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

Not Available

This study compared conditions, practices, and attitudes at underground bituminous coal mines having low injury incidence rates with those found at mines having high injury incidence rates. Several characteristics common to many of the low incidence rate mines that differentiate them from those having high incidence rates were identified. (1) Training programs: adequate and relevant training materials; qualified instructors; restricted classroom size to encourage student participation; and tailored to meet individual miner needs. (2) Management/labor relations tend to have a positive impact upon a mine's accident and injury experience when: both management and labor have a positive attitude toward safetymore » and health; open lines of communication permit management and labor to jointly reconcile problems affecting safety and health; representatives of labor become actively involved in issues concerning safety, health and production; and management and labor identify and accept their joint responsibility for correcting unsafe conditions and practices. (3) Safety and health conditions are improved when: standard operating procedures are established, understood, and implemented; management equitably enforces established policies concerning absenteeism, job assignments, and standard operating procedures; formal safety and health programs are communicated to all employees and subsequently implemented by management and labor; safety department has top management support in terms of funds, manpower, and the authority necessary to implement the safety and health program; mine plans are thoroughly reviewed by management, labor, and MSHA to insure that such plans incorporate measures to adequately control the physical environment of a coal mine; and MSHA inspection activity is most effective when the inspectors encourage increased cooperative interaction between themselves, mine management, and labor.« less

Using archived data to measure operational benefits of ITS investments, volume 2 : region 1 incident response program.

DOT National Transportation Integrated Search

2004-06-01

The objective of this project is to use the existing data, surveillance and communications infrastructure (to the extent possible) to : develop two case study evaluations for Oregon, including an evaluation of the COMET incident management program an...

76 FR 24901 - Privacy Act of 1974; Department of Homeland Security United States Coast Guard-DHS/USCG-002...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-03

.... USCG Critical Incident Stress Management-related records: Work-Life staff, Peers, Incident commander... leadership personnel regarding alleged work place violence incidents; USCG Critical Incident Stress... Work-Life Offices who are responsible for providing services for the related programs described above...

Rhode Island congestion management plan : executive summary

DOT National Transportation Integrated Search

1997-09-01

This document provides an overview of the Rhode Island Congestion Management System (CMS) program consisting of the following: Congestion Management System Plan; Incident Management Plan; and Intelligent Transportation System (ITS) Early Deployment P...

Vision for a treasured resource. Part 2. Nurse manager learning needs.

PubMed

Horvath, K J; Aroian, J F; Secatore, J A; Alpert, H; Costa, M J; Powers, E; Stengrevics, S S

1997-04-01

Part 1 in this two-part series focused on the meaning of significant incidents in nurse managers' practice related to role implementation. Explanation of the authors' application of the Manager as Developer Model (MADM) as a useful model for organizing and understanding some of the data was also discussed. Part 2 describes significant incidents in nurse managers' practice related to their ongoing learning needs. The authors address issues of performance counseling and intervention versus coaching and make recommendations for management development programs.

Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Technology

PubMed Central

Yang, Ruijie; Wang, Junjie; Zhang, Xile; Sun, Haitao; Gao, Yang; Liu, Lu; Lin, Lei

2014-01-01

Objective. To explore the implementation of incident learning for quality management of radiotherapy in a new established radiotherapy program. Materials and Methods. With reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically established for reporting, investigating, and learning of individual incidents. The incidents that occurred in external beam radiotherapy from February, 2012, to February, 2014, were reported. Results. A total of 28 near misses and 5 incidents were reported. Among them, 5 originated in imaging for planning, 25 in planning, and 1 in plan transfer, commissioning, and delivery, respectively. One near miss/incident was classified as wrong patient, 7 wrong sites, 6 wrong laterality, and 5 wrong dose. Five reported incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, and inadequate training contributed to 19, 15, and 12 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4. Conclusion. Effective implementation of incident learning can reduce the occurrence of near misses/incidents and enhance the culture of safety. PMID:25140309

ITS Architecture Development Program, Phase I; Summary Report

DOT National Transportation Integrated Search

1994-11-01

IN-VEHICLE EMISSIONS DIAGNOSIS, COMMERCIAL VEHICLES OPERATIONS OR CVO, ADVANCED VEHICLE CONTROL AND SAFETY SYSTEMS OR AVCSS, ADVANCED PUBLIC TRANSPORTATION SYSTEMS OR APTS, INCIDENT MANAGEMENT/INCIDENT DETECTION, COLLISION AVOIDANCE SYSTEM, AUTOMATED...

Don't overlook disease management programs for low-incidence, high-cost diseases to improve your bottom line.

PubMed

Bruce, D; Dickmeyer, J

2001-01-01

Comprehensive coordinated care management for low-incident, high-cost diseases, like chronic renal failure, can provide a great opportunity for health plans to add immediate and significant profit to their bottom line. The resultant benefits of improved operations, improved clinical outcomes and increased patient satisfaction add further incentive for health plans to take action to implement outsourced disease management for this condition.

From novice to proficient general practitioner: a critical incident study.

PubMed

Sim, M G; Kamien, M; Diamond, M R

1996-09-01

To obtain information about any change in the performance or perceptions of doctors undertaking the Royal Australian College of General Practitioners (RACGP) Training Program, with advancing general practice experience. The critical incident technique' was used, which is a comparative qualitative analysis. It involved interviews at 12 to 18 months after the basic term interview. Eighteen Western Australian doctors, who had been interviewed in 1992, at the end of their first 6 months of general practice training and were now completing their advanced or mentor terms in the RACGP Training Program took part in the study. Doctors reported an average of 4.4 critical incidents in their first interview and 5.0 in their second interview. The major areas of positive change included relationships with patients and other health care professionals, including supervisors; paediatrics and orthopaedics skills; the skills of developing a therapeutic relationship to enhance patient compliance and the ability to manage complex cardiovascular and psychiatric problems without reliance on specialist referral; attitudes of responsibility for and enjoyment of long term care of patients and families; and reduced levels of anxiety over difficult problems. New or continuing areas of difficulty were found in gynaecology; pharmacotherapy and dermatology; the diagnosis of common complaints with uncommon presentations; the skill of managing difficult or angry patients; the organisation for the follow-up of patients with potentially severe disorders; and in managing feelings of guilt over missed diagnoses or poor management. An analysis of commonly occurring positive and negative critical incidents shows that RACGP Training Program doctors develop competence, confidence and reduced levels of performance anxiety with advancing experience. All but one doctor found the Training Program helpful in achieving these proficiencies. However, many ongoing areas of difficulty remain. The Critical Incident method is a useful tool for learning and assessment in a vocational training program.

The effectiveness of the error reporting promoting program on the nursing error incidence rate in Korean operating rooms.

PubMed

Kim, Myoung-Soo; Kim, Jung-Soon; Jung, In Sook; Kim, Young Hae; Kim, Ho Jung

2007-03-01

The purpose of this study was to develop and evaluate an error reporting promoting program(ERPP) to systematically reduce the incidence rate of nursing errors in operating room. A non-equivalent control group non-synchronized design was used. Twenty-six operating room nurses who were in one university hospital in Busan participated in this study. They were stratified into four groups according to their operating room experience and were allocated to the experimental and control groups using a matching method. Mann-Whitney U Test was used to analyze the differences pre and post incidence rates of nursing errors between the two groups. The incidence rate of nursing errors decreased significantly in the experimental group compared to the pre-test score from 28.4% to 15.7%. The incidence rate by domains, it decreased significantly in the 3 domains-"compliance of aseptic technique", "management of document", "environmental management" in the experimental group while it decreased in the control group which was applied ordinary error-reporting method. Error-reporting system can make possible to hold the errors in common and to learn from them. ERPP was effective to reduce the errors of recognition-related nursing activities. For the wake of more effective error-prevention, we will be better to apply effort of risk management along the whole health care system with this program.

The Effect of Intravenous Infiltration Management Program for Hospitalized Children.

PubMed

Park, Soon Mi; Jeong, Ihn Sook; Kim, Kyoung Lae; Park, Kyung Ju; Jung, Moon Ju; Jun, Seong Suk

2016-01-01

This study aimed to identify the effect of IV infiltration management program among hospitalized children. This was a quasi-experimental study with history comparison group design with 2,894 catheters inserted during 3 months comparison phase and 3,651 catheters inserted during 4 months experimental phase. The intervention was composed of seven activities including applying poster, documentation of catheter insertion, parents education, making infiltration report, assessment of vein condition before inserting catheter, appropriate site selection, and documentation of catheter insertion, and assessment of peripheral catheter insertion site every shift. Data were analyzed using of X2-test, Fisher's exact test. The infiltration incidence rate was 0.9% for experimental group and 4.4% for comparison group, which was significantly different (x2=80.42, p<.001). The catheter maintenance period (p=.035) and infiltration state (p=.039) were significantly different among participants with infiltration between comparison and experimental groups. IV Infiltration management program was founded to be effective in reducing the IV infiltration incidence rate and increasing early detection of IV infiltration. Considering the effect of IV Infiltration management program, we recommend that this infiltration management program would be widely used in the clinical settings. Copyright © 2016 Elsevier Inc. All rights reserved.

Advanced consequence management program: challenges and recent real-world implementations

NASA Astrophysics Data System (ADS)

Graser, Tom; Barber, K. S.; Williams, Bob; Saghir, Feras; Henry, Kurt A.

2002-08-01

The Enhanced Consequence Management, Planning and Support System (ENCOMPASS) was developed under DARPA's Advanced Consequence Management program to assist decision-makers operating in crisis situations such as terrorist attacks using conventional and unconventional weapons and natural disasters. ENCOMPASS provides the tools for first responders, incident commanders, and officials at all levels to share vital information and consequently, plan and execute a coordinated response to incidents of varying complexity and size. ENCOMPASS offers custom configuration of components with capabilities ranging from map-based situation assessment, situation-based response checklists, casualty tracking, and epidemiological surveillance. Developing and deploying such a comprehensive system posed significant challenges for DARPA program management, due to an inherently complex domain, a broad spectrum of customer sites and skill sets, an often inhospitable runtime environment, demanding development-to-deployment transition requirements, and a technically diverse and geographically distributed development team. This paper introduces ENCOMPASS and explores these challenges, followed by an outline of selected ENCOMPASS deployments, demonstrating how ENCOMPASS can enhance consequence management in a variety real world contexts.

Incidence and Management Costs of Freshwater Aquatic Nuisance Species at Projects Operated by the U.S. Army Corps of Engineers

DTIC Science & Technology

2010-07-01

the occurrence of ANS impacts (Yes or No) from freshwater algae, large aquatic plants, fish, zebra mussels, Asiatic clams, water fleas, crayfish...2005. Freshwater aquatic nuisance species impacts and management costs and benefits at federal water resources projects. ERDC/TN ANSRP-06-3...ER D C/ EL T R- 10 -1 3 Aquatic Nuisance Species Research Program Incidence and Management Costs of Freshwater Aquatic Nuisance Species

Development of an asthma disease management program in a children's hospital.

PubMed

Miller, Kelly; Ward-Smith, Peggy; Cox, Karen; Jones, Erika M; Portnoy, Jay M

2003-11-01

The incidence, morbidity, and mortality of asthma have been increasing at an alarming rate, making asthma the most common chronic illness of childhood. An asthma disease management program was developed to improve the care and management of patients with asthma--a comprehensive health care delivery model that was designed to improve the management of patients with asthma was designed and implemented. The goal of the program was to provide high-quality interventions for those children diagnosed with asthma. The asthma disease management program at Children's Mercy Hospital improved the care received, decreased costs, and improved the quality of life for those children with asthma.

Integrated Modeling, Mapping, and Simulation (IMMS) framework for planning exercises.

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

Friedman-Hill, Ernest J.; Plantenga, Todd D.

2010-06-01

The Integrated Modeling, Mapping, and Simulation (IMMS) program is designing and prototyping a simulation and collaboration environment for linking together existing and future modeling and simulation tools to enable analysts, emergency planners, and incident managers to more effectively, economically, and rapidly prepare, analyze, train, and respond to real or potential incidents. When complete, the IMMS program will demonstrate an integrated modeling and simulation capability that supports emergency managers and responders with (1) conducting 'what-if' analyses and exercises to address preparedness, analysis, training, operations, and lessons learned, and (2) effectively, economically, and rapidly verifying response tactics, plans and procedures.

Near-miss incident management in the chemical process industry.

PubMed

Phimister, James R; Oktem, Ulku; Kleindorfer, Paul R; Kunreuther, Howard

2003-06-01

This article provides a systematic framework for the analysis and improvement of near-miss programs in the chemical process industries. Near-miss programs improve corporate environmental, health, and safety (EHS) performance through the identification and management of near misses. Based on more than 100 interviews at 20 chemical and pharmaceutical facilities, a seven-stage framework has been developed and is presented herein. The framework enables sites to analyze their own near-miss programs, identify weak management links, and implement systemwide improvements.

A critical incident study of general practice trainees in their basic general practice term.

PubMed

Diamond, M R; Kamien, M; Sim, M G; Davis, J

1995-03-20

To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Safety awareness, pilot education, and incident reporting programs

NASA Technical Reports Server (NTRS)

Enders, J.

1984-01-01

Education in safety awareness, pilot training, and accident reporting is discussed. Safety awareness and risk management are examined. Both quantitative and qualitive risk management are explored. Information dissemination on safety is considered.

Redding Responder phase I final report.

DOT National Transportation Integrated Search

2005-12-19

The Redding Responder Study was initiated as a component of the Redding Incident : Management Enhancement (RIME) Program. The goals of the RIME program are to leverage : technology and communications deployments for emergency communication providers ...

CTC Sentinel. Volume 2, Issue 6, June 2009

DTIC Science & Technology

2009-06-01

Pakistan also makes it easier for al-Qa`ida to manage local perceptions and deny involvement in controversial terrorist attacks within the country...Combating Terrorism Center (CTC) at West Point, where he manages the Harmony Program and is developing the CTC’s South Asian research program. Prior to...operational art. Police operational art is defined as the capacity to go beyond managing single tactical incidents to influencing the effects of multiple

Division of Forestry Fire and Aviation Program

Science.gov Websites

Conservation Education Timber Management Wildland Fire & Aviation Burn Permits Firewise Alaska Brochure (PDF) Fire Management Plans Fire Assignments Annual Fire Statistics Fire Terms Glossary Incident Business Management Grants Become an Alaska Firewise Community Community Wildland Fire Protection Plans

The Efficacy of a Multifaceted Weight Management Program for Children and Young Adolescents

ERIC Educational Resources Information Center

Kihm, Holly Spencer

2014-01-01

The incidence of overweight and obesity among children and young adolescents remains unacceptably high and places our youth at risk for several negative outcomes. Recognizing the need for a youth-focused weight management program in our community, the researcher developed, implemented, and evaluated a small pilot study, FitKids. The aims of…

A return on investment study of the Hampton Roads Safety Service Patrol program.

DOT National Transportation Integrated Search

2007-01-01

Safety Service Patrol (SSP) programs are widely used to help mitigate the effects of nonrecurring congestion on our nation's highways and have become an increasingly vital element of incident management programs. SSPs are typically deployed in areas ...

14 CFR 91.1021 - Internal safety reporting and incident/accident response.

Code of Federal Regulations, 2010 CFR

2010-01-01

.../accident response. 91.1021 Section 91.1021 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... incident/accident response. (a) Each program manager must establish an internal anonymous safety reporting...

Topical Backgrounder: New Ways to Prevent Chemical Incidents

EPA Pesticide Factsheets

Part of a May 1999 series of publications on the Risk Management Program Rule and issues related to chemical emergency management. Explains how RMP compliance and the impact of right-to-know will reduce hazards.

Cultural differences in dealing with critical incidents.

PubMed

Leonhardt, Jörg; Vogt, Joachim

2009-01-01

This article discusses the cultural aspects of High Reliability Organizations (HROs), such as air navigation services. HROs must maintain a highly professional safety culture and constantly be prepared to handle crises. The article begins with a general discussion of the concept of organizational culture. The special characteristics of HROs and their safety culture is then described. Finally the article illustrates how Critical Incident Stress Management (CISM) is becoming an ingrained feature of the organizational culture in air traffic control systems. Critical Incident Stress Management is a prevention program that can successfully guard against the negative effects of critical incidents. The CISM program of DFS (Deutsche Flugsicherung) was recently evaluated by the University of Copenhagen. This evaluation not only confirmed the successful prevention of negative effects at the operation's employee level (especially air traffic controllers), but also showed a sustained improvement of its safety culture and its overall organizational performance. The special aspects of cross-cultural crisis intervention and the challenges it faces, as well as the importance of prevention programs, such as CISM, are illustrated using the examples of two aircraft accidents: the crash landing of a calibration aircraft and the Lake Constance air disaster.

A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital

PubMed Central

Nakajima, K; Kurata, Y; Takeda, H

2005-01-01



Problem: When patient safety programs were mandated for Japanese health care institutions, a safety culture, a tool for collecting incident reports, an organizational arrangement for multidisciplinary collaboration, and interventional methods for improvement had to be established. Design: Observational study of effects of new patient safety programs. Setting: Osaka University Hospital, a large government-run teaching hospital. Strategy for change: A voluntary and anonymous web-based incident reporting system was introduced. For the new organizational structure a clinical risk management committee, a department of clinical quality management, and area clinical risk managers were established with their respective roles clearly defined to advance the plan-do-study-act cycle and to integrate efforts. For preventive action, alert procedures, staff education, ward rounds by peers, a system oriented approach for reducing errors, and various feedback channels were introduced. Effects of change: Continuous incident reporting by all hospital staff has been observed since the introduction of the new system. Several error inducing situations have been improved: wrong choice of drug in computer prescribing, maladministration of drugs due to a look-alike appearance or confusion about the manipulation of a medical device, and poor after hours service of the blood transfusion unit. Staff participation in educational seminars has been dramatically improved. Ward rounds have detected problematic procedures which needed to be dealt with. Lessons learnt: Patient safety programs based on a web-based incident reporting system, responsible persons, staff education, and a variety of feedback procedures can help promote a safety culture, multidisciplinary collaboration, and strong managerial leadership resulting in system oriented improvement. PMID:15805458

Regional Traffic Incident Management Programs : Implementation Guide

DOT National Transportation Integrated Search

2012-08-01

This report presents the test plan for conducting the Air Quality Analysis for the United States Department of Transportation (U.S. DOT) evaluation of the Dallas U.S. 75 Integrated Corridor Management (ICM) Initiative Demonstration. The ICM projects ...

Summary of the 2012 Wide Area Recovery and Resiliency Program (WARRP) Waste Management Workshop

EPA Pesticide Factsheets

Workshop advanced the planning of federal, state and local officials in the area of waste management following a chemical, biological or radiological wide-area incident in the Denver, Colorado urban area.

Safety and compliance-related hazards in the medical practice: Part one.

PubMed

Calway, R C

2001-01-01

Safety and risk management hazards are a fact of life for the medical practice, and the costs of these incidents can place the group at significant risk of liability. Good compliance and risk management programs help minimize these incidents, improve staff morale, increase a practice's visibility in the community, and positively affect the practice's financial and operational bottom line performance. Medical practices that implement effective safety and risk management programs can realize savings in staffing costs, operational efficiency, morale, insurance premiums, and improved third-party relationships while at the same time avoiding embarrassing risks, fines, and liability. This article outlines some of the most common safety and risk management-related deficiencies seen in medical practices today. The author explains how to remedy these deficiencies and provides a self-test tool to enable the reader to assess areas within his or her own practice in need of attention.

Results of an asthma disease management program in an urban pediatric community clinic.

PubMed

Newcomb, Patricia

2006-07-01

Asthma is increasing in incidence, but adherence to national diagnosis and treatment guidelines is poor. The Children's Asthma Management Program (CHAMP) was designed and implemented by nurse practitioners to address the problem of inconsistent asthma management. This is an outcome-based evaluation of a novel asthma management program in which practitioners created a structured mechanism for implementing national evidence-based asthma treatment guidelines. Children who completed the program experienced an 85% decrease in hospitalizations for asthma, 87% decrease in emergency room visits for asthma, and 71% decrease in acute office visits for asthma exacerbations. Patients may benefit from microsystem structures intentionally designed to facilitate implementation of evidence-based guidelines.

Report: Fiscal Year 2006 Federal Information Security Management Act Report Status of EPA’s Computer Security Program

EPA Pesticide Factsheets

Report #2006-S-00008, September 25, 2006. Although the Agency has made substantial progress to improve its security program, the OIG identified weaknesses in the Agency’s incident reporting practices.

Modeling wildfire incident complexity dynamics.

PubMed

Thompson, Matthew P

2013-01-01

Wildfire management in the United States and elsewhere is challenged by substantial uncertainty regarding the location and timing of fire events, the socioeconomic and ecological consequences of these events, and the costs of suppression. Escalating U.S. Forest Service suppression expenditures is of particular concern at a time of fiscal austerity as swelling fire management budgets lead to decreases for non-fire programs, and as the likelihood of disruptive within-season borrowing potentially increases. Thus there is a strong interest in better understanding factors influencing suppression decisions and in turn their influence on suppression costs. As a step in that direction, this paper presents a probabilistic analysis of geographic and temporal variation in incident management team response to wildfires. The specific focus is incident complexity dynamics through time for fires managed by the U.S. Forest Service. The modeling framework is based on the recognition that large wildfire management entails recurrent decisions across time in response to changing conditions, which can be represented as a stochastic dynamic system. Daily incident complexity dynamics are modeled according to a first-order Markov chain, with containment represented as an absorbing state. A statistically significant difference in complexity dynamics between Forest Service Regions is demonstrated. Incident complexity probability transition matrices and expected times until containment are presented at national and regional levels. Results of this analysis can help improve understanding of geographic variation in incident management and associated cost structures, and can be incorporated into future analyses examining the economic efficiency of wildfire management.

Transfusion risks and transfusion-related pro-inflammatory responses.

PubMed

Despotis, George John; Zhang, Lini; Lublin, Douglas M

2007-02-01

Despite improvements in blood screening and administration techniques, serious adverse events related to transfusion continue to occur, albeit at a much lower incidence. In addition to the development and implementation of new screening and blood purification/modification techniques and implementation of an optimal blood management program, the incidence and consequences of transfusion reactions can be reduced by a basic understanding of transfusion-related complications. Although acute hemolytic transfusion reactions, transfusion-associated anaphylaxis and sepsis, and transfusion-associated acute lung injury occur infrequently, diligence in administration of blood and monitoring for development of respective signs/symptoms can minimize the severity of these potentially life-threatening complications. In addition, emerging blood-banking techniques such as psoralen-UV inactivation of pathogens and use of patient identification systems may attenuate the incidence of adverse events related to transfusion. With respect to optimizing blood management by means of an effective blood management program involving pharmacologic and nonpharmacologic strategies, the ability to reduce use of blood products and to decrease operative time or re-exploration rates has important implications for disease prevention, blood inventory and costs, and overall health care costs.

[Second victim : Critical incident stress management in clinical medicine].

PubMed

Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A

2013-09-01

Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

Review of literature and practices for incident management programs : technical report.

DOT National Transportation Integrated Search

2016-06-01

The project team examined project evaluations, best practice summaries, and synthesis documents, and derived a summary of key elements of programs to speed the time to find and clear stalled vehicles and crashes from freeway shoulders and main lanes....

Idea Project Final Report, Autoalert: Automated Acoustic Detection Of Incidents

DOT National Transportation Integrated Search

1995-12-26

THIS INVESTIGATION WAS COMPLETED AS PART OF THE ITS-IDEA PROGRAM, WHICH IS ONE OF THREE IDEA PROGRAMS MANAGED BY THE TRANSPORTATION RESEARCH BOARD (TRB) TO FOSTER INNOVATIONS IN SURFACE TRANSPORTATION. IT FOCUSES ON PRODUCTS AND RESULTS FOR THE DEVEL...

Idea Project Final Report, A Prototype System For Real-Time Incident Likelihood Prediction

DOT National Transportation Integrated Search

1995-02-28

THIS INVESTIGATION WAS COMPLETED AS PART OF THE ITS-IDEA PROGRAM WHICH IS ONE OF THREE IDEA PROGRAMS MANAGED BY THE TRANSPORTATION RESEARCH BOARD (TRB) TO FOSTER INNOVATIONS IN SURFACE TRANSPORTATION. IT FOCUSES ON PRODUCTS AND RESULT FOR THE DEVELOP...

Local, Regional and National Responses for Medical Management of a Radiological/Nuclear Incident

PubMed Central

Dainiak, Nicholas; Skudlarska, Beata; Albanese, Joseph

2013-01-01

Radiological and nuclear devices may be used by terrorists or may be the source of accidental exposure. A tiered approach has been recommended for response to a terrorist event wherein local, regional, state and federal assets become involved sequentially, as the magnitude in severity of the incident increases. State-wide hospital plans have been developed and published for Connecticut, New York and California. These plans address delineation of responsibilities of various categories of health professionals, protection of healthcare providers, identification and classification of individuals who might have been exposed to and/or contaminated by radiation and, in the case of Connecticut response plan, early management of victims. Regional response programs such as the New England Regional Health Compact (consisting of 6 member states) have been developed to manage consequences of radiation injury. The Department of Homeland Security is ultimately responsible for managing both health consequences and the crisis. Multiple US national response assets may be called upon for use in radiological incidents. These include agencies and programs that have been developed by the Department of Energy, the Environmental Protection Agency and the Department of Defense. Coordination of national, regional and state assets with local response efforts is necessary to provide a timely and efficient response. PMID:23447742

Local, regional and national responses for medical management of a radiological/nuclear incident.

PubMed

Dainiak, Nicholas; Skudlarska, Beata; Albanese, Joseph

2013-01-01

Radiological and nuclear devices may be used by terrorists or may be the source of accidental exposure. A tiered approach has been recommended for response to a terrorist event wherein local, regional, state and federal assets become involved sequentially, as the magnitude in severity of the incident increases. State-wide hospital plans have been developed and published for Connecticut, New York and California. These plans address delineation of responsibilities of various categories of health professionals, protection of healthcare providers, identification and classification of individuals who might have been exposed to and/or contaminated by radiation and, in the case of Connecticut response plan, early management of victims. Regional response programs such as the New England Regional Health Compact (consisting of 6 member states) have been developed to manage consequences of radiation injury. The Department of Homeland Security is ultimately responsible for managing both health consequences and the crisis. Multiple US national response assets may be called upon for use in radiological incidents. These include agencies and programs that have been developed by the Department of Energy, the Environmental Protection Agency and the Department of Defense. Coordination of national, regional and state assets with local response efforts is necessary to provide a timely and efficient response.

Prospective Vigilance: Assessing Complex Coordinated Attack Preparedness Programs

DTIC Science & Technology

2017-12-01

for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and...significant challenges with incident command, strategic communication, and information management ; limitations in both training and equipment; and... information management ; limitations in both training and equipment; and inadequate response protocols.9 During the Mumbai CCA, fire and emergency

A Case Study in the Identification of Critical Factors Leading to Successful Implementation of the Hospital Incident Command System

DTIC Science & Technology

2015-06-01

California EMSA, National Incident Management System, NIMS, hospital preparedness program, Nursing Home Incident Command System, NHICS, Hospital...The International Journal of Trauma Nursing published an article in 2007 entitled “Organization of a Hospital-based Victim Decontamination Plan...Journal of Trauma Nursing 5, no. 4 (October– November 2007): 119–123. 32 Ellen Lanser May, “Scarred but Smarter: Lessons Learned from Florida’s 2004

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

PubMed

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

2008-09-01

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

Ethics and School Business Management.

ERIC Educational Resources Information Center

McCormick, Charles H.

1995-01-01

Lists a variety of possible ethical incidents that may confront a school business manager. Proposes that ethics be given adequate treatment in preservice programs, that all educators be made more aware of ethics, and that members of the profession be trained and encouraged to police their fellow members. (MLF)

Volunteer First Responders for Optimizing Management of Mass Casualty Incidents.

PubMed

Yafe, Eli; Walker, Blake Byron; Amram, Ofer; Schuurman, Nadine; Randall, Ellen; Friger, Michael; Adini, Bruria

2018-06-04

Rapid response to a trauma incident is vital for saving lives. However, in a mass casualty incident (MCI), there may not be enough resources (first responders and equipment) to adequately triage, prepare, and evacuate every injured person. To address this deficit, a Volunteer First Responder (VFR) program was established. This paper describes the organizational structure and roles of the VFR program, outlines the geographical distribution of volunteers, and evaluates response times to 3 MCIs for both ambulance services and VFRs in 2000 and 2016. When mapped, the spatial distribution of VFRs and ambulance stations closely and deliberately reflects the population distribution of Israel. We found that VFRs were consistently first to arrive at the scene of an MCI and greatly increased the number of personnel available to assist with MCI management in urban, suburban, and rural settings. The VFR program provides an important and effective life-saving resource to supplement emergency first response. Given the known importance of rapid response to trauma, VFRs likely contribute to reduced trauma mortality, although further research is needed in order to examine this question specifically. (Disaster Med Public Health Preparedness. 2018;page 1 of 8).

EAP-based critical incident stress management: utilization of a practice-based assessment of incident severity level in responding to workplace trauma.

PubMed

DeFraia, Gary S

2013-01-01

Central to the field of trauma psychology is assessment of the impact of critical incidents on individuals, as measured by individual symptoms of stress. Accordingly, the trauma literature reflects a proliferation of clinical impact of event scales. Workplace incidents however, affect not only individual employees, but also work organizations, requiring a multi-level response. Critical incident stress management (CISM) is the most prevalent multi-level incident response strategy utilized by organizations, often through specialized CISM units operating within their employee assistance programs (EAPs). While EAP-based CISM units seeks to support both individuals and organizations, studies focused on individual stress dominate the literature, mirroring assessment scales that tend to emphasize clinical as opposed to organizational practice. This research contributes to less-prevalent studies exploring incident characteristics as disruptive to organizations, rather than clinical symptoms as disruptive to individuals. To measure incident disruption, an EAP-based CISM unit developed a critical incident severity scale. By analyzing this unit's extensive practice database, this exploratory study examines how critical incident severity level varies among various types of incidents. Employing the methodology of clinical data mining, this practice-based research generates evidence-informed practice recommendations in the areas of EAP-based CISM intake assessment, organizational consultation and incident response planning.

Cost-effectiveness of diabetes case management for low-income populations.

PubMed

Gilmer, Todd P; Roze, Stéphane; Valentine, William J; Emy-Albrecht, Katrina; Ray, Joshua A; Cobden, David; Nicklasson, Lars; Philis-Tsimikas, Athena; Palmer, Andrew J

2007-10-01

To evaluate the cost-effectiveness of Project Dulce, a culturally specific diabetes case management and self-management training program, in four cohorts defined by insurance status. Clinical and cost data on 3,893 persons with diabetes participating in Project Dulce were used as inputs into a diabetes simulation model. The Center for Outcomes Research Diabetes Model, a published, peer-reviewed and validated simulation model of diabetes, was used to evaluate life expectancy, quality-adjusted life expectancy (QALY), cumulative incidence of complications and direct medical costs over patient lifetimes (40-year time horizon) from a third-party payer perspective. Cohort characteristics, treatment effects, and case management costs were derived using a difference in difference design comparing data from the Project Dulce program to a cohort of historical controls. Long-term costs were derived from published U.S. sources. Costs and clinical benefits were discounted at 3.0 percent per annum. Sensitivity analyses were performed. Incremental cost-effectiveness ratios of $10,141, $24,584, $44,941, and $69,587 per QALY gained were estimated for Project Dulce participants versus control in the uninsured, County Medical Services, Medi-Cal, and commercial insurance cohorts, respectively. The Project Dulce diabetes case management program was associated with cost-effective improvements in quality-adjusted life expectancy and decreased incidence of diabetes-related complications over patient lifetimes. Diabetes case management may be particularly cost effective for low-income populations.

Employee Assistance Programmes: The Emperor's New Clothes of Stress Management?

ERIC Educational Resources Information Center

Arthur, Andrew R.

2000-01-01

Discusses the employee assistance program (EAP), a benefit increasingly provided by United Kingdom employers that claims to reduce the effects of stress on individuals and organizations, provide a management tool to improve workplace performance and productivity, and respond to critical incidents. Describes EAPs, their history, development and…

Developing an interdisciplinary community-based sports concussion management program.

PubMed

LoGalbo, Anthony; Salinas, Christine M; Dougherty, Michael; Field, Mel

2014-01-01

The increasing incidence and associated consequences of sport-related concussion have been at the forefront of public health concerns in recent years, prompting the need for safe and effective management guidelines and availability of appropriately trained healthcare providers. In this report we provide practical and user-friendly information regarding several important factors to consider when developing a sports concussion program, including how to select relevant team members, assess community needs and available resources, provide concussion education, secure and nurture partnerships with athletic programs, implement management strategies that align with current practice standards, and cater to athletes' unique needs in terms of program accessibility. It is hoped that the knowledge shared and proposed recommendations will be beneficial for guiding both newly developing and established concussion programs alike. © 2014 S. Karger AG, Basel.

Idea Project Final Report, A Sequential Hypothesis Testing-Based Decision-Making System For Freeway Incident Response

DOT National Transportation Integrated Search

1995-10-01

THIS INVESTIGATION WAS COMPLETED AS PART OF THE ITS-IDEA PROGRAM WHICH IS ONE OF THREE IDEA PROGRAMS MANAGED BY THE TRANSPORTATION RESEARCH BOARD (TRB) TO FOSTER INNOVATIONS IN SURFACE TRANSPORTATION. IT FOCUSES ON PRODUCTS AND RESULT FOR THE DEVELOP...

[Impact of interventions in the pressure ulcer rate].

PubMed

Araya Farías, I; Febré, N

To evaluate the impact of a risk management program for prevention of pressure ulcers (PUs) in an adult Intensive Care Unit (ICU). A quantitative, prospective study performed with a «before and after» evaluation, and designed in three stages: 1) PU incidence study; 2) Intervention by implementing a risk management program, and 3) Assessment of the impact. Adherence to the preventive measures showed a significant increase (11.7%) between the first month of the program and the final month (58.5%) of the assessment. Initial PU rate was 20.9, with a decrease in the rate to 14.0 per 1000 bed occupancy days (P<.05) after the risk management program. The data show that the risk management program, using prevention measures, was effective in reducing the rate of PU in the period under study by more than 33%. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Cost of Preventing, Managing, and Treating Human Papillomavirus (HPV)-Related Diseases in Sweden before the Introduction of Quadrivalent HPV Vaccination

PubMed Central

Östensson, Ellinor; Fröberg, Maria; Leval, Amy; Hellström, Ann-Cathrin; Bäcklund, Magnus; Zethraeus, Niklas; Andersson, Sonia

2015-01-01

Objective Costs associated with HPV-related diseases such as cervical dysplasia, cervical cancer, and genital warts have not been evaluated in Sweden. These costs must be estimated in order to determine the potential savings if these diseases were eradicated and to assess the combined cost-effectiveness of HPV vaccination and cervical cancer screening. The present study aimed to estimate prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts from a societal perspective in Sweden in 2009, 1 year before the quadrivalent HPV vaccination program was implemented. Methods and Materials Data from the Swedish cervical cancer screening program was used to calculate the costs associated with prevention (cytological cervical cancer screening), management (colposcopy and biopsy following inadequate/abnormal cytological results), and treatment of CIN. Swedish official statistics were used to estimate treatment costs associated with cervical cancer. Published epidemiological data were used to estimate the number of incident, recurrent, and persistent cases of genital warts; a clinical expert panel assessed management and treatment procedures. Estimated visits, procedures, and use of medications were used to calculate the annual cost associated with genital warts. Results From a societal perspective, total estimated costs associated with cervical cancer and genital warts in 2009 were €106.6 million, of which €81.4 million (76%) were direct medical costs. Costs associated with prevention, management, and treatment of CIN were €74 million; screening and management costs for women with normal and inadequate cytology alone accounted for 76% of this sum. The treatment costs associated with incident and prevalent cervical cancer and palliative care were €23 million. Estimated costs for incident, recurrent and persistent cases of genital warts were €9.8 million. Conclusion Prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts are substantial. Defining these costs is important for future cost-effectiveness analyses of the quadrivalent HPV vaccination program in Sweden. PMID:26398189

Interagency Biological Restoration Demonstration (IBRD): a collaborative approach to biological incident recovery.

PubMed

Crockett, Katie

2011-09-01

Following the terrorist attacks in 2001, much time and effort has been put toward improving catastrophic incident response. But recovery--the period following initial response that focuses on the long-term viability of the affected area--has received less attention. Recognizing the importance of being able to recover an area following a catastrophic incident, the Department of Defense, through its Defense Threat Reduction Agency (DTRA), and the Department of Homeland Security, through its Science and Technology Directorate (DHS S&T), created the Interagency Biological Restoration Demonstration (IBRD) program. IBRD was a 4-year program jointly managed and funded by DTRA and DHS S&T, the goal of which was to reduce the time and resources necessary to recover a wide urban area from an intentional release of Bacillus anthracis. Specific program objectives included understanding the social, economic, and operational interdependencies that affect recovery; establishing long-term coordination between the Departments of Defense and Homeland Security; developing strategic recovery/restoration plans; identifying and demonstrating technologies that support recovery; and exercising recovery activities and technology solutions. IBRD has made important first steps toward improving national preparedness in the area biological incident recovery. Specifically, IBRD has helped enhance the efficacy and efficiency of recovering large urban areas by developing consequence management guidance; identifying key S&T capabilities and integrating them with planning and guidance documents; and establishing key relationships across the federal interagency, federal-to-regional, civilian-to-military, and public-to-private stakeholders. Upon completion of IBRD in fall 2010, both DTRA and DHS S&T planned follow-on programs.

Limb deficiency and prosthetic management. 2. Aging with limb loss.

PubMed

Flood, Katherine M; Huang, Mark E; Roberts, Toni L; Pasquina, Paul F; Nelson, Virginia S; Bryant, Phillip R

2006-03-01

This self-directed learning module highlights the issues faced by people aging with limb loss. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the impact that limb loss has on health and physical function throughout the life span. Case examples are used to illustrate what effect limb loss in childhood or young adulthood has on the incidence and management of new impairments or disease processes commonly associated with aging. To discuss the impact of early-life limb loss on the incidence and management of physiologic and functional changes associated with aging.

Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China.

PubMed

Xu, Wenhong; Sun, Changxian; Lin, Zheng; Lin, Lin; Wang, Meifeng; Zhang, Hongjie; Song, Yulei

2016-01-01

Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible.

Factors affecting reproductive performance of dairy cows.

PubMed

Coleman, D A; Thayne, W V; Dailey, R A

1985-07-01

We conducted two studies to determine how herd management practices and traits of individual cows affect performance of the herd and of the cow within a herd. Management practices, reproductive performance of the herd, and relationships between management and reproductive performance were characterized on 83 dairy farms with 7596 cows. Data included 21 management variables (e.g., facilities, herd health program, estrous detection program) and 8 performance variables obtained from Dairy Herd Improvement or unofficial records (e.g., size of herd, production, days open). Although varying among herds, annual average herd incidences of reproductive disorders and reproductive performance were similar to those reported. Managerial practices influenced incidences of retained placenta and uterine infection, days open of cows not bred and of all cows, services per conception, and percentages of herd open more than 100 days and culled for low production. Veterinarian was the most consistent variable influencing herd reproductive performance. Data also were collected from production and lifetime records of 2532 cows in 19 herds. Reproductive performance was affected by season of calving, production, maturity, and reproductive disorders. Several cows with extremely poor reproductive records were maintained.

Effectiveness of a stress management pilot program aimed at reducing the incidence of sports injuries in young football (soccer) players.

PubMed

Olmedilla-Zafra, Aurelio; Rubio, Victor J; Ortega, Enrique; García-Mas, Alexandre

2017-03-01

Several attempts to reduce the incidence of sport injuries using psychosocial interventions produced fruitful, although inconclusive results. This paper presents the effectiveness and implementation issues of a pilot 3-month stress-management and muscle relaxation program aimed at reducing sport injury incidence. Pre-post treatment-non treatment group comparison. The program was administered by a trained psychologist on a once-a-week, 1-h session basis. Seventy-four male soccer players from four National Youth league teams voluntarily participated. Teams were randomly assigned to either treatment/non-treatment group. Injury protocol, Self-monitoring cards, Athletes' satisfaction and commitment survey, Coaches' interview. Group main effect and Time-Group interaction effect were both statistically significant, F(1,60) = 8.30, p = 0.005, η 2 p  = 0.121, with the average number of injuries larger in the post-treatment phase of non-treatment group (p = 0.005, η 2 p  = 0.077). There was a significant decrease in the average number of injuries for the intervention group before and after implementing the program (p < 0.001, η 2 p  = 0.309). A controlled implementation of a psychosocial program was effective in reducing youth soccer sport injuries, with a high level of satisfaction and commitment from the athletes, as well as high acceptance from the coaches. Copyright © 2016 Elsevier Ltd. All rights reserved.

A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates

PubMed Central

2011-01-01

Background Tuberculosis (TB) in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates. Methods Descriptive study of immigration TB screening programs Results 16 out of 18 eligible countries responded to the written standardized survey and phone interview. Comparisons in specific areas of TB immigration screening programs included authorities responsible for TB screening, the primary objectives of the TB screening program, the yield of detection of active TB disease, screening details and aspects of follow up for inactive pulmonary TB. No two countries had the same approach to TB screening among migrants. Important differences, common practices, common problems, evidence or lack of evidence for program specifics were noted. Conclusions In spite of common goals, there is great diversity in the processes and practices designed to mitigate the impact of migration-associated TB among nations that screen migrants for the disease. The long-term goal in decreasing migration-related introduction of TB from high to low incidence countries remains diminishing the prevalence of the disease in those high incidence locations. In the meantime, existing or planned migration screening programs for TB can be made more efficient and evidenced based. Cooperation among countries doing research in the areas outlined in this study should facilitate the development of improved screening programs. PMID:21205318

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

NSTec Environmental Restoration

Homeland Security Presidential Directive HSPD-5 requires all federal departments and agencies to adopt a National Incident Management System (NIMS)/Incident Command System (ICS) and use it in their individual domestic incident management and emergency prevention, preparedness, response, recovery, and mitigation programs and activities, as well as in support of those actions taken to assist state and local entities. This system provides a consistent nationwide template to enable federal, state, local, and tribal governments, private-sector, and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, includingmore » acts of catastrophic terrorism. This document identifies the operational concepts of the Federal Radiological Monitoring and Assessment Center's (FRMAC) implementation of the NIMS/ICS response structure under the National Response Plan (NRP). The construct identified here defines the basic response template to be tailored to the incident-specific response requirements. FRMAC's mission to facilitate interagency environmental data management, monitoring, sampling, analysis, and assessment and link this information to the planning and decision staff clearly places the FRMAC in the Planning Section. FRMAC is not a mitigating resource for radiological contamination but is present to conduct radiological impact assessment for public dose avoidance. Field monitoring is a fact-finding mission to support this effort directly. Decisions based on the assessed data will drive public protection and operational requirements. This organizational structure under NIMS is focused by the mission responsibilities and interface requirements following the premise to provide emergency responders with a flexible yet standardized structure for incident response activities. The coordination responsibilities outlined in the NRP are based on the NIMS/ICS construct and Unified Command (UC) for management of a domestic incident. The NRP Nuclear/Radiological Incident Annex (NUC) further provides requirements and protocols for coordinating federal government capabilities to respond to nuclear/radiological Incidents of National Significance (INS) and other radiological incidents. When a FRMAC is established, it operates under the parameters of NIMS as defined in the NRP. FRMAC and its operations have been modified to reflect NIMS/ICS concepts and principles and to facilitate working in a Unified Command structure. FRMAC is established at or near the scene of the incident to coordinate radiological monitoring and assessment and is established in coordination with the U.S. Department of Homeland Security (DHS); the coordinating agency; other federal agencies; and state, local, and tribal authorities. However, regardless of the coordinating agency designation, U.S. Department of Energy (DOE) coordinates radiological monitoring and assessment activities for the initial phases of the offsite federal incident response through the Radiological Assistance Program (RAP) and FRMAC assets. Monitoring and assessment data are managed by FRMAC in an accountable, secure, and retrievable format. Monitoring data interpretations, including exposure rate contours, dose projections, and any requested radiological assessments are to be provided to the DHS; to the coordinating agency; and to state, local, and tribal government agencies.« less

FBI's Employee Assistance Program: an advanced law enforcement model.

PubMed

McNally, V J

1999-01-01

As we approach the 21st century the FBI has enhanced its Employee Assistance Program (EAP) to include EAP services, Peer Support and Critical Incident Stress Management/Debriefing (CISM/D) and Chaplains' Program. This EAP is now anticipating the future to include a Compassion Fatigue Program for its counselors and coordinators, as well as developing CISD protocols for incidents involving weapons of mass destruction. As the FBI has accepted new challenges in the investigative arena throughout the world, so the FBI's Employee Assistance and related programs have set out to support their employees and family members with a continuum of integrated confidential services. The FBI recognizes that its most important asset is its personnel, and EAP is the vehicle to assist the FBI family in remaining healthy and strong for the continuous quest to fulfill its mission.

What factors are related to success on conditional release/discharge? Findings from the New Orleans forensic aftercare clinic: 2002-2013.

PubMed

Manguno-Mire, Gina M; Coffman, Kelly L; DeLand, Sarah M; Thompson, John W; Myers, Leann

2014-09-01

The present study investigated the empirically based factors that predicted success on conditional release among a sample of individuals conditionally discharged in Louisiana. Not guilty by reason of insanity acquittees and individuals on conditional release/discharge for incompetency to stand trial were included in the study. Success on conditional release was defined as maintenance of conditional release during the study period. Recidivism (arrest on new charges) and incidents were empirically evaluated. Success on conditional release was maintained in over 70% of individuals. Recidivism was low, with only five arrests on new charges. Success on conditional release was predicted by financial resources, not having a personality disorder, and having fewer total incidents in the program. After controlling for the influence of other variables, having an incident on conditional release was predicted by a substance use diagnosis and being released from jail. Individuals conditionally released from jail showed fewer number of days to first incident (67 vs. 575 days) compared with individuals discharged from the hospital. These data provide support for the successful management of forensic patients in the community via conditional release, although they highlight specific factors that should be considered when developing community-based release programming. Conditional release programs should consider empirical factors in the development of risk assessment and risk management approaches to improve successful maintenance of community-based forensic treatment alternatives. Copyright © 2014 John Wiley & Sons, Ltd.

Causal Factors and Adverse Events of Aviation Accidents and Incidents Related to Integrated Vehicle Health Management

NASA Technical Reports Server (NTRS)

Reveley, Mary S.; Briggs, Jeffrey L.; Evans, Joni K.; Jones, Sharon M.; Kurtoglu, Tolga; Leone, Karen M.; Sandifer, Carl E.

2011-01-01

Causal factors in aviation accidents and incidents related to system/component failure/malfunction (SCFM) were examined for Federal Aviation Regulation Parts 121 and 135 operations to establish future requirements for the NASA Aviation Safety Program s Integrated Vehicle Health Management (IVHM) Project. Data analyzed includes National Transportation Safety Board (NSTB) accident data (1988 to 2003), Federal Aviation Administration (FAA) incident data (1988 to 2003), and Aviation Safety Reporting System (ASRS) incident data (1993 to 2008). Failure modes and effects analyses were examined to identify possible modes of SCFM. A table of potential adverse conditions was developed to help evaluate IVHM research technologies. Tables present details of specific SCFM for the incidents and accidents. Of the 370 NTSB accidents affected by SCFM, 48 percent involved the engine or fuel system, and 31 percent involved landing gear or hydraulic failure and malfunctions. A total of 35 percent of all SCFM accidents were caused by improper maintenance. Of the 7732 FAA database incidents affected by SCFM, 33 percent involved landing gear or hydraulics, and 33 percent involved the engine and fuel system. The most frequent SCFM found in ASRS were turbine engine, pressurization system, hydraulic main system, flight management system/flight management computer, and engine. Because the IVHM Project does not address maintenance issues, and landing gear and hydraulic systems accidents are usually not fatal, the focus of research should be those SCFMs that occur in the engine/fuel and flight control/structures systems as well as power systems.

Decrease of Johne's disease prevalence and incidence in six Minnesota, USA, dairy cattle herds on a long-term management program.

PubMed

Ferrouillet, C; Wells, S J; Hartmann, W L; Godden, S M; Carrier, J

2009-02-01

The objective of this prospective longitudinal field study was to describe changes in prevalence of seroconversion and fecal shedding and changes in incidence rate of seroconversion, fecal shedding and culling of milk cows for clinical signs of Johne's disease (JD) in six Minnesota (USA) herds participating to the JD Demonstration Herd Project (JDDHP) from 2000 to December 2005. Changes in prevalence and incidence rate were evaluated in light of the owner's compliance to the JDDHP using a risk assessment (RA) score. Adult cows were tested regularly using serum ELISA and bacterial fecal culture to evaluate progress made throughout the control program. Logistic regression was used to evaluate the association between the risk for a cow to test positive and the year on the program. After 5 years of follow-up, the proportion of cows that tested positive to serum ELISA and fecal culture (all positive cultures as well as moderate to heavy shedders only) decreased significantly from the first to the last year (8-3.1%, 10.4-5.6% and 3.1-1.5%, respectively). Cox proportional hazards regression was used to evaluate change of incidence rate across birth cohorts. Birth cohorts were defined by birth date of the animals with the reference cohort or oldest cohort being already 12-24 months of age at the onset of the long-term management program. All cohorts were censored at 45 months of age. Compared to cows from the reference cohort, cows from cohorts that could have benefitted from the JDDHP in their young age (less than 12 months of age at the start of the program or born later) were significantly less at risk of seroconversion and fecal shedding (hazard ratios for seroconversion, any fecal shedding and heavy shedding less than 0.63, 0.67 and 0.62, respectively). For the three herds achieving good management changes with a risk assessment score under 30 at their last year of the study, the cohorts that were born after the program was instituted did better than those born before the start of the program, implying that the program could have helped around birth as well for those herds. This study suggests that reduction of environmental contamination of heifers up to a year of age may have had some impact on the success of the program. The JDDHP appears more beneficial for herds achieving a better reduction of their RA score with a decrease risk for infection in very young calves.

Incidence of admission to the Physical Training and Rehabilitation Programs in Initial Entry Training during fiscal year 2011.

PubMed

Devlin, Jevettra D; Knapik, Joseph J; Solomon, Zack; Hauret, Keith G; Morris, Krystal; Carter, Robert; McGill, Ryan; Paoli, Latondra

2014-05-01

The Physical Training and Rehabilitation Program (PTRP) is a recovery and reintegration program for recruits in Initial Entry Training (IET) who are unable to continue training because of serious injury. This investigation examined PTRP admission incidence among recruits in IET at Forts Jackson, Leonard Wood, Benning, and Sill during Fiscal Year 2011 (FY11). PTRP admission data were collected from a spreadsheet completed monthly by PTRP commanders. Total number of recruits was obtained from each post's Directorate of Programs, Training, and Management. In FY11, 368 men and 268 women were admitted into PTRPs at all installations. For Forts Jackson, Leonard Wood, Benning, and Sill, male admission incidences (cases/1,000 recruits) were 2.6, 3.0, 6.2, and 5.4, respectively; female admission incidences for Forts Jackson, Leonard Wood, and Sill, were 11.1, 10.1, and 22.6, respectively. Most injuries sent to PTRP were bone stress injuries (65%) or fractures (21%). 76% of recruits were returned to duty. Differences in admission incidence between posts appear primarily related to different local policies regarding convalescent leave and admission criteria. PTRP admission rates are lower than in the past, presumably related to policy changes and injury-reduction efforts. A cost-benefit analysis would assist in determining the value of the PTRP. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China

PubMed Central

Xu, Wenhong; Sun, Changxian; Lin, Lin; Wang, Meifeng; Zhang, Hongjie; Song, Yulei

2016-01-01

Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible. PMID:27684637

SU-C-BRD-05: Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Techniques

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

Yang, R; Wang, J

2014-06-15

Purpose: To explore the implementation and effectiveness of incident learning for the safety and quality of radiotherapy in a new established radiotherapy program with advanced technology. Methods: Reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically designed for reporting, investigating, and learning of individual radiotherapy incidents in a new established radiotherapy program, with 4D CBCT, Ultrasound guided radiotherapy, VMAT, gated treatment delivered on two new installed linacs. The incidents occurring in external beam radiotherapy from February, 2012 to January, 2014 were reported. Results: A total of 33 reports were analyzed, includingmore » 28 near misses and 5 incidents. Among them, 5 originated in imaging for planning, 25 in planning, 1 in plan transfer, 1 in commissioning and 1 in treatment delivery. Among them, three near misses originated in the safety barrier of the radiotherapy process. In terms of error type, 1 incident was classified as wrong patient, 7 near misses/incidents as wrong site, 6 as wrong laterality, 5 as wrong dose, 7 as wrong prescription, and 7 as suboptimal plan quality. 5 incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, inadequate training, failure to develop an effective plan, and communication contributed to 19, 15, 12, 5 and 3 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4; this rate fell to 0.28% in the second year from 0.56% in the first year. The rate of near miss fell to 1.24% from 2.22%. Conclusion: Effective incident learning can reduce the occurrence of near miss/incidents, enhance the culture of safety. Incident learning is an effective proactive method for improving the quality and safety of radiotherapy.« less

The Effects of Anger Management on Children's Social and Emotional Outcomes: A Meta-Analysis

ERIC Educational Resources Information Center

Candelaria, Ashley M.; Fedewa, Alicia L.; Ahn, Soyeon

2012-01-01

The occurrence of violent behaviors and bullying in schools continues to be a recognized problem among students and school personnel. The concern caused by these behaviors have led many schools to implement anger management and other impulse control based programs for at-risk students in an effort to prevent many of these incidences. This study…

Heat injury prevention practices in high school football.

PubMed

Luke, Anthony C; Bergeron, Michael F; Roberts, William O

2007-11-01

To survey high school American football programs regarding current prevention measures for reducing heat injuries during the football season. Web-based survey of 27 questions based on consensus statement guidelines by the American College of Sports Medicine on reducing heat injury risk in youth football. National (United States) and community-based. High school programs receiving survey distribution from their state athletic association and the National Federation of State High School Associations. Responses (percentage and incidence) to questions on preseason acclimatization procedures, practice modification protocols, preparticipation risk factors, hydration management strategies, rest period strategies, heat injury education and policies, and preparation for heat-related emergency care. A total of 540 high school football programs from 26 states completed the survey. The reported number of preseason heat injuries per program (1.38+/-2.08) was greater (P<0.001) compared to during the regular season (0.98+/-1.84). Programs modified equipment configurations during preseason (no helmets or pads, 31.3%; just helmets, 57.0%; helmets and shoulder pads only, 33.5%) or altered the practice schedule when there was excessive heat. Hydration management, education, and preparation for dealing with an acute heat injury varied among programs. Greater implementation of effective prevention measures to reduce the incidence of heat-related injury and death in high school American football is needed. Strategies should focus on modifying practices appropriately on a day-to-day basis to minimize heat strain and optimize hydration, identifying and educating at-risk individuals during the preparticipation period, and developing an emergency action plan for effectively managing heat injuries.

Tackling TB in low-incidence countries: improving diagnosis and management in vulnerable populations.

PubMed

Heuvelings, C C; de Vries, S G; Grobusch, M P

2017-03-01

In low tuberculosis incidence regions, tuberculosis is mainly concentrated among hard-to-reach populations like migrants, homeless people, drug or alcohol abusers, prisoners and people living with HIV. To be able to eliminate tuberculosis from these low incidence regions tuberculosis screening and treatment programs should focus on these hard-to-reach populations. Here we discuss the barriers and facilitators of health care-seeking, interventions improving tuberculosis screening uptake and interventions improving treatment adherence in these hard-to-reach populations. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Application of research findings and summary of research needs: Bud Britton Memorial Symposium on Metabolic Disorders of Feedlot Cattle.

PubMed

Galyean, M L; Eng, K S

1998-01-01

Updated research findings with acidosis, feedlot bloat, liver abscesses, and sudden death syndromes were presented at the Bud Britton Memorial Symposium on Metabolic Disorders of Feedlot Cattle. Possible industry applications include the need to establish guidelines for use of clostridial vaccines in feedlot cattle, further assessment of the relationship between acidosis and polioencephalomalacia, examination of the effects of various ionophores on the incidence of metabolic disorders, and evaluation of the effects of feed bunk management and limit- and restricted-feeding programs on the incidence of metabolic disorders. A multidisciplinary approach among researchers, consulting nutritionists and veterinarians, and feedlot managers will be required for effective progress in research and in the application of research findings. Areas suggested for further research include 1) assessment of feed consumption patterns and social behavior of cattle in large-pen, feedlot settings; 2) evaluation of the relationship between feed intake management systems (feed bunk management programs, limit- and programmed-feeding) and the incidence of metabolic disorders, including delineation of the role of variability in feed intake in the etiology of such disorders; 3) efforts to improve antemortem and postmortem diagnosis, and to establish standardized regional or national epidemiological databases for various metabolic disorders; 4) ascertaining the accuracy of diagnosis of metabolic disorders and determining the relationship of previous health history of animals to the incidence of metabolic disorders; 5) further defining ruminal and intestinal microbiology as it relates to metabolic disorders and deeper evaluation of metabolic changes that occur with such disorders; 6) continued appraisal of the effects of grain processing and specific feed ingredients and nutrients on metabolic disorders, and development of new feed additives to control or prevent these disorders; and 7) application of biotechnology to develop grain varieties with altered nutrient degradation profiles that decrease the propensity for disastrous acid loads in the rumen, feed-grade enzymes and probiotics that modify nutrient digestion or microbial profiles in the rumen and intestine, and specific strains of ruminal bacteria and protozoa that alter ruminal and metabolic conditions that may precipitate metabolic disorders.

Workplace Violence Training Programs for Health Care Workers: An Analysis of Program Elements.

PubMed

Arbury, Sheila; Hodgson, Michael; Zankowski, Donna; Lipscomb, Jane

2017-06-01

Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration's (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.

75 FR 23783 - National Protection and Programs Directorate; Sector-Specific Agency Executive Management Office...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-04

... incidents. To achieve this mission, SSA EMO leverages the resources and knowledge of its CIKR sectors to... SSA EMO will use the information collected to reserve space at a meeting for the registrant; contact...

Applying the 15 Public Health Emergency Preparedness Capabilities to Support Large-Scale Tuberculosis Investigations in Complex Congregate Settings

PubMed Central

Toren, Katelynne Gardner; Elsenboss, Carina; Narita, Masahiro

2017-01-01

Public Health—Seattle and King County, a metropolitan health department in western Washington, experiences rates of tuberculosis (TB) that are 1.6 times higher than are state and national averages. The department’s TB Control Program uses public health emergency management tools and capabilities sustained with Centers for Disease Control and Prevention grant funding to manage large-scale complex case investigations. We have described 3 contact investigations in large congregate settings that the TB Control Program conducted in 2015 and 2016. The program managed the investigations using public health emergency management tools, with support from the Preparedness Program. The 3 investigations encompassed medical evaluation of more than 1600 people, used more than 100 workers, identified nearly 30 individuals with latent TB infection, and prevented an estimated 3 cases of active disease. These incidents exemplify how investments in public health emergency preparedness can enhance health outcomes in traditional areas of public health. PMID:28892445

DoD Needs a Comprehensive Approach to Address Workplace Violence

DTIC Science & Technology

2015-10-15

respond to an act of workplace violence, which could jeopardize their safety during a workplace violence threat or incident. Workplace Violence Prevention... Management Command (IMCOM) Prevention of Workplace Violence Program (U),” September 21, 2012. 18 OPORD 14-091, “U.S. Army Installation Management ... Safety and Health Administration’s definition of workplace violence25 and applies to military, civilian, and contractor personnel. 22 SECNAVINST

Ventilator-associated pneumonia improvement program.

PubMed

Murray, Theresa; Goodyear-Bruch, Caryl

2007-01-01

Ventilator-associated pneumonia (VAP) is a significant clinical problem associated with increased intensive care unit and hospital length of stay and substantial increases in delivery cost and associated morbidity and mortality. With system changes and management of the environment of care, the incidence of VAP was reduced in seven of our intensive care units across the system. Steps necessary to reduce VAP were identified and put into place in all the intensive care units. Patient positioning, oral care, nutrition, and management of comfort drugs are a few of the processes addressed to reduce VAP. Standardization of these essential care practices can reduce the incidence of this nosocomial infection and its associated increases in the cost of care delivery and mortality.

10 CFR 37.7 - Communications.

Code of Federal Regulations, 2014 CFR

2014-01-01

... regulations in this part may be sent as follows: (a) By mail addressed to: ATTN: Document Control Desk... Management Programs; or Director, Division of Security Policy, Office of Nuclear Security and Incident... electronic submission, for example, Electronic Information Exchange, or CD-ROM. Electronic submissions must...

Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations.

PubMed

Lavery, Lawrence A; Wunderlich, Robert P; Tredwell, Jeffrey L

2005-10-01

To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05). A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.

Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving Doxorubicin and Cyclophosphamide in Chemotherapy Day Centre

PubMed Central

Mak, Wai Chi; Yin Ching, Shirley Siu

2015-01-01

Objective: To evaluate the efficacy of an education program on the prevention of febrile neutropenia (FN) among breast cancer patients receiving AC regimen. Methods: Randomized controlled trial with the repeated-measures design was conducted in a Chemotherapy Day Centre of an acute hospital in Hong Kong. Twenty-five subjects in the intervention group received an individual education session followed by three follow-up sessions and routine care. Twenty-four subjects in the control group received routine care. Primary outcomes included the incidence of admission due to FN, the self-care behavior adherence, the knowledge level on prevention of FN and the self-efficacy in self-management, handwashing competence were assessed by self-designed questionnaires, Chinese version of patient activation measure, and handwashing competence checklist. Results: No statistically significant difference between the intervention group and the control group on the incidence of admission due to FN, the self-efficacy in self-management, and the knowledge on prevention of FN. The self-care behavior adherence was significant at cycle 4 of AC regimen in favor of the intervention group (P = 0.036). Handwashing competence improved more significantly among subjects in the intervention group than the control group (P = 0.009). Conclusions: The education program on the prevention of FN had significantly favorable effects on self-care behavior adherence and handwashing competence across time. However, the intervention did not lead to statistically significant improvement on the incidence of admission due to FN, the self-efficacy in self-management and the knowledge level on prevention of FN. PMID:27981125

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

PubMed

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

2016-07-08

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

49 CFR 26.69 - What rules govern determinations of ownership?

Code of Federal Regulations, 2011 CFR

2011-10-01

... DISADVANTAGED BUSINESS ENTERPRISES IN DEPARTMENT OF TRANSPORTATION FINANCIAL ASSISTANCE PROGRAMS Certification... disadvantaged owners must enjoy the customary incidents of ownership, and share in the risks and profits..., exercises effective control over the management, policy-making, and daily operational activities of the firm...

Intelligent transportation systems for traffic incident management : deployment benefits and lessons learned.

DOT National Transportation Integrated Search

2001-01-01

This report discusses why the Long Term Pavement Performance (LTPP) program is still important today; what the current investment in LTPP is; what the value of this investment is; the benefits of LTPP to date; falling weight deflectometer (FWD) calib...

Using employee experts to offer an interprofessional diabetes risk reduction program to fellow employees.

PubMed

Lenz, Thomas L; Gillespie, Nicole D; Skrabal, Maryann Z; Faulkner, Michele A; Skradski, Jessica J; Ferguson, Liz A; Pagenkemper, Joni J; Moore, Geri A; Jorgensen, Diane

2013-03-01

A recent increase in the incidence of diabetes and pre-diabetes is causing many employers to spend more of their healthcare benefit budgets to manage the conditions. A self-insured university in the USA has implemented an interprofessional diabetes mellitus risk reduction program using its own employee faculty and staff experts to help fellow employees manage their diabetes and pre-diabetes. The interprofessional team consists of five pharmacists, a dietitian, an exercise physiologist, a health educator and a licensed mental health practitioner. In addition, the participant's physician serves as a consultant to the program, as does a human resources healthcare benefits specialist and a wellness coordinator. The volunteer program takes place at the worksite during regular business hours and is free of charge to the employees. The faculty and staff delivering the program justify the cost of their time through an interprofessional educational model that the program will soon provide to university students.

Injuries in a modern dance company effect of comprehensive management on injury incidence and cost.

PubMed

Ojofeitimi, Sheyi; Bronner, Shaw

2011-09-01

Injury costs strain the finances of many dance companies. The objectives of this study were to analyze the effect of comprehensive management on injury patterns, incidence, and time loss and examine its financial impact on workers compensation premiums in a modern dance company. In this retrospective-prospective cohort study, injury was defined as any physical insult that required financial outlay (workers compensation or self insurance) or caused a dancer to cease dancing beyond the day of injury (time-loss injury). Injury data and insurance premiums were analyzed over an eight-year period. Injuries were compared using a mixed linear model with phase and gender as fixed effects. It was found that comprehensive management resulted in 34% decline in total injury incidence, 66% decrease in workers compensation claims, and 56% decrease in lost days. These outcomes achieved substantial savings in workers compensation premiums. Thus, this study demonstrates the effectiveness of an injury prevention program in reducing injury-related costs and promoting dancers' health and wellness in a modern dance company.

Cancer mortality-to-incidence ratio as an indicator of cancer management outcomes in Organization for Economic Cooperation and Development countries.

PubMed

Choi, Eunji; Lee, Sangeun; Nhung, Bui Cam; Suh, Mina; Park, Boyoung; Jun, Jae Kwan; Choi, Kui Son

2017-01-01

Assessing long-term success and efficiency is an essential part of evaluating cancer control programs. The mortality-to-incidence ratio (MIR) can serve as an insightful indicator of cancer management outcomes for individual nations. By calculating MIRs for the top five cancers in Organization for Economic Cooperation and Development (OECD) countries, the current study attempted to characterize the outcomes of national cancer management policies according to the health system ranking of each country. The MIRs for the five most burdensome cancers globally (lung, colorectal, prostate, stomach, and breast) were calculated for all 34 OECD countries using 2012 GLOBOCAN incidence and mortality statistics. Health system rankings reported by the World Health Organization in 2000 were updated with relevant information when possible. A linear regression model was created, using MIRs as the dependent variable and health system rankings as the independent variable. The linear relationships between MIRs and health system rankings for the five cancers were significant, with coefficients of determination ranging from 49 to 75% when outliers were excluded. A clear outlier, Korea reported lower-than-predicted MIRs for stomach and colorectal cancer, reflecting its strong national cancer control policies, especially cancer screening. The MIR was found to be a practical measure for evaluating the long-term success of cancer surveillance and the efficacy of cancer control programs, especially cancer screening. Extending the use of MIRs to evaluate other cancers may also prove useful.

Incident Management in Academic Information System using ITIL Framework

NASA Astrophysics Data System (ADS)

Palilingan, V. R.; Batmetan, J. R.

2018-02-01

Incident management is very important in order to ensure the continuity of a system. Information systems require incident management to ensure information systems can provide maximum service according to the service provided. Many of the problems that arise in academic information systems come from incidents that are not properly handled. The objective of this study aims to find the appropriate way of incident management. The incident can be managed so it will not be a big problem. This research uses the ITIL framework to solve incident problems. The technique used in this study is a technique adopted and developed from the service operations section of the ITIL framework. The results of this research found that 84.5% of incidents appearing in academic information systems can be handled quickly and appropriately. 15.5% incidents can be escalated so as to not cause any new problems. The model of incident management applied to make academic information system can run quickly in providing academic service in a good and efficient. The incident management model implemented in this research is able to manage resources appropriately so as to quickly and easily manage incidents.

Exertional heat stroke management strategies in United States high school football.

PubMed

Kerr, Zachary Y; Marshall, Stephen W; Comstock, R Dawn; Casa, Douglas J

2014-01-01

The 5-year period of 2005-2009 saw more exertional heat stroke-related deaths in organized sports than any other 5-year period in the past 35 years. The risk of exertional heat stroke appears highest in football, particularly during the preseason. To estimate the incidence of exertional heat stroke events and assess the utilization of exertional heat stroke management strategies during the 2011 preseason in United States high school football programs. Cross-sectional study; Level of evidence, 3. A self-administered online questionnaire addressing the incidence of exertional heat stroke events and utilization of exertional heat stroke management strategies (eg, removing athlete's football equipment, calling Emergency Medical Services [EMS]) was completed in May to June 2012 by 1142 (18.0%) athletic trainers providing care to high school football athletes during the 2011 preseason. Among all respondents, 20.3% reported treating at least 1 exertional heat stroke event. An average of 0.50 ± 1.37 preseason exertional heat stroke events were treated per program. Athletic trainers responding to exertional heat stroke reported using an average of 6.6 ± 1.8 management strategies. The most common management strategies were low-level therapeutic interventions such as removing the athlete's football equipment (98.2%) and clothing (77.8%) and moving the athlete to a shaded area (91.6%). Few athletic trainers reported active management strategies such as calling EMS (29.3%) or using a rectal thermometer to check core body temperature (0.9%). Athletic trainers in states with mandated preseason heat acclimatization guidelines reported a higher utilization of management strategies such as cooling the athlete through air conditioning (90.1% vs 65.0%, respectively; P < .001), immersion in ice water (63.0% vs 45.4%, respectively; P = .01), or fans (54.3% vs 42.0%, respectively; P = .06) and monitoring the athlete's temperature (60.5% vs 46.2%, respectively; P = .04). Preseason exertional heat stroke events, which are likely to be fatal if untreated, were reported by one fifth of all athletic trainers in high school football programs. The standard of care is (and should be) to treat proactively; therefore, treatment is not a perfect proxy for incidence. Nevertheless, there is an urgent need for improved education and awareness of exertional heat stroke in high school football. Areas of improvement include the greatly increased use of rectal thermometers and immersion in ice water.

NOAA Homeland Security Program Office

Science.gov Websites

Emergency Managment Institute IS 100.b - Introduction to Incident Command System IS 700.a - NIMS An Introduction IS 701.b - NIMS Multiagency Coordination System (MACS) Course IS 800.b - National Response Framework, An Introduction United States Coast Guard; Maritime Domain Awareness Privacy Act Statement

Rh immunization in Manitoba: progress in prevention and management.

PubMed Central

Bowman, J. M.; Pollock, J.

1983-01-01

For two decades the perinatal mortality caused by erythroblastosis has been decreasing in Manitoba. The improved management of Rh-immunized pregnancies has lowered the death rate among affected infants from 10.8% to 3.4%, while the prevention of Rh immunization has reduced its incidence from 9.1 to 2.2 per 1000 total births. In its first 6 years and 8 months Manitoba's antenatal prophylaxis program, in which immunoglobulin is administered to Rh-negative women at 28 weeks' gestation, reduced the incidence of Rh immunization during pregnancy by 93%. In combination with post-abortion and postpartum prophylaxis the antenatal treatment has provided a protection rate of 98.6% among primigravidas at risk. Further improvements are expected. PMID:6409390

Pediatric anesthesia after APRICOT (Anaesthesia PRactice In Children Observational Trial): who should do it?

PubMed

Habre, Walid

2018-06-01

This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. A large prospective cohort study, Anaesthesia PRactice In Children Observational Trial (APRICOT), revealed a high incidence of perioperative severe critical events and a large variability of anesthesia practice across 33 European countries. Relevantly, quality improvement programs have been implemented in North America, which precisely define the requirements to manage anesthesia care for children. These programs, with the introduction of an incident-reporting system at local and national levels, could contribute to the improvement of anesthesia care for children in Europe. The main factors that likely contributed to the APRICOT study results are discussed with the goal of defining clear requirement guidelines for anesthetizing children. Emphasis is placed on the importance of an incident-reporting system that can be used for both competency-based curriculum for postgraduate training as well as for continuous professional development. Variability in training as well as in available resources, equipment and facilities limit the generalization of some of the APRICOT results. Finally, the impact on case outcome of the total number of pediatric cases attended by the anesthesiologist should be taken into consideration along with the level of expertise of the anesthesiologist for complex pediatric anesthesia cases.

[Educational program to type 1 diabetes mellitus patients: basic topics].

PubMed

Leite, Silmara A Oliveira; Zanim, Ligia Maria; Granzotto, Paula Carolina D; Heupa, Sabrina; Lamounier, Rodrigo N

2008-03-01

Type 1 diabetes incidence has been increasing worldwide, however the vast majority of patients do not have a good glycaemic control. This review focuses on diabetes educational programs designed for children, young adults and their families, as well as regular pump users educational tips, collected from papers published between 2000 and 2007. A comprehensive review of the literature has identified 40 articles describing the methods and the evaluation of diabetes self-management education interventions. Three research questions are posed. First: what are the recommendations and standards for diabetes self-management education from the different diabetes institutions/associations? Second: is there sufficient evidence to recommend any adaptation of any particular program? And third: Are the educational programs effective in lowering glycated haemoglobin (HbA1c)? The patient and his family should be instructed and trained to take appropriate decisions for diabetes management regarding their daily care. Diabetes self-management education improves glicaemic control (both in an individual basis as well as in groups) in such a way that the longer the education training in diabetes the better is the effect on glycaemic control is.

Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification.

PubMed

Arnold, Pamela; Scheurer, Danielle; Dake, Andrew W; Hedgpeth, Angela; Hutto, Amy; Colquitt, Caroline; Hermayer, Kathie L

2016-04-01

The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes. On a daily basis at the Medical University of South Carolina (MUSC) Medical Center, there are approximately 130-150 inpatients with a diagnosis of diabetes. The program encompasses all service lines at MUSC. Some important features of the program include: a program champion or champion team, written blood glucose monitoring protocols, staff education in diabetes management, medical record identification of diabetes, a plan coordinating insulin and meal delivery, plans for treatment of hypoglycemia and hyperglycemia, data collection for incidence of hypoglycemia, and patient education on self-management of diabetes. The major clinical components to develop, implement, and evaluate an inpatient diabetes care program are: I. Program management, II. Delivering or facilitating clinical care, III. Supporting self-management, IV. Clinical information management and V. performance measurement. The standards receive guidance from a Disease-Specific Care Certification Advisory Committee, and the Standards and Survey Procedures Committee of the Joint Commission Board of Commissioners. The Joint Commission-ADA Advanced Inpatient Diabetes Certification represents a clinical program of excellence, improved processes of care, means to enhance contract negotiations with providers, ability to create an environment of teamwork, and heightened communication within the organization. Published by Elsevier Inc.

Evaluating the Effectiveness of Fatigue Management Training to Improve Police Sleep Health and Wellness: A Pilot Study.

PubMed

James, Lois; Samuels, Charles H; Vincent, Fiona

2018-01-01

To evaluate the effectiveness of an intervention for improving sleep health in a sample of employees from the Royal Canadian Mounted Police (RCMP). Using a pre- and post-design we exposed 61 RCMP members to a fatigue-management training program. Pre- and post-intervention surveys included the Pittsburg Sleep Quality Index (PSQI), the World Health Organization Quality of Life (WHOQOL) instrument, and the six item index of psychological distress (Symptom Checklist-90). We found the training improved member satisfaction with sleep (Wald = 2.58; df = 1; P = 0.03) and reduced symptoms of insomnia (Wald = 5.5; df = 1; P = 0.02). Furthermore, the training reduced the incidence of headaches (Wald = 6.5; df = 1; P = 0.01). Our findings suggest that a fatigue management training program resulted in positive sleep health benefits for police. We stress the importance of continued evaluation to inform the large-scale implementation of fatigue-management programs.

Pilot Mental Health, Negative Life Events, and Improving Safety with Peer Support and a Just Culture.

PubMed

Mulder, Sanne; de Rooy, Diederik

2018-01-01

In the last 35 yr, 17 commercial aviation accidents and incidents, with 576 fatalities, could likely have been attributed to mental disease of a pilot. Screening tools for mental health risks in airline pilots are needed. There is growing interest in pilot peer-support programs and how to incorporate them in a just culture, meaning that pilots can report mental health complaints without a risk of job or income loss. We combined findings from aviation accidents and incidents with a search of scientific literature to provide data-based recommendations for screening, peer-support, and a just culture approach to mental health problems. Commercial aviation accidents and incidents in which a mental disorder of a pilot was thought to play a role were reviewed. Subsequently, PubMed and PsychInfo literature searches were performed on peer-support programs, just culture human resource management, and the risk of negative life events on developing suicidal ideation and behavior in comparable professional groups. Lethal accidents were mostly related to impaired coping with negative life events. Negative life events are clearly related to suicidal thoughts, attempts, and completed suicide. A protective effect of peer-support programs on mental health problems has not been established, although peer-support programs are generally appreciated by those involved. We did not find relevant literature on just culture. Negative life events are likely a useful screening tool for mental health risks. There is still a lack of evidence on how peer-support groups should be designed and how management of mental health risks can be implemented in a just culture.Mulder S, de Rooy D. Pilot mental health, negative life events, and improving safety with peer support and a just culture. Aerosp Med Hum Perform. 2018; 89(1):41-51.

Best Practices for Fatigue Risk Management in Non-Traditional Shiftwork

NASA Technical Reports Server (NTRS)

Flynn-Evans, Erin E.

2016-01-01

Fatigue risk management programs provide effective tools to mitigate fatigue among shift workers. Although such programs are effective for typical shiftwork scenarios, where individuals of equal skill level can be divided into shifts to cover 24 hour operations, traditional programs are not sufficient for managing sleep loss among individuals with unique skill sets, in occupations where non-traditional schedules are required. Such operations are prevalent at NASA and in other high stress occupations, including among airline pilots, military personnel, and expeditioners. These types of operations require fatigue risk management programs tailored to the specific requirements of the mission. Without appropriately tailored fatigue risk management, such operations can lead to an elevated risk of operational failure, disintegration of teamwork, and increased risk of accidents and incidents. In order to design schedules for such operations, schedule planners must evaluate the impact of a given operation on circadian misalignment, acute sleep loss, chronic sleep loss and sleep inertia. In addition, individual-level factors such as morningness-eveningness preference and sleep disorders should be considered. After the impact of each of these factors has been identified, scheduling teams can design schedules that meet operational requirements, while also minimizing fatigue.

Challenges in the development and implementation of the National Comprehensive Cancer Control Program in Mexico.

PubMed

Reynoso-Noverón, Nancy; Meneses-García, Abelardo; Erazo-Valle, Aura; Escudero-de Los Ríos, Pedro; Kuri-Morales, Pablo Antonio; Mohar-Betancourt, Alejandro

2016-04-01

Chronic noncommunicable diseases (NCDs), including cancer, have become the leading cause of human morbidity and mortality. In Mexico, cancer is the third leading cause of death, with a high incidence among the economically active population, a high proportion of advanced stages at diagnosis and limited care coverage for patients. However, no public policy aimed at managing this important public health problem has been developed and implemented to date. This manuscript describes the first interinstitutional proposal of a National Program for Cancer Control, considering the known risk factors, early detection, treatment, palliative care and patient rehabilitation. This manuscript also outlines a series of thoughts on the difficulties and needs that the Mexican health system faces in achieving the main objectives of the program: to decrease the incidence of cancer, to increase survival and to improve the quality of life for this group of patients.

Radiation accident preparedness: a European approach to train physicians to manage mass radiation casualties.

PubMed

Hotz, Mark E; Fliedner, Theodor M; Meineke, Viktor

2010-06-01

Mass casualties after radiation exposure pose an enormous logistical challenge for national health services worldwide. Successful medical treatment of radiation victims requires that a plan for medical radiation accident management be established, that the plan be tested in regular exercises, and that it be found to be effective in the management of actual victims of a radiological incident. These activities must be provided by a critical mass of clinicians who are knowledgeable in the diagnosis and management of radiation injury. Here, we describe efforts to provide education to physicians engaged in clinical transplantation. Following intensive discussion among European experts at the International Center for Advanced Studies in Health Sciences and Services, University of Ulm, Germany, an advanced training program on "radiation syndromes" was developed for physicians with experience in the management of patients with pancytopenia and multi-organ failure occurring in a transplant setting. The first European advanced training course using this educational tool took place at Oberschleissheim, Germany, on 28-30 November 2007. Small group discussions and practical exercises were employed to teach general principles and unique features of whole body radiation exposure. Topics included the biological effects of contamination, incorporation of radionuclides, clinical consequences of exposure to radiation, and approaches to medical management. Recommendations resulting from this initial educational experience include (1) provision of funding for attending, conducting and updating the curriculum, and (2) development of an educational program that is harmonized among European and non-European experts in medical management of mass casualties from a radionuclear incident.

Borehole Disposal and the Cradle-To-Grave Management Program for Radioactive Sealed Sources in Egypt

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

Cochran, J.R.; Carson, S.D.; El-Adham, K.

2006-07-01

The Integrated Management Program for Radioactive Sealed Sources (IMPRSS) is greatly improving the management of radioactive sealed sources (RSSs) in Egypt. When completed, IMPRSS will protect the people and the environment from another radioactive incident. The Government of Egypt and Sandia National Laboratories are collaboratively implementing IMPRSS. The integrated activities are divided into three broad areas: the safe management of RSSs in-use, the safe management of unwanted RSSs, and crosscutting infrastructure. Taken together, these work elements comprise a cradle-to-grave program. To ensure sustainability, the IMPRSS emphasizes such activities as human capacity development through technology transfer and training, and development ofmore » a disposal facility. As a key step in the development of a disposal facility, IMPRSS is conducting a safety assessment for intermediate-depth borehole disposal in thick arid alluvium in Egypt based on experience with the U.S.'s Greater Confinement Disposal boreholes. This safety assessment of borehole disposal is being supported by the International Atomic Energy Agency (IAEA) through an IAEA Technical Cooperation Project. (authors)« less

Preventative programs for respiratory disease in cow/calf operations.

PubMed

Engelken, T J

1997-11-01

Control of respiratory disease in cow/calf operations presents many challenges. The incidence of disease in the suckling calf is not well documented and the logistics of handling range animals make control programs difficult to implement. Health programs have to be built around normal working patterns, and these patterns may not provide the best "fit" for immune management of the calf. Weaned calves undergo significant disease challenge when they enter typical marketing channels. This provides the potential for high levels of calf morbidity, mortality, medicine costs, and losses from decreased performance as they arrive at a stocker operation or feedyard. If preweaning calf health and preconditioning programs are used, they must be planned so that the producer has an opportunity to obtain a return on their investment. Options for increasing calf weight marketed, certified calf health sales, or retained ownership through the next phase of production should be evaluated carefully. Any potential increase in calf value must be weighed against program costs. This affords the veterinarian an opportunity to build on traditional disease management and prevention skills and expand their influence in overall ranch management.

Health and productivity management: establishing key performance measures, benchmarks, and best practices.

PubMed

Goetzel, R Z; Guindon, A M; Turshen, I J; Ozminkowski, R J

2001-01-01

Major areas considered under the rubric of health and productivity management (HPM) in American business include absenteeism, employee turnover, and the use of medical, disability, and workers' compensation programs. Until recently, few normative data existed for most HPM areas. To meet the need for normative information in HPM, a series of Consortium Benchmarking Studies were conducted. In the most recent application of the study, 1998 HPM costs, incidence, duration, and other program data were collected from 43 employers on almost one million workers. The median HPM costs for these organizations were $9992 per employee, which were distributed among group health (47%), turnover (37%), unscheduled absence (8%), nonoccupational disability (5%), and workers' compensation programs (3%). Achieving "best-practice" levels of performance (operationally defined as the 25th percentile for program expenditures in each HPM area) would realize savings of $2562 per employee (a 26% reduction). The results indicate substantial opportunities for improvement through effective coordination and management of HPM programs. Examples of best-practice activities collated from on-site visits to "benchmark" organizations are also reviewed.

An Examination of Commercial Aviation Accidents and Incidents Related to Integrated Vehicle Health Management

NASA Technical Reports Server (NTRS)

Reveley, Mary S.; Briggs, Jeffrey L.; Thomas, Megan A.; Evans, Joni K.; Jones, Sharon M.

2011-01-01

The Integrated Vehicle Health Management (IVHM) Project is one of the four projects within the National Aeronautics and Space Administration's (NASA) Aviation Safety Program (AvSafe). The IVHM Project conducts research to develop validated tools and technologies for automated detection, diagnosis, and prognosis that enable mitigation of adverse events during flight. Adverse events include those that arise from system, subsystem, or component failure, faults, and malfunctions due to damage, degradation, or environmental hazards that occur during flight. Determining the causal factors and adverse events related to IVHM technologies will help in the formulation of research requirements and establish a list of example adverse conditions against which IVHM technologies can be evaluated. This paper documents the results of an examination of the most recent statistical/prognostic accident and incident data that is available from the Aviation Safety Information Analysis and Sharing (ASIAS) System to determine the causal factors of system/component failures and/or malfunctions in U.S. commercial aviation accidents and incidents.

Perspectives of Immunization Program Managers on 2009-10 H1N1 Vaccination in the United States: A National Survey

PubMed Central

Seib, Katherine; Wells, Katelyn; Hannan, Claire; Orenstein, Walter A.; Whitney, Ellen A. S.; Hinman, Alan R.; Berkelman, Ruth L.; Omer, Saad B.

2012-01-01

Abstract In June and July 2010, we conducted a national internet-based survey of 64 city, state, and territorial immunization program managers (IPMs) to assess their experiences in managing the 2009-10 H1N1 influenza vaccination campaign. Fifty-four (84%) of the managers or individuals responsible for an immunization program responded to the survey. To manage the campaign, 76% indicated their health department activated an incident command system (ICS) and 49% used an emergency operations center (EOC). Forty percent indicated they shared the leadership of the campaign with their state-level emergency preparedness program. The managers' perceptions of the helpfulness of the emergency preparedness staff was higher when they had collaborated with the emergency preparedness program on actual or simulated mass vaccination events within the previous 2 years. Fifty-seven percent found their pandemic influenza plan helpful, and those programs that mandated that vaccine providers enter data into their jurisdiction's immunization information system (IIS) were more likely than those who did not mandate data entry to rate their IIS as valuable for facilitating registration of nontraditional providers (42% vs. 25%, p<0.05) and tracking recalled influenza vaccine (50% vs. 38%, p<0.05). Results suggest that ICS and EOC structures, pandemic influenza plans, collaborations with emergency preparedness partners during nonemergencies, and expanded use of IIS can enhance immunization programs' ability to successfully manage a large-scale vaccination campaign. Maintaining the close working relationships developed between state-level immunization and emergency preparedness programs during the H1N1 influenza vaccination campaign will be especially important as states prepare for budget cuts in the coming years. PMID:22360580

Incidence Trend and Epidemiology of Common Cancers in the Center of Iran.

PubMed

Rafiemanesh, Hosein; Rajaei-Behbahani, Narjes; Khani, Yousef; Hosseini, Sayedehafagh; Pournamdar, Zahra; Mohammadian-Hafshejani, Abdollah; Soltani, Shahin; Hosseini, Seyedeh Akram; Khazaei, Salman; Salehiniya, Hamid

2015-07-13

Cancer is a major public health problem in Iran and many other parts of the world. The cancer incidence is different in various countries and in country provinces. Geographical differences in the cancer incidence lead to be important to conduct an epidemiological study of the disease. This study aimed to investigate cancer epidemiology and trend in the province of Qom, located in center of Iran. This is an analytical cross-sectional study carried out based on re-analysis cancer registry report and the disease management center of health ministry from 2004 to 2008 in the province of Qom. To describe incidence time trends, we carried out join point regression analysis using the software Join point Regression Program, Version 4.1.1.1. There were 3,029 registered cases of cancer during 5 years studied. Sex ratio was 1.32 (male to female). Considering the frequency and mean standardized incidence, the most common cancer in women were breast, skin, colorectal, stomach, and esophagus, respectively while in men the most common cancers included skin, stomach, colorectal, bladder, and prostate, respectively. There was an increasing and significant trend, according to the annual percentage change (APC) equal to 8.08% (CI: 5.1-11.1) for all site cancer in women. The incidence trend of all cancers was increasing in this area. Hence, planning for identifying risk factors and performing programs for dealing with the disease are essential.

Management of urinary tract infections in pregnancy.

PubMed

Hodgman, D E

1994-06-01

Urinary tract infections (UTIs) are one of the most frequent complications of pregnancy. When the lower UTIs of asymptomatic bacteriuria and cystitis are not eradicated, the subsequent risk of the development of pyelonephritis is increased. The associated decreased maternal morbidity and fetal prematurity are the goals of a screening and treatment program for pregnant women. This clinical article presents information on the etiology, incidence, diagnosis, and management of asymptomatic bacteriuria and cystitis. Nursing implications regarding teaching are included.

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

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

Marsha Keister

2001-02-01

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

Development of a comprehensive and sustainable gynecologic oncology training program in western Kenya, a low resource setting.

PubMed

Rosen, Barry; Itsura, Peter; Tonui, Philip; Covens, Alan; van Lonkhuijzen, Luc; Orang'o, Elkanah Omenge

2017-08-01

To provide information on the development of a gynecologic oncology training program in a low-resource setting in Kenya. This is a review of a collaboration between Kenyan and North American physicians who worked together to develop a gynecologic oncology training in Kenya. We review the published data on the increase of cancer incidence in sub-Saharan Africa and outline the steps that were taken to develop this program. The incidence of cervical cancer in Kenya is very high and is the leading cause of cancer mortality in Kenya. WHO identifies cancer as a new epidemic affecting countries in sub-Saharan Africa. In Kenya, a country of 45 million, there is limited resources to diagnose and treat cancer. In 2009 in western Kenya, at Moi University there was no strategy to manage oncology in the Reproductive Health department. There was only 1 gynecologic oncologists in Kenya in 2009. A collaboration between Canadian and Kenya physicians resulted in development of a gynecologic oncology clinical program and initiation of fellowship training in Kenya. In the past 4 years, five fellows have graduated from a 2 year fellowship training program. Integration of data collection on all the patients as part of this program provided opportunities to do clinical research and to acquire peer reviewed grants. This is the first recognized fellowship training program in sub-Saharan Africa outside of South Africa. It is an example of a collaborative effort to improve women's health in a low-resource country. This is a Kenyan managed program through Moi University. These subspecialty trained doctors will also provide advice that will shape health care policy and provide sustainable expertise for women diagnosed with a gynecologic cancer.

Technical Review of Law Enforcement Standards and Guides Relative to Incident Management

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

Stenner, Robert D.; Salter, R.; Stanton, J. R.

2009-03-24

In an effort to locate potential law enforcement-related standards that support incident management, a team from the Pacific Northwest National Laboratory (PNNL) contacted representatives from the National Institute of Standards-Office of Law Enforcement Standards (NIST-OLES), National Institute of Justice (NIJ), Federal Bureau of Investigation (FBI), Secret Service, ASTM International committees that have a law enforcement focus, and a variety of individuals from local and regional law enforcement organizations. Discussions were held with various state and local law enforcement organizations. The NIJ has published several specific equipment-related law enforcement standards that were included in the review, but it appears that lawmore » enforcement program and process-type standards are developed principally by organizations that operate at the state and local level. Input is provided from state regulations and codes and from external non-government organizations (NGOs) that provide national standards. The standards that are adopted from external organizations or developed independently by state authorities are available for use by local law enforcement agencies on a voluntary basis. The extent to which they are used depends on the respective jurisdictions involved. In some instances, use of state and local disseminated standards is mandatory, but in most cases, use is voluntary. Usually, the extent to which these standards are used appears to depend on whether or not jurisdictions receive certification from a “governing” entity due to their use and compliance with the standards. In some cases, these certification-based standards are used in principal but without certification or other compliance monitoring. In general, these standards appear to be routinely used for qualification, selection for employment, and training. In these standards, the term “Peace Officer” is frequently used to refer to law enforcement personnel. This technical review of national law enforcement standards and guides identified the following four guides as having content that supports incident management: • TE-02-02 Guide to Radio Communications Interoperability Strategies and Products • OSHA 335-10N Preparing and Protecting Security Personnel in Emergencies • NIJ 181584 Fire and Arson Scene Evidence: A Guide for Public Safety Personnel • NIJ 181869 A Guide for Explosion and Bombing Scene Investigation In conversations with various state and local law enforcement officials, it was determined that the following National Fire Protection Association (NPFA) standards are generally recognized and tend to be universally used by law enforcement organizations across the country: • NFPA 1600 Standard on Disaster/Emergency Management and Business Continuity Programs • NFPA 1561 Standard on Fire Department Incident Management Systems • NFPA 472 Standard for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents (2008 Edition) • NFPA 473 Standard for Competencies for EMS Personnel Responding to Hazardous Materials/Weapons of Mass Destruction Incidents (2008 Edition)« less

DEVELOPMENT OF A MULTI-TIERED INSECT RESISTANCE MANAGEMENT PROGRAM FOR GENETICALLY MODIFIED CORN HYBRIDS EXPRESSING THE PLANT INCORPORATED PROTECTANT, BACILLUS THURINGIENSIS

EPA Science Inventory

A significant increase in genetically modified corn planting driven by biofuel demand is expected for the 2007 growing season with future planted acreages approaching 80% of total corn plantings anticipated by 2009. As demand increases, incidence of farmer non-compliance with ma...

HIITE: HIV-1 incidence and infection time estimator.

PubMed

Park, Sung Yong; Love, Tanzy M T; Kapoor, Shivankur; Lee, Ha Youn

2018-06-15

Around 2.1 million new HIV-1 infections were reported in 2015, alerting that the HIV-1 epidemic remains a significant global health challenge. Precise incidence assessment strengthens epidemic monitoring efforts and guides strategy optimization for prevention programs. Estimating the onset time of HIV-1 infection can facilitate optimal clinical management and identify key populations largely responsible for epidemic spread and thereby infer HIV-1 transmission chains. Our goal is to develop a genomic assay estimating the incidence and infection time in a single cross-sectional survey setting. We created a web-based platform, HIV-1 incidence and infection time estimator (HIITE), which processes envelope gene sequences using hierarchical clustering algorithms and informs the stage of infection, along with time since infection for incident cases. HIITE's performance was evaluated using 585 incident and 305 chronic specimens' envelope gene sequences collected from global cohorts including HIV-1 vaccine trial participants. HIITE precisely identified chronically infected individuals as being chronic with an error less than 1% and correctly classified 94% of recently infected individuals as being incident. Using a mixed-effect model, an incident specimen's time since infection was estimated from its single lineage diversity, showing 14% prediction error for time since infection. HIITE is the first algorithm to inform two key metrics from a single time point sequence sample. HIITE has the capacity for assessing not only population-level epidemic spread but also individual-level transmission events from a single survey, advancing HIV prevention and intervention programs. Web-based HIITE and source code of HIITE are available at http://www.hayounlee.org/software.html. Supplementary data are available at Bioinformatics online.

The cost-effectiveness of syndromic management in pharmacies in Lima, Peru.

PubMed

Adams, Elisabeth J; Garcia, Patricia J; Garnett, Geoffrey P; Edmunds, W John; Holmes, King K

2003-05-01

Many people with sexually transmitted diseases (STDs) in Lima, Peru, seek treatment in pharmacies. The goal was to assess the cost-effectiveness of training pharmacy workers in syndromic management of STDs. Cost-effectiveness from both the program and societal perspectives was determined on the basis of study costs, societal costs (cost of medicine), and the number of cases adequately managed. The latter was calculated from estimated incidence, proportion of symptomatic patients, proportion seeking treatment in pharmacies, and proportion of cases adequately managed in both comparison and intervention districts. Univariate and multivariate sensitivity analyses were performed. Under base-case assumptions, from the societal perspective the intervention saved an estimated US$1.51 per case adequately managed; from the program perspective, it cost an estimated US$3.67 per case adequately managed. In the sensitivity analyses, the proportion of females with vaginal discharge or pelvic inflammatory disease who seek treatment in pharmacies had the greatest impact on the estimated cost-effectiveness, along with the medication costs under the societal perspective. Training pharmacists in syndromic management of STDs appears to be cost-effective when only program costs are used and cost-saving from the societal perspective. Our methods provide a template for assessing the cost-effectiveness of managing STD syndromes, on the basis of indirect estimates of effectiveness.

Information sharing for traffic incident management.

DOT National Transportation Integrated Search

2009-01-01

Traffic incident management focuses on developing procedures, implementing policies, and deploying technologies to more quickly identify incidents, improve response times, and more effectively and efficiently manage the incident scene. Because so man...

Constructing a resilience index for the Enhanced Critical Infrastructure Protection Program

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

Fisher, R. E.; Bassett, G. W.; Buehring, W. A.

2010-10-14

Following recommendations made in Homeland Security Presidential Directive 7, which established a national policy for the identification and increased protection of critical infrastructure and key resources (CIKR) by Federal departments and agencies, the U.S. Department of Homeland Security (DHS) in 2006 developed the Enhanced Critical Infrastructure Protection (ECIP) program. The ECIP program aimed to provide a closer partnership with state, regional, territorial, local, and tribal authorities in fulfilling the national objective to improve CIKR protection. The program was specifically designed to identify protective measures currently in place in CIKR and to inform facility owners/operators of the benefits of new protectivemore » measures. The ECIP program also sought to enhance existing relationships between DHS and owners/operators of CIKR and to build relationships where none existed (DHS 2008; DHS 2009). In 2009, DHS and its protective security advisors (PSAs) began assessing CIKR assets using the ECIP program and ultimately produced individual protective measure and vulnerability values through the protective measure and vulnerability indices (PMI/VI). The PMI/VI assess the protective measures posture of individual facilities at their 'weakest link,' allowing for a detailed analysis of the most vulnerable aspects of the facilities (Schneier 2003), while maintaining the ability to produce an overall protective measures picture. The PMI has six main components (physical security, security management, security force, information sharing, protective measures assessments, and dependencies) and focuses on actions taken by a facility to prevent or deter the occurrence of an incident (Argonne National Laboratory 2009). As CIKR continue to be assessed using the PMI/VI and owners/operators better understand how they can prevent or deter incidents, academic research, practitioner emphasis, and public policy formation have increasingly focused on resilience as a necessary component of the risk management framework and infrastructure protection. This shift in focus toward resilience complements the analysis of protective measures by taking into account the three other phases of risk management: mitigation, response, and recovery (Figure 1). Thus, the addition of a robust resilience index (RI) to the established PMI/VI provides vital information to owners/operators throughout the risk management process. Combining a pre-incident focus with a better understanding of resilience, as well as potential consequences from damaged CIKR, allows owners/operators to better understand different ways to decrease risk by (1) increasing physical security measures to prevent an incident, (2) supplementing redundancy to mitigate the effects of an incident, and (3) enhancing emergency action and business continuity planning to increase the effectiveness of recovery procedures. Information provided by the RI methodology is also used by facility owners/operators to better understand how their facilities compare to similar sector/subsector sites and to help them make risk-based decisions. This report provides an overview of the RI methodology developed to estimate resilience and provide resilience comparisons for sectors and subsectors. The information will be used to (1) assist DHS in analyzing existing response and recovery methods and programs at facilities and (2) identify potential ways to increase resilience. The RI methodology is based on principles of Appreciative Inquiry, which is 'the coevolutionary search for the best in people, their organizations, and the relevant world around them' (Cooperrider et al. 2005). Appreciative Inquiry identifies the best of 'what is' and helps to envision 'what might be.' The ECIP program and the RI represent a new model (using Appreciative Inquiry principles) for information sharing between government and industry (Fisher and Petit 2010). A 'dashboard' display, which provides an interactive tool - rather than a static report, presents the results of the RI in a convenient format. Additional resilience measures can be modeled to illustrate how such actions would impact the asset's RI value.« less

Ability, incentives, and management feedback: organizational change to reduce pressure ulcers in a nursing home.

PubMed

Rosen, Jules; Mittal, Vikas; Degenholtz, Howard; Castle, Nick; Mulsant, Benoit H; Hulland, Shelley; Nace, David; Rubin, Fred

2006-03-01

Quality improvement (QI) processes in nursing homes are highly variable and often ineffective. This study evaluated an innovative QI process to reduce pressure ulcers (PUs) in a nursing home with a high rate of PUs. This was a 48-week, longitudinal study comparing the incidence of PUs during 12-week baseline and intervention and post-intervention periods. Not-for-profit, 136-bed nursing home in urban Western Pennsylvania. All residents and all staff at the nursing home participated in this study. The intervention consisted of 3 components: Ability enhancement, incentivization, and management feedback. To enhance ability, all staff members completed a computer-based interactive video education program on PU prevention and were mandated to use penlights to promote early detection. Incentivization included $75 for each staff member if the desired reduction in PU incidence was achieved. Management feedback provided real-time information of staff"s adherence to the mandated training. Outcome measures consisted of staff's adherence to mandated training and the incidence of new PUs during the baseline period compared to the intervention and post-intervention periods. Management responded to noncompliance with training with both rewards and stepped discipline. Adherence to protocol, as measured by training compliance, was 100%. There was a significant reduction (P < .05) in the incidence of stage 2 or worse PUs during the intervention period. During the post-intervention periods, the effect was lost. An innovative QI initiative resulted in a significant decrease in PUs in 1 facility. This intervention was not sustainable when the 3 components of the QI intervention were no longer actively maintained.

The Role of the Polio Program Infrastructure in Response to Ebola Virus Disease Outbreak in Nigeria 2014

PubMed Central

Vaz, Rui G.; Mkanda, Pascal; Banda, Richard; Komkech, William; Ekundare-Famiyesin, Olubowale O.; Onyibe, Rosemary; Abidoye, Sunday; Nsubuga, Peter; Maleghemi, Sylvester; Hannah-Murele, Bolatito; Tegegne, Sisay G.

2016-01-01

Background. The current West African outbreak of the Ebola virus disease (EVD) began in Guinea in December 2013 and rapidly spread to Liberia and Sierra Leone. On 20 July 2014, a sick individual flew into Lagos, Nigeria, from Monrovia, Liberia, setting off an outbreak in Lagos and later in Port Harcourt city. The government of Nigeria, supported by the World Health Organization and other partners, mounted a response to the outbreak relying on the polio program experiences and infrastructure. On 20 October 2014, the country was declared free of EVD. Methods. We examined the organization and operations of the response to the 2014 EVD outbreak in Nigeria and how experiences and support from the country's polio program infrastructure accelerated the outbreak response. Results. The deputy incident manager of the National Polio Emergency Operations Centre was appointed the incident manager of the Ebola Emergency Operations Centre (EEOC), the body that coordinated and directed the response to the EVD outbreak in the country. A total of 892 contacts were followed up, and blood specimens were collected from 61 persons with suspected EVD and tested in designated laboratories. Of these, 19 (31%) were positive for Ebola, and 11 (58%) of the case patients were healthcare workers. The overall case-fatality rate was 40%. EVD sensitization and training were conducted during the outbreak and for 2 months after the outbreak ended. The World Health Organization deployed its surveillance and logistics personnel from non–Ebola-infected states to support response activities in Lagos and Rivers states. Conclusions. The support from the polio program infrastructure, particularly the coordination mechanism adopted (the EEOC), the availability of skilled personnel in the polio program, and lessons learned from managing the polio eradication program greatly contributed to the speedy containment of the 2014 EVD outbreak in Nigeria. PMID:26908718

Towards an improved global understanding of treatment and outcomes in people with type 2 diabetes: Rationale and methods of the DISCOVER observational study program.

PubMed

Ji, Linong; Bonnet, Fabrice; Charbonnel, Bernard; Gomes, Marilia B; Kosiborod, Mikhail; Khunti, Kamlesh; Nicolucci, Antonio; Pocock, Stuart; Rathmann, Wolfgang; Shestakova, Marina V; Shimomura, Iichiro; Watada, Hirotaka; Fenici, Peter; Hammar, Niklas; Hashigami, Kiyoshi; Macaraeg, Greg; Surmont, Filip; Medina, Jesús

2017-07-01

Contemporary global real-world data on the management of type 2 diabetes are scarce. The global DISCOVER study program aims to describe the disease management patterns and a broad range of associated outcomes in patients with type 2 diabetes initiating a second-line glucose-lowering therapy in routine clinical practice. The DISCOVER program comprises two longitudinal observational studies involving more than 15,000 patients in 38 countries across six continents. Study sites have been selected to be representative of type 2 diabetes management in each country. Data will be collected at baseline (initiation of second-line therapy), at 6months, and yearly during a 3-year follow-up period. The DISCOVER program will record patient, healthcare provider, and healthcare system characteristics, treatment patterns, and factors influencing changes in therapy. In addition, disease control (e.g. achievement of glycated hemoglobin target), management of associated risk factors (e.g. hypercholesterolemia and hypertension), and healthcare resource utilization will be recorded. Microvascular and macrovascular complications, incidence of hypoglycemic events, and patient-reported outcomes will also be captured. The DISCOVER program will provide insights into the current management of patients with type 2 diabetes worldwide, which will contribute to informing future clinical guidelines and improving patient care. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

The Technology Boom

PubMed Central

Gilmore, L. Anne; Duhé, Abby F.; Frost, Elizabeth A.

2014-01-01

As technology continues to develop rapidly, the incidence of obesity also continues to climb at an alarming rate. The increase in available technology is thought to be a contributor in the obesogenic environment, yet at the same time technology can also be used to intervene and improve health and health behaviors. This article reviews the components of effective weight management programs and the novel role that technology, such as SMS, websites, and smartphone apps, is playing to improve the success of such programs. Use of these modern technologies can now allow for individualized treatment recommendations to be delivered to individuals remotely, increased self-monitoring/tracking of health-related data, broader and more rapid dissemination of health information/recommendations, and increased patient–dietician/physician contact. The use of technology in weight management programs results in improved long-term weight management, and in most cases improved cost-effectiveness. Rather than blaming increased food intake and sedentary lifestyle on technology, rapidly developing and innovative technologies should be used to our advantage and deployed to combat the obesity epidemic. PMID:24876625

30 CFR 250.1510 - What will MMS do if my training program does not comply with this subpart?

Code of Federal Regulations, 2010 CFR

2010-07-01

... not comply with this subpart? 250.1510 Section 250.1510 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Well... one or more of the following enforcement actions: (a) Issue an Incident of Noncompliance (INC); (b...

Waveform-Diverse Sensors

DTIC Science & Technology

2009-12-01

independent information on each individual radar pulse that is incident upon an illuminated RF tag/transponder. As such, data-rates commensurate with...Final Report Office of Naval Research Program Manager: Dr. Rabinder Madan Project Title: Waveform-Diverse Sensors Award # N00014-06-1-0004...multistatic, pulse compression, waveform diversity, DOA estimation 16. SECURITY CLASSIFICATION OF: a. REPORT b. ABSTRACT c. THIS PAGE 17. LIMITATION

Summary Report: Visitor Safety and Security at Corps of Engineers Projects.

DTIC Science & Technology

1982-10-01

23 Incident Reporting System. ..... .............. 23 Contract Law Enforcement ...... .............. 25 Project Management...average length of stay being 3.3 days. Contract Law Enforcement Conclusions , The Corps’ contract law enforcement program is extremely fragile in terms...to prohibit the public display alcoholic beverages and consumption of alcoholic beverages. Use contract law initiate law enforcement contracts

Implementation of a diabetes self-management education program in primary care for adults using shared medical appointments.

PubMed

Sanchez, Iris

2011-01-01

The purpose of this study was to implement diabetes self-management education in primary care using the Chronic Care Model and shared medical appointments (SMA) to provide evidence-based interventions to improve process and measure outcomes. A quality improvement project using the Plan-Do-Check-Act cycle was implemented in a primary care setting in South Texas to provide diabetes self-management education for adults. Biological measures were evaluated in 70 patients at initiation of the project and thereafter based on current practice guidelines. The results of the project were consistent with the literature regarding the benefits, sustainability, and viability of SMA. As compared with that in studies presented in the literature, the patient population who participated in SMA had similar outcomes regarding improvement in A1C, self-management skills, and satisfaction. SMA are an innovative system redesign concept with the potential to provide comprehensive and coordinated care for patients with multiple and chronic health conditions while still being an efficient, effective, financially viable, and sustainable program. As the incidence and prevalence of diabetes increase, innovative models of care can meet the growing demand for access and utilization of diabetes self-management education programs. Programs focusing on chronic conditions to improve outcomes can be replicated by health care providers in primary care settings. SMA can increase revenue and productivity, improve disease management, and increase provider and patient satisfaction.

Incident management successful practices : a cross-cutting study : improving mobility and saving lives

DOT National Transportation Integrated Search

2000-04-01

Incident management is the process of managing multi-agency, multi-jurisdictional responses to highway traffic disruptions. Efficient and coordinated management of incidents reduces their adverse impacts on public safety, traffic conditions, and the ...

The impact of training program on nurses' attitudes toward workplace violence in Jordan.

PubMed

Al-Ali, Nahla Mansour; Al Faouri, Ibrahim; Al-Niarat, Tahany Fareed

2016-05-01

Nurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence. To study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan. One group before-after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. "The Framework Guidelines for addressing workplace violence in the health sector", was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire. A total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t=6. 62, df=96, p=0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%). The study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study. Copyright © 2015 Elsevier Inc. All rights reserved.

Violence prevention at work. A business perspective.

PubMed

Wilkinson, C W

2001-02-01

The risk of workplace violence varies depending on the type and location of the business. Business managers should assess violence risk and develop a program based on the level of risk faced by their employees. This assessment should include: (1) a review of workplace security and identification of positions with increased risk of exposure to violence, (2) risk reduction through environmental design and employee training, (3) development of a plan and identification of professional resources to respond to incidents should they occur, and (4) communication of the employer's commitment to providing a safe work environment for employees. For most businesses, threat assessment and management comprise the cornerstone of a workplace violence-prevention program. Planning and preparation are key to workplace violence prevention.

76 FR 61371 - All-Hazard Position Task Books for Type 3 Incident Management Teams

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-04

...-Hazard Position Task Books for Type 3 Incident Management Teams AGENCY: Federal Emergency Management... Books for Type 3 Incident Management Teams were developed to assist personnel achieve qualifications in... Management Teams were developed to assist personnel achieve qualifications in the All-Hazard ICS positions...

[Analysis on the performance evaluation of the Global Fund Malaria Programme in China from 2003 to 2013].

PubMed

Zhang, Q F; Wang, R B; Zheng, B; Xia, Z G; Zhou, S S

2017-05-06

Objective: To analyze the performance of the 5 Global Fund Malaria Programmes in China from 2003 to 2013. Methods: All of the proposals, summaries, progress reports, survey reports, Monitoring& Evaluation reports, and performance rating reports of the 5 Global Fund Malaria Programmes in China and the epidemic data of program areas were collected for statistical analysis from 2012 to 2014. Symposiums were held with relevant experts from national and provincial Centers for Disease Control and Prevention, program managers and staffs from national and provincial Global Fund Malaria Programme offices. The completion of the relevant programme indicators (including the general grant information such as program areas, beneficiaries and funding; the implementation of malaria control measures; the performance of malaria control measures; the malaria incidence in the program areas; the prevalence of malaria parasites; and program management and performance evaluation) were analyzed, and the results: of the symposiums were summarized. Results The implementation period of the 5 Global Fund Malaria Programs were as follows: Round 1 from 2003 to 2008, Round 5 from 2006 to 2010, Round 6 from 2007 to 2012, Round 10 from 2012 to 2013, and National Strategy Application (NSA) from 2010 to 2012. Under the support of all the Global Fund Malaria Programs, a total of 11 936 726 fever cases received microscopic tests, 1 485 915 confirmed and suspected malaria cases were treated, 1 579 773 Long Lasting Insecticide-treated Nets were distributed, 3 414 633 regular nets were treated by insecticide, 40 298 284 primary and middle school students received health education on malaria control. Compared with the baseline value, the completion rates of each indicator increased after the implementation of the programs. The growth value ranged from 12.83% to 83.11%, among which the biggest growth was the value of the indicator'Percentage of households with at least one LLIN/ITN in target areas', and it increased from 9.2% (baseline value of 2006) to 92.31% (value of 2012). The malaria incidence in program areas has dropped significantly year by year, the annual reported malaria incidence in Yunnan and Hainan provinces decreased from 1 950/100 000, 3 850/100 000 in 2002 to 3.31/100 000, 0.15/100 000 in 2012, the P. falciparum malaria incidence in target counties in Hainan province decreased from 90.6/100 000 in 2002 to 0/100 000 in 2012. As from the implementation of NSA grant in 2010 to 2012, the annual reported malaria incidence in 92% of the 75 Type 1 counties was less than 1 per 10 000, 60.00% of Type 1 counties and 98.69% of the 687 Type 2 counties reported zero locally transmitted malaria cases. The Global Fund Secretariat had conducted a total of 37 performance evaluations, of which 9 have been rated as A1, 4 rated as A2, 19 rated as B1 and 5 rated as B1. Conclusions: The Global Fund Malaria Program in China has been closely integrated with the goal and task of National Malaria Control Program, reducing malaria burden in target areas, and pushing Chinese malaria control efforts to move from control to elimination.

TH-E-19A-01: Quality and Safety in Radiation Therapy

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

Ford, E; Ezzell, G; Miller, B

2014-06-15

Clinical radiotherapy data clearly demonstrate the link between the quality and safety of radiation treatments and the outcome for patients. The medical physicist plays an essential role in this process. To ensure the highest quality treatments, the medical physicist must understand and employ modern quality improvement techniques. This extends well beyond the duties traditionally associated with prescriptive QA measures. This session will review the current best practices for improving quality and safety in radiation therapy. General elements of quality management will be reviewed including: what makes a good quality management structure, the use of prospective risk analysis such as FMEA,more » and the use of incident learning. All of these practices are recommended in society-level documents and are incorporated into the new Practice Accreditation program developed by ASTRO. To be effective, however, these techniques must be practical in a resource-limited environment. This session will therefore focus on practical tools such as the newly-released radiation oncology incident learning system, RO-ILS, supported by AAPM and ASTRO. With these general constructs in mind, a case study will be presented of quality management in an SBRT service. An example FMEA risk assessment will be presented along with incident learning examples including root cause analysis. As the physicist's role as “quality officer” continues to evolve it will be essential to understand and employ the most effective techniques for quality improvement. This session will provide a concrete overview of the fundamentals in quality and safety. Learning Objectives: Recognize the essential elements of a good quality management system in radiotherapy. Understand the value of incident learning and the AAPM/ASTRO ROILS incident learning system. Appreciate failure mode and effects analysis as a risk assessment tool and its use in resource-limited environments. Understand the fundamental principles of good error proofing that extends beyond traditional prescriptive QA measures.« less

Short Duration Emergency Incidents Managed as Projects

NASA Astrophysics Data System (ADS)

Nixon, Thomas J.

Emergency incidents have historically been managed by experience and some directional principles usually found in SOPs/SOGs or other pre-incident planning documents. The use of experience has the risk of bias influencing the decisions being made in truly life or death situations. Responders of disasters, long duration emergency incidents, are often equipped with a framework adapted to the project management lifecycle to assure the project priorities are adequately addressed. The disaster framework provides for savings from risk, loss, waste. This research is demonstrating the ability and reasoning to develop a framework to address short duration emergency incidents and expand the events that can be managed as a project. The research of the literature found that a framework can be applied to the project management lifecycle and the priorities of a short duration emergency incident can be managed as a project. The limitations of not having the ability to conduct empirical testing and the risks of not developing a formal implementation plan are discussed. Short duration emergency incidents are found to be capable of being managed as projects and will benefit from the effectiveness of project management methodologies.

Peer power: how Dare County, North Carolina, is addressing chronic disease through innovative programming.

PubMed

Thomas, Anne B; Ward, Ellie

2006-01-01

Peer Power is an innovative school-based program that trains high school students as health educators and mentors for middle school students. The program was designed to produce positive health behavior changes in youth and reduce long-term incidence of chronic diseases of the heart and lung. This program, developed at the Management Academy for Public Health, has been successful in receiving grant funds and has demonstrated positive behavioral changes in youth in the areas of physical activity, nutrition, and tobacco use. Peer Power has far exceeded the anticipated outcomes and proven to be a catalyst for improved health behaviors throughout the community. Positive unintended consequences of Peer Power include the development of an effective social marketing campaign, reduction in tobacco sales to minors, and an increase in smoke-free restaurants in Dare County. Benefits received by Management Academy participants are evident through improved business and administrative skills at the Dare County Department of Public Health, the number of new and innovative programs that have succeeded in securing grant funds, and the sustainability of the programs developed.

The Evolution of Process Safety: Current Status and Future Direction.

PubMed

Mannan, M Sam; Reyes-Valdes, Olga; Jain, Prerna; Tamim, Nafiz; Ahammad, Monir

2016-06-07

The advent of the industrial revolution in the nineteenth century increased the volume and variety of manufactured goods and enriched the quality of life for society as a whole. However, industrialization was also accompanied by new manufacturing and complex processes that brought about the use of hazardous chemicals and difficult-to-control operating conditions. Moreover, human-process-equipment interaction plus on-the-job learning resulted in further undesirable outcomes and associated consequences. These problems gave rise to many catastrophic process safety incidents that resulted in thousands of fatalities and injuries, losses of property, and environmental damages. These events led eventually to the necessity for a gradual development of a new multidisciplinary field, referred to as process safety. From its inception in the early 1970s to the current state of the art, process safety has come to represent a wide array of issues, including safety culture, process safety management systems, process safety engineering, loss prevention, risk assessment, risk management, and inherently safer technology. Governments and academic/research organizations have kept pace with regulatory programs and research initiatives, respectively. Understanding how major incidents impact regulations and contribute to industrial and academic technology development provides a firm foundation to address new challenges, and to continue applying science and engineering to develop and implement programs to keep hazardous materials within containment. Here the most significant incidents in terms of their impact on regulations and the overall development of the field of process safety are described.

A Study of the Effects of Physical Activity on Asthmatic Symptoms and Obesity Risk in Elementary School-Aged Children

ERIC Educational Resources Information Center

Haines, Michael S.; Kim, Danny H.

2013-01-01

Background: Children with moderate persistent asthma are often reluctant to engage in physical activity and as a result are more prone to obesity and increased incidence of asthma attacks. Purpose: This study developed an asthma program that included physical activity and asthma management education for elementary school children with moderate…

Treatment for Youth in Short-Term Care Facilities: The Impact of a Comprehensive Behavior Management Intervention

ERIC Educational Resources Information Center

Hurley, Kristin Duppong; Ingram, Stephanie; Czyz, J. Douglas; Juliano, Nicholas; Wilson, Evelyn

2006-01-01

We describe a comprehensive program to train emergency shelter staff in effective methods for dealing with youth who have behavioral and emotional problems; assess the degree to which staff implemented the treatment approach; measure the impact of the intervention on shelter-wide incidents such as out-of-control behavior, runaways, and violence…

AFCOMS (Air Force Commissary Service): Does this SOA Need an Executive Development Program?

DTIC Science & Technology

1985-03-01

ll)NALHuKAU U STADARS 19,l liii I0 󈧽 AAfR WAR COLLG RESEARCH REPORT LZ? e lNo. AU-AWC-35-011 - N4 AFCOMS: DOES THIS SQA NEED AN EXECUTIVE cm...high incidence of safety and physical security violations. Serious deficiencies existed in the financial management area. Accounting errors were not

Factors influencing the incidence of maxillofacial fractures.

PubMed

Chrcanovic, Bruno Ramos

2012-03-01

Maxillofacial injuries occur in a significant proportion of trauma patients. Trauma causes considerable economic expense due to procedural costs, the time a patient is off work, and the associated loss of income. For these reasons, it is an important health and economic issue. The aim of this study is to discuss the factors that may influence the incidence of maxillofacial fractures. As it is necessary to determine trends to help guide the development of new methods of injury prevention, preventative measures are also discussed. An electronic search was undertaken in March 2011, including articles published between 1980 and 2011 with the terms "facial fractures" and "maxillofacial fractures" in the title. The texts of epidemiological studies were reviewed in order to identify factors that may influence the incidence of maxillofacial fractures. From the selected articles, ten factors were identified: age, gender, geographic region and cultural aspects, socioeconomic status, temporal and climatic influence, use of alcohol and drugs, compliance with road traffic legislation, domestic violence, osteoporosis, and etiology of the maxillofacial trauma. Care of injured patients should include not only management of the acute phase, but also combine preventive programs and interventional programs aimed at reducing the incidence of maxillofacial fractures. Therefore, there is a need to ensure strict compliance of traffic rules and regulations, implement improvement in automotive safety devices, organize prevention programs to minimize assaults, implement school education in alcohol abuse and handling potentially hostile situations (especially for men), improve protection during sporting activities, and legislate wearing of protective headgear in workers. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of trauma. Societal attitudes and behaviors must be modified before a significant reduction in the incidence of maxillofacial fractures will be seen.

Incident Management: Process into Practice

ERIC Educational Resources Information Center

Isaac, Gayle; Moore, Brian

2011-01-01

Tornados, shootings, fires--these are emergencies that require fast action by school district personnel, but they are not the only incidents that require risk management. The authors have introduced the National Incident Management System (NIMS) and the Incident Command System (ICS) and assured that these systems can help educators plan for and…

How Staff of Youth Programs Respond to Culture-Related Incidents: Nonengagement Versus Going "Full-Right-In"

ERIC Educational Resources Information Center

Gutiérrez, Vanessa; Larson, Reed W.; Raffaelli, Marcela; Fernandez, Mariela; Guzman, Sandy

2017-01-01

Incidents in which program leaders confront issues of culture and race occur regularly in many youth programs. These incidents are important because they reflect powerful dimensions of youth's lived experience and bring issues of injustice and program inclusiveness to the fore. This study examined these culture-related incidents and how leaders…

Explaining mastitis incidence in Dutch dairy farming: the influence of farmers' attitudes and behaviour.

PubMed

Jansen, J; van den Borne, B H P; Renes, R J; van Schaik, G; Lam, T J G M; Leeuwis, C

2009-11-15

When mastitis incidence increases, either infection pressure has increased or cows' resistance has decreased. This usually indicates that farm management is not optimal. Numerous quantitative studies have demonstrated the effect of management practices on mastitis. In most of these studies, the identified risk factors could explain only part of the variance in mastitis incidence on farms. Several studies suggest that the unexplained variance is caused by farmers' attitudes towards different aspects of mastitis treatment and preventive behaviour. This study aims to determine, to quantify and to specify the extent to which farmers' attitudes, over and above farmers' behaviour, are factors that explain the variation in mastitis incidence, measured in terms of the quantifiable effect of management factors. An extensive survey on self-reported attitudes, behaviour and mastitis incidence was conducted on 336 Dutch dairy farms. Results of multiple linear regression analyses show that farmers' self-reported behaviour and attitudes together explain 48%, 31% and 23% of the variation within, respectively, the average farm bulk milk somatic cell count (BMSCC), the clinical mastitis incidence and the combined clinical and subclinical mastitis incidence. Both behaviour and attitudes explain part of the variance. However, most of the variance in all three dependant measures is explained solely by the attitude variables. The variation in BMSCC value is best explained by (1) farmers' normative frame of reference about mastitis, (2) farmers' perceptions about the control of mastitis and (3) the perceived effect of a BMSCC penalty level. The variation in clinical mastitis is best explained by farmers' perceptions about mastitis control. The variation in the combined clinical and subclinical mastitis incidence rate is best explained by the perceived effect of a BMSCC penalty level and the frequency of contact with others. The results of this study show that farmers' attitudes are a better measure than farmers' self-reported behaviour to explain and predict differences in mastitis incidence between farms. Consequently, future research and animal health promotion programs should take into account not only farmers' behaviour, but also farmers' attitudes. This study provides a first empirical investigation into the social processes applicable to mastitis incidence and is therefore considered a good starting point for future research to further investigate the causal effect of attitude change on farmers' behaviour and animal health.

Impact of improved neonatal care on the profile of retinopathy of prematurity in rural neonatal centers in India over a 4-year period.

PubMed

Vinekar, Anand; Jayadev, Chaitra; Kumar, Siddesh; Mangalesh, Shwetha; Dogra, Mangat Ram; Bauer, Noel J; Shetty, Bhujang

2016-01-01

To report the reduction in the incidence and severity of retinopathy of prematurity (ROP) in rural India over a 4-year period following the introduction of improved neonatal care practices. The Karnataka Internet Diagnosis of Retinopathy of Prematurity program (KIDROP), is a tele-medicine network that screens for ROP in different zones of Karnataka state in rural India. North Karnataka is the most underdeveloped and remote zone of this program and did not have any ROP screening programs before the intervention of the KIDROP in 2011. Six government and eleven private neonatal centers in this zone were screened weekly. Specific neonatal guidelines for ROP were developed and introduced in these centers. They included awareness about risk factors, oxygen regulation protocols, use of pulse oxymetry, monitoring postnatal weight gain, nutritional best practices, and management of sepsis. The incidence and severity of ROP were compared before the guidelines were introduced (Jan 2011 to Dec 2012) and after the guidelines were introduced (July 2013 to June 2015). During this 4-year period, 4,167 infants were screened over 11,390 imaging sessions. The number of enrolled infants increased from 1,825 to 2,342 between the two periods ( P <0.001). The overall incidence of any stage ROP reduced significantly from 26.8% to 22.4% ( P <0.001). The incidence of treatment-requiring ROP reduced from 20.7% to 16% ( P =0.06), and of the treated disease, aggressive posterior ROP reduced from 20.8% to 13.1% ( P =0.23) following introduction of the guidelines. Rural neonatal centers in middle-income countries have a large, unscreened burden of ROP. Improving neonatal care in these centers can positively impact the incidence and severity of ROP even in a relatively short period. A combined approach of a robust ROP screening program and improved neonatal care practices is required to address the challenge.

Impact of improved neonatal care on the profile of retinopathy of prematurity in rural neonatal centers in India over a 4-year period

PubMed Central

Vinekar, Anand; Jayadev, Chaitra; Kumar, Siddesh; Mangalesh, Shwetha; Dogra, Mangat Ram; Bauer, Noel J; Shetty, Bhujang

2016-01-01

Purpose To report the reduction in the incidence and severity of retinopathy of prematurity (ROP) in rural India over a 4-year period following the introduction of improved neonatal care practices. Methods The Karnataka Internet Diagnosis of Retinopathy of Prematurity program (KIDROP), is a tele-medicine network that screens for ROP in different zones of Karnataka state in rural India. North Karnataka is the most underdeveloped and remote zone of this program and did not have any ROP screening programs before the intervention of the KIDROP in 2011. Six government and eleven private neonatal centers in this zone were screened weekly. Specific neonatal guidelines for ROP were developed and introduced in these centers. They included awareness about risk factors, oxygen regulation protocols, use of pulse oxymetry, monitoring postnatal weight gain, nutritional best practices, and management of sepsis. The incidence and severity of ROP were compared before the guidelines were introduced (Jan 2011 to Dec 2012) and after the guidelines were introduced (July 2013 to June 2015). Results During this 4-year period, 4,167 infants were screened over 11,390 imaging sessions. The number of enrolled infants increased from 1,825 to 2,342 between the two periods (P<0.001). The overall incidence of any stage ROP reduced significantly from 26.8% to 22.4% (P<0.001). The incidence of treatment-requiring ROP reduced from 20.7% to 16% (P=0.06), and of the treated disease, aggressive posterior ROP reduced from 20.8% to 13.1% (P=0.23) following introduction of the guidelines. Discussion Rural neonatal centers in middle-income countries have a large, unscreened burden of ROP. Improving neonatal care in these centers can positively impact the incidence and severity of ROP even in a relatively short period. A combined approach of a robust ROP screening program and improved neonatal care practices is required to address the challenge. PMID:28539801

Updates on the Management of Non-Melanoma Skin Cancer (NMSC)

PubMed Central

Fahradyan, Artur; Howell, Anna C.; Wolfswinkel, Erik M.; Tsuha, Michaela; Sheth, Parthiv; Wong, Alex K.

2017-01-01

Non-melanoma skin cancers (NMSCs) are the most common malignancy worldwide, of which 99% are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of skin. NMSCs are generally considered a curable diseases, yet they currently pose an increasing global healthcare problem due to rising incidence. This has led to a shift in emphasis on prevention of NMSCs with development of various skin cancer prevention programs worldwide. This article aims to summarize the most recent changes and advances made in NMSC management with a focus on prevention, screening, diagnosis, and staging. PMID:29104226

The medical communications officer. A resource for data collection, quality management and medical control.

PubMed

Gunderson, Michael; Barnard, Jeff; McPherson, John; Kearns, Conrad T

2002-08-01

Pinellas County EMS' Medical Communications Officers provide a wide variety of services to patients, field clinicians, managers and their medical director. The concurrent data collection processes used in the MCO program for performance measurement of resuscitation efforts, intubations, submersion incidents and aeromedical transports for trauma cases have been very effective in the integration of data from multiple computer databases and telephone follow-ups with field crews and receiving emergency department staffs. This has facilitated significant improvements in the performance of these and many other aspects of our EMS system.

Frail elderly patients. New model for integrated service delivery.

PubMed Central

Hébert, Rejean; Durand, Pierre J.; Dubuc, Nicole; Tourigny, André

2003-01-01

PROBLEM BEING ADDRESSED: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION: Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions. PMID:12943358

A mixed-method evaluation of a workforce development intervention for nursing assistants in nursing homes: the case of WIN A STEP UP.

PubMed

Morgan, Jennifer Craft; Konrad, Thomas R

2008-07-01

The purpose of this study was to evaluate WIN A STEP UP, a workforce development program for nursing assistants (NAs) in nursing homes (NHs) involving continuing education by onsite trainers, compensation for education modules, supervisory skills training of frontline supervisors, and short-term retention contracts for bonuses and/or wage increases upon completion. We collected longitudinal semistructured interview and survey data from NAs, supervisors, and managers at 8 program NHs and 10 comparison NHs. To control for selection bias, we matched 77 NA program participants to 81 participating site and 135 comparison site controls using propensity scores in a quasi-experimental design supplemented by qualitative assessments. Managers at seven of eight participating NHs wanted to repeat the program. At 3 months after baseline, participants differed from controls by having (a) more improved nursing care and supportive leadership scores, (b) greater improvement in team care, and (c) stronger ratings of career and financial rewards. Nurse supervisors participating in supervisory skills training reported positive changes in management practices for themselves and peers. Modest 3-month turnover reductions occurred in six settings where the program was fully implemented without incident. Managers', supervisors', and participating NAs' consistent perceptions of improved quality of care and job quality, along with a promise of increased retention, suggest that interventions like WIN A STEP UP are beneficial.

An evolution in interdisciplinary competencies to prevent and manage patient violence.

PubMed

Morton, Paula G

2002-01-01

Patient violence is a growing problem in healthcare institutions. Incidents of violence lead to injuries and increased operating costs. An innovative organizational approach to this problem is inclusion of interdisciplinary competency-based staff education and practice, as a key component of a comprehensive violence prevention program.Interdisciplinary competencies include a variety of behavioral responses, aimed at prevention, environmental, interpersonal, and physical interventions and postvention techniques for aggression and violence. Methods to maintain, monitor, document, and improve staff performance and skills are delineated. Organizational investment in such interdisciplinary competency-based education and practice evolves over time. Results include fewer incidents and injuries and enhanced interdisciplinary cooperation.

Corridor incident management (CIM)

DOT National Transportation Integrated Search

2007-09-01

The objective of the Corridor Incident Management (CIM) research project was to develop and demonstrate a set of multi-purpose methods, tools and databases to improve corridor incident management in Tennessee, relying primarily on resources already a...

Chronic kidney disease management program in Shahreza, Iran.

PubMed

Barahimi, Hamid; Aghighi, Mohammad; Aghayani, Katayon; Rahimi Foroushani, Abbas

2014-11-01

Chronic kidney disease (CKD) is a public health problem that needs an integrated program to be detected, monitored, and controlled. This study reports the results of a CKD program designed and implemented in Shahreza, Iran. After initial evaluation of CKD in Shahreza, a CKD management program was developed in the Ministry of Health and the pilot project was started in February 2011 in Shahreza rural areas. The patients at risk, including those with diabetes mellitus and hypertension, were tested with serum creatinine and urine albumin-creatinine ratio. The CKD management program included training, screening, monitoring, and controlling of weight, hypertension, diabetes mellitus, lipids, and vitamin D. This pilot program was organized in the rural population aged over 30 years who were suffering from hypertension, diabetes mellitus, or both, and resulted in the discovery of cases in various stages of CKD. The prevalence of CKD in this high-risk group was 21.5%. Persistent albuminuria and a glomerular filtration rate less than 60 mL/min/1.73 m(2) were 13% and 11%, respectively. The rate of CKD stages 1, 2, 3a, 3b, 4, and 5 were 2.75%, 6.82%, 10.08%, 0.92%, 0.31%, and 0.17% respectively. After 1 year of the program implemented, incidence rate of CKD was 24% and improvement rate was 21%. In diabetic patients, the mean of hemoglobin A1c decreased from 8.5 ± 1.9% to 7.5% ± 1.8%. Integration of CKD programs in primary health care is possible and results in improvement in management of CKD patients.

Implementing a wound care resource nurse program.

PubMed

Tully, Sandra; Ganson, Claudia; Savage, Pamela; Banez, Carol; Zarins, Baiba

2007-08-01

Nurses are leaders in implementing innovations that can create positive outcomes in the prevention and management of pressure ulcers in patients admitted to acute care hospitals. Believing that nurses knowledgeable in best practices could impact prevalence, incidence, and care of pressure ulcers, an educational program was developed in a Canadian healthcare system to inform and empower nurses providing skin and wound care. The program afforded participants the opportunity to acquire the knowledge and skill to recognize patients at risk for developing pressure ulcers and to independently treat Stage I and Stage II pressure ulcers and skin breakdown related to moisture, friction, and shear. The program includes evidence-based practice recommendations and highlights the Best Practice Guidelines developed by the Registered Nurses Association of Ontario, a provincial body taking an active role in the development, implementation, and evaluation of published guidelines derived from global research literature synthesis. Pre- and post participation assessment of 65 nurse participants from three hospitals deemed the program successful in terms of knowledge and fulfillment of their educational expectations. Organizational support to implement the skin and wound care resource nurse role was encouraging and medical directives for Stage I and Stage II pressure ulcers by nurses were implemented. Evaluation and monitoring of program outcomes, including pressure ulcer incidence rates, continue.

Incidence and Prevalence of Rheumatoid Arthritis in a Health Management Organization in Argentina: A 15-year Study.

PubMed

Di, Wai Tan; Vergara, Facundo; Bertiller, Emmanuel; Gallardo, Maria de Los Angeles; Gandino, Ignacio; Scolnik, Marina; Martinez, Maximiliano J; Schpilberg, Mónica G; Rosa, Javier; Soriano, Enrique R

2016-07-01

To estimate incidence and prevalence rates of rheumatoid arthritis (RA) in the city of Buenos Aires (CABA), Argentina, using data from a university hospital-based health management organization. Global, age-specific, and sex-specific incidence and prevalence rates were calculated for members of the Hospital Italiano Medical Care Program (HIMCP), age ≥ 18 years. Incidence study followed members with continuous affiliation ≥ 1 year from January 2000 to January 2015 until he/she voluntarily left the HIMCP, RA was diagnosed, death, or study finalization. Cases from the Rheumatology Section database, electronic medical records, laboratory database, and pharmacy database were filtered with the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Prevalence was calculated on January 1, 2015, and standardized for CABA. Capture-recapture (C-RC) analysis estimated true population sizes. In the study period, incidence rates (cases per 100,000 person-yrs) were 18.5 (95% CI 16.7-20.4) overall, 25.2 (95% CI 22.4-28.0) for women, and 8.8 (95% CI 6.8-10.8) for men. Prevalence rates (percentage of RA cases in the sample population) were 0.329 (95% CI 0.298-0.359) overall, 0.464 (95% CI 0.417-0.510) for women, and 0.123 (95% CI 0.093-0.152) for men. Standardized CABA prevalence rate was 0.300 (95% CI 0.292-0.307). C-RC adjusted rates were almost the same as unadjusted rates. This study's incidence and prevalence rates are in the lower range of the rates found around the world. Our female to male prevalence ratio was 4:1. Our peak incidence age was in the sixth and seventh decades for both sexes.

Structuring the Chief Information Security Officer Organization

DTIC Science & Technology

2015-09-07

GP9 Objectively Evaluate Adherence CERT-RMM HRM Human Resource Management CERT-RMM ID Identity Management CERT-RMM IMC Incident Management and...Detect, triage, analyze, respond to, and recover from suspicious events and security incidents Security incident management IMC IR IR-1, IR- 2, IR-3...2015-TN-007 | SOFTWARE ENGINEERING INSTITUTE | CARNEGIE MELLON UNIVERSITY 6 Table 2: Source Acronyms3 CERT-RMM NIST 800-53 C2M2 IMC Incident

Geographical Variations and Trends in Major Cancer Incidences throughout Korea during 1999-2013.

PubMed

Won, Young-Joo; Jung, Kyu-Won; Oh, Chang-Mo; Park, Eun-Hye; Kong, Hyun-Joo; Lee, Duk Hyoung; Lee, Kang Hyun

2018-01-04

We aimed to describe the temporal trends and district-level geographical variations in cancer incidences throughout Korea during 1999-2013. Data were obtained from the Korean National Cancer Incidence Database. We calculated the age-standardized cumulative cancer incidences according to sex and geographical region (metropolitan cities, provinces, and districts) for three 5-year periods (1999-2003, 2004-2008, and 2009-2013). Each quintile interval contained the same number of regions. Disease maps were created to visualize regional differences in the cancer incidences. Substantial differences in cancer incidences were observed according to district and cancer type. The largest variations between geographical regions were found for thyroid cancer among both men and women. There was little variation in the incidences of stomach, colorectal, and lung cancer according to geographical region. Substantially elevated incidences of specific cancers were observed in Jeollanam-do (thyroid); Daejeon (colorectum); Jeollanam-do, Gyeongsangbuk-do, and Chungcheongbuk-do (lung); Seocho-gu, Gangnam-gu, and Seongnam, Bundang-gu (breast and prostate); Chungcheong and Gyeongsang provinces (stomach); Ulleung-gun and the southern districts of Gyeongsangnam-do and Jeollanam-do (liver); and along the Nakdonggang River (gallbladder and biliary tract). Mapping regional cancer incidences in Korea allowed us to compare the results according to geographical region. Our results may facilitate the development of infrastructure for systematic cancer incidence monitoring, which could promote the planning and implementation of region-specific cancer management programs.

Traffic Incident Management in the Presence of Hazards

NASA Astrophysics Data System (ADS)

Wang, Z.; Zlatanova, S.; Steenbruggen, J.

2016-09-01

Traffic incidents can result in different kinds of hazards (e.g., plumes) that influence the status of road networks, therefore there is a great need for incident management in the presence of the hazards. When incidents occur, the created hazards not only affect the normal road users (make them detour or blocked), but also influence the movement of first responders. Traffic managers, who are responsible for maintaining the road safety and traffic stability, should carry out quick and effective measures to manage the incidents. In this paper, we present four issues to help people better understand the situations that could occur in the management of incidents with hazards: 1). Evacuation in the presence of hazards; 2). 3D incident management; 3). Navigation support for first responders; 4). Navigation support for road users. To address these issues, we propose a solution which combines agent technology, geo-database, hazard simulation, and traffic simulation. Further research would be needed to investigate the potentials of the proposed solution in real applications.

New York integrated incident management system evaluation project final report

DOT National Transportation Integrated Search

2007-03-23

The Integrated Incident Management System (IIMS) enables incident response personnel to transmit data about an incident to other responders and dispatchers on a real-time basis. When an incident is entered into IIMS, the system uses GPS to identify t...

Nevada National Security Site Environmental Report 2016

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

Wills

This Nevada National Security Site Environmental Report (NNSSER) was prepared to satisfy DOE Order DOE O 231.1B, “Environment, Safety and Health Reporting.” Its purpose is to (1) report compliance status with environmental standards and requirements, (2) present results of environmental monitoring of radiological and nonradiological effluents, (3) report estimated radiological doses to the public from releases of radioactive material, (4) summarize environmental incidents of noncompliance and actions taken in response to them, (5) describe the National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Environmental Management System and characterize its performance, and (6) highlight significant environmental programs and efforts. This NNSSERmore » summarizes data and compliance status for calendar year 2016 at the Nevada National Security Site (NNSS) and its two Nevada-based support facilities, the North Las Vegas Facility (NLVF) and the Remote Sensing Laboratory–Nellis (RSL-Nellis). It also addresses environmental restoration (ER) projects conducted at the Tonopah Test Range (TTR) and the Nevada Test and Training Range (NTTR). NNSA/NFO directs the management and operation of the NNSS and six sites across the nation. In addition to the NNSA itself, the six sites include two in Nevada (NLVF and RSL-Nellis) and four in other states (RSL-Andrews in Maryland, Livermore Operations in California, Los Alamos Operations in New Mexico, and Special Technologies Laboratory in California). Los Alamos, Lawrence Livermore, and Sandia National Laboratories are the principal organizations that sponsor and implement the nuclear weapons programs at the NNSS. National Security Technologies, LLC (NSTec), is the current Management and Operating contractor accountable for the successful execution of work and ensuring that work is performed in compliance with environmental regulations. The six sites all provide support to enhance the NNSS as a location for its multiple missions. The three major NNSS missions include National Security/Defense, Environmental Management, and Nondefense. The major programs that support these missions are Stockpile Stewardship and Management, Nonproliferation and Counterterrorism, Nuclear Emergency Response, Strategic Partnership Projects, Environmental Restoration, Waste Management, Conservation and Renewable Energy, Other Research and Development, and Infrastructure. The major facilities that support the programs include the U1a Facility, Big Explosives Experimental Facility (BEEF), Device Assembly Facility, Dense Plasma Focus Facility, Joint Actinide Shock Physics Experimental Research Facility, Radiological/Nuclear Countermeasures Test and Evaluation Complex, Nonproliferation Test and Evaluation Complex (NPTEC), Radiological/Nuclear Weapons of Mass Destruction Incident Exercise Site, the Area 5 Radioactive Waste Management Complex (RWMC), and the Area 3 Radioactive Waste Management Site (RWMS).« less

Questionnaire-based study to assess the association between management practices and mastitis within tie-stall and free-stall dairy housing systems in Switzerland

PubMed Central

2013-01-01

Background Prophylactic measures are key components of dairy herd mastitis control programs, but some are only relevant in specific housing systems. To assess the association between management practices and mastitis incidence, data collected in 2011 by a survey among 979 randomly selected Swiss dairy farms, and information from the regular test day recordings from 680 of these farms was analyzed. Results The median incidence of farmer-reported clinical mastitis (ICM) was 11.6 (mean 14.7) cases per 100 cows per year. The median annual proportion of milk samples with a composite somatic cell count (PSCC) above 200,000 cells/ml was 16.1 (mean 17.3) %. A multivariable negative binomial regression model was fitted for each of the mastitis indicators for farms with tie-stall and free-stall housing systems separately to study the effect of other (than housing system) management practices on the ICM and PSCC events (above 200,000 cells/ml). The results differed substantially by housing system and outcome. In tie-stall systems, clinical mastitis incidence was mainly affected by region (mountainous production zone; incidence rate ratio (IRR) = 0.73), the dairy herd replacement system (1.27) and farmers age (0.81). The proportion of high SCC was mainly associated with dry cow udder controls (IRR = 0.67), clean bedding material at calving (IRR = 1.72), using total merit values to select bulls (IRR = 1.57) and body condition scoring (IRR = 0.74). In free-stall systems, the IRR for clinical mastitis was mainly associated with stall climate/temperature (IRR = 1.65), comfort mats as resting surface (IRR = 0.75) and when no feed analysis was carried out (IRR = 1.18). The proportion of high SSC was only associated with hand and arm cleaning after calving (IRR = 0.81) and beef producing value to select bulls (IRR = 0.66). Conclusions There were substantial differences in identified risk factors in the four models. Some of the factors were in agreement with the reported literature while others were not. This highlights the multifactorial nature of the disease and the differences in the risks for both mastitis manifestations. Attempting to understand these multifactorial associations for mastitis within larger management groups continues to play an important role in mastitis control programs. PMID:24107254

Questionnaire-based study to assess the association between management practices and mastitis within tie-stall and free-stall dairy housing systems in Switzerland.

PubMed

Gordon, Paz F; van den Borne, Bart H P; Reist, Martin; Kohler, Samuel; Doherr, Marcus G

2013-10-09

Prophylactic measures are key components of dairy herd mastitis control programs, but some are only relevant in specific housing systems. To assess the association between management practices and mastitis incidence, data collected in 2011 by a survey among 979 randomly selected Swiss dairy farms, and information from the regular test day recordings from 680 of these farms was analyzed. The median incidence of farmer-reported clinical mastitis (ICM) was 11.6 (mean 14.7) cases per 100 cows per year. The median annual proportion of milk samples with a composite somatic cell count (PSCC) above 200,000 cells/ml was 16.1 (mean 17.3) %. A multivariable negative binomial regression model was fitted for each of the mastitis indicators for farms with tie-stall and free-stall housing systems separately to study the effect of other (than housing system) management practices on the ICM and PSCC events (above 200,000 cells/ml). The results differed substantially by housing system and outcome. In tie-stall systems, clinical mastitis incidence was mainly affected by region (mountainous production zone; incidence rate ratio (IRR) = 0.73), the dairy herd replacement system (1.27) and farmers age (0.81). The proportion of high SCC was mainly associated with dry cow udder controls (IRR = 0.67), clean bedding material at calving (IRR = 1.72), using total merit values to select bulls (IRR = 1.57) and body condition scoring (IRR = 0.74). In free-stall systems, the IRR for clinical mastitis was mainly associated with stall climate/temperature (IRR = 1.65), comfort mats as resting surface (IRR = 0.75) and when no feed analysis was carried out (IRR = 1.18). The proportion of high SSC was only associated with hand and arm cleaning after calving (IRR = 0.81) and beef producing value to select bulls (IRR = 0.66). There were substantial differences in identified risk factors in the four models. Some of the factors were in agreement with the reported literature while others were not. This highlights the multifactorial nature of the disease and the differences in the risks for both mastitis manifestations. Attempting to understand these multifactorial associations for mastitis within larger management groups continues to play an important role in mastitis control programs.

[Lessons learned from a distribution incident at the Alps-Mediterranean Division of the French Blood Establishment].

PubMed

Legrand, D

2008-11-01

The Alps-Mediterranean division of the French blood establishment (EFS Alpes-Mediterranée) has implemented a risk management program. Within this framework, the labile blood product distribution process was assessed to identify critical steps. Subsequently, safety measures were instituted including computer-assisted decision support, detailed written instructions and control checks at each step. Failure of these measures to prevent an incident underlines the vulnerability of the process to the human factor. Indeed root cause analysis showed that the incident was due to underestimation of the danger by one individual. Elimination of this type of risk will require continuous training, testing and updating of personnel. Identification and reporting of nonconformities will allow personnel at all levels (local, regional, and national) to share lessons and implement appropriate risk mitigation strategies.

Managing Materials and Wastes for Homeland Security Incidents

EPA Pesticide Factsheets

To provide information on waste management planning and preparedness before a homeland security incident, including preparing for the large amounts of waste that would need to be managed when an incident occurs, such as a large-scale natural disaster.

49 CFR 1542.307 - Incident management.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 9 2013-10-01 2013-10-01 false Incident management. 1542.307 Section 1542.307 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION... Incident management. (a) Each airport operator must establish procedures to evaluate bomb threats, threats...

49 CFR 1542.307 - Incident management.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 9 2012-10-01 2012-10-01 false Incident management. 1542.307 Section 1542.307 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION... Incident management. (a) Each airport operator must establish procedures to evaluate bomb threats, threats...

49 CFR 1542.307 - Incident management.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 9 2014-10-01 2014-10-01 false Incident management. 1542.307 Section 1542.307 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION... Incident management. (a) Each airport operator must establish procedures to evaluate bomb threats, threats...

49 CFR 1542.307 - Incident management.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 9 2011-10-01 2011-10-01 false Incident management. 1542.307 Section 1542.307 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION... Incident management. (a) Each airport operator must establish procedures to evaluate bomb threats, threats...

Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching

PubMed Central

Willoughby, Deborah; Aybar-Damali, Begum; Grady, Carmelita; Oran, Rebecca; Knudson, Alana

2018-01-01

The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS) through the use of volunteers. The study’s priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition) were not statistically significant, the treatment group’s rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19). The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care. PMID:29614803

A Decade of Experience: Which Network Structures Maximize Fire Service Capacity for Homeland Security Incidents in Metropolitan Regions?

DTIC Science & Technology

2011-12-01

Pennsylvania Emergency Management Agency QHSR Quadrennial Homeland Security Review Report RCP Regional Catastrophic Preparedness SAA State...service has evolved from a single-purpose service focused on controlling fires to a multidimensional response element responsible for pre- hospital ... hospital preparedness program Preparedness Training for all personnel; training and network activities during prior year assist in preparedness

Crime on Campus: Analyzing and Managing the Increasing Risk of Institutional Liability. The Publication Series.

ERIC Educational Resources Information Center

Burling, Philip

This monograph reviews a college or university's responsibility for incidents of crime occurring on its campus or in the course of its programs. Part 1 reviews the legal analyses which courts undertake in responding to claims that, under common tort law or contract theories, liability for the injuries suffered by a person ought to be shifted from…

Fault Management Technology Maturation for NASA's Constellation Program

NASA Technical Reports Server (NTRS)

Waterman, Robert D.

2010-01-01

This slide presentation reviews the maturation of fault management technology in preparation for the Constellation Program. There is a review of the Space Shuttle Main Engine (SSME) and a discussion of a couple of incidents with the shuttle main engine and tanking that indicated the necessity for predictive maintenance. Included is a review of the planned Ares I-X Ground Diagnostic Prototype (GDP) and further information about detection and isolation of faults using Testability Engineering and Maintenance System (TEAMS). Another system that being readied for use that detects anomalies, the Inductive Monitoring System (IMS). The IMS automatically learns how the system behaves and alerts operations it the current behavior is anomalous. The comparison of STS-83 and STS-107 (i.e., the Columbia accident) is shown as an example of the anomaly detection capabilities.

Database management systems for process safety.

PubMed

Early, William F

2006-03-17

Several elements of the process safety management regulation (PSM) require tracking and documentation of actions; process hazard analyses, management of change, process safety information, operating procedures, training, contractor safety programs, pre-startup safety reviews, incident investigations, emergency planning, and compliance audits. These elements can result in hundreds of actions annually that require actions. This tracking and documentation commonly is a failing identified in compliance audits, and is difficult to manage through action lists, spreadsheets, or other tools that are comfortably manipulated by plant personnel. This paper discusses the recent implementation of a database management system at a chemical plant and chronicles the improvements accomplished through the introduction of a customized system. The system as implemented modeled the normal plant workflows, and provided simple, recognizable user interfaces for ease of use.

41 CFR 102-80.65 - What are Federal agencies' responsibilities concerning the investigation of incidents, such as...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., and environmental incidents? 102-80.65 Section 102-80.65 Public Contracts and Property Management...-SAFETY AND ENVIRONMENTAL MANAGEMENT Safety and Environmental Management Incident Investigation § 102-80... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What are Federal...

Wireless just-in-time training of mobile skilled support personnel

NASA Astrophysics Data System (ADS)

Bandera, Cesar; Marsico, Michael; Rosen, Mitchel; Schlegel, Barry

2006-05-01

Skilled Support Personnel (SSP) serve emergency response organizations during an emergency incident, and include laborers, operating engineers, carpenters, ironworkers, sanitation workers and utility workers. SSP called to an emergency incident rarely have recent detailed training on the chemical, biological, radiological, nuclear and/or explosives (CBRNE) agents or the personal protection equipment (PPE) relevant to the incident. This increases personal risk to the SSP and mission risk at the incident site. Training for SSP has been identified as a critical need by the National Institute for Environmental Health Sciences, Worker Education and Training Program. We present a system being developed to address this SSP training shortfall by exploiting a new training paradigm called just-in-time training (JITT) made possible by advances in distance learning and cellular telephony. In addition to the current conventional training at regularly scheduled instructional events, SSP called to an emergency incident will have secure access to short (<5 minutes) training modules specific to the incident and derived from the Occupational Safety and Health Administration (OSHA) Disaster Site Worker Course. To increase retention, each learning module incorporates audio, video, interactive simulations, graphics, animation, and assessment designed for the user interface of most current cell phones. Engineering challenges include compatibility with current cell phone technologies and wireless service providers, integration with the incident management system, and SCORM compliance.

Evaluating and improving incident management using historical incident data : case studies at Texas transportation management centers.

DOT National Transportation Integrated Search

2009-08-01

The companion guidebook (0-5485-P2) developed as part of this study provides the procedures and : methodologies for effective use of historical incident data at Texas Transportation Management Centers : (TMCs). This research report documents the resu...

Changing perspectives in screening for congenital hypothyroidism and congenital adrenal hyperplasia.

PubMed

Mitchell, Marvin L; Hsu, Ho-Wen; Sahai, Inderneel

2014-02-01

The purpose of this review is to summarize recent information that has had a significant impact on the laboratory diagnosis and clinical management of newborns with congenital hypothyroidism and congenital adrenal hyperplasia (CAH). An approximate doubling of the incidence rate of congenital hypothyroidism in many parts of the world has been attributed to increased detection of infants with mild disease, delayed thyroid stimulating hormone elevations and demographic changes. A substantial number of children with modest thyroid stimulating hormone elevations on screening have permanent disease. Circulating levels of thyroxine may vary among hypothyroid children who are given identical dosages of medication. Treated infants should be monitored every 1-2 months during the first year of life. Although, generic and brand name thyroxine preparations may not be bioequivalent, children can be well controlled on generic formulations.Enzyme linked immunoassay assay for 17-hydroxyprogesterone is associated with a high rate of false positive specimens. In attempts to minimize this problem, some programs have resorted to two-tier screening of the initial specimen with steroid profiling as the second tier. Several programs are routinely testing second specimens in an effort to reduce the incidence of missed CAH cases. This review explains the uptick in incidence rate of congenital hypothyroidism and underscores issues in management that can affect developmental outcome. One specimen two-tier testing for CAH resulted in an increased false negative rate without significantly reducing the false positive rate. The benefit of collecting second specimens for CAH screening is problematic. Optimal treatment of CAH continues to pose a challenge.

Responses to professional identity threat: Identity management strategies in incident narratives of health care professionals.

PubMed

van Os, Annemiek; de Gilder, Dick; van Dyck, Cathy; Groenewegen, Peter

2015-01-01

The purpose of this paper is to explore sensemaking of incidents by health care professionals through an analysis of the role of professional identity in narratives of incidents. Using insights from social identity theory, the authors argue that incidents may create a threat of professional identity, and that professionals make use of identity management strategies in response to this identity threat. The paper draws on a qualitative analysis of incident narratives in 14 semi-structured interviews with physicians, nurses, and residents at a Dutch specialist hospital. The authors used an existing framework of identity management strategies to categorize the narratives. The analysis yielded two main results. First, nurses and residents employed multiple types of identity management strategies simultaneously, which points to the possible benefit of combining different strategies. Second, physicians used the strategy of patronization of other professional groups, a specific form of downward comparison. The authors discuss the implications of the findings in terms of the impact of identity management strategies on the perpetuation of hierarchical differences in health care. The authors argue that efforts to manage incident handling may profit from considering social identity processes in sensemaking of incidents. This is the first study that systematically explores how health care professionals use identity management strategies to maintain a positive professional identity in the face of incidents. This study contributes to research on interdisciplinary cooperation in health care.

Season-Ending Shoulder Injuries in the National Collegiate Athletic Association: Data From the NCAA Injury Surveillance Program, 2009-2010 Through 2013-2014.

PubMed

Goodman, Avi D; DeFroda, Steven F; Gil, Joseph A; Kleiner, Justin E; Li, Neill Y; Owens, Brett D

2018-05-01

Examination of the incidence of shoulder season-ending injury (SEI) in the collegiate athlete population is limited. To determine the incidence of shoulder SEI in the National Collegiate Athletic Association (NCAA) and to investigate the risk factors for a shoulder injury ending an athlete's season. Descriptive epidemiology study. All shoulder injuries from the NCAA Injury Surveillance Program database for the years 2009-2010 to 2013-2014 were extracted, and SEI status was noted. The incidences of SEI and non-SEI were calculated for athlete, activity, and injury characteristics and compared via univariable analysis and risk ratios to determine risk factors for an injury being season ending. Shoulder injuries were season ending in 4.3% of cases. The overall incidence of shoulder SEI was 0.31 per 10,000 athlete exposures (AEs), as opposed to 7.25 per 10,000 AEs for all shoulder injuries. Shoulder instability constituted 49.1% of SEI, with an incidence of 0.15 per 10,000 AEs, while fractures had the highest rate of being season ending (41.9%). Men's wrestling had the highest incidence of shoulder SEI (1.65 per 10,000 AEs), while men's soccer had the highest proportion of shoulder injuries that ended a season (14.6%). Overall, men had a 6.3-fold higher incidence of SEI than women and a 2.4-fold increased likelihood that an injury would be season ending. Injury to the shoulder of an NCAA athlete, while somewhat infrequent, can have significant implications on time lost from play. Incidence of these injuries varies widely by sport and injury, with a number of associated risk factors. Athletes sustaining potentially season-ending shoulder injuries, with their coaches and medical providers, may benefit from these data to best manage expectations and outcomes.

Workplace road safety risk management: An investigation into Australian practices.

PubMed

Warmerdam, Amanda; Newnam, Sharon; Sheppard, Dianne; Griffin, Mark; Stevenson, Mark

2017-01-01

In Australia, more than 30% of the traffic volume can be attributed to work-related vehicles. Although work-related driver safety has been given increasing attention in the scientific literature, it is uncertain how well this knowledge has been translated into practice in industry. It is also unclear how current practice in industry can inform scientific knowledge. The aim of the research was to use a benchmarking tool developed by the National Road Safety Partnership Program to assess industry maturity in relation to risk management practices. A total of 83 managers from a range of small, medium and large organisations were recruited through the Victorian Work Authority. Semi-structured interviews aimed at eliciting information on current organisational practices, as well as policy and procedures around work-related driving were conducted and the data mapped onto the benchmarking tool. Overall, the results demonstrated varying levels of maturity of risk management practices across organisations, highlighting the need to build accountability within organisations, improve communication practices, improve journey management, reduce vehicle-related risk, improve driver competency through an effective workplace road safety management program and review organisational incident and infringement management. The findings of the study have important implications for industry and highlight the need to review current risk management practices. Copyright © 2016 Elsevier Ltd. All rights reserved.

40 CFR 68.60 - Incident investigation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Incident investigation. 68.60 Section 68.60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Program 2 Prevention Program § 68.60 Incident investigation. (a...

Preventing Occupational Skin Disease: A Review of Training Programs.

PubMed

Zack, Bethany; Arrandale, Victoria H; Holness, D Linn

Occupational contact dermatitis (OCD) is a common occupational disease that impacts a variety of worker groups. Skin protection and disease prevention training programs have shown promise for improving prevention practices and reducing the incidence of OCD. This review details the features of training programs for primary prevention of OCD and identifies gaps in the literature. Twelve studies were identified for in-depth review: many studies included wet workers employed in health care, hairdressing, cleaning, and food preparation; 1 program featured manufacturing workers. Few programs provided content on allergic contact dermatitis, and only 1 was evaluated for long-term effectiveness. Effective programs were similar in content, delivery method, and timing and were characterized by industry specificity, multimodal learning, participatory elements, skin care resource provision, repeated sessions, and management engagement. Long-term effectiveness, generalizability beyond OCD, workplace health and safety culture impact, and translation of programs in the North American context represent areas for future research.

Experiences and lessons learned from 29 HPV vaccination programs implemented in 19 low and middle-income countries, 2009-2014.

PubMed

Ladner, Joël; Besson, Marie-Hélène; Audureau, Etienne; Rodrigues, Mariana; Saba, Joseph

2016-10-13

Cervical cancer is the greatest cause of age-weighted years of life lost in the developing world. Human papillomavirus (HPV) infection is associated with a high proportion of cervical cancers, and HPV vaccination may help to reduce the incidence of cancer. The aim of the study was to identify barriers, obstacles, and strategies and to analyze key concerns and lessons learned with respect to the implementation of HPV vaccination program in low- and middle-income countries. The Gardasil Access Program (GAP) is a donation program established to enable organizations and institutions in eligible low-resource countries to gain operational experience designing and implementing HPV vaccination programs. This study used an online survey to capture the experiences and insights of program managers participating in the GAP. Different factors related to HPV vaccination program management were collected. A mixed-method approach enabled the presentation of both quantitative measurements and qualitative insights. Twenty-nine programs implemented by 23 institutions in 19 low- and middle-income countries were included. Twenty programs managers (97.7 %) reported that their institution implemented sensitization strategies about vaccination prior to the launch of vaccination campaign. The most frequently reported obstacles to HPV vaccination by the program managers were erroneous perceptions of population related to the vaccine's safety and efficacy. Reaching and maintaining follow-up with target populations were identified as challenges. Insufficient infrastructure and human resources financing and the vaccine delivery method were identified as significant health system barriers. Coupling HPV vaccination with other health interventions for mothers of targeted girls helped to increase vaccination and cervical cancer screening. The majority of program managers reported that their programs had a positive impact on national HPV vaccination policy. The majority of institutions had national and international partners that provided support for human resources, technical assistance, and training and financial support for health professionals. Local organizations and institutions can implement successful HPV vaccination campaigns. Adequate and adapted planning and resources that support information sharing, sensitization, and mobilization are essential for such success. These results can inform the development of programs and policies related to HPV vaccination in low- and middle-income countries.

Learning from Taiwan patient-safety reporting system.

PubMed

Lin, Chung-Chih; Shih, Chung-Liang; Liao, Hsun-Hsiang; Wung, Cathy H Y

2012-12-01

The aim of this study is to create a national database to record incidents that endanger patient safety. We try to identify systemic problems in hospitals in order to avoid safety incidents in the future and improve the quality of healthcare. The Taiwan Patient Safety Reporting System employs a voluntary notification model. We define 13 types of patient safety incidents, and the reports of different types of incidents are recorded using common terminology. Statistical analysis is used to identify the incident type, time of occurrence, location, person who reported the incident, and possible reasons for frequently occurring incidents. There were 340 hospitals that joined this program from 2005 to 2010. Over 128,271 incident events were reported and analyzed. The three most common incidents were drug-related incidents, falls, and endo tube related incidents. By analyzing the time of occurrence of incidents, we found that drug-related incidents usually occurred between 8 and 10 am. Falls and endo tube incidents usually occurred between 4 and 6 am. The most common location was wards (57.6%), followed by intensive care areas (13.5%), and pharmacies (9.1%). Among hospital staff, nurses reported the highest number of incidents (68.9%), followed by pharmacists (14.5%) and administrative staff (5.5%). The number of incidents reported by doctors was much lower (1.2%). Most staff members who reported incidents had been working for less than five years (58.1%). The unified reporting system was found to improve the recording and analysis of patient safety incidents. To encourage hospital staff to report incidents, hospitals need to be assisted in establishing an internal report and management system for safety incidents. Hospitals also need a protection mechanism to allow staff members to report incidents without the fear of punishment. By identifying the root causes of safety incidents and sharing the lessons learned across hospitals is the only way such incidents can be stopped from happening again. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Performance of 21 HPV vaccination programs implemented in low and middle-income countries, 2009–2013

PubMed Central

2014-01-01

Background Cervical cancer is the third most common cancer in women worldwide, with high incidence in lowest income countries. Vaccination against Human Papilloma Virus (HPV) may help to reduce the incidence of cervical cancer. The aim of the study was to analyze HPV vaccination programs performance implemented in low and middle-income countries. Methods The Gardasil Access Program provides HPV vaccine at no cost to help national institutions gain experience implementing HPV vaccination. Data on vaccine delivery model, number of girls vaccinated, number of girls completing the three-dose campaign, duration of vaccination program, community involvement and sensitization strategies were collected from each program upon completion. Vaccine Uptake Rate (VUR) and Vaccine Adherence between the first and third doses (VA) rate were calculated. Multivariate linear regressions analyses were fitted. Results Twenty-one programs were included in 14 low and middle-income countries. Managing institutions were non-governmental organizations (NGOs) (n = 8) or Ministries of Health (n = 13). Twelve programs were school-based, five were health clinic-based and four utilized a mixed model. A total of 217,786 girls received a full course of vaccination. Mean VUR was 88.7% (SD = 10.5) and VA was 90.8% (SD = 7.3). The mean total number of girls vaccinated per program-month was 2,426.8 (SD = 2,826.6) in school model, 335.1 (SD = 202.5) in the health clinic and 544.7 (SD = 369.2) in the mixed models (p = 0.15). Community involvement in the follow-up of girls participating in the vaccination campaign was significantly associated with VUR. Multivariate analyses identified school-based (β = 13.35, p = 0.001) and health clinic (β = 13.51, p = 0.03) models, NGO management (β = 14.58, p < 10-3) and duration of program vaccination (β = -1.37, p = 0.03) as significant factors associated with VUR. Conclusion School and health clinic-based models appeared as predictive factors for vaccination coverage, as was management by an NGO; program duration could play a role in the program’s effectiveness. Results suggest that HPV vaccine campaigns tailored to meet the needs of communities can be effective. These results may be useful in the development of national HPV vaccination policies in low and middle-income countries. PMID:24981818

Raising suspicions with the Food and Drug Administration: detecting misconduct.

PubMed

Hamrell, Michael R

2010-12-01

The clinical Bioresearch Monitoring (BIMO) oversight program of the US Food and Drug Administration (FDA) assesses the quality and integrity of data submitted to the FDA for new product approvals and human subjects protection during clinical studies. A comprehensive program of on-site inspections and data verification, the BIMO program routinely performs random inspections to verify studies submitted to the FDA to support a marketing application. On occasion the FDA will conduct a directed inspection of a specific site or study to look for problems that may have previously been identified. The inspection of a clinical study sometimes uncovers evidence of research fraud or misconduct and it must be decided how to deal with the investigator and the suspect data. The prevention of [or] decreasing the incidence of fraud and misconduct through monitoring by the sponsor is one way to manage compliance issues and can help prevent misconduct. A training program is another way to manage compliance issues in clinical research. While training does not guarantee quality, it does help to ensure that all individuals involved understand the rules and the consequences of research misconduct.

CDC's Emergency Management Program activities - worldwide, 2003-2012.

PubMed

2013-09-06

In 2003, recognizing the increasing frequency and complexity of disease outbreaks and disasters and a greater risk for terrorism, CDC established the Emergency Operations Center (EOC), bringing together CDC staff members who respond to public health emergencies to enhance communication and coordination. To complement the physical EOC environment, CDC implemented the Incident Management System (IMS), a staffing structure and set of standard operational protocols and services to support and monitor CDC program-led responses to complex public health emergencies. The EOC and IMS are key components of CDC's Emergency Management Program (EMP), which applies emergency management principles to public health practice. To enumerate activities conducted by the EMP during 2003-2012, CDC analyzed data from daily reports and activity logs. The results of this analysis determined that, during 2003-2012, the EMP fully activated the EOC and IMS on 55 occasions to support responses to infectious disease outbreaks, natural disasters, national security events (e.g., conventions, presidential addresses, and international summits), mass gatherings (e.g., large sports and social events), and man-made disasters. On 109 other occasions, the EMP was used to support emergency responses that did not require full EOC activation, and the EMP also conducted 30 exercises and drills. This report provides an overview of those 194 EMP activities.

A Cross-Sectional Study of Horse-Related Injuries in Veterinary and Animal Science Students at an Australian University

PubMed Central

Riley, Christopher B.; Liddiard, Jessica R.; Thompson, Kirrilly

2015-01-01

Specific estimates of the risk of horse-related injury (HRI) to university students enrolled in veterinary and animal sciences have not been reported. This study aimed to determine the risk of student HRI during their university education, the nature and management of such injuries. A retrospective questionnaire solicited demographic information, data on students’ equine experience prior to and during their educational programs, and on HRI during their program of study. Of 260 respondents, 22 (8.5%) reported HRI (27 incidents). Including concurrent injuries the most commonly injured body parts were the foot or ankle (nine of 32 injures), the upper leg or knee (eight of 32), and hands (three of 32). Trampling and being kicked by a hind limb were each associated with 30.4% of HRI, and 13% with being bitten. Bruising (91.3% of respondents) and an open wound (17.4%) were most commonly described. No treatment occurred for 60.9% of incidents; professional medical treatment was not sought for the remainder. Most incidents (56.5%) occurred during program-related work experience placements. Although injury rates and severity were modest, a proactive approach to injury prevention and reporting is recommended for students required to handle horses as part of their education. Student accident and injury data should be monitored to ensure effective evaluation of risk-reduction initiatives. The risk and nature of university student horse-related injury (HRI) was studied. Of 260 students, 22 (8.5%) reported HRI (27 incidents). Including multiple injuries, reports described involvement of the foot or ankle (nine of 32 injures), upper leg or knee (eight of 32), and hands (three of 32). Trampling (30.4%) and being kicked (30.4%) accounted for most HRI. The injuries were usually bruising (91.3%) or an open wound (17.4%). Most (60.9%) injuries were untreated; professional medical treatment was not sought for the rest. Most incidents (56.5%) occurred during program-related off-campus work experiences. A proactive approach to injury prevention is recommended for students handling horses. PMID:26479478

Coordinated Traffic Incident and Congestion Management (TIM-CM) : Mitigating Regional Impacts of Major Traffic Incidents in the Seattle I-5 Corridor

DOT National Transportation Integrated Search

2018-02-02

Within the Seattle metropolitan area, traffic incident management (TIM) operations provide a multi-jurisdictional and coordinated strategy to detect, respond to, and clear traffic incidents so that traffic flow can be restored quickly and safely. The...

Factors affecting fire suppression costs as identified by incident management teams

Treesearch

Janie Canton-Thompson; Brooke Thompson; Krista Gebert; David Calkin; Geoff Donovan; Greg Jones

2006-01-01

This study uses qualitative sociological methodology to discover information and insights about the role of Incident Management Teams in wildland fire suppression costs. We interviewed 48 command and general staff members of Incident Management Teams throughout the United States. Interviewees were asked about team structure, functioning, and decision making as a...

Improving freight crash incident management.

DOT National Transportation Integrated Search

2015-06-01

The objective of this study was to determine the most effective way to mitigate the effect of freight : crash incidents on Louisiana freeways. Candidate incident management strategies were reviewed from : practice in other states and from those publi...

Analyzing human errors in flight mission operations

NASA Technical Reports Server (NTRS)

Bruno, Kristin J.; Welz, Linda L.; Barnes, G. Michael; Sherif, Josef

1993-01-01

A long-term program is in progress at JPL to reduce cost and risk of flight mission operations through a defect prevention/error management program. The main thrust of this program is to create an environment in which the performance of the total system, both the human operator and the computer system, is optimized. To this end, 1580 Incident Surprise Anomaly reports (ISA's) from 1977-1991 were analyzed from the Voyager and Magellan projects. A Pareto analysis revealed that 38 percent of the errors were classified as human errors. A preliminary cluster analysis based on the Magellan human errors (204 ISA's) is presented here. The resulting clusters described the underlying relationships among the ISA's. Initial models of human error in flight mission operations are presented. Next, the Voyager ISA's will be scored and included in the analysis. Eventually, these relationships will be used to derive a theoretically motivated and empirically validated model of human error in flight mission operations. Ultimately, this analysis will be used to make continuous process improvements continuous process improvements to end-user applications and training requirements. This Total Quality Management approach will enable the management and prevention of errors in the future.

KSC-2009-1871

NASA Image and Video Library

2009-02-25

CAPE CANAVERAL, Fla. – NASA's Chief Safety and Mission Assurance Officer, Bryan D. O'Connor (left), presents a Quality and Safety Achievement Recognition, or QASAR, award for 2008 to Steven M. Davis (center). Davis, an employee of the Defense Contract Management Agency at NASA's Kennedy Space Center, received the award for his attention to detail in an incident involving a space shuttle solid rocket booster. At right is Dr. Michael Ryschkewitsch, NASA's chief engineer. Davis received the award at NASA's sixth annual Project Management Challenge in Daytona Beach, Fla. The QASAR award recognizes individual government and contractor employees who have demonstrated exemplary performance in contributing to the quality and/or safety of products, services, processes or management programs and activities. Photo credit: NASA/Ben Smegelsky

Integrating an incident management system within a continuity of operations programme: case study of the Bank of Canada.

PubMed

Loop, Carole

2013-01-01

Carrying out critical business functions without interruption requires a resilient and robust business continuity framework. By embedding an industry-standard incident management system within its business continuity structure, the Bank of Canada strengthened its response plan by enabling timely response to incidents while maintaining a strong focus on business continuity. A total programme approach, integrating the two disciplines, provided for enhanced recovery capabilities. While the value of an effective and efficient response organisation is clear, as demonstrated by emergency events around the world, incident response structures based on normal operating hierarchy can experience unique challenges. The internationally-recognised Incident Command System (ICS) model addresses these issues and reflects the five primary incident management functions, each contributing to the overall strength and effectiveness of the response organisation. The paper focuses on the Bank of Canada's successful implementation of the ICS model as its incident management and continuity of operations programmes evolved to reflect current best practices.

The influence of incident management teams on the deployment of wildfire suppression resources

Treesearch

Michael Hand; Hari Katuwal; David E. Calkin; Matthew P. Thompson

2017-01-01

Despite large commitments of personnel and equipment to wildfire suppression, relatively little is known about the factors that affect how many resources are ordered and assigned to wildfire incidents and the variation in resources across incident management teams (IMTs). Using detailed data on suppression resource assignments for IMTs managing the highest complexity...

Enhancing the Safety of Children in Foster Care and Family Support Programs: Automated Critical Incident Reporting

ERIC Educational Resources Information Center

Brenner, Eliot; Freundlich, Madelyn

2006-01-01

The Adoption and Safe Families Act of 1997 has made child safety an explicit focus in child welfare. The authors describe an automated critical incident reporting program designed for use in foster care and family-support programs. The program, which is based in Lotus Notes and uses e-mail to route incident reports from direct service staff to…

Effect of STOP technique on safety climate in a construction company.

PubMed

Darvishi, Ebrahim; Maleki, Afshin; Dehestaniathar, Saeed; Ebrahemzadih, Mehrzad

2015-01-01

Safety programs are a core part of safety management in workplaces that can reduce incidents and injuries. The aim of this study was to investigate the influence of Safety Training Observation Program (STOP) technique as a behavior modification program on safety climate in a construction company. This cross-sectional study was carried out on workers of the Petrochemical Construction Company, western Iran. In order to improve safety climate, an unsafe behavior modification program entitled STOP was launched among workers of project during 12 months from April 2013 and April 2014. The STOP technique effectiveness in creating a positive safety climate was evaluated using the Safety Climate Assessment Toolkit. 76.78% of total behaviors were unsafe. 54.76% of total unsafe acts/ at-risk behaviors were related to the fall hazard. The most cause of unsafe behaviors was associated with habit and unavailability of safety equipment. After 12 month of continuous implementation the STOP technique, 55.8% of unsafe behaviors reduced among workers. The average score of safety climate evaluated using of the Toolkit, before and after the implementation of the STOP technique was 5.77 and 7.24, respectively. The STOP technique can be considered as effective approach for eliminating at-risk behavior, reinforcing safe work practices, and creating a positive safety climate in order to reduction incidents/injuries.

Workplace Violence in Higher Education.

ERIC Educational Resources Information Center

Rice, Edward D.

2003-01-01

Addresses workplace violence prevention, beginning by defining violence, why people become violent, and the cycle of violence. Then discusses steps in prevention, including pre-incident planning, an incident management team, threat management, assessment, post-incident response, and training. (EV)

Social and Environmental Impacts of Forest Management Certification in Indonesia

PubMed Central

Miteva, Daniela A.; Loucks, Colby J.; Pattanayak, Subhrendu K.

2015-01-01

In response to unsustainable timber production in tropical forest concessions, voluntary forest management certification programs such as the Forest Stewardship Council (FSC) have been introduced to improve environmental, social, and economic performance over existing management practices. However, despite the proliferation of forest certification over the past two decades, few studies have evaluated its effectiveness. Using temporally and spatially explicit village-level data on environmental and socio-economic indicators in Kalimantan (Indonesia), we evaluate the performance of the FSC-certified timber concessions compared to non-certified logging concessions. Employing triple difference matching estimators, we find that between 2000 and 2008 FSC reduced aggregate deforestation by 5 percentage points and the incidence of air pollution by 31%. It had no statistically significant impacts on fire incidence or core areas, but increased forest perforation by 4 km2 on average. In addition, we find that FSC reduced firewood dependence (by 33%), respiratory infections (by 32%) and malnutrition (by 1 person) on average. By conducting a rigorous statistical evaluation of FSC certification in a biodiversity hotspot such as Indonesia, we provide a reference point and offer methodological and data lessons that could aid the design of ongoing and future evaluations of a potentially critical conservation policy. PMID:26132491

Emergency and crisis management: critical incident stress management for first responders and business organisations.

PubMed

Guenthner, Daniel H

2012-01-01

A literature review was performed on critical incident stress after September 11th, 2001 (9/11), and Hurricanes Katrina and Rita, which focused on the need to implement a holistic critical incident stress management programme for first responders and business organisations. Critical incident stress management is required to handle acute stress and other distress in the face of natural or man-made disasters, including terrorist attacks. A holistic approach to community resilience through a well-planned and implemented critical incident stress management programme has been shown in the literature to promote self-help and self-efficacy of individuals and organisations. The interventions and programme elements defined clearly show how a number of different intervention and prevention strategies will promote business and community resilience and also self-efficacy in a culturally-diverse community and organisation. Implementing a critical incident stress management programme within a responding business organisation is critical because of the fact that first responders are the most susceptible every day to exposure to critical incidents that will affect their mental health; and business employees will suffer some of the same maladies as first responders in the event of a disaster or crisis. Utilising the framework provided, a holistic critical incident stress management programme can be implemented to help reduce the effects of burnout, absenteeism, acute stress, post-traumatic stress, substance use and traumatic stress, and to work to promote community resilience and toughen individuals against the effects of stress. Taking care of the needs of the employees of a business organisation, and of those of first responders, is clearly required.

Traffic incident management resource management.

DOT National Transportation Integrated Search

2009-01-01

The necessity of a multi-disciplinary approach involving law enforcement, fire and rescue, transportation, towing and recovery, and others has been well-recognized and integrated into incident management operations. This same multidisciplinar...

Demonstration of Unmanned Aircraft Systems Use for Traffic Incident Management (UAS-TIM)

DOT National Transportation Integrated Search

2017-12-01

Previous investigations into technologies that can improve incident response, monitoring, and clearance resulted in the potential application of Unmanned Aerial System (UAS) for use in Traffic Incident Management (TIM). An initial investigation of UA...

A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

PubMed

Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

2018-02-21

Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Overall intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311). An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.

Social skills training of Prader-Willi staff.

PubMed

Mitchell, W; Cook, K V

1987-12-01

Over the past 30 years, research interest in PWS has focused on questions related to the identification of syndrome features, determination of etiology and incidence, and effectiveness of both medical and nutritional management strategies. Residential and day treatment facilities have emphasized control of food and of inappropriate behaviors. The present training program developed techniques and materials to encourage positive behaviors and minimize inappropriate behaviors, supplementing earlier techniques. Activities from social skills training curricula were adapted to the needs of PWS persons. Training sessions were held with staff in residential settings to field test the techniques. This paper summarizes the training program and describes effective techniques and materials.

Need for hyperlipidemia management policy reform in China: learning from the global experience.

PubMed

Yu, Wei; Shi, Ruizhi; Li, Jim; Lan, Yong; Li, Qian; Hu, Shanlian

2018-02-01

To evaluate the hyperlipidemia prevention programs and policies in different countries and highlight the need of reforming the hyperlipidemia prevention policies in China to lower the growing cardiovascular disease (CVD) risk. PubMed, Google Scholar and Cochrane were searched for global hyperlipidemia prevention policies. Government-funded policies pertaining to lipid management were considered for this review. Only those studies that evaluated the success of prevention policies on the basis of: (i) achievement of hyperlipidemia targets; (ii) improvement in Cardiovascular (CV) risk reduction; and (iii) outcomes with reduction in hyperlipidemia after implementation of the policy, were included. Several global policies and programs aimed to improve CV health by highlighting lipid profile management. Implementation of the global and national policies led to improvement in cholesterol related outcomes such as availability of diagnostic measures, awareness of the risk factors, decrease in cholesterol levels, achieving healthy lifestyle to prevent CVD and improvement in availability of hypolipidemic medications, etc. Statins have been covered under reimbursement policies in many countries to improve usage and thereby preventing incidence of stroke and CVD. We observed a need for introducing new programs in China as the ongoing hyperlipidemia management policies are inadequate. The World Bank Report 2016 recommended that prevention policies in China be modeled on the US Million Hearts program. New hyperlipidemia prevention policies must set a time-bound target, and need to be patient and clinician centric in terms of applications, and revised periodically for long-term benefits.

[Evaluation on the effects of prevention and control programs regarding typhoid fever and paratyphoid fever in Guizhou province, from 2007 to 2012].

PubMed

Yao, Guanghai; Zou, Zhiting; Wang, Dan; Huang, Yanping; Nie, Wei; Liu, Huihui; Tang, Guangpeng

2014-05-01

This study was to evaluate the effects of prevention and control regarding programs on typhoid fever and paratyphoid fever, in Guizhou province, from 2007 to 2012, to provide evidence for the improvement of related programs. Data on typhoid fever and paratyphoid including information on epidemics, individual, cases, measures for prevention and control programs taken and relative government documents were collected and analyzed in Guizhou province, from 2007 to 2012. Information related to the average annual incidence, nature of outbreaks, time span before confirmed diagnosis was made, unit which carried the case report, proportion of laboratory confirmed diagnosed cases and case-management were compared between 2007-2009 and 2010-2012 descriptively while chi-square test with Excel and EpiInfo software were used for data analysis. In the period of 2007-2009, a total of 5 978 typhoid fever and paratyphoid fever cases were reported in Guizhou province with the average yearly incidence as 5.29/100 000. In the period of 2010-2012, 2 765 cases were reported with the average yearly incidence as 2.57/100 000. When compared to the former, data from the latter period showed that the average yearly incidence had declined 51.31% in all the prefectures. There were still some outbreaks appeared but the total number of cases involved reduced 87.50%. The time span before the confirmation of diagnosis became shorter but the difference was not statistically significant (χ² = 0.08, P = 0.99). Number of cases reported by hospitals at county or above had 11.51% of increase while those cases reported at the township hospitals or below decreased for 61.47% . The proportion of laboratory diagnosed cases increased 23.63%. Rates of timeliness on cards being filled in, input and audited showed increase of 8.44%, 6.76% and 2.40% respectively. Successful measures for prevention and control on typhoid fever and paratyphoid fever had been remarkably taken in Guizhou province, but the potential risk of outbreaks still existed in some areas, suggesting that health education and surveillance programs including laboratory diagnosis, should be strengthened.

Structure and management of tuberculosis control programs in fragile states--Afghanistan, DR Congo, Haiti, Somalia.

PubMed

Mauch, Verena; Weil, Diana; Munim, Aayid; Boillot, Francois; Coninx, Rudi; Huseynova, Sevil; Powell, Clydette; Seita, Akihiro; Wembanyama, Henriette; van den Hof, Susan

2010-07-01

Health care delivery is particularly problematic in fragile states often connected with increased incidence of communicable diseases, among them tuberculosis. This article draws upon experiences in tuberculosis control in four fragile states from which four lessons learned were derived. A structured inventory to extract common themes specific for TB control in fragile states was conducted among twelve providers of technical assistance who have worked in fragile states. The themes were applied to the TB control programs of Afghanistan, DR Congo, Haiti and Somalia during the years 2000-2006. Case notifications and treatment outcomes have increased in all four countries since 2003 (treatment success rates 81-90%). Access to care and case detection however have remained insufficient (case detection rates 39-62%); There are four lessons learned: 1. TB control programs can function in fragile states. 2. National program leadership and stewardship are essential for quality and sustained TB control. 3. Partnerships with non-governmental providers are vital for continuous service delivery; 4. TB control programs in fragile states require consistent donor support. Despite challenges in management, coordination, security, logistics and funding, TB control programs can function in fragile states, but face considerable problems in access to diagnosis and treatment and therefore case detection. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Federal Highway Administration Focus States Initiative : traffic incident management performance measures final report

DOT National Transportation Integrated Search

2009-12-01

The Traffic Incident Management Performance Measures Focus States Initiative (TIM PM FSI) involves 11 States that have defined three traffic incident performance measures (PM) and conducted field tests of two of these measures. The following measures...

Safer travel, improved economic productivity : incident management systems

DOT National Transportation Integrated Search

1999-01-01

This brochure gives an overview of how incident management technologies can be used to reduce incident-related congestion and increase road safety. It focuses on the need for interagency cooperation and the benefits that can be derived from the coope...

Development of incident data collection standards for Virginia Department of Transportation freeway operations.

DOT National Transportation Integrated Search

2005-01-01

The effective management of incidents is necessary in order to maintain efficient freeway operations. Within the Virginia Department of Transportation (VDOT), there are a number of units responsible for supporting incident management. These groups co...

Managing incidents on urban arterial roadways

DOT National Transportation Integrated Search

1997-01-01

Limiting the impact on traffic of nonrecurring events such as crashes, traffic stops, or disabled vehicles through effective incident management should be one objective for emergency response professionals. Moreover, such management is an integral pa...

A research model--forecasting incident rates from optimized safety program intervention strategies.

PubMed

Iyer, P S; Haight, J M; Del Castillo, E; Tink, B W; Hawkins, P W

2005-01-01

INTRODUCTION/PROBLEM: Property damage incidents, workplace injuries, and safety programs designed to prevent them, are expensive aspects of doing business in contemporary industry. The National Safety Council (2002) estimated that workplace injuries cost $146.6 billion per year. Because companies are resource limited, optimizing intervention strategies to decrease incidents with less costly programs can contribute to improved productivity. Systematic data collection methods were employed and the forecasting ability of a time-lag relationship between interventions and incident rates was studied using various statistical methods (an intervention is not expected to have an immediate nor infinitely lasting effect on the incident rate). As a follow up to the initial work, researchers developed two models designed to forecast incident rates. One is based on past incident rate performance and the other on the configuration and level of effort applied to the safety and health program. Researchers compared actual incident performance to the prediction capability of each model over 18 months in the forestry operations at an electricity distribution company and found the models to allow accurate prediction of incident rates. These models potentially have powerful implications as a business-planning tool for human resource allocation and for designing an optimized safety and health intervention program to minimize incidents. Depending on the mathematical relationship, one can determine what interventions, where and how much to apply them, and when to increase or reduce human resource input as determined by the forecasted performance.

Principal Experiences with Crisis Management Professional Development, Collaboration, and Implementation of the National Incident Management System Phases of Emergency Management

ERIC Educational Resources Information Center

Naradko, Anthony M.

2017-01-01

The purpose of this qualitative single-subject case study was to identify the elements critical to crisis management professional development for school principals; the factors influencing the implementation of the National Incident Management System Phases of Emergency Management (2010) for principals; and the necessary elements for fostering…

Comparison of Open and Closed Hand Fractures and the Effect of Urgent Operative Intervention.

PubMed

Minhas, Shobhit V; Catalano, Louis W

2018-06-13

To establish and compare the incidence of 30-day postoperative infection in surgically managed open and closed metacarpal and phalangeal fractures, and to determine whether open fractures treated urgently had a lower incidence of postoperative infection. We conducted a retrospective analysis of patient demographics, comorbidities, and 30-day infection rates of patients undergoing operative fixation of metacarpal, proximal, or middle phalanx fractures from 2008 to 2015 using the American College of Surgeons' National Surgical Quality Improvement Program database. A total of 3,506 patients were identified and patient variables and infection incidence were compared between open and closed injuries, as well as open injuries managed within 1 day of admission and those treated on an elective basis or treated more than 1 day after admission. Bivariate analysis was used to determine independent risk factors for postoperative infection. Although 34.2% of open hand fractures were taken urgently to the operating room, the diagnosis of open fractures along with nonurgent surgical treatment for open fractures was associated with a low incidence of postoperative infection. In addition, smoking was a risk factor for postoperative infection although anatomic location (phalanx vs metacarpal) was not. Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone. In addition, patients with open fractures who are taken to the operating room more than 1 day from presentation did not have a higher incidence of infection. Smoking is associated with increased 30-day infection rates after surgery, and surgeons should identify these patients for preoperative risk stratification, counseling, and postoperative wound monitoring. Prognostic II. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Poster - 27: Incident Learning Practices in Ontario

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

Angers, Crystal; Medlam, Gaylene; Liszewski, Brian

Purpose: The Radiation Incident and Safety Committee (RISC), established and supported by Cancer Care Ontario (CCO), is responsible for advising the Provincial Head of the Radiation Treatment program on matters relating to provincial reporting of radiation incidents with the goal of improved risk mitigation. Methods: The committee is made up of Radiation Incident Leads (RILs) with representation from each of the 14 radiation medicine programs in the province. RISC routinely meets to review recent critical incidents and to discuss provincial reporting processes and future directions of the committee. Regular face to face meetings have provided an excellent venue for sharingmore » incident learning practices. A summary of the incident learning practices across Ontario has been compiled. Results: Almost all programs in Ontario employ an incident learning committee to review incidents and identify corrective actions or process improvements. Tools used for incident reporting include: paper based reporting, a number of different commercial products and software solutions developed in-house. A wide range of classification schema (data taxonomies) are employed, although most have been influenced by national guidance documents. The majority of clinics perform root cause analyses but utilized methodologies vary significantly. Conclusions: Most programs in Ontario employ a committee approach to incident learning. However, the reporting tools and taxonomies in use vary greatly which represents a significant challenge to provincial reporting. RISC is preparing to adopt the National System for Incident Reporting – Radiation Therapy (NSIR-RT) which will standardize incident reporting and facilitate data analyses aimed at identifying targeted improvement initiatives.« less

Reduction in incidence of Johne's disease associated with implementation of a disease control program in Minnesota demonstration herds.

PubMed

Espejo, L A; Godden, S; Hartmann, W L; Wells, S J

2012-07-01

This prospective longitudinal observational study was conducted to evaluate the effect of a standardized control program on the incidence of Johne's disease in 8 dairy herds in Minnesota. Depending on recruitment year, herds were followed for between 5 and 10 yr. Program compliance was evaluated using a cohort risk assessment score by birth cohort. Fecal samples from cows in study herds were tested annually using bacterial culture to detect Mycobacterium avium ssp. paratuberculosis (MAP), and serum samples from study cows were tested using an ELISA to detect antibodies to MAP. Clinical Johne's disease was also recorded. Cohort risk assessment score decreased along birth cohorts. Depending on the follow-up period in each herd, 5 to 8 birth cohorts were followed to describe changes in time to MAP bacterial culture positivity, serum ELISA positivity, MAP heavy shedding status, and clinical Johne's disease. The analysis of time to bacterial culture positivity, serum ELISA positivity, heavy fecal shedding status, and clinical Johne's disease using a time-dependent Cox regression indicated a reduction of the instantaneous hazard ratio by birth cohorts and by cohort risk score; however, the strength of association between the cohort risk score and each of the 4 disease outcomes decreased over time. The age at which the cows first tested positive for bacterial culture, serum ELISA, and heavy fecal shedding, and the age of the cows at onset of clinical Johne's disease signs remained constant for all birth cohorts. Based on herd risk scores, overall herds complied with the recommended management practices in the program. Results were consistent with a within-herd reduction of Johne's disease transmission, and that reduction was associated with herd-level management practices implemented as part of the control program. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Helpful Hints for School Emergency Management: The National Incident Management System (NIMS) and Schools. Frequently Asked Questions and FY 2006 NIMS Compliance Activities for Schools

ERIC Educational Resources Information Center

US Department of Education, 2006

2006-01-01

"Helpful Hints" offers a quick overview of school emergency preparedness topics that are frequently the subject of inquiries. The National Incident Management System (NIMS) is a comprehensive system that improves tribal and local emergency response operations through the use of the Incident Command System (ICS) and the application of standardized…

Research Contributing to Psychological Health and Traumatic Brain Injury Programs and Guidance

DTIC Science & Technology

2011-01-24

AGP, 2004)  Panic disorder (e.g., Roy-Byrne et al, AGP 2005)  Somatic symptoms (e.g., Smith et al, AGP 1995)  Health anxiety (e.g., Barsky et al...management of concussed service members and those with recurrent concussion  Transition from symptom driven reporting to incident driven DESIRED END STATE...and Readiness DDR&E = Director, Defense Research & Engineering JIEDDO = Joint Improvised Explosive Device Defeat Organization BIR PCO = Blast Injury

Incident management in Virginia : a state of the practice report : final report.

DOT National Transportation Integrated Search

1991-01-01

Because of the number of incidents and the magnitude of their consequences, the Virginia Department of transportation made a concerted effort to ensure that incident management became a top priority and spearheaded an effort to start a statewide inci...

Ohio QuickClear : professional responders guide for safe and effective highway incident management

DOT National Transportation Integrated Search

2007-10-01

Thousands of responders and motorists are needlessly killed or injured each year as a result of inefficient incident scene management. Traffic incidents are causing millions of hours of congestion delay annually, which results in billions of dollars ...

[Tuberculosis in Havana City, 1995-1999].

PubMed

Sevy Court, José I; Peláez Sánchez, Otto; Arteaga Yero, Ana L; Armas Pérez, Luisa; Borroto Gutiérrez, Susana; González Ochoa, C Edilberto

2003-06-01

Tuberculosis is a worldwide health problem getting a prioritized attention by the Cuban National Health System. To describe the main indicators of the Cuban Tuberculosis Control Program. Based on surveillance data from the Provincial Center of Hygiene and Epidemiology, the health care network and strategies of the tuberculosis control program were reviewed; incidence rates, case finding indicators, diagnosis and case management were described. Eight subjects with respiratory symptoms were found per 1,000 attending general medical care services. The incidence rates of all tuberculosis types declined from 16.4 in 1995 to 12.0 x 10(5) people in 1999. Pulmonary tuberculosis incidence rate was reduced from 15.1 in1995 to 10.4 x 10(5) in 1999, whereas extrapulmonary tuberculosis had an increment from 1.3 to 1.6 x 10(5) in the same period. Of all new cases, 40-50 % were diagnosed at multispecialty clinics, 67.6% were diagnosed by positive smears, 15.2 % by positive cultures, 13.8 % by clinical and X-rays evidences only; and 0.9 % and 1.5 % were respectively diagnosed by biopsy and necropsy. There was an increase in the incidence rate in the age group 15-64 years in 1996 and 1997 but it declined again in 1998 and 1999. The age group 64 years and over showed a rate reduction from 1995 to 1999. In general, incidence rates diminished in the overall period. The average delay between onset of symptoms and diagnosis improved from 42 days in 1995 to 28.6 days in 1999. There seems to be a halt in reporting trends of new cases in 1996. Tuberculosis indicators reveal satisfactory changes in the study period.

Handbook of emergency management for state-level transportation agencies.

DOT National Transportation Integrated Search

2010-03-01

The Department of Homeland Security has mandated specific systems and techniques for the management of emergencies in the United States, including the Incident Command System, the National Incident Management System, Emergency Operations Plans, Emerg...

Government management of two media-facilitated crises involving dioxin contamination of food.

PubMed

Jacob, Casey J; Lok, Corie; Morley, Katija; Powell, Douglas A

2011-03-01

Incidents become crises through a constant and intense public scrutiny facilitated by the media. Two incidents involving dioxin contamination of food led to crises in Belgium and the Republic of Ireland in 1999 and 2008, respectively. Thought to cause cancer in humans, dioxins reached the food supply in both incidents through the contamination of fat used for animal feed. The food and agricultural industries connected to each incident relied on crisis management activities of federal governments to limit adverse public reaction. Analysis of the management of the two crises by their respective federal governments, and a subsequent review of crisis management literature, led to the development of an effective crisis management model. Such a model, appropriately employed, may insulate industries associated with a crisis against damaged reputations and financial loss.

The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint?

PubMed

Kalapatapu, Raj K; Giles, Gordon M

2017-11-01

The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. New data on interventions used in the RNA and on how the RNA interventions can be used with patients with acquired brain injury (ABI) who have differing levels of functional impairment are provided in this paper. The study was conducted over a 6-week period in a secure 65-bed program for individuals with ABI that is housed in two units of a skilled nursing facility (SNF). Implementation of the RNA was compared between two units that housed patients with differing levels of functional impairment (n = 65 adults). Since this was a hierarchical clustered dataset, Generalized Estimating Equations regression was used in the analyses. RNA interventions used to manage the 495 aggressive incidents included the following: Aggression ignored, Closer observation, Talking to patient, Reassurance, Physical distraction, Isolation without seclusion, Immediate medication by mouth, Holding patient. Different interventions were implemented differentially by staff based on level of functional impairment and without use of seclusion or mechanical restraint. The RNA can be used to non-aversively manage aggression in patients with brain injury and with differing levels of functional impairment. Programs adopting the RNA can potentially manage brain injury-related aggression without seclusion or mechanical restraint. Implications for Rehabilitation The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. RNA methods can be used to manage aggression in patients with brain injury who have differing levels of functional impairment. Successful implementation of the RNA may allow for the management of brain injury-related aggression without seclusion or mechanical restraint.

Who Benefits from Student Aid? The Economic Incidence of Tax-Based Federal Student Aid

ERIC Educational Resources Information Center

Turner, Nicholas

2012-01-01

Federal benefit programs, including federal student aid, are designed to aid targeted populations. Behavioral responses to these programs may alter the incidence of their benefits, a possibility that receives less attention in the literature compared to tax incidence. I demonstrate the importance of benefit incidence analysis by showing that the…

Principles of hospital disaster management: an integrated and multidisciplinary approach.

PubMed

Hendrickx, C; Hoker, S D; Michiels, G; Sabbe, M B

Principles of hospital disaster management: an integrated and multidisciplinary approach. Hospitals play an important role during a disaster response, and are also at risk for internal incidents. We propose an integrated and multidisciplinary approach towards hospital disaster management and preparedness. In addition to response strategies, much attention is given to risk assessment and preparedness in the pre-incident phase and to business continuity planning (BCP) in the post-incident phase. It is essential to train key players and all personnel to understand the Hospital Incident Management System (HIMS) and to perform specific emergency procedures. All emergency procedures should be grounded in evidence-based practice resulting from essential disaster response research.

Education in Disaster Management: What Do We Offer and What Do We Need? Proposing a New Global Program.

PubMed

Khorram-Manesh, Amir; Lupesco, Olivera; Friedl, Tom; Arnim, Gotz; Kaptan, Kubilay; Djalali, Ahmadreza R; Foletti, Marco; Ingrasia, Pier Luigi; Ashkenazi, Michael; Arculeo, Chris; Fischer, Philipp; Hreckovski, Boris; Komadina, Radko; Voigt, Stefan; Carlström, Eric; James, James

2016-12-01

Although there is a significant willingness to respond to disasters, a review of post-event reports following incidents shows troubling repeated patterns with poorly integrated response activities and response managers inadequately trained for the requirements of disasters. This calls for a new overall approach in disaster management. An in-depth review of the education and training opportunities available to responders and disaster managers has been undertaken, as well as an extensive review of the educational competencies and their parent domains identified by subject matter experts as necessary for competent performance. Seven domains of competency and competencies that should be mastered by disaster mangers were identified. This set of domains and individual competencies was utilized to define a new and evolving curriculum. In order to evaluate and assess the mastery of each competency, objectives were more widely defined as activities under specific topics, as the measurable elements of the curriculum, for each managerial level. This program enables interagency cooperation and collaboration and could be used to increase and improve decision-makers' understanding of disaster managers' capabilities; at the strategic/tactical level to promote the knowledge and capability of the disaster managers themselves; and as continuing education or further career development for disaster managers at the operational level. (Disaster Med Public Health Preparedness. 2016;10:854-873).

Developing freeway and incident management systems using the national ITS architecture

DOT National Transportation Integrated Search

1998-08-01

This is one of a series of documents providing support for deploying Intelligent Transportation Systems (ITS). This series addresses Traffic Signal Control Systems, Freeway and Incident Management Systems, Transit Management Systems, and Traveler Inf...

Synergi and E&P forum HSE management system helps companies improve HSE performance and reduce losses

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

Grundt, H.J.

1996-12-31

This paper discusses the use of information on accidents and near-misses to improve HSE performance and reduce losses in Exploration and Production activities. Incidents are considered a result of management system failure. To avoid incidents and recurrence of incidents, companies should adopt an integrated HSE Management System and software especially designed for recording, analyzing and following up events. The E&P Forum has issued guidelines to support current company HSE Management systems and practices. Concurrently, the Synergi Project has been established to facilitate experience transfer and effective handling of incidents as part of an integrated HSE Management System. The paper describesmore » how important it is to learn from past mistakes, to have a management system which facilitates the implementation of the required corrective action, and that tools for improved loss control are available.« less

Incidence and prevalence rates of diabetes mellitus in Saudi Arabia: An overview.

PubMed

Alotaibi, Abdulellah; Perry, Lin; Gholizadeh, Leila; Al-Ganmi, Ali

2017-12-01

This study aimed to report on the trends in incidence and prevalence rates of diabetes mellitus in Saudi Arabia over the last 25 years (1990-2015). A descriptive review. A systematic search was conducted for English-language, peer reviewed publications of any research design via Medline, EBSCO, PubMed and Scopus from 1990 to 2015. Of 106 articles retrieved, after removal of duplicates and quality appraisal, 8 studies were included in the review and synthesised based on study characteristics, design and findings. Studies originated from Saudi Arabia and applied a variety of research designs and tools to diagnosis diabetes. Of the 8 included studies; three reported type 1 diabetes and five on type 2 diabetes. Overall, findings indicated that the incidence and prevalence rate of diabetes is rising particularly among females, older children/adolescent and in urban areas. Further development are required to assess the health intervention, polices, guidelines, self-management programs in Saudi Arabia. Copyright © 2017. Published by Elsevier Ltd.

[Program for lowering the incidence of pressure sores in neurosurgical patients].

PubMed

Chang, Chau-Hui; Chen, Hui-Ling; Chen, Hsiang-Chi

2007-12-01

Pressure sores are one of the well known problems that occur in hospitals. As the literature on the subject indicates, a lot of money is expended in managing this problem every year, and 12-66% of pressure sores are caused during surgery. Patients who undergo neurosurgical procedures are susceptible to pressure sores because of lengthy operations. We collected data on patients with pressure sores who underwent surgery between May 2004 and August 2004, and found that the incidence of pressure sore in neurosurgical patients was 9.5%, which was the highest among all surgical patients. This project was developed to solve the problem of pressure sores by setting up standard preventive procedures, a nursing follow up system and continuing education courses, and utilizing cotton rolls to pad sites of pressure sores. The incidence of pressure sore in neurosurgical patients was reduced from 9.5% to 7% after the improvement project was carried out. The more concerned nurses are about pressure sores, the better the quality of operative nursing care.

Evaluating the effectiveness of cockpit resource management training

NASA Technical Reports Server (NTRS)

Helmreich, Robert L.

1989-01-01

The concept of providing flight crews with intensive training in crew coordination and interpersonal skills (cockpit resource management training - CRM) is outlined with emphasis on full mission simulator training (line-oriented flight training - LOFT). Findings from several airlines that have instituted CRM and LOFT are summarized. Four types of criteria used for evaluating CRM programs: observer ratings of crew behavior, measures of attitudes regarding cockpit management, self-reports by participants on the value of the training, and case studies of CRM-related incidents and accidents are covered. Attention is focused on ratings of the performance of crews during line flights and during simulator sessions conducted as a part of LOFT. A boomerang effect - the emergence of a subgroup that has changed the attitudes in the opposite direction from that desired is emphasized.

Evolving management of metaplasia and dysplasia in Barrett's epithelium.

PubMed

Evans, Richard P T; Mourad, Moustafa Mabrouk; Fisher, Simon G; Bramhall, Simon R

2016-12-21

Oesophageal cancer affects more than 450000 people worldwide and despite continued medical advancements the incidence of oesophageal cancer is increasing. Oesophageal cancer has a 5 year survival of 15%-25% and now globally attempts are made to more aggressively diagnose and treat Barrett's oesophagus the known precursor to invasive disease. Currently diagnosis the of Barrett's oesophagus is predominantly made after endoscopic visualisation and histopathological confirmation. Minimally invasive techniques are being developed to improve the viability of screening programs. The management of Barrett's oesophagus can vary greatly dependent on the presence and severity of dysplasia. There is no consensus between the major international medical societies to determine and agreed surveillance and intervention pathway. In this review we analysed the current literature to demonstrate the evolving management of metaplasia and dysplasia in Barrett's epithelium.

Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment

DOT National Transportation Integrated Search

2017-12-01

Traffic incidents have long been recognized as the main contributor to congestion in highway networks. Thus, contending with non-recurrent congestion has been a priority task for most highway agencies over the past decades. Under most incident scenar...

In-Vehicle Safety Advisory And Warning System (Ivsaws), Volume Iii: Appendices A Through H (Reference Materials)

DOT National Transportation Integrated Search

2000-05-01

It has been estimated that 57 percent of the nation?s traffic congestion is due to crashes and other incidents. Organized traffic incident management is the primary tool in mitigating the impact. Traffic incident management involves multi-agency, mul...

Case and Administrative Support Tools

EPA Pesticide Factsheets

Case and Administrative Support Tools (CAST) is the secure portion of the Office of General Counsel (OGC) Dashboard business process automation tool used to help reduce office administrative labor costs while increasing employee effectiveness. CAST supports business functions which rely on and store Privacy Act sensitive data (PII). Specific business processes included in CAST (and respective PII) are: -Civil Rights Cast Tracking (name, partial medical history, summary of case, and case correspondance). -Employment Law Case Tracking (name, summary of case). -Federal Tort Claims Act Incident Tracking (name, summary of incidents). -Ethics Program Support Tools and Tracking (name, partial financial history). -Summer Honors Application Tracking (name, home address, telephone number, employment history). -Workforce Flexibility Initiative Support Tools (name, alternative workplace phone number). -Resource and Personnel Management Support Tools (name, partial employment and financial history).

Development of Kentucky's highway incident management strategic plan.

DOT National Transportation Integrated Search

2005-05-01

ven though Kentucky has undertaken many initiatives to improve specific aspects of incident management, there has never been a plan that establishes an overall framework for a systematic, statewide, multi-agency effort to improve the management of hi...

A concept for major incident triage: full-scaled simulation feasibility study.

PubMed

Rehn, Marius; Andersen, Jan E; Vigerust, Trond; Krüger, Andreas J; Lossius, Hans M

2010-08-11

Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents. The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7). Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001. Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.

Documentation and tagging of casualties in multiple casualty incidents.

PubMed

Garner, Alan

2003-01-01

The use of triage tags is widely advocated as a tool to improve the management of multiple casualty incident scenes. However, there are no published reports to suggest that triage tags have improved the management of incidents involving more than 24 persons, and a number of reports have detailed problems associated with triage tag use. Alternative systems of scene management such as geographical triage have been successfully used in very large incidents, and are recommended as an alternative to triage tags. Documentation cards attached to casualties may be of use in situations where casualties will pass through an extended evacuation chain, and clear labels for deceased casualties are of benefit as they discourage repeat assessments. Adoption of an evidence-based approach to multiple casualty incident scene management will require a paradigm shift in the thinking of ambulance services. A broad-based educational approach that encourages critical reappraisal of existing procedures is recommended.

Symptom management strategies for men with early-stage prostate cancer: results from the Prostate Cancer Patient Education Program (PC PEP).

PubMed

Vij, Alok; Kowalkowski, Marc A; Hart, Tae; Goltz, Heather Honoré; Hoffman, David J; Knight, Sara J; Caroll, Peter R; Latini, David M

2013-12-01

While the literature on prostate cancer health-related quality of life has grown extensively, little is known about symptom management strategies used by men to manage treatment-related side effects and the effectiveness of those strategies. We collected 628 symptom management reports from 98 men treated for localized prostate cancer. Participants were recruited from email lists and a prostate cancer clinic in Northern California. Data were collected using the Critical Incident Technique. Symptom management reports were assigned to categories of urinary, sexual, bowel, mental health, systemic, or "other." We calculated descriptive statistics by symptom type and management strategy effectiveness. The most common symptoms were urinary (26 %) and sexual (23 %). Participants' symptom management strategies varied widely, from medical and surgical interventions (20 %) to behavioral strategies (11 %) to diet and lifestyle interventions (12 %). The effectiveness of symptom management strategies varied, with sexual symptoms being managed effectively only 47 % of the time to mental health symptom management strategies considered effective 89 % of the time. Doing nothing was a commonly reported (15 %) response to symptoms and was effective only 14 % of the time. Men report the least effectiveness in symptom management for sexual dysfunction after prostate cancer treatment. Including men's experience with managing treatment side effects may be an important way to improve survivorship programs and make them more acceptable to men. More work is needed to find out why men frequently do nothing in response to symptoms when effective solutions exist and how providers can successfully engage such men.

Symptom Management Strategies for Men with Early-Stage Prostate Cancer: Results from the Prostate Cancer Patient Education Program (PCPEP)

PubMed Central

Vij, Alok; Kowalkowski, Marc A.; Hart, Tae; Goltz, Heather Honoré; Hoffman, David J.; Knight, Sara J.; Caroll, Peter R.

2013-01-01

While the literature on prostate cancer health-related quality of life has grown extensively, little is known about symptom management strategies used by men to manage treatment-related side effects and the effectiveness of those strategies. We collected 628 symptom management reports from 98 men treated for localized prostate cancer. Participants were recruited from email lists and a prostate cancer clinic in Northern California. Data were collected using the Critical Incident Technique. Symptom management reports were assigned to categories of urinary, sexual, bowel, mental health, systemic, or “other.” We calculated descriptive statistics by symptom type and management strategy effectiveness. The most common symptoms were urinary (26 %) and sexual (23 %). Participants’ symptom management strategies varied widely, from medical and surgical interventions (20 %) to behavioral strategies (11 %) to diet and lifestyle interventions (12 %). The effectiveness of symptom management strategies varied, with sexual symptoms being managed effectively only 47 % of the time to mental health symptom management strategies considered effective 89 % of the time. Doing nothing was a commonly reported (15 %) response to symptoms and was effective only 14 % of the time. Men report the least effectiveness in symptom management for sexual dysfunction after prostate cancer treatment. Including men’s experience with managing treatment side effects may be an important way to improve survivorship programs and make them more acceptable to men. More work is needed to find out why men frequently do nothing in response to symptoms when effective solutions exist and how providers can successfully engage such men. PMID:23996206

Significant Reduction in the Incidence of Genital Warts in Young Men 5 Years into the Danish Human Papillomavirus Vaccination Program for Girls and Women.

PubMed

Bollerup, Signe; Baldur-Felskov, Birgitte; Blomberg, Maria; Baandrup, Louise; Dehlendorff, Christian; Kjaer, Susanne K

2016-04-01

Denmark introduced the quadrivalent human papillomavirus vaccine into the vaccination program for 12- to 15-year-old girls in 2008 to 2009. In 2012, the program was supplemented with a catch-up program for women aged up to 27 years. We evaluated the effectiveness of the Danish vaccination program on the nationwide incidence of genital warts (GWs), after the second catch-up by including information on both hospital treatments and on self-administered treatment with podophyllotoxin. Genital wart incidence was investigated in both sexes; however, the main focus was on potential herd protection of men. Incident cases of GWs were identified from the Danish National Patient Register and through redemptions of prescription for podophyllotoxin in the Danish National Prescription Registry in 2006 to 2013. Age-specific incidence rates (IRs) were assessed, and estimated annual percentage change (EAPC) was calculated by Poisson regression. Genital wart incidence was either stable or increased in both sexes in 2006 to 2008. After introduction of the vaccination program, GW incidence decreased significantly in women aged 12 to 35 years and men aged 12 to 29 years, with rapid decrease among 16- to 17-year-olds (IRwomen, from 1071 to 58 per 100,000 person-years [EAPC, -55.1%; 95% confidence interval, -58.7 to-51.2]; IRmen, from 365 to 77 per 100,000 person-years [EAPC, -36.6%; 95% confidence interval, -40.5 to -32.5] in 2008-2013). We found a significantly decreasing incidence of GWs in women up to 35 years of age after the start of the human papillomavirus vaccination program. A similar pattern was observed for men aged 12 to 29 years, indicating substantial herd protection.

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

Gordon, S.

During the period from fiscal year (FY) 2009 to FY 2011, there were a total of 21 incidents involving radioactively contaminated shipment trailers and 9 contaminated waste packages received at the Nevada National Security Site (NNSS) Area 5 Radioactive Waste Management Site (RWMS). During this time period, the EnergySolutions (ES) Clive, Utah, disposal facility had a total of 18 similar incidents involving trailer and package contamination issues. As a result of the increased occurrence of such incidents, DOE Environmental Management Headquarters (EM/HQ) Waste Management organization (EM-30) requested that the Energy Facility Contractors’ Group (EFCOG) Waste Management Working Group (WMWG) conductmore » a detailed review of these incidents and report back to EM-30 regarding the results of this review, including providing any recommendations formulated as a result of the evaluation of current site practices involving handling and management of radioactive material and waste shipments.« less

Use of photogrammetry as a tool for accident investigation and reconstruction : a review of the literature and state of the practice.

DOT National Transportation Integrated Search

2007-01-01

One of the key goals of incident management is the rapid clearance of traffic incidents. Many transportation agencies focus their incident management on quicker and more reliable detection techniques. Another focus, however, should be the reduction i...

Management practices to reduce lupine-induced Crooked Calf Syndrome in the Northwest

USDA-ARS?s Scientific Manuscript database

Many factors contribute to the incidence of lupine-induced “Crooked Calf Syndrome” (CCS) in the northwestern U.S. A 1-5% incidence of CCS is common on many ranches and higher incidences occur when environmental conditions are conducive to lupine population increases. Multiple management strategies s...

Incident Management, Fast-Trac, Phase Iib Deliverables, #20. The Model Analysis Report On The Benefits Of Scats In Alleviating The Impacts Of Incidents

DOT National Transportation Integrated Search

1996-01-01

FAST-TRAC : SELECTING THE MOST APPROPRIATE TRAFFIC CONTROL STRATEGY FOR INCIDENT CONGESTION MANAGEMENT CAN HAVE A MAJOR IMPACT ON THE EXTENT AND DURATION OF THE RESULTING CONGESTION. THIS RESEARCH INVESTIGATED THE EFFECTIVENESSES OF SEVERAL CONTRO...

Social, institutional, and psychological factors affecting wildfire incident decision making

Treesearch

Matthew P. Thompson

2014-01-01

Managing wildland fire incidents can be fraught with complexity and uncertainty. Myriad human factors can exert significant influence on incident decision making, and can contribute additional uncertainty regarding programmatic evaluations of wildfire management and attainment of policy goals. This article develops a framework within which human sources of uncertainty...

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

PubMed

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

2015-07-01

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

Simultaneous personnel and vehicle shift scheduling in the waste management sector.

PubMed

Ghiani, Gianpaolo; Guerriero, Emanuela; Manni, Andrea; Manni, Emanuele; Potenza, Agostino

2013-07-01

Urban waste management is becoming an increasingly complex task, absorbing a huge amount of resources, and having a major environmental impact. The design of a waste management system consists in various activities, and one of these is related to the definition of shift schedules for both personnel and vehicles. This activity has a great incidence on the tactical and operational cost for companies. In this paper, we propose an integer programming model to find an optimal solution to the integrated problem. The aim is to determine optimal schedules at minimum cost. Moreover, we design a fast and effective heuristic to face large-size problems. Both approaches are tested on data from a real-world case in Southern Italy and compared to the current practice utilized by the company managing the service, showing that simultaneously solving these problems can lead to significant monetary savings. Copyright © 2013 Elsevier Ltd. All rights reserved.

Project #8, Task 2 - Travel Information Services (TIS), Definition Of Goals For The I-95 Corridor

DOT National Transportation Integrated Search

1995-01-23

CONTINUED FROM DOCUMENT NUMBER 6303 : RESEARCH AND DEVELOPMENT OR R&D, ELECTRONIC PAYMENT SYSTEMS, AUTOMATED FARE COLLECTION, EMERGENCY MANAGEMENT SERVICES OR EMS, FREEWAY MANAGEMENT SYSTEMS, INCIDENT MANAGEMENT/INCIDENT DETECTION : THE L-95 CORRI...

Infectious and parasitic diseases of cranes: Principles of treatment and prevention

USGS Publications Warehouse

Carpenter, James W.; Derrickson, Scott R.; Archibald, George W.; Pasquier, Roger F.

1987-01-01

Little is known of the incidence and pathogenic effects of infectious and parasitic diseases in the world's 15 crane species. in addition to being a primary cause of crane morality, diseases increase the susceptibility of an animal to depredation, malnutrition, accidents, and other mortality factors and reduces its chances of survival during times of stress. Although the treatment and control of diseases of wild cranes is difficult, the management of captive cranes is becoming more and more successful through the use of intensive husbandry, preventative medicine, and parasite control programs. this paper describes some of the infectious and parasitic diseases of wild and captive cranes and outlines management principles for their control, especially in confinement.

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

PubMed

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

2010-01-01

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

Reducing severe hypoglycaemia in hospitalised patients with diabetes: Early outcomes of standardised reporting and management.

PubMed

Araque, Katherine A; Kadayakkara, Deepak K; Gigauri, Nino; Sheehan, Diane; Majumdar, Sachin; Buller, Gregory; Flannery, Clare A

2018-01-01

Severe hypoglycaemic events (HGEs) in hospitalised patients are associated with poor outcomes and prolonged hospitalization. Systematic, coordinated care is required for acute management and prevention of HGEs; however, studies evaluating quality control efforts are scarce. To investigate the effectiveness of system-based interventions to improve management response to HGEs. System-based interventions were designed and implemented following a root cause analysis of HGE in adult patients with diabetes from two general medical wards with the highest incidence of HGE. Interventions included electronic medical record programming for a standardised order set for basal-bolus insulin regimen and hypoglycemia protocol, automated dextrose order, automated MD notification, and recommendation for endocrine consultation after two critical HGEs. The Pyxis MedStation was programmed to alert nurses to recheck blood glucose 15 min after the treatment. A card with the HGE management protocol was attached to each provider's ID badge and educational seminars were given to all providers. Primary outcomes were to evaluate median time from HGE (glucose <50 mg/dL) to euglycemia (>100 mg/dL), and time from HGE to follow-up finger-stick (FS) testing preintervention and postintervention. Secondary outcomes were cumulative incidence of HGEs, recurrent hypoglycemia, rate of physician notification and use of standardised treatments among adults with diabetes on the two general medical wards. Among hospitalised adults with diabetes and HGE, median time from HGE to euglycemia declined from 225±46 min preintervention to 87±26 min postintervention (p=0.03). Median time from HGE to next FS testing also declined (76±14 min to 28±10 min, p<0.001). Standardised treatment administration for HGE improved significantly from 34% (12/35) to 97% (36/37); physician notification rate improved significantly from 51% (18/35) to 78% (29/37).Among hospitalised adults with diabetes, incidence of HGE decreased from 12% (35/295) over 3 months (preintervention period) to 6% (37/610) over 6 months (postintervention period) (p<0.001), while recurrent HGE did not show significant differences (37% (13/35) to 24% (9/37), p=0.09). System-based interventions had a clinically important impact on decreasing time from HGE to euglycemia and to next FS testing. This hypoglycemia bundle of care may be applied and tested in other community hospitals to improve patient safety.

Helicopter emergency medical services in major incident management: A national Norwegian cross-sectional survey.

PubMed

Johnsen, Anne Siri; Sollid, Stephen J M; Vigerust, Trond; Jystad, Morten; Rehn, Marius

2017-01-01

Helicopter Emergency Medical Services (HEMS) aim to bring a highly specialised crew to the scene of major incidents for triage, treatment and transport. We aim to describe experiences made by HEMS in Norway in the management of major incidents. Doctors, rescue paramedics and pilots working in Norwegian HEMS and Search and Rescue Helicopters (SAR) January 1st 2015 were invited to a cross-sectional study on experiences, preparedness and training in major incident management. We identified a total of 329 Norwegian crewmembers of which 229 (70%) responded; doctors 101/150, (67%), rescue paramedics 64/78 (82%), pilots 64/101, (63%). HEMS and SAR crewmembers had experience from a median of 2 (interquartile range 0-6) major incidents. Road traffic incidents were the most frequent mechanism and blunt trauma the dominating injury. HEMS mainly contributed with triage, treatment and transport. Communication with other emergency services prior to arrival was described as bad, but good to excellent when cooperating on scene. The respondents called for more interdisciplinary exercises. HEMS and SAR crewmembers have limited exposure to major incident management. Interdisciplinary training on frequent scenarios with focus on cooperation and communication is called for.

49 CFR 1542.307 - Incident management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Incident management. (a) Each airport operator must establish procedures to evaluate bomb threats, threats... operations, including specific bomb threats to aircraft and airport facilities. (c) Airport operators...

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

Burger, J.R.

Loss control, both as a phrase and a concept, isn't used very widely in the U.S. coal industry although a U.S. manufacturer has cut accidents 71% and increased productivity 40% using the system. Safety is a part of the loss control concept, but it goes beyond traditional accident and illness prevention to become management control of anything that can result in loss or property damage. This includes what ILCI calls incidents, that is, ''any undesired or unwanted event that could (or does) degrade the efficiency of the business operation.'' These incidents could be accidents, quality or production problems, or evenmore » security breaches (such as thefts). So while safety is always a basic element-loss control also includes absenteeism control, security, fire prevention and industrial hygiene, since they're all interrelated disciplines for reducing loss. A baseline evaluation is followed by recommendations and guidance in self-sustaining corrective measures. This program would cost about $3,500 the first year. Possibly this approach is not used in the U.S. because miners feel that with all the legislation and regulation of the industry no further program is needed.« less

Evaluation of anger management groups in a high-security hospital.

PubMed

Wilson, Claire; Gandolfi, Stacy; Dudley, Alison; Thomas, Brian; Tapp, James; Moore, Estelle

2013-12-01

Anger management programmes for offenders typically aim to improve the management of emotion associated with aggressive and antisocial behaviour. Such programmes have been quite extensively evaluated in prison and probation settings, but there is less published research in forensic mental health settings. This study aimed to evaluate anger management groups in a high-security hospital. Eighty-six patients were referred for a 20-session anger management intervention. Outcomes were self-reported experiences of anger and changes in institutionally documented incidents of aggression. Incident rates were retrospectively reviewed for all group graduates, where data were available, including a comparison group of graduates who acted as their own controls. Group graduates reported sustained reductions in feelings of anger and positive changes in their use of aggression in reaction to provocation. Some reduction in incidents of physical aggression was noted when group completers were compared with non-completers. Incidents of verbal aggression were observed to increase for graduates. There was also a trend towards improvement when treated men were compared with men on the waiting list. Our findings contribute to the growing evidence for anger management groups for aggressive men, although the low-base rate of incidents, typical of such a containing and therapeutic hospital setting, rendered the analysis of behavioural outcomes difficult. Anger management sessions for male forensic psychiatric patients can be effective in reducing incidents of physical aggression in response to provocation. Evaluation of treatments for anger is particularly difficult in secure and protective settings, where the aim is to keep incidents of actual physical aggression to a minimum. Further research of this kind is needed to test the value of self-reported reduction in angry feelings as an indicator of clinically useful progress. Copyright © 2013 John Wiley & Sons, Ltd.

What Happened, and Why: Toward an Understanding of Human Error Based on Automated Analyses of Incident Reports. Volume 2

NASA Technical Reports Server (NTRS)

Ferryman, Thomas A.; Posse, Christian; Rosenthal, Loren J.; Srivastava, Ashok N.; Statler, Irving C.

2006-01-01

The objective of the Aviation System Monitoring and Modeling project of NASA's Aviation Safety and Security Program was to develop technologies to enable proactive management of safety risk, which entails identifying the precursor events and conditions that foreshadow most accidents. Information about what happened can be extracted from quantitative data sources, but the experiential account of the incident reporter is the best available source of information about why an incident happened. In Volume I, the concept of the Scenario was introduced as a pragmatic guide for identifying similarities of what happened based on the objective parameters that define the Context and the Outcome of a Scenario. In this Volume II, that study continues into the analyses of the free narratives to gain understanding as to why the incident occurred from the reporter s perspective. While this is just the first experiment, the results of our approach are encouraging and indicate that it will be possible to design an automated analysis process guided by the structure of the Scenario that can achieve the level of consistency and reliability of human analysis of narrative reports.

Gender ratios of administrative prevalence and incidence of attention-deficit/hyperactivity disorder (ADHD) across the lifespan: A nationwide population-based study in Taiwan.

PubMed

Huang, Charles Lung-Cheng; Weng, Shih-Feng; Ho, Chung-Han

2016-10-30

To verify the hypothesis that there is different gender ratio of attention-deficit/hyperactivity disorder (ADHD) among adults compared to children and adolescents in the clinical setting among Asian population. The nationwide population-based database containing data on enrollees in the National Health Insurance program in Taiwan during 2000-2007 was used in this study, and we investigated the lifetime gender ratios of administrative prevalence and incidence in healthcare-seeking ADHD patients (n=228,029). The male-to-female ratios of diagnosed incidence and prevalence of child/adolescent ADHD (age <20 years) ranged from 3.39 to 4.07 and 3.87-4.31, respectively. The male-to-female ratios of diagnosed incidence and prevalence of ADHD in the adult group (age 20-65 years) ranged from 0.24 to 0.76 and 0.35-0.98, respectively. In conclusion, there was substantially increased female-to-male ratio in adults ADHD compared to children and adolescents in the clinical setting. Further researches on the management and mechanism are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Use of after action reports (AARs) to promote organizational and systems learning in emergency preparedness.

PubMed

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D

2012-08-01

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The "lessons-learned" approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the "Lessons Learned Information Sharing (LLIS.gov)" system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strove to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed.

Use of After Action Reports (AARs) to Promote Organizational and Systems Learning in Emergency Preparedness

PubMed Central

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D.

2012-01-01

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The “lessons-learned” approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the “Lessons Learned Information Sharing (LLIS.gov)” system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strived to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed. PMID:23066408

Using the Critical Incident Technique for Triangulation and Elaboration of Communication Management Competencies

ERIC Educational Resources Information Center

Brunton, Margaret Ann; Jeffrey, Lynn Maud

2010-01-01

This paper presents the findings from research using the critical incident technique to identify the use of key competencies for communication management practitioners. Qualitative data was generated from 202 critical incidents reported by 710 respondents. We also present a brief summary of the quantitative data, which identified two superordinate…

41 CFR 102-33.445 - What accident and incident data must we report?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What accident and... 33-MANAGEMENT OF GOVERNMENT AIRCRAFT Reporting Information on Government Aircraft Accident and Incident Data § 102-33.445 What accident and incident data must we report? You must report within 14...

Simulation of Automatic Incidents Detection Algorithm on the Transport Network

ERIC Educational Resources Information Center

Nikolaev, Andrey B.; Sapego, Yuliya S.; Jakubovich, Anatolij N.; Berner, Leonid I.; Ivakhnenko, Andrey M.

2016-01-01

Management of traffic incident is a functional part of the whole approach to solving traffic problems in the framework of intelligent transport systems. Development of an effective process of traffic incident management is an important part of the transport system. In this research, it's suggested algorithm based on fuzzy logic to detect traffic…

Employee Assistance Program Issues

NASA Technical Reports Server (NTRS)

Gettleman, Alan G.; McGuire, William

1999-01-01

Employee Assistance Program (EAP) officers, as well as personnel in other disciplines from eight NASA Centers, attended this breakout session. Ms. Brenda Blair, MA, CEAP, a guest speaker at the conference, also attended as a consultant. Representatives from the NASA Centers introduced themselves and spoke briefly about their programs. In a discussion related to the conference theme on benchmarking, quality control issues within the EAP community and adequate documentation of cases were addressed. Disposition and provision for quality assurance checks for EAP providers in single person offices were also discussed. Ms. Blair presented methods for consulting with other NASA personnel in single person EAP offices as a quality control measure. EAP intervention in critical incidents was discussed. The question of whether EAP assistance is an asset or a potential liability in those situations was addressed. Suggestions were made of topics for future EAP video-teleconference topics. A program on EAP ethics was planned for a September video teleconference. Each person was asked to provide intake forms they use to Mr. Gettleman or Ms. Blair. Ms. Blair said she would review the forms to ensure that adequate notification is provided to the client for confidentiality. She would also review them to ensure they have adequate limits of confidentiality--a topic for future video teleconferencing. Mr. Gettleman described the NASA initiative to reduce stresses in the workplace, and the activities of an ad-hoc EAP group that will make recommendations to NASA senior management. Alternative training methods were discussed for reaching target audiences such as employees at risk, supervisors, and others. Pfc. David A. Pendleton, Victim Assistance Coordinator, U.S. Capitol Police. U.S. House of Representatives made a special presentation. Pfc. Pendleton was on duty during the tragic shooting of two Federal guards at the U.S. Capitol. He related the events immediately after the incident. He described the nature and structure of the EAP's and the separate nature of the House and Senate programs. This episode was a particularly difficult situation as large numbers of tourists were involved. William S. Barry, MD, the new Manager of the NASA Occupational Health Program Office was introduced to those attending the breakout session.

Preventive dental management of osteonecrosis of the jaws related to zoledronic acid treatment.

PubMed

Coello-Suanzes, J A; Rollon-Ugalde, V; Castaño-Seiquer, A; Lledo-Villar, E; Herce-Lopez, J; Infante-Cossio, P; Rollon-Mayordomo, A

2018-02-07

To evaluate the effect of preventive dental management on reducing the incidence and delaying the onset of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients treated with intravenous zoledronic acid (ZA). This single-center clinical study included 255 cancer patients monitored over a 6-year period. Patients received dental treatment prior (Group A) or after (Group B) the initiation of ZA therapy. Dental treatments performed, incidence proportion (IP) and incidence rate (IR) in both groups were analyzed using significance tests. BRONJ onset were estimated using the Kaplan-Meier estimator and log-rank test. Independent risk factors to develop BRONJ were evaluated using Cox regression analysis models. 37 patients suffered from BRONJ (IP=14.5%), 7.3% in group A and 36.5% in group B (p=0.000). The IR was 0.007 patients/month in group B and 0.004 in group A. BRONJ free survival at 3 years were 97% in group A and 66% in group B. Survival curves were significant (p=0.056) according to log-rank test. Multivariate Cox models showed that dental extractions (p=0.000) were significant. BRONJ occurred significantly in patients who underwent dental extractions after the initiation of ZA and did not accomplish a preventive dental program. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review.

PubMed

Bui, David P; Balland, Samantha; Giblin, Casey; Jung, Alesia M; Kramer, Sandy; Peng, Abigail; Aquino, Marie Corazon Ponce; Griffin, Stephanie; French, Dustin D; Pollack Porter, Keshia; Crothers, Steve; Burgess, Jefferey L

2018-06-01

Emergency service vehicle incidents (ESVI), including crashes, rollovers, and roadside struck-by-incidents, are a leading cause of occupational fatality and injury among firefighters and other emergency responders. Though there are numerous strategies and interventions to prevent ESVIs, the evidence base for these strategies is limited and dispersed. The goal of this study was to gather and present a review of evidence-based ESVI interventions. We searched five academic databases for articles published within the last decade featuring interventions to reduce or prevent ESVIs. We interviewed key informants from fire departments serving major metropolitan areas for additional interventions. Interventions from both sources were summarized and data on intervention effectiveness were reported when available. Sixty-five articles were included in the final review and 17 key informant interviews were completed. Most articles focused on vehicle engineering interventions (38%), followed by policy and administration interventions (26%), environmental engineering interventions (19%) and education or training (17%). Most key informants reported policy (49%) and training interventions (29%). Enhanced drivers' training and risk management programs were associated with 19-50% and 19-58% reductions in ESVIs, respectively. Only a limited number of interventions to address ESVIs had adequate outcome data. Based on the available data, training and risk management approaches may be particularly effective approaches to reducing ESVIs. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

A Knowledge-based System for Estimating Incident Clearance Duration for Maryland : I-95 a Case Study for the Project of MD-17-SHA/UM/4-19 : “Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment”

DOT National Transportation Integrated Search

2017-12-01

For the incident response operations to be appreciated by the general public, it is essential that responsible highway agencies be capable of providing the estimated clearance duration of a detected incident at the level sufficiently reliable for mot...

What Happened, and Why: Toward an Understanding of Human Error Based on Automated Analyses of Incident Reports. Volume 1

NASA Technical Reports Server (NTRS)

Maille, Nicolas P.; Statler, Irving C.; Ferryman, Thomas A.; Rosenthal, Loren; Shafto, Michael G.; Statler, Irving C.

2006-01-01

The objective of the Aviation System Monitoring and Modeling (ASMM) project of NASA s Aviation Safety and Security Program was to develop technologies that will enable proactive management of safety risk, which entails identifying the precursor events and conditions that foreshadow most accidents. This presents a particular challenge in the aviation system where people are key components and human error is frequently cited as a major contributing factor or cause of incidents and accidents. In the aviation "world", information about what happened can be extracted from quantitative data sources, but the experiential account of the incident reporter is the best available source of information about why an incident happened. This report describes a conceptual model and an approach to automated analyses of textual data sources for the subjective perspective of the reporter of the incident to aid in understanding why an incident occurred. It explores a first-generation process for routinely searching large databases of textual reports of aviation incident or accidents, and reliably analyzing them for causal factors of human behavior (the why of an incident). We have defined a generic structure of information that is postulated to be a sound basis for defining similarities between aviation incidents. Based on this structure, we have introduced the simplifying structure, which we call the Scenario as a pragmatic guide for identifying similarities of what happened based on the objective parameters that define the Context and the Outcome of a Scenario. We believe that it will be possible to design an automated analysis process guided by the structure of the Scenario that will aid aviation-safety experts to understand the systemic issues that are conducive to human error.

Health economic evaluation of an infection prevention and control program: are quality and patient safety programs worth the investment?

PubMed

Raschka, Stefanie; Dempster, Linda; Bryce, Elizabeth

2013-09-01

The effect of regional consolidation of an infection prevention and control (IPC) program on reduction of selected health care-acquired infections (HAIs), the economic burden of these illnesses, and where the potential for greatest financial benefit in reducing infection rates lies was assessed. Cost-benefit analysis (in Canadian $) was used to evaluate the effectiveness of a regional IPC program in preventing incident cases of HAIs. The costs of managing these infections, as well as the operational costs of the IPC program were compared against reductions in HAI rates over a 4-year period. Benefits were calculated as cost avoided by reducing HAI cases year over year. The Health Authority spent more than $66.3 million managing 24,937 HAI cases over the 4-year evaluation period. Urinary tract infections, methicillin-resistant Staphylococcus aureus, and bacteremias incurred the greatest costs. A reduction of 4,739 HAI cases led to avoided costs of $9.1 million in 4 years; the IPC program budget was $6.7 million during this period. Regionalization of the IPC program with standardized policies, procedures, and initiatives led to a 19% reduction in selected HAIs over 4 years and a cost avoidance of at least $9 million. This was particularly evident in years 3 and 4 of the program when $7.2 million (79% of the total) savings were realized. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Cervical cancer in sub-Saharan Africa: an emerging and preventable disease associated with oncogenic human papillomavirus.

PubMed

Mboumba Bouassa, R S; Prazuck, T; Lethu, T; Meye, J F; Bélec, L

2017-02-01

Highly oncogenic human papillomavirus (HPV) infections are responsible for 7.7 % of cancers in developing countries, mainly cervical cancer. The incidence of this emerging cancer is steadily increasing in sub-Saharan Africa, with more than 75,000 new cases and close to 50,000 deaths a year, a toll further increased by HIV infection. According to the World Health Organization, cervical cancer will kill more than 443,000 women per year worldwide by 2030, nearly 90 % of them in sub-Saharan Africa. This increase in cervical cancer incidence in Africa is now counteracting the progress made by African women in reducing maternal mortality and increasing longevity. Nevertheless, cervical cancer is a potentially preventable noncommunicable disease that can be averted or halted by primary (vaccination), secondary (early diagnosis of situations at risk), and tertiary (early diagnosis of proven cases of cervical neoplasia) prevention. The close links between HIV and HPV justify linking cervical cancer prevention, screening, and management programs with AIDS programs as part of the "90-90-90" initiative of the UNAIDS, both nationally and regionally. Innovative strategies based on effective, rapid, inexpensive, and mobile screening tools, including at best molecular biology as well as vaccination and awareness programs, should be rapidly implemented and evaluated in sub-Saharan Africa.

Expanded Newborn Screening Program in Saudi Arabia: Incidence of screened disorders.

PubMed

Alfadhel, Majid; Al Othaim, Ali; Al Saif, Saif; Al Mutairi, Fuad; Alsayed, Moeenaldeen; Rahbeeni, Zuhair; Alzaidan, Hamad; Alowain, Mohammed; Al-Hassnan, Zuhair; Saeedi, Mohamad; Aljohery, Saeed; Alasmari, Ali; Faqeih, Eissa; Alwakeel, Mansour; AlMashary, Maher; Almohameed, Sulaiman; Alzahrani, Mohammed; Migdad, Abeer; Al-Dirbashi, Osama Y; Rashed, Mohamed; Alamoudi, Mohamed; Jacob, Minnie; Alahaidib, Lujane; El-Badaoui, Fahd; Saadallah, Amal; Alsulaiman, Ayman; Eyaid, Wafaa; Al-Odaib, Ali

2017-06-01

To address the implementation of the National Newborn Screening Program (NBS) in Saudi Arabia and stratify the incidence of the screened disorders. A retrospective study conducted between 1 August 2005 and 31 December 2012, total of 775 000 newborns were screened from 139 hospitals distributed among all regions of Saudi Arabia. The NBS Program screens for 16 disorders from a selective list of inborn errors of metabolism (IEM) and endocrine disorders. Heel prick dry blood spot samples were obtained from all newborns for biochemical and immunoassay testing. Recall screening testing was performed for Initial positive results and confirmed by specific biochemical assays. A total of 743 cases were identified giving an overall incidence of 1:1043. Frequently detected disorders nationwide were congenital hypothyroidism and congenital adrenal hyperplasia with an incidence of 1:7175 and 1:7908 correspondingly. The highest incidence among the IEM was propionic acidaemia with an incidence rate of 1:14 000. The article highlights the experience of the NBS Program in Saudi Arabia and providing data on specific regional incidences of all the screened disorders included in the programme; and showed that the incidence of these disorders is one of the highest reported so far world-wide. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Managing the risks of risk management on large fires

Treesearch

Donald G. MacGregor; Armando González-Cabán

2013-01-01

Large fires pose risks to a number of important values, including the ecology, property and the lives of incident responders. A relatively unstudied aspect of fire management is the risks to which incident managers are exposed due to organizational and sociopolitical factors that put them in a position of, for example, potential liability or degradation of their image...

[The critical incident reporting system as an instrument of risk management for better patient safety].

PubMed

Panzica, M; Krettek, C; Cartes, M

2011-09-01

The probability that an inpatient will be harmed by a medical procedure is at least 3% of all patients. As a consequence, hospital risk management has become a central management task in the health care sector. The critical incident reporting system (CIRS) as a voluntary instrument for reporting (near) incidents plays a key role in the implementation of a risk management system. The goal of the CIRS is to register system errors without assigning guilt or meting out punishment and at the same time increasing the number of voluntary reports.

Active Fire Mapping Program

MedlinePlus

Active Fire Mapping Program Current Large Incidents (Home) New Large Incidents Fire Detection Maps MODIS Satellite Imagery VIIRS Satellite Imagery Fire Detection GIS Data Fire Data in Google Earth ...

The Barrow-in-Furness legionnaires' outbreak: qualitative study of the hospital response and the role of the major incident plan.

PubMed

Smith, A F; Wild, C; Law, J

2005-04-01

To document the organisational response of Furness General Hospital to the large outbreak of legionnaire's disease in April 2002 and assess the contribution made by the hospital's major incident plan. Qualitative analysis of interview transcripts and written comments from some staff involved in the management of the incident. Documentary analysis of major incident plan and other written materials. The incident posed considerable managerial and clinical problems and this paper describes how they were overcome. In particular, strategies for dealing with supply (of staff, beds, and resources) and managing demand (by liaising with primary care and the public) seem to have been successful. Many functions necessary for managing the incident were poorly dealt with in the plan, especially procedures for handling the news media and liaison with agencies outside the hospital. Lack of explicit guidance appeared not to hinder the organisational response. There may have been an unspoken high level decision to allow staff to draw on their skills and experience in improvising a response to the initial challenge and learning adaptively as the incident unfolded. There was also evidence that staff disregarded existing job and role boundaries and focused instead on tasks, working flexibly to ensure that these tasks were completed. Protracted major incidents pose particular management challenges and may benefit from an approach different from that set out in typical major incident plans. Staff must be able to act flexibly and responsively. Some form of checklist or toolkit may be preferable to a detailed plan for some types of incident.

The Barrow-in-Furness legionnaires' outbreak: qualitative study of the hospital response and the role of the major incident plan

PubMed Central

Smith, A; Wild, C; Law, J

2005-01-01

Objective: To document the organisational response of Furness General Hospital to the large outbreak of legionnaire's disease in April 2002 and assess the contribution made by the hospital's major incident plan. Method: Qualitative analysis of interview transcripts and written comments from some staff involved in the management of the incident. Documentary analysis of major incident plan and other written materials. Results: The incident posed considerable managerial and clinical problems and this paper describes how they were overcome. In particular, strategies for dealing with supply (of staff, beds, and resources) and managing demand (by liaising with primary care and the public) seem to have been successful. Many functions necessary for managing the incident were poorly dealt with in the plan, especially procedures for handling the news media and liaison with agencies outside the hospital. Lack of explicit guidance appeared not to hinder the organisational response. There may have been an unspoken high level decision to allow staff to draw on their skills and experience in improvising a response to the initial challenge and learning adaptively as the incident unfolded. There was also evidence that staff disregarded existing job and role boundaries and focused instead on tasks, working flexibly to ensure that these tasks were completed. Conclusions: Protracted major incidents pose particular management challenges and may benefit from an approach different from that set out in typical major incident plans. Staff must be able to act flexibly and responsively. Some form of checklist or toolkit may be preferable to a detailed plan for some types of incident. PMID:15788822

Project #8, Task 1 - Travel Information Services (TIS), Inventory Of Traveler Information Services And Commercial Opportunities In The I-95 Corridor

DOT National Transportation Integrated Search

1995-12-01

CONTINUED FROM DOCUMENT NUMBER 6303 : RESEARCH AND DEVELOPMENT OR R&D, ELECTRONIC PAYMENT SYSTEMS, AUTOMATED FARE COLLECTION, EMERGENCY MANAGEMENT SERVICES OR EMS, FREEWAY MANAGEMENT SYSTEMS, INCIDENT MANAGEMENT/INCIDENT DETECTION : THE L-95 CORRI...

Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment : Research Summary

DOT National Transportation Integrated Search

2017-12-01

In designing an effective traffic management plan for non-recurrent congestion, it is critical for responsible highway agencies to have some vital information, such as estimated incident duration, resulting traffic queues, and the expected delays. Ov...

Evolving management of metaplasia and dysplasia in Barrett's epithelium

PubMed Central

Evans, Richard P T; Mourad, Moustafa Mabrouk; Fisher, Simon G; Bramhall, Simon R

2016-01-01

Oesophageal cancer affects more than 450000 people worldwide and despite continued medical advancements the incidence of oesophageal cancer is increasing. Oesophageal cancer has a 5 year survival of 15%-25% and now globally attempts are made to more aggressively diagnose and treat Barrett’s oesophagus the known precursor to invasive disease. Currently diagnosis the of Barrett’s oesophagus is predominantly made after endoscopic visualisation and histopathological confirmation. Minimally invasive techniques are being developed to improve the viability of screening programs. The management of Barrett’s oesophagus can vary greatly dependent on the presence and severity of dysplasia. There is no consensus between the major international medical societies to determine and agreed surveillance and intervention pathway. In this review we analysed the current literature to demonstrate the evolving management of metaplasia and dysplasia in Barrett’s epithelium. PMID:28058012

Emergency response to mass casualty incidents in Lebanon.

PubMed

El Sayed, Mazen J

2013-08-01

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

Evaluation of the Olweus Bullying Prevention Program in Nine Urban Schools: Effective Practices and next Steps

ERIC Educational Resources Information Center

Black, Sally; Washington, Ericka

2008-01-01

The Olweus Bullying Prevention Program (BPP) is an internationally recognized school-based bullying prevention program. This project sought to evaluate pilot implementation of the program in one urban district using fidelity of implementation, bullying incident density (BID), student surveys, and serious incident reports as process and outcome…

Incident management under SCAT adaptive control system : FAST-TRAC phase III deliverable. #11, Final report on incident management under SCATS adaptive control system

DOT National Transportation Integrated Search

1998-04-01

The report documents the results of a study designed to test the effectiveness of ATMS and ATIS strategies to reduce delay resulting from an incident. The study had two main sections: a simulation study to test the effectiveness of several control st...

Public health incident management: Logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

PubMed

Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

2015-01-01

Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

Public health incident management: logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

PubMed

Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

2015-01-01

Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

Evaluation of a Hepatitis C Patient Management Program at a University Specialty Pharmacy.

PubMed

Zaepfel, Michelle; Cristofaro, Lisa; Trawinski, Allison; McCarthy, Katharine; Rightmier, Elizabeth; Khadem, Tina

2017-04-01

The University of Rochester (UR) Specialty Pharmacy hepatitis C patient management program offers a unique advantage of being integrated within the same health system as the University of Rochester Medical Center (URMC) Gastroenterology and Hepatology division. The primary purpose of this study was to assess treatment success through the incidence of achieving a sustained virological response (SVR) in patients served by the UR Specialty Pharmacy versus other nonintegrated pharmacies. This was a single-center retrospective cohort study in adult patients of URMC Gastroenterology and Hepatology prescribed hepatitis C treatment between January 1, 2014, and July 15, 2015. The incidence of SVR, adherence, delay in therapy initiation, early treatment discontinuation, rate of attainment of viral load measurement post-therapy completion, and predictors associated with treatment outcome were assessed. A total of 414 patients were prescribed hepatitis C virus treatment during the study period; 137 did not initiate therapy. The rate of SVR was 93% among patients at the UR Specialty Pharmacy and 89% at nonintegrated pharmacies ( P = 0.357). Adherence to therapy was 100% and 97% at the UR Specialty Pharmacy and nonintegrated pharmacies, respectively ( P = 0.046). The UR Specialty Pharmacy was associated with a 93% SVR rate and significantly greater adherence compared with nonintegrated pharmacies. Larger studies are needed to determine if a significant difference in SVR exists between integrated and nonintegrated pharmacies. This study provides a framework for other institutions to justify developing integrated hepatitis C specialty pharmacy services and evaluate their success.

Waterfowl exposure to lead and steel shot on selected hunting areas

USGS Publications Warehouse

White, D.H.; Stendell, R.C.

1977-01-01

Gizzards and wingbones from immature mallards (Anas platyrhynchos), pintails (Anas acuta), black ducks (A. rubripes), and Canada geese (Branta canadensis) were collected from 12 national and stat hunting are.as during the hunting season of 1974-75. The gizzards were examined for the occurrence of lead and steel shot and the wingbones were analyzed for lead residues. Incidence of lead shot in gizzards ranged from 1.3 percent in mallards from Monte Vista National Wildlife Refuge to 29 percent in pintails from Sauvie Island Wildlife Management Area. Lead in wingbones ranged from trace residues (<0.5 ppm) to 345 ppm. The incidence of steel shot in gizzards surpassed lead shot on some refuges that have had mandatory steel shot programs. There was a significant correlation between frequency of lead shot in gizzards and lead residues in wingbones.

National Response Framework (NRF)

EPA Pesticide Factsheets

The NRF establishes a single, comprehensive approach to domestic incident management to prevent, prepare for, respond to, and recover from terrorist attacks, major disasters, and other emergencies. Built on the National Incident Management System template.

41 CFR 102-33.450 - How must we report accident and incident data?

Code of Federal Regulations, 2010 CFR

2010-07-01

...-MANAGEMENT OF GOVERNMENT AIRCRAFT Reporting Information on Government Aircraft Accident and Incident Data... Street, NW., Washington, DC 20405. Common Aviation Management Information Standard (C-AMIS) ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false How must we report...

American Contact Dermatitis Society Contact Allergy Management Program: An Epidemiologic Tool to Quantify Ingredient Usage.

PubMed

Scheman, Andrew; Severson, David

2016-01-01

The usage prevalence of ingredients in topical products is important to dermatologists and industry. To determine the prevalence of methylisothiazolinone (MI) in various types of consumer products The Contact Allergy Management Program (CAMP) database was mapped and sorted in spreadsheet format to determine the prevalence of MI in various types of consumer products. Methylisothiazolinone was found in 13.2% of 4660 total products in CAMP. High usage of MI was seen in dishwashing products (64%), shampoos (53%), bathroom/kitchen/all-purpose cleaners (47%), hair conditioners (45%), hair dyes (43%), laundry additives/fresheners/softeners (30%), soaps/cleansers (29%), and surface cleaners/disinfectants (27%). Of the products containing MI, MI alone (without methylchloroisothiazolinone) was most common in makeup products (100%), cleaning/dish/laundry products (>99%), moisturizers (82%), shaving products (78%), sunscreens (71%), and antiaging products (67%). The American Contact Dermatitis Society's CAMP is a valuable tool to collect epidemiologic data on the incidence of specific ingredient usage in various types of topical products.

Kentucky's highway incident management strategic plan.

DOT National Transportation Integrated Search

2005-06-01

Kentucky s Highway Incident Management Strategic Plan consists of a mission statement, 4 goals, 16 objectives, and 49 action strategies. The action strategies are arranged by priority and recommended time frame for implementation. When implemented...

Development of Incident Report Database for Organizational Learning

NASA Astrophysics Data System (ADS)

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

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

Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas.

PubMed

Yuan, X; Tao, Y; Zhao, J P; Liu, X S; Xiong, W N; Xie, J G; Ni, W; Xu, Y J; Liu, H G

2015-11-01

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.

Critical Drivers for Safety Culture: Examining Department of Energy and U.S. Army Operational Experiences - 12382

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

Lowes, Elizabeth A.

2012-07-01

Evaluating operational incidents can provide a window into the drivers most critical to establishing and maintaining a strong safety culture, thereby minimizing the potential project risk associated with safety incidents. By examining U.S. Department of Energy (DOE) versus U.S. Army drivers in terms of regulatory and contract requirements, programs implemented to address the requirements, and example case studies of operational events, a view of the elements most critical to making a positive influence on safety culture is presented. Four case studies are used in this evaluation; two from DOE and two from U.S. Army experiences. Although the standards guiding operationsmore » at these facilities are different, there are many similarities in the level of hazards, as well as the causes and the potential consequences of the events presented. Two of the incidents examined, one from a DOE operation and the other from a U.S. Army facility, resulted in workers receiving chemical burns. The remaining two incidents are similar in that significant conduct of operations failures occurred resulting in high-level radioactive waste (in the case of the DOE facility) or chemical agent (in the case of the Army facility) being transferred outside of engineering controls. A review of the investigation reports for all four events indicates the primary causes to be failures in work planning leading to ineffective hazard evaluation and control, lack of procedure adherence, and most importantly, lack of management oversight to effectively reinforce expectations for safe work planning and execution. DOE and Army safety programs are similar, and although there are some differences in contractual requirements, the expectations for safe performance are essentially the same. This analysis concludes that instilling a positive safety culture comes down to management leadership and engagement to (1) cultivate an environment that values a questioning attitude and (2) continually reinforce expectations for the appropriate level of rigor in work planning and procedure adherence. A review of the root causes and key contributing causes to the events indicate: - Three of the four root cause analyses cite lack of management engagement (oversight, involvement, ability to recognize issues, etc.) as a root cause to the events. - Two of the four root cause analyses cite work planning failures as a root cause to the events and all cause analyses reflect work planning failures as contributing factors to the events. - All events with the exception of the Tuba City plant shutdown indicate procedure noncompliance as a key contributor; in the case of Tuba City the procedure issues were primarily related to a lack of procedures, or a lack of sufficiently detailed procedures. - All events included discussion or suggestion of a lack of a questioning attitude, either on the part of management/supervision, work planners, or workers. This analysis suggests that the most critical drivers to safety culture are: - Management engagement, - Effective work planning and procedures, and - Procedure adherence with a questioning attitude to ensure procedural problems are identified and fixed. In high-hazard operational environments the importance of robust work planning processes and procedure adherence cannot be overstated. However, having the processes by themselves is not enough. Management must actively engage in expectation setting and ensure work planning that meets expectations for hazard analysis and control, develop a culture that encourages incident reporting and a questioning attitude, and routinely observe work performance to reinforce expectations for adherence to procedures/work control documents. In conclusion, the most critical driver to achieving a workforce culture that supports safe and effective project performance can be summarized as follows: 'Management engagement to continually reinforce expectations for work planning processes and procedure adherence in an environment that cultivates a questioning attitude'. (authors)« less

Management of small hepatocellular carcinoma in cirrhosis: Focus on portal hypertension

PubMed Central

Hernandez-Gea, Virginia; Turon, Fanny; Berzigotti, Annalisa; Villanueva, Augusto

2013-01-01

The incidence of hepatocellular carcinoma (HCC) is rising worldwide being currently the fifth most common cancer and third cause of cancer-related mortality. Early detection of HCC through surveillance programs have enabled the identification of small nodules with higher frequency, and nowadays account for 10%-15% of patients diagnosed in the West and almost 30% in Japan. Patients with small HCC can be candidates for potential curative treatments: liver transplantation, surgical resection and percutaneous ablation, depending on the presence of portal hypertension and co-morbidities. This review will analyze recent advancements in the clinical management of these individuals, focusing on issues related to the role of portal hypertension, the debate between resection and ablative therapies and the future impact of molecular technologies. PMID:23482437

Neural network model for automatic traffic incident detection : executive summary.

DOT National Transportation Integrated Search

2001-04-01

Automatic freeway incident detection is an important component of advanced transportation management systems (ATMS) that provides information for emergency relief and traffic control and management purposes. In this research, a multi-paradigm intelli...

Work site stress management: national survey results.

PubMed

Fielding, J E

1989-12-01

The National Survey of Work Site Health Promotion Activities established baseline data on the frequency of nine types of health promotion activity at private work sites with more than 50 employees in the United States. Stress management activities were provided at 26.6% of work sites. Types of activities at those work sites with some stress management activity included group counseling (58.5%), individual counseling (39.3%), follow-up counseling (25.9%), special events (11.5%), providing information about stress (80.7%), providing a place to relax (64.8%), and making organizational changes to reduce employee stress (81.2%). Frequency of activities varied by industry type and by region of the country. Incidence of most types of activities did not increase as work site size increased, although the likelihood of having any of these activities did increase with work site size. Stress management activities were more likely to be present at work sites with a medical staff or health educator. An increase in output, productivity, or quality was the most frequently cited benefit (46.5%). Negative effects were reported at 2.6% of the work sites. Other health promotion activities found at the work sites surveyed included smoking cessation (61.8%), treatment and control of high blood pressure (36.7%), and weight control (34.7%). Employee Assistance Programs were responsible for stress management at 62% of the work sites with an Employee Assistance Program.

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

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 4 2013-01-01 2013-01-01 false Reports of change in control of bank management... Reports of change in control of bank management incident to a merger. (a) A State member bank has inquired whether Pub. L. 88-593 (78 Stat. 940) requires reports of change in control of bank management in...

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

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 4 2014-01-01 2014-01-01 false Reports of change in control of bank management... Reports of change in control of bank management incident to a merger. (a) A State member bank has inquired whether Pub. L. 88-593 (78 Stat. 940) requires reports of change in control of bank management in...

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

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 3 2011-01-01 2011-01-01 false Reports of change in control of bank management... change in control of bank management incident to a merger. (a) A State member bank has inquired whether Pub. L. 88-593 (78 Stat. 940) requires reports of change in control of bank management in situations...

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

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 4 2012-01-01 2012-01-01 false Reports of change in control of bank management... Reports of change in control of bank management incident to a merger. (a) A State member bank has inquired whether Pub. L. 88-593 (78 Stat. 940) requires reports of change in control of bank management in...

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

Code of Federal Regulations, 2010 CFR

2010-01-01

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

Developing a Decision Support System for Flood Response: NIMS/ICS Fundamentals

NASA Astrophysics Data System (ADS)

Gutenson, J. L.; Zhang, X.; Ernest, A. N. S.; Oubeidillah, A.; Zhu, L.

2015-12-01

Effective response to regional disasters such as floods requires a multipronged, non-linear approach to reduce loss of life, property and harm to the environment. These coordinated response actions are typically undertaken by multiple jurisdictions, levels of government, functional agencies and other responsible entities. A successful response is highly dependent on the effectiveness and efficiency of each coordinated response action undertaken across a broad spectrum of organizations and activities. In order to provide a unified framework for those responding to incidents or planned events, FEMA provides a common and flexible approach for managing incidents, regardless of cause, size, location or complexity, referred to as the National Incident Management System (NIMS). Integral to NIMS is the Incident Command System (ICS), which establishes a common, pre-defined organizational structure to ensure coordination and management of procedures, resources and communications, for efficient incident management. While being both efficient and rigorous, NIMS, and ICS to a lesser extent, is an inherently complex framework that requires significant amount of training for planners, responders and managers to master, especially considering the wide array of incident types that Local Emergency Planning Committees (LEPCs) must be prepared to respond to. The existing Water-Wizard Decision Support System (DSS), developed to support water distribution system recovery operations for Decontamination (Decon), Operational Optimization (WDS), and Economic Consequence Assessment (Econ), is being evolved to integrate incident response functions. Water-Wizard runs on both mobile and desktop devices, and is being extended to utilize smartphone and mobile device specific data streams (e.g GPS location) to augment its fact-base in real-time for situational-aware DSS recommendations. In addition, the structured NIMS and ICS frameworks for incident management and response are being incorporated into the Water-Wizard knowledgebase, with a mid-term goal of integrating flood-specific emergency response domain knowledge to provide a real-time flood responder decision support.

Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis.

PubMed

Safavi, Arash; Skarsgard, Erik D; Rhee, Peter; Zangbar, Bardiya; Kulvatunyou, Narong; Tang, Andrew; O'Keeffe, Terence; Friese, Randall S; Joseph, Bellal

2016-03-01

Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE). 6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7%) vs. 52 (4.9%); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95% CI: 1.02-2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence. Operative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs. Published by Elsevier Inc.

Integrated Incident Management System (IIMS) web client application development, deployment and evaluation: an evaluation of a potential IIMS deployment in Western New York : final report.

DOT National Transportation Integrated Search

2015-09-30

Incident Management (IM) is an area of transportation management that can significantly decrease the congestion and increase the : efficiency of transportation networks in non-ideal conditions. In this study, the existing state of the Integrated Inci...

Incident Management Organization succession planning stakeholder feedback

Treesearch

Anne E. Black

2013-01-01

This report presents complete results of a 2011 stakeholder feedback effort conducted for the National Wildfire Coordination Group (NWCG) Executive Board concerning how best to organize and manage national wildland fire Incident Management Teams in the future to meet the needs of the public, agencies, fire service and Team members. Feedback was collected from 858...

Responding to Terrorist Incidents in Your Community: Flammable-Liquid Fire Fighting Techniques for Municipal and Rural Firefighters

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

Denise Baclawski

2010-03-08

The University of Nevada, Reno Fire Science Academy (FSA) applied for grant funding to develop and deliver programs for municipal, rural, and volunteer firefighters. The FSA specializes in preparing responders for a variety of emergency events, including flammable liquid fires resulting from accidents, intentional acts, or natural disasters. Live fire training on full scale burnable props is the hallmark of FSA training, allowing responders to practice critical skills in a realistic, yet safe environment. Unfortunately, flammable liquid live fire training is often not accessible to municipal, rural, or volunteer firefighters due to limited department training budgets, even though most departmentmore » personnel will be exposed to flammable liquid fire incidents during the course of their careers. In response to this training need, the FSA developed a course during the first year of the grant (Year One), Responding to Terrorist Incidents in Your Community: Flammable-Liquid Fire Fighting Techniques for Municipal and Rural Firefighters. During the three years of the grant, a total of 2,029 emergency responders received this training. In Year Three, two new courses, a train-the-trainer for Responding to Terrorist Incidents in Your Community and Management of Large-Scale Disasters for Public Officials were developed and pilot tested during the Real-World Disaster Management Conference held at the FSA in June of 2007. Two research projects were conducted during Years Two and Three. The first, conducted over a two year period, evaluated student surveys regarding the value of the flammable liquids training received. The second was a needs assessment conducted for rural Nevada. Both projects provided important feedback and a basis for curricula development and improvements.« less

Incidence of Transient Ischemic Attack in Auckland, New Zealand, in 2011 to 2012.

PubMed

Barber, P Alan; Krishnamurthi, Rita; Parag, Varsha; Anderson, Neil E; Ranta, Annemarei; Kilfoyle, Dean; Wong, Edward; Green, Geoff; Arroll, Bruce; Bennett, Derrick A; Witt, Emma; Rush, Elaine; Minsun Suh, Flora; Theadom, Alice; Rathnasabapathy, Yogini; Te Ao, Braden; Parmar, Priyakumari; Feigin, Valery L

2016-09-01

There have been few recent population-based studies reporting the incidence (first ever) and attack rates (incident and recurrent) of transient ischemic attack (TIA). The fourth Auckland Regional Community Stroke study (ARCOS IV) used multiple overlapping case ascertainment methods to identify all hospitalized and nonhospitalized cases of TIA that occurred in people ≥16 years of age usually resident in Auckland (population ≥16 years of age is 1.12 million), during the 12 months from March 1, 2011. All first-ever and recurrent new TIAs (any new TIA 28 days after the index event) during the study period were recorded. There were 785 people with TIA (402 [51.2%] women, mean [SD] age 71.5 [13.8] years); 614 (78%) of European origin, 84 (11%) Māori/Pacific, and 75 (10%) Asian/Other. The annual incidence of TIA was 40 (95% confidence interval, 36-43), and attack rate was 63 (95% confidence interval, 59-68), per 100 000 people, age standardized to the World Health Organization world population. Approximately two thirds of people were known to be hypertensive or were being treated with blood pressure-lowering agents, half were taking antiplatelet agents and just under half were taking lipid-lowering therapy before the index TIA. Two hundred ten (27%) people were known to have atrial fibrillation at the time of the TIA, of whom only 61 (29%) were taking anticoagulant therapy, suggesting a failure to identify or treat atrial fibrillation. This study describes the burden of TIA in an era of aggressive primary and secondary vascular risk factor management. Education programs for medical practitioners and patients around the identification and management of atrial fibrillation are required. © 2016 American Heart Association, Inc.

Efficacy of a control program for bovine trichomonosis based on testing and culling infected bulls in beef cattle managed under mountain pastoral systems of Northern Spain.

PubMed

Collantes-Fernández, Esther; Mendoza-Ibarra, Jesús Alberto; Pedraza-Díaz, Susana; Rojo-Montejo, Silvia; Navarro-Lozano, Vanesa; Sánchez-Sánchez, Roberto; Ruiz-Santa-Quiteria, Jose Antonio; Ortega-Mora, Luis Miguel; Osoro, Koldo

2014-04-01

Bovine trichomonosis (BT) is a sexually transmitted disease that is considered a cause of early reproductive failure in cattle under extensive management conditions. Recently, Tritrichomonas foetus was detected in 41.5% of herds from one representative beef cattle breed (Asturiana de la Montaña; AM) reared in traditional mountain systems in Spain. The objective of the present study was to evaluate the effect of BT on reproductive performance and the economic consequences in AM herds. The benefits of a control program based on testing and culling infected bulls were also studied by comparing T. foetus prevalence and reproductive data before and after the implementation of the control measures. In infected herds, T. foetus infection increased calving intervals by 79 days (P<0.0001) and resulted in a higher percentage of cows-not-in calf (36% vs. 19%; P<0.001). An economic analysis showed that BT could reduce income by 68.7% in AM herds. The implementation of the control program decreased calving intervals (P<0.0001) and increased calving percentage (P<0.05). T. foetus prevalence showed a significant decline compared with the prevalence before implementing the control program (P<0.05). Nevertheless, after 2 years, the herd prevalence did not decrease (12.7-13.6%; P>0.05) and the herd incidence was 22.72%. The testing and culling policy was effective in improving reproductive efficiency but the complete elimination of BT without substantial changes in management appears unlikely because putative risk factors associated with the disease are present in the management of this breed. Copyright © 2014 Elsevier Ltd. All rights reserved.

78 FR 43230 - Agency Information Collection Activities: Submission to OMB for Reinstatement, Without Change, of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

... Insured Credit Unions to maintain an information security program and an incident response plan that... Federally Insured Credit Unions to maintain an information security program and an incident response plan... credit unions to develop a written security program to safeguard sensitive member information. This...

Contemporary, age-based trends in the incidence and management of patients with early-stage kidney cancer.

PubMed

Tan, Hung-Jui; Filson, Christopher P; Litwin, Mark S

2015-01-01

Although kidney cancer incidence and nephrectomy rates have risen in tandem, clinical advances have generated new uncertainty regarding the optimal management of patients with small renal tumors, especially the elderly. To clarify existing practice patterns, we assessed contemporary trends in the incidence and management of patients with early-stage kidney cancer. Using Surveillance, Epidemiology, and End Results data, we identified adult patients diagnosed with T1aN0M0 kidney cancer from 2000 to 2010. We determined age-adjusted and age-specific incidence and management rates (i.e., nonoperative, ablation, partial nephrectomy [PN], and radical nephrectomy) per 100,000 adults and determined the average annual percent change (AAPC). Finally, we compared management groups using multinomial logistic regression accounting for patient characteristics, cancer information, and county-level measures for health. From 2000 to 2010, we identified 41,645 adults diagnosed with T1aN0M0 kidney cancer. Overall incidence increased from 3.7 to 7.0 per 100,000 adults (AAPC = 7.0%, P<0.001). Over the study interval, rates of PN (AAPC = 13.1%, P<0.001) increased substantially, becoming the most used treatment by 2010. Among the elderly, rates of nonoperative management and ablation approached nephrectomy rates for those aged 75 to 84 years and became the predominant strategy for patients older than 84 years. Adjusting for clinical, oncological, and environmental factors, older patients less frequently underwent PN and more often received ablative or nonoperative management (P<0.001). As the incidence of early-stage kidney cancer rises, patients are increasingly treated with nonoperative and nephron-sparing strategies, especially among the most elderly. The broader array of treatment options suggests opportunities to better personalize kidney cancer care for seniors. Published by Elsevier Inc.

Neural network model for automatic traffic incident detection : final report, August 2001.

DOT National Transportation Integrated Search

2001-08-01

Automatic freeway incident detection is an important component of advanced transportation management systems (ATMS) that provides information for emergency relief and traffic control and management purposes. In this research, a multi-paradigm intelli...

Demonstration of the application of traffic management center decision support tools.

DOT National Transportation Integrated Search

2013-03-01

Decision support tools were developed in previous Florida Department of Transportation (FDOT) : research projects to allow for better analysis and visualization of historical traffic and incident : data, in support of incident management and traffic ...

Lifting HOV/HOT lane eligibility and shoulder use restrictions for traffic incident management : [technical summary].

DOT National Transportation Integrated Search

2013-12-01

High occupancy vehicle lanes{Pmrcpmj}; : High occupancy toll lanes{Pmrcpmjh}; : Incident management{Dcmthcj}; : Road shoulders{Pmrcps}; : Traffic diversion{Bthh}; : Decision making{Epdmd}; : General purpose lanes{Pmrcpmd}; : Ramp metering{Dcmthcfr}; ...

Sharing resources, coordinating response : deploying and operating incident management systems

DOT National Transportation Integrated Search

1999-01-05

This brochure describes how cost-effective incident management technologies can be useful in handling traffic congestion. Embedded sensors, closed circuit television cameras, and variable message signs are examples of existing technologies that can b...

Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings.

PubMed

Lopez, Melissa S; Baker, Ellen S; Milbourne, Andrea M; Gowen, Rose M; Rodriguez, Ana M; Lorenzoni, Cesaltina; Mwaba, Catherine; Msadabwe, Susan Citonje; Tavares, José Humberto; Fontes-Cintra, Georgia; Zucca-Matthes, Gustavo; Callegaro-Filho, Donato; Ramos-Martin, Danielle; Thiago de Carvalho, Icaro; Coelho, Robson; Marques, Renato Moretti; Chulam, Thiago; Pontremoli-Salcedo, Mila; Nozar, Fernanda; Fiol, Veronica; Maza, Mauricio; Arora, Sanjeev; Hawk, Ernest T; Schmeler, Kathleen M

2017-10-01

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.

Acceptability and perceived utility of drone technology among emergency medical service responders and incident commanders for mass casualty incident management.

PubMed

Hart, Alexander; Chai, Peter R; Griswold, Matthew K; Lai, Jeffrey T; Boyer, Edward W; Broach, John

2017-01-01

This study seeks to understand the acceptability and perceived utility of unmanned aerial vehicle (UAV) technology to Mass Casualty Incidents (MCI) scene management. Qualitative questionnaires regarding the ease of operation, perceived usefulness, and training time to operate UAVs were administered to Emergency Medical Technicians (n = 15). A Single Urban New England Academic Tertiary Care Medical Center. Front-line emergency medical service (EMS) providers and senior EMS personnel in Incident Commander roles. Data from this pilot study indicate that EMS responders are accepting to deploying and operating UAV technology in a disaster scenario. Additionally, they perceived UAV technology as easy to adopt yet impactful in improving MCI scene management.

Anatomy of a Security Operations Center

NASA Technical Reports Server (NTRS)

Wang, John

2010-01-01

Many agencies and corporations are either contemplating or in the process of building a cyber Security Operations Center (SOC). Those Agencies that have established SOCs are most likely working on major revisions or enhancements to existing capabilities. As principle developers of the NASA SOC; this Presenters' goals are to provide the GFIRST community with examples of some of the key building blocks of an Agency scale cyber Security Operations Center. This presentation viII include the inputs and outputs, the facilities or shell, as well as the internal components and the processes necessary to maintain the SOC's subsistence - in other words, the anatomy of a SOC. Details to be presented include the SOC architecture and its key components: Tier 1 Call Center, data entry, and incident triage; Tier 2 monitoring, incident handling and tracking; Tier 3 computer forensics, malware analysis, and reverse engineering; Incident Management System; Threat Management System; SOC Portal; Log Aggregation and Security Incident Management (SIM) systems; flow monitoring; IDS; etc. Specific processes and methodologies discussed include Incident States and associated Work Elements; the Incident Management Workflow Process; Cyber Threat Risk Assessment methodology; and Incident Taxonomy. The Evolution of the Cyber Security Operations Center viII be discussed; starting from reactive, to proactive, and finally to proactive. Finally, the resources necessary to establish an Agency scale SOC as well as the lessons learned in the process of standing up a SOC viII be presented.

Factors associated with delayed measles vaccination among children in Shenzhen, China: A case-control study

PubMed Central

Lin, Weiyan; Xiong, Yongzhen; Tang, Hao; Chen, Baoli; Ni, Jindong

2015-01-01

A delay in the first dose of measles-containing vaccine (MCV1) may contribute to outbreaks of measles, resulting in a high age-specific incidence in infants <1 y of age. To determine the factors associated with delayed MCV1 vaccinations, we used data from the China Information Management System for Immunization Programming. Additionally, the parents/guardians of 430 children whose MCV1 vaccinations were delayed, as well as the parents/guardians of 424 children who received timely vaccinations, were surveyed by telephone. Children were less likely to receive timely MCV1 vaccinations if they belonged to an immigrant group, were male, had poor health status, had a father whose occupation e.g., a manager, had a history of delays in other Expanded Programs on Immunization (EPI) vaccinations, had parents who did not believe vaccinations were important for their children, and experienced shorter travel times to and longer waiting times in EPI clinics. The children of mothers whose occupational status (technician) were more likely to receive timely MCV1 vaccinations. The timeliness of MCV1 vaccinations should be considered as an additional indicator of the quality of vaccination programs. PMID:25668667

Factors associated with delayed measles vaccination among children in Shenzhen, China: a case-control study.

PubMed

Lin, Weiyan; Xiong, Yongzhen; Tang, Hao; Chen, Baoli; Ni, Jindong

2014-01-01

A delay in the first dose of measles-containing vaccine (MCV1) may contribute to outbreaks of measles, resulting in a high age-specific incidence in infants<1 y of age. To determine the factors associated with delayed MCV1 vaccinations, we used data from the China Information Management System for Immunization Programming. Additionally, the parents/guardians of 430 children whose MCV1 vaccinations were delayed, as well as the parents/guardians of 424 children who received timely vaccinations, were surveyed by telephone. Children were less likely to receive timely MCV1 vaccinations if they belonged to an immigrant group, were male, had poor health status, had a father whose occupation e.g., a manager, had a history of delays in other Expanded Programs on Immunization (EPI) vaccinations, had parents who did not believe vaccinations were important for their children, and experienced shorter travel times to and longer waiting times in EPI clinics. The children of mothers whose occupational status (technician) were more likely to receive timely MCV1 vaccinations. The timeliness of MCV1 vaccinations should be considered as an additional indicator of the quality of vaccination programs.

[Resource management: ICF-oriented exercise programs for patients with diabetes mellitus type 2. Chronic illnesses and biopsychosocial status].

PubMed

Pfeifer, K; Huber, G; Baldus, A; Pöthig, D; Schüle, K

2012-02-01

Common health problems are increasing due to the combination of decreased physical activity demands in everyday life and demographic changes; thus, the importance of exercise therapy is increasing. The incidence and prevalence of today's predominant chronic diseases are directly related to physical activity. However, daily clinical routine does not stay abreast with these changes. The education of physicians, and thus their scope of action, is dominated by biomedical therapy concepts, predominantly drug therapy concepts. Differential and consolidated findings of modern exercise and sport science are astonishingly rare in the counselling and treatment portfolio of medical care. The present disease management program for persons with diabetes mellitus type 2 is a good example. Referring to this background, the authors address the new approach of "ICF-oriented exercise programs and biopsychosocial status." They present resource-related interventional strategies and health care concepts for chronic health disorders like the metabolic syndrome or diabetes mellitus type 2. The relevance and use of active health promotion and care - due to lifestyle- and age-related health problems of the population - will increase in importance and be more commonly recommended.

The key incident monitoring and management system - history and role in quality improvement.

PubMed

Badrick, Tony; Gay, Stephanie; Mackay, Mark; Sikaris, Ken

2018-01-26

The determination of reliable, practical Quality Indicators (QIs) from presentation of the patient with a pathology request form through to the clinician receiving the report (the Total Testing Process or TTP) is a key step in identifying areas where improvement is necessary in laboratories. The Australasian QIs programme Key Incident Monitoring and Management System (KIMMS) began in 2008. It records incidents (process defects) and episodes (occasions at which incidents may occur) to calculate incident rates. KIMMS also uses the Failure Mode Effects Analysis (FMEA) to assign quantified risk to each incident type. The system defines risk as incident frequency multiplied by both a harm rating (on a 1-10 scale) and detection difficulty score (also a 1-10 scale). Between 2008 and 2016, laboratories participating rose from 22 to 69. Episodes rose from 13.2 to 43.4 million; incidents rose from 114,082 to 756,432. We attribute the rise in incident rate from 0.86% to 1.75% to increased monitoring. Haemolysis shows the highest incidence (22.6% of total incidents) and the highest risk (26.68% of total risk). "Sample is suspected to be from the wrong patient" has the second lowest frequency, but receives the highest harm rating (10/10) and detection difficulty score (10/10), so it is calculated to be the 8th highest risk (2.92%). Similarly, retracted (incorrect) reports QI has the 10th highest frequency (3.9%) but the harm/difficulty calculation confers the second highest risk (11.17%). TTP incident rates are generally low (less than 2% of observed episodes), however, incident risks, their frequencies multiplied by both ratings of harm and discovery difficulty scores, concentrate improvement attention and resources on the monitored incident types most important to manage.

The Impact of Comer's School Development Program's Student Staff Support Team Process on High-Incidence Special Education Referrals in One Elementary School

ERIC Educational Resources Information Center

Gibson-Robinson, Joi

2010-01-01

This study examines whether the Comer (1996) placement model process reduces the overrepresentation of certain student groups into high-incidence disabilities programs. High-incidence disabilities are those disabilities which require an extensive degree of "professional judgment" by the teacher in determining whether or not a disability exists…

Management of Meconium-Stained Newborns in the Delivery Room.

PubMed

Gandhi, Chintan Kiritkumar

2018-05-01

The approach to the management of meconium-stained newborns in the delivery room has been changing for over 40 years. The goal is to prevent meconium aspiration syndrome (MAS) and complications related to MAS. For decades, airway obstruction was believed to be a major component of MAS and, consequently, suction maneuvers to remove meconium from the airways were recommended to decrease the frequency and severity of MAS. Initial recommendations were based on observational studies. However, the incidence of MAS and mortality related to MAS has declined since the 1970s, mostly because of a decrease in the number of postterm deliveries. Recently updated guidelines by the American Heart Association and the Neonatal Resuscitation Program have reflected the strength of evidence supporting tracheal intubation and suctioning for nonvigorous, meconium-stained newborns. This article examines practice change since the 1970s in the delivery room management of meconium-stained newborns and evaluates evidence behind the changes.

Concussion evaluation and management in pediatrics.

PubMed

Rivera, Robin G; Roberson, Susan P; Whelan, Margaret; Rohan, Annie

2015-01-01

Concussions are among the most complex injuries to assess and manage in sports medicine and primary care. Sports concussion in youth has received much attention in recent years because research shows that improperly managed concussion can lead to long-term cognitive deficits and mental health problems. There are several notable risk factors affecting the incidence and severity of concussion in school-age children and adolescents, including a history of a previous concussion. A more conservative approach for return to activities following concussion has been proposed for children and adolescents. Programs of individualized, stepwise increases in physical activity have largely replaced use of algorithms for assigning a grade and activity expectations to concussions. Although validity and reliability testing is ongoing to support use of concussion assessment instruments in pediatric patients, it is practical and appropriate that clinicians incorporate symptom checklists, sideline and balance assessment tools, and neurocognitive assessment instruments into their practice in accordance with evidence-based guidelines.

Defining the problem, main objective, and strategies of medical management in mass-casualty incidents caused by terrorist events.

PubMed

Ashkenazi, Itamar; Kessel, Boris; Olsha, Oded; Khashan, Tawfik; Oren, Meir; Haspel, Jacob; Alfici, Ricardo

2008-01-01

Based on the experience of managing > 20 such events during the last decade, the authors' understanding of a mass-casualty incident is that it is an event in which there may be many victims, but only a few that actually suffer from life-threatening injuries. To make an impact on survival, one must identify those who are severely wounded as quickly as possible and offer those patients optimal care. Experienced trauma physicians are the most important resource available to achieve this objective, and they should be allocated to the treatment of seriously injured victims instead of more traditional management roles such as triage and incident manager.

Impact Of Rapid Incident Detection On Freeway Accident Fatalities

DOT National Transportation Integrated Search

1996-06-01

Heavily congested urban highways in the United States have spurred the development of Freeway Management Systems (FMS). Among the goals of these systems is the improvement of traffic management and the facilitation of more rapid incident detection an...

Incorporating ITS into transportation planning : phase 1 final report

DOT National Transportation Integrated Search

2000-04-01

Incident management is the process of managing multi-agency, multi-jurisdictional responses to highway traffic disruptions. Traffic incidents are a major cause of congestion on the nation?s highway network. More than half of all freeway traffic conge...

Simulating traffic for incident management and ITS investment decisions

DOT National Transportation Integrated Search

1998-08-01

UTPS-type models were designed to adequately support planning activities typical of the 1960s and 1970s. However, these packages were not designed to model intelligent transportation systems (ITS) and support incident management planning. To ov...

I-95 Corridor Coalition Project Summary and Closeout

DOT National Transportation Integrated Search

2010-12-22

The Southern Traffic Incident eXchange (STIX) program was implemented on April 1, 2008 to facilitate incident notification/information sharing between the Southern States (Florida, Georgia, North Carolina and South Carolina). The program's intent is ...

Impact of outpatient management following appendectomy for acute appendicitis: An ACS NSQIP-P analysis.

PubMed

Litz, Cristen N; Stone, Laurie; Alessi, Roberta; Walford, Nebbie E; Danielson, Paul D; Chandler, Nicole M

2018-04-01

In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development. The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes. There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84% vs 48%, p<0.0001). Surgical length of stay was shorter compared to national rates (0.3±0.7 vs 1.1±1.9days, p<0.0001). There was no significant difference in the incidence of superficial (1.9% vs 1.0%, p=0.2), deep (0.6% vs 0.1%, p=0.17) or organ/space surgical site infections (1.3% vs 0.7%, p=0.31). The incidences of other complications (1.3% vs 0.6%, p=0.26) and 30-day readmissions (3.2% vs 2.6%, p=0.61) were similar. Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system. Prognosis study, level II. Copyright © 2017 Elsevier Inc. All rights reserved.

Traffic incident management in hazardous materials spills in incident clearance.

DOT National Transportation Integrated Search

2009-01-01

Hazardous materials spills provide unique challenges to traffic incident clearance. When hazardous materials are present, not only do response personnel have to deal with typical traffic incident issues, they also must deal with potential chemical ha...

Organizational safety culture and medical error reporting by Israeli nurses.

PubMed

Kagan, Ilya; Barnoy, Sivia

2013-09-01

To investigate the association between patient safety culture (PSC) and the incidence and reporting rate of medical errors by Israeli nurses. Self-administered structured questionnaires were distributed to a convenience sample of 247 registered nurses enrolled in training programs at Tel Aviv University (response rate = 91%). The questionnaire's three sections examined the incidence of medication mistakes in clinical practice, the reporting rate for these errors, and the participants' views and perceptions of the safety culture in their workplace at three levels (organizational, departmental, and individual performance). Pearson correlation coefficients, t tests, and multiple regression analysis were used to analyze the data. Most nurses encountered medical errors from a daily to a weekly basis. Six percent of the sample never reported their own errors, while half reported their own errors "rarely or sometimes." The level of PSC was positively and significantly correlated with the error reporting rate. PSC, place of birth, error incidence, and not having an academic nursing degree were significant predictors of error reporting, together explaining 28% of variance. This study confirms the influence of an organizational safety climate on readiness to report errors. Senior healthcare executives and managers can make a major impact on safety culture development by creating and promoting a vision and strategy for quality and safety and fostering their employees' motivation to implement improvement programs at the departmental and individual level. A positive, carefully designed organizational safety culture can encourage error reporting by staff and so improve patient safety. © 2013 Sigma Theta Tau International.

National health and medical services response to incidents of chemical and biological terrorism.

PubMed

Tucker, J B

1997-08-06

In response to the growing threat of terrorism with chemical and biological weapons, the US government has developed a national concept of operations for emergency health and medical services response. This capability was developed and tested for the first time during the Atlanta Olympic Games in the summer of 1996. In the event of a chemical or biological terrorist incident that exceeded local and state-level response capabilities, federal agencies would provide specialized teams and equipment to help manage the consequences of the attack and treat, decontaminate, and evacuate casualties. The US Congress has also established a Domestic Preparedness Program that provides for enhanced training of local first-responders and the formation of metropolitan medical strike teams in major cities around the country. While these national response capabilities are promising, their implementation to date has been problematic and their ultimate effectiveness is uncertain.

Current status of liver diseases in Korea: hepatocellular carcinoma.

PubMed

Song, Il Han; Kim, Kyung Sik

2009-12-01

Primary liver cancer, most of which is hepatocellular carcinoma (HCC), is the third common leading cancer in Korea. During the last two decades, the incidence rate of primary liver cancer has shown a modest decrease, but its mortality rate has slightly increased. The incidence of HCC, according to age, peaks in the late sixth decade in men and in the early seventh decade in women. Hepatitis B virus (HBV) is the most important risk factor, which represents approximately 70% of all HCC, and hepatitis C virus (HCV) and alcohol are the next in order of major risk factors for the development of HCC in Korea. HBV-associated HCC occurs 10 years earlier than HCV-associated HCC due to a more prolonged exposure to HBV, which is vertically transmitted almost from HBsAg-positive mother in HBV-endemic area. National Cancer Control Institute, which was reorganized in 2005, is now working for several national projects such as National Cancer Registration Program, National R&D Program for Cancer Control and National Cancer Screening Program. International collaboration for the clinico-epidemiologic research would be needed to provide the specific measures for managing HCC in diverse etiologic situations. Finally, the mechanisms of hepatitis virus-associated hepatocellular carcinogenesis might be clarified to provide insights into the advanced therapeutic and preventive approaches for HCC in Korea, where the majority of HCC originate from chronic HBV and HCV infections.

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

EPA Pesticide Factsheets

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

Review and enhancement of CHART operations to maximize the benefit of incident response and management.

DOT National Transportation Integrated Search

2012-07-01

This project was focused on identifying potential areas for Marylands Coordinated Highway : Action Response Team (CHART) to enhance its incident management efficiency and to maximize the : resulting benefits under existing resource constraints. Us...

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

DOT National Transportation Integrated Search

1995-02-01

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

Management of sepsis involving expanded polytetrafluoroethylene grafts for hemodialysis access.

PubMed

Bhat, D J; Tellis, V A; Kohlberg, W I; Driscoll, B; Veith, F J

1980-04-01

The incidence and management of infections in 80 polytetrafluoroethylene (PTFE) grafts is reviewed. In a follow-up period of 12 to 30 months, the overall incidence of infection was 19%. In functioning grafts the majority of infections occurred after dialysis puncture or reoperation. With appropriate management, by incision, drainage, and packing of wounds with povidone-iodine solution, it was possible, even in the face of positive blood cultures, to treat four of five localized infections successfully without loss of graft function. Prophylactic antibiotics may be useful in reducing the high incidence of infection associated with secondary operations.

The effect of a comprehensive injury audit program on injury incidence in ballet: a 3-year prospective study.

PubMed

Allen, Nick; Nevill, Alan M; Brooks, John H M; Koutedakis, Yiannis; Wyon, Matthew A

2013-09-01

The aim of this study was to determine whether an intervention with individualized conditioning program based on injury history and functional movement screening would be effective in reducing ballet injury incidence. Prospective 3-year epidemiological study. Professional ballet company and its in-house medical facility. Dancers from a professional ballet company over the 3-year study period. Participant numbers ranged from 52 to 58 (year 1: 52; year 2: 58; year 3: 53). The intervention consisted of individual conditioning programs developed using injury history and functional movement screening. Analysis was undertaken of the all dancers who were present in the company during the study period. The significance of change in injuries over a 3-year period was determined using a Poisson distribution model. To determine whether individual conditioning programs resulted in a decrease in injury incidence over the study period. The injury count reduced significantly in years 2 and 3 (P < 0.001). Injury incidence for male dancers declined from year 1 (in year/1000 h) (4.76/1000 h) to year 2 (2.40/1000 h) and year 3 (2.22/1000 h). For women, a reduction in the injury incidence was observed from year 1 (4.14/1000 h) to year 2 (1.71/1000 h) and year 3 (1.81/1000 h). Through prospective injury surveillance, we were able to demonstrate the benefit of individualized conditioning programs based on injury history and functional movement screening in reducing injuries in ballet. The implementation of well-structured injury surveillance programs can impact on injury incidence through its influence on intervention programs.

A Windows application for computing standardized mortality ratios and standardized incidence ratios in cohort studies based on calculation of exact person-years at risk.

PubMed

Geiss, Karla; Meyer, Martin

2013-09-01

Standardized mortality ratios and standardized incidence ratios are widely used in cohort studies to compare mortality or incidence in a study population to that in the general population on a age-time-specific basis, but their computation is not included in standard statistical software packages. Here we present a user-friendly Microsoft Windows program for computing standardