayed immediately after any provider entered prediction rule data. One central site developed and tested the intervention package to be exported to other sites. The intervention package included a clinical trial alert, an electronic data collection form, the CDS rules and the format for recommendations. Results The original PECARN head trauma prediction rules were derived from physician documentation while this pragmatic trial led each site to customize their workflows and allow multiple different providers to complete the head trauma assessments. These differences in workflows led to varying completion rates across sites as well as differences in the types of providers completing the electronic data form. Site variation in internal change management processes made it challenging to maintain the same rigor across all sites. This led to downstream effects when data reports were developed. Conclusions The process of a centralized build and export of a CDS system in one commercial EHR system successfully supported a multicenter clinical trial. PMID:27437059

The outcome of a rapid training program on nurses' attitudes regarding the prevention of aggression in emergency departments: a multi-site evaluation.

PubMed

Gerdtz, Marie Frances; Daniel, Catherine; Dearie, Vikki; Prematunga, Roshani; Bamert, Merrin; Duxbury, Joy

2013-11-01

Patient aggression is a common source of occupational violence in emergency departments. Staff attitudes regarding the causes for aggression influence the way they manage it. The Management of Clinical Aggression - Rapid Emergency Department Intervention is a 45 min educational program that aims to promote the use of de-escalation techniques and effective communication skills to prevent patient aggression. We sought to evaluate the impact of the program on staff attitudes regarding the prevention and early management of patient aggression. A mixed methods approach was used including a pre-test post-test survey of training participants and individual interviews with key stakeholders. The setting was public sector hospital emergency departments located in metropolitan and regional Victoria, Australia. A convenience sample of eighteen emergency departments was recruited via the Victorian Department of Health. Survey participants were nurses and midwives who were employed at the study sites. Interview participants were a purposive sample of nurse unit managers and trainers. The Management of Aggression and Violence Attitude Scale was administered to training participants immediately before and 6-8 weeks after training. Semi-structured telephone interviews with trainers and managers occurred 8-10 weeks after the intervention. Four hundred and seventy one participants completed the pre-test and post-test. Statistically significant shifts were observed in 5/23 items (Wilcoxon Signed Ranks Test: p ≤ 0.01). Despite training, participants were undecided if it was possible to prevent patient aggression, and continued to be unsure about the use of physical restraint. Twenty-eight (82.3%) of managers' and trainers' eligible to be interviewed provided their perceptions of the impact of the program. Overall, these perceptions were consistent with the significant shifts observed in the survey items. There was limited evidence to demonstrate that the program significantly modified staff attitudes towards the prevention of patient aggression using the Management of Aggression and Violence Attitude Scale. Additional survey items that specifically measure staff attitudes about the use of restraint in emergency settings are needed to better understand decision making about restraining practices. Further work is indicated to quantify the impact of training in practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Learning Curves for Ultrasound Assessment of Lumbar Puncture Insertion Sites: When is Competency Established?

PubMed

Rankin, Jessica H; Elkhunovich, Marsha A; Rangarajan, Vijayeta; Chilstrom, Mikaela; Mailhot, Tom

2016-07-01

Ultrasound (US) can be used to improve lumbar puncture (LP) success. How to achieve competency in LP US has not been defined. Cumulative sum statistics (CUSUM) characterized competency acquisition in other skills. Identify the learning curve for 80% success rate in LP US insertion site (IS) identification among pediatric emergency medicine fellows. This prospective study took place in a single pediatric emergency department. Fellows with limited ultrasound experience received didactics, training, and three proctored examinations. Skills were evaluated in three 2-h sessions: using US, subjects identified LP ISs on a convenience sample of patients ages 0-20 years old. Subjects' IS markings were compared to markings by an expert, an emergency US fellowship-trained attending. Successful IS identification was defined as markings within 2 mm or 5 mm of the expert mark in infants and older children, respectively. A second expert marked 17 cases for interrater agreement. CUSUM was used to analyze individual learning curves. Five fellows evaluated 72 patients (mean age 11.4 years [SD = 4, range 3-20], mean body mass index 20.5 [SD = 4.4, range 13.1-37.7]) over a 3-month period. Mean number of attempts per fellow was 14.4 ± 3.1 (R 11-19); mean time to landmark identification was 72 ± 46 s (R 27-240). The two experts demonstrated 100% observed agreement. Aggregate success rate for all fellows was 75% (54/72). Four fellows showed learning curves that trended toward, but did not achieve, the acceptable success rate of 80%. Nineteen attempts are insufficient among fellows to achieve competency in US-guided LP IS identification. Copyright © 2016 Elsevier Inc. All rights reserved.

Sociomaterial Perspectives on Work and Learning: Sites of Emergent Learning

ERIC Educational Resources Information Center

Reich, Ann; Rooney, Donna; Hopwood, Nick

2017-01-01

Purpose: This paper aims to introduce, explain and illustrate the concept of "sites of emergent learning" (SEL), which pinpoints particular instances of learning in everyday practice. This concept is located within contemporary practice-oriented and sociomaterial approaches to understanding workplace learning.…

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study.

PubMed

Hopkins, Jammie M; Glenn, Beth A; Cole, Brian L; McCarthy, William; Yancey, Antronette

2012-06-01

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations' full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite's intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60-70 worksites in Los Angeles County.

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study

PubMed Central

Hopkins, Jammie M.; Glenn, Beth A.; Cole, Brian L.; McCarthy, William; Yancey, Antronette

2012-01-01

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations’ full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite’s intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60–70 worksites in Los Angeles County. PMID:22323279

Hanford Site ground-water monitoring for 1993

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

Dresel, P.E.; Luttrell, S.P.; Evans, J.C.

This report presents the results of the Ground-Water Surveillance Project monitoring for calendar year 1993 on the Hanford Site, Washington. Hanford Site operations from 1943 onward produced large quantities of radiological and chemical waste that have impacted ground-water quality on the Site. Monitoring of water levels and ground-water chemistry is performed to track the extent of contamination and trends in contaminant concentrations. The 1993 monitoring was also designed to identify emerging ground-water quality problems. The information obtained is used to verify compliance with applicable environmental regulations and to evaluate remedial actions. Data from other monitoring and characterization programs were incorporatedmore » to provide an integrated assessment of Site ground-water quality. Additional characterization of the Site`s geologic setting and hydrology was performed to support the interpretation of contaminant distributions. Numerical modeling of sitewide ground-water flow also supported the overall project goals. Water-level monitoring was performed to evaluate ground-water flow directions, to track changes in water levels, and to relate such changes to changes in site disposal practices. Water levels over most of the Hanford Site continued to decline between June 1992 and June 1993. The greatest declines occurred in the 200-West Area. These declines are part of the continued response to the cessation of discharge to U Pond and other disposal facilities. The low permeability in this area which enhanced mounding of waste-water discharge has also slowed the response to the reduction of disposal. Water levels remained nearly constant in the vicinity of B Pond, as a result of continued disposal to the pond. Water levels measured from wells in the unconfined aquifer north and east of the Columbia River indicate that the primary source of recharge is irrigation practices.« less

Critical design elements of e-health applications for users with severe mental illness: singular focus, simple architecture, prominent contents, explicit navigation, and inclusive hyperlinks.

PubMed

Rotondi, Armando J; Eack, Shaun M; Hanusa, Barbara H; Spring, Michael B; Haas, Gretchen L

2015-03-01

E-health applications are becoming integral components of general medical care delivery models and emerging for mental health care. Few exist for treatment of those with severe mental illness (SMI). In part, this is due to a lack of models to design such technologies for persons with cognitive impairments and lower technology experience. This study evaluated the effectiveness of an e-health design model for persons with SMI termed the Flat Explicit Design Model (FEDM). Persons with schizophrenia (n = 38) performed tasks to evaluate the effectiveness of 5 Web site designs: 4 were prominent public Web sites, and 1 was designed according to the FEDM. Linear mixed-effects regression models were used to examine differences in usability between the Web sites. Omnibus tests of between-site differences were conducted, followed by post hoc pairwise comparisons of means to examine specific Web site differences when omnibus tests reached statistical significance. The Web site designed using the FEDM required less time to find information, had a higher success rate, and was rated easier to use and less frustrating than the other Web sites. The home page design of one of the other Web sites provided the best indication to users about a Web site's contents. The results are consistent with and were used to expand the FEDM. The FEDM provides evidence-based guidelines to design e-health applications for person with SMI, including: minimize an application's layers or hierarchy, use explicit text, employ navigational memory aids, group hyperlinks in 1 area, and minimize the number of disparate subjects an application addresses. © The Author 2013. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Hospital all-risk emergency preparedness in Ghana.

PubMed

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

2012-03-01

This paper assessed the emergency preparedness programs of health facilities for all-risks but focused on Road Traffic Accidents, (RTA) resulting in surge demand. It adopted W. H. O checklist covering hospital preparedness, equipment, manpower and surge capacity planning as best practices for the mitigation of public health emergencies. This is a cross-sectional study of purposively selected health facilities. The method used consisted of site visit, questionnaire survey, literature and internet review. The W. H. O. standard for emergency preparedness of health facilities was used to evaluate and assess the nation's hospitals surge capacity programs. The study was conducted between March-June, 2010. A total of 22 district and regional health facilities including teaching hospitals participated in the study. All 10 regions of the country were covered. These were: (1) many of the nation's hospitals were not prepared for large RTA's resulting in surge demands, and did not possess general emergency preparedness programs. (2) The hospitals' respective abilities to handle large scale RTA's were compromised by the lack of competent medical and allied health personnel and adequate supplies. The inadequacies of the hospital system in responding to emergencies raise serious public health concerns. The biggest challenge facing the hospitals in their emergency intervention is the lack of pre-emergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. The paper ended with recommendations on how the nation's hospitals and their supervisory agencies could improve emergency preparedness.

Mobile radiography at a music festival.

PubMed

Walker, A; Brenchley, J; Hughes, N

2009-08-01

Limb injuries are common at music festival sites and traditionally patients seen by on-site medical services require referral to hospital emergency departments for radiographic exclusion of bony injury. This takes clinical personnel off site, increases demand on local emergency departments and is inconvenient for revellers. This is an audit of the use of a portable digital radiography system at the Virgin music festival in Staffordshire over a 3-year period.

Letter from Brian Croft and Andrew Johnson, Tetra Tech EM, Inc., to Steve Spurlin, USEPA. Subject: Emergency Response Report, American Drum and Pallet Site, TN. EPA Contract Ep-W-05-054, TDD No. TTEMI-05-001-0040

EPA Pesticide Factsheets

Contains April l4, 2008 letter submitting the emergency response report for the American Drum and Pallet Site in Memphis, Shelby County, Tennessee. This report summarizes field activities conducted at the site from June 11, 2007 through January 18, 2008.

Geotechnical Aspects of Rock Erosion in Emergency Spillway Channels. Report 5 Summary of Results, Conclusions and Recommendations

DTIC Science & Technology

1990-09-01

channel. Erosion susceptibility, similar to spillway evaluation, must emphasize rock-mass rating or classification systems (e.g. rippability ) which, when...recommends site-specific "proof of concept" testing of an Erosion Probability Index (EPI) based on rock-mass rippability rating and lithostratigraphic...and rock-mass parameters that provide key input parameters to Weaver’s (1975) Rippability Rating (RR) scheme (or Bieniawski’s (1974) Rock Mass Rating

Intraosseous Vascular Access through the Anterior Mandible – A Cadaver Model Pilot Study

PubMed Central

Goldschalt, Christin; Doll, Sara; Ihle, Brit; Kirsch, Joachim; Mutzbauer, Till Sebastian

2014-01-01

Background Several insertion sites have been described for intraosseous puncture in cases of emergencies when a conventional vascular access cannot be established. This pilot study has been designed to evaluate the feasibility of the mandibular bone for the use of an intraosseous vascular access in a cadaver model. Methodology/Principal Findings 17 dentistry and 16 medical students participating in a voluntary course received a short introduction into the method and subsequently used the battery powered EZ-IO system with a 15 mm cannula for a puncture of the anterior mandible in 33 cadavers. The time needed to perform each procedure was evaluated. India ink was injected into the accesses and during the anatomy course cadavers were dissected to retrace the success or failure of the puncture. Dental students needed 25.5±18.9(mean±standard deviation)s and medical students 33±20.4 s for the procedure (p = 0.18). Floor of mouth extravasation occurred in both groups in 3 cases. Success rates were 82 and 75% (p = 0.93). Conclusions/Significance Despite floor of mouth extravasation of injected fluid into a mandibular intraosseous access might severely complicate this procedure, the anterior mandible may be helpful as an alternative to other intraosseous and intravenous insertion sites when these are not available in medical emergencies. PMID:25405476

The Correlation Between Candida Colonization of Distinct Body Sites and Invasive Candidiasis in Emergency Intensive Care Units: Statistical and Molecular Biological Analysis.

PubMed

Li, Zhen; Jiang, Cen; Dong, Danfeng; Zhang, Lihua; Tian, Yuan; Ni, Qi; Mao, Enqiang; Peng, Yibing

2016-08-01

Both statistical and molecular biological methods were used to evaluate the association between Candida colonization of different body sites and invasive candidiasis (IC) and analyse the potential infection sources of IC. Candida surveillance cultures from the urine, sputum, rectum and skin were performed on patients admitted to an emergency intensive care units (EICU) of a tertiary care hospital in Shanghai, China, from February 2014 to January 2015. Specimens were collected once a week at admission and thereafter. The patients' clinical data were collected, and Candida isolates were genotyped using polymorphic microsatellite markers. A total of 111 patients were enrolled. Patients with positive urine (23.3 vs. 2.5 %, p = 0.001) and rectal swab (13.6 vs. 0 %, p = 0.010) cultures were more likely to develop IC. However, the risk for IC was not significantly different among patients with and without respiratory (10.0 vs. 5.8 %, p = 0.503) and skin (33.3 vs. 6.5 %, p = 0.056) colonization. Gene microevolution frequently occurred at rectal swab and urine sites, and IC with possible source of infection was caused by rectal isolates (2/7), urine isolates (4/7) and sputum isolate (1/7).The colonization of gut and urinary tract maybe more relevant indicators of IC, which should be taken into consideration when selecting practical body sites for Candida surveillance cultures.

An assessment of the efficacy and peak catch rates of emergence tents for measuring bee nesting.

PubMed

Pane, Alexander M; Harmon-Threatt, Alexandra N

2017-06-01

Emergence tents are a new tool used to understand nesting ecology of ground nesting bee species. However, many questions remain about how to use tents effectively. We assessed (a) variance in tent capture rates over time, (b) the effects of site characteristics on proportion of tents capturing bees, and (c) the effect of soil characteristics on nest site choice. Emergence tents were placed out for one week in May, June, and August and checked daily. Soil, bee, and floral characteristics were recorded. Across all sites and months the average number of tents capturing bees was less than 20% during one week of sampling, but this varied between sites. Tent captures decreased after 48 h deployment, but accumulation differed seasonally, with slower accumulation of total bees caught in May than in June or August. Although capture rates were not affected by bee or floral abundance, soil moisture beneath a tent influenced where bees were captured. Effective use of emergence tents may require adjusting the length of deployment depending on season and will require a minimum of 48 h installation to help maximize efficacy. The overall low capture rates demonstrate the need to optimize emergence tent use.

Restoration of riparian vegetation: A global review of implementation and evaluation approaches in the international, peer-reviewed literature.

PubMed

González, Eduardo; Sher, Anna A; Tabacchi, Eric; Masip, Adrià; Poulin, Monique

2015-08-01

We examined how restoration of riparian vegetation has been implemented and evaluated in the scientific literature during the past 25 years. A total of 169 papers were read systematically to extract information about the following: 1) restoration strategies applied, 2) scale of monitoring and use of reference sites, 3) metrics used for evaluation, and 4) drivers of success. Hydro-geomorphic approaches (e.g., dam operations, controlled floods, landform reconfiguration) were the most frequent, followed by active plant introduction, exotic species control, natural floodplain conversion and grazing and herbivory control. Our review revealed noteworthy limitations in the spatio-temporal approaches chosen for evaluation. Evaluations were mostly from one single project and frequently ignored the multi-dimensional nature of rivers: landscape spatial patterns were rarely assessed, and most projects were assessed locally (i.e., ≤meander scale). Monitoring rarely lasted for more than six years and the projects evaluated were usually not more than six years old. The impact of the restoration was most often (43%) assessed by tracking change over time rather than by comparing restored sites to unrestored and reference sites (12%), and few projects (30%) did both. Among the ways which restoration success was evaluated, vegetation structure (e.g., abundance, density, etc.) was assessed more often (152 papers) than vegetation processes (e.g., biomass accumulation, survival, etc.) (112 papers) and vegetation diversity (78 papers). Success was attributed to hydro-geomorphic factors in 63% of the projects. Future evaluations would benefit from incorporating emerging concepts in ecology such as functional traits to assess recovery of functionality, more rigorous experimental designs, enhanced comparisons among projects, longer term monitoring and reporting failure. Copyright © 2015 Elsevier Ltd. All rights reserved.

Do vegetated rooftops attract more mosquitoes? Monitoring disease vector abundance on urban green roofs.

PubMed

Wong, Gwendolyn K L; Jim, C Y

2016-12-15

Green roof, an increasingly common constituent of urban green infrastructure, can provide multiple ecosystem services and mitigate climate-change and urban-heat-island challenges. Its adoption has been beset by a longstanding preconception of attracting urban pests like mosquitoes. As more cities may become vulnerable to emerging and re-emerging mosquito-borne infectious diseases, the knowledge gap needs to be filled. This study gauges the habitat preference of vector mosquitoes for extensive green roofs vis-à-vis positive and negative control sites in an urban setting. Seven sites in a university campus were selected to represent three experimental treatments: green roofs (GR), ground-level blue-green spaces as positive controls (PC), and bare roofs as negative controls (NC). Mosquito-trapping devices were deployed for a year from March 2015 to 2016. Human-biting mosquito species known to transmit infectious diseases in the region were identified and recorded as target species. Generalized linear models evaluated the effects of site type, season, and weather on vector-mosquito abundance. Our model revealed site type as a significant predictor of vector mosquito abundance, with considerably more vector mosquitoes captured in PC than in GR and NC. Vector abundance was higher in NC than in GR, attributed to the occasional presence of water pools in depressions of roofing membrane after rainfall. Our data also demonstrated seasonal differences in abundance. Weather variables were evaluated to assess human-vector contact risks under different weather conditions. Culex quinquefasciatus, a competent vector of diseases including lymphatic filariasis and West Nile fever, could be the most adaptable species. Our analysis demonstrates that green roofs are not particularly preferred by local vector mosquitoes compared to bare roofs and other urban spaces in a humid subtropical setting. The findings call for a better understanding of vector ecology in diverse urban landscapes to improve disease control efficacy amidst surging urbanization and changing climate. Copyright © 2016 Elsevier B.V. All rights reserved.

Hospital Disaster Preparedness in Italy: a preliminary study utilizing the World Health Organization Hospital Emergency Response Evaluation Toolkit.

PubMed

Ingrassia, Pier L; Mangini, Marco; Azzaretto, Massimo; Ciaramitaro, Ilenia; Costa, Laura; Burkle, Frederick M; Della Corte, Francesco; Djalali, Ahmadreza

2016-12-01

Natural and human-initiated disasters are occurring with greater devastating consequences and increased frequency. During these events, hospitals have the burden to care for acutely ill and injured patients. The aim of this study was to evaluate the level of disaster preparedness of Italian hospitals. Site visits were conducted from January, 2014 to December, 2014. The hospital emergency response checklist, developed by the WHO, was used as an evaluation toolkit. It consists of 92 items classified as 9 key components, such as command and control, triage, and critical services. The status of each component was determined by consensus of 3 independent evaluators. The study selected 15 hospitals from different areas in Italy. Out of the 15 hospitals, 12 were considered to be at insufficients level of preparedness, only 3 were considered to have an effective level of preparedness. The average preparedness of all components were lower than the optimal level suggested by the WHO checklist. The study revealed that a large majority of Italian hospitals evaluated are not well prepared to manage potential disasters. Also, all important elements of hospital preparedness, such as the command system, surge capacity, and safety, were insufficiently implemented. Nationwide standards, guidelines and procedures are required to improve hospital disaster preparedness in Italy.

THE U.S. ENVIRONMENTAL PROTECTION AGENCY'S SITE EMERGING TECHNOLOGY PROGRAM

EPA Science Inventory

Under the SITE Emerging Technology Program, the U.S. Environmental Protection Agency is seeking to foster the further development of technol- ogies that have been successfully tested at bench-scale and are now ready for pilot-scale testing, prior to field- or full-scale demonstra...

Rural Palliative Care in North India: Rapid Evaluation of a Program Using a Realist Mixed Method Approach.

PubMed

Munday, Daniel F; Haraldsdottir, Erna; Manak, Manju; Thyle, Ann; Ratcliff, Cathy M

2018-01-01

Palliative care has not developed widely in rural North India. Since 2010, the Emmanuel Hospitals Association (EHA) has been developing a model of palliative care appropriate for this setting, based on teams undertaking home visits with the backup of outpatient and inpatient services. A project to further develop the model operated from 2012 to 2015 supported by funding from the UK. This study aims to evaluate the EHA palliative care project. Rapid evaluation method using a mixed method realist approach at the five project hospital sites. An overview of the project was obtained by analyzing project documents and key informant interviews. Questionnaire data from each hospital were collected, followed by interviews with staff, patients, and relatives and observations of home visits and other activities at each site. Descriptive analysis of quantitative and thematic analysis of qualitative data was undertaken. Each site was measured against the Indian Minimum Standards Tool for Palliative Care (IMSTPC). Each team followed the EHA model, with local modifications. Services were nurse led with medical support. Eighty percent of patients had cancer. Staff demonstrated good palliative care skills and patients and families appreciated the care. Most essential IMSTPC markers were achieved but morphine licenses were available to only two teams. Remarkable synergy was emerging between palliative care and community health. Hospitals planned to fund palliative care through income from surgical services. Excellent palliative care appropriate for rural north India is delivered through the EHA model. It could be extended to other similar sites.

Accuracy of Marketing Claims by Providers of Stereotactic Radiation Therapy

PubMed Central

Narang, Amol K.; Lam, Edwin; Makary, Martin A.; DeWeese, Theodore L.; Pawlik, Timothy M.; Pronovost, Peter J.; Herman, Joseph M.

2013-01-01

Purpose: Direct-to-consumer advertising by industry has been criticized for encouraging overuse of unproven therapies, but advertising by health care providers has not been as carefully scrutinized. Stereotactic radiation therapy is an emerging technology that has sparked controversy regarding the marketing campaigns of some manufacturers. Given that this technology is also being heavily advertised on the Web sites of health care providers, the accuracy of providers' marketing claims should be rigorously evaluated. Methods: We reviewed the Web sites of all US hospitals and private practices that provide stereotactic radiation using two leading brands of stereotactic radiosurgery technology. Centers were identified by using data from the manufacturers. Centers without Web sites were excluded. The final study population consisted of 212 centers with online advertisements for stereotactic radiation. Web sites were evaluated for advertisements that were inconsistent with advertising guidelines provided by the American Medical Association. Results: Most centers (76%) had individual pages dedicated to the marketing of their brand of stereotactic technology that frequently contained manufacturer-authored images (50%) or text (55%). Advertising for the treatment of tumors that have not been endorsed by professional societies was present on 66% of Web sites. Centers commonly claimed improved survival (22%), disease control (20%), quality of life (17%), and toxicity (43%) with stereotactic radiation. Although 40% of Web sites championed the center's regional expertise in delivering stereotactic treatments, only 15% of Web sites provided data to support their claims. Conclusion: Provider advertisements for stereotactic radiation were prominent and aggressive. Further investigation of provider advertising, its effects on quality of care, and potential oversight mechanisms is needed. PMID:23633973

Accuracy of marketing claims by providers of stereotactic radiation therapy.

PubMed

Narang, Amol K; Lam, Edwin; Makary, Martin A; Deweese, Theodore L; Pawlik, Timothy M; Pronovost, Peter J; Herman, Joseph M

2013-01-01

Direct-to-consumer advertising by industry has been criticized for encouraging overuse of unproven therapies, but advertising by health care providers has not been as carefully scrutinized. Stereotactic radiation therapy is an emerging technology that has sparked controversy regarding the marketing campaigns of some manufacturers. Given that this technology is also being heavily advertised on the Web sites of health care providers, the accuracy of providers' marketing claims should be rigorously evaluated. We reviewed the Web sites of all U.S. hospitals and private practices that provide stereotactic radiation using two leading brands of stereotactic radiosurgery technology. Centers were identified by using data from the manufacturers. Centers without Web sites were excluded. The final study population consisted of 212 centers with online advertisements for stereotactic radiation. Web sites were evaluated for advertisements that were inconsistent with advertising guidelines provided by the American Medical Association. Most centers (76%) had individual pages dedicated to the marketing of their brand of stereotactic technology that frequently contained manufacturer-authored images (50%) or text (55%). Advertising for the treatment of tumors that have not been endorsed by professional societies was present on 66% of Web sites. Centers commonly claimed improved survival (22%), disease control (20%), quality of life (17%), and toxicity (43%) with stereotactic radiation. Although 40% of Web sites championed the center's regional expertise in delivering stereotactic treatments, only 15% of Web sites provided data to support their claims. Provider advertisements for stereotactic radiation were prominent and aggressive. Further investigation of provider advertising, its effects on quality of care, and potential oversight mechanisms is needed.

Copepod (Crustacea) emergence from soils from everglades marshes with different hydroperiods

USGS Publications Warehouse

Loftus, W.F.; Reid, J.W.

2000-01-01

During a severe drought period in the winter and spring of 1989, we made three collections of dried marsh soils from freshwater sloughs in Everglades National Park, Florida, at sites characterized by either long or intermediate annual periods of flooding (hydroperiod). After rehydrating the soils in aquaria, we documented the temporal patterns of copepod emergence over two-week periods. The species richness of copepods in the rehydrated soils was lower than in pre-drought samples from the same slough sites. Only six of the 16 species recorded from the Everglades emerged in the aquarium tests. The long hydroperiod site had a slightly different assemblage and higher numbers of most species than the intermediate-hydroperiod sites. More individuals and species emerged from the early dry-season samples compared with samples taken later in the dry season. The harpacticoid, Cletocamptus deitersi, and the cyclopoid, Microcyclops rubellus, were abundant at most sites. The cyclopoids - Ectocyclops phaleratus, Homocyclops ater, and Paracyclops chiltoni - are new records for the Everglades. We infer that 1) only a subset of Everglades copepod species can survive drought by resting in soils; and that 2) survival ability over time differs by species.

68Ga-PSMA Expression in Pseudoangiomatous Stromal Hyperplasia of the Breast.

PubMed

Malik, Dharmender; Basher, Rajender K; Mittal, Bhagwant Rai; Jain, Tarun Kumar; Bal, Amanjit; Singh, Shrawan Kumar

2017-01-01

Ga-labeled prostate-specific membrane antigen ligand PET-CT has emerged as a promising technique to evaluate the extent of disease in patients with prostate carcinoma. We are reporting a 63-year-old man with prostatic carcinoma subjected to Ga-prostate-specific membrane antigen ligand PET-CT for initial staging. In addition to the radiotracer uptake in known primary site (prostate), focal increased radiotracer uptake was also noticed in the left breast. Subsequent biopsy of the breast lesion revealed PASH (pseudoangiomatous stromal hyperplasia), which is a benign mesenchymal proliferative lesion that may present clinically as palpable mass requiring further evaluation to rule out malignancy.

75 FR 47825 - Emergency Exemption; Issuance of Emergency Permit to Rehabilitate Sea Turtles Affected by the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-09

... tag live sea turtles; transport live and dead sea turtles to rehabilitation facilities, satellite transmitter attachment sites, and necropsy sites and necropsy dead sea turtles and collect samples; examine gut contents from dead sea turtles; attach satellite transmitters to nesting Kemp's ridley turtles...

Effectiveness of Telementoring in Surgery Compared With On-site Mentoring: A Systematic Review.

PubMed

Bilgic, Elif; Turkdogan, Sena; Watanabe, Yusuke; Madani, Amin; Landry, Tara; Lavigne, Daniel; Feldman, Liane S; Vassiliou, Melina C

2017-08-01

Mentorship is important but may not be feasible for distance learning. To bridge this gap, telementoring has emerged. The purpose of this systematic review was to evaluate the effectiveness of telementoring compared with on-site mentoring. A search was done up to March 2015. Studies were included if they used telementoring between surgeons during a clinical encounter and if they compared on-site mentoring and telementoring. A total of 11 studies were included. All reported no difference in complication rates, and 9 (82%) reported similar operative times; 4 (36%) reported technical issues, which was 3% of the total number of cases in the 11 studies. No study reported on higher levels of evidence for effectiveness of telementoring as an educational intervention. Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring. However, the level of evidence to support the effectiveness of telementoring as a training tool is limited. There is a need for studies that provide evidence for the equivalence of the effectiveness of telementoring as an educational intervention in comparison with on-site mentoring.

Effective autodissemination of pyriproxyfen to breeding sites by the exophilic malaria vector Anopheles arabiensis in semi-field settings in Tanzania.

PubMed

Lwetoijera, Dickson; Harris, Caroline; Kiware, Samson; Dongus, Stefan; Devine, Gregor J; McCall, Philip J; Majambere, Silas

2014-04-29

Malaria vector control strategies that target adult female mosquitoes are challenged by the emergence of insecticide resistance and behavioural resilience. Conventional larviciding is restricted by high operational costs and inadequate knowledge of mosquito-breeding habitats in rural settings that might be overcome by the juvenile hormone analogue, Pyriproxyfen (PPF). This study assessed the potential for Anopheles arabiensis to pick up and transfer lethal doses of PPF from contamination sites to their breeding habitats (i.e. autodissemination of PPF). A semi-field system (SFS) with four identical separate chambers was used to evaluate PPF-treated clay pots for delivering PPF to resting adult female mosquitoes for subsequent autodissemination to artificial breeding habitats within the chambers. In each chamber, a tethered cow provided blood meals to laboratory-reared, unfed female An. arabiensis released in the SFS. In PPF-treated chambers, clay pot linings were dusted with 0.2 - 0.3 g AI PPF per pot. Pupae were removed from the artificial habitats daily, and emergence rates calculated. Impact of PPF on emergence was determined by comparing treatment with an appropriate control group. Mean (95% CI) adult emergence rates were (0.21 ± 0.299) and (0.95 ± 0.39) from PPF-treated and controls respectively (p < 0.0001). Laboratory bioassay of water samples from artificial habitats in these experiments resulted in significantly lower emergence rates in treated chambers (0.16 ± 0.23) compared to controls 0.97 ± 0.05) (p < 0.0001). In experiments where no mosquitoes introduced, there were no significant differences between control and treatment, indicating that transfer of PPF to breeding sites only occurred when mosquitoes were present; i.e. that autodissemination had occurred. Treatment of a single clay pot reduced adult emergence in six habitats to (0.34 ± 0.13) compared to (0.98 ± 0.02) in the controls (p < 0.0001), showing a high level of habitats coverage amplification of the autodissemination event. The study provides proof of principle for the autodissemination of PPF to breeding habitats by malaria vectors. These findings highlight the potential for this technique for outdoor control of malaria vectors and call for the testing of this technique in field trials.

Effective autodissemination of pyriproxyfen to breeding sites by the exophilic malaria vector Anopheles arabiensis in semi-field settings in Tanzania

PubMed Central

2014-01-01

Background Malaria vector control strategies that target adult female mosquitoes are challenged by the emergence of insecticide resistance and behavioural resilience. Conventional larviciding is restricted by high operational costs and inadequate knowledge of mosquito-breeding habitats in rural settings that might be overcome by the juvenile hormone analogue, Pyriproxyfen (PPF). This study assessed the potential for Anopheles arabiensis to pick up and transfer lethal doses of PPF from contamination sites to their breeding habitats (i.e. autodissemination of PPF). Methods A semi-field system (SFS) with four identical separate chambers was used to evaluate PPF-treated clay pots for delivering PPF to resting adult female mosquitoes for subsequent autodissemination to artificial breeding habitats within the chambers. In each chamber, a tethered cow provided blood meals to laboratory-reared, unfed female An. arabiensis released in the SFS. In PPF-treated chambers, clay pot linings were dusted with 0.2 – 0.3 g AI PPF per pot. Pupae were removed from the artificial habitats daily, and emergence rates calculated. Impact of PPF on emergence was determined by comparing treatment with an appropriate control group. Results Mean (95% CI) adult emergence rates were (0.21 ± 0.299) and (0.95 ± 0.39) from PPF-treated and controls respectively (p < 0.0001). Laboratory bioassay of water samples from artificial habitats in these experiments resulted in significantly lower emergence rates in treated chambers (0.16 ± 0.23) compared to controls 0.97 ± 0.05) (p < 0.0001). In experiments where no mosquitoes introduced, there were no significant differences between control and treatment, indicating that transfer of PPF to breeding sites only occurred when mosquitoes were present; i.e. that autodissemination had occurred. Treatment of a single clay pot reduced adult emergence in six habitats to (0.34 ± 0.13) compared to (0.98 ± 0.02) in the controls (p < 0.0001), showing a high level of habitats coverage amplification of the autodissemination event. Conclusion The study provides proof of principle for the autodissemination of PPF to breeding habitats by malaria vectors. These findings highlight the potential for this technique for outdoor control of malaria vectors and call for the testing of this technique in field trials. PMID:24779515

Multicriteria relocation analysis of an off-site radioactive monitoring network for a nuclear power plant.

PubMed

Chang, Ni-Bin; Ning, Shu-Kuang; Chen, Jen-Chang

2006-08-01

Due to increasing environmental consciousness in most countries, every utility that owns a commercial nuclear power plant has been required to have both an on-site and off-site emergency response plan since the 1980s. A radiation monitoring network, viewed as part of the emergency response plan, can provide information regarding the radiation dosage emitted from a nuclear power plant in a regular operational period and/or abnormal measurements in an emergency event. Such monitoring information might help field operators and decision-makers to provide accurate responses or make decisions to protect the public health and safety. This study aims to conduct an integrated simulation and optimization analysis looking for the relocation strategy of a long-term regular off-site monitoring network at a nuclear power plant. The planning goal is to downsize the current monitoring network but maintain its monitoring capacity as much as possible. The monitoring sensors considered in this study include the thermoluminescence dosimetry (TLD) and air sampling system (AP) simultaneously. It is designed for detecting the radionuclide accumulative concentration, the frequency of violation, and the possible population affected by a long-term impact in the surrounding area regularly while it can also be used in an accidental release event. With the aid of the calibrated Industrial Source Complex-Plume Rise Model Enhancements (ISC-PRIME) simulation model to track down the possible radionuclide diffusion, dispersion, transport, and transformation process in the atmospheric environment, a multiobjective evaluation process can be applied to achieve the screening of monitoring stations for the nuclear power plant located at Hengchun Peninsula, South Taiwan. To account for multiple objectives, this study calculated preference weights to linearly combine objective functions leading to decision-making with exposure assessment in an optimization context. Final suggestions should be useful for narrowing the set of scenarios that decision-makers need to consider in this relocation process.

Evaluation of asbestos levels in two schools before and after asbestos removal. Final report

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

Karaffa, M.A.; Chesson, J.; Russell, J.

This report presents a statistical evaluation of airborne asbestos data collected at two schools before and after removal of asbestos-containing material (ACM). Although the monitoring data are not totally consistent with new Asbestos Hazard Emergency Response Act (AHERA) requirements and recent EPA guidelines, the study evaluates these historical data by standard statistical methods to determine if abated work areas meet proposed clearance criteria. The objectives of this statistical analysis were to compare (1) airborne asbestos levels indoors after removal with levels outdoors, (2) airborne asbestos levels before and after removal of asbestos, and (3) static sampling and aggressive sampling ofmore » airborne asbestos. The results of this evaluation indicated the following: the effect of asbestos removal on indoor air quality is unpredictable; the variability in fiber concentrations among different sampling sites within the same building indicates the need to treat different sites as separate areas for the purpose of clearance; and aggressive sampling is appropriate for clearance testing because it captures more entrainable asbestos structures. Aggressive sampling lowers the chance of declaring a worksite clean when entrainable asbestos is still present.« less

Assessment of radioisotope heaters for remote terrestrial applications

NASA Astrophysics Data System (ADS)

Uherka, Kenneth L.

This paper examines the feasibility of using radioisotope byproducts for special heating applications at remote sites in Alaska and other cold regions. The investigation included assessment of candidate radioisotope materials for heater applications, identification of the most promising cold-region applications, evaluation of key technical issues and implementation constraints, and development of conceptual heater designs for candidate applications. Strontium-90 (Sr-90) was selected as the most viable fuel for radioisotopic heaters used in terrestrial applications. Opportunities for the application of radioisotopic heaters were determined through site visits to representative Alaskan installations. Candidate heater applications included water storage tanks, sludge digesters, sewage lagoons, water piping systems, well-head pumping stations, emergency shelters, and fuel storage tank deicers. Radio-isotopic heaters for freeze-up protection of water storage tanks and for enhancement of biological waste treatment processes at remote sites were selected as the most promising applications.

Sleeping above the enemy: Sleeping site choice by black-fronted titi monkeys (Callicebus nigrifrons).

PubMed

Caselli, Christini B; Gestich, Carla C; Nagy-Reis, Mariana B

2017-10-01

The costs imposed by predation may result in behavioral adaptations to reduce mortality risk, including the choice and use of sleeping sites. The threat of predation, however, is rarely the sole force shaping sleeping site choice, which is likely to reflect other factors such as foraging needs as well. Here we describe the use of sleeping sites by three groups of small Neotropical monkeys, the black-fronted titi monkeys (Callicebus nigrifrons), and evaluate the role of predation pressure and foraging optimization in their choice of sleeping sites. We monitored each group for 9-20 months at two Atlantic Forest sites in southeastern Brazil. The titi monkeys used taller and larger trees to sleep than the average trees at each study site and chose branches with high vegetation coverage and located in higher forest strata than those used during diurnal activity. Sleeping sites were randomly distributed within each group's home range, and the groups avoided using the same site on consecutive nights. The characteristics of the sleeping sites and the behavior of the titi monkeys suggest that predation avoidance, especially of scansorial carnivores, is an important factor driving sleeping site choice. We conclude that titi monkeys' strategy to avoid predation while sleeping depends on the presence of a heterogeneous forest stratum with large emergent trees and liana tangles, which offer a physical barrier against predators. © 2017 Wiley Periodicals, Inc.

Strategies to reduce nonurgent emergency department use: experience of a Northern Virginia Employer Group.

PubMed

DeVries, Andrea; Li, Chia-Hsuan; Oza, Manish

2013-03-01

This administrative claims analysis evaluated the impact of a health plan-sponsored Emergency Room Utilization Management Initiative (ERUMI), which combined increased patient copays for ED visits with educational outreach to reduce inappropriate ED use and encourage use of retail health clinics (RHCs) and other alternative treatment sites among a commercially insured population. Emergency department (ED) utilization rates for select acute but nonurgent conditions that could be treated appropriately in an RHC were compared for members of an employer group with (intervention group) and without (comparators) ERUMI. Utilization was compared for baseline period (January-June 2009) and ERUMI implementation period (January-June 2010). A total of 56,896 members (14,224 intervention, 42,672 matched comparators) were included. ED utilization for conditions that could be treated appropriately by RHCs decreased by 10.39 visits/1000 members in the intervention group versus 6.29 visits in comparators. RHC visits rose for both the groups, with a greater increase in the intervention group (22.61 visits/1000 members, P<0.001) versus comparison (1.64/1000, P=0.064). After ERUMI implementation, intervention group members were nearly 5 times more likely than comparators to choose RHCs over ED for nonurgent care. The health plan-sponsored ERUMI program, consisting of both financial and educational components, decreased nonurgent ED utilization while increasing the use of alternative treatment sites.

Chemical characterization and spatial distribution of PAHs and heavy hydrocarbons in rural sites of Campania Region, South Italy.

PubMed

Monaco, D; Riccio, A; Chianese, E; Adamo, P; Di Rosa, S; Fagnano, M

2015-10-01

In this paper, the behaviour and distribution patterns of heavy hydrocarbons and several polycyclic aromatic hydrocarbon (PAH) priority pollutants, as listed by the US Environmental Protection Agency, were evaluated in 891 soil samples. The samples were collected in three expected polluted rural sites in Campania (southern Italy) as part of the LIFE11 ECOREMED project, funded by the European Commission, to test innovative agriculture-based soil restoration techniques. These sites have been selected because they have been used for the temporary storage of urban and building waste (Teverola), subject to illicit dumping of unknown material (Trentola-Ducenta), or suspected to be polluted by metals due to agricultural practices (Giugliano). Chemical analysis of soil samples allowed the baseline pollution levels to be determined prior to any intervention. It was found that these areas can be considered contaminated for residential use, in accordance with Italian environmental law (Law Decree 152/2006). Statistical analysis applied to the data proved that average mean concentrations of heavy hydrocarbons could be as high as 140 mg/kg of dry soil with peaks of 700 mg/kg of dry soil, for the Trentola-Ducenta site; the median concentration of analytical results for hydrocarbon (HC) concentration for the Trentola-Ducenta and Giugliano sites was 63 and 73.4 mg/kg dry soil, respectively; for Teverola, the median level was 35 mg/kg dry soil. Some PAHs (usually benzo(a)pyrene) also exceeded the maximum allowed level in all sites. From the principal component analysis applied to PAH concentrations, it emerged that pollutants can be supposed to derive from a single source for the three sites. Diagnostic ratios calculated to determine possible PAH sources suggest petroleum combustion or disposal practice. Our sampling protocol also showed large dishomogeneity in soil pollutant spatial distribution, even at a scale as small as 3.3 m, indicating that variability could emerge at very short spatial scales.

Motivation, recruitment, and screening of volunteers for a phase I/II HIV preventive vaccine trial in Thailand.

PubMed

Jenkins, R A; Chinaworapong, S; Morgan, P A; Ruangyuttikarn, C; Sontirat, A; Chiu, J; Michael, R A; Nitayaphan, S; Khamboonruang, C

1998-06-01

Data from recruitment and screening for a phase I/II preventive HIV-1 vaccine trial in Thailand were evaluated with respect to correlates of participation at each phase. Correlates included demographic variables, motivation for interest in the trial, and factors related to communication and contact. Participants were recruited at two sites through varied methods. The majority of prescreenees reported altruistic motives for interest in the trial and blood donors emerged as a group that may have been particularly altruistic. Findings indicated site differences in attrition during recruitment and screening, but not in enrollment into the vaccine trial. Blood donation and willingness to be contacted by phone at home were significantly related to making and keeping screening appointments.

75 FR 43996 - Agency Information Collection Activities: Proposed Collection; Comment Request, OMB No. 1660-0029...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... space and/or housing for emergency preparedness training conducted at the Federal Emergency Management... Federal Emergency Management Agency (FEMA) may conduct training for the purpose of emergency preparedness... emergency preparedness. The NETC site has facilities and housing available for those participating in...

Re-Emerging Malaria Vectors in Rural Sahel (nouna, Burkina Faso): the Paluclim Project

NASA Astrophysics Data System (ADS)

Vignolles, Cécile; Sauerborn, Rainer; Dambach, Peter; Viel, Christian; Soubeyroux, Jean-Michel; Sié, Ali; Rogier, Christophe; Tourre, Yves M.

2016-06-01

The Paluclim project applied the tele-epidemiology approach, linking climate, environment and public health (CNES, 2008), to rural malaria in Nouna (Burkina Faso). It was to analyze the climate impact on vectorial risks, and its consequences on entomological risks forecast. The objectives were to: 1) produce entomological risks maps in the Nouna region, 2) produce dynamic maps on larvae sites and their productivity, 3) study the climate impact on malaria risks, and 4) evaluate the feasibility of strategic larviciding approach.

HIV-1 drug resistance mutations among antiretroviral-naive HIV-1-infected patients in Asia: results from the TREAT Asia Studies to Evaluate Resistance-Monitoring Study.

PubMed

Sungkanuparph, Somnuek; Oyomopito, Rebecca; Sirivichayakul, Sunee; Sirisanthana, Thira; Li, Patrick C K; Kantipong, Pacharee; Lee, Christopher K C; Kamarulzaman, Adeeba; Messerschmidt, Liesl; Law, Matthew G; Phanuphak, Praphan

2011-04-15

Of 682 antiretroviral-naïve patients initiating antiretroviral therapy in a prospective, multicenter human immunodeficiency virus type 1 (HIV-1) drug resistance monitoring study involving 8 sites in Hong Kong, Malaysia, and Thailand, the prevalence of patients with ≥1 drug resistance mutation was 13.8%. Primary HIV drug resistance is emerging after rapid scaling-up of antiretroviral therapy use in Asia.

44 CFR 352.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... preparedness such as: Provision of support for the preparation off site radiological emergency response plans....1 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... the Administrator, FEMA or designee. (c) EPZ means Emergency Planning Zone. (d) FEMA means the Federal...

Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments.

PubMed

Schnitker, Linda M; Martin-Khan, Melinda; Burkett, Ellen; Beattie, Elizabeth R A; Jones, Richard N; Gray, Len C

2015-03-01

The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation. In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay. This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions to improve any suboptimal processes of care. Further validation and utility of the indicators in a wider population is now indicated. © 2015 by the Society for Academic Emergency Medicine.

Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use.

PubMed

Vandenberg, Ann E; Vaughan, Camille P; Stevens, Melissa; Hastings, Susan N; Powers, James; Markland, Alayne; Hwang, Ula; Hung, William; Echt, Katharina V

2017-02-01

Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers. Existing prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns. Geriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed. Geriatric order sets were implemented at two sites as part of the multicomponent 'Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department' quality improvement initiative. Facilitators and barriers to order sets use at the two sites were evaluated. Phone interviews were conducted with two provider groups (n = 20), those 'EQUiPPED' with the interventions (n = 10, 5 at each site) and Comparison providers who were only exposed to order sets through a clickable option on the ED order menu within the patient's medical record (n = 10, 5 at each site). All providers were asked about order set 'use' and 'usefulness'. Users (n = 11) were asked about 'usability'. Order set adopters described 'usefulness' in terms of 'safety' and 'efficiency', whereas order set consultants and order set non-users described 'usefulness' in terms of 'information' or 'training'. Provider 'autonomy', 'comfort' level with existing tools, and 'learning curve' were stated as barriers to use. Quantifying efficiency advantages and communicating safety benefit over preexisting practices and tools may improve adoption of CDS in ED and in other settings of care. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Evaluation of postoperative antibiotics after non-perforated appendectomy.

PubMed

Rafiq, Muhammad Salman; Khan, Mah Muneer; Khan, Attaullah; Jan, Hizbullah

2015-08-01

To evaluate the role of postoperative antibiotics in reducing surgical site infections after appendectomy for non-perforated appendicitis. The randomised controlled trial was conducted at Khyber Teaching Hospital, Peshawar, Pakistan, from November 11, 2012, to May 30, 2014, and comprised patients of emergency appendectomy for non-perforated appendicitis who were divided into groups A and B. Group A received a single dose of cefuroxime sodium and metronidazole half-an-hour before induction, while Group B received one more dose of the same antibiotics postoperatively. Both groups were followed for 6 weeks. SPSS 20 was used for statistical analysis. Of the 390 patients in the study, 192(49.2%) were in Group A and 198(50.7%) in Group B. Number of surgical site infections was 15(7.8%) in Group A and 18(9.1%) in Group B (p=0.65). Mean hospital stay of 3.32±0.4 days and 3.59±0.46 days was observed for Group A and B, respectively, (p<0.001). A single pre-operative dose of cefuroxime and metronidazole had the same efficacy in preventing surgical site infections in cases of non-perforated appendicitis as when the same regimen was repeated post-operatively.

Cost-effectiveness of simulation-based team training in obstetric emergencies (TOSTI study).

PubMed

van de Ven, J; van Baaren, G J; Fransen, A F; van Runnard Heimel, P J; Mol, B W; Oei, S G

2017-09-01

Team training is frequently applied in obstetrics. We aimed to evaluate the cost-effectiveness of obstetric multi-professional team training in a medical simulation centre. We performed a model-based cost-effectiveness analysis to evaluate four strategies for obstetric team training from a hospital perspective (no training, training without on-site repetition and training with 6 month or 3-6-9 month repetition). Data were retrieved from the TOSTI study, a randomised controlled trial evaluating team training in a medical simulation centre. We calculated the incremental cost-effectiveness ratio (ICER), which represent the costs to prevent the adverse outcome, here (1) the composite outcome of obstetric complications and (2) specifically neonatal trauma due to shoulder dystocia. Mean costs of a one-day multi-professional team training in a medical simulation centre were €25,546 to train all personnel of one hospital. A single training in a medical simulation centre was less effective and more costly compared to strategies that included repetition training. Compared to no training, the ICERs to prevent a composite outcome of obstetric complications were €3432 for a single repetition training course on-site six months after the initial training and €5115 for a three monthly repetition training course on-site after the initial training during one year. When we considered neonatal trauma due to shoulder dystocia, a three monthly repetition training course on-site after the initial training had an ICER of €22,878. Multi-professional team training in a medical simulation centre is cost-effective in a scenario where repetition training sessions are performed on-site. Copyright © 2017 Elsevier B.V. All rights reserved.

Post-den emergence behavior of polar bears (Ursus maritimus) in Northern Alaska

USGS Publications Warehouse

Smith, T.S.; Partridge, Steven T.; Amstrup, Steven C.; Schliebe, S.

2007-01-01

We observed polar bear (Ursus maritimus) maternity den sites on Alaska’s North Slope in March 2002 and 2003 in an effort to describe bears’ post-den emergence behavior. During 40 sessions spanning 459 h, we observed 8 adults and 14 dependent cubs outside dens for 37.5 h (8.2% of total observation time). There was no significant difference between den emergence dates in 2002 (mean = 15 Mar ± 4.1 d) and 2003 (mean = 21 Mar ± 2.1 d). Following initial den breakout, polar bears remained at their den sites for 1.5 to 14 days (mean = 8.1 ± 5.1 d). The average length of stay in dens between emergent periods was significantly shorter in 2002 (1.79 h) than in 2003 (4.82 h). While outside, adult bears were inactive 49.5% of the time, whereas cubs were inactive 13.4% of the time. We found no significant relationships between den emergence activity and weather. Adult polar bears at den sites subjected to industrial activity exhibited significantly fewer bouts of vigilance than denned bears in undisturbed areas (t = -5.5164, df = 4, p= 0.00). However, the duration of vigilance behaviors at sites near industrial activity was not significantly shorter than at the other sites studied (t = -1.8902, df = 4, p = 0.07). Results for these bears were within the range of findings in other studies of denned polar bears.

Phosphorylation of Bem2p and Bem3p may contribute to local activation of Cdc42p at bud emergence

PubMed Central

Knaus, Michèle; Pelli-Gulli, Marie-Pierre; van Drogen, Frank; Springer, Sander; Jaquenoud, Malika; Peter, Matthias

2007-01-01

Site-specific activation of the Rho-type GTPase Cdc42p is critical for the establishment of cell polarity. Here we investigated the role and regulation of the GTPase-activating enzymes (GAPs) Bem2p and Bem3p for Cdc42p activation and actin polarization at bud emergence in Saccharomyces cerevisiae. Bem2p and Bem3p are localized throughout the cytoplasm and the cell cortex in unbudded G1 cells, but accumulate at sites of polarization after bud emergence. Inactivation of Bem2p results in hyperactivation of Cdc42p and polarization toward multiple sites. Bem2p and Bem3p are hyperphosphorylated at bud emergence most likely by the Cdc28p-Cln2p kinase. This phosphorylation appears to inhibit their GAP activity in vivo, as non-phosphorylatable Bem3p mutants are hyperactive and interfere with Cdc42p activation. Taken together, our results indicate that Bem2p and Bem3p may function as global inhibitors of Cdc42p activation during G1, and their inactivation by the Cdc28p/Cln kinase contributes to site-specific activation of Cdc42p at bud emergence. PMID:17914457

Resident evaluation of clinical teachers based on teachers' certification.

PubMed

Steiner, Ivan P; Yoon, Philip W; Kelly, Karen D; Diner, Barry M; Donoff, Michel G; Mackey, Duncan S; Rowe, Brian H

2003-07-01

To examine the influence of emergency medicine (EM) certification of clinical teaching faculty on evaluations provided by residents. A prospective cohort analysis was conducted of assessments between July 1994 and July 2000 on residents' evaluations of EM faculty at the University of Alberta, Edmonton, Canada. Resident- and faculty-related variables were entered anonymously using the validated evaluation tool (ER Scale). Credentialing and demographic information on EM faculty was supplemented by data obtained through a nine-question survey. Groups were compared using ANOVA. The 562 residents returned 705 (91%) valid evaluation sheets on 115 EM faculty members. The four domains of didactic teaching, clinical teaching, approachability, and helpfulness were assessed. The majority of ratings were in the very good or superb categories for each domain. Instructors with certification in EM had higher scores in didactic, clinical teaching compared with others, and teachers without national certification scored lower in the helpful and approachable categories (p < 0.05). The route of obtaining EM certifications either through training or practice eligibility did not affect scores. Instructors under the age of 40 years had higher scores than the older age groups in three of four categories (p < 0.05). Instructors working at the teaching sites on a half-time basis received higher scores than those working full-time, and scores varied based on site. Overall, teaching ratings improved over the study period (p < 0.05). Significant differences exist among instructors in the EM setting that affect their teaching rating scores. National certification in EM, academic track, rotation year, and site are all correlated with better teaching performance.

Integrating multi-criteria evaluation techniques with geographic information systems for landfill site selection: a case study using ordered weighted average.

PubMed

Gorsevski, Pece V; Donevska, Katerina R; Mitrovski, Cvetko D; Frizado, Joseph P

2012-02-01

This paper presents a GIS-based multi-criteria decision analysis approach for evaluating the suitability for landfill site selection in the Polog Region, Macedonia. The multi-criteria decision framework considers environmental and economic factors which are standardized by fuzzy membership functions and combined by integration of analytical hierarchy process (AHP) and ordered weighted average (OWA) techniques. The AHP is used for the elicitation of attribute weights while the OWA operator function is used to generate a wide range of decision alternatives for addressing uncertainty associated with interaction between multiple criteria. The usefulness of the approach is illustrated by different OWA scenarios that report landfill suitability on a scale between 0 and 1. The OWA scenarios are intended to quantify the level of risk taking (i.e., optimistic, pessimistic, and neutral) and to facilitate a better understanding of patterns that emerge from decision alternatives involved in the decision making process. Copyright © 2011 Elsevier Ltd. All rights reserved.

Global emergency medicine journal club: social media responses to the march 2014 annals of emergency medicine journal club on targeted temperature management.

PubMed

Thoma, Brent; Rolston, Daniel; Lin, Michelle

2014-08-01

In March 2014, Annals of Emergency Medicine continued a successful collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host another Global Emergency Medicine Journal Club session featuring the 2013 New England Journal of Medicine article "Targeted Temperature Management at 33°C (91.4°F) Versus 36°C (96.8°F) After Cardiac Arrest" by Nielsen et al. This online journal club used Twitter conversations, a live videocast with the authors, and detailed discussions on the ALiEM Web site's comment section. This summary article details the community discussion, shared insights, and analytic data generated using this novel, multiplatform approach. Copyright © 2014 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Disaster relief volunteerism: Evaluating cities' planning for the usage and management of spontaneous volunteers.

PubMed

Rivera, Jason David; Wood, Zachary David

2016-01-01

This exploratory study sought to observe the perceptions, usage, and planned management of spontaneous volunteers in disaster planning and response within various urban environments. The authors discuss the perceptions of spontaneous volunteerism in America, specifically the challenges of using spontaneous volunteers in disaster response activities. A content analysis of the 50 largest cities in the US Office of Emergency Management Web sites and a survey instrument administered to emergency managers in these 50 cities were used to explore various questions raised throughout the discussion of the literature. The authors found significant discrepancies between what is stated in the disaster plans of cities and what emergency managers claim is covered in their plans. Of the managers surveyed, only a handful mention spontaneous volunteers in their plans at all, and even fewer cities discuss them extensively. In addition, stated perceptions of the value of spontaneous volunteers may impact both how we plan for them and the value they provide.

Farm Mapping to Assist, Protect, and Prepare Emergency Responders: Farm MAPPER.

PubMed

Reyes, Iris; Rollins, Tami; Mahnke, Andrea; Kadolph, Christopher; Minor, Gerald; Keifer, Matthew

2014-01-01

Responders such as firefighters and emergency medical technicians who respond to farm emergencies often face complex and unknown environments. They may encounter hazards such as fuels, solvents, pesticides, caustics, and exploding gas storage cylinders. Responders may be unaware of dirt roads within the farm that can expedite their arrival at critical sites or snow-covered manure pits that act as hidden hazards. A response to a farm, unless guided by someone familiar with the operation, may present a risk to responders and post a challenge in locating the victim. This project explored the use of a Web-based farm-mapping application optimized for tablets and accessible via easily accessible on-site matrix barcodes, or quick response codes (QR codes), to provide emergency responders with hazard and resource information to agricultural operations. Secured portals were developed for both farmers and responders, allowing both parties to populate and customize farm maps with icons. Data were stored online and linked to QR codes attached to mailbox posts where emergency responders may read them with a mobile device. Mock responses were conducted on dairy farms to test QR code linking efficacy, Web site security, and field usability. Findings from farmer usability tests showed willingness to enter data as well as ease of Web site navigation and data entry even with farmers who had limited computer knowledge. Usability tests with emergency responders showed ease of QR code connectivity to the farm maps and ease of Web site navigation. Further research is needed to improve data security as well as assess the program's applicability to nonfarm environments and integration with existing emergency response systems. The next phases of this project will expand the program for regional and national use, develop QR code-linked, Web-based extrication guidance for farm machinery for victim entrapment rescue, and create QR code-linked online training videos and materials for limited English proficient immigrant farm workers.

Site energy distribution analysis and influence of Fe3O4 nanoparticles on sulfamethoxazole sorption in aqueous solution by magnetic pine sawdust biochar.

PubMed

Reguyal, Febelyn; Sarmah, Ajit K

2018-02-01

Magnetisation of carbonaceous adsorbents using iron oxides has been found to be one of the potential solutions for easy recovery of adsorbent after use. We evaluated the effects of Fe 3 O 4 nanoparticle addition on the physico-chemical properties of biochar and its sorption properties. Five adsorbents with varying amount of Fe 3 O 4 per mass of adsorbent (0%, 25%, 50%, 75% and 100%) were used to adsorb sulfamethoxazole (SMX), an emerging micropollutant. Five isotherm models were used to evaluate the sorption behaviour of SMX onto the adsorbents where Redlich-Peterson model was found to best describe the data. Based on this model, the approximate site energy distribution for each adsorbent was determined. Surface area and sorption capacity had strong negative linear relationship with the amount of Fe 3 O 4 per mass of adsorbent while the pore volume and saturation magnetisation of the adsorbent increased with increasing percentage of Fe 3 O 4 . The results of the approximate site energy distribution analysis showed that the addition of Fe 3 O 4 on biochar reduced the area under the frequency distribution curve of sorption site energies leading to the lowering of the sorption sites available for SMX. This could be attributed to the blockage of the hydrophobic surface of biochar reducing the hydrophobic interaction between SMX and biochar. Copyright © 2017 Elsevier Ltd. All rights reserved.

Phytolith aided paleoenvironmental studies from the Dutch Neolithic

NASA Astrophysics Data System (ADS)

Persaits, Gergő; Gulyás, Sándor; Náfrádi, Katalin; Sümegi, Pál; Szalontai, Csaba

2015-11-01

There is increasing evidence for crop cultivation at sites of the Neolithic Swifterbant culture from ca. 4300 B.C. onwards. Presence of cereal fields at the Swifterbant S2, S3 and S4 sites has been corroborated from micro morphological studies of soil samples. Swifterbant sites with evidence for cultivated plants are still scarce though and only emerging, and have produced very low numbers of charred cereals only. The major aim of our work was to elucidate the environmental background of the Dutch Neolithic site Swifterbant S4 based on the investigation of phytolith remains retrieved from soil samples. In addition to find evidence for crop cultivation independently from other studies. Samples were taken at 1 cm intervals vertically from the soil section at the central profile of site S4. Additional samples were taken from pocket-like structures and adjacent horizons above and below. Pig coprolites yielded an astonishing phytolith assemblage which was compared to that of the soil samples. A pig tooth also yielded evaluable material via detailed investigation using SEM. The evaluation of phytolith assemblages retrieved from the soil horizons plus those ending up in the droppings of pigs feasting in the area enabled to draw a relatively reliable environmental picture of the area. All these refer to the presence of a Neolithic horticulture (cereal cultivation) under balanced micro-climatic conditions as a result of the vicinity of the nearby floodplain. These findings corroborate those of previous soil micro-morphological studies.

Icon and user interface design for emergency medical information systems: a case study.

PubMed

Salman, Y Batu; Cheng, Hong-In; Patterson, Patrick E

2012-01-01

A usable medical information system should allow for reliable and accurate interaction between users and the system in emergencies. A participatory design approach was used to develop a medical information system in two Turkish hospitals. The process consisted of task and user analysis, an icon design survey, initial icon design, final icon design and evaluation, and installation of the iconic medical information system with the icons. We observed work sites to note working processes and tasks related to the information system and interviewed medical personnel. Emergency personnel then participated in the design process to develop a usable graphical user interface, by drawing icon sketches for 23 selected tasks. Similar sketches were requested for specific tasks such as family medical history, contact information, translation, addiction, required inspections, requests and applications, and nurse observations. The sketches were analyzed and redesigned into computer icons by professional designers and the research team. A second group of physicians and nurses then tested the understandability of the icons. The user interface layout was examined and evaluated by system users, followed by the system's installation. Medical personnel reported the participatory design process was interesting and believed the resulting designs would be more familiar and friendlier. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Steroid Sulfatase Inhibition by Aryl Sulfamates: Clinical Progress, Mechanism and Future Prospects.

PubMed

Potter, Barry V L

2018-04-04

Steroid sulfatase is an emerging drug target for the endocrine therapy of hormone-dependent diseases, catalyzing estrogen sulfate hydrolysis to estrogen. Drug discovery, developing the core aryl O-sulfamate pharmacophore, has led to steroidal and non-steroidal drugs entering numerous clinical trials, with promising results in oncology and women's health. Steroidal estrogen sulfamate derivatives were the first irreversible active-site-directed inhibitors and one was developed clinically as an oral estradiol pro-drug and for endometriosis applications. This review summarizes work leading to the therapeutic concept of sulfatase inhibition, clinical trials executed to date and new insights into the mechanism of inhibition of steroid sulfatase. To date the non-steroidal sulfatase inhibitor Irosustat has been evaluated clinically in breast cancer, alone and in combination, in endometrial cancer and in prostate cancer. The versatile core pharmacophore both imbues attractive pharmaceutical properties and functions via three distinct mechanisms of action, as a pro-drug, an enzyme active site-modifying motif, likely through direct sulfamoyl group transfer, and as a structural component augmenting activity, for example by enhancing interactions at the colchicine binding site of tubulin. Preliminary new structural data on the Pseudomonas aeruginosa arylsulfatase enzyme suggest two possible sulfamate-based adducts with active site hydrated formylglycine as candidates for the inhibition end product via sulfamoyl group transfer, and a speculative choice is suggested. The clinical status of sulfatase inhibition is surveyed and how it might develop in the future. Also discussed are dual-targeting approaches, development of 2-substituted steroidal sulfamates and nonsteroidal derivatives as multi-targeting agents for hormone-independent tumours with other emerging directions.

1987 Oak Ridge model conference: Proceedings: Volume 2, Environmental protection

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

Not Available

1987-01-01

See the abstract for Volume I for general information on the conference. Topics discussed in Volume II include data management techiques for environmental protection efforts, the use of models in environmental auditing, in emergency plans, chemical accident emergency response, risk assessment, monitoring of waste sites, air and water monitoring of waste sites, and in training programs. (TEM)

How is rehabilitation with and without an integrated self-management approach perceived by UK community-dwelling stroke survivors? A qualitative process evaluation to explore implementation and contextual variations

PubMed Central

Jones, Fiona; McKevitt, Christopher; Riazi, Afsane; Liston, Matthew

2017-01-01

Objective Self-management programmes could support long-term needs after stroke and using methods integrated into rehabilitation is one option. To explore theoretical assumptions and possible mechanisms of implementation a process evaluation was delivered alongside a cluster trial which has demonstrated feasibility of an integrated self-management programme (Bridges SMP) in community-dwelling stroke survivors. This paper aims to show the extent to which experiences from stroke survivors receiving rehabilitation in control (usual care) and intervention (integrated self-management) sites reflected the differences in rehabilitation received and whether their understandings aligned with the self-management approach employed. Design Semistructured qualitative interviews carried out as part of a process evaluation analysed thematically. Setting Study was based in South London; all interviews were carried out in participants' home setting. Participants 22 stroke participants recruited; 12 from integrated self-management sites and 10 from usual care sites. Results All participants revealed shared appreciation of knowledge and support from therapists but subtle differences emerged between sites in respect to perceptions about responsibility, control and how previous experiences were used. Accounts depicted a variance regarding who had structured and planned their rehabilitation, with greater flexibility about content and involvement perceived by participants from the integrated self-management sites. They also provided accounts and experiences which aligned with principles of the intervention, such as self-discovery and problem-solving. Conclusions The findings reflect our theoretical assumptions and possible mechanisms of implementation that rehabilitation with a focus on supporting self-management is reflected in accounts and understandings of stroke survivors. Taken together with our previous research this justifies evaluating the effectiveness of Bridges SMP in a larger sample to further contribute to an understanding of the functioning of the intervention, implementation, contextual factors and mechanisms of impact. Trial registration number ISRCTN42534180; Post-results. PMID:28373253

An operations-partnered evaluation of care redesign for high-risk patients in the Veterans Health Administration (VHA): Study protocol for the PACT Intensive Management (PIM) randomized quality improvement evaluation.

PubMed

Chang, Evelyn T; Zulman, Donna M; Asch, Steven M; Stockdale, Susan E; Yoon, Jean; Ong, Michael K; Lee, Martin; Simon, Alissa; Atkins, David; Schectman, Gordon; Kirsh, Susan R; Rubenstein, Lisa V

2018-06-01

Patient-centered medical homes have made great strides providing comprehensive care for patients with chronic conditions, but may not provide sufficient support for patients at highest risk for acute care use. To address this, the Veterans Health Administration (VHA) initiated a five-site demonstration project to evaluate the effectiveness of augmenting the VA's Patient Aligned Care Team (PACT) medical home with PACT Intensive Management (PIM) teams for Veterans at highest risk for hospitalization. Researchers partnered with VHA leadership to design a mixed-methods prospective multi-site evaluation that met leadership's desire for a rigorous evaluation conducted as quality improvement rather than research. We conducted a randomized QI evaluation and assigned high-risk patients to participate in PIM and compared them with high-risk Veterans receiving usual care through PACT. The summative evaluation examines whether PIM: 1) decreases VHA emergency department and hospital use; 2) increases satisfaction with VHA care; 3) decreases provider burnout; and 4) generates positive returns on investment. The formative evaluation aims to support improved care for high-risk patients at demonstration sites and to inform future initiatives for high-risk patients. The evaluation was reviewed by representatives from the VHA Office of Research and Development and the Office of Research Oversight and met criteria for quality improvement. VHA aims to function as a learning organization by rapidly implementing and rigorously testing QI innovations prior to final program or policy development. We observed challenges and opportunities in designing an evaluation consistent with QI standards and operations priorities, while also maintaining scientific rigor. This trial was retrospectively registered at ClinicalTrials.gov on April 3, 2017: NCT03100526. Protocol v1, FY14-17. Copyright © 2018 Elsevier Inc. All rights reserved.

Comparison of topological clustering within protein networks using edge metrics that evaluate full sequence, full structure, and active site microenvironment similarity.

PubMed

Leuthaeuser, Janelle B; Knutson, Stacy T; Kumar, Kiran; Babbitt, Patricia C; Fetrow, Jacquelyn S

2015-09-01

The development of accurate protein function annotation methods has emerged as a major unsolved biological problem. Protein similarity networks, one approach to function annotation via annotation transfer, group proteins into similarity-based clusters. An underlying assumption is that the edge metric used to identify such clusters correlates with functional information. In this contribution, this assumption is evaluated by observing topologies in similarity networks using three different edge metrics: sequence (BLAST), structure (TM-Align), and active site similarity (active site profiling, implemented in DASP). Network topologies for four well-studied protein superfamilies (enolase, peroxiredoxin (Prx), glutathione transferase (GST), and crotonase) were compared with curated functional hierarchies and structure. As expected, network topology differs, depending on edge metric; comparison of topologies provides valuable information on structure/function relationships. Subnetworks based on active site similarity correlate with known functional hierarchies at a single edge threshold more often than sequence- or structure-based networks. Sequence- and structure-based networks are useful for identifying sequence and domain similarities and differences; therefore, it is important to consider the clustering goal before deciding appropriate edge metric. Further, conserved active site residues identified in enolase and GST active site subnetworks correspond with published functionally important residues. Extension of this analysis yields predictions of functionally determinant residues for GST subgroups. These results support the hypothesis that active site similarity-based networks reveal clusters that share functional details and lay the foundation for capturing functionally relevant hierarchies using an approach that is both automatable and can deliver greater precision in function annotation than current similarity-based methods. © 2015 The Authors Protein Science published by Wiley Periodicals, Inc. on behalf of The Protein Society.

Distinguishing nitrous oxide production from nitrification and denitrification on the basis of isotopomer abundances.

PubMed

Sutka, R L; Ostrom, N E; Ostrom, P H; Breznak, J A; Gandhi, H; Pitt, A J; Li, F

2006-01-01

The intramolecular distribution of nitrogen isotopes in N2O is an emerging tool for defining the relative importance of microbial sources of this greenhouse gas. The application of intramolecular isotopic distributions to evaluate the origins of N2O, however, requires a foundation in laboratory experiments in which individual production pathways can be isolated. Here we evaluate the site preferences of N2O produced during hydroxylamine oxidation by ammonia oxidizers and by a methanotroph, ammonia oxidation by a nitrifier, nitrite reduction during nitrifier denitrification, and nitrate and nitrite reduction by denitrifiers. The site preferences produced during hydroxylamine oxidation were 33.5 +/- 1.2 per thousand, 32.5 +/- 0.6 per thousand, and 35.6 +/- 1.4 per thousand for Nitrosomonas europaea, Nitrosospira multiformis, and Methylosinus trichosporium, respectively, indicating similar site preferences for methane and ammonia oxidizers. The site preference of N2O from ammonia oxidation by N. europaea (31.4 +/- 4.2 per thousand) was similar to that produced during hydroxylamine oxidation (33.5 +/- 1.2 per thousand) and distinct from that produced during nitrifier denitrification by N. multiformis (0.1 +/- 1.7 per thousand), indicating that isotopomers differentiate between nitrification and nitrifier denitrification. The site preferences of N2O produced during nitrite reduction by the denitrifiers Pseudomonas chlororaphis and Pseudomonas aureofaciens (-0.6 +/- 1.9 per thousand and -0.5 +/- 1.9 per thousand, respectively) were similar to those during nitrate reduction (-0.5 +/- 1.9 per thousand and -0.5 +/- 0.6 per thousand, respectively), indicating no influence of either substrate on site preference. Site preferences of approximately 33 per thousand and approximately 0 per thousand are characteristic of nitrification and denitrification, respectively, and provide a basis to quantitatively apportion N2O.

Comparison of topological clustering within protein networks using edge metrics that evaluate full sequence, full structure, and active site microenvironment similarity

PubMed Central

Leuthaeuser, Janelle B; Knutson, Stacy T; Kumar, Kiran; Babbitt, Patricia C; Fetrow, Jacquelyn S

2015-01-01

The development of accurate protein function annotation methods has emerged as a major unsolved biological problem. Protein similarity networks, one approach to function annotation via annotation transfer, group proteins into similarity-based clusters. An underlying assumption is that the edge metric used to identify such clusters correlates with functional information. In this contribution, this assumption is evaluated by observing topologies in similarity networks using three different edge metrics: sequence (BLAST), structure (TM-Align), and active site similarity (active site profiling, implemented in DASP). Network topologies for four well-studied protein superfamilies (enolase, peroxiredoxin (Prx), glutathione transferase (GST), and crotonase) were compared with curated functional hierarchies and structure. As expected, network topology differs, depending on edge metric; comparison of topologies provides valuable information on structure/function relationships. Subnetworks based on active site similarity correlate with known functional hierarchies at a single edge threshold more often than sequence- or structure-based networks. Sequence- and structure-based networks are useful for identifying sequence and domain similarities and differences; therefore, it is important to consider the clustering goal before deciding appropriate edge metric. Further, conserved active site residues identified in enolase and GST active site subnetworks correspond with published functionally important residues. Extension of this analysis yields predictions of functionally determinant residues for GST subgroups. These results support the hypothesis that active site similarity-based networks reveal clusters that share functional details and lay the foundation for capturing functionally relevant hierarchies using an approach that is both automatable and can deliver greater precision in function annotation than current similarity-based methods. PMID:26073648

An evaluation of information on the internet about a new device: the cervical artificial disc replacement.

PubMed

Qureshi, Sheeraz A; Koehler, Steven M; Lin, James D; Bird, Justin; Garcia, Ryan M; Hecht, Andrew C

2012-05-01

Cross-sectional survey. The objective of this study was to investigate the authorship, content, and quality of information available to the public on the Internet pertaining to the cervical artificial disc replacement device. The Internet is widely used by patients as an educational tool for health care information. In addition, the Internet is used as a medium for direct-to-consumer marketing. Increasing interest in cervical artificial disc replacement has led to the emergence of numerous Web sites offering information about this procedure. It is thought that patients can be influenced by information found on the Internet. A cross section of Web sites accessible to the general public was surveyed. Three commonly used search engines were used to locate 150 (50/search engine) Web sites providing information about the cervical artificial disc replacement. Each Web site was evaluated with regard to authorship and content. Fifty-three percent of the Web sites reviewed were authorized by a private physician group, 4% by an academic physician group, 13% by industry, 16% were news reports, and 14% were not otherwise categorized. Sixty-five percent of Web sites offered a mechanism for direct contact and 19% provided clear patient eligibility criteria. Benefits were expressed in 80% of Web sites, whereas associated risks were described in 35% or less. European experiences were noted in 17% of Web sites, whereas only 9% of Web sites detailed the current US experience. CONCLUSION.: The results of this study demonstrate that much of the content of the Internet-derived information pertaining to the cervical artificial disc replacement is for marketing purposes and may not represent unbiased information. Until we can confirm the content on a Web site to be accurate, patients should be cautioned when using the Internet as a source for health care information related to cervical disc replacement.

Estimates of genetics and phenotypics parameters for the yield and quality of soybean seeds.

PubMed

Zambiazzi, E V; Bruzi, A T; Guilherme, S R; Pereira, D R; Lima, J G; Zuffo, A M; Ribeiro, F O; Mendes, A E S; Godinho, S H M; Carvalho, M L M

2017-09-27

Estimating genotype x environment (GxE) parameters for quality and yield in soybean seed grown in different environments in Minas Gerais State was the goal of this study, as well as to evaluate interaction effects of GxE for soybean seeds yield and quality. Seeds were produced in three locations in Minas Gerais State (Lavras, Inconfidentes, and Patos de Minas) in 2013/14 and 2014/15 seasons. Field experiments were conducted in randomized blocks in a factorial 17 x 6 (GxE), and three replications. Seed yield and quality were evaluated for germination in substrates paper and sand, seedling emergence, speed emergency index, mechanical damage by sodium hypochlorite, electrical conductivity, speed aging, vigor and viability of seeds by tetrazolium test in laboratory using completely randomized design. Quadratic component genotypic, GXE variance component, genotype determination coefficient, genetic variation coefficient and environmental variation coefficient were estimated using the Genes software. Percentage analysis of genotypes contribution, environments and genotype x environment interaction were conducted by sites combination two by two and three sites combination, using the R software. Considering genotypes selection of broad adaptation, TMG 1179 RR, CD 2737 RR, and CD 237 RR associated better yield performance at high physical and physiological potential of seed. Environmental effect was more expressive for most of the characters related to soybean seed quality. GxE interaction effects were expressive though genotypes did not present coincidental behavior in different environments.

[The fundamental role of stage control technology on the detectability for Salmonella networking laboratory].

PubMed

Zhou, Yong-ming; Chen, Xiu-hua; Xu, Wen; Jin, Hui-ming; Li, Chao-qun; Liang, Wei-li; Wang, Duo-chun; Yan, Mei-ying; Lou, Jing; Kan, Biao; Ran, Lu; Cui, Zhi-gang; Wang, Shu-kun; Xu, Xue-bin

2013-11-01

To evaluated the fundamental role of stage control technology (SCT) on the detectability for Salmonella networking laboratories. Appropriate Salmonella detection methods after key point control being evaluated, were establishment and optimized. Our training and evaluation networking laboratories participated in the World Health Organization-Global Salmonella Surveillance Project (WHO-GSS) and China-U.S. Collaborative Program on Emerging and Re-emerging infectious diseases Project (GFN) in Shanghai. Staff members from the Yunnan Yuxi city Center for Disease Control and Prevention were trained on Salmonella isolation from diarrhea specimens. Data on annual Salmonella positive rates was collected from the provincial-level monitoring sites to be part of the GSS and GFN projects from 2006 to 2012. The methodology was designed based on the conventional detection procedure of Salmonella which involved the processes as enrichment, isolation, species identification and sero-typing. These methods were simultaneously used to satisfy the sensitivity requirements on non-typhoid Salmonella detection for networking laboratories. Public Health Laboratories in Shanghai had developed from 5 in 2006 to 9 in 2011, and Clinical laboratories from 8 to 22. Number of clinical isolates, including typhoid and non-typhoid Salmonella increased from 196 in 2006 to 1442 in 2011. The positive rate of Salmonella isolated from the clinical diarrhea cases was 2.4% in Yuxi county, in 2012. At present, three other provincial monitoring sites were using the SBG technique as selectivity enrichment broth for Salmonella isolation, with Shanghai having the most stable positive baseline. The method of SCT was proved the premise of the network laboratory construction. Based on this, the improvement of precise phenotypic identification and molecular typing capabilities could reach the level equivalent to the national networking laboratory.

Deciphering the use and predictive value of "emergency medical services provider judgment" in out-of-hospital trauma triage: a multisite, mixed methods assessment.

PubMed

Newgard, Craig D; Kampp, Michael; Nelson, Maria; Holmes, James F; Zive, Dana; Rea, Thomas; Bulger, Eileen M; Liao, Michael; Sherck, John; Hsia, Renee Y; Wang, N Ewen; Fleischman, Ross J; Barton, Erik D; Daya, Mohamud; Heineman, John; Kuppermann, Nathan

2012-05-01

"Emergency medical services (EMS) provider judgment" was recently added as a field triage criterion to the national guidelines, yet its predictive value and real world application remain unclear. We examine the use and independent predictive value of EMS provider judgment in identifying seriously injured persons. We analyzed a population-based retrospective cohort, supplemented by qualitative analysis, of injured children and adults evaluated and transported by 47 EMS agencies to 94 hospitals in five regions across the Western United States from 2006 to 2008. We used logistic regression models to evaluate the independent predictive value of EMS provider judgment for Injury Severity Score ≥ 16. EMS narratives were analyzed using qualitative methods to assess and compare common themes for each step in the triage algorithm, plus EMS provider judgment. 213,869 injured patients were evaluated and transported by EMS over the 3-year period, of whom 41,191 (19.3%) met at least one of the field triage criteria. EMS provider judgment was the most commonly used triage criterion (40.0% of all triage-positive patients; sole criterion in 21.4%). After accounting for other triage criteria and confounders, the adjusted odds ratio of Injury Severity Score ≥ 16 for EMS provider judgment was 1.23 (95% confidence interval, 1.03-1.47), although there was variability in predictive value across sites. Patients meeting EMS provider judgment had concerning clinical presentations qualitatively similar to those meeting mechanistic and other special considerations criteria. Among this multisite cohort of trauma patients, EMS provider judgment was the most commonly used field trauma triage criterion, independently associated with serious injury, and useful in identifying high-risk patients missed by other criteria. However, there was variability in predictive value between sites.

Evaluation of NDI compressed air foam system (cafs) applied as a retrofit. Final report

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

Duncan, S.

1994-08-01

Army Engineer Firefighting Detachments require increased firefighting capability to compensate for deficiencies in structural, brush, or wildland and large petroleum storage site fires. Additionally, Army fire departments responsible for protection and prevention on posts, camps and stations have difficulty accessing new or emerging technology do not possess state-of-the-art equipment. The results of this evaluation and subsequent projects, will be reported throughout the Army in an attempt to mitigate operational deficiencies and widen the scope of knowledge in the Army fire service. The evaluation of non-developmental retrofitted compressed air foam systems show an efficiency of suppressive capabilities of water superseded bymore » water alone. Retrofitting the equipment was not easy or inexpensive but it was very successful.« less

Abandoned Mine Lands: Site Information

EPA Pesticide Factsheets

A catalogue of mining sites proposed for and listed on the NPL as well as mining sites being cleaned up using the Superfund Alternative Approach. Also mine sites not on the NPL but that have had removal or emergency response cleanup actions.

Rapid building damage assessment system using mobile phone technology

NASA Astrophysics Data System (ADS)

Cimellaro, Gian Paolo; Scura, G.; Renschler, C. S.; Reinhorn, A. M.; Kim, H. U.

2014-09-01

One common scenario during disasters such as earthquakes is that the activity of damage field reconnaissance on site is not well-coordinated. For example in Italy the damage assessment of structures after an earthquake is managed from the Italian Emergency Authority, using printed forms (AeDES) which are filled by experts on site generating a lot of confusion in filling and transferring the forms to the Disaster Management Operative Center. Because of this, the paper explores the viability of using mobile communication technologies (smart phones) and the Web to develop response systems that would aid communities after a major disaster, providing channels for allowing residents and responders of uploading and distributing information, related to structural damages coordinating the damage field reconnaissance. A mobile application that can be run by residents on smart phones has been developed, to give an initial damage evaluation of the area, which is going to be very useful when resources (e.g. the number of experts is limited). The mobile application has been tested for the first time during 2012 Emilia earthquake to enhance the emergency response, showing the efficiency of the proposed method in statistical terms comparing the proposed procedure with the standard procedure.

Economic evaluation of nasogastric versus intravenous hydration in infants with bronchiolitis.

PubMed

Oakley, Ed; Carter, Rob; Murphy, Bridie; Borland, Meredith; Neutze, Jocelyn; Acworth, Jason; Krieser, David; Dalziel, Stuart; Davidson, Andrew; Donath, Susan; Jachno, Kim; South, Mike; Babl, Franz E

2017-06-01

Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospitalisation. We aimed to assess whether intravenous hydration (IVH) was more cost-effective than nasogastric hydration (NGH) as a planned secondary economic analysis of a randomised trial involving 759 infants (aged 2-12 months) admitted to hospital with a clinical diagnosis of bronchiolitis and requiring non-oral hydration. No Australian cost data exist to aid clinicians in decision-making around interventions in bronchiolitis. Cost data collections included hospital and intervention-specific costs. The economic analysis was reduced to a cost-minimisation study, focusing on intervention-specific costs of IVH versus NGH, as length of stay was equal between groups. All analyses are reported as intention to treat. Intervention costs were greater for IVH than NGH ($113 vs $74; cost difference of $39 per child). The intervention-specific cost advantage to NGH was robust to inter-site variation in unit prices and treatment activity. Intervention-specific costs account for <10% of total costs of bronchiolitis admissions, with NGH having a small cost saving across all sites. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Establishing an NP-staffed minor emergency area.

PubMed

Buchanan, L; Powers, R D

1997-04-01

Patients with problems of high acuity need fully trained emergency physicians and nurses. Some patients with nonurgent problems can be cared for within the emergency department (ED) in a lower-cost setting designed and staffed specifically for this purpose. Staffing a fast track or minor emergency area (MEA) with nurse practitioners (NPs) is one way to satisfy the ED's care needs. One site analysis of the effectiveness of NPs indicates that patients are satisfied with their care, that nurses' interpersonal skills are better than those of physicians, that technical skills are equivalent, that patient outcomes are equivalent or superior and that NPs improve access to care. A nurse practitioner-staffed minor emergency area provides high quality care for approximately 21% of this site's adult emergency department population. Patients are triaged based on set criteria, allowing for short treatment times. The physical layout, triage criteria, and the NPs' scope of practice in the level 1 trauma center's ED are detailed.

Process Waste Assessment, Mechanics Shop

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

Phillips, N.M.

1993-05-01

This Process Waste Assessment was conducted to evaluate hazardous wastes generated in the Mechanics Shop. The Mechanics Shop maintains and repairs motorized vehicles and equipment on the SNL/California site, to include motorized carts, backhoes, street sweepers, trash truck, portable emergency generators, trencher, portable crane, and man lifts. The major hazardous waste streams routinely generated by the Mechanics Shop are used oil, spent off filters, oily rags, and spent batteries. The used off and spent off filters make up a significant portion of the overall hazardous waste stream. Waste oil and spent batteries are sent off-site for recycling. The rags andmore » spent on filters are not recycled. They are disposed of as hazardous waste. Mechanics Shop personnel continuously look for opportunities to minimize hazardous wastes.« less

Performance of passive samplers for monitoring estuarine water column concentrations: 2. Emerging contaminants.

PubMed

Perron, Monique M; Burgess, Robert M; Suuberg, Eric M; Cantwell, Mark G; Pennell, Kelly G

2013-10-01

Measuring dissolved concentrations of emerging contaminants, such as polybrominated diphenyl ethers (PBDEs) and triclosan, can be challenging due to their physicochemical properties resulting in low aqueous solubilities and association with particles. Passive sampling methods have been applied to assess dissolved concentrations in water and sediments primarily for legacy contaminants. Although the technology is applicable to some emerging contaminants, the use of passive samplers with emerging contaminants is limited. In the present study, the performance of 3 common passive samplers was evaluated for sampling PBDEs and triclosan. Passive sampling polymers included low-density polyethylene (PE) and polyoxymethylene (POM) sheets, and polydimethylsiloxane (PDMS)-coated solid-phase microextraction (SPME) fibers. Dissolved concentrations were calculated using measured sampler concentrations and laboratory-derived partition coefficients. Dissolved tri-, tetra-, and pentabrominated PBDE congeners were detected at several of the study sites at very low pg/L concentrations using PE and POM. Calculated dissolved water concentrations of triclosan ranged from 1.7 ng/L to 18 ng/L for POM and 8.8 ng/L to 13 ng/L for PE using performance reference compound equilibrium adjustments. Concentrations in SPME were not reported due to lack of detectable chemical in the PDMS polymer deployed. Although both PE and POM were found to effectively accumulate emerging contaminants from the water column, further research is needed to determine their utility as passive sampling devices for emerging contaminants. © 2013 SETAC.

A method for using unmanned aerial vehicles for emergency investigation of single geo-hazards and sample applications of this method

NASA Astrophysics Data System (ADS)

Huang, Haifeng; Long, Jingjing; Yi, Wu; Yi, Qinglin; Zhang, Guodong; Lei, Bangjun

2017-11-01

In recent years, unmanned aerial vehicles (UAVs) have become widely used in emergency investigations of major natural hazards over large areas; however, UAVs are less commonly employed to investigate single geo-hazards. Based on a number of successful investigations in the Three Gorges Reservoir area, China, a complete UAV-based method for performing emergency investigations of single geo-hazards is described. First, a customized UAV system that consists of a multi-rotor UAV subsystem, an aerial photography subsystem, a ground control subsystem and a ground surveillance subsystem is described in detail. The implementation process, which includes four steps, i.e., indoor preparation, site investigation, on-site fast processing and application, and indoor comprehensive processing and application, is then elaborated, and two investigation schemes, automatic and manual, that are used in the site investigation step are put forward. Moreover, some key techniques and methods - e.g., the layout and measurement of ground control points (GCPs), route planning, flight control and image collection, and the Structure from Motion (SfM) photogrammetry processing - are explained. Finally, three applications are given. Experience has shown that using UAVs for emergency investigation of single geo-hazards greatly reduces the time, intensity and risks associated with on-site work and provides valuable, high-accuracy, high-resolution information that supports emergency responses.

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

PubMed

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

2017-01-01

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

10 CFR 50.47 - Emergency plans.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

Increasing impact of mental health presentations on New South Wales public hospital emergency departments 1999-2006.

PubMed

Tankel, Alan S; Di Palma, Matthew J; Kramer, Kathy M; van der Zwan, Rick

2011-12-01

The percentage of mental health (MH) presentations to New South Wales (NSW) EDs in recent years has not been described at the statewide level. Evidence from other states suggests this burden might be increasing. The present study aims to evaluate recent trends in MH presentations to NSW EDs, including geographic variations and the spectrum of MH disorders encountered. Data were sourced from the NSW Emergency Department Data Collection, which collates information from routine reporting undertaken in all NSW EDs. The database employs ICD-9 diagnostic descriptors. The present study retrospectively analyses presentations from 1999 to 2006 for patients who received an MH primary discharge diagnosis, as defined by ICD-9. In addition, rates of presentation for poisoning are considered. The percentage of MH presentations to the three largest hospital categories--principal referral, major metropolitan and rural base (i.e. major non-metropolitan)--is examined. During 1999 and 2006, there were 9,013,357 ED presentations at the study sites. Of these, 3.22% received an MH primary discharge diagnosis. An additional 0.93% received a diagnosis of poisoning. In 2006, there were 15,262 more MH presentations than in 1999, a 49.78% increase. Over this period, total annual ED presentations increased by 201,763 (19.30%). General population growth was 6.31%. Across the state, 32.0% of MH presentations were for psychotic conditions and 68.0% for neurotic illnesses. Mental health presentations to NSW EDs are increasing. There is a need to review emergency services to accommodate these changes. The reasons for this growth remain unclear and require formal prospective evaluation. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

The Emergency Medical Care of Patients With Acute Myocardial Infarction.

PubMed

Stockburger, Martin; Maier, Birga; Fröhlich, Georg; Rutsch, Wolfgang; Behrens, Steffen; Schoeller, Ralph; Theres, Heinz; Poloczek, Stefan; Plock, Gerd; Schühlen, Helmut

2016-07-25

Optimizing the emergency medical care chain might shorten the time to treatment of patients with ST-elevation myocardial infarction (STEMI). The initial care by a physician, and, in particular, correct ECG interpretation, are critically important factors. From 1999 onward, data on the care of patients with myocardial infarction have been recorded and analyzed in the Berlin Myocardial Infarction Registry. In the First Medical Contact Study, data on initial emergency medical care were obtained on 1038 patients who had been initially treated by emergency physicians in 2012. Their pre-hospital ECGs were re-evaluated in a blinded fashion according to the criteria of the European Society of Cardiology. The retrospective re-evaluation of pre-hospital ECGs revealed that 756 of the 1038 patients had sustained a STEMI. The emergency physicians had correctly diagnosed STEMI in 472 patients (62.4%), and they had correctly diagnosed ventricular fibrillation in 85 patients (11.2%); in 199 patients (26.3%), the ECG interpretation was unclear. The pre-hospital ECG interpretation was significantly associated with the site of initial hospitalization and the ensuing times to treatment. In particular, the time from hospital admission to cardiac catheterization was longer in patients with an unclear initial ECG interpretation than in those with correctly diagnosed STEMI (121 [54; 705] vs. 36 [19; 60] minutes, p <0.001). After multivariate adjustment, this corresponded to a hazard ratio* of 2.67 [2.21; 3.24]. Pre-hospital ECG interpretation in patients with STEMI was a trigger factor with a major influence on the time to treatment in the hospital. The considerable percentage of pre-hospital ECGs whose interpretation was unclear implies that there is much room for improvement.

American black bear denning behavior: Observations and applications using remote photography

USGS Publications Warehouse

Bridges, A.S.; Fox, J.A.; Olfenbuttel, C.; Vaughan, M.B.

2004-01-01

Researchers examining American black bear (Ursus americanus) denning behavior have relied primarily on den-site visitation and radiotelemetry to gather data. Repeated den-site visits are time-intensive and may disturb denning bears, possibly causing den abandonment, whereas radiotelemetry is sufficient only to provide gross data on den emergence. We used remote cameras to examine black bear denning behavior in the Allegheny Mountains of western Virginia during March-May 2003. We deployed cameras at 10 den sites and used 137 pictures of black bears. Adult female black bears exhibited greater extra-den activity than we expected prior to final den emergence, which occurred between April 12 and May 6, 2003. Our technique provided more accurate den-emergence estimation than previously published methodologies. Additionally, we observed seldom-documented behaviors associated with den exits and estimated cub age at den emergence. Remote cameras can provide unique insights into denning ecology, and we describe their potential application to reproductive, survival, and behavioral research.

The Prescription Opioid Epidemic: Social Media Responses to the Residents' Perspective Article.

PubMed

Choo, Esther K; Mazer-Amirshahi, Maryann; Juurlink, David; Kobner, Scott; Scott, Kevin; Lin, Michelle

2016-01-01

In June 2014, Annals of Emergency Medicine collaborated with the Academic Life in Emergency Medicine (ALiEM) blog-based Web site to host an online discussion session featuring the Annals Residents' Perspective article "The Opioid Prescription Epidemic and the Role of Emergency Medicine" by Poon and Greenwood-Ericksen. This dialogue included a live videocast with the authors and other experts, a detailed discussion on the ALiEM Web site's comment section, and real-time conversations on Twitter. Engagement was tracked through various Web analytic tools, and themes were identified by content curation. The dialogue resulted in 1,262 unique page views from 433 cities in 41 countries on the ALiEM Web site, 408,498 Twitter impressions, and 168 views of the video interview with the authors. Four major themes about prescription opioids identified included the following: physician knowledge, inconsistent medical education, balance between overprescribing and effective pain management, and approaches to solutions. Free social media technologies provide a unique opportunity to engage with a diverse community of emergency medicine and non-emergency medicine clinicians, nurses, learners, and even patients. Such technologies may allow more rapid hypothesis generation for future research and more accelerated knowledge translation. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Abundance and Frequency of the Asiatic Oak Weevil (Coleoptera: Curculionidae) and Defoliation on American, Chinese, and Hybrid Chestnut (Castanea)

PubMed Central

Case, Ashley E.; Mayfield, Albert E.; Clark, Stacy L.; Schlarbaum, Scott E.; Reynolds, Barbara C.

2016-01-01

The Asiatic oak weevil, Cyrtepistomus castaneus Roelofs (Coleoptera: Curculionidae), is a nonnative defoliator of trees in the Fagaceae family in the United States but has not been studied on Castanea species in the southern Appalachian Mountains. Planted trees of Castanea dentata (Marsh.) Borkh. (Fagales: Fagaceae), Castanea mollissima Blume (Fagales: Fagaceae), and four hybrid breeding generations were evaluated in 2012 for insect defoliation and C. castaneus abundance and frequency. Defoliation was visually assessed throughout the growing season at two sites in the southern Appalachian Mountains (western North Carolina and eastern Tennessee). C. castaneus abundance and frequency were monitored on trees using beat sheets and emergence was recorded from ground traps. Asiatic oak weevils were more abundant and more frequently collected on American chestnut (Ca. dentata) and its most closely related BC3F3 hybrid generation than on the Asian species Ca. mollissima. In most months, C. castaneus colonization of hybrid generations was not significantly different than colonization of parental species. Frequency data for C. castaneus suggested that adults were distributed relatively evenly throughout the study sites rather than in dense clusters. Emergence of C. castaneus was significantly higher under a canopy dominated by Quercus species than under non-Quercus species or open sky. C. castaneus emergence began in May and peaked in late June and early July. These results may be useful for resource managers trying to restore blight-resistant chestnut to the Southern Appalachians while minimizing herbivory by insect pests. PMID:27001964

The effectiveness of an educational program on preventing and treating compassion fatigue in emergency nurses.

PubMed

Flarity, Kathleen; Gentry, J Eric; Mesnikoff, Nathan

2013-01-01

The purpose of this qualitative study was to examine the treatment effectiveness of a multifaceted education program to decrease compassion fatigue (CF) and burnout (BO) symptoms and increase compassion satisfaction of emergency nurses participating in the training. The goal of the CF multifaceted intervention program was to demonstrate a statistically significant improvement in the 3 CF subscales: an increase on the Compassion Satisfaction (CS) subscale and a decrease on the Secondary Traumatic Stress (STS) and BO subscales in the participants' pretest and posttest scores as measured by The Professional Quality of Life test (B. H. , ). The study sites were 2 emergency departments in Colorado Springs, CO. A convenience sample consisted of emergency nurses who self-selected to participate in the study. Univariate statistics were used, and data were examined for normalcy of distribution. Because these data were not distributed normally, Wilcoxon signed-rank tests were used to evaluate the differences between the baseline and postintervention groups. The multifaceted education program resulted in a statistically significant increase in CS (p = 0.004) and a decrease in BO (p = 0.001 or less) and STS (p = 0.001) symptoms.

Multilocation teleradiology system for emergency triage consultation

NASA Astrophysics Data System (ADS)

Herron, John M.; Yonas, Howard

1996-05-01

A remote consultation system is available at the University of Pittsburgh Medical Center (UPMC) which links four outlying hospitals in Western Pennsylvania and Eastern Ohio. This system has the potential to improve short and long term clinical outcomes and to reduce overall medical care cost by establishing improved emergency triage capability. An EMED, Inc. teleradiology system permits rapid, high-quality transfer of digitized film and CT images from the remote sites to the tertiary care center (UPMC). The images are sent over dial-on- demand ISDN and SW56 lines from the remote hospitals to a central server where they are transmitted to a dual 2K monitor workstation in the Emergency Department, thirteen Eastman Kodak PDS workstations within UPMC, and to three physician homes. Transmission to a workstation at each of the physician homes over ISDN lines enables `after hours' consultation. The radiographic images along with voice and fax communications provide a technique where physicians in outlying hospitals will be able to consult with specialists at any time. A study is in progress to evaluate the effectiveness of this system in terms of perception of utility and its potential to improve emergency triage capability, as well as selection of the appropriate transportation mode (helicopter versus ambulance).

Visible and infrared remote imaging of hazardous waste: A review

USGS Publications Warehouse

Slonecker, Terrence; Fisher, Gary B.; Aiello, Danielle P.; Haack, Barry

2010-01-01

One of the critical global environmental problems is human and ecological exposure to hazardous wastes from agricultural, industrial, military and mining activities. These wastes often include heavy metals, hydrocarbons and other organic chemicals. Traditional field and laboratory detection and monitoring of these wastes are generally expensive and time consuming. The synoptic perspective of overhead remote imaging can be very useful for the detection and remediation of hazardous wastes. Aerial photography has a long and effective record in waste site evaluations. Aerial photographic archives allow temporal evaluation and change detection by visual interpretation. Multispectral aircraft and satellite systems have been successfully employed in both spectral and morphological analysis of hazardous wastes on the landscape and emerging hyperspectral sensors have permitted determination of the specific contaminants by processing strategies using the tens or hundreds of acquired wavelengths in the solar reflected and/or thermal infrared parts of the electromagnetic spectrum. This paper reviews the literature of remote sensing and overhead imaging in the context of hazardous waste and discusses future monitoring needs and emerging scientific research areas.

Laboratory measurements of biomarkers and individual performances in Chironomus xanthus to evaluate pesticide contamination of sediments in a river of southeastern Brazil.

PubMed

Printes, Liane Biehl; Fernandes, Marisa Narciso; Espíndola, Evaldo Luiz Gaeta

2011-03-01

This study aimed at evaluating biomarkers, individual and population responses in the native Chironomus xanthus to assess the toxicity of pesticide-contaminated sediments from the Monjolinho River (Southeast Brazil). We measured cholinesterase (ChE) and glutathione S-transferase activities (GST), as biomarkers and survival, individual growth and adult emergence, as individual performances. There was no response of the ChE activity and a tendency to decreased GST activity in contaminated sites, but this was generally not statistically significant. Therefore, there was no association of the biomarker responses with exposure to sediment containing pesticides. In contrast, ash free dry mass was significantly increased and male emergence was decreased in C. xanthus exposed to the same sediments. In conclusion, the selected biomarkers were not sensitive and specific enough to detect and anticipate effects of pesticide contamination at the levels measured in the study area. Nevertheless, individual performances alterations pointed to potential pollution problems and possible ecological consequences. Copyright © 2010 Elsevier Inc. All rights reserved.

Reducing emergency bed-days for older people? Network governance lessons from the 'Improving the Future for Older People' programme.

PubMed

Sheaff, Rod; Windle, Karen; Wistow, Gerald; Ashby, Sue; Beech, Roger; Dickinson, Angela; Henderson, Catherine; Knapp, Martin

2014-04-01

In 2007, the UK government set performance targets and public service agreements to control the escalation of emergency bed-days. Some years earlier, nine English local authorities had each created local networks with their health and third sector partners to tackle this increase. These networks formed the 'Improving the Future for Older People' initiative (IFOP), one strand of the national 'Innovation Forum' programme, set up in 2003. The nine sites set themselves one headline target to be achieved jointly over three years; a 20 per cent reduction in the number of emergency bed-days used by people aged 75 and over. Three ancillary targets were also monitored: emergency admissions, delayed discharges and project sustainability. Collectively the sites exceeded their headline target. Using a realistic evaluation approach, we explored which aspects of network governance appeared to have contributed to these emergency bed-day reductions. We found no simple link between network governance type and outcomes. The governance features associated with an effective IFOP network appeared to suggest that the selection and implementation of a small number of evidence-based services was central to networks' effectiveness. Each service needed to be coordinated by a network-based strategic group and hierarchically implemented at operational level by the responsible network member. Having a network-based implementation group with a 'joined-at-the-top' governance structure also appeared to promote network effectiveness. External factors, including NHS incentives, health reorganisations and financial targets similarly contributed to differences in performance. Targets and financial incentives could focus action but undermine horizontal networking. Local networks should specify which interventions network structures are intended to deliver. Effective projects are those likely to be evidence based, unique to the network and difficult to implement through vertical structures alone. Copyright © 2014 Elsevier Ltd. All rights reserved.

HIV-1 Drug Resistance Mutations Among Antiretroviral-Naïve HIV-1–Infected Patients in Asia: Results From the TREAT Asia Studies to Evaluate Resistance-Monitoring Study

PubMed Central

Oyomopito, Rebecca; Sirivichayakul, Sunee; Sirisanthana, Thira; Kantipong, Pacharee; Lee, Christopher K. C.; Kamarulzaman, Adeeba; Messerschmidt, Liesl; Law, Matthew G.; Phanuphak, Praphan

2011-01-01

(See editorial commentary by Jordan on pages 1058–1060.) Of 682 antiretroviral-naïve patients initiating antiretroviral therapy in a prospective, multicenter human immunodeficiency virus type 1 (HIV-1) drug resistance monitoring study involving 8 sites in Hong Kong, Malaysia, and Thailand, the prevalence of patients with ≥1 drug resistance mutation was 13.8%. Primary HIV drug resistance is emerging after rapid scaling-up of antiretroviral therapy use in Asia. PMID:21460324

32 CFR 263.7 - Emergency vehicles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 2 2013-07-01 2013-07-01 false Emergency vehicles. 263.7 Section 263.7 National... TRAFFIC AND VEHICLE CONTROL ON CERTAIN DEFENSE MAPPING AGENCY SITES § 263.7 Emergency vehicles. No person shall fail or refuse to yield the right-of-way to an emergency vehicle when operating with siren or...

32 CFR 263.7 - Emergency vehicles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 2 2012-07-01 2012-07-01 false Emergency vehicles. 263.7 Section 263.7 National... TRAFFIC AND VEHICLE CONTROL ON CERTAIN DEFENSE MAPPING AGENCY SITES § 263.7 Emergency vehicles. No person shall fail or refuse to yield the right-of-way to an emergency vehicle when operating with siren or...

32 CFR 263.7 - Emergency vehicles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Emergency vehicles. 263.7 Section 263.7 National... TRAFFIC AND VEHICLE CONTROL ON CERTAIN DEFENSE MAPPING AGENCY SITES § 263.7 Emergency vehicles. No person shall fail or refuse to yield the right-of-way to an emergency vehicle when operating with siren or...

32 CFR 263.7 - Emergency vehicles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 2 2011-07-01 2011-07-01 false Emergency vehicles. 263.7 Section 263.7 National... TRAFFIC AND VEHICLE CONTROL ON CERTAIN DEFENSE MAPPING AGENCY SITES § 263.7 Emergency vehicles. No person shall fail or refuse to yield the right-of-way to an emergency vehicle when operating with siren or...

32 CFR 263.7 - Emergency vehicles.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 2 2014-07-01 2014-07-01 false Emergency vehicles. 263.7 Section 263.7 National... TRAFFIC AND VEHICLE CONTROL ON CERTAIN DEFENSE MAPPING AGENCY SITES § 263.7 Emergency vehicles. No person shall fail or refuse to yield the right-of-way to an emergency vehicle when operating with siren or...

Traffic signal preemption for emergency vehicles : a cross-cutting study : putting the "first" in "first response"

DOT National Transportation Integrated Search

2006-01-01

This cross-cutting study identifies issues associated with emergency vehicle operations and emergency vehicle preemption. This study reports information gathered during a review of publications and site visits to three jurisdictions operating emergen...

Emergent climate and CO2 sensitivities of net primary productivity in ecosystem models do not agree with empirical data in temperate forests of eastern North America.

PubMed

Rollinson, Christine R; Liu, Yao; Raiho, Ann; Moore, David J P; McLachlan, Jason; Bishop, Daniel A; Dye, Alex; Matthes, Jaclyn H; Hessl, Amy; Hickler, Thomas; Pederson, Neil; Poulter, Benjamin; Quaife, Tristan; Schaefer, Kevin; Steinkamp, Jörg; Dietze, Michael C

2017-07-01

Ecosystem models show divergent responses of the terrestrial carbon cycle to global change over the next century. Individual model evaluation and multimodel comparisons with data have largely focused on individual processes at subannual to decadal scales. Thus far, data-based evaluations of emergent ecosystem responses to climate and CO 2 at multidecadal and centennial timescales have been rare. We compared the sensitivity of net primary productivity (NPP) to temperature, precipitation, and CO 2 in ten ecosystem models with the sensitivities found in tree-ring reconstructions of NPP and raw ring-width series at six temperate forest sites. These model-data comparisons were evaluated at three temporal extents to determine whether the rapid, directional changes in temperature and CO 2 in the recent past skew our observed responses to multiple drivers of change. All models tested here were more sensitive to low growing season precipitation than tree-ring NPP and ring widths in the past 30 years, although some model precipitation responses were more consistent with tree rings when evaluated over a full century. Similarly, all models had negative or no response to warm-growing season temperatures, while tree-ring data showed consistently positive effects of temperature. Although precipitation responses were least consistent among models, differences among models to CO 2 drive divergence and ensemble uncertainty in relative change in NPP over the past century. Changes in forest composition within models had no effect on climate or CO 2 sensitivity. Fire in model simulations reduced model sensitivity to climate and CO 2 , but only over the course of multiple centuries. Formal evaluation of emergent model behavior at multidecadal and multicentennial timescales is essential to reconciling model projections with observed ecosystem responses to past climate change. Future evaluation should focus on improved representation of disturbance and biomass change as well as the feedbacks with moisture balance and CO 2 in individual models. © 2017 John Wiley & Sons Ltd.

Occurrence of pharmaceuticals, hormones, and organic wastewater compounds in Pennsylvania waters, 2006-09

USGS Publications Warehouse

Reif, Andrew G.; Crawford, J. Kent; Loper, Connie A.; Proctor, Arianne; Manning, Rhonda; Titler, Robert

2012-01-01

Concern over the presence of contaminants of emerging concern, such as pharmaceutical compounds, hormones, and organic wastewater compounds (OWCs), in waters of the United States and elsewhere is growing. Laboratory techniques developed within the last decade or new techniques currently under development within the U.S. Geological Survey now allow these compounds to be measured at concentrations in nanograms per liter. These new laboratory techniques were used in a reconnaissance study conducted by the U.S. Geological Survey, in cooperation with the Pennsylvania Department of Environmental Protection, to determine the occurrence of contaminants of emerging concern in streams, streambed sediment, and groundwater of Pennsylvania. Compounds analyzed for in the study are pharmaceuticals (human and veterinary drugs), hormones (natural and synthetic), and OWCs (detergents, fragrances, pesticides, industrial compounds, disinfectants, polycyclic aromatic hydrocarbons, fire retardants and plasticizers). Reconnaissance sampling was conducted from 2006 to 2009 to identify contaminants of emerging concern in (1) groundwater from wells used to supply livestock, (2) streamwater upstream and downstream from animal feeding operations, (3) streamwater upstream from and streamwater and streambed sediment downstream from municipal wastewater effluent discharges, (4) streamwater from sites within 5 miles of drinking-water intakes, and (5) streamwater and streambed sediment where fish health assessments were conducted. Of the 44 pharmaceutical compounds analyzed in groundwater samples collected in 2006 from six wells used to supply livestock, only cotinine (a nicotine metabolite) and the antibiotics tylosin and sulfamethoxazole were detected. The maximum concentration of any contaminant of emerging concern was 24 nanograms per liter (ng/L) for cotinine, and was detected in a groundwater sample from a Lebanon County, Pa., well. Seven pharmaceutical compounds including acetaminophen, caffeine, carbamazepine, and the four antibiotics tylosin, sulfadimethoxine, sulfamethoxazole, and oxytetracycline were detected in streamwater samples collected in 2006 from six paired stream sampling sites located upstream and downstream from animal-feeding operations. The highest reported concentration of these seven compounds was for the antibiotic sulfamethoxazole (157 ng/L), in a sample from the downstream site on Snitz Creek in Lancaster County, Pa. Twenty-one pharmaceutical compounds were detected in streamwater samples collected in 2006 from five paired stream sampling sites located upstream or downstream from a municipal wastewater-effluent-discharge site. The most commonly detected compounds and maximum concentrations were the anticonvulsant carbamazepine, 276 ng/L; the antihistamine diphenhydramine, 135 ng/L; and the antibiotics ofloxacin, 329 ng/L; sulfamethoxazole, 1,340 ng/L; and trimethoprim, 256 ng/L. A total of 51 different contaminants of emerging concern were detected in streamwater samples collected from 2007 through 2009 at 13 stream sampling sites located downstream from a wastewater-effluent-discharge site. The concentrations and numbers of compounds detected were higher in stream sites downstream from a wastewater-effluent-discharge site than in stream sites upstream from a wastewater-effluent-discharge site. This finding indicates that wastewater-effluent discharges are a source of contaminants of emerging concern; these contaminants were present more frequently in the streambed-sediment samples than in streamwater samples. Antibiotic compounds were often present in both the streamwater and streambed-sediment samples, but many OWCs were present exclusively in the streambed-sediment samples. Compounds with endocrine disrupting potential including detergent metabolites, pesticides, and flame retardants, were present in the streamwater and streambed-sediment samples. Killinger Creek, a stream where wastewater-effluent discharges contribute a large percentage of the total flow, stands out as a stream with particularly high numbers of compounds detected and detected at the highest concentrations measured in the reconnaissance sampling. Nineteen contaminants of emerging concern were detected in streamwater samples collected quarterly from 2007 through 2009 at 27 stream sites within 5 miles of a drinking-water intake. The number of contaminants and the concentrations detected at the stream sites within 5 miles of drinking-water intakes were generally very low (concentrations less than 50 ng/L), much lower than those at sites downstream from a wastewater-effluent discharge. The most commonly detected compounds and maximum concentrations were caffeine, 517 ng/L; carbamazepine, 95 ng/L; sulfamethoxazole, 146 ng/L; and estrone, 3.15 ng/L. The concentrations and frequencies of detection of some of the contaminants of emerging concern appear to vary by season, which could be explained by compound use, flow regime, or differences in degradation rates. Concentrations of some contaminants were associated with lower flows as a result of decreased in-stream dilution of wastewater effluents or other contamination sources. Twenty-two contaminants of emerging concern were detected once each in streamwater samples collected in 2007 and 2008 from 16 fish-health stream sites located statewide. The highest concentrations were for the OWCs, including flame retardants tri(2-butoxyethyl)phosphate (604 ng/L) and tri(2-chloroethyl)phosphate (272 ng/L) and the fragrance isoquinoline (330 ng/L). Far fewer numbers of contaminants of emerging concern were detected at the fish-health sites than at the wastewater-effluent-discharge sites. Most of the fish-health sites were not located directly downstream from a wastewater-effluent discharge, but there were multiple wastewater-effluent discharges in the drainage basins upstream from the sampling sites. No distinct pattern of contaminant occurrence could be discerned for the fish-health stream sites

Not Your Father's Web Site: Corporate Sites Emerge as New Content Innovators.

ERIC Educational Resources Information Center

O'Leary, Mick

2002-01-01

New economy corporate Web sites have pioneered exciting techniques-rich media, interactivity, personalization, community, and integration of much third-party content. Discusses business-to-business (B2B) Web commerce, with examples of several B2B corporate sites; portal and content elements of these sites; and corporate content outlooks. (AEF)

Engaging, Recruiting, and Retaining Black Men Who Have Sex With Men in Research Studies: Don’t Underestimate the Importance of Staffing—Lessons Learned From HPTN 061, the BROTHERS Study

PubMed Central

Magnus, Manya; Franks, Julie; Griffith, Sam; Arnold, Michael P.; Goodman, Krista; Wheeler, Darrell P.

2014-01-01

Context HIV/AIDS in the United States continues to primarily impact men who have sex with men (MSM), with disproportionately high rates among black MSM. Objective The purpose of this study was to identify factors that may influence engagement and retention of black MSM in HIV research. Design and Participants This was a qualitative evaluation of study implementation within a multisite, prospective, observational study (HIV Prevention Trials Network 061, BROTHERS) that enrolled 1553 black MSM in 6 cities throughout the United States. Data collection for this evaluation included a written, structured survey collected from each of the sites describing site characteristics including staff and organizational structure, reviews of site standard operating procedures, and work plans; semistructured key informant interviews were conducted with site coordinators to characterize staffing, site-level factors facilitating or impeding effective community engagement, study recruitment, and retention. Data from completed surveys and site standard operating procedures were collated, and notes from key informant interviews were thematically coded for content by 2 independent reviewers. Results Several key themes emerged from the data, including the importance of inclusion of members of the community being studied as staff, institutional hiring practices that support inclusive staffing, cultivating a supportive working environment for study implementation, and ongoing relationships between research institutions and community. Conclusions This study underscores the importance of staffing in implementing research with black MSM. Investigators should consider how staffing and organizational structures affect implementation during study design and when preparing to initiate study activities. Ongoing monitoring of community engagement can inform and improve methods for engagement and ensure cultural relevance while removing barriers for participation. PMID:24406940

Engaging, recruiting, and retaining black men who have sex with men in research studies: don't underestimate the importance of staffing--lessons learned from HPTN 061, the BROTHERS study.

PubMed

Magnus, Manya; Franks, Julie; Griffith, Sam; Arnold, Michael P; Goodman, Krista; Wheeler, Darrell P

2014-01-01

HIV/AIDS in the United States continues to primarily impact men who have sex with men (MSM), with disproportionately high rates among black MSM. The purpose of this study was to identify factors that may influence engagement and retention of black MSM in HIV research. This was a qualitative evaluation of study implementation within a multisite, prospective, observational study (HIV Prevention Trials Network 061, BROTHERS) that enrolled 1553 black MSM in 6 cities throughout the United States. Data collection for this evaluation included a written, structured survey collected from each of the sites describing site characteristics including staff and organizational structure, reviews of site standard operating procedures, and work plans; semistructured key informant interviews were conducted with site coordinators to characterize staffing, site-level factors facilitating or impeding effective community engagement, study recruitment, and retention. Data from completed surveys and site standard operating procedures were collated, and notes from key informant interviews were thematically coded for content by 2 independent reviewers. Several key themes emerged from the data, including the importance of inclusion of members of the community being studied as staff, institutional hiring practices that support inclusive staffing, cultivating a supportive working environment for study implementation, and ongoing relationships between research institutions and community. This study underscores the importance of staffing in implementing research with black MSM. Investigators should consider how staffing and organizational structures affect implementation during study design and when preparing to initiate study activities. Ongoing monitoring of community engagement can inform and improve methods for engagement and ensure cultural relevance while removing barriers for participation.

A hyper-temporal remote sensing protocol for high-resolution mapping of ecological sites

PubMed Central

Karl, Jason W.

2017-01-01

Ecological site classification has emerged as a highly effective land management framework, but its utility at a regional scale has been limited due to the spatial ambiguity of ecological site locations in the U.S. or the absence of ecological site maps in other regions of the world. In response to these shortcomings, this study evaluated the use of hyper-temporal remote sensing (i.e., hundreds of images) for high spatial resolution mapping of ecological sites. We posit that hyper-temporal remote sensing can provide novel insights into the spatial variability of ecological sites by quantifying the temporal response of land surface spectral properties. This temporal response provides a spectral ‘fingerprint’ of the soil-vegetation-climate relationship which is central to the concept of ecological sites. Consequently, the main objective of this study was to predict the spatial distribution of ecological sites in a semi-arid rangeland using a 28-year time series of normalized difference vegetation index from Landsat TM 5 data and modeled using support vector machine classification. Results from this study show that support vector machine classification using hyper-temporal remote sensing imagery was effective in modeling ecological site classes, with a 62% correct classification. These results were compared to Gridded Soil Survey Geographic database and expert delineated maps of ecological sites which had a 51 and 89% correct classification, respectively. An analysis of the effects of ecological state on ecological site misclassifications revealed that sites in degraded states (e.g., shrub-dominated/shrubland and bare/annuals) had a higher rate of misclassification due to their close spectral similarity with other ecological sites. This study identified three important factors that need to be addressed to improve future model predictions: 1) sampling designs need to fully represent the range of both within class (i.e., states) and between class (i.e., ecological sites) spectral variability through time, 2) field sampling protocols that accurately characterize key soil properties (e.g., texture, depth) need to be adopted, and 3) additional environmental covariates (e.g. terrain attributes) need to be evaluated that may help further differentiate sites with similar spectral signals. Finally, the proposed hyper-temporal remote sensing framework may provide a standardized approach to evaluate and test our ecological site concepts through examining differences in vegetation dynamics in response to climatic variability and other drivers of land-use change. Results from this study demonstrate the efficacy of the hyper-temporal remote sensing approach for high resolution mapping of ecological sites, and highlights its utility in terms of reduced cost and time investment relative to traditional manual mapping approaches. PMID:28414731

A hyper-temporal remote sensing protocol for high-resolution mapping of ecological sites.

PubMed

Maynard, Jonathan J; Karl, Jason W

2017-01-01

Ecological site classification has emerged as a highly effective land management framework, but its utility at a regional scale has been limited due to the spatial ambiguity of ecological site locations in the U.S. or the absence of ecological site maps in other regions of the world. In response to these shortcomings, this study evaluated the use of hyper-temporal remote sensing (i.e., hundreds of images) for high spatial resolution mapping of ecological sites. We posit that hyper-temporal remote sensing can provide novel insights into the spatial variability of ecological sites by quantifying the temporal response of land surface spectral properties. This temporal response provides a spectral 'fingerprint' of the soil-vegetation-climate relationship which is central to the concept of ecological sites. Consequently, the main objective of this study was to predict the spatial distribution of ecological sites in a semi-arid rangeland using a 28-year time series of normalized difference vegetation index from Landsat TM 5 data and modeled using support vector machine classification. Results from this study show that support vector machine classification using hyper-temporal remote sensing imagery was effective in modeling ecological site classes, with a 62% correct classification. These results were compared to Gridded Soil Survey Geographic database and expert delineated maps of ecological sites which had a 51 and 89% correct classification, respectively. An analysis of the effects of ecological state on ecological site misclassifications revealed that sites in degraded states (e.g., shrub-dominated/shrubland and bare/annuals) had a higher rate of misclassification due to their close spectral similarity with other ecological sites. This study identified three important factors that need to be addressed to improve future model predictions: 1) sampling designs need to fully represent the range of both within class (i.e., states) and between class (i.e., ecological sites) spectral variability through time, 2) field sampling protocols that accurately characterize key soil properties (e.g., texture, depth) need to be adopted, and 3) additional environmental covariates (e.g. terrain attributes) need to be evaluated that may help further differentiate sites with similar spectral signals. Finally, the proposed hyper-temporal remote sensing framework may provide a standardized approach to evaluate and test our ecological site concepts through examining differences in vegetation dynamics in response to climatic variability and other drivers of land-use change. Results from this study demonstrate the efficacy of the hyper-temporal remote sensing approach for high resolution mapping of ecological sites, and highlights its utility in terms of reduced cost and time investment relative to traditional manual mapping approaches.

The evolution of the emergency care practitioner role in England: experiences and impact.

PubMed

Mason, S; Coleman, P; O'Keeffe, C; Ratcliffe, J; Nicholl, J

2006-06-01

The emergency care practitioner (ECP) is a generic practitioner who combines extended nursing and paramedic skills. The "new" role emerged out of changing workforce initiatives intended to improve staff career opportunities in the National Health Service and ensure that patients' health needs are assessed appropriately. To describe the development of ECP Schemes in 17 sites, identify criteria contributing to a successful operational framework, analyse routinely collected data and provide a preliminary estimate of costs. There were three methods used: (a) a quantitative survey, comprising a questionnaire to project leaders in 17 sites, and analysis of data collected routinely; (b) qualitative interpretation based on telephone interviews in six sites; and (c) an economic costing study. Of 17 sites, 14 (82.5%) responded to the questionnaire. Most ECPs (77.4%) had trained as paramedics. Skills and competencies have been extended through educational programmes, training, and assessment. Routine data indicate that 54% of patient contacts with the ECP service did not require a referral to another health professional or use of emergency transport. In a subset of six sites, factors contributing to a successful operational framework were strategic visions crossing traditional organisational boundaries and appropriately skilled workforce integrating flexibly with existing services. Issues across all schemes were patient safety, appropriate clinical governance, and supervision and workforce issues. On the data available, the mean cost per ECP patient contact is 24.00 pounds sterling, which is less than an ED contact of 55.00 pounds sterling. Indications are that the ECP schemes are moving forward in line with original objectives and could be having a significant impact on the emergency services workload.

Long-term urban carbon dioxide observations reveal spatial and temporal dynamics related to urban characteristics and growth

DOE PAGES

Mitchell, Logan E.; Lin, John C.; Bowling, David R.; ...

2018-03-05

Cities are concentrated areas of CO 2 emissions and have become the foci of policies for mitigation actions. However, atmospheric measurement networks suitable for evaluating urban emissions over time are scarce. Here we present a unique long-term (decadal) record of CO 2 mole fractions from five sites across Utah’s metropolitan Salt Lake Valley. We examine “excess” CO 2 above background conditions resulting from local emissions and meteorological conditions. We ascribe CO 2 trends to changes in emissions, since we did not find longterm trends in atmospheric mixing proxies. Three contrasting CO 2 trends emerged across urban types: negative trends atmore » a residentialindustrial site, positive trends at a site surrounded by rapid suburban growth, and relatively constant CO 2 over time at multiple sites in the established, residential, and commercial urban core. Analysis of populationwithin the atmospheric footprints of the different sites reveals approximately equal increases in population influencing the observed CO 2, implying a nonlinear relationshipwith CO 2 emissions: Population growth in rural areas that experienced suburban development was associated with increasing emissions while population growth in the developed urban core was associated with stable emissions. Four state-of-the-art global-scale emission inventories also have a nonlinear relationship with population density across the city; however, in contrast to our observations, they all have nearly constant emissions over time. Our results indicate that decadal scale changes in urban CO 2 emissions are detectable through monitoring networks and constitute a valuable approach to evaluate emission inventories and studies of urban carbon cycles.« less

Long-term urban carbon dioxide observations reveal spatial and temporal dynamics related to urban characteristics and growth

NASA Astrophysics Data System (ADS)

Mitchell, Logan E.; Lin, John C.; Bowling, David R.; Pataki, Diane E.; Strong, Courtenay; Schauer, Andrew J.; Bares, Ryan; Bush, Susan E.; Stephens, Britton B.; Mendoza, Daniel; Mallia, Derek; Holland, Lacey; Gurney, Kevin R.; Ehleringer, James R.

2018-03-01

Cities are concentrated areas of CO2 emissions and have become the foci of policies for mitigation actions. However, atmospheric measurement networks suitable for evaluating urban emissions over time are scarce. Here we present a unique long-term (decadal) record of CO2 mole fractions from five sites across Utah’s metropolitan Salt Lake Valley. We examine “excess” CO2 above background conditions resulting from local emissions and meteorological conditions. We ascribe CO2 trends to changes in emissions, since we did not find long-term trends in atmospheric mixing proxies. Three contrasting CO2 trends emerged across urban types: negative trends at a residential-industrial site, positive trends at a site surrounded by rapid suburban growth, and relatively constant CO2 over time at multiple sites in the established, residential, and commercial urban core. Analysis of population within the atmospheric footprints of the different sites reveals approximately equal increases in population influencing the observed CO2, implying a nonlinear relationship with CO2 emissions: Population growth in rural areas that experienced suburban development was associated with increasing emissions while population growth in the developed urban core was associated with stable emissions. Four state-of-the-art global-scale emission inventories also have a nonlinear relationship with population density across the city; however, in contrast to our observations, they all have nearly constant emissions over time. Our results indicate that decadal scale changes in urban CO2 emissions are detectable through monitoring networks and constitute a valuable approach to evaluate emission inventories and studies of urban carbon cycles.

Long-term urban carbon dioxide observations reveal spatial and temporal dynamics related to urban characteristics and growth

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

Mitchell, Logan E.; Lin, John C.; Bowling, David R.

Cities are concentrated areas of CO 2 emissions and have become the foci of policies for mitigation actions. However, atmospheric measurement networks suitable for evaluating urban emissions over time are scarce. Here we present a unique long-term (decadal) record of CO 2 mole fractions from five sites across Utah’s metropolitan Salt Lake Valley. We examine “excess” CO 2 above background conditions resulting from local emissions and meteorological conditions. We ascribe CO 2 trends to changes in emissions, since we did not find longterm trends in atmospheric mixing proxies. Three contrasting CO 2 trends emerged across urban types: negative trends atmore » a residentialindustrial site, positive trends at a site surrounded by rapid suburban growth, and relatively constant CO 2 over time at multiple sites in the established, residential, and commercial urban core. Analysis of populationwithin the atmospheric footprints of the different sites reveals approximately equal increases in population influencing the observed CO 2, implying a nonlinear relationshipwith CO 2 emissions: Population growth in rural areas that experienced suburban development was associated with increasing emissions while population growth in the developed urban core was associated with stable emissions. Four state-of-the-art global-scale emission inventories also have a nonlinear relationship with population density across the city; however, in contrast to our observations, they all have nearly constant emissions over time. Our results indicate that decadal scale changes in urban CO 2 emissions are detectable through monitoring networks and constitute a valuable approach to evaluate emission inventories and studies of urban carbon cycles.« 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.

Development of emergency response tools for accidental radiological contamination of French coastal areas.

PubMed

Duffa, Céline; Bailly du Bois, Pascal; Caillaud, Matthieu; Charmasson, Sabine; Couvez, Céline; Didier, Damien; Dumas, Franck; Fievet, Bruno; Morillon, Mehdi; Renaud, Philippe; Thébault, Hervé

2016-01-01

The Fukushima nuclear accident resulted in the largest ever accidental release of artificial radionuclides in coastal waters. This accident has shown the importance of marine assessment capabilities for emergency response and the need to develop tools for adequately predicting the evolution and potential impact of radioactive releases to the marine environment. The French Institute for Radiological Protection and Nuclear Safety (IRSN) equips its emergency response centre with operational tools to assist experts and decision makers in the event of accidental atmospheric releases and contamination of the terrestrial environment. The on-going project aims to develop tools for the management of marine contamination events in French coastal areas. This should allow us to evaluate and anticipate post-accident conditions, including potential contamination sites, contamination levels and potential consequences. In order to achieve this goal, two complementary tools are developed: site-specific marine data sheets and a dedicated simulation tool (STERNE, Simulation du Transport et du transfert d'Eléments Radioactifs dans l'environNEment marin). Marine data sheets are used to summarize the marine environment characteristics of the various sites considered, and to identify vulnerable areas requiring implementation of population protection measures, such as aquaculture areas, beaches or industrial water intakes, as well as areas of major ecological interest. Local climatological data (dominant sea currents as a function of meteorological or tidal conditions) serving as the basis for an initial environmental sampling strategy is provided whenever possible, along with a list of possible local contacts for operational management purposes. The STERNE simulation tool is designed to predict radionuclide dispersion and contamination in seawater and marine species by incorporating spatio-temporal data. 3D hydrodynamic forecasts are used as input data. Direct discharge points or atmospheric deposition source terms can be taken into account. STERNE calculates Eulerian radionuclide dispersion using advection and diffusion equations established offline from hydrodynamic calculations. A radioecological model based on dynamic transfer equations is implemented to evaluate activity concentrations in aquatic organisms. Essential radioecological parameters (concentration factors and single or multicomponent biological half-lives) have been compiled for main radionuclides and generic marine species (fish, molluscs, crustaceans and algae). Dispersion and transfer calculations are performed simultaneously on a 3D grid. Results can be plotted on maps, with possible tracking of spatio-temporal evolution. Post-processing and visualization can then be performed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Design, synthesis, and pharmacological evaluation of 2-amino-5-nitrothiazole derived semicarbazones as dual inhibitors of monoamine oxidase and cholinesterase: effect of the size of aryl binding site.

PubMed

Tripathi, Rati K P; M Sasi, Vishnu; Gupta, Sukesh K; Krishnamurthy, Sairam; Ayyannan, Senthil R

2018-12-01

A series of 2-amino-5-nitrothiazole derived semicarbazones were designed, synthesised and investigated for MAO and ChE inhibition properties. Most of the compounds showed preferential inhibition towards MAO-B. Compound 4, (1-(1-(4-Bromophenyl)ethylidene)-4-(5-nitrothiazol-2-yl)semicarbazide) emerged as lead candidate (IC 50  = 0.212 µM, SI = 331.04) against MAO-B; whereas compounds 21 1-(5-Bromo-2-oxoindolin-3-ylidene)-4-(5-nitrothiazol-2-yl)semicarbazide (IC 50  = 0.264 µM) and 17 1-((4-Chlorophenyl) (phenyl)methylene)-4-(5-nitrothiazol-2-yl)semicarbazide (IC 50  = 0.024 µM) emerged as lead AChE and BuChE inhibitors respectively; with activity of compound 21 almost equivalent to tacrine. Kinetic studies indicated that compound 4 exhibited competitive and reversible MAO-B inhibition while compounds 21 and 17 showed mixed-type of AChE and BuChE inhibition respectively. Docking studies revealed that these compounds were well-accommodated within MAO-B and ChE active sites through stable hydrogen bonding and/or hydrophobic interactions. This study revealed the requirement of small heteroaryl ring at amino terminal of semicarbazone template for preferential inhibition and selectivity towards MAO-B. Our results suggest that 5-nitrothiazole derived semicarbazones could be further exploited for its multi-targeted role in development of anti-neurodegenerative agents. [Formula: see text] A library of 2-amino-5-nitrothiazole derived semicarbazones (4-21) was designed, synthesised and evaluated for in vitro MAO and ChE inhibitory activity. Compounds 4, 21 and 17 (shown) have emerged as lead MAO-B (IC 50 :0.212 µM, competitive and reversible), AChE (IC 50 :0.264 µM, mixed and reversible) and BuChE (IC 50 :0.024 µM, mixed and reversible) inhibitor respectively. SAR studies disclosed several structural aspects significant for potency and selectivity and indicated the role of size of aryl binding site in potency and selectivity towards MAO-B. Antioxidant activity and neurotoxicity screening results further suggested their multifunctional potential for the therapy of neurodegenerative diseases.

Chimeric GII.4 norovirus virus-like-particle-based vaccines induce broadly blocking immune responses.

PubMed

Debbink, Kari; Lindesmith, Lisa C; Donaldson, Eric F; Swanstrom, Jesica; Baric, Ralph S

2014-07-01

There is currently no licensed vaccine for noroviruses, and development is hindered, in part, by an incomplete understanding of the host adaptive immune response to these highly heterogeneous viruses and rapid GII.4 norovirus molecular evolution. Emergence of a new predominant GII.4 norovirus strain occurs every 2 to 4 years. To address the problem of GII.4 antigenic variation, we tested the hypothesis that chimeric virus-like particle (VLP)-based vaccine platforms, which incorporate antigenic determinants from multiple strains into a single genetic background, will elicit a broader immune response against contemporary and emergent strains. Here, we compare the immune response generated by chimeric VLPs to that of parental strains and a multivalent VLP cocktail. Results demonstrate that chimeric VLPs induce a more broadly cross-blocking immune response than single parental VLPs and a similar response to a multivalent GII.4 VLP cocktail. Furthermore, we show that incorporating epitope site A alone from one strain into the background of another is sufficient to induce a blockade response against the strain donating epitope site A. This suggests a mechanism by which population-wide surveillance of mutations in a single epitope could be used to evaluate antigenic changes in order to identify potential emergent strains and quickly reformulate vaccines against future epidemic strains as they emerge in human populations. Noroviruses are gastrointestinal pathogens that infect an estimated 21 million people per year in the United States alone. GII.4 noroviruses account for >70% of all outbreaks, making them the most clinically important genotype. GII.4 noroviruses undergo a pattern of epochal evolution, resulting in the emergence of new strains with altered antigenicity over time, complicating vaccine design. This work is relevant to norovirus vaccine design as it demonstrates the potential for development of a chimeric VLP-based vaccine platform that may broaden the protective response against multiple GII.4 strains and proposes a potential reformulation strategy to control newly emergent strains in the human population. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Analysis of Alternative (Low Impact) Development on a Theoretical Residential Development in North Central Florida

NASA Astrophysics Data System (ADS)

Wise, W. R.

2001-05-01

Research currently in progress will evaluate land development options on a 161 +/- HA site in North Central Florida lying within a 292+/- HA watershed that contributes to Bullfrog Creek in the Camp Blanding Wildlife Management Area. The research analyzes aspects of an emerging storm-water management philosophy, called low-impact development (LID) by Prince Georges County, Maryland. LID seeks to preserve site hydrology by reducing the area of disturbance on the site, preserving natural drainage features on the site and by utilizing BMPs that promote infiltration and slower transport of runoff. This research investigates the benefits and problems associated with this design philosophy, particularly in Florida. Two scenarios will be investigated: Low density residential and Medium density residential. Within each scenario the hydrologic response of the site under conventional and LID will be explored. Furthermore, the impact of using cluster developments in LIDs will be investigated. Parameters to be measured include: peak flow, runoff volume, pollutant load generated/removed by BMPs, peak-flow timing and base flow. HEC-HMS will be used for hydrologic modeling (soil moisture accounting module). Pollutant loads generated and removed will be based on published data for land use and BMPs. An economic analysis, based on the estimated construction costs of conventional and LID, will also be done. Further sensitivity analyses will be conducted on the effect that various watershed conditions have on the hydrologic response of the site developed as a LID. This research will provide insight to several questions. In the most general sense it will indicate whether this emerging design philosophy, much of which was developed in other regions of the country, is beneficial to Florida watersheds "as it is" and what, if any, alterations should be considered. Secondly, this research will show the impact of development with different site-planning options, for example cluster development versus deed restrictions on lots. Thirdly, the research will give insight to the applicability of this land-development approach under different allowable residential densities. Lastly, the effect of different physical characteristics on the watershed can be explored.

Toward identifying the next generation of superfund and hazardous waste site contaminants.

PubMed

Ela, Wendell P; Sedlak, David L; Barlaz, Morton A; Henry, Heather F; Muir, Derek C G; Swackhamer, Deborah L; Weber, Eric J; Arnold, Robert G; Ferguson, P Lee; Field, Jennifer A; Furlong, Edward T; Giesy, John P; Halden, Rolf U; Henry, Tala; Hites, Ronald A; Hornbuckle, Keri C; Howard, Philip H; Luthy, Richard G; Meyer, Anita K; Sáez, A Eduardo; Vom Saal, Frederick S; Vulpe, Chris D; Wiesner, Mark R

2011-01-01

This commentary evolved from a workshop sponsored by the National Institute of Environmental Health Sciences titled "Superfund Contaminants: The Next Generation" held in Tucson, Arizona, in August 2009. All the authors were workshop participants. Our aim was to initiate a dynamic, adaptable process for identifying contaminants of emerging concern (CECs) that are likely to be found in future hazardous waste sites, and to identify the gaps in primary research that cause uncertainty in determining future hazardous waste site contaminants. Superfund-relevant CECs can be characterized by specific attributes: They are persistent, bioaccumulative, toxic, occur in large quantities, and have localized accumulation with a likelihood of exposure. Although still under development and incompletely applied, methods to quantify these attributes can assist in winnowing down the list of candidates from the universe of potential CECs. Unfortunately, significant research gaps exist in detection and quantification, environmental fate and transport, health and risk assessment, and site exploration and remediation for CECs. Addressing these gaps is prerequisite to a preventive approach to generating and managing hazardous waste sites. A need exists for a carefully considered and orchestrated expansion of programmatic and research efforts to identify, evaluate, and manage CECs of hazardous waste site relevance, including developing an evolving list of priority CECs, intensifying the identification and monitoring of likely sites of present or future accumulation of CECs, and implementing efforts that focus on a holistic approach to prevention.

Evaluating species-specific changes in hydrologic regimes: an iterative approach for salmonids in the Greater Yellowstone Area (USA)

USGS Publications Warehouse

Al-Chokhachy, Robert K.; Sepulveda, Adam; Ray, Andrew M.; Thoma, David P.; Tercek, Michael T.

2017-01-01

Despite the importance of hydrologic regimes to the phenology, demography, and abundance of fishes such as salmonids, there have been surprisingly few syntheses that holistically assess regional, species-specific trends in hydrologic regimes within a framework of climate change. Here, we consider hydrologic regimes within the Greater Yellowstone Area in the Rocky Mountains of western North America to evaluate changes in hydrologic metrics anticipated to affect salmonids, a group of fishes with high regional ecological and socioeconomic value. Our analyses assessed trends across different sites and time periods (1930–, 1950–, and 1970–2015) as means to evaluate spatial and temporal shifts. Consistent patterns emerged from our analyses indicating substantial shifts to (1) earlier peak discharge events; (2) reductions of summer minimum streamflows; (3) declines in the duration of river ice; and (4) decreases in total volume of water. We found accelerated trends in hydrologic change for the 1970–2015 period, with an average peak discharge 7.5 days earlier, 27.5% decline in summer minimum streamflows, and a 15.6% decline in the annual total volume of water (1 October–September 30) across sites. We did observe considerable variability in magnitude of change across sites, suggesting different levels of vulnerability to a changing climate. Our analyses provide an iterative means for assessing climate predictions and an important step in identifying the climate resilience of landscapes.

Safety and efficacy of transcatheter embolization with Glubran®2 cyanoacrylate glue for acute arterial bleeding: a single-center experience with 104 patients.

PubMed

Abdulmalak, Gilles; Chevallier, Olivier; Falvo, Nicolas; Di Marco, Lucy; Bertaut, Aurélie; Moulin, Benjamin; Abi-Khalil, Célina; Gehin, Sophie; Charles, Pierre-Emmanuel; Latournerie, Marianne; Midulla, Marco; Loffroy, Romaric

2018-03-01

To assess the efficacy and the safety of Glubran ® 2 n-butyl cyanoacrylate metacryloxysulfolane (NBCA-MS) transcatheter arterial embolization (TAE) for acute arterial bleeding from varied anatomic sites and to evaluate the predictive factors associated with clinical success and 30-day mortality. A retrospective review of consecutive patients who underwent emergent NBCA-MS Glubran ® 2 TAE between July 2014 and August 2016 was conducted. Variables including age, sex, underlying malignancy, cardiovascular comorbidities, coagulation data, systolic blood pressure, and number of red blood cells units (RBC) transfused before TAE were collected. Clinical success, 30-day mortality, and complication rates were evaluated. Prognostic factors were evaluated by uni- and multivariate logistic regression analyses for clinical success, and by uni- and bivariate analyses after adjustment by bleeding sites for 30-day mortality. 104 patients underwent technically successful embolization with bleeding located in muscles (n = 34, 32.7%), digestive tract (n = 28, 26.9%), and viscera (n = 42, 40.4%). Clinical success rate was 76% (n = 79) and 30-day mortality rate was 21.2% (n = 22). Clinical failure was significantly associated with mortality (p < 0.0001). A number of RBC units transfused greater than or equal to 3 were associated with poorer clinical success (p = 0.025) and higher mortality (p = 0.03). Complications (n = 4, 3.8%) requiring surgery occurred only at puncture site. No ischemic complications requiring further invasive treatment occurred. Mean TAE treatment time was 4.55 min. NBCA-MS Glubran ® 2 TAE is a fast, effective, and safe treatment for acute arterial bleeding whatever the bleeding site.

Housing and overdose: an opportunity for the scale-up of overdose prevention interventions?

PubMed

Bardwell, Geoff; Collins, Alexandra B; McNeil, Ryan; Boyd, Jade

2017-12-06

North America is currently experiencing an overdose epidemic due to a significant increase of fentanyl-adulterated opioids and related analogs. Multiple jurisdictions have declared a public health emergency given the increasing number of overdose deaths. In the province of British Columbia (BC) in Canada, people who use drugs and who are unstably housed are disproportionately affected by a rising overdose crisis, with close to 90% of overdose deaths occurring indoors. Despite this alarming number, overdose prevention and response interventions have yet to be widely implemented in a range of housing settings. There are few examples of overdose prevention interventions in housing environments. In BC, for example, there are peer-led naloxone training and distribution programs targeted at some housing environments. There are also "supervised" spaces such as overdose prevention sites (similar to supervised consumption sites (SCS)) located in some housing environments; however, their coverage remains limited and the impacts of these programs are unclear due to the lack of evaluation work undertaken to date. A small number of SCS exist globally in housing environments (e.g., Germany), but like overdose prevention sites in BC, little is known about the design or effectiveness, as they remain under-evaluated. Implementing SCS and other overdose prevention interventions across a range of housing sites provides multiple opportunities to address overdose risk and drug-related harms for marginalized people who use drugs. Given the current overdose crisis rising across North America, and the growing evidence of the relationship between housing and overdose, the continued implementation and evaluation of novel overdose prevention interventions in housing environments should be a public health priority. A failure to do so will simply perpetuate what has proven to be a devastating epidemic of preventable death.

TEMA-DOE annual report, July 1, 1997--June 30, 1998

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

NONE

1998-09-01

The Tennessee Emergency Management Agency (TEMA) will develop off-site Multi-Jurisdictional Emergency Response Plans (MJERPs) in coordination with Federal, State, and local agencies. The MJERPs will describe actions to minimize the risks to the citizens of Tennessee as a result of an off-site release of hazardous material from the DOE Oak Ridge Reservation. This report describes actions made during each quarter of the year.

7 CFR 331.14 - Incident response. 6

Code of Federal Regulations, 2010 CFR

2010-01-01

... other natural disasters; workplace violence; bomb threats and suspicious packages; and emergencies such... equipment, and their locations; (10) Site security and control; (11) Procedures for emergency evacuation...

"Friending Facebook?" A minicourse on the use of social media by health professionals.

PubMed

George, Daniel R

2011-01-01

Health professionals are working in an era of social technologies that empower users to generate content in real time. This article describes a 3-part continuing education minicourse called "Friending Facebook?" undertaken at Penn State Hershey Medical Center that aimed to model the functionality of current technologies in health care and encourage discussion about how health professionals might responsibly utilize social media. Fifteen health professionals participated in the course and provided written evaluation at its conclusion. The course instructor took field notes during each of the 3 classes to document emergent themes. The course received uniformly positive evaluations, and participants identified several current tools perceived as being potentially useful in their professional lives, including news aggregators, Google Alerts, and--if used responsibly--social networking sites such as Facebook. Developing innovative and appropriate programming that teaches to emerging social media technologies and ideologies will be crucial to helping the health professions adapt to a new, networked era. Medical institutions would do well to foster interprofessional-and perhaps even intergenerational-conversations to share not only the dangers and risks of social media, but also the opportunities that are emerging out of a rapidly evolving online world. Copyright © 2010 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Research to support design and siting of deposition areas for dredged material from the Rodanthe Emergency Channel

DOT National Transportation Integrated Search

2017-06-30

The Rodanthe Emergency Ferry Channel (REFC) is essential for transporting emergency personnel, equipment, and supplies to Hatteras Island communities following any event that renders the Herbert C. Bonner Bridge and/or North Carolina Highway 12 impas...

Waste Receiving and Processing (WRAP) Module 1 Hazards Assessment

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

CAMPBELL, L.R.

1999-09-29

This document establishes the technical basis in support of Emergency Planning activities for the WRAP Module 1 Facility on the Hanford Site. Through this document, the technical basis for the development of facility specific Emergency Action Levels and Emergency Planning Zone is demonstrated.

The three Rs of fire safety, emergency action, and fire prevention planning: promoting safety at the worksite.

PubMed

Thompson, Marcella R

2003-04-01

Fire safety is of paramount importance for everyone. In many workplaces, the occupational health nurse's scope of practice encompasses safety related activities. Included within this role is the responsibility for fire safety, emergency action, and fire prevention planning. The Three Rs of fire safety, emergency action, and fire prevention plans are rules, responsibilities, and resources. Myriad building and fire safety codes, regulations, and standards exist with which an employer must comply. An employer's responsibility for installing, testing, inspecting, and maintaining fire safety related equipment is extensive. Emergency action and fire prevention planning begins with conducting a detailed physical survey and preparing site maps. It includes making key policy decisions, writing procedures, and training employees in those procedures by practicing and executing site drills. The best resources available for emergency planning are the local fire department and the property insurer. Planning ahead means an efficient emergency response if disaster strikes. It saves lives, limits property damage, and preserves the environment.

Site management of health issues in the 2001 World Trade Center disaster.

PubMed

Bradt, David A

2003-06-01

The terrorist destruction of the World Trade Center led to the greatest loss of life from a criminal incident in the history of the United States. There were 2,801 persons killed or missing at the disaster site, including 147 dead on two hijacked aircraft. Hundreds of buildings sustained direct damage or contamination. Forty different agencies responded with command and control exercised by an incident command system as well as an emergency operations center. Dozens of hazards complicated relief and recovery efforts. Five victims were rescued from the rubble. Up to 1,000 personnel worked daily at the World Trade Center disaster site. These workers collectively made an average of 270 daily presentations to health care providers in the first month post-disaster. Of presentations for clinical symptoms, leading clinical diagnoses were ocular injuries, headaches, and lung injuries. Mechanical injury accounted for 39% of clinical presentations and appeared preventable by personal protective equipment. Limitations emerged in the site application of emergency triage and clinical care. Notable assets in the site management of health issues include action plans from the incident command system, geographic information system products, wireless application technology, technical consensus among health and safety authorities, and workers' respite care.

Vehicle coordinated transportation dispatching model base on multiple crisis locations

NASA Astrophysics Data System (ADS)

Tian, Ran; Li, Shanwei; Yang, Guoying

2018-05-01

Many disastrous events are often caused after unconventional emergencies occur, and the requirements of disasters are often different. It is difficult for a single emergency resource center to satisfy such requirements at the same time. Therefore, how to coordinate the emergency resources stored by multiple emergency resource centers to various disaster sites requires the coordinated transportation of emergency vehicles. In this paper, according to the problem of emergency logistics coordination scheduling, based on the related constraints of emergency logistics transportation, an emergency resource scheduling model based on multiple disasters is established.

Superfund Training/Tech Transfer

EPA Pesticide Factsheets

This asset includes a collection of information resources, training, and other media related to hazardous waste site cleanup and characterization. A major part of this asset is the CLU-IN System, which is a collection of websites designed to be the central reference library for the development, collection, evaluation, coordination, and dissemination of information relating to the utilization of alternative or innovative treatment technologies... for cleaning up hazardous waste sites (Title 42 Section 9660 (b)(8)). Information includes Best Practices for using innovative technologies, case studies and focus areas about characterization and remediation technologies, emerging issues, optimization, and green(ing) remediation. CLU-IN is available via web-based documentation, live events, podcasts, and videos. Additionally, the Technology Innovation and Field Services Division (TIFSD) supports both classroom and online training registration through Trainex.org. All EPA content is also posted on EPA's website.

Do the conventional clinicopathologic parameters predict for response and survival in head and neck cancer patients undergoing neoadjuvant chemotherapy?

PubMed

Fonseca, E; Cruz, J J; Dueñas, A; Gómez, A; Sánchez, P; Martín, G; Nieto, A; Soria, P; Muñoz, A; Gómez, J L; Pardal, J L

1996-01-01

Neoadjuvant chemotherapy for head and neck carcinoma is still an important treatment modality. The prognostic value of patient and tumor parameters has been extensively evaluated in several trials, yielding mixed results. We report the prognostic factors emerging from a group of patients undergoing neoadjuvant chemotherapy. From April 1986 to June 1992, 149 consecutive patients received cisplatin-5-fluorouracil-based neoadjuvant chemotherapy. After four courses of chemotherapy, patients underwent local-regional treatment with surgery, radiation or both. A variety of patient and tumor characteristics were evaluated as predictors for response to chemotherapy and survival. The complete response, partial response and no response rates to NAC were 52%, 33% and 15%, respectively. No parameters predicted response to chemotherapy. At a maximum follow-up of 87 months, overall survival was 39% and disease-free survival was 49%. Variables shown to be predictors of survival in univariate analyses were age, performance status, histology, site, T, N, stage, and response to chemotherapy. Using the Cox regression analysis, only complete response to induction chemotherapy (P = 0.0006), performance status (P = 0.03), stage (P = 0.01), age (P = 0.03) and primary tumor site (P = 0.04) emerged as independent prognostic factors for survival. Complete response to chemotherapy was confirmed as the strongest prognostic factor influencing survival. However, conventional clinicopathologic factors did not predict response, hence, potential prognostic biologic and molecular factors for response must be sought. At present, much effort must be made for the improvement of the complete response rate, which seems to be a requisite to prolong survival.

An intervention for enhancing public health crisis response willingness among local health department workers: a qualitative programmatic analysis.

PubMed

Harrison, Krista L; Errett, Nicole A; Rutkow, Lainie; Thompson, Carol B; Anderson, Marilyn K; Ferrell, Justin L; Freiheit, Jennifer M; Hudson, Robert; Koch, Michelle M; McKee, Mary; Mejia-Echeverry, Alvaro; Spitzer, James B; Storey, Doug; Barnett, Daniel J

2014-01-01

This study evaluated the impact of a novel multimethod curricular intervention using a train-the-trainer model: the Public Health Infrastructure Training (PHIT). PHIT was designed to 1) modify perceptions of self-efficacy, response efficacy, and threat related to specific hazards and 2) improve the willingness of local health department (LHD) workers to report to duty when called upon. Between June 2009 and October 2010, eight clusters of US LHDs (n = 49) received PHIT. Two rounds of focus groups at each intervention site were used to evaluate PHIT. The first round of focus groups included separate sessions for trainers and trainees, 3 weeks after PHIT. The second round of focus groups combined trainers and trainees in a single group at each site 6 months following PHIT. During the second focus group round, participants were asked to self-assess their preparedness before and after PHIT implementation. Focus groups were conducted at eight geographically representative clusters of LHDs. Focus group participants included PHIT trainers and PHIT trainees within each LHD cluster. Focus groups were used to assess attitudes toward the curricular intervention and modifications of willingness to respond (WTR) to an emergency; self-efficacy; and response efficacy. Participants reported that despite challenges in administering the training, PHIT was well designed and appropriate for multiple management levels and disciplines. Positive mean changes were observed for all nine self-rated preparedness factors (p < 0.001). The findings show PHIT's benefit in improving self-efficacy and WTR among participants. The PHIT has the potential to enhance emergency response willingness and related self-efficacy among LHD workers.

Social media in the emergency medicine residency curriculum: social media responses to the residents' perspective article.

PubMed

Hayes, Bryan D; Kobner, Scott; Trueger, N Seth; Yiu, Stella; Lin, Michelle

2015-05-01

In July to August 2014, Annals of Emergency Medicine continued a collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Integration of Social Media in Emergency Medicine Residency Curriculum" by Scott et al. The objective was to describe a 14-day worldwide clinician dialogue about evidence, opinions, and early relevant innovations revolving around the featured article and made possible by the immediacy of social media technologies. Six online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and YouTube, which featured 3 preselected questions. Engagement was tracked through various Web analytic tools, and themes were identified by content curation. The dialogue resulted in 1,222 unique page views from 325 cities in 32 countries on the ALiEM Web site, 569,403 Twitter impressions, and 120 views of the video interview with the authors. Five major themes we identified in the discussion included curriculum design, pedagogy, and learning theory; digital curation skills of the 21st-century emergency medicine practitioner; engagement challenges; proposed solutions; and best practice examples. The immediacy of social media technologies provides clinicians the unique opportunity to engage a worldwide audience within a relatively short time frame. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

kmos: A lattice kinetic Monte Carlo framework

NASA Astrophysics Data System (ADS)

Hoffmann, Max J.; Matera, Sebastian; Reuter, Karsten

2014-07-01

Kinetic Monte Carlo (kMC) simulations have emerged as a key tool for microkinetic modeling in heterogeneous catalysis and other materials applications. Systems, where site-specificity of all elementary reactions allows a mapping onto a lattice of discrete active sites, can be addressed within the particularly efficient lattice kMC approach. To this end we describe the versatile kmos software package, which offers a most user-friendly implementation, execution, and evaluation of lattice kMC models of arbitrary complexity in one- to three-dimensional lattice systems, involving multiple active sites in periodic or aperiodic arrangements, as well as site-resolved pairwise and higher-order lateral interactions. Conceptually, kmos achieves a maximum runtime performance which is essentially independent of lattice size by generating code for the efficiency-determining local update of available events that is optimized for a defined kMC model. For this model definition and the control of all runtime and evaluation aspects kmos offers a high-level application programming interface. Usage proceeds interactively, via scripts, or a graphical user interface, which visualizes the model geometry, the lattice occupations and rates of selected elementary reactions, while allowing on-the-fly changes of simulation parameters. We demonstrate the performance and scaling of kmos with the application to kMC models for surface catalytic processes, where for given operation conditions (temperature and partial pressures of all reactants) central simulation outcomes are catalytic activity and selectivities, surface composition, and mechanistic insight into the occurrence of individual elementary processes in the reaction network.

Mass emergency water-based foam depopulation of poultry.

PubMed

Benson, E R; Alphin, R L; Rankin, M K; Caputo, M P; Hougentogler, D P; Johnson, A L

2012-12-01

When an avian influenza or virulent Newcastle disease outbreak occurs within commercial poultry, a large number of birds that are infected or suspected of infection must be destroyed on site to prevent the rapid spread of disease. The choice of mass emergency depopulation procedures is limited, and all options have limitations. Water-based foam mass emergency depopulation of poultry was developed in 2006 and conditionally approved by the U.S. Department of Agriculture and American Veterinary Medical Association. Water-based foam causes mechanical hypoxia and can be used for broilers, layers, turkeys, and ducks. The time to physiologic states was evaluated for broilers, layer hens, turkeys, and ducks, comparing water-based foam and CO2 gas using electroencephalogram (unconsciousness and brain death), electrocardiogram (altered terminal cardiac activity), and accelerometer (motion cessation). In broilers, turkeys, and layer hens, water-based foam results in equivalent times to unconsciousness, terminal convulsions, and altered terminal cardiac activity. With Pekin ducks, however, CO2 gas resulted in shorter times to key physiologic states, in particular unconsciousness, altered terminal cardiac activity, motion cessation, and brain death.

Preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission for surgical repair.

PubMed

Lucki, Michelle M; Napier, Deborah E; Wagner, Cynthia

2012-01-01

Recognizing a patient's needs during the emergency department to operating room interval is crucial to identify areas for improvement. A review of the literature provided no pertinent research regarding this phase of the preoperative experience. This descriptive study examined the preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission. Data were collected through a systematic retrospective chart review. Demographic variables included gender, age, and comorbidities. Preoperative patient variables included type of analgesia, level of pain, antiembolism interventions, fluid intake, sensory perception/cognition, mobility, and nutritional intake. Subjects were patients cared for at 3 sites in a large multihospital system. A total of 137 charts were reviewed. Although findings were not statistically significant, opportunities to improve care were identified. More attention is needed to evaluate patients effectively for pain, particularly where there are cognitive deficits. Designing and implementing a program for increased bed mobility and protocols that closely monitor and manage fluid intake may offset postoperative complications.

Readmissions for surgical site infections following caesarean section.

PubMed

El-Achi, Vanessa; Wan, King Man; Brown, James; Marshall, Drew; McGee, Therese

2018-03-05

This retrospective study was conducted to identify the incidence and characteristics associated with readmissions for surgical site infections following caesarean section in a tertiary hospital from 2012 to 2015. Of 6334 patients who underwent caesarean section, 165 (2.6%) were readmitted, most commonly for surgical site infection (25.5%, n = 42). Thirty-seven of these patients (88%) had an emergency caesarean compared to five (12%) following an elective caesarean section. Of the women with surgical site infections, 69% were overweight and 14% had diabetes. Emergency caesarean sections were responsible for the majority of readmissions, particularly in women with co-morbidities that predisposed them to infection. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Blog and Podcast Watch: Neurologic Emergencies

PubMed Central

Grock, Andrew; Joshi, Nikita; Swaminathan, Anand; Rezaie, Salim; Gaafary, Chris; Lin, Michelle

2016-01-01

Introduction The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of neurologic emergencies from the AIR series. Methods The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Director’s (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. Results A total of 125 blog posts and podcasts were evaluated. Key educational pearls from the 14 AIR posts are summarized, and the 20 honorable mentions are listed. Conclusion The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on neurologic emergencies. PMID:27833680

Blog and Podcast Watch: Neurologic Emergencies.

PubMed

Grock, Andrew; Joshi, Nikita; Swaminathan, Anand; Rezaie, Salim; Gaafary, Chris; Lin, Michelle

2016-11-01

The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of neurologic emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Director's (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. A total of 125 blog posts and podcasts were evaluated. Key educational pearls from the 14 AIR posts are summarized, and the 20 honorable mentions are listed. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on neurologic emergencies.

Blog and Podcast Watch: Orthopedic Emergencies.

PubMed

Grock, Andrew; Rezaie, Salim; Swaminathan, Anand; Min, Alice; Shah, Kaushal H; Lin, Michelle

2017-04-01

The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of orthopedic emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. A total of 87 blog posts and podcasts were evaluated. Key educational pearls from the three AIR posts and the 14 honorable mentions are summarized. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on orthopedic emergencies.

Blog and Podcast Watch: Orthopedic Emergencies

PubMed Central

Grock, Andrew; Rezaie, Salim; Swaminathan, Anand; Min, Alice; Shah, Kaushal H.; Lin, Michelle

2017-01-01

Introduction The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of orthopedic emergencies from the AIR series. Methods The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. Results A total of 87 blog posts and podcasts were evaluated. Key educational pearls from the three AIR posts and the 14 honorable mentions are summarized. Conclusion The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on orthopedic emergencies. PMID:28435507

Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda

PubMed Central

Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

2015-01-01

Background Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Methods and Findings Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Conclusion Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach. PMID:26207986

[Assessment of user embracement with risk rating in emergency hospital services].

PubMed

Versa, Gelena Lucinéia Gomes da Silva; Vituri, Dagmar Wilamowius; Buriola, Aline Aparecida; Carlos Aparecido de Oliveira; Matsuda, Laura Misue

2014-09-01

Cross-sectional and quantitative study, conducted in 2013, aiming to evaluate the implementation of User Embracement with Risk Rating (ACCR) in four Emergency Hospital Services. One hundred fifty six nurses participated and answered the questionnaire"User Embracement with Risk Rating". The data were treated through descriptive and inferential statistics, from the Kruskal-Wallis test. The implementation of ACCR was assessed as precarious, mainly due to the lack of referral of low complexity cases to the basic health system, the inadequate physical space for companions and the lack of discussion and periodic assessment of the flow of care in ACCR. The dimension Result of Implementation obtained a slightly higher score and Structure was the dimension with the lowest score. It was concluded that the negative assessments by nursing professionals of the referred dimensions in the investigated sites suggests the need for improvements, especially in the dimension Structure.

Natural Areas Analysis and Evaluation: Oak Ridge Reservation

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

Baranski, Micahel J

EXECUTIVE SUMMARY The Oak Ridge Reservation, encompassing 33,639 acres in the Valley and Ridge Physiographic Province of East Tennessee, has long been known for its unfragmented forests and high biodiversity. Many areas on the Reservation have been recognized as important natural areas, but no comprehensive treatment has been performed to evaluate the relative significance and importance of these areas compared to each other. The present study was conducted to develop a set of guidelines for evaluating the natural value of specific areas, to evaluate all the terrestrial areas that are currently delineated, and to rank all areas according to theirmore » relative biodiversity importance. All available data, reports and site-specific information relevant to Reservation lands, including Tennessee Division of Natural Areas database information, were evaluated and field work was conducted. Methodologies and criteria for assessment and evaluation of areas were developed; categories of criteria were devised; and a ranking system for evaluation of natural areas was produced. There were 70 areas evaluated during the study. The system is flexible, dynamic and easily revised to reflect updated and new information and interpretations. Eight categories of evaluation factors were established and used to characterize each site. These were the following: size of area, number or status taxa present, number of Endangered and Threatened taxa present, rarity of the Endangered and Threatened taxa on the Reservation, community diversity, site integrity and quality, disturbance and threat levels, and other significant features and factors. Each category generally consisted of a 5-point ranking scale from 0-4, allowing for a possible composite score of 32, with higher ranked, more important, sites attaining higher scores. Highly ranked sites are representative of regional natural diversity; contain outstanding natural features, communities or geology and/or very rare taxa or other elements; are relatively large in size with mature or old-growth community composition; lack current disturbance factors or potential threats and disturbances; are in excellent condition with good buffers; are places where ecological and evolutionary processes can occur relatively unaffected by humans; and can be reasonably defended and maintained as natural areas in an undeveloped condition. Highly ranked sites are the most significant and should receive the greatest protections. Composite scores of the ranked areas ranged from 1-25.5, with a mean score of 12. The ranked areas were divided into three Priority Groups. Group I, the most highly ranked group, included 20 sites and covered 5189 acres or 15.4% of Reservation lands; Group II included 31 sites and covered 4108 acres; Group III included 19 sites covering 400 acres of Reservation lands. All sites together comprise 9697 acres or 28.8% of Reservation lands. Six sites emerged as clearly the most significant natural areas on the Reservation. The study developed a number of recommendations that should be implemented in order to enhance and refine the natural areas data for the Reservation. There is a clear need for better and standardized ecological community classification and identification. Several areas are proposed for merger into larger units, and some new areas are proposed for inclusion and recognition in a natural areas system. Various gaps and discrepancies in the existing data are described and should be corrected. Other recommendations are made, including the development of a corollary system that can accommodate aquatic natural areas. The study relied primarily on the synthesis of information from many sources and from limited reconnaissance and direct observation during field work to produce a methodology for assessing natural area importance and assigning priorities for protection. Many instances of incomplete, missing or conflicting information made it difficult to complete thorough analysis. Further review and discussion among natural resources personnel will likely reveal possibilities for refinement and some additional factors that should be included in the evaluation. Despite the limitations, this study, as conducted, illustrates the importance of the Oak Ridge Reservation for protecting the nation s increasingly threatened and declining biodiversity.« less

Blog and Podcast Watch: Cutaneous Emergencies.

PubMed

Grock, Andrew; Morley, Eric J; Roppolo, Lynn; Khadpe, Jay; Ankel, Felix; Lin, Michelle

2017-02-01

The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of cutaneous emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 most accessed sites per the Social Media Index published within the previous 12 months and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an "honorable mention" label, if the editorial board agrees that the post is accurate and educationally valuable. A total of 35 blog posts and podcasts were evaluated. None scored ≥30 points necessary for the AIR label, although four honorable mention posts were identified. Key educational pearls from these honorable mention posts are summarized. This Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on cutaneous emergencies.

Blog and Podcast Watch: Cutaneous Emergencies

PubMed Central

Grock, Andrew; Morley, Eric J.; Roppolo, Lynn; Khadpe, Jay; Ankel, Felix; Lin, Michelle

2017-01-01

Introduction The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of cutaneous emergencies from the AIR series. Methods The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 most accessed sites per the Social Media Index published within the previous 12 months and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an “honorable mention” label, if the editorial board agrees that the post is accurate and educationally valuable. Results A total of 35 blog posts and podcasts were evaluated. None scored ≥30 points necessary for the AIR label, although four honorable mention posts were identified. Key educational pearls from these honorable mention posts are summarized. Conclusion This Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on cutaneous emergencies. PMID:28210366

Court Officers as Certified First Responders Assisting in Homeland Security and Community Emergency Preparedness

DTIC Science & Technology

2005-06-01

Should a disaster or violence strike numerous sites in the City, our 54 officer would possibly be soley (sic) responsible for responding to an...the ability to interact efficiently with other first responders . 59 3. The New York State Courts would have, on site a well trained, dedicated...AS CERTIFIED FIRST RESPONDERS ASSISTING IN HOMELAND SECURITY AND COMMUNITY EMERGENCY PREPAREDNESS by Jewel E. Williams June 2005

Emergency Physicians’ Views of Direct Notification of Laboratory and Radiology Results to Patients Using the Internet: A Multisite Survey

PubMed Central

2015-01-01

Background Patients are increasingly using the Internet to communicate with health care providers and access general and personal health information. Missed test results have been identified as a critical safety issue with studies showing up to 75% of tests for emergency department (ED) patients not being followed-up. One strategy that could reduce the likelihood of important results being missed is for ED patients to have direct access to their test results. This could be achieved electronically using a patient portal tied to the hospital’s electronic medical record or accessed from the relevant laboratory information system. Patients have expressed interest in accessing test results directly, but there have been no reported studies on emergency physicians’ opinions. Objective The aim was to explore emergency physicians’ current practices of test result notification and attitudes to direct patient notification of clinically significant abnormal and normal test results. Methods A cross-sectional survey was self-administered by senior emergency physicians (site A: n=50; site B: n=39) at 2 large public metropolitan teaching hospitals in Australia. Outcome measures included current practices for notification of results (timing, methods, and responsibilities) and concerns with direct notification. Results The response rate was 69% (61/89). More than half of the emergency physicians (54%, 33/61) were uncomfortable with patients receiving direct notification of abnormal test results. A similar proportion (57%, 35/61) was comfortable with direct notification of normal test results. Physicians were more likely to agree with direct notification of normal test results if they believed it would reduce their workload (OR 5.72, 95% CI 1.14-39.76). Main concerns were that patients could be anxious (85%, 52/61), confused (92%, 56/61), and lacking in the necessary expertise to interpret their results (90%, 55/61). Conclusions Although patients’ direct access to test results could serve as a safety net reducing the likelihood of abnormal results being missed, emergency physicians’ concerns need further exploration: which results are suitable and the timing and method of direct release to patients. Methods of access, including secure Web-based patient portals with drill-down facilities providing test descriptions and result interpretations, or laboratories sending results directly to patients, need evaluation to ensure patient safety is not compromised and the processes fit with ED clinician and laboratory work practices and patient needs. PMID:25739322

Emergency physicians' views of direct notification of laboratory and radiology results to patients using the Internet: a multisite survey.

PubMed

Callen, Joanne; Giardina, Traber Davis; Singh, Hardeep; Li, Ling; Paoloni, Richard; Georgiou, Andrew; Runciman, William B; Westbrook, Johanna I

2015-03-04

Patients are increasingly using the Internet to communicate with health care providers and access general and personal health information. Missed test results have been identified as a critical safety issue with studies showing up to 75% of tests for emergency department (ED) patients not being followed-up. One strategy that could reduce the likelihood of important results being missed is for ED patients to have direct access to their test results. This could be achieved electronically using a patient portal tied to the hospital's electronic medical record or accessed from the relevant laboratory information system. Patients have expressed interest in accessing test results directly, but there have been no reported studies on emergency physicians' opinions. The aim was to explore emergency physicians' current practices of test result notification and attitudes to direct patient notification of clinically significant abnormal and normal test results. A cross-sectional survey was self-administered by senior emergency physicians (site A: n=50; site B: n=39) at 2 large public metropolitan teaching hospitals in Australia. Outcome measures included current practices for notification of results (timing, methods, and responsibilities) and concerns with direct notification. The response rate was 69% (61/89). More than half of the emergency physicians (54%, 33/61) were uncomfortable with patients receiving direct notification of abnormal test results. A similar proportion (57%, 35/61) was comfortable with direct notification of normal test results. Physicians were more likely to agree with direct notification of normal test results if they believed it would reduce their workload (OR 5.72, 95% CI 1.14-39.76). Main concerns were that patients could be anxious (85%, 52/61), confused (92%, 56/61), and lacking in the necessary expertise to interpret their results (90%, 55/61). Although patients' direct access to test results could serve as a safety net reducing the likelihood of abnormal results being missed, emergency physicians' concerns need further exploration: which results are suitable and the timing and method of direct release to patients. Methods of access, including secure Web-based patient portals with drill-down facilities providing test descriptions and result interpretations, or laboratories sending results directly to patients, need evaluation to ensure patient safety is not compromised and the processes fit with ED clinician and laboratory work practices and patient needs.

75 FR 68614 - Agency Information Collection Activities: Submission for OMB Review; Comment Request, OMB No...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-08

... preparedness. The NETC site has facilities and housing available for those participating in emergency... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID: FEMA-2010-0043...: Federal Emergency Management Agency, DHS. ACTION: Notice; 30-day notice and request for comments; revision...

Transportation of Hazardous Materials Emergency Preparedness Hazards Assessment

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

Blanchard, A.

This report documents the Emergency Preparedness Hazards Assessment (EPHA) for the Transportation of Hazardous Materials (THM) at the Department of Energy (DOE) Savannah River Site (SRS). This hazards assessment is intended to identify and analyze those transportation hazards significant enough to warrant consideration in the SRS Emergency Management Program.

The Patient-Centered Medical Home (PCMH) Framing Typology for Understanding the Structure, Function, and Outcomes of PCMHs.

PubMed

Kieber-Emmons, Autumn M; Miller, William L

2017-01-01

Patient-centered medical homes (PCHMs) aspire to transform today's challenged primary care services. However, it is unclear which PCMH characteristics produce specific outcomes of interest for care delivery. This study tested a novel typology of PCMH practice transformation, the PCMH framing typology, and evaluated measurable outcomes by each type. Using the Patient-Centered Primary Care Collaborative 2012 to 2013 Annual Review, this secondary analysis of the published PCMH literature extracted data from publications of 59 PCMHs. Each of the 59 sites was categorized as 1 of 4 PCMH types: add-on, renovated, hybrid, or integrated. Six outcome measures (cost reductions, decreased emergency department/hospital utilization, improved quality, improved access, increased preventive services, and improved patient satisfaction) were independently coded for each site. Practices were combined based on type, and mean outcomes scores for each measure were displayed on radar graphs for comparison. While each type showed a characteristic pattern of success, only the integrated type improved in all 6 outcomes. No type achieved high success in all measures. There seem to be 4 types of PCMH, each of which shows a distinctive outcomes profile. Within the PCMH framing typology, direction is emerging for how best to transform primary care to achieve the greatest success. © Copyright 2017 by the American Board of Family Medicine.

First examination of varying health outcomes of the chronically homeless according to Housing First configuration.

PubMed

Whittaker, Elizabeth; Dobbins, Timothy; Swift, Wendy; Flatau, Paul; Burns, Lucinda

2017-06-01

To determine whether two Housing First configurations (scattered site [SS] versus congregated site [CS]) are associated with different health-related outcomes. This ecological study employed a longitudinal, quantitative design to compare the outcomes from 63 individuals (SS: n=37; CS: n=26) in Sydney, Australia, over 12 months. Both configurations showed similar improvements in quality of life and psychological distress. While recent use of substances remained stable across the two configurations over time, a marginally greater increase in the proportion of CS individuals injecting more than weekly was found. For health service utilisation, CS participants had notably higher service utilisation rates for mental health specialists and the emergency department for mental health reasons at follow-up than SS participants. Preliminary evidence of differential injecting and health service utilisation outcomes between configurations emerged within this small-scale study over the 12-month period. Implications for public health: Given the rapid expansion of both SS and CS Housing First configurations across Western countries and the indications from this initial study that outcomes may differ according to configuration, there remains a need for robust evaluative evidence on the efficacy of various supported housing models on long-term individual outcomes. © 2017 Public Health Association of Australia.

Community exposures to chemical incidents: development and evaluation of the first environmental public health surveillance system in europe.

PubMed

Bowen, H J; Palmer, S R; Fielder, H M; Coleman, G; Routledge, P A; Fone, D L

2000-11-01

To describe the frequency, nature and location of acute chemical incidents in Wales, and the morbidity in employees, emergency responders and the general public who were exposed. Active multi-agency community-based surveillance system. Wales, 1993-5. Frequency, nature and location of incidents, populations potentially exposed and with symptoms. Most of the 402 incidents identified were not associated with sites governed by the Control of Industrial Major Accident Hazard Regulations but with smaller industrial sites and commercial premises. About two in every thousand of the estimated 236 000 members of the public considered to be at risk from exposure reported symptoms, which were mainly nausea, headaches, and irritation of the eye, skin and respiratory tract. The most commonly reported chemicals that members of the public were exposed to were smoke toxins, miscellaneous organics, toxic gases and flammable gases. A health authority was reported to be involved in only 34 (8%) of the incidents and in only 3 of the 29 incidents where more than 100 members of the public were exposed. A geographically defined, multi-agency surveillance system can identify high risk locations and types of incidents, together with the chemicals most likely to be involved. Such ongoing surveillance information is essential for appropriate policy making, emergency planning, operational management and training.

76 FR 28425 - Sunshine Act Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-17

..., emergency preparedness, and nuclear materials disposition. During Session I, the Board will receive... reduce risk in the tank farms. The Board will examine the state of emergency preparedness at the Site and...

Piloting a real-time surface water flood nowcasting system for enhancing operational resilience of emergency responders

NASA Astrophysics Data System (ADS)

Yu, Dapeng; Guan, Mingfu; Wilby, Robert; Bruce, Wright; Szegner, Mark

2017-04-01

Emergency services (such as Fire & Rescue, and Ambulance) can face the challenging tasks of having to respond to or operate under extreme and fast changing weather conditions, including surface water flooding. UK-wide, return period based surface water flood risk mapping undertaken by the Environment Agency provides useful information about areas at risks. Although these maps are useful for planning purposes for emergency responders, their utility to operational response during flood emergencies can be limited. A street-level, high resolution, real-time, surface water flood nowcasting system, has been piloted in the City of Leicester, UK to assess emergency response resilience to surface water flooding. Precipitation nowcasting over 7- and 48-hour horizons are obtained from the UK Met Office and used as inputs to the system. A hydro-inundation model is used to simulate urban surface water flood depths/areas at both the city and basin scale, with a 20 m and 3 m spatial resolution respectively, and a 15-minute temporal resolution, 7-hour and 48-hour in advance. Based on this, we evaluate both the direct and indirect impacts of potential surface water flood events on emergency responses, including: (i) identifying vulnerable populations (e.g. care homes and schools) at risk; and (ii) generating novel metrics of accessibility (e.g. travel time from service stations to vulnerable sites; spatial coverage with certain legislative timeframes) in real-time. In doing so, real-time information on potential risks and impacts of emerging flood incidents arising from intense rainfall can be communicated via a dedicated web-based platform to emergency responders thereby improving response times and operational resilience.

Photographic evaluation of the impacts of bottom fishing on benthic epifauna

USGS Publications Warehouse

Collie, J.S.; Escanero, G.A.; Valentine, P.C.

2000-01-01

The gravel sediment habitat on the northern edge of Georges Bank (East coast of North America) is an important nursery area for juvenile fish, and the site of a productive scallop fishery. During two cruises to this area in 1994 we made photographic transects at sites of varying depths that experience varying degrees of disturbance from otter trawling and scallop dredging. Differences between sites were quantified by analyzing videos and still photographs of the sea bottom. Videos were analyzed for sediment types and organism abundance. In the still photos, the percentages of the bottom covered by bushy, plant-like organisms and colonial worm tubes (Filograna implexa) were determined, as was the presence/absence of encrusting bryozoa. Non-colonial organisms were also identified as specifically as possible and sediment type was quantified. Significant differences between disturbed and undisturbed areas were found for the variables measured in the still photos; colonial epifaunal species were conspicuously less abundant at disturbed sites. Results from the videos and still photos were generally consistent although less detail was visible in the videos. Emergent colonial epifauna provide a complex habitat for shrimp, polychaetes, brittle stars and small fish at undisturbed sites. Bottom fishing removes this epifauna, thereby reducing the complexity and species diversity of the benthic community. (C) 2000 International Council for the Exploration of the Sea.

Beyond 'flood hotspots': Modelling emergency service accessibility during flooding in York, UK

NASA Astrophysics Data System (ADS)

Coles, Daniel; Yu, Dapeng; Wilby, Robert L.; Green, Daniel; Herring, Zara

2017-03-01

This paper describes the development of a method that couples flood modelling with network analysis to evaluate the accessibility of city districts by emergency responders during flood events. We integrate numerical modelling of flood inundation with geographical analysis of service areas for the Ambulance Service and the Fire & Rescue Service. The method was demonstrated for two flood events in the City of York, UK to assess the vulnerability of care homes and sheltered accommodation. We determine the feasibility of emergency services gaining access within the statutory 8- and 10-min targets for high-priority, life-threatening incidents 75% of the time, during flood episodes. A hydrodynamic flood inundation model (FloodMap) simulates the 2014 pluvial and 2015 fluvial flood events. Predicted floods (with depth >25 cm and areas >100 m2) were overlain on the road network to identify sites with potentially restricted access. Accessibility of the city to emergency responders during flooding was quantified and mapped using; (i) spatial coverage from individual emergency nodes within the legislated timeframes, and; (ii) response times from individual emergency service nodes to vulnerable care homes and sheltered accommodation under flood and non-flood conditions. Results show that, during the 2015 fluvial flood, the area covered by two of the three Fire & Rescue Service stations reduced by 14% and 39% respectively, while the remaining station needed to increase its coverage by 39%. This amounts to an overall reduction of 6% and 20% for modelled and observed floods respectively. During the 2014 surface water flood, 7 out of 22 care homes (32%) and 15 out of 43 sheltered accommodation nodes (35%) had modelled response times above the 8-min threshold from any Ambulance station. Overall, modelled surface water flooding has a larger spatial footprint than fluvial flood events. Hence, accessibility of emergency services may be impacted differently depending on flood mechanism. Moreover, we expect emergency services to face greater challenges under a changing climate with a growing, more vulnerable population. The methodology developed in this study could be applied to other cities, as well as for scenario-based evaluation of emergency preparedness to support strategic decision making, and in real-time forecasting to guide operational decisions where heavy rainfall lead-time and spatial resolution are sufficient.

Current and future antimicrobial treatment of gonorrhoea - the rapidly evolving Neisseria gonorrhoeae continues to challenge.

PubMed

Unemo, Magnus

2015-08-21

Neisseria gonorrhoeae has developed antimicrobial resistance (AMR) to all drugs previously and currently recommended for empirical monotherapy of gonorrhoea. In vitro resistance, including high-level, to the last option ceftriaxone and sporadic failures to treat pharyngeal gonorrhoea with ceftriaxone have emerged. In response, empirical dual antimicrobial therapy (ceftriaxone 250-1000 mg plus azithromycin 1-2 g) has been introduced in several particularly high-income regions or countries. These treatment regimens appear currently effective and should be considered in all settings where local quality assured AMR data do not support other therapeutic options. However, the dual antimicrobial regimens, implemented in limited geographic regions, will not entirely prevent resistance emergence and, unfortunately, most likely it is only a matter of when, and not if, treatment failures with also these dual antimicrobial regimens will emerge. Accordingly, novel affordable antimicrobials for monotherapy or at least inclusion in new dual treatment regimens, which might need to be considered for all newly developed antimicrobials, are essential. Several of the recently developed antimicrobials deserve increased attention for potential future treatment of gonorrhoea. In vitro activity studies examining collections of geographically, temporally and genetically diverse gonococcal isolates, including multidrug-resistant strains particularly with resistance to ceftriaxone and azithromycin, are important. Furthermore, understanding of effects and biological fitness of current and emerging (in vitro induced/selected and in vivo emerged) genetic resistance mechanisms for these antimicrobials, prediction of resistance emergence, time-kill curve analysis to evaluate antibacterial activity, appropriate mice experiments, and correlates between genetic and phenotypic laboratory parameters, and clinical treatment outcomes, would also be valuable. Subsequently, appropriately designed, randomized controlled clinical trials evaluating efficacy, ideal dose, toxicity, adverse effects, cost, and pharmacokinetic/pharmacodynamics data for anogenital and, importantly, also pharyngeal gonorrhoea, i.e. because treatment failures initially emerge at this anatomical site. Finally, in the future treatment at first health care visit will ideally be individually-tailored, i.e. by novel rapid phenotypic AMR tests and/or genetic point of care AMR tests, including detection of gonococci, which will improve the management and public health control of gonorrhoea and AMR. Nevertheless, now is certainly the right time to readdress the challenges of developing a gonococcal vaccine.

The Utah rural residency study: a blueprint for evaluating potential sites for development of a 4-4-4 family practice residency program in a rural community.

PubMed

Catinella, A Peter; Magill, Michael K; Thiese, Steven M; Turner, Deborah; Elison, Gar T; Baden, Daniel J

2003-01-01

Most graduates of rural residencies enter rural practice. Rural residencies therefore have emerged over the past 2 decades to increase the supply of rural physicians. However, researchers have published few descriptions of strategies to evaluate and select communities in which to locate rural residencies. This report describes the development and application of such a strategy to assess 7 rural communities in Utah as potential sites for family practice residency training. Criteria were developed on the basis of an examination of the literature, residency accreditation requirements, and characteristics of existing rural residency programs. Ten rural or frontier communities with hospitals were selected as study candidates, and 7 agreed to participate. Data were collected through hospital surveys, state hospital discharge records, and community site visits. Specific evaluation criteria that were developed included the presence of a medical practice of the appropriate specialty and size, a sufficient number of medical subspecialty physicians, an adequate number and mix of hospitalized patients, an adequate number of ambulatory patients, adequate outpatient facility space to accommodate learners, and a commitment by the practicing physician and hospital to lead the program and teach residents. Two communities were found to be potentially capable of supporting a residency if physicians and hospital leaders in the communities were to become motivated to lead program development. These criteria may be useful in other states, but they have not been tested for validity or reliability and are subject to limitations such as exclusion of alternate rural residency models. Future research should address data needs and the relationship of the evaluation criteria to the quality of resident learning.

An evaluation of general practice websites in the UK.

PubMed

Howitt, Alistair; Clement, Sarah; de Lusignan, Simon; Thiru, Krish; Goodwin, Daryl; Wells, Sally

2002-10-01

General practice websites are an emerging phenomenon, but there have been few critical evaluations of their content. Previously developed rating instruments to assess medical websites have been criticized for failing to report their reliability and validity. The purpose of this study was to develop a rating instrument for assessing UK general practice websites, and then to evaluate them critically. The STaRNet Website Assessment Tool (SWAT) was developed listing criteria that general practice websites may meet, which was then used to evaluate a random sample of websites drawn from an electronic database. A second assessor rated a subsample of the sites to assess the tool's inter-rater reliability. The setting was an information technology group of a general practice research network using a random sample of 108 websites identified from the database. The main outcome measures were identification of rating criteria and frequency counts from the website rating instrument. Ninety (93.3%) sites were accessible, of which 84 were UK general practice websites. Criteria most frequently met were those describing the scope of the website and their functionality. Apart from e-mail to practices, criteria related to electronic communication were rarely met. Criteria relating to the quality of information were least often met. Inter-rater reliability kappa values for the items in the tool ranged from -0.06 to 1.0 (mean 0.59). Values were >0.6 for 15 out of 25 criteria assessed in 40 sites which were rated by two assessors. General practice websites offer a wide range of information. They are technically satisfactory, but do not exploit fully the potential for electronic doctor-patient communication. The quality of information they provide is poor. The instrument may be developed as a template for general practices producing or revising their own websites.

How can systems engineering inform the methods of programme evaluation in health professions education?

PubMed

Rojas, David; Grierson, Lawrence; Mylopoulos, Maria; Trbovich, Patricia; Bagli, Darius; Brydges, Ryan

2018-04-01

We evaluate programmes in health professions education (HPE) to determine their effectiveness and value. Programme evaluation has evolved from use of reductionist frameworks to those addressing the complex interactions between programme factors. Researchers in HPE have recently suggested a 'holistic programme evaluation' aiming to better describe and understand the implications of 'emergent processes and outcomes'. We propose a programme evaluation framework informed by principles and tools from systems engineering. Systems engineers conceptualise complexity and emergent elements in unique ways that may complement and extend contemporary programme evaluations in HPE. We demonstrate how the abstract decomposition space (ADS), an engineering knowledge elicitation tool, provides the foundation for a systems engineering informed programme evaluation designed to capture both planned and emergent programme elements. We translate the ADS tool to use education-oriented language, and describe how evaluators can use it to create a programme-specific ADS through iterative refinement. We provide a conceptualisation of emergent elements and an equation that evaluators can use to identify the emergent elements in their programme. Using our framework, evaluators can analyse programmes not as isolated units with planned processes and planned outcomes, but as unfolding, complex interactive systems that will exhibit emergent processes and emergent outcomes. Subsequent analysis of these emergent elements will inform the evaluator as they seek to optimise and improve the programme. Our proposed systems engineering informed programme evaluation framework provides principles and tools for analysing the implications of planned and emergent elements, as well as their potential interactions. We acknowledge that our framework is preliminary and will require application and constant refinement. We suggest that our framework will also advance our understanding of the construct of 'emergence' in HPE research. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Refugial forests of the southern Appalachians: photosynthesis and survival in current-year Abies fraseri seedlings.

PubMed

Johnson, Daniel M; Smith, William K

2005-11-01

Fraser fir (Abies fraseri (Pursh) Poiret) is an endemic, high-elevation conifer confined to six relict mountaintop communities in the southern Appalachian Mountains, USA. High adult mortality has occurred over the past 50 years, possibly the result of an introduced insect (Adelges piceae Ratzeburg), air pollution, or both. Knowledge of the mechanisms of and limitations to seedling establishment may allow reestablisment and perpetuation of this unique community type, notwithstanding global climate change. We monitored seedling emergence and mortality in relation to photosynthetic performance and water relations in microsites differing in canopy openness (sunlight exposure) over the summer of 2004. Abundance of cotyledonous seedlings in early summer was 2.3 times greater (849 versus 366 seedlings m(-2)) in microsites with lower sky exposure (greater canopy closure) than in microsites with greater sky exposure (greater canopy openness). In contrast, late-season abundance and survival were greater in areas beneath more open canopies than in areas beneath less open canopies (3.3 times and 11.7 times greater, respectively). However, newly emerged seedling survival in a completely open site (no overhead canopy) was zero, despite an initial density of 124 seedlings m(-2). Seedling water status was similar in open- and closed-canopy sites (-0.52 and -0.74 MPa, respectively). Photosynthetic carbon gain was higher in newly emerged seedlings at open canopy than at closed canopy sites, especially during early morning. Based on photosynthetic light response curves and measured sunlight regimes, seedlings in open canopy sites were estimated to assimilate 3.3-4.5 times more carbon than seedlings at closed sites. Reductions in carbon gain of closed-site seedlings, primarily a result of limited sunlight, corresponded to substantial increases in seedling mortality (98 versus 79% in open canopy sites). Thus, sunlight exposure, which reflects overstory canopy structure, appears to be an important factor influencing newly emerged seedling survival and distribution.

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.

A microcomputer based traffic evacuation modeling system for emergency planning application

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

Rathi, A.K.

1995-12-31

The US Army stockpiles unitary chemical weapons, both as bulk chemicals and as munitions, at eight major sites in the United States. The continued storage and disposal of the chemical stockpile has the potential for accidental releases of toxic gases that could escape the installation boundaries and pose a threat to the civilian population in the vicinity. Vehicular evacuation is one of the major and often preferred protective action options available for emergency management in a real or anticipated disaster. Computer simulation models of evacuation traffic flow are used to estimate the time required for the affected populations to evacuatemore » to safer areas, to evaluate effectiveness of vehicular evacuations as a protective action option, and to develop comprehensive evacuation plans when required. Following a review of the past efforts to simulate traffic flow during emergency evacuations, an overview of the key features in Version 2.0 of the Oak Ridge Evacuation Modeling System (OREMS) are presented in this paper. OREMS is a microcomputer-based model developed to simulate traffic flow during regional emergency evacuations. OREMS integrates a state-of-the-art dynamic traffic flow and simulation model with advanced data editing and output display programs operating under a MS-Windows environment.« less

Epidemiology of fishing related upper extremity injuries presenting to the emergency department in the United States.

PubMed

Gil, Joseph A; Elia, Gregory; Shah, Kalpit N; Owens, Brett D; Got, Christopher

2018-04-16

Fishing injuries commonly affect the hands. The goal of this study was to quantify the incidence of fishing-related upper extremity injuries that present to emergency departments in the United States. We examined the reported cases of fishing-related upper extremity injuries in the National Electronic Injury Surveillance System database. Analysis was performed based on age, sex and the type of injury reported. The national incidence of fishing-related upper extremity injuries was 119.6 per 1 million person-years in 2014. The most common anatomic site for injury was the finger (63.3%), followed by the hand (20.3%). The most common type of injury in the upper extremity was the presence of a foreign body (70.4%). The incidence of fishing-related upper extremity injuries in males was 200 per 1 million person-years, which was significantly higher than the incidence in females (41 per 1 million person-years). The incidence of fishing-related upper extremity injuries that present to the Emergency Department was 120 per 1 million person-years. The incidence was significantly higher in males. With the widespread popularity of the activity, it is important for Emergency Physicians and Hand Surgeons to understand how to properly evaluate and manage these injuries.

Seismic hazard study for selected sites in New Mexico and Nevada

NASA Astrophysics Data System (ADS)

Johnston, J. C.

1983-12-01

Seismic hazard evaluations were conducted for specific sites in New Mexico and Nevada. For New Mexico, a model of seismicity was developed from historical accounts of medium to large shocks and the current microactivity record from local networks. Ninety percent confidence levels at Albuquerque and Roswell were computed to be 56 gals for a 10-year period and 77 gals for a 20-year period. Values of ground motion for Clovis were below these values. Peak velocity and displacement were also computed for each site. Deterministic spectra based on the estimated maximum credible earthquake for the zones which the sites occupy were also computed. For the sites in Nevada, the regionalizations used in Battis (1982) for the uniform seismicity model were slightly modified. For 10- and 20-year time periods, peak acceleration values for Indian Springs were computed to be 94 gals and 123 gals and for Hawthorne 206 gals and 268 gals. Deterministic spectra were also computed. The input parameters were well determined for the analysis for the Nevada sites because of the abundance of data. The values computed for New Mexico, however, are likely upper limits. As more data are collected from the area of the Rio Grande rift zone, the pattern of seismicity will become better understood. At this time a more detailed, and thus more accurate, model may emerge.

Anti-mycobacterium tuberculosis activity of polyherbal medicines used for the treatment of tuberculosis in Eastern Cape, South Africa.

PubMed

Famewo, Elizabeth B; Clarke, Anna M; Wiid, Ian; Ngwane, Andile; van Helden, Paul; Afolayan, Anthony J

2017-09-01

The emergence of drug-resistant strains of Mycobacterium tuberculosis has become a global public health problem. Polyherbal medicines offer great hope for developing alternative drugs for the treatment of tuberculosis. To evaluate the anti-tubercular activity of polyherbal medicines used for the treatment of tuberculosis. The remedies were screened against Mycobacterium tuberculosis H37Rv using Middlebrook 7H9 media and MGIT BACTEC 960 system. They were liquid preparations from King Williams Town site A (KWTa), King Williams Town site B (KWTb), King Williams Town site C (KWTc), Hogsback first site (HBfs), Hogsback second site (HBss), Hogsback third site (HBts), East London (EL), Alice (AL) and Fort Beaufort (FB). The susceptibility testing revealed that all the remedies contain anti-tubercular activity with KWTa, KWTb, KWTc, HBfs, HBts, AL and FB exhibiting more activity at a concentration below 25 µl/ml. Furthermore, MIC values exhibited inhibitory activity with the most active remedies from KWTa, HBfs and HBts at 1.562 µg/ml. However, isoniazid showed more inhibitory activity against M. tuberculosis at 0.05 µg/ml when compare to the polyherbal remedies. This study has indicated that these remedies could be potential sources of new anti-mycobacterial agents against M. tuberculosis . However, the activity of these preparations and their active principles still require in vivo study in order to assess their future as new anti-tuberculosis agents.

The Implementation and Evaluation of the Patient Admission Prediction Tool: Assessing Its Impact on Decision-Making Strategies and Patient Flow Outcomes in 2 Australian Hospitals.

PubMed

Crilly, Julia L; Boyle, Justin; Jessup, Melanie; Wallis, Marianne; Lind, James; Green, David; FitzGerald, Gerry

2015-01-01

To evaluate the implementation of a Patient Admission Prediction Tool (PAPT) in terms of patient flow outcomes and decision-making strategies. The PAPT was implemented in 2 Australian public teaching hospitals during October-December 2010 (hospital A) and October-December 2011 (hospital B). A multisite prospective, comparative (before and after) design was used. Patient flow outcomes measured included access block and hospital occupancy. Daily and weekly data were collected from patient flow reports and routinely collected emergency department information by the site champion and researchers. Daily decision-making strategies ranged from business as usual to use of overcensus beds. Weekly strategies included advanced approval to use of overcensus beds and prebooking nursing staff. These strategies resulted in improved weekend discharges to manage incoming demand for the following week. Following the introduction of the PAPT and workflow guidelines, patient access and hospital occupancy levels could be maintained despite increases in patient presentations (hospital A). The use of a PAPT, embedded in patient flow management processes and championed by a manager, can benefit bed and staff management. Further research that incorporates wider evaluation of the use of the tool at other sites is warranted.

44 CFR 16.110 - Self-evaluation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Self-evaluation. 16.110 Section 16.110 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... ACTIVITIES CONDUCTED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY § 16.110 Self-evaluation. (a) The agency...

Radio Interoperability: Addressing the Real Reasons We Don’t Communicate Well During Emergencies

DTIC Science & Technology

2006-03-01

remoteness or traffic load on the network , and dead batteries. Public safety first responders experience many of the same things as they use their radio...provider may hold thousands of frequency licenses nationwide, but deploys only a handful at each tower site . The limitation of the phone network to handle...support players off- site (still responding , or at alternate locations, such as Emergency Operations Centers). 9. Listening to recordings after an

Facts about Infectious Diseases (ID)

MedlinePlus

... of microorganisms will emerge. Infectious Diseases Society of America 1300 Wilson Boulevard Suite 300 Arlington, VA 22209 | ... Us © Copyright IDSA 2018 Infectious Diseases Society of America Full Site Mobile Site

76 FR 17427 - Notice of Submission of Proposed Information Collection to OMB; Emergency Comment Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-29

... (HPRP) grantees, as well as the site visit interview guide that will serve as the protocol for 15-18... site visit interview guide that will serve as the protocol for 15-18 site visits to be conducted to...

International distance-learning outreach: the APEC EINet experience.

PubMed

Kimball, A M; Shih, L; Brown, J; Harris, T G; Pautler, N; Jamieson, R W; Bolles, J; Horwitch, C

2003-01-01

The Emerging Infections Network is a mature electronic network that links Public Health professionals in the Asia Pacific through regular e-mail bulletins and an extensive Web site (http://www.apec.org/infectious). Emerging infections is a new area of study; learning materials help foster education. Our objective is to quantify the response of the network to the introduction of distance-learning materials on the Web site. Distance-learning materials, developed by the University of Washington School of Public Health, were field tested and launched on the site. Publicity was carried out prior to the launch of the materials. Access was tracked prospectively using server counts of page downloads. Web access increased substantially during the month after the materials were launched, especially among Asia based computers. The effect was isolated to the distance-learning pages, and not general to the site. This Web site appears to be responsive to the advertisement and to the materials. Prospective Web-site monitoring proved useful. Copyright 2002 Elsevier Science Ireland Ltd.

Emergency Preparedness and Response Requirements

EPA Pesticide Factsheets

To reduce exposure risks to people who may be near a buffer zone, soil fumigant pesticide applicators are required to either provide on-site monitoring of the perimeter, or provide emergency response information directly to neighbors.

Emergency Response Alternatives

EPA Pesticide Factsheets

Based on the National Contingency Plan, EPA defines the following types: classic emergencies, requiring on-site activities within minutes/hours; time-critical actions, which must occur within 6 months; and non-time-critical actions, which can take longer.

ED services: the impact of caring behaviors on patient loyalty.

PubMed

Liu, Sandra S; Franz, David; Allen, Monette; Chang, En-Chung; Janowiak, Dana; Mayne, Patricia; White, Ruth

2010-09-01

This article describes an observational study of caring behaviors in the emergency departments of 4 Ascension Health hospitals and the impact of these behaviors on patient loyalty to the associated hospital. These hospitals were diverse in size and geography, representing 3 large urban community hospitals in metropolitan areas and 1 in a midsized city. Research assistants from Purdue University (West Lafayette, IN) conducted observations at the first study site and validated survey instruments. The Purdue research assistants trained contracted observers at the subsequent study sites. The research assistants conducted observational studies of caregivers in the emergency departments at 4 study sites using convenience sampling of patients. Caring behaviors were rated from 0 (did not occur) to 5 (high intensity). The observation included additional information, for example, caregiver roles, timing, and type of visit. Observed and unobserved patients completed exit surveys that recorded patient responses to the likelihood-to-recommend (loyalty) questions, patient perceptions of care, and demographic information. Common themes across all study sites emerged, including (1) the area that patients considered most important to an ED experience (prompt attention to their needs upon arrival to the emergency department); (2) the area that patients rated as least positive in their actual ED experience (prompt attention to their needs upon arrival to the emergency department); (3) caring behaviors that significantly affected patient loyalty (eg, making sure that the patient is aware of care-related details, working with a caring touch, and making the treatment procedure clearly understood by the patient); and (4) the impact of wait time to see a caregiver on patient loyalty. A number of correlations between caring behaviors and patient loyalty were statistically significant (P < .05) at all sites. The study results raised considerations for ED caregivers, particularly with regard to those caring behaviors that are most closely linked to patient loyalty but that occurred least frequently. The study showed through factor analysis that some caring behaviors tended to occur together, suggesting an underlying, unifying dimension to that factor. Copyright © 2010 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Simulation Technology Laboratory Building 970 hazards assessment document

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

Wood, C.L.; Starr, M.D.

1994-11-01

The Department of Energy Order 5500.3A requires facility-specific hazards assessments be prepared, maintained, and used for emergency planning purposes. This hazards assessment document describes the chemical and radiological hazards associated with the Simulation Technology Laboratory, Building 970. The entire inventory was screened according to the potential airborne impact to onsite and offsite individuals. The air dispersion model, ALOHA, estimated pollutant concentrations downwind from the source of a release, taking into consideration the toxicological and physical characteristics of the release site, the atmospheric conditions, and the circumstances of the release. The greatest distances at which a postulated facility event will producemore » consequences exceeding the ERPG-2 and Early Severe Health Effects thresholds are 78 and 46 meters, respectively. The highest emergency classification is a Site Area Emergency. The Emergency Planning Zone is 100 meters.« less

High Resolution Tsunami Modelling for the Evaluation of Potential Risk Areas in Setubal

NASA Astrophysics Data System (ADS)

Ribeiro, João.; Silva, Adélio; Leitão, Paulo

2010-05-01

Modeling has a relevant role in today's natural hazards mitigation planning as it can cover a wide range of natural phenomena. This is also the case for an event like a tsunami. In order to support the urban planning or prepare emergency response plans it is of major importance to be able to properly evaluate the vulnerability associated with different areas and/or equipments. The use of high resolution models can provide relevant information about the most probable inundation areas which complemented with other data such as the type of buildings, location of prioritary equipments, etc., may effectively contribute to better identify the most vulnerable zones, define rescue and escape routes and adequate the emergency plans to the constraints associated to these type of events. In the framework of FP6 SCHEMA project these concepts are being applied to different test sites and a detailed evaluation of the vulnerability of buildings and people to a tsunami event is being evaluated. One of the sites selected it is located in Portugal, in the Atlantic coast, and it refers to Setúbal area which is located about 40 km south of Lisbon. Within this site two specific locations are being evaluated: one is the city of Setúbal (in the Sado estuary right margin) and the other is the Tróia peninsula (in the Sado estuary left margin). Setúbal city is a medium size town with about 114,000 inhabitants while Tróia is a touristic resort located in a shallow area with a high seasonal occupation and has the river Sado as one of the main sources of income to the city. Setúbal was one of the Portuguese villages that was seriously damaged by the of 1755 earthquake event. The 1755 earthquake, also known as the Great Lisbon Earthquake, took place on 1 November 1755, the catholic holiday of All Saints, around 09:30 AM. The earthquake was followed by a tsunami and fires which caused a huge destruction of Lisboa and Setúbal In the framework of the present study, a detailed evaluation of the site vulnerability to a tsunami event based on the consideration of the wave heights, buildings type and access routes characteristics was performed. The wave height and most probable inundation areas was made on the basis of the simulation of three earthquake potential sources with different level of impact (extreme, moderate and weak) in the Setúbal area. In the case of the extreme event the selected source for simulation corresponds to an interpretation of the origins of the 1755 earthquake proposed by Baptista et al (2003).In this study it is suggest that the 1755 tsunami event had two sources: one located in the Marques de Pombal thrust (MPTF) and a second one located in the Guadalquivir Bank. The other two sources are based on a study done by Omira et al (2009) regarding the design of a Sea-level Tsunami Detection Network for the Gulf of Cadiz. In the framework of this study there are analyzed different areas of seismic activity in the South of Portugal and proposed some possible earthquake sources and characteristics. The tsunami propagation simulations were performed using MOHID modelling system which is an open source three-dimensional water modelling system, developed by Hidromod and MARETEC (Marine and Environmental Technology Research Center - Technical University of Lisbon). As a result of the study detailed inundation maps associated to the different events and to different tide levels were produced. As a result of the combination of these maps with the available information of the city infrastructures (building types, roads and streets characteristics, prioritary buildings, etc.) there were also produced high scale vulnerability maps, escape routes, emergency routes maps.

An automated approach to mapping ecological sites using hyper-temporal remote sensing and SVM classification

USDA-ARS?s Scientific Manuscript database

The development of ecological sites as management units has emerged as a highly effective land management framework, but its utility has been limited by spatial ambiguity of ecological site locations in the U.S., lack of ecological site concepts in many other parts of the world, and the inability to...

10 CFR Appendix E to Part 50 - Emergency Planning and Preparedness for Production and Utilization Facilities

Code of Federal Regulations, 2013 CFR

2013-01-01

... organization shall be described. The communication steps to be taken to alert or activate emergency personnel... operations facility must include the following: (1) Space for members of an NRC site team and Federal, State, and local responders; (2) Additional space for conducting briefings with emergency response personnel...

10 CFR Appendix E to Part 50 - Emergency Planning and Preparedness for Production and Utilization Facilities

Code of Federal Regulations, 2014 CFR

2014-01-01

... organization shall be described. The communication steps to be taken to alert or activate emergency personnel... operations facility must include the following: (1) Space for members of an NRC site team and Federal, State, and local responders; (2) Additional space for conducting briefings with emergency response personnel...

10 CFR Appendix E to Part 50 - Emergency Planning and Preparedness for Production and Utilization Facilities

Code of Federal Regulations, 2012 CFR

2012-01-01

... organization shall be described. The communication steps to be taken to alert or activate emergency personnel... operations facility must include the following: (1) Space for members of an NRC site team and Federal, State, and local responders; (2) Additional space for conducting briefings with emergency response personnel...

Usefulness of Cone-Beam Computed Tomography and Automatic Vessel Detection Software in Emergency Transarterial Embolization.

PubMed

Carrafiello, Gianpaolo; Ierardi, Anna Maria; Duka, Ejona; Radaelli, Alessandro; Floridi, Chiara; Bacuzzi, Alessandro; de Bucourt, Maximilian; De Marchi, Giuseppe

2016-04-01

This study was designed to evaluate the utility of dual phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software to guide transarterial embolization (TAE) of angiographically challenging arterial bleedings in emergency settings. Twenty patients with an arterial bleeding at computed tomography angiography and an inconclusive identification of the bleeding vessel at the initial 2D angiographic series were included. Accuracy of DP-CBCT and AVD software were defined as the ability to detect the bleeding site and the culprit arterial bleeder, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software. Clinical success was defined as the successful embolization. Total volume of iodinated contrast medium and overall procedure time were registered. The bleeding site was not detected by initial angiogram in 20% of cases, while impossibility to identify the bleeding vessel was the reason for inclusion in the remaining cases. The bleeding site was detected by DP-CBCT in 19 of 20 (95%) patients; in one case CBCT-CT fusion was required. AVD software identified the culprit arterial branch in 18 of 20 (90%) cases. In two cases, vessel tracking required manual marking of the candidate arterial bleeder. Technical success was 95%. Successful embolization was achieved in all patients. Mean contrast volume injected for each patient was 77.5 ml, and mean overall procedural time was 50 min. C-arm CBCT and AVD software during TAE of angiographically challenging arterial bleedings is feasible and may facilitate successful embolization. Staff training in CBCT imaging and software manipulation is necessary.

Preparing public health nurses for pandemic influenza through distance learning.

PubMed

Macario, Everly; Benton, Lisa D; Yuen, Janet; Torres, Mara; Macias-Reynolds, Violet; Holsclaw, Patricia; Nakahara, Natalie; Jones, Marcy Connell

2007-01-01

As a global influenza pandemic appears imminent with the spread of avian influenza, the California Department of Health Services (CDHS) and the California Distance Learning Health Network (CDLHN) presented a live 90-min satellite broadcast and subsequent 2-hr small group problem-solving tabletop exercise to practice interventions needed to minimize the consequences of a pandemic event. Public health nurses (PHNs), managers, and other staff in laboratories, clinical care, veterinary medicine, environmental health, public information and safety, emergency management, and transportation down linked the program, broadcast by satellite from the CDHS Richmond Laboratory Campus, to view on-site locally. PHNs represented the professional category with the highest number of participants for those conducting the program outside of California. For those in California, PHNs represented the professional category with the second highest number of participants. Participants and distance-learning facilitators completed a training evaluation survey. Continuing education credits were provided by the Centers for Disease Control and Prevention to participants who completed the satellite broadcast evaluation. This distance-learning-by-satellite method of education paired with an activities-based tabletop exercise, and a focus on local rather than State-based responsibility, marks an innovative method of training PHNs and other staff in emergency preparedness response.

A Profile of Indian Health Service Emergency Departments.

PubMed

Bernard, Kenneth; Hasegawa, Kohei; Sullivan, Ashley; Camargo, Carlos

2017-06-01

The Indian Health Service provides health care to eligible American Indians and Alaskan Natives. No published data exist on emergency services offered by this unique health care system. We seek to determine the characteristics and capabilities of Indian Health Service emergency departments (EDs). All Indian Health Service EDs were surveyed about demographics and operational characteristics for 2014 with the National Emergency Department Inventory survey (available at http://www.emnet-nedi.org/). Of the forty eligible sites, there were 34 respondents (85% response rate). Respondents reported a total of 637,523 ED encounters, ranging from 521 to 63,200 visits per site. Overall, 85% (95% confidence interval 70% to 94%) had continuous physician coverage. Of all physicians staffing the ED, a median of 13% (interquartile range 0% to 50%) were board certified or board prepared in emergency medicine. Overall, 50% (95% confidence interval 34% to 66%) of respondents reported that their ED was operating over capacity. Indian Health Service EDs varied widely in visit volume, with many operating over capacity. Most were not staffed by board-certified or -prepared emergency physicians. Most lacked access to specialty consultation and telemedicine capabilities. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Characterization of injuries during hardcourt bike polo participation: a descriptive survey.

PubMed

Noh, Maureen Y; Laker, Scott R; Vincent, Heather K

2011-06-01

To describe injury rates and patterns in the emerging sport of hardcourt bike polo (HBP). Descriptive survey. HBP playing areas (urban flat concrete surfaces). Twenty-two adult (≥18 years) HBP players who presented to a routine thrice-weekly playing site completed the survey. Participants completed a survey that was used to evaluate demographics; frequency of play; rate, localization, and severity of injuries sustained in the past 1 year; and use of medical care. The incidence of sustaining an injury in 1 year was 0.86. The main sites of injury involved the knee, elbow, wrist, and hand. Medical attention was sought by 15% of the injured players. HBP is a rapidly evolving urban sport in which participants are at risk for trauma-related injury, some of which may be preventable by the addition of appropriate safety equipment. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Online Assessment, Measurement and Evaluation: Emerging Practices

ERIC Educational Resources Information Center

Williams, David, Ed.; Hricko, Mary, Ed.; Howell, Scott, Ed.

2006-01-01

"Online Assessment, Measurement and Evaluation: Emerging Practices" provides a view of the possibilities and challenges facing online educators and evaluators in the 21st Century. As technology evolves and online measurement and assessment follow, "Online Assessment, Measurement and Evaluation: Emerging Practices" uses…

Rural Organization of Australian Stroke Teams: Emergency Department project.

PubMed

Wright, A; McGrail, M; Disler, P

2008-08-01

Many junior doctors have poor stroke assessment skills. Although major efforts have gone in to changing the attitudes of clinicians to stroke through the development of guidelines and implementation strategies, the most important step may be to make sure that medical schools include appropriate teaching of this important topic in their curricula. The Rural Organization of Australian Stroke Teams Emergency Department (ROASTED) project sought to determine the effectiveness of a practical intervention to improve the assessment and education of stroke knowledge among our junior emergency department doctors. We used a prospective before and after study of two separate cohorts (intervention vs no intervention) to assess the stroke knowledge of our junior emergency department doctors and to test the effectiveness of an educational intervention. The project took place at five sites in rural Victoria in November 2006. Both cohorts undertook the same two validated quizzes 1 month apart. At the intervention sites two 1-h tutorials were conducted between the quizzes and participants were encouraged to use a web-based educational tool. Pre-project stroke knowledge was shown to be poor at all of the participating sites. At the sites where no intervention took place no improvement in knowledge was shown (z = 0.83, P = 0.41, two-sided Mann-Whitney U-test). The median score for quiz 1 was 8.1 (41%, interquartile range (IQR) 6.5-9.4) and for quiz 2, 7.2 (36%, IQR 5.1-9.3). At the intervention sites, participants significantly improved their stroke knowledge between quiz 1 and quiz 2 (z = 4.75, P < 0.001). The median score for quiz 1 in this cohort was 8.3 (42%, IQR 6.5-10.0) and for quiz 2, 12.8 (64%, IQR 12.0-14.8). This project showed that junior doctors have an inadequate knowledge of stroke and that among our junior emergency department doctors there is a need for the ROASTED intervention and other innovative educational measures.

Toward Identifying the Next Generation of Superfund and Hazardous Waste Site Contaminants

PubMed Central

Ela, Wendell P.; Sedlak, David L.; Barlaz, Morton A.; Henry, Heather F.; Muir, Derek C.G.; Swackhamer, Deborah L.; Weber, Eric J.; Arnold, Robert G.; Ferguson, P. Lee; Field, Jennifer A.; Furlong, Edward T.; Giesy, John P.; Halden, Rolf U.; Henry, Tala; Hites, Ronald A.; Hornbuckle, Keri C.; Howard, Philip H.; Luthy, Richard G.; Meyer, Anita K.; Sáez, A. Eduardo; vom Saal, Frederick S.; Vulpe, Chris D.; Wiesner, Mark R.

2011-01-01

Background This commentary evolved from a workshop sponsored by the National Institute of Environmental Health Sciences titled “Superfund Contaminants: The Next Generation” held in Tucson, Arizona, in August 2009. All the authors were workshop participants. Objectives Our aim was to initiate a dynamic, adaptable process for identifying contaminants of emerging concern (CECs) that are likely to be found in future hazardous waste sites, and to identify the gaps in primary research that cause uncertainty in determining future hazardous waste site contaminants. Discussion Superfund-relevant CECs can be characterized by specific attributes: They are persistent, bioaccumulative, toxic, occur in large quantities, and have localized accumulation with a likelihood of exposure. Although still under development and incompletely applied, methods to quantify these attributes can assist in winnowing down the list of candidates from the universe of potential CECs. Unfortunately, significant research gaps exist in detection and quantification, environmental fate and transport, health and risk assessment, and site exploration and remediation for CECs. Addressing these gaps is prerequisite to a preventive approach to generating and managing hazardous waste sites. Conclusions A need exists for a carefully considered and orchestrated expansion of programmatic and research efforts to identify, evaluate, and manage CECs of hazardous waste site relevance, including developing an evolving list of priority CECs, intensifying the identification and monitoring of likely sites of present or future accumulation of CECs, and implementing efforts that focus on a holistic approach to prevention. PMID:21205582

Global emergency medicine journal club: social media responses to the January 2014 online emergency medicine journal club on subarachnoid hemorrhage.

PubMed

Chan, Teresa M; Rosenberg, Hans; Lin, Michelle

2014-07-01

From January 20 to 24, 2014, Annals continued a successful collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host another Global Emergency Medicine Journal Club session featuring the 2013 Journal of the American Medical Association article "Clinical Decision Rules to Rule Out Subarachnoid Hemorrhage for Acute Headache" by Perry et al. This online journal club used the power of rapid Twitter conversations, a live videocast with the authors, and more detailed discussions hosted on the ALiEM Web site's comment section. There were more than 1,431 individuals from 501 cities in 59 countries who viewed the blog post. During this 5-day event, 28 comments (average word count 153 words) and 206 tweets were made. This summary article details the community discussion, shared insights, and analytic data generated during this novel, multiplatform approach. Copyright © 2014 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Social media responses to the Annals of Emergency Medicine residents' perspective article on multiple mini-interviews.

PubMed

Joshi, Nikita K; Yarris, Lalena M; Doty, Christopher I; Lin, Michelle

2014-09-01

In May 2014, Annals of Emergency Medicine continued a successful collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM) to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Does the Multiple Mini-Interview Address Stakeholder Needs? An Applicant's Perspective" by Phillips and Garmel. This dialogue included Twitter conversations, a live videocast with the authors and other experts, and detailed discussions on the ALiEM Web site's comment section. This summary article serves the dual purpose of reporting the qualitative thematic analysis from a global online discussion and the Web analytics for our novel multimodal approach. Social media technologies provide a unique opportunity to engage with a diverse audience to detect existing and new emerging themes. Such technologies allow rapid hypothesis generation for future research and enable more accelerated knowledge translation. Copyright © 2014 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

SITE - EMERGING TECHNOLOGY: REMOVAL AND RECOVERY OF METAL IONS FROM GROUNDWATER - APPENDICES

EPA Science Inventory

A series of laboratory tests and an on-site pilot scale demonstration of Bio-Recovery Systems' AlgaSORB technology for the removal and recovery of mercury-contaminated groundwater were conducted under the SITE program. ptimum conditions were determined for mercury binding to Alga...

Biomechanics of Atherosclerotic Coronary Plaque: Site, Stability and In Vivo Elasticity Modeling

PubMed Central

Ohayon, Jacques; Finet, Gérard; Le Floc’h, Simon; Cloutier, Guy; Gharib, Ahmed M.; Heroux, Julie; Pettigrew, Roderic I.

2016-01-01

Coronary atheroma develop in local sites that are widely variable among patients and are considerably variable in their vulnerability for rupture. This article summarizes studies conducted by our collaborative laboratories on predictive biomechanical modeling of coronary plaques. It aims to give insights into the role of biomechanics in the development and localization of atherosclerosis, the morphologic features that determine vulnerable plaque stability, and emerging in vivo imaging techniques that may detect and characterize vulnerable plaque. Composite biomechanical and hemodynamic factors that influence the actual site of development of plaques have been studied. Plaque vulnerability, in vivo, is more challenging to assess. Important steps have been made in defining the biomechanical factors that are predictive of plaque rupture and the likelihood of this occurring if characteristic features are known. A critical key in defining plaque vulnerability is the accurate quantification of both the morphology and the mechanical properties of the diseased arteries. Recently, an early IVUS based palpography technique developed to assess local strain, elasticity and mechanical instabilities has been successfully revisited and improved to account for complex plaque geometries. This is based on an initial best estimation of the plaque components’ contours, allowing subsequent iteration for elastic modulus assessment as a basis for plaque stability determination. The improved method has also been preliminarily evaluated in patients with successful histologic correlation. Further clinical evaluation and refinement are on the horizon. PMID:24043605

Medical emergencies in the dermatology office: incidence and options for crisis preparedness.

PubMed

Hazen, Paul G; Daoud, Shaza; Hazen, Brent P; Engstrom, Conley W; Turgeon, Karen L; Reep, Michael D; Tanphaichitr, Arthapol; Styron, Brandie T

2014-05-01

Medical emergencies may occur in any setting, including dermatology offices. We examined the incidence of medical emergencies in a survey of 34 dermatologists northeast Ohio. Fifty-five events occurred over 565 combined years of clinical practice, an incidence of 1 episode every 10.3 years. We also review options for better preparedness for medical emergencies in dermatology practices, ranging from an emergency action plan for emergency personnel, basic life support (BLS) certification, advanced cardiac life support (ACLS) certification, and on-site automatic electronic defibrillators (AEDs).

Macroscopic characterisations of Web accessibility

NASA Astrophysics Data System (ADS)

Lopes, Rui; Carriço, Luis

2010-12-01

The Web Science framework poses fundamental questions on the analysis of the Web, by focusing on how microscopic properties (e.g. at the level of a Web page or Web site) emerge into macroscopic properties and phenomena. One research topic on the analysis of the Web is Web accessibility evaluation, which centres on understanding how accessible a Web page is for people with disabilities. However, when framing Web accessibility evaluation on Web Science, we have found that existing research stays at the microscopic level. This article presents an experimental study on framing Web accessibility evaluation into Web Science's goals. This study resulted in novel accessibility properties of the Web not found at microscopic levels, as well as of Web accessibility evaluation processes themselves. We observed at large scale some of the empirical knowledge on how accessibility is perceived by designers and developers, such as the disparity of interpretations of accessibility evaluation tools warnings. We also found a direct relation between accessibility quality and Web page complexity. We provide a set of guidelines for designing Web pages, education on Web accessibility, as well as on the computational limits of large-scale Web accessibility evaluations.

Evaluation of Off-season Potential Breeding Sources for Spotted Wing Drosophila (Drosophila suzukii Matsumura) in Michigan.

PubMed

Bal, Harit K; Adams, Christopher; Grieshop, Matthew

2017-12-05

It has been suggested that fruit wastes including dropped and unharvested fruits, and fruit byproducts (i.e., pomace) found in fruit plantings and cideries or wine-making facilities could serve as potential off-season breeding sites for spotted wing Drosophila (Drosophila suzukii Matsumura (Diptera: Drosophilidae)). This idea, however, has yet to be widely tested. The goal of our study was to determine the potential of dropped fruit and fruit wastes as Fall spotted wing Drosophila breeding resources in Michigan, USA. Fruit waste samples were collected from 15 farms across the lower peninsula of Michigan and were evaluated for spotted wing Drosophila and other drosophilid emergence and used in host suitability bioassays. All of the dropped apples, pears, grapes, and raspberries and 40% of apple and 100% of grape fruit pomace evaluated were found to contain spotted wing Drosophila with the highest numbers collected from dropped grapes and pears. Greater spotted wing Drosophila recovery was found in fruit wastes at sites attached with cideries and wine-making facilities and with multiple cultivated fruit crops than sites with no cideries and only one crop. Females oviposited in raspberry, pear, apple, grape, apple pomace and grape pomace samples with the highest rates of reproduction in raspberries. Our results demonstrate that fruit wastes including dropped berry, pomme and stone fruits, as well as fruit compost may be important late season reproductive resources for spotted wing Drosophila. © The Author(s) 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project

PubMed Central

Stewart, Elizabeth E.; Nutting, Paul A.; Crabtree, Benjamin F.; Stange, Kurt C.; Miller, William L.; Jaén, Carlos Roberto

2010-01-01

PURPOSE We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). RESULTS The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. CONCLUSIONS The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning. PMID:20530392

Implementing the patient-centered medical home: observation and description of the national demonstration project.

PubMed

Stewart, Elizabeth E; Nutting, Paul A; Crabtree, Benjamin F; Stange, Kurt C; Miller, William L; Jaén, Carlos Roberto

2010-01-01

We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning.

How Adolescents Search for and Appraise Online Health Information: A Systematic Review.

PubMed

Freeman, Jaimie L; Caldwell, Patrina H Y; Bennett, Patricia A; Scott, Karen M

2018-04-01

To conduct a systematic review of the evidence concerning whether and how adolescents search for online health information and the extent to which they appraise the credibility of information they retrieve. A systematic search of online databases (MEDLINE, EMBASE, PsycINFO, ERIC) was performed. Reference lists of included papers were searched manually for additional articles. Included were studies on whether and how adolescents searched for and appraised online health information, where adolescent participants were aged 13-18 years. Thematic analysis was used to synthesize the findings. Thirty-four studies met the inclusion criteria. In line with the research questions, 2 key concepts were identified within the papers: whether and how adolescents search for online health information, and the extent to which adolescents appraise online health information. Four themes were identified regarding whether and how adolescents search for online health information: use of search engines, difficulties in selecting appropriate search strings, barriers to searching, and absence of searching. Four themes emerged concerning the extent to which adolescents appraise the credibility of online health information: evaluation based on Web site name and reputation, evaluation based on first impression of Web site, evaluation of Web site content, and absence of a sophisticated appraisal strategy. Adolescents are aware of the varying quality of online health information. Strategies used by individuals for searching and appraising online health information differ in their sophistication. It is important to develop resources to enhance search and appraisal skills and to collaborate with adolescents to ensure that such resources are appropriate for them. Copyright © 2017 Elsevier Inc. All rights reserved.

The Emerging Shield. The Air Force and the Evolution of Continental Air Defense 1945-1960

DTIC Science & Technology

1991-01-01

flight plans other than those reported to the Presque Isle site. No one blamed the pilots; they had reported their changes in flighit to Canadian flight...monitor stations. Communications between the stations and ADC’s Presque Isle radar site had failed, and the course changes were not identified in the...Identification Zone: 134 "Pregnant Goose": 20 GOC on coast of: 156 Presque Isle , Maine: 170-71 Northw st emergency air defense for: Project CHARLEs: 145

[Application of multiple-attribute utility technology (MAUT) to decisions about a work-site stress-control intervention for public-sector office workers].

PubMed

Hagihara, Akihito; Tarumi, Kimio

2013-01-01

The reasons behind the establishment of particular health-promotion programs in community or work settings are often unclear, and such programs are rarely evaluated from a broad perspective after they are implemented. Thus, multiattribute utility technology (MAUT) was used to design a work-site stress-control program. The sample consisted of public-sector workers in B City in Japan. Stakeholders in the work-site stress-control program included employers (municipal authorities), employees (public workers), and healthcare personnel. Six goals and three strategies (i.e., personnel, self-care, and staff) related to stress-control programs were considered. The results showed that the self-care strategy received the highest score for overall utility (i.e., 96.2), and the overall-utility score for the remaining two strategies was approximately 70. The self-care strategy emerged as the most useful of the three strategies for developing a stress-control program in a target work place. The application of MAUT may be useful for developing an effective stress-control program in occupational settings.

APPLICATION, PERFORMANCE, AND COSTS OF ...

EPA Pesticide Factsheets

A critical review of biological treatment processes for remediation of contaminated soils is presented. The focus of the review is on documented cost and performance of biological treatment technologies demonstrated at full- or field-scale. Some of the data were generated by the U.S. Environmental Protection Agency's (EPA's) Bioremediation in the Field Program, jointly supported by EPA's Office of Research and Development, EPA's Office of Solid Waste and Emergency Waste, and the EPA Regions through the Superfund Innovative Technology Evaluation Program (SITE) Program. Military sites proved to be another fertile data source. Technologies reviewed in this report include both ex-situ processes, (land treatment, biopile/biocell treatment, composting, and bioslurry reactor treatment) and in-situ alternatives (conventional bioventing, enhanced or cometabolic bioventing, anaerobic bioventing, bioslurping, phytoremediation, and natural attenuation). Targeted soil contaminants at the documented sites were primarily organic chemicals, including BTEX, petroleum hydrocarbons, polycyclic aromatic hydrocarbons (PAHs), chlorinated aliphatic hydrocarbons (CAHs), organic solvents, polychlorinated biphenyls (PCBs), pesticides, dioxin, and energetics. The advantages, limitations, and major cost drivers for each technology are discussed. Box and whisker plots are used to summarize before and after concentrations of important contaminant groups for those technologies consider

A combination of 19F NMR and surface plasmon resonance for site-specific hit selection and validation of fragment molecules that bind to the ATP-binding site of a kinase.

PubMed

Nagatoishi, Satoru; Yamaguchi, Sou; Katoh, Etsuko; Kajita, Keita; Yokotagawa, Takane; Kanai, Satoru; Furuya, Toshio; Tsumoto, Kouhei

2018-05-01

19 F NMR has recently emerged as an efficient, sensitive tool for analyzing protein binding to small molecules, and surface plasmon resonance (SPR) is also a popular tool for this purpose. Herein a combination of 19 F NMR and SPR was used to find novel binders to the ATP-binding pocket of MAP kinase extracellular regulated kinase 2 (ERK2) by fragment screening with an original fluorinated-fragment library. The 19 F NMR screening yielded a high primary hit rate of binders to the ERK2 ATP-binding pocket compared with the rate for the SPR screening. Hit compounds were evaluated and categorized according to their ability to bind to different binding sites in the ATP-binding pocket. The binding manner was characterized by using isothermal titration calorimetry and docking simulation. Combining 19 F NMR with other biophysical methods allows the identification of multiple types of hit compounds, thereby increasing opportunities for drug design using preferred fragments. Copyright © 2018 Elsevier Ltd. All rights reserved.

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

PubMed Central

Duda, Stephany N; Farr, Amanda M; Lindegren, Mary Lou; Blevins, Meridith; Wester, C William; Wools-Kaloustian, Kara; Ekouevi, Didier K; Egger, Matthias; Hemingway-Foday, Jennifer; Cooper, David A; Moore, Richard D; McGowan, Catherine C; Nash, Denis

2014-01-01

Introduction HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. Methods Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. Results Most sites reported serving urban (61%; region range (rr): 33–100%) and both adult and paediatric populations (77%; rr: 29–96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services – nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) – were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. Conclusions This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care. PMID:25516092

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration.

PubMed

Duda, Stephany N; Farr, Amanda M; Lindegren, Mary Lou; Blevins, Meridith; Wester, C William; Wools-Kaloustian, Kara; Ekouevi, Didier K; Egger, Matthias; Hemingway-Foday, Jennifer; Cooper, David A; Moore, Richard D; McGowan, Catherine C; Nash, Denis

2014-01-01

HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.

Climate Influence on Emerging Risk Areas for Rift Valley Fever Epidemics in Tanzania.

PubMed

Mweya, Clement N; Mboera, Leonard E G; Kimera, Sharadhuli I

2017-07-01

Rift Valley Fever (RVF) is a climate-related arboviral infection of animals and humans. Climate is thought to represent a threat toward emerging risk areas for RVF epidemics globally. The objective of this study was to evaluate influence of climate on distribution of suitable breeding habitats for Culex pipiens complex, potential mosquito vector responsible for transmission and distribution of disease epidemics risk areas in Tanzania. We used ecological niche models to estimate potential distribution of disease risk areas based on vectors and disease co-occurrence data approach. Climatic variables for the current and future scenarios were used as model inputs. Changes in mosquito vectors' habitat suitability in relation to disease risk areas were estimated. We used partial receiver operating characteristic and the area under the curves approach to evaluate model predictive performance and significance. Habitat suitability for Cx. pipiens complex indicated broad-scale potential for change and shift in the distribution of the vectors and disease for both 2020 and 2050 climatic scenarios. Risk areas indicated more intensification in the areas surrounding Lake Victoria and northeastern part of the country through 2050 climate scenario. Models show higher probability of emerging risk areas spreading toward the western parts of Tanzania from northeastern areas and decrease in the southern part of the country. Results presented here identified sites for consideration to guide surveillance and control interventions to reduce risk of RVF disease epidemics in Tanzania. A collaborative approach is recommended to develop and adapt climate-related disease control and prevention strategies.

Barriers to administering intravenous tissue plasminogen activator (tPA) for acute ischemic stroke in the emergency department: A cross-sectional survey of stroke centers.

PubMed

Hargis, Mitch; Shah, Jharna N; Mazabob, Janine; Rao, Chethan Venkatasubba; Suarez, Jose I; Bershad, Eric M

2015-08-01

The logistics involved in administration of IV tPA for acute ischemic stroke patients are complex, and may contribute to variability in door-to-needle times between different hospitals. We sought to identify practice patterns in stroke centers related to IV tPA use. We hypothesized that there would be significant variability in logistics related to ancillary staff (i.e. nursing, pharmacists) processes in the emergency room setting. A 21 question survey was distributed to attendees of the AHA/ASA Southwest Affiliate Stroke Coordinators Conference to evaluate potential barriers and delays with regards to thrombolysis for acute strokes patients in the Emergency Department setting. Answers were anonymous and aggregated to examine trends in responses. Responses were obtained from 37 of 67 (55%) stroke centers, which were located mainly in the Southwest United States. Logistical processes differed between facilities. Nursing and pharmacy carried stroke pagers in only 19% of the centers, and pharmacy responded to stroke alerts only one-third of centers. Insertion of Foley catheters and nasogastric tubes prior to tPA was routine in some of the sites. Other barriers to IV tPA administration included physician reluctance and inadequate communication between health care providers. Practices regarding logistics for giving IV tPA may be variable amongst different stroke centers. Given this potential variability, prospective evaluation to confirm these preliminary findings is warranted. Copyright © 2015 Elsevier B.V. All rights reserved.

Reducing Emergency Room Visits and In-Hospitalizations by Implementing Best Practice for Transitional Care Using Innovative Technology and Big Data.

PubMed

Hewner, Sharon; Sullivan, Suzanne S; Yu, Guan

2018-06-01

Efforts to improve care transitions require coordination across the healthcare continuum and interventions that enhance communication between acute and community settings. To improve post-discharge utilization value using technology to identify high-risk individuals who might benefit from rapid nurse outreach to assess social and behavioral determinants of health with the goal of reducing inpatient and emergency department visits. The project employed a before and after comparison of the intervention site with similar primary care practice sites using population-level Medicaid claims data. The intervention targeted discharged persons with preexisting chronic disease and delivered a care transition alert to a nurse care coordinator for immediate telephonic outreach. The nurse assessed social determinants of health and incorporated problems into the EHR to share across settings. The project evaluated health outcomes and the value of nursing care on existing electronic claims data to compare utilization in the years before and during the intervention using negative binomial regression to account for rare events such as inpatient visits. Avoiding readmissions and emergency visits, and increasing timely outpatient visits improved the individual's experience of care and the work life of healthcare providers, while reducing per capita costs (Quadruple Aim). In the intervention practice, the nurse care coordinator demonstrated the value of nursing care by reducing inpatient (25%) and emergency (35%) visits, and increasing outpatient visits (27%). The estimated value of avoided encounters over the secular Medicaid trend was $664 per adult with chronic disease, generating $71,289 in revenue from additional outpatient visits. Using health information exchange to deliver appropriate and timely evidence-based clinical decision support in the form of care transition alerts and assessment of social determinants of health, in conjunction with data science methods, demonstrates the value of nursing care and resulted in achieving the Quadruple Aim. © 2018 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

Global Emergency Medicine Journal Club: A Social Media Discussion About the Outpatient Management of Patients With Spontaneous Pneumothorax by Using Pigtail Catheters.

PubMed

Trueger, N Seth; Murray, Heather; Kobner, Scott; Lin, Michelle

2015-10-01

Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM) to host a public discussion featuring the 2014 Annals article on the outpatient management of patients with a spontaneous pneumothorax by using pigtail catheters. The objective was to curate a 14-day (November 10 to 23, 2014) worldwide academic dialogue among clinicians about the article. Four online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and Google Hangout. Comments across the social media platforms were curated for this report, as framed by 4 preselected questions. Engagement was tracked through Web analytic tools. Blog comments, tweets, and video expert commentary involving the featured article are summarized and reported. The dialogue resulted in 1,023 page views from 347 cities in 49 countries on the ALiEM Web site, 279,027 Twitter impressions, and 88 views of the video interview with experts. This Global Emergency Medicine Journal Club created a virtual community of practice from around the world and identified common themes around the management of spontaneous pneumothorax, which included substantial practice variation in regard to inpatient versus outpatient management, location of chest tube, the use of aspiration, and chest radiography after placement. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

MIDG-Emerging grid technologies for multi-site preclinical molecular imaging research communities.

PubMed

Lee, Jasper; Documet, Jorge; Liu, Brent; Park, Ryan; Tank, Archana; Huang, H K

2011-03-01

Molecular imaging is the visualization and identification of specific molecules in anatomy for insight into metabolic pathways, tissue consistency, and tracing of solute transport mechanisms. This paper presents the Molecular Imaging Data Grid (MIDG) which utilizes emerging grid technologies in preclinical molecular imaging to facilitate data sharing and discovery between preclinical molecular imaging facilities and their collaborating investigator institutions to expedite translational sciences research. Grid-enabled archiving, management, and distribution of animal-model imaging datasets help preclinical investigators to monitor, access and share their imaging data remotely, and promote preclinical imaging facilities to share published imaging datasets as resources for new investigators. The system architecture of the Molecular Imaging Data Grid is described in a four layer diagram. A data model for preclinical molecular imaging datasets is also presented based on imaging modalities currently used in a molecular imaging center. The MIDG system components and connectivity are presented. And finally, the workflow steps for grid-based archiving, management, and retrieval of preclincial molecular imaging data are described. Initial performance tests of the Molecular Imaging Data Grid system have been conducted at the USC IPILab using dedicated VMware servers. System connectivity, evaluated datasets, and preliminary results are presented. The results show the system's feasibility, limitations, direction of future research. Translational and interdisciplinary research in medicine is increasingly interested in cellular and molecular biology activity at the preclinical levels, utilizing molecular imaging methods on animal models. The task of integrated archiving, management, and distribution of these preclinical molecular imaging datasets at preclinical molecular imaging facilities is challenging due to disparate imaging systems and multiple off-site investigators. A Molecular Imaging Data Grid design, implementation, and initial evaluation is presented to demonstrate the secure and novel data grid solution for sharing preclinical molecular imaging data across the wide-area-network (WAN).

44 CFR 350.9 - Exercises.

Code of Federal Regulations, 2013 CFR

2013-10-01

... its boundaries or is within the 10-mile plume exposure pathway Emergency Planning Zone of such site... planning zone of a site shall exercise their plans and preparedness related to ingestion exposure pathway measures at least once every five years in conjunction with a plume exposure pathway exercise for that site...

44 CFR 350.9 - Exercises.

Code of Federal Regulations, 2010 CFR

2010-10-01

... its boundaries or is within the 10-mile plume exposure pathway Emergency Planning Zone of such site... planning zone of a site shall exercise their plans and preparedness related to ingestion exposure pathway measures at least once every five years in conjunction with a plume exposure pathway exercise for that site...

44 CFR 350.9 - Exercises.

Code of Federal Regulations, 2011 CFR

2011-10-01

... its boundaries or is within the 10-mile plume exposure pathway Emergency Planning Zone of such site... planning zone of a site shall exercise their plans and preparedness related to ingestion exposure pathway measures at least once every five years in conjunction with a plume exposure pathway exercise for that site...

44 CFR 350.9 - Exercises.

Code of Federal Regulations, 2014 CFR

2014-10-01

... its boundaries or is within the 10-mile plume exposure pathway Emergency Planning Zone of such site... planning zone of a site shall exercise their plans and preparedness related to ingestion exposure pathway measures at least once every five years in conjunction with a plume exposure pathway exercise for that site...

44 CFR 350.9 - Exercises.

Code of Federal Regulations, 2012 CFR

2012-10-01

... its boundaries or is within the 10-mile plume exposure pathway Emergency Planning Zone of such site... planning zone of a site shall exercise their plans and preparedness related to ingestion exposure pathway measures at least once every five years in conjunction with a plume exposure pathway exercise for that site...

Legal Risks for Students Using Social Networking Sites

ERIC Educational Resources Information Center

Henderson, Michael; de Zwart, Melissa; Lindsay, David; Phillips, Michael

2010-01-01

There are significant privacy, intellectual property, copyright and disclosure risks associated with the ill-considered use of social networking sites, however, the implementation of regulatory actions may also undermine the social and emerging educational utility of social networking sites for young people. Inevitably the burden of dealing with…

Habitat quality of historic Snake River fall Chinook salmon spawning locations and implications for incubation survival: part 1, substrate quality

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

Hanrahan, Timothy P.; Geist, David R.; Arntzen, Evan V.

2005-07-01

We evaluated substrate quality at two historic fall Chinook salmon (Oncorhynchus tshawytscha) spawning sites in the Snake River, Idaho, USA. The primary objective of this evaluation was to measure sediment permeability within these areas to determine the potential quality of the habitat in the event that anadromous salmonids are reintroduced to the upper Snake River. Riverbed sediments within the two sites in the upper Snake River were sampled using freeze cores and hydraulic slug tests. Sediment grain size distributions at both sites were typical of gravel-bed rivers with the surface layer coarser than the underlying substrate, suggesting the riverbed surfacemore » was armored. Despite the armored nature of the bed, the size of the largest material present on the riverbed surface was well within the size limit of material capable of being excavated by spawning fall Chinook salmon. The percentage of fines was low, suggesting good quality substrate for incubating salmon embryos. Geometric mean particle sizes found in this study compared to a 55% to 80% survival to emergence based on literature values. Hydraulic slug tests showed moderate to high hydraulic conductivity and were comparable to values from current fall Chinook salmon spawning areas in the Hells Canyon Reach of the Snake River and the Hanford Reach of the Columbia River. Predicted estimates of mean egg survival at both sites (48% and 74%) equaled or exceeded estimates from fall Chinook salmon spawning areas in the Hells Canyon Reach and the Hanford Reach.« less

Predicted utilization of emergency medical services telemedicine in decreasing ambulance transports.

PubMed

Haskins, Paul A; Ellis, David G; Mayrose, James

2002-01-01

To determine predicted utilization, decrease in ambulance transports, and target population for emergency medical services (EMS) if telemedicine capabilities were available to the medic units in the field. A retrospective chart review of 345 consecutive ambulance transports to four hospitals (Level I urban trauma center, urban tertiary care center, children's hospital and suburban community hospital) was performed by a panel of three board-certified emergency medicine physicians experienced and credentialed in emergency telemedicine. They independently reviewed the emergency department (ED) and EMS records and were asked to determine whether patients required ambulance transport for evaluation or whether disposition could be made following paramedic and emergency physician assessment via telemedicine. A five-point Likert scale was used to grade feasibility of telemedicine disposition (definitely yes, probably yes, maybe, probably no, definitely no). Other variables analyzed included age, sex, race, chief complaint, phone, private medical doctor, and call location by patient zip code, call site, and receiving hospital. In 14.7% of cases (6% definitely yes and 8.7% probably yes), disposition could be made without transport using telemedicine. The age range for eliminating transport was 2 weeks through 92 years, with mean age of 26.6 years. Under the age of 50 years, 46 out of 238 patients (19.3%) could have possibly been managed by telemedicine. Use of EMS telemedicine could result in an approximately 15% decrease in ambulance transports when it alone is added to the prehospital care provider's armamentarium. Emphasis for implementation should be placed on younger patients and an identified subset of chief complaints conducive to management using telemedicine.

ALiEM Blog and Podcast Watch: Procedures in Emergency Medicine.

PubMed

Joshi, Nikita; Morley, Eric J; Taira, Taku; Branzetti, Jeremy; Grock, Andrew

2017-10-01

The WestJEM Blog and Podcast Watch presents high-quality, open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in EM (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of procedure emergencies from the AIR Series. The AIR Series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors' (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an "honorable mention" label if the executive board agrees that the post is accurate and educationally valuable. A total of 85 blog posts and podcasts were evaluated in June 2016. This report summarizes key educational pearls from the three AIR posts and the 10 Honorable Mentions. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high-quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians, with this installment focusing on procedure emergencies within the AIR series.

ALiEM Blog and Podcast Watch: Procedures in Emergency Medicine

PubMed Central

Joshi, Nikita; Morley, Eric J.; Taira, Taku; Branzetti, Jeremy; Grock, Andrew

2017-01-01

Introduction The WestJEM Blog and Podcast Watch presents high-quality, open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in EM (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of procedure emergencies from the AIR Series. Methods The AIR Series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors’ (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an “honorable mention” label if the executive board agrees that the post is accurate and educationally valuable. Results A total of 85 blog posts and podcasts were evaluated in June 2016. This report summarizes key educational pearls from the three AIR posts and the 10 Honorable Mentions. Conclusion The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high-quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians, with this installment focusing on procedure emergencies within the AIR series. PMID:29085547

14 CFR Appendix J to Part 25 - Emergency Evacuation

Code of Federal Regulations, 2011 CFR

2011-01-01

... airplane emergency lighting system. (b) The airplane must be in a normal attitude with landing gear... place for the demonstration or which have to do with the demonstration site. Prior to the start of the...

Tier I Emergency and Hazardous Chemical Inventory Form

EPA Pesticide Factsheets

Form required for reporting chemicals by hazard type, maximum amount, average daily amount, number of days on-site, and general location. May be subject to Emergency Planning under EPCRA, or Chemical Accident Prevention under Risk Management Program.

Multidecadal Changes and Interannual Variation in Springtime Phenology of North American Temperate and Boreal Deciduous Forests

NASA Astrophysics Data System (ADS)

Melaas, Eli K.; Sulla-Menashe, Damien; Friedl, Mark A.

2018-03-01

The timing of leaf emergence is an important diagnostic of climate change impacts on ecosystems. Here we present the first continental-scale analysis of multidecadal changes in the timing of spring onset across North American temperate and boreal forests based on Landsat imagery. Our results show that leaf emergence in Eastern Temperate Forests has consistently trended earlier, with a median change of about 1 week over the 30 year study period. Changes in leaf emergence dates in boreal forests were more heterogeneous, with some sites showing trends toward later dates. Interannual variability in leaf emergence dates was strongly sensitive to springtime accumulated growing degree days across all sites, and geographic patterns of changes in onset dates were highly correlated with changes in regional springtime temperatures. These results provide a refined characterization of recent changes in springtime forest phenology and improve understanding regarding the sensitivity of North American forests to climate change.

Experimental investigation of the early interaction between cyanobacterial soil crusts and vascular plants

NASA Astrophysics Data System (ADS)

Klemens Zaplata, Markus; Veste, Maik; Pohle, Ina; Schümberg, Sabine; Abreu Schonert, Iballa; Hinz, Christoph

2016-04-01

While there are hints that biological soil crusts (BSCs) can constitute physical barriers for the emergence of vascular plants, a conceptual approach for the quantitative evaluation of these effects is still missing. Here we present an experimental design to test the emergence of seedlings in situ with (i) capping natural intact, (ii) destroyed and (iii) removed BSC. The selected field site is directly adjacent to the constructed Hühnerwasser catchment (Lusatia, Germany). This site exists since the end of 2008 and consists of loamy sand. Serving as proxy for seedling thrust, we inserted pre-germinated seeds of three confamiliar plant species with different seed masses (members of the Fabaceae family: Lotus corniculatus L., Ornithopus sativus Brot., and Glycine max (L.) Merr.). In each treatment as well as in the control group planting depths were 10 mm. We took care that experimental plots had identical crust thickness, slightly less than 4 mm, serving as proxy for mechanical resistance. A plot became established as follows: Firstly, the pristine crusted surface was vertically cut. To the windward side the BSC remained intact (i: "with BSC" stripe). To the downwind side soil material was temporarily excavated for laterally inserting the seeds beneath the surface of the first stripe. Then at the thereby disturbed second stripe pulverised BSC material became filled as a top layer (ii: "BSC mix" stripe). From the next stripe the BSC was removed (iii: "no BSC" stripe). Thus each plot had each experimental group in spatial contiguity (within 50 cm × 50 cm). The overall 50 plots were distributed across an area of 40 m × 12 m. When individuals of a species either emerged at all stripes, "× × ×", or at no stripe of a plot, "- - -", there was no reason to suppose any effect of a crust. The "- × ×" emergence pattern (depicting the appearance of seedlings in both stripes possessing manipulated surfaces) points towards hindrance more clearly than "- × -" or "- - ×". Altogether eight possible combinations exist. Combinatorial analysis turned out that seedling emergence had been notably impeded for light-weighted seeds but little for heavy seeds. Repeated recordings enable to account for adaptable emergence of seedlings according to varying crust conditions - in spatial as well as temporal terms. The proposed experimental procedure hence is highly recommended as a viable instrument to further investigate filter and facilitation processes between BSCs and vascular plants.

Pipeline corridors through wetlands - impacts on plant communities: Cassadaga Creek Tributary Crossing, Gerry Township, Chautauqua County, New York. Topical report, August 1992--November 1993

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

Shem, L.M.; Van Dyke, G.D.; Zimmerman, R.E.

1994-12-01

The goal of the Gas Research Institute Wetland Corridors Program is to document impacts of existing pipelines on the wetlands they traverse. To accomplish this goal, 12 existing wetland crossings were surveyed. These sites varied in elapsed time since pipeline construction, wetland type, pipeline installation techniques, and right-of-way (ROW) management practices. This report presents the results of a survey conducted over the period of August 3-4, 1992, at the Cassadaga wetlands crossing in Gerry Township, Chautauqua County, New York. The pipeline at this site was installed during February and March 1981. After completion of pipeline installation, the ROW was fertilized,more » mulched, and seeded with annual ryegrass. Two adjacent sites were surveyed in this study: a forested wetland and an emergent wetlands Eleven years after pipeline installation, the ROW at both sites supported diverse vegetative communities. Although devoid of large woody species, the ROW within the forested wetland had a dense vegetative cover. The ROW within the emergent wetland had a slightly less dense and more diverse vegetative community compared with that in the adjacent natural areas (NAs). The ROW within the emergent wetland also had a large number of introduced species that were not present in the adjacent NAs. The ROW, with its emergent marsh plant community, provided habitat diversity within the forested wetlands Because the ROW contained species not found within the adjacent NAs, overall species diversity was increased.« less

Global Emergency Medicine Journal Club: A Social Media Discussion About the Lack of Association Between Press Ganey Scores and Emergency Department Analgesia.

PubMed

Westafer, Lauren; Hensley, Justin; Shaikh, Sameed; Lin, Michelle

2016-01-01

Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM), to host a public discussion featuring the 2014 Annals article on the association between Press Ganey scores and emergency department (ED) analgesia by Schwartz et al. The objective was to curate a 14-day (December 1 through 14, 2014) worldwide academic dialogue among clinicians in regard to preselected questions about the article. Five online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and Google Hangout. Comments across the social media platforms were curated for this report, as framed by the 4 preselected questions. Engagement was tracked through Web analytic tools and analysis of tweets. Blog comments, tweets, and video expert commentary involving the featured article are summarized and reported. The dialogue resulted in 978 page views from 342 cities in 33 countries on the ALiEM Web site, 464,345 Twitter impressions, and 83 views of the video interview with experts. Of the unique 169 identified tweets, discussion (53.3%) and learning points (32.5%) were the most common category of tweets identified. Common themes that arose in the open-access multimedia discussions included Press Ganey data validity and the utility of patient satisfaction in determining pain treatment efficacy. This educational approach using social media technologies demonstrates a free, asynchronous means to engage a worldwide scholarly discourse. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions.

PubMed

Faucheron, J-L; Paquette, B; Trilling, B; Heyd, B; Koch, S; Mantion, G

2018-02-01

Few studies compare management and outcomes of obstructive colonic cancer, depending on the tumor site. We aim to evaluate the differences in patient characteristics, tumor characteristics, and outcomes of emergency surgery for obstructive right-sided versus left-sided colonic cancers. Between 2000 and 2009, 71 consecutive patients had an emergency colectomy following strict and clear definition of obstruction in a single institution. We retrospectively analyzed pre, per, and postoperative data that were prospectively collected. There were 31 and 40 patients in the right and left group, respectively. Patients aged over 80 were more frequent in the right group (p = 0.03). At operation, ileocecal valve was less often competent in the right group (p = 0.03). The one-stage strategy was more frequent in the right group (p = 0.008). Patients in the right group had a higher rate of nodes invasion (p = 0.04). One- and two-year mortality rate in the right group had a tendency to be higher. Patients presenting with a right obstructive colonic cancer are older, have a more advanced locoregional disease, and are more often treated in a one-stage strategy than patients with a left obstructive tumor.

Sea-level rise and coastal groundwater inundation and shoaling at select sites in California, USA

USGS Publications Warehouse

Hoover, Daniel J.; Odigie, Kingsley; Swarzenski, Peter W.; Barnard, Patrick

2017-01-01

Study regionThe study region spans coastal California, USA, and focuses on three primary sites: Arcata, Stinson Beach, and Malibu Lagoon.Study focus1 m and 2 m sea-level rise (SLR) projections were used to assess vulnerability to SLR-driven groundwater emergence and shoaling at select low-lying, coastal sites in California. Separate and combined inundation scenarios for SLR and groundwater emergence were developed using digital elevation models of study site topography and groundwater surfaces constructed from well data or published groundwater level contours.New hydrological insights for the regionSLR impacts are a serious concern in coastal California which has a long (∼1800 km) and populous coastline. Information on the possible importance of SLR-driven groundwater inundation in California is limited. In this study, the potential for SLR-driven groundwater inundation at three sites (Arcata, Stinson Beach, and Malibu Lagoon) was investigated under 1 m and 2 m SLR scenarios. These sites provide insight into the vulnerability of Northern California coastal plains, coastal developments built on beach sand or sand spits, and developed areas around coastal lagoons associated with seasonal streams and berms. Northern California coastal plains with abundant shallow groundwater likely will see significant and widespread groundwater emergence, while impacts along the much drier central and southern California coast may be less severe due to the absence of shallow groundwater in many areas. Vulnerability analysis is hampered by the lack of data on shallow coastal aquifers, which commonly are not studied because they are not suitable for domestic or agricultural use. Shallow saline aquifers may be present in many areas along coastal California, which would dramatically increase vulnerability to SLR-driven groundwater emergence and shoaling. Improved understanding of the extent and response of California coastal aquifers to SLR will help in preparing for mitigation and adaptation.

Costs of Emergency Care

MedlinePlus

... All RSS Feeds ACEP In the News Multimedia Image Gallery ACEP Video ACEP Radio ACEP Ads Resources Statistics & Reports Health Policy Campaigns Published Letters Journalism Awards Fact Sheets Social Media Contact Us Site Body Main Content Annals of Emergency Medicine | EMAF Website | ...

Remote Sensing Decision Support System for Optimal Access Restoration in Post Disaster Environments

DOT National Transportation Integrated Search

2017-01-01

Access restoration is an extremely important part of disaster response. Without access to the site, critically important emergency functions like search and rescue, emergency evacuation, and relief distribution, cannot commence. Frequently, roads are...

Information technology and emergency response

DOT National Transportation Integrated Search

1997-12-01

This document reports on a study of the application of information technology to emergency response for hazardous materials incidents. Focus is on the information needs of first responders, i.e., those who are first on the site of an incident. The re...

The Emergence of Homo sapiens.

ERIC Educational Resources Information Center

Rensberger, Boyce

1980-01-01

Describes chronologically the evolution of the human race on earth so as to refute Darwin's theory of descent from animals. Skull fragments from sites around the world suggest at least two possible routes toward the emergence of Homo sapiens sapiens. (Author/SK)

Hospital referral patterns: how emergency medical care is accessed in a disaster.

PubMed

Reilly, Michael J; Markenson, David

2010-10-01

A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.

Macroinvertebrate communities evaluated prior to and following a channel restoration project in Silver Creek, Blaine County, Idaho, 2001-16

USGS Publications Warehouse

MacCoy, Dorene E.; Short, Terry M.

2017-11-22

The U.S. Geological Survey, in cooperation with Blaine County and The Nature Conservancy, evaluated the status of macroinvertebrate communities prior to and following a channel restoration project in Silver Creek, Blaine County, Idaho. The objective of the evaluation was to determine whether 2014 remediation efforts to restore natural channel conditions in an impounded area of Silver Creek caused declines in local macroinvertebrate communities. Starting in 2001 and ending in 2016, macroinvertebrates were sampled every 3 years at two long-term trend sites and sampled seasonally (spring, summer, and autumn) in 2013, 2015, and 2016 at seven synoptic sites. Trend-site communities were collected from natural stream-bottom substrates to represent locally established macroinvertebrate assemblages. Synoptic site communities were sampled using artificial (multi-plate) substrates to represent recently colonized (4–6 weeks) assemblages. Statistical summaries of spatial and temporal patterns in macroinvertebrate taxonomic composition at both trend and synoptic sites were completed.The potential effect of the restoration project on resident macroinvertebrate populations was determined by comparing the following community assemblage metrics:Total taxonomic richness (taxa richness);Total macroinvertebrate abundance (total abundance);Ephemeroptera, Plecoptera, Trichoptera (EPT) richness;EPT abundance;Simpson’s diversity; andSimpson’s evenness for periods prior to and following restoration.A significant decrease in one or more metric values in the period following stream channel restoration was the basis for determining impairment to the macroinvertebrate communities in Silver Creek.Comparison of pre-restoration (2001–13) and post‑restoration (2016) macroinvertebrate community composition at trend sites determined that no significant decreases occurred in any metric parameter for communities sampled in 2016. Taxa and EPT richness of colonized assemblages at synoptic sites increased significantly from pre-restoration in 2013 to post-restoration in 2015 and 2016. Similarly, total and EPT abundances at synoptic sites showed non-significant increases from 2013 to 2015 and 2016. Significant seasonal differences in macroinvertebrate assemblages were apparent at synoptic site locations and likely reflected typical life-history patterns of increased insect emergence and development in the late spring and early summer months. Taxa and EPT richness were each significantly higher in spring and summer than in autumn, and total abundances were significantly higher in spring than in summer and autumn. No significant differences in community diversity or evenness of colonized communities were noted at synoptic site locations between pre- and post-restoration years or among seasons. Select community-metric results from the trend- and synoptic‑site sampling indicated that the Silver Creek restoration effort in 2014 did not result in a significant decline in resident macroinvertebrate communities.

[Telematics equipment for poison control surveillance. Its applications in the health management of relevant chemical incidents].

PubMed

Butera, R; Locatelli, C; Gandini, C; Minuco, G; Mazzoleni, M C; Giordano, A; Zanuti, M; Varango, C; Petrolini, V; Candura, S M; Manzo, L

1997-01-01

Health management of major chemical incidents requires a close collaboration between rescuers (on the disaster site and in the emergency department) and the poison center. The study tested telematic technologies allowing telepresence and teleconsulting, a real time and continuous connection among health care personnel and toxicologists involved in the management of the emergency. The link between the poison center (PC) and the emergency department in the local hospital is provided by a ISDN operating video conferencing system, while the data transmission from the site of the accident to the PC is achieved with a personal computer and GSM cellular data transmission. Toxicological databases and risk assessment software are integrated in the system, to support information sharing. To test such instruments in operative nearly realistic conditions, the main phase of the study has implemented simulated chemical disasters in different locations in Italy. Instruments for telepresence and teleconsulting have been effectively utilized to evaluate from a remote location the scenario and the severity of the accident, by inspecting either specific details or the whole scene, to enable PC guiding the triage of the victims before and after hospitalization, to utilize and share data, such as intervention protocols or patient records, and to document all the activities. In summary, this experience shows that the telematic link allows the toxicologists of the poison center to rapidly understand the situation, and to correctly learn about the conditions of patients with the help of images. The results of this study indicate the valuable benefits of telematic instruments for the health care in case of major chemical disasters occurring in a remote geographical location or in an area which lacks local toxicological experts, where specialized expertise can be achieved by the use of telematic technologies.

Effect of emergent aquatic insects on bat foraging in a riparian forest.

PubMed

Fukui, Dai; Murakami, Masashi; Nakano, Shigeru; Aoi, Toshiki

2006-11-01

1. Riparian zones serve several ecological functions for bats. They provide a source of prey and likely provide favourable structural habitats and shelter from predators. Many studies have shown that bats use the space above streams, ponds or riparian vegetation as feeding habitat. These studies, however, have never distinguished between the effects of habitat structure and prey availability on the foraging activities of bats. Such effects can only be distinguished by an experimental approach. We predicted that bat activity along a stream is influenced by the number of emerged aquatic insects. 2. We evaluated the response of terrestrial consumers, insectivorous bats, to changes in the abundance of emergent aquatic insects by conducting a manipulative field experiment. In a deciduous riparian forest in Japan, aquatic insect flux from the stream to the riparian zone was controlled with an insect-proof cover over a 1.2 km stream reach. 3. We estimated the abundance of emergent aquatic and flying terrestrial arthropods near the treatment and control reaches using Malaise traps. The foraging activity of bats was evaluated in both treatment and control reaches using ultrasonic detectors. 4. The insect-proof cover effectively reduced the flux of emergent aquatic insects to the riparian zone adjacent to the treatment reach. Adjacent to the control reach, adult aquatic insect biomass was highest in spring, and then decreased gradually. Terrestrial insect biomass increased gradually during the summer at both treatment and control reaches. 5. Foraging activity of bats was correlated with insect abundance. In spring, foraging activity of bats at the control reach was significantly greater than at the treatment reach, and increased at both sites with increasing terrestrial insect abundance. 6. Our result suggests that the flux of aquatic insects emerging from streams is one of the most important factors affecting the distribution of riparian-foraging bats. As is the case with other riparian consumers, resource subsidies from streams can directly enhance the performance or population density of riparian-dependent bats. To conserve and manage bat populations, it is important to protect not only forest ecosystems, but also adjacent aquatic systems such as streams.

Off-Site Supervision in Social Work Education: What Makes It Work?

ERIC Educational Resources Information Center

Maynard, Sarah P.; Mertz, Linda K. P.; Fortune, Anne E.

2015-01-01

The field practicum is the signature pedagogy of the social work profession, yet field directors struggle to find adequate field placements--both in quantity and quality. To accommodate more students with a dwindling pool of practicum sites, creative models of field supervision have emerged. This article considers off-site supervision and its…

24 CFR 3286.203 - Installation license required.

Code of Federal Regulations, 2010 CFR

2010-04-01

... emergency housing after a natural disaster; or (7) Work performed at the home site that is not covered by...) The installer must display an original or a copy of a valid installation license at the site of the... installation license is not required for: (1) Site preparation that is not subject to the requirements of part...

15 CFR 265.31 - Closing the site.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Closing the site. 265.31 Section 265..., GAITHERSBURG, MARYLAND, AND BOULDER AND FORT COLLINS, COLORADO Buildings and Grounds § 265.31 Closing the site... may be closed to the public in emergency situations and at such other times as may be necessary for...

An Evaluation of Emergency Medicine Core Content Covered by Free Open Access Medical Education Resources.

PubMed

Stuntz, Robert; Clontz, Robert

2016-05-01

Emergency physicians are using free open access medical education (FOAM) resources at an increasing rate. The extent to which FOAM resources cover the breadth of emergency medicine core content is unknown. We hypothesize that the content of FOAM resources does not provide comprehensive or balanced coverage of the scope of knowledge necessary for emergency medicine providers. Our objective is to quantify emergency medicine core content covered by FOAM resources and identify the predominant FOAM topics. This is an institutional review board-approved, retrospective review of all English-language FOAM posts between July 1, 2013, and June 30, 2014, as aggregated on http://FOAMem.com. The topics of FOAM posts were compared with those of the emergency medicine core content, as defined by the American Board of Emergency Medicine's Model of the Clinical Practice of Emergency Medicine (MCPEM). Each FOAM post could cover more than 1 topic. Repeated posts and summaries were excluded. Review of the MCPEM yielded 915 total emergency medicine topics grouped into 20 sections. Review of 6,424 FOAM posts yielded 7,279 total topics and 654 unique topics, representing 71.5% coverage of the 915 topics outlined by the MCPEM. The procedures section was covered most often, representing 2,285 (31.4%) FOAM topics. The 4 sections with the least coverage were cutaneous disorders, hematologic disorders, nontraumatic musculoskeletal disorders, and obstetric and gynecologic disorders, each representing 0.6% of FOAM topics. Airway techniques; ECG interpretation; research, evidence-based medicine, and interpretation of the literature; resuscitation; and ultrasonography were the most overrepresented subsections, equaling 1,674 (23.0%) FOAM topics when combined. The data suggest an imbalanced and incomplete coverage of emergency medicine core content in FOAM. The study is limited by its retrospective design and use of a single referral Web site to obtain available FOAM resources. More comprehensive and balanced coverage of emergency medicine core content is needed if FOAM is to serve as a primary educational resource. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Federal Emergency Management Information System (FEMIS) system administration guide, version 1.4.5

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

Arp, J.A.; Burnett, R.A.; Carter, R.J.

The Federal Emergency Management Information Systems (FEMIS) is an emergency management planning and response tool that was developed by the Pacific Northwest National Laboratory (PNNL) under the direction of the US Army Chemical Biological Defense Command. The FEMIS System Administration Guide provides information necessary for the system administrator to maintain the FEMIS system. The FEMIS system is designed for a single Chemical Stockpile Emergency Preparedness Program (CSEPP) site that has multiple Emergency Operations Centers (EOCs). Each EOC has personal computers (PCs) that emergency planners and operations personnel use to do their jobs. These PCs are connected via a local areamore » network (LAN) to servers that provide EOC-wide services. Each EOC is interconnected to other EOCs via a Wide Area Network (WAN). Thus, FEMIS is an integrated software product that resides on client/server computer architecture. The main body of FEMIS software, referred to as the FEMIS Application Software, resides on the PC client(s) and is directly accessible to emergency management personnel. The remainder of the FEMIS software, referred to as the FEMIS Support Software, resides on the UNIX server. The Support Software provides the communication, data distribution, and notification functionality necessary to operate FEMIS in a networked, client/server environment. The UNIX server provides an Oracle relational database management system (RDBMS) services, ARC/INFO GIS (optional) capabilities, and basic file management services. PNNL developed utilities that reside on the server include the Notification Service, the Command Service that executes the evacuation model, and AutoRecovery. To operate FEMIS, the Application Software must have access to a site specific FEMIS emergency management database. Data that pertains to an individual EOC`s jurisdiction is stored on the EOC`s local server. Information that needs to be accessible to all EOCs is automatically distributed by the FEMIS database to the other EOCs at the site.« less

Social Media Use and Conduct Problems in Emerging Adults.

PubMed

Galica, Victoria L; Vannucci, Anna; Flannery, Kaitlin M; Ohannessian, Christine McCauley

2017-07-01

Social media use has become pervasive in the lives of emerging adults. Although social media may provide individuals with positive opportunities for communication and learning, social media sites also may provide an outlet for youth conduct problems, such as bullying, harassment, and intentional hostility and aggression toward others. Yet, the relationship between social media use and conduct problems remains unclear. This study investigated the association between conduct disorder (CD) symptoms before age 15 and social media use during emerging adulthood in a large, nationally representative sample. Concurrent associations between antisocial personality disorder (ASPD) symptoms and social media use in emerging adults also were examined. Data for this study were based on 567 emerging adults (50.2 percent female; M age  = 20.0 years). Self-report questionnaires were completed online. Results suggested that more childhood CD symptoms were significantly associated with greater daily social media use during emerging adulthood, and that more daily social media use was significantly associated with current ASPD symptoms. Possible directional and cyclical explanations for these findings are explored. Given the pervasiveness of social media in the lives of emerging adults, these results underscore the importance of considering nuanced methods for using social media sites to encourage positive social interactions and to displace the promotion of conduct problems.

Federal Emergency Management Information System (FEMIS) system administration guide. Version 1.4

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

Arp, J.A.; Burnett, R.A.; Downing, T.R.

The Federal Emergency Management Information System (FEMIS) is an emergency management planning and analysis tool that was developed by the Pacific Northwest National Laboratory (PNNL) under the direction of the US Army Chemical Biological Defense Command. The FEMIS System Administration Guide defines FEMIS hardware and software requirements and gives instructions for installing the FEMIS software package. This document also contains information on the following: software installation for the FEMIS data servers, communication server, mail server, and the emergency management workstations; distribution media loading and FEMIS installation validation and troubleshooting; and system management of FEMIS users, login privileges, and usage. Themore » system administration utilities (tools), available in the FEMIS client software, are described for user accounts and site profile. This document also describes the installation and use of system and database administration utilities that will assist in keeping the FEMIS system running in an operational environment. The FEMIS system is designed for a single Chemical Stockpile Emergency Preparedness Program (CSEPP) site that has multiple Emergency Operations Centers (EOCs). Each EOC has personal computers (PCs) that emergency planners and operations personnel use to do their jobs. These PCs are connected via a local area network (LAN) to servers that provide EOC-wide services. Each EOC is interconnected to other EOCs via telecommunications links.« less

Black and Brown Bear Activity at Selected Coastal Sites in Glacier Bay National Park and Preserve, Alaska: A Preliminary Assessment Using Noninvasive Procedures

USGS Publications Warehouse

Partridge, Steve; Smith, Tom; Lewis, Tania

2009-01-01

A number of efforts in recent years have sought to predict bear activity in various habitats to minimize human disturbance and bear/human conflicts. Alaskan coastal areas provide important foraging areas for bears (Ursus americanus and U. arctos), particularly following den emergence when there may be no snow-free foraging alternatives. Additionally, coastal areas provide important food items for bears throughout the year. Glacier Bay National Park and Preserve (GLBA) in southeastern Alaska has extensive coastal habitats, and the National Park Service (NPS) has been long interested in learning more about the use of these coastal habitats by bears because these same habitats receive extensive human use by park visitors, especially kayaking recreationists. This study provides insight regarding the nature and intensity of bear activity at selected coastal sites within GLBA. We achieved a clearer understanding of bear/habitat relationships within GLBA by analyzing bear activity data collected with remote cameras, bear sign mapping, scat collections, and genetic analysis of bear hair. Although we could not quantify actual levels of bear activity at study sites, agreement among measures of activity (for example, sign counts, DNA analysis, and video record) lends support to our qualitative site assessments. This work suggests that habitat evaluation, bear sign mapping, and periodic scat counts can provide a useful index of bear activity for sites of interest.

20 CFR 671.110 - What are major economic dislocations or other events which may qualify for a national emergency...

Code of Federal Regulations, 2010 CFR

2010-04-01

... single site of employment; (c) Closures and realignments of military installations; (d) Multiple layoffs... individuals in a community; (e) Emergencies or natural disasters, as defined in paragraphs (1) and (2) respectively, of section 102 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C...

Emergency Response Capability Baseline Needs Assessment - Requirements Document

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

Sharry, John A.

This document was prepared by John A. Sharry, LLNL Fire Marshal and LLNL Division Leader for Fire Protection and reviewed by LLNL Emergency Management Department Head James Colson. The document follows and expands upon the format and contents of the DOE Model Fire Protection Baseline Capabilities Assessment document contained on the DOE Fire Protection Web Site, but only addresses emergency response.

Space shuttle EVA/IVA support equipment requirements study. Volume 1: Final summary report

NASA Technical Reports Server (NTRS)

1973-01-01

A study was conducted to determine the support equipment requirements for space shuttle intravehicular and extravehicular activities. The subjects investigated are; (1) EVA/IVA task identification and analysis,. (2) primary life support system, (3) emergency life support system, (4) pressure suit assembly, (5) restraints, (6) work site provision, (7) emergency internal vehicular emergencies, and (8) vehicular interfaces.

[BACE1 inhibitors for the treatment of Alzheimer disease].

PubMed

Tomita, Taisuke

2016-03-01

β-Site amyloid precursor protein cleaving enzyme 1 (BACEl) is the enzyme required for the production of the amyloid-β peptide(Aβ), which is associated with Alzheimer disease (AD). BACEl has emerged as a prime molecular target for reducing the brain Aβ levels. Recently, several BACEl inhibitors have been developed in clinical trials to test the efficacy in AD patients and individuals with prodromal AD. However, identification of BACE1 substrates and phenotypes of Bace1 knockout mice have raised concerns regarding potential mechanism-based adverse effects. This review summarizes the current status of the development of BACE1 inhibitors and the evaluation of their therapeutic potential against AD.

Surgical videos online: a survey of prominent sources and future trends.

PubMed

Dinscore, Amanda; Andres, Amy

2010-01-01

This article determines the extent of the online availability and quality of surgical videos for the educational benefit of the surgical community. A comprehensive survey was performed that compared a number of online sites providing surgical videos according to their content, production quality, authority, audience, navigability, and other features. Methods for evaluating video content are discussed as well as possible future directions and emerging trends. Surgical videos are a valuable tool for demonstrating and teaching surgical technique and, despite room for growth in this area, advances in streaming video technology have made providing and accessing these resources easier than ever before.

Beyond multidrug-resistant tuberculosis in Europe: a TBNET study.

PubMed

Günther, G; van Leth, F; Altet, N; Dedicoat, M; Duarte, R; Gualano, G; Kunst, H; Muylle, I; Spinu, V; Tiberi, S; Viiklepp, P; Lange, C

2015-12-01

The emergence of drug-resistant tuberculosis (TB) is a challenge to TB control in Europe. We evaluated second-line drug susceptibility testing in Mycobacterium tuberculosis isolates from patients with multidrug-resistant, pre-extensively drug-resistant (pre-XDR-TB) and XDR-TB at 23 TBNET sites in 16 European countries. Over 30% of bacilli from patients with pre-XDR-TB showed resistance to any fluoroquinolone and almost 70% to any second-line injectable drug. Respectively >90% and >80% of the XDR-TB strains tested showed phenotypic resistance to pyrazinamide and ethambutol. Resistance to prothionamide/ethionamide was high in bacilli from pre-XDR-TB patients (43%) and XDR-TB patients (49%).

DEVELOPMENT AND IMPLEMENTATION OF A PRACTICAL PUBLIC HEALTH TRAINING SYSTEM IN CHINA.

PubMed

Liu, Changjiang; Zhang, Junyue; Chen, Guoyuan; Yang, Kedi

2015-03-01

Public health education is becoming an increasing priority among educators of medicine. In China, little attention has been paid to public health education reform. A new public health training system was introduced in China in 2007. We conducted this study during 2006-2012 to evaluate the graduate core competencies under the new system. Data were collected from 231 graduates and 49 public health agencies. The 144 graduates who enrolled in 2006 and were trained under the old system constituted the control group; the 87 graduates who enrolled in 2007 and were trained under the new system constituted the experimental group. Surveys of graduate core competencies found analyzing and solving problems in the laboratory, conducting on-site practice and learning new technologies were the top three abilities most expected by public health agencies. After 5-year practical ability training, the graduates in the experimental group had better performance; on-site practical ability and laboratory practical ability increased significantly by 24.5% and 20.0%, respectively. Three other important competencies also improved: designing epidemiologic surveys, collecting information from the literature and doing statistical analyses. However, preventing and controlling common diseases and dealing with emergencies remained weak. These results show the new training system should be continued, but revisions are needed to improve this training system, especially in the areas of preventing and controlling common diseases and dealing with emergencies.

Evaluation of aerial microbial pollutants in Al-Haram Al-Nabawi during pilgrimage of 2013.

PubMed

Alananbeh, Kholoud M; Boquellah, Nahla; Kaff, Nadia Al; Ahmadi, Majid Al

2017-01-01

Al-Madinah Al-Munawwarah is the second holiest site in Islam. The possibility of new emerging microbes is valid due to the increased number of pilgrims. The objectives of the current study were to estimate the numbers of fungi and bacteria inside and outside Al-Haram Al-Nabawi and to find whether new bacterial and fungal species have emerged compared to previous studies. Air samples were collected twice a day from 12 spots and four directions during the pilgrim year of 2013 for four consecutive weeks by using the sedimentation method. Thirty five genera and fifty eight species were identified. The most recovered bacterial genera were Staphylococcus, Micrococcus, Bacillus, and Dermacoccus with 32.47%, 18.18%, 12.85%, and 11.23%, respectively. Fifty nine isolates of fungi were molecularly identified. Aspergillus species had the highest percentage (78%). The other fungal genera identified ( Alternaria triticina , Emericella nidulans , Emericella striata , Mucor circinelloides , Penicillium chrysogenum , Penicillium minioluteum , Rhizopus arrhizus , Rhizopus oryzae , and Syncephalastrum racemosum ) had less than 5% frequency. In places such as Al-Haram Al-Nabawi, a large and crowded public (millions) exist especially during pilgrimages and Ramadan, thus, exposure to microorganisms is high. On the other hand, microorganism infectivity depends on many factors including their virulence, landing site, and person's immunity. For those reasons, many aspects should be considered to avoid aerosol contaminants.

Are there any differences in medical emergency team interventions between rural and urban areas? A single-centre cohort study.

PubMed

Aftyka, Anna; Rybojad, Beata; Rudnicka-Drozak, Ewa

2014-10-01

To compare interventions of medical emergency teams in urban and rural areas with particular emphasis on response time and on-site medical rescue activities. A retrospective analysis of ambulance call reports from two emergency medical service substations: one in the city and the other in a rural area. Two emergency medical service substations: one in the city and the other in a rural area. Medical emergency teams. Interventions in the city were associated with a substantially shorter response time in comparison to rural areas. In the city, the distances were generally less than 10 km. In the rural area, however, such short distances accounted for only 7.2% of events, while 33.8% were over 30 km. Medical emergency teams more often acted exclusively on-site or ceased any interventions in rural areas. Compared with the city, actions in the rural setting were associated with significantly increased use of cervical collars and decreased use of intravenous access. The presence of a physician in the team raised the probability of pharmacotherapy. The relationship between medical emergency teams activities and the location of intervention shows the real diversity of the functioning of emergency medical service within a city and rural areas. Further research should aim to improve the generalisability of these findings. © 2014 National Rural Health Alliance Inc.

Phytoremediation of soils and water contaminated with toxic elements and radionuclides

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

Cornish, J.E.; Huddleston, G.J.; Levine, R.S.

1995-12-31

At many U.S. Department of Energy (DOE) facilities and other sites, large volumes of soils, sediments and waters are contaminated with heavy metals and/or radionuclides, often at only a relatively small factor above regulatory action levels. In response, the DOE`s Office of Technology Development is evaluating the emerging biotechnology known as phytoremediation; this approach utilizes the accelerated transfer of contaminant mass from solution to either root or above ground biomass. After growth, the plant biomass - containing 100 to 1,000 times the contaminant levels observed with conventional plants - is processed to achieve further volume reduction and contaminant concentration. Thus,more » phytoremediation offers the potential for low cost remediation of highly to moderately contaminated media. Progress made to date by DOE in developing this technology will be summarized and evaluated.« less

Desert tortoise hibernation: Temperatures, timing, and environment

USGS Publications Warehouse

Nussear, K.E.; Esque, T.C.; Haines, D.F.; Tracy, C.R.

2007-01-01

This research examined the onset, duration, and termination of hibernation in Desert Tortoises (Gopherus agassizii) over several years at multiple sites in the northeastern part of their geographic range, and recorded the temperatures experienced by tortoises during winter hibernation. The timing of hibernation by Desert Tortoises differed among sites and years. Environmental cues acting over the short-term did not appear to influence the timing of the hibernation period. Different individual tortoises entered hibernation over as many as 44 days in the fall and emerged from hibernation over as many as 49 days in the spring. This range of variation in the timing of hibernation indicates a weak influence at best of exogenous cues hypothesized to trigger and terminate hibernation. There do appear to be regional trends in hibernation behavior as hibernation tended to begin earlier and continue longer at sites that were higher in elevation and generally cooler. The emergence date was generally more similar among study sites than the date of onset. While the climate and the subsequent timing of hibernation differed among sites, the average temperatures experienced by tortoises while hibernating differed by only about five degrees from the coldest site to the warmest site. ?? 2007 by the American Society of Ichthyologists and Herpetologists.

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration

PubMed Central

Sullivan, Jennifer L.; Adjognon, Omonyêlé L.; Engle, Ryann L.; Shin, Marlena H.; Afable, Melissa K.; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

2018-01-01

Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Methodology: Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. Results: The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. Discussion: This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Implications: Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges. PMID:28125459

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

PubMed

Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.

Privacy Impact Assessment for the Emergency Management Portal

EPA Pesticide Factsheets

The Emergency Management Portal System collects cleanup site data, and personnel readiness data. Learn how this data will be collected in the system, how it will be used, access to the data, the purpose of data collection, and record retention policies.

44 CFR 352.20 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... providing Federal technical assistance to the licensee for developing its offsite emergency response plan... response functions which Federal agencies may be called upon to provide; (d) Describes the process for allocating responsibilities among Federal agencies for planning site-specific emergency response functions...

44 CFR 352.20 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... providing Federal technical assistance to the licensee for developing its offsite emergency response plan... response functions which Federal agencies may be called upon to provide; (d) Describes the process for allocating responsibilities among Federal agencies for planning site-specific emergency response functions...

44 CFR 352.20 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... providing Federal technical assistance to the licensee for developing its offsite emergency response plan... response functions which Federal agencies may be called upon to provide; (d) Describes the process for allocating responsibilities among Federal agencies for planning site-specific emergency response functions...

44 CFR 352.20 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... providing Federal technical assistance to the licensee for developing its offsite emergency response plan... response functions which Federal agencies may be called upon to provide; (d) Describes the process for allocating responsibilities among Federal agencies for planning site-specific emergency response functions...

SITE EMERGING TECHNOLOGY Program

EPA Science Inventory

This document is intended as a reference guide for EPA Regional decision makers and others interested in tchnologies in the SITE Demonstration and Technologies programs. The Technologies are described in technology profiles presented in alphabetical order by developer name and se...

Shuttle abort landing site emergency medical services

NASA Technical Reports Server (NTRS)

Mckenas, David K.; Jennings, Richard T.

1991-01-01

NASA and DOD studies of medical-planning and logistical problems are reviewed as applicable to providing emergency medical care at remote transoceanic abort landing (TAL) sites. Two options are analyzed including a modified surgical response team and a combination physician/medical technician team. The two concepts are examined in terms of cost-effectiveness, specific types of medical support such as blood procurement, and search-and-rescue requirements. It is found that the physician/technician team is more economically efficient, and the description of the concept permits the development of an effective TAL-site astronaut medical-support system. A balance is struck between the competing problems of cost and medical capability by planning for on-scene medical stabilization and air evacuation to DOD tertiary medical centers.

Hazardous Materials Management and Emergency Response Training Center at Hanford

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

Ollero, J.; Muth, G.; Bergland, R.

1994-12-31

The Hanford Site will provide high-fidelity training using simulated job-site situations to prepare workers for known and unknown hazards. Hanford is developing the Hazardous Materials Management and Emergency Response (HAMMER) Training Center to operate as a user facility for the site, region and international labor unions. The center will focus on providing hands-on, realistic training situations. The Training Center is a partnership among U.S. Department of Energy (DOE); its contractors; labor; local, state, and tribal governments; Xavier and Tulane Universities of Louisiana and other Federal agencies. The hands-on training aids at HAMMER is justified based on regulatory training requirements, themore » desire for enhanced safety, and the commitment to continuous improvement of training quality.« less

Evisceration of Appendix through the Drain Site: A Rare Case Report.

PubMed

Ravishankaran, Praveen; Rajamani, A

2013-06-01

Placing a drain after surgery is a usual procedure in any emergency abdominal operation. The drain is removed as soon as its purpose of draining the intraabdominal collection in served. Evisceration of intraabdominal organs through the drain site is a rare occurance. This case report is about an 12 year old girl who was admitted with blunt trauma abdomen. After completion of emergency laparotomy a drain was placed in the right lower quadrant. When the drain was removed on the 6th post operative day, the appendix eviscerated out of the drain site. The wound was extended a little and an appendectomy was done. This case is presented for its rarity as only two similar instances have been reported in literature so far.

Challenges of establishing big sgebrush (Artemisia tridentata) in rangeland restoration: effects of herbicide, mowing, whole-community seeding, and sagebrush seed sources

USGS Publications Warehouse

Brabec, Martha M.; Germino, Matthew J.; Shinneman, Douglas J.; Pilliod, David S.; McIlroy, Susan K.; Arkle, Robert S.

2015-01-01

The loss of big sagebrush (Artemisia tridentata Nutt.) on sites disturbed by fire has motivated restoration seeding and planting efforts. However, the resulting sagebrush establishment is often lower than desired, especially in dry areas. Sagebrush establishment may be increased by addressing factors such as seed source and condition or management of the plant community. We assessed initial establishment of seeded sagebrush and four populations of small outplants (from different geographies, climates, and cytotypes) and small sagebrush outplants in an early seral community where mowing, herbicide, and seeding of other native plants had been experimentally applied. No emergence of seeded sagebrush was detected. Mowing the site before planting seedlings led to greater initial survival probabilities for sagebrush outplants, except where seeding also occurred, and these effects were related to corresponding changes in bare soil exposure. Initial survival probabilities were > 30% greater for the local population of big sagebrush relative to populations imported to the site from typical seed transfer distances of ~320–800 km. Overcoming the high first-year mortality of outplanted or seeded sagebrush is one of the most challenging aspects of postfire restoration and rehabilitation, and further evaluation of the impacts of herb treatments and sagebrush seed sources across different site types and years is needed.

Predicting conformational ensembles and genome-wide transcription factor binding sites from DNA sequences.

PubMed

Andrabi, Munazah; Hutchins, Andrew Paul; Miranda-Saavedra, Diego; Kono, Hidetoshi; Nussinov, Ruth; Mizuguchi, Kenji; Ahmad, Shandar

2017-06-22

DNA shape is emerging as an important determinant of transcription factor binding beyond just the DNA sequence. The only tool for large scale DNA shape estimates, DNAshape was derived from Monte-Carlo simulations and predicts four broad and static DNA shape features, Propeller twist, Helical twist, Minor groove width and Roll. The contributions of other shape features e.g. Shift, Slide and Opening cannot be evaluated using DNAshape. Here, we report a novel method DynaSeq, which predicts molecular dynamics-derived ensembles of a more exhaustive set of DNA shape features. We compared the DNAshape and DynaSeq predictions for the common features and applied both to predict the genome-wide binding sites of 1312 TFs available from protein interaction quantification (PIQ) data. The results indicate a good agreement between the two methods for the common shape features and point to advantages in using DynaSeq. Predictive models employing ensembles from individual conformational parameters revealed that base-pair opening - known to be important in strand separation - was the best predictor of transcription factor-binding sites (TFBS) followed by features employed by DNAshape. Of note, TFBS could be predicted not only from the features at the target motif sites, but also from those as far as 200 nucleotides away from the motif.

Synthesis of common management concerns associated with dam removal

USGS Publications Warehouse

Tullos, Desiree D.; Collins, Mathias J.; Bellmore, J. Ryan; Bountry, Jennifer A.; Connolly, Patrick J.; Shafroth, Patrick B.; Wilcox, Andrew C.

2016-01-01

Managers make decisions regarding if and how to remove dams in spite of uncertainty surrounding physical and ecological responses, and stakeholders often raise concerns about certain negative effects, regardless of whether or not these concerns are warranted at a particular site. We used a dam-removal science database supplemented with other information sources to explore seven frequently-raised concerns, herein Common Management Concerns (CMCs). We investigate the occurrence of these concerns and the contributing biophysical controls. The CMCs addressed are: degree and rate of reservoir sediment erosion, excessive channel incision upstream of reservoirs, downstream sediment aggradation, elevated downstream turbidity, drawdown impacts on local water infrastructure, colonization of reservoir sediments by non-native plants, and expansion of invasive fish. Biophysical controls emerged for some of the concerns, providing managers with information to assess whether a given concern is likely to occur at a site. To fully assess CMC risk, managers should concurrently evaluate site conditions and identify the ecosystem or human uses that will be negatively affected if the biophysical phenomenon producing the CMC occurs. We show how many CMCs have one or more controls in common, facilitating the identification of multiple risks at a site, and demonstrate why CMC risks should be considered in the context of other factors like natural watershed variability and disturbance history.

Monitoring HIV Drug Resistance Early Warning Indicators in Cameroon: A Study Following the Revised World Health Organization Recommendations

PubMed Central

Fokam, Joseph; Elat, Jean-Bosco N.; Billong, Serge C.; Kembou, Etienne; Nkwescheu, Armand S.; Obam, Nicolas M.; Essiane, André; Torimiro, Judith N.; Ekanmian, Gatien K.; Ndjolo, Alexis; Shiro, Koulla S.; Bissek, Anne C. Z-K.

2015-01-01

Background The majority (>95%) of new HIV infection occurs in resource-limited settings, and Cameroon is still experiencing a generalized epidemic with ~122,638 patients receiving antiretroviral therapy (ART). A detrimental outcome in scaling-up ART is the emergence HIV drug resistance (HIVDR), suggesting the need for pragmatic approaches in sustaining a successful ART performance. Methods A survey was conducted in 15 ART sites of the Centre and Littoral regions of Cameroon in 2013 (10 urban versus 05 rural settings; 8 at tertiary/secondary versus 7 at primary healthcare levels), evaluating HIVDR-early warning indicators (EWIs) as-per the 2012 revised World Health Organization’s guidelines: EWI1 (on-time pill pick-up), EWI2 (retention in care), EWI3 (no pharmacy stock-outs), EWI4 (dispensing practices), EWI5 (virological suppression). Poor performance was interpreted as potential HIVDR. Results Only 33.3% (4/12) of sites reached the desirable performance for “on-time pill pick-up” (57.1% urban versus 0% rural; p<0.0001) besides 25% (3/12) with fair performance. 69.2% (9/13) reached the desirable performance for “retention in care” (77.8% urban versus 50% rural; p=0.01) beside 7.7% (1/13) with fair performance. Only 14.4% (2/13) reached the desirable performance of “no pharmacy stock-outs” (11.1% urban versus 25% rural; p=0.02). All 15 sites reached the desirable performance of 0% “dispensing mono- or dual-therapy”. Data were unavailable to evaluate “virological suppression” due to limited access to viral load testing (min-max: <1%-15%). Potential HIVDR was higher in rural (57.9%) compared to urban (27.8%) settings, p=0.02; and at primary (57.9%) compared to secondary/tertiary (33.3%) healthcare levels, p=0.09. Conclusions Delayed pill pick-up and pharmacy stock-outs are major factors favoring HIVDR emergence, with higher risks in rural settings and at primary healthcare. Retention in care appears acceptable in general while ART dispensing practices are standard. There is need to support patient-adherence to pharmacy appointments while reinforcing the national drug supply system. PMID:26083364

44 CFR 352.7 - Review and evaluation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Review and evaluation. 352.7 Section 352.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS COMMERCIAL NUCLEAR POWER PLANTS: EMERGENCY PREPAREDNESS PLANNING...

Effects of Educational Messaging on Urgent and Emergent Care–Seeking Behaviors Among Publicly Insured Populations

PubMed Central

Cambon, Jesse; Cordier, Tristan; Munnich, Elizabeth L.; Renda, Andrew; Kapur, Bobby; Hoxhaj, Shkelzen; Williams, Meredith

2018-01-01

Background The impact of messaging campaigns on influencing urgent care– and emergent care–seeking behaviors, including the use of in-network providers, is not well-understood. Although out-of-network healthcare utilization can have negative financial consequences for patients in narrow network Affordable Care Act plans, individuals with time-sensitive medical conditions, and especially patients visiting the emergency department, may not think about out-of-network issues. Inappropriate or avoidable emergency department visits can also create unnecessary costs for patients. Objective To evaluate the impact of 5 messaging strategies to educate individuals about the use of in-network providers and when care should be sought in the emergency department, urgent care center, or other sites of care. Methods Using a retrospective analysis, individuals aged ≥18 years who were enrolled in an individually purchased Affordable Care Act–compliant Humana plan as of July 1, 2015, were randomized to 1 of 5 messaging arms (e-mail, magnet mailer with or without e-mail, and key-tag mailer with or without e-mail) or to a control group. The outreach was implemented and evaluated in 2 distinct, geographically defined populations of Orlando, Palm Beach, and Tampa, Florida (Population 1); and Atlanta, Georgia, and San Antonio and Austin, Texas (Population 2). The relative number of each emergency department, urgent care, and out-of-network visits during follow-up was modeled using negative binomial regression. Cox proportional hazard models were used to calculate the risk for ≥1 of each visit type (assessed separately) and high emergency department utilization (defined as ≥3 visits during follow-up) relative to the control, while accounting for variable follow-up time. Results The relative numbers of each visit type assessed were not significantly different for any message group compared with the control in either population. The risk for an emergency department visit was 4% lower in the e-mail arm of Population 2 (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94–0.99; P = .005) and 7% lower in the e-mail/key-tag arm of Population 1 (HR, 0.93; 95% CI, 0.89–0.97; P = .001). The risk for high emergency department utilization was significantly reduced by the key-tag, magnet, and e-mail/key-tag strategies in Population 1, but no impact was found in Population 2. Conclusion Despite the mixed results, the study provides new insights into how different messaging strategies could be used to educate patients and influence healthcare utilization decisions by people with health insurance. PMID:29915641

Tier-2 Optimisation for Computational Density/Diversity and Big Data

NASA Astrophysics Data System (ADS)

Fay, R. B.; Bland, J.

2014-06-01

As the number of cores on chip continues to trend upwards and new CPU architectures emerge, increasing CPU density and diversity presents multiple challenges to site administrators. These include scheduling for massively multi-core systems (potentially including Graphical Processing Units (GPU), integrated and dedicated) and Many Integrated Core (MIC)) to ensure a balanced throughput of jobs while preserving overall cluster throughput, as well as the increasing complexity of developing for these heterogeneous platforms, and the challenge in managing this more complex mix of resources. In addition, meeting data demands as both dataset sizes increase and as the rate of demand scales with increased computational power requires additional performance from the associated storage elements. In this report, we evaluate one emerging technology, Solid State Drive (SSD) caching for RAID controllers, with consideration to its potential to assist in meeting evolving demand. We also briefly consider the broader developing trends outlined above in order to identify issues that may develop and assess what actions should be taken in the immediate term to address those.

On the discovery of new potent human farnesyltransferase inhibitors: emerging pyroglutamic derivatives.

PubMed

Homerin, Germain; Lipka, Emmanuelle; Rigo, Benoît; Farce, Amaury; Dubois, Joëlle; Ghinet, Alina

2017-10-04

In the current context of lack of emergence of innovative human farnesyltransferase inhibitors families, and given all new therapeutic perspectives that open up for such molecules in rare diseases (e.g. Hutchinson-Gilford progeria syndrome), and in delta hepatitis, cardiovascular or neuroinflammatory diseases, we have just discovered a new series of powerful inhibitors. These molecules are pyroglutamic acid derivatives, and were evaluated on human farnesyltransferase in vitro then modeled in silico on the active site of the protein. Three main points of the pyroglutamic acid cycle have undergone chemical modulations pyroglutamides in position 5 (compounds 7a-h), constrained bicyclic analogues of pyrroloimidazoledione type (compounds 1a-h), modulation of the position 3 (compounds 2-5 and 8), and allowed the first SAR in the field. Five derivatives in the current work have IC 50 values in the small nanomolar range (2-5 nM). These new lead compounds open the way for the next generation of farnesyltransferase inhibitors.

Accumulation of PCB congeners in nestling tree swallows (Tachycineta bicolor) on the Hudson River, New York

USGS Publications Warehouse

Echols, Kathy R.; Tillitt, Donald E.; Nichols, John W.; Secord, Anne L.; McCarty, John P.

2004-01-01

Tree swallows (Tachycineta bicolor) were used as a sentinel species to monitor the contamination and bioavailability of polychlorinated biphenyls (PCBs) in the Hudson River watershed. Several tree swallow nest box colonies around and downstream from Hudson Falls, NY, were studied. Tree swallow eggs, adults, and 5-, 10-, and 15-day-old nestlings were collected and analyzed for 103 PCB congeners. Emergent insects collected by net (primarily Odonata) or as a food bolus (primarily Diptera) taken from the mouths of adult tree swallows returning to the nest were analyzed in the same manner. Total PCB concentrations (wet weight) in eggs from two contaminated sites ranged from 9000 to 25 000 ng/g and accumulated to 32 000 and 96 000 ng/g in 15-day-old nestling at two contaminated sites. The congener patterns of PCBs in eggs, nestlings, and adults were compared to those found in emergent insects (Odonata and Diptera) using principal components analysis. The PCB patterns of the biota differed from that of Aroclor technical mixtures. PCB patterns in adult tree swallows were similar to those in eggs, while the patterns in dietary insects were similar to nestling tree swallows. Uptake rate constants were determined for tree swallow nestlings and compared between the two contaminated sites. The estimated PCB congener uptake rate constants were 0.008-0.02 d-1 based on uptake in nestlings until day 15 post-hatch. The rate constants were comparable between the two study areas and may be used to predict nestling contamination at other locations. Our studies confirm the utility of nestling tree swallows to evaluate localized PCB contamination.

Usefulness of Cone-Beam Computed Tomography and Automatic Vessel Detection Software in Emergency Transarterial Embolization

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

Carrafiello, Gianpaolo, E-mail: gcarraf@gmail.com; Ierardi, Anna Maria, E-mail: amierardi@yahoo.it; Duka, Ejona, E-mail: ejonaduka@hotmail.com

BackgroundThis study was designed to evaluate the utility of dual phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software to guide transarterial embolization (TAE) of angiographically challenging arterial bleedings in emergency settings.MethodsTwenty patients with an arterial bleeding at computed tomography angiography and an inconclusive identification of the bleeding vessel at the initial 2D angiographic series were included. Accuracy of DP-CBCT and AVD software were defined as the ability to detect the bleeding site and the culprit arterial bleeder, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software. Clinical success was definedmore » as the successful embolization. Total volume of iodinated contrast medium and overall procedure time were registered.ResultsThe bleeding site was not detected by initial angiogram in 20 % of cases, while impossibility to identify the bleeding vessel was the reason for inclusion in the remaining cases. The bleeding site was detected by DP-CBCT in 19 of 20 (95 %) patients; in one case CBCT-CT fusion was required. AVD software identified the culprit arterial branch in 18 of 20 (90 %) cases. In two cases, vessel tracking required manual marking of the candidate arterial bleeder. Technical success was 95 %. Successful embolization was achieved in all patients. Mean contrast volume injected for each patient was 77.5 ml, and mean overall procedural time was 50 min.ConclusionsC-arm CBCT and AVD software during TAE of angiographically challenging arterial bleedings is feasible and may facilitate successful embolization. Staff training in CBCT imaging and software manipulation is necessary.« less

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

Sanki, Aditya K.; Boucau, Julie; Umesiri, Francis E.

Peptide-based 1,2-dicarbonyl compounds have emerged as potent inhibitors for serine proteases. Herein, we have designed and synthesized D-arabinose and D-trehalose-based esters, {alpha}-ketoesters and {alpha}-ketoamides, and evaluated their inhibitory activity against Mycobacterium tuberculosis (Mtb) antigen 85C (ag85C), an acyltransferase in the serine hydrolase superfamily. In addition the compounds were evaluated for the ability to inhibit the growth of Mycobacterium smegmatis ATCC 14468, a non-pathogenic surrogate for Mtb. Among the synthetic analogs evaluated only the methyl ester1 derived from D-arabinose was found to inhibit the acyltransferase activity of ag85C (IC{sub 50} = 25 mM). Based on this weak inhibitory activity it wasmore » not surprising that none of the compounds inhibits the growth of M. smegmatis. In spite of the weak inhibitory activity of 1, X-ray crystallography on crystals of ag85C soaked with 1 suggested the formation of a covalent ester adduct between 1 and the Ser124 side chain hydroxyl moiety found within the catalytic site of ag85C; however, some of the active site electron density appears to result from bound glycerol. The lack of activity associated with the {alpha}-ketoester and {alpha}-ketoamide derivatives of D-trehalose may be the result of intramolecular cyclization of the {alpha}-keto moiety with the nearby C-4/4' hydroxyls leading to the formation of stable bicyclo-ester and amide derivatives.« less

Genetic Evidence of Contemporary Dispersal of the Intermediate Snail Host of Schistosoma japonicum: Movement of an NTD Host Is Facilitated by Land Use and Landscape Connectivity.

PubMed

Head, Jennifer R; Chang, Howard; Li, Qunna; Hoover, Christopher M; Wilke, Thomas; Clewing, Catharina; Carlton, Elizabeth J; Liang, Song; Lu, Ding; Zhong, Bo; Remais, Justin V

2016-12-01

While the dispersal of hosts and vectors-through active or passive movement-is known to facilitate the spread and re-emergence of certain infectious diseases, little is known about the movement ecology of Oncomelania spp., intermediate snail host of the parasite Schistosoma japonicum, and its consequences for the spread of schistosomiasis in East and Southeast Asia. In China, despite intense control programs aimed at preventing schistosomiasis transmission, there is evidence in recent years of re-emergence and persistence of infection in some areas, as well as an increase in the spatial extent of the snail host. A quantitative understanding of the dispersal characteristics of the intermediate host can provide new insights into the spatial dynamics of transmission, and can assist public health officials in limiting the geographic spread of infection. Oncomelania hupensis robertsoni snails (n = 833) were sampled from 29 sites in Sichuan, China, genotyped, and analyzed using Bayesian assignment to estimate the rate of recent snail migration across sites. Landscape connectivity between each site pair was estimated using the geographic distance distributions derived from nine environmental models: Euclidean, topography, incline, wetness, land use, watershed, stream use, streams and channels, and stream velocity. Among sites, 14.4% to 32.8% of sampled snails were identified as recent migrants, with 20 sites comprising >20% migrants. Migration rates were generally low between sites, but at 8 sites, over 10% of the overall host population originated from one proximal site. Greater landscape connectivity was significantly associated with increased odds of migration, with the minimum path distance (as opposed to median or first quartile) emerging as the strongest predictor across all environmental models. Models accounting for land use explained the largest proportion of the variance in migration rates between sites. A greater number of irrigation channels leading into a site was associated with an increase in the site's propensity to both attract and retain snails. Our findings have important implications for controlling the geographic spread of schistosomiasis in China, through improved understanding of the dispersal capacity of the parasite's intermediate host.

BIOHAZ: Rapid On-Site Biological Detection for First Responders

DTIC Science & Technology

2001-09-01

numbers comprise the compilation report: ADP013371 thru ADP013468 UNCLASSIFIED 84. BIORAZ: Rapid On- Site Biological Detection for First Responders Randall... responders an integated capability to collect an environmental sample and to rapidly screen that sample on site for the presence of biological material. This...further analyzed on site with immunoassay tickets before being sent to a laboratory. This system provides the emergency responders with a capability that

Developing a Sustainable Need-Based Pediatric Acute Care Training Curriculum in Solomon Islands.

PubMed

Yu, Daniel Ta Yo; Gillon, Jason T; Dickson, Raymond; Schneider, Karen A; Stevens, Martha W

2017-01-01

The Johns Hopkins Hospital Pediatric Emergency Department (PED) was invited to collaborate with the National Referral Hospital (NRH), Solomon Islands, to establish an acute care pediatric education program for the country's inaugural class of national medical graduate trainees. To develop and evaluate a sustainable, need-based post-graduate training curriculum in pediatric acute care, resuscitation, and point-of-care ultrasound. A need-based training curriculum was developed utilizing the ADDIE model and was implemented and revised over the course of 2 years and two site visits. Implementation followed a train-the-trainer model. The curriculum consisted of high-yield didactics including workshops, simulations, hands-on ultrasound sessions, and lectures at the NRH. A mixed-methods design was used to evaluate the curriculum, including pre/posttesting, qualitative group discussions, and individual surveys. The curriculum was revised in response to ongoing learner evaluations and needs assessments. Continuing educational sessions after the site visit demonstrated sustainability. The curriculum included 19 core topics with 42 teaching sessions during the two site visits. A total of 135 pre/posttests and 366 individual surveys were collected from 46 trainees. Completion rates were 78.2% for surveys and 71.3% for pre/posttests. Pre/posttest scores increased from 44 to 63% during the first site visit and 69.6 to 77.6% during the second. Learners reported a mean 4.81/5 on a standard Likert scale for curriculum satisfaction. Group discussions and surveys highlighted key areas of knowledge growth, important clinical care advances, and identified further needs. Initial sustainability was demonstrated by continued ultrasound sessions led by local graduate trainees. A collaborative team including Johns Hopkins PED staff, Solomon Islands' graduate trainees, and NRH administration initiated a professional education curriculum for the first class of Solomon Islands' medical graduates. Knowledge growth and positive impacts of the program were reflected in learner survey and test scores. Graduate trainees were identified as local champions to continue as course instructors. This innovative curriculum was developed, revised, and initially sustained on site. It has been successful in introducing life-saving pediatric acute care and graduate training in Solomon Islands.

1990 UPDATE OF THE US ENVIRONMENTAL PROTECTION AGENCY'S SITE EMERGING TECHNOLOGY PROGRAM

EPA Science Inventory

The Superfund Amendments and Reauthorization Act of 1986 (SARA) directed the U.S. Environmental Protection AGency (EPA) to establish an Alternative/Innovative Treatment Technology Research and Demonstration Program. The EPA's Office of Solid Waste and Emergency Response and the ...

Herbicide Trials in Intensively Cultured Populus Plantations in Northern Wisconsin

Treesearch

Daniel A. Netzer; Nonan V. Noste

1978-01-01

Populus had good survival and growth when planting sites had been treated with linuron, a pre-emergent herbicide, alone or in combination with paraquat, a post-emergent herbicide. the herbicide treatments that are most effective in intensive culture are discussed.

48 CFR 452.236-77 - Emergency Response.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Response. As prescribed in 436.577, the following clause may be used in Forest Service construction contracts: Emergency Response (NOV 1996) (a) Contractor's Responsibility for Fire Fighting. (1) The..., Equipment, Utilities, and Improvements, shall immediately extinguish all fires on the work site other than...

48 CFR 452.236-77 - Emergency Response.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Response. As prescribed in 436.577, the following clause may be used in Forest Service construction contracts: Emergency Response (NOV 1996) (a) Contractor's Responsibility for Fire Fighting. (1) The..., Equipment, Utilities, and Improvements, shall immediately extinguish all fires on the work site other than...

48 CFR 452.236-77 - Emergency Response.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Response. As prescribed in 436.577, the following clause may be used in Forest Service construction contracts: Emergency Response (NOV 1996) (a) Contractor's Responsibility for Fire Fighting. (1) The..., Equipment, Utilities, and Improvements, shall immediately extinguish all fires on the work site other than...

48 CFR 452.236-77 - Emergency Response.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Response. As prescribed in 436.577, the following clause may be used in Forest Service construction contracts: Emergency Response (NOV 1996) (a) Contractor's Responsibility for Fire Fighting. (1) The..., Equipment, Utilities, and Improvements, shall immediately extinguish all fires on the work site other than...

48 CFR 452.236-77 - Emergency Response.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Response. As prescribed in 436.577, the following clause may be used in Forest Service construction contracts: Emergency Response (NOV 1996) (a) Contractor's Responsibility for Fire Fighting. (1) The..., Equipment, Utilities, and Improvements, shall immediately extinguish all fires on the work site other than...

Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study.

PubMed

Leonard, Chelsea; Lawrence, Emily; McCreight, Marina; Lippmann, Brandi; Kelley, Lynette; Mayberry, Ashlea; Ladebue, Amy; Gilmartin, Heather; Côté, Murray J; Jones, Jacqueline; Rabin, Borsika A; Ho, P Michael; Burke, Robert

2017-10-23

Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM) to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources, coupled with internal and external facilitation, is a novel approach to engaging sites in adapting interventions while promoting fidelity to the intervention. Our application of PRISM to pre-implementation and midline evaluation, as well as documentation of adaptations, provides an opportunity to identify and address contextual factors that may impede or enhance implementation and sustainability of health interventions and inform dissemination.

Risk factors for admission at three urban emergency departments in England: a cross-sectional analysis of attendances over 1 month.

PubMed

Ismail, Sharif A; Pope, Ian; Bloom, Benjamin; Catalao, Raquel; Green, Emilie; Longbottom, Rebecca E; Jansen, Gwyneth; McCoy, David; Harris, Tim

2017-06-22

To investigate factors associated with unscheduled admission following presentation to emergency departments (EDs) at three hospitals in England. Cross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (site 1) and two district general hospitals (sites 2 and 3). Variables included patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome. Coding inconsistencies in routine ED data used for this study meant that diagnosis could not be included. The primary outcome for the study was unscheduled admission. All adults aged 16 and older attending the three inner London EDs in December 2013. Data on 19 734 unique patient attendances were gathered. Outcome data were available for 19 721 attendances (>99%), of whom 6263 (32%) were admitted to hospital. Site 1 was set as the baseline site for analysis of admission risk. Risk of admission was significantly greater at sites 2 and 3 (adjusted OR (AOR) relative to site 1 for site 2 was 1.89, 95% CI 1.74 to 2.05, p<0.001) and for patients of black or black British ethnicity (AOR 1.29, 1.16 to 1.44, p<0.001). Deprivation was strongly associated with admission. Analysis of departmental and hospital-wide workload pressures gave conflicting results, but proximity to the "4-hour target" (a rule that limits patient stays in EDs to 4 hours in the National Health Service in England) emerged as a strong driver for admission in this analysis (AOR 3.61, 95% CI 3.30 to 3.95, p<0.001). This study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED-level and clinician-level behaviour relating to admission decisions. The 4-hour target is a strong driver for emergency admission. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Social Networking Sites as Communication, Interaction, and Learning Environments: Perceptions and Preferences of Distance Education Students

ERIC Educational Resources Information Center

Bozkurt, Aras; Karadeniz, Abdulkadir; Kocdar, Serpil

2017-01-01

The advent of Web 2.0 technologies transformed online networks into interactive spaces in which user-generated content has become the core material. With the possibilities that emerged from Web 2.0, social networking sites became very popular. The capability of social networking sites promises opportunities for communication and interaction,…

When Web Sites Post Test Answers, Professors Worry

ERIC Educational Resources Information Center

Young, Jeffrey R.

2008-01-01

Several Web sites have emerged in recent years that encourage students to upload old exams to build a bank of test questions and answers that can be consulted by other students. This article reports that some professors have raised concerns about these sites, arguing that these could be used to cheat, especially if professors reuse old tests.…

An Analysis of Dialogistic Presence on Community College Web Sites in Nine Mega-States

ERIC Educational Resources Information Center

Shadinger, David Allen

2010-01-01

The institutional web site is ubiquitous and has emerged as nearly universal in its utilization as a recruiting and informational tool for the twenty-first century community college. Community colleges have embraced utilization of the Internet through the establishment of institutional web sites containing volumes of information, forms, and links.…

Pride on the Other Side: The Emergence of LGBT Web Sites for Prospective Students

ERIC Educational Resources Information Center

Mathis, Daniel; Tremblay, Christopher

2010-01-01

For several decades, colleges have maintained an LGBT Web presence for currently enrolled students. These Web sites inform students about resources, services, events, and staff . They serve as a way to communicate a school's inclusivity and commitment to the LGBT population. Only recently have Web sites specifically targeted for the prospective…

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

Walsh, P.; El Adlouni, C.; Mukhopadhyay, M.J.

The importance of the search for reliable biomarkers of DNA damage in environmental health assessment is well recognized by the scientific community and regulatory agencies. Among the major biomarkers of DNA damage is the measurement of DNA adducts in target cells or tissues. Up to now, DNA adduct determinations have been directed mostly toward human exposure to toxic substances from the workplace and environment. Moreover, techniques for measuring DNA adducts, and in particular the {sup 32}P-postlabelling technique, presented also the possibility of determining DNA adduct levels in endogenous animal populations exposed to polluted environments as early warning monitors of ecotoxicity.more » Soil contamination is becoming a major environmental issue. Therefore, numerous contaminated sites must now be remediated to protect human health and to permit new uses of these sites as agricultural, residential, or industrial areas. Fulfillment of this task requires standardized and sensitive bioassays to carry out site evaluations and to establish scientifically defensible soil quality criteria. To that effect, the earthworm appears to be one of the best organisms for use in soil toxicity evaluation. Earthworms are probably the most relevant soil species, representing 60 to 80% of the total animal biomass in soil. Present soil bioassays focus mostly on plant species with end points like seed germination, root elongation, seedling growth and seedling emergence, and on acute toxicity evaluation (re: LC 50) on the earthworm Eisenia fetida. As yet, a standardized soil invertebrate test for teratogenic or mutagenic end points has not been developed. In this paper, we report the feasibility of DNA adduct determination by {sup 32}P-postlabelling in the earthworm Lumbricus terrestris as a way to detect the presence of genotoxic substances in soils. 20 refs., 1 fig., 1 tab.« less

D Applications in Disaster Mitigation and Management: Core Results of Ditac Project

NASA Astrophysics Data System (ADS)

Kaptan, K.; Kavlak, U.; Yilmaz, O.; Celik, O. T.; Manesh, A. K.; Fischer, P.; Lupescu, O.; Ingrassia, P. L.; Ammann, W. J.; Ashkenazi, M.; Arculeo, C.; Komadina, R.; Lechner, K.; Arnim, G. v.; Hreckovski, B.

2013-08-01

According to statistical data, natural disasters as well as the number of people affected by them are occurring with increasing frequency compared to the past. This situation is also seen in Europe Union; So, Strengthening the EU capacity to respond to Disasters is very important. This paper represents the baseline results of the FP-7 founded DITAC project, which aims to develop a holistic and highly structured curriculum for responders and strategic crisis managers. Up-to-date geospatial information is required in order to create an effective disaster response plan. Common sources for geospatial information such as Google Earth, GIS databases, and aerial surveys are frequently outdated, or insufficient. This limits the effectiveness of disaster planning. Disaster Management has become an issue of growing importance. Planning for and managing large scale emergencies is complex. The number of both victims and relief workers is large and the time pressure is extreme. Emergency response and triage systems with 2D user interfaces are currently under development and evaluation. Disasters present a number of spatially related problems and an overwhelming quantity of information. 3D user interfaces are well suited for intuitively solving basic emergency response tasks. Such tasks include commanding rescue agents and prioritizing the disaster victims according to the severity of their medical condition. Further, 3D UIs hold significant potential for improving the coordination of rescuers as well as their awareness of relief workers from other organizations. This paper describes the outline of a module in a Disaster Management Course related to 3D Applications in Disaster Mitigation and Management. By doing this, the paper describes the gaps in existing systems and solutions. Satellite imageries and digital elevation data of Turkey are investigated for detecting sites prone to natural hazards. Digital image processing methods used to enhance satellite data and to produce morphometric maps in order to contribute to the detection of causal factors related to landslides, local site conditions influencing and/or experiencing earthquake damage intensity or those of tsunami and storm surge hazard sites at the coasts.

Shifting stream planform state decreases stream productivity yet increases riparian animal production.

PubMed

Venarsky, Michael P; Walters, David M; Hall, Robert O; Livers, Bridget; Wohl, Ellen

2018-05-01

In the Colorado Front Range (USA), disturbance history dictates stream planform. Undisturbed, old-growth streams have multiple channels and large amounts of wood and depositional habitat. Disturbed streams (wildfires and logging < 200 years ago) are single-channeled with mostly erosional habitat. We tested how these opposing stream states influenced organic matter, benthic macroinvertebrate secondary production, emerging aquatic insect flux, and riparian spider biomass. Organic matter and macroinvertebrate production did not differ among sites per unit area (m -2 ), but values were 2 ×-21 × higher in undisturbed reaches per unit of stream valley (m -1 valley) because total stream area was higher in undisturbed reaches. Insect emergence was similar among streams at the per unit area and per unit of stream valley. However, rescaling insect emergence to per meter of stream bank showed that the emerging insect biomass reaching the stream bank was lower in undisturbed sites because multi-channel reaches had 3 × more stream bank than single-channel reaches. Riparian spider biomass followed the same pattern as emerging aquatic insects, and we attribute this to bottom-up limitation caused by the multi-channeled undisturbed sites diluting prey quantity (emerging insects) reaching the stream bank (riparian spider habitat). These results show that historic landscape disturbances continue to influence stream and riparian communities in the Colorado Front Range. However, these legacy effects are only weakly influencing habitat-specific function and instead are primarily influencing stream-riparian community productivity by dictating both stream planform (total stream area, total stream bank length) and the proportional distribution of specific habitat types (pools vs riffles).

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

Shifting stream planform state decreases stream productivity yet increases riparian animal production

USGS Publications Warehouse

Venarsky, Michael P.; Walters, David M.; Hall, Robert O.; Livers, Bridget; Wohl, Ellen

2018-01-01

In the Colorado Front Range (USA), disturbance history dictates stream planform. Undisturbed, old-growth streams have multiple channels and large amounts of wood and depositional habitat. Disturbed streams (wildfires and logging < 200 years ago) are single-channeled with mostly erosional habitat. We tested how these opposing stream states influenced organic matter, benthic macroinvertebrate secondary production, emerging aquatic insect flux, and riparian spider biomass. Organic matter and macroinvertebrate production did not differ among sites per unit area (m−2), but values were 2 ×–21 × higher in undisturbed reaches per unit of stream valley (m−1 valley) because total stream area was higher in undisturbed reaches. Insect emergence was similar among streams at the per unit area and per unit of stream valley. However, rescaling insect emergence to per meter of stream bank showed that the emerging insect biomass reaching the stream bank was lower in undisturbed sites because multi-channel reaches had 3 × more stream bank than single-channel reaches. Riparian spider biomass followed the same pattern as emerging aquatic insects, and we attribute this to bottom-up limitation caused by the multi-channeled undisturbed sites diluting prey quantity (emerging insects) reaching the stream bank (riparian spider habitat). These results show that historic landscape disturbances continue to influence stream and riparian communities in the Colorado Front Range. However, these legacy effects are only weakly influencing habitat-specific function and instead are primarily influencing stream–riparian community productivity by dictating both stream planform (total stream area, total stream bank length) and the proportional distribution of specific habitat types (pools vs riffles).

Transient habitats limit development time for periodical cicadas.

PubMed

Karban, Richard

2014-01-01

Periodical cicadas (Magicicada spp.) mature in 13 or 17 years, the longest development times for any non-diapausing insects. Selection may favor prolonged development since nymphs experience little mortality and individuals taking 17 years have been shown to have greater fecundity than those taking 13 years. Why don't periodical cicadas take even longer to develop? Nymphs feed on root xylem fluid and move little. Ovipositing females prefer fast-growing trees at forest edges. I hypothesized that (1) adults emerging at edges would be heavier than those from forest interiors and (2) habitat changes could limit development time. I collected newly eclosed females that had neither fed as adults nor moved from their site of development. For M. septendecim, females from edges were 4.9% heavier than those from the interior. I assumed that emergence density indicated habitat quality and measured density at eight sites in 1979, 1996, and 2013. Over three generations, variation in densities was great; densities at two sites crashed, and at one site they exploded to 579/m2 Habitat transience may limit development time because only adults can reassess habitats and reposition offspring. In conclusion, cicadas are affected by habitat characteristics, habitats change over 17 years, and cicadas may emerge, mate, and redistribute their offspring to track habitat dynamics.

Possibility of microscopic liquid water formation at landing sites on Mars and their observational potential

NASA Astrophysics Data System (ADS)

Pál, B.; Kereszturi, Á.

2017-01-01

Microscopic liquid brines, especially calcium-perchlorate could emerge by deliquescence on Mars during night time hours. Using climate model computations and orbital humidity observations, the ideal periods and their annual plus daily characteristics at various past, current and future landing sites were compared. Such results provide context for future analysis and targeting the related observations by the next missions for Mars. Based on the analysis, at most (but not all) past missions' landing sites, microscopic brine could emerge during night time for different durations. Analysing the conditions at ExoMars rover's primary landing site at Oxia Planum, the best annual period was found to be between Ls 115-225, and in Local Time 2-5, after midnight. In an ideal case, 4 h of continuous liquid phase can emerge there. Local conditions might cause values to differ from those estimated by the model. Thermal inertia could especially make such differences (low TI values favour fast cooling and H2O cold trapping at loose surfaces) and the concentration of calcium-perchlorate salt in the regolith also influences the process (it might occur preferentially at long-term exposed surfaces without recent loose dust coverage). These factors should be taken into account while targeting future liquid water observations on Mars.

Multi-site evaluation of a computer aided detection (CAD) algorithm for small acute intra-cranial hemorrhage and development of a stand-alone CAD system ready for deployment in a clinical environment

NASA Astrophysics Data System (ADS)

Deshpande, Ruchi R.; Fernandez, James; Lee, Joon K.; Chan, Tao; Liu, Brent J.; Huang, H. K.

2010-03-01

Timely detection of Acute Intra-cranial Hemorrhage (AIH) in an emergency environment is essential for the triage of patients suffering from Traumatic Brain Injury. Moreover, the small size of lesions and lack of experience on the reader's part could lead to difficulties in the detection of AIH. A CT based CAD algorithm for the detection of AIH has been developed in order to improve upon the current standard of identification and treatment of AIH. A retrospective analysis of the algorithm has already been carried out with 135 AIH CT studies with 135 matched normal head CT studies from the Los Angeles County General Hospital/ University of Southern California Hospital System (LAC/USC). In the next step, AIH studies have been collected from Walter Reed Army Medical Center, and are currently being processed using the AIH CAD system as part of implementing a multi-site assessment and evaluation of the performance of the algorithm. The sensitivity and specificity numbers from the Walter Reed study will be compared with the numbers from the LAC/USC study to determine if there are differences in the presentation and detection due to the difference in the nature of trauma between the two sites. Simultaneously, a stand-alone system with a user friendly GUI has been developed to facilitate implementation in a clinical setting.

Investigation of Amphibian Mortality Events in Wildlife Reveals an On-Going Ranavirus Epidemic in the North of the Netherlands

PubMed Central

Spitzen-van der Sluijs, Annemarieke; Wilkie, Gavin S.; van Asten, Alphons J. A. M.; van den Broek, Jan; Boonyarittichaikij, Roschong; Stege, Marisca; van der Sterren, Fleur; Martel, An; Pasmans, Frank; Hughes, Joseph; Gröne, Andrea; van Beurden, Steven J.; Kik, Marja J. L.

2016-01-01

In the four years following the first detection of ranavirus (genus Ranavirus, family Iridoviridae) infection in Dutch wildlife in 2010, amphibian mortality events were investigated nationwide to detect, characterize and map ranaviruses in amphibians over time, and to establish the affected host species and the clinico-pathological presentation of the disease in these hosts. The ultimate goal was to obtain more insight into ranavirus disease emergence and ecological risk. In total 155 dead amphibians from 52 sites were submitted between 2011 and 2014, and examined using histopathology, immunohistochemistry, virus isolation and molecular genetic characterization. Ranavirus-associated amphibian mortality events occurred at 18 sites (35%), initially only in proximity of the 2010 index site. Specimens belonging to approximately half of the native amphibian species were infected, including the threatened Pelobates fuscus (spadefoot toad). Clustered massive outbreaks involving dead adult specimens and ranavirus genomic identity indicated that one common midwife toad virus (CMTV)-like ranavirus strain is emerging in provinces in the north of the Netherlands. Modelling based on the spatiotemporal pattern of spread showed a high probability that this emerging virus will continue to be detected at new sites (the discrete reproductive power of this outbreak is 0.35). Phylogenetically distinct CMTV-like ranaviruses were found in the south of the Netherlands more recently. In addition to showing that CMTV-like ranaviruses threaten wild amphibian populations not only in Spain but also in the Netherlands, the current spread and risk of establishment reiterate that understanding the underlying causes of CMTV-like ranavirus emergence requires international attention. PMID:27315226

Investigation of Amphibian Mortality Events in Wildlife Reveals an On-Going Ranavirus Epidemic in the North of the Netherlands.

PubMed

Rijks, Jolianne M; Saucedo, Bernardo; Spitzen-van der Sluijs, Annemarieke; Wilkie, Gavin S; van Asten, Alphons J A M; van den Broek, Jan; Boonyarittichaikij, Roschong; Stege, Marisca; van der Sterren, Fleur; Martel, An; Pasmans, Frank; Hughes, Joseph; Gröne, Andrea; van Beurden, Steven J; Kik, Marja J L

2016-01-01

In the four years following the first detection of ranavirus (genus Ranavirus, family Iridoviridae) infection in Dutch wildlife in 2010, amphibian mortality events were investigated nationwide to detect, characterize and map ranaviruses in amphibians over time, and to establish the affected host species and the clinico-pathological presentation of the disease in these hosts. The ultimate goal was to obtain more insight into ranavirus disease emergence and ecological risk. In total 155 dead amphibians from 52 sites were submitted between 2011 and 2014, and examined using histopathology, immunohistochemistry, virus isolation and molecular genetic characterization. Ranavirus-associated amphibian mortality events occurred at 18 sites (35%), initially only in proximity of the 2010 index site. Specimens belonging to approximately half of the native amphibian species were infected, including the threatened Pelobates fuscus (spadefoot toad). Clustered massive outbreaks involving dead adult specimens and ranavirus genomic identity indicated that one common midwife toad virus (CMTV)-like ranavirus strain is emerging in provinces in the north of the Netherlands. Modelling based on the spatiotemporal pattern of spread showed a high probability that this emerging virus will continue to be detected at new sites (the discrete reproductive power of this outbreak is 0.35). Phylogenetically distinct CMTV-like ranaviruses were found in the south of the Netherlands more recently. In addition to showing that CMTV-like ranaviruses threaten wild amphibian populations not only in Spain but also in the Netherlands, the current spread and risk of establishment reiterate that understanding the underlying causes of CMTV-like ranavirus emergence requires international attention.

Ketamine use for rapid sequence intubation in Australian and New Zealand emergency departments from 2010 to 2015: A registry study.

PubMed

Ferguson, Ian; Alkhouri, Hatem; Fogg, Toby; Aneman, Anders

2018-06-11

This study aimed to quantify the proportion of patients undergoing rapid sequence intubation using ketamine in Australian and New Zealand EDs between 2010 and 2015. The Australian and New Zealand Emergency Department Airway Registry is a multicentre airway registry prospectively capturing data from 43 sites. Data on demographics and physiology, the attending staff and indication for intubation were recorded. The primary outcome was the annual percentage of patients intubated with ketamine. A logistic regression analysis was conducted to evaluate the factors associated with ketamine use. A total of 4658 patients met inclusion criteria. The annual incidence of ketamine use increased from 5% to 28% over the study period (P < 0.0001). In the logistic regression analysis, the presence of an emergency physician as a team leader was the strongest predictor of ketamine use (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.44-2.34). The OR for an increase in one point on the Glasgow Coma Scale was 1.10 (95% CI 1.07-1.12), whereas an increase of 1 mmHg of systolic blood pressure had an OR of 0.98 (95% CI 0.98-0.99). Intubation occurring in a major referral hospital had an OR of 0.68 (95% CI 0.56-0.82), while trauma conferred an OR of 1.38 (95% CI 1.25-1.53). Ketamine use increased between 2010 and 2015. Lower systolic blood pressure, the presence of an emergency medicine team leader, trauma and a higher Glasgow Coma Scale were associated with increased odds of ketamine use. Intubation occurring in a major referral centre was associated with lower odds of ketamine use. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Early identification of trauma patients in need for emergent transfusion: results of a single-center retrospective study evaluating three scoring systems.

PubMed

Swerts, Frederic; Mathonet, Pierre Yves; Ghuysen, Alexandre; D Orio, Vincenzo; Minon, Jean Marc; Tonglet, Martin

2018-05-31

The Trauma-Induced Coagulopathy Clinical Score (TICCS) was developed to be calculable on the site of injury to discriminate between trauma patients with or without the need for damage control resuscitation and thus transfusion. This early alert could then be translated to in-hospital parameters at patient arrival. Base excess (BE) and ultrasound (FAST) are known to be predictive parameters for emergent transfusion. We emphasize that adding these two parameters to the TICCS could improve the scoring system predictability. A retrospective study was conducted in the University Hospital of Liège. TICCS was calculated for every patient. BE and FAST results were recorded and points were added to the TICCS according to the TICCS.BE definition (+ 3 points if BE < - 5 and + 3 points in case of a positive FAST). Emergent transfusion was defined as the use of at least one blood product in the resuscitation room. The capacity of the TICCS, the TICCS.BE and the Trauma-Associated Severe Hemorrhage (TASH) to predict emergent transfusion was assessed. A total of 328 patients were included. Among them, 14% needed emergent transfusion. The probability for emergent transfusion grows with the TICCS and the TICCS.BE values. We did not find a significant difference between the TICCS (AUC 0.73) and the TICCS.BE (AUC 0.76). The TASH proved to be more predictive (AUC 0.89). 66.6% of the patients with a TICCS ≥ 10 and 81.5% with a TICCS.BE ≥ 14 required emergent transfusion. Adding BE and FAST to the original TICCS does not significantly improve the scoring system predictability. A prehospital TICCS > 10 could be used as a trigger for emergent transfusion activation. TASH could then be used at hospital arrival. Prehospital TASH calculation may be possible but should be further investigated. Diagnostic test, level III.

Application of Near-Surface Remote Sensing and computer algorithms in evaluating impacts of agroecosystem management on Zea mays (corn) phenological development in the Platte River - High Plains Aquifer Long Term Agroecosystem Research Network field sites.

NASA Astrophysics Data System (ADS)

Okalebo, J. A.; Das Choudhury, S.; Awada, T.; Suyker, A.; LeBauer, D.; Newcomb, M.; Ward, R.

2017-12-01

The Long-term Agroecosystem Research (LTAR) network is a USDA-ARS effort that focuses on conducting research that addresses current and emerging issues in agriculture related to sustainability and profitability of agroecosystems in the face of climate change and population growth. There are 18 sites across the USA covering key agricultural production regions. In Nebraska, a partnership between the University of Nebraska - Lincoln and ARD/USDA resulted in the establishment of the Platte River - High Plains Aquifer LTAR site in 2014. The site conducts research to sustain multiple ecosystem services focusing specifically on Nebraska's main agronomic production agroecosystems that comprise of abundant corn, soybeans, managed grasslands and beef production. As part of the national LTAR network, PR-HPA participates and contributes near-surface remotely sensed imagery of corn, soybean and grassland canopy phenology to the PhenoCam Network through high-resolution digital cameras. This poster highlights the application, advantages and usefulness of near-surface remotely sensed imagery in agroecosystem studies and management. It demonstrates how both Infrared and Red-Green-Blue imagery may be applied to monitor phenological events as well as crop abiotic stresses. Computer-based algorithms and analytic techniques proved very instrumental in revealing crop phenological changes such as green-up and tasseling in corn. This poster also reports the suitability and applicability of corn-derived computer based algorithms for evaluating phenological development of sorghum since both crops have similarities in their phenology; with sorghum panicles being similar to corn tassels. This later assessment was carried out using a sorghum dataset obtained from the Transportation Energy Resources from Renewable Agriculture Phenotyping Reference Platform project, Maricopa Agricultural Center, Arizona.

Consequence assessment for Airborne Releases of SO{sub 2} from the Y-12 Pilot Dechlorination Facility

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

Pendergrass, W.R.

The Atmospheric Turbulence and Diffusion Division was requested by the Department of Energy`s Oak Ridge Operations Office to conduct a consequence assessment for potential atmospheric releases of SO{sub 2} from the Y-12 Pilot Dechlorination Facility. The focus of the assessment was to identify ``worst`` case meteorology which posed the highest concentration exposure potential for both on-site as well as off-site populations. A series of plausible SO{sub 2} release scenarios were provided by Y-12 for the consequence assessment. Each scenario was evaluated for predictions of downwind concentration, estimates of a five-minute time weighted average, and estimate of the dimension of themore » puff. The highest hazard potential was associated with Scenario 1, in which a total of eight SO{sub 2} cylinders are released internally to the Pilot Facility and exhausted through the emergency venting system. A companion effort was also conducted to evaluate the potential for impact of releases of SO{sub 2} from the Pilot Facility on the population of Oak Ridge. While specific transport trajectory data is not available for the Pilot Facility, extrapolations based on the Oak Ridge Site Survey and climatological records from the Y-12 meteorological program does not indicate the potential for impact on the city of Oak Ridge. Steering by the local topographical features severely limits the potential impact ares. Due to the lack of specific observational data, both tracer and meteorological, only inferences can be made concerning impact zones. It is recommended tat the Department of Energy Oak Ridge Operations examine the potential for off-site impact and develop the background data to prepare impact zones for releases of hazardous materials from the Y-12 facility.« less

A Molecular Sensor To Characterize Arenavirus Envelope Glycoprotein Cleavage by Subtilisin Kexin Isozyme 1/Site 1 Protease.

PubMed

Oppliger, Joel; da Palma, Joel Ramos; Burri, Dominique J; Bergeron, Eric; Khatib, Abdel-Majid; Spiropoulou, Christina F; Pasquato, Antonella; Kunz, Stefan

2016-01-15

Arenaviruses are emerging viruses including several causative agents of severe hemorrhagic fevers in humans. The advent of next-generation sequencing technology has greatly accelerated the discovery of novel arenavirus species. However, for many of these viruses, only genetic information is available, and their zoonotic disease potential remains unknown. During the arenavirus life cycle, processing of the viral envelope glycoprotein precursor (GPC) by the cellular subtilisin kexin isozyme 1 (SKI-1)/site 1 protease (S1P) is crucial for productive infection. The ability of newly emerging arenaviruses to hijack human SKI-1/S1P appears, therefore, to be a requirement for efficient zoonotic transmission and human disease potential. Here we implement a newly developed cell-based molecular sensor for SKI-1/S1P to characterize the processing of arenavirus GPC-derived target sequences by human SKI-1/S1P in a quantitative manner. We show that only nine amino acids flanking the putative cleavage site are necessary and sufficient to accurately recapitulate the efficiency and subcellular location of arenavirus GPC processing. In a proof of concept, our sensor correctly predicts efficient processing of the GPC of the newly emergent pathogenic Lujo virus by human SKI-1/S1P and defines the exact cleavage site. Lastly, we employed our sensor to show efficient GPC processing of a panel of pathogenic and nonpathogenic New World arenaviruses, suggesting that GPC cleavage represents no barrier for zoonotic transmission of these pathogens. Our SKI-1/S1P sensor thus represents a rapid and robust test system for assessment of the processing of putative cleavage sites derived from the GPCs of newly discovered arenavirus by the SKI-1/S1P of humans or any other species, based solely on sequence information. Arenaviruses are important emerging human pathogens that can cause severe hemorrhagic fevers with high mortality in humans. A crucial step in productive arenavirus infection of human cells is the processing of the viral envelope glycoprotein by the cellular subtilisin kexin isozyme 1 (SKI-1)/site 1 protease (S1P). In order to break the species barrier during zoonotic transmission and cause severe disease in humans, newly emerging arenaviruses must be able to hijack human SKI-1/S1P efficiently. Here we implement a newly developed cell-based molecular sensor for human SKI-1/S1P to characterize the processing of arenavirus glycoproteins in a quantitative manner. We further use our sensor to correctly predict efficient processing of the glycoprotein of the newly emergent pathogenic Lujo virus by human SKI-1/S1P. Our sensor thus represents a rapid and robust test system with which to assess whether the glycoprotein of any newly emerging arenavirus can be efficiently processed by human SKI-1/S1P, based solely on sequence information. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Emergency presentations of head and neck cancer: a modern perspective.

PubMed

Bannister, M; Vallamkondu, V; Ah-See, K W

2016-06-01

Head and neck cancer emergency presentations are uncommon but persistent. However, there is little published literature on this aspect of cancer and patient demographics. This study aimed to assess the incidence, patient profile, tumour site and stage of emergency cancer presentations in our region. Retrospective review of regional cancer database over a five-year period. Emergency presentations accounted for 7 per cent of all cases. There was no difference in patient age and risk factors between the emergency and non-emergency presentations. The emergency presentation group showed a greater proportion of female patients compared to the non-emergency presentation group (30 vs 15 per cent). In all emergency presentations, the cancer was at advanced stages. Oropharyngeal cancer was the commonest emergency presentation of cancer, but the third commonest in the non-emergency group. Emergency presentations are increasing annually. Female patients and oropharyngeal cancer showed greater representation compared to male patients and laryngeal cancer.

[Current state of measures to deal with natural disasters at public universities].

PubMed

Hirouchi, Tomoko; Tanka, Mamoru; Shimada, Ikuko; Yoshimoto, Yoshinobu; Sato, Atsushi

2012-03-01

The responsibility of a university after a large-scale, natural disaster is to secure the safety of students' and local residents' lives. The present study investigated the current state of measures at public universities to deal with natural disasters in coordination with the local community. A survey was administered at 77 public universities in Japan from March 25 to May 10, 2011. The survey included questions on the existence of local disaster evacuation sites, a disaster manual, disaster equipment storage, emergency drinking water, and food storage. A total of 51% of universities had designated local evacuation sites. Based on responses for the remaining questions, universities with and without the designated disaster response solutions accounted for 42% and 57%, respectively, for disaster manuals; 55% and 33%, respectively, for disaster equipment; 32% and 13%, respectively, for disaster drinking water storage; and 26% and 7%, respectively, for emergency food storage. A majority of public universities have not created disaster manuals, regardless of whether they have a local evacuation site. The survey results also indicated that most universities have no storage of disaster equipment or emergency supplies.

Communications between local health departments and the public during emergencies: the importance of standardized web sites.

PubMed

Fallon, L Fleming; Schmalzried, Hans D; Hasan, Nausheen

2011-01-01

Of the 2790 local health departments (LHDs) in the United States, Internet homepages were located for 1986. We reviewed each homepage to document the presence of 9 elements deemed to be critical for effective communications during emergency or disaster situations. LHD Web site homepages had a mean of 4.1 (±1.4) elements. Among the findings, this review revealed that 4 of 5 (80.5%) of the LHDs included the agency phone number, half (49.4%) provided links to emergency information, and about 1 in 5 (19.6%) listed an agency e-mail address. Fewer than 1 in 20 (4.3%) of the LHD homepages reviewed allowed visitors to sign up for automatic alerts or notifications. We suggest that these results be used as a starting point in developing a standardized template containing the 9 homepage elements. Such a template complements National Incident Management System protocols and can provide a recognizable source of consistent and reliable information for people during a public health emergency or disaster.

AHERA CLEARANCE AT TWENTY ABATEMENT SITES

EPA Science Inventory

A study was conducted during the summer of 1988 to document Asbestos Hazard Emergency Response Act (AHERA) clearance air-sampling practices and clearance concentrations of airborne asbestos at 20 asbestos-abatement sites in New Jersey. Each abatement took place in a school buildi...

AHERA CLEARANCE AT TWENTY ABATEMENT SITES

EPA Science Inventory

A study was conducted during the summer of 1988 to document Asbestos Hazard Emergency Response Act (AHERA) clearance air sampling practices and clearance concentrations of airborne asbestos at 20 asbestos-abatement sites in New Jersey. ach abatement took place in a school buildin...

The Emergency Department: Challenges and Opportunities for Suicide Prevention.

PubMed

Asarnow, Joan Rosenbaum; Babeva, Kalina; Horstmann, Elizabeth

2017-10-01

Emergency departments (EDs) can offer life-saving suicide prevention care. This article focuses on the ED and emergency services as service delivery sites for suicide prevention. Characteristics of EDs, models of emergency care, ED screening and brief intervention models, and practice guidelines and parameters are reviewed. A care process model for youths at risk for suicide and self-harm is presented, with guidance for clinicians based on the scientific evidence. Strengthening emergency infrastructure and integrating effective suicide prevention strategies derived from scientific research are critical for advancing suicide prevention objectives. Copyright © 2017 Elsevier Inc. All rights reserved.

10 CFR 960.3-2-2-3 - Comparative evaluation of all sites proposed for nomination.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Comparative evaluation of all sites proposed for...-3 Comparative evaluation of all sites proposed for nomination. Sixth, for those potentially... reasonable comparative evaluation of each such site with all other such sites shall be made. For each site...

10 CFR 960.3-2-2-3 - Comparative evaluation of all sites proposed for nomination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Comparative evaluation of all sites proposed for...-3 Comparative evaluation of all sites proposed for nomination. Sixth, for those potentially... reasonable comparative evaluation of each such site with all other such sites shall be made. For each site...

10 CFR 960.3-2-2-3 - Comparative evaluation of all sites proposed for nomination.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Comparative evaluation of all sites proposed for...-3 Comparative evaluation of all sites proposed for nomination. Sixth, for those potentially... reasonable comparative evaluation of each such site with all other such sites shall be made. For each site...

10 CFR 960.3-2-2-3 - Comparative evaluation of all sites proposed for nomination.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Comparative evaluation of all sites proposed for...-3 Comparative evaluation of all sites proposed for nomination. Sixth, for those potentially... reasonable comparative evaluation of each such site with all other such sites shall be made. For each site...

10 CFR 960.3-2-2-3 - Comparative evaluation of all sites proposed for nomination.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Comparative evaluation of all sites proposed for...-3 Comparative evaluation of all sites proposed for nomination. Sixth, for those potentially... reasonable comparative evaluation of each such site with all other such sites shall be made. For each site...

Towards the Enhancement of "MINOR" Archaeological Heritage

NASA Astrophysics Data System (ADS)

Morandi, S.; Tremari, M.; Mandelli, A.

2017-02-01

The research is an analysis of the recording, reconstruction and visualisation of the 3D data of a XVIII century watermill, identified in an emergency archaeological excavation during the construction of the mini-hydroelectric plant on the bank of the Adda river in the municipality of Pizzighettone (Cremona, Lombardy, Italy). The work examines the use and the potentials of modern digital 3D modelling techniques applied to archaeological heritage aimed to increase the research, maintenance and presentation with interactive products. The use of three-dimensional models managed through AR (Augmented Reality) and VR (Virtual Reality) technologies with mobile devices gives several opportunities in the field of study and communication. It also improves on-site exploration of the landscape, enhancing the "minor" archaeological sites, daily subjected to numerous emergency works and facilitating the understanding of heritage sites.

Multi-hierarchical movements in self-avoiding walks

NASA Astrophysics Data System (ADS)

Sakiyama, Tomoko; Gunji, Yukio-Pegio

2017-07-01

A self-avoiding walk (SAW) is a series of moves on a lattice that visit the same place only once. Several studies reported that repellent reactions of foragers to previously visited sites induced power-law tailed SAWs in animals. In this paper, we show that modelling the agent's multi-avoidance reactions to its trails enables it to show ballistic movements which result in heavy-tailed movements. There is no literature showing emergent ballistic movements in SAWs. While following SAWs, the agent in my model changed its reactions to marked patches (visited sites) by considering global trail patterns based on local trail patterns when the agent was surrounded by previously visited sites. As a result, we succeeded in producing ballistic walks by the agents which exhibited emergent power-law tailed movements.

Managing and understanding risk perception of surface leaks from CCS sites: risk assessment for emerging technologies and low-probability, high-consequence events

NASA Astrophysics Data System (ADS)

Anagnostou, E. N.; Seyyedi, H.; Beighley, E., II; McCollum, J.

2014-12-01

Carbon capture and storage (CCS) has been suggested by the Intergovernmental Panel on Climate Change as a partial solution to the greenhouse gas emissions problem. As CCS has become mainstream, researchers have raised multiple risk assessment issues typical of emerging technologies. In our research, we examine issues occuring when stored carbon dioxide (CO2) migrates to the near-surface or surface. We believe that both the public misperception and the physical reality of potential environmental, health, and commercial impacts of leak events from such subsurface sites have prevented widespread adoption of CCS. This paper is presented in three parts; the first is an evaluation of the systemic risk of a CCS site CO2 leak and models indicating potential likelihood of a leakage event. As the likelihood of a CCS site leak is stochastic and nonlinear, we present several Bayesian simulations for leak events based on research done with other low-probability, high-consequence gaseous pollutant releases. Though we found a large, acute leak to be exceptionally rare, we demonstrate potential for a localized, chronic leak at a CCS site. To that end, we present the second piece of this paper. Using a combination of spatio-temporal models and reaction-path models, we demonstrate the interplay between leak migrations, material interactions, and atmospheric dispersion for leaks of various duration and volume. These leak-event scenarios have implications for human, environmental, and economic health; they also have a significant impact on implementation support. Public acceptance of CCS is essential for a national low-carbon future, and this is what we address in the final part of this paper. We demonstrate that CCS remains unknown to the general public in the United States. Despite its unknown state, we provide survey findings -analyzed in Slovic and Weber's 2002 framework - that show a high unknown, high dread risk perception of leaks from a CCS site. Secondary findings are a conflation of CCS with the more advanced, widespread technology hydraulic fracturing and corresponding strong risk associations. We conclude with suggestions on how to integrate modeling results into public conversations to improve risk awareness and we provide preliminary policy recommendations to increase public support for CCS.

Managing and understanding risk perception of surface leaks from CCS sites: risk assessment for emerging technologies and low-probability, high-consequence events

NASA Astrophysics Data System (ADS)

Augustin, C. M.

2015-12-01

Carbon capture and storage (CCS) has been suggested by the Intergovernmental Panel on Climate Change as a partial solution to the greenhouse gas emissions problem. As CCS has become mainstream, researchers have raised multiple risk assessment issues typical of emerging technologies. In our research, we examine issues occuring when stored carbon dioxide (CO2) migrates to the near-surface or surface. We believe that both the public misperception and the physical reality of potential environmental, health, and commercial impacts of leak events from such subsurface sites have prevented widespread adoption of CCS. This paper is presented in three parts; the first is an evaluation of the systemic risk of a CCS site CO2 leak and models indicating potential likelihood of a leakage event. As the likelihood of a CCS site leak is stochastic and nonlinear, we present several Bayesian simulations for leak events based on research done with other low-probability, high-consequence gaseous pollutant releases. Though we found a large, acute leak to be exceptionally rare, we demonstrate potential for a localized, chronic leak at a CCS site. To that end, we present the second piece of this paper. Using a combination of spatio-temporal models and reaction-path models, we demonstrate the interplay between leak migrations, material interactions, and atmospheric dispersion for leaks of various duration and volume. These leak-event scenarios have implications for human, environmental, and economic health; they also have a significant impact on implementation support. Public acceptance of CCS is essential for a national low-carbon future, and this is what we address in the final part of this paper. We demonstrate that CCS remains unknown to the general public in the United States. Despite its unknown state, we provide survey findings -analyzed in Slovic and Weber's 2002 framework - that show a high unknown, high dread risk perception of leaks from a CCS site. Secondary findings are a conflation of CCS with the more advanced, widespread technology hydraulic fracturing and corresponding strong risk associations. We conclude with suggestions on how to integrate modeling results into public conversations to improve risk awareness and we provide preliminary policy recommendations to increase public support for CCS.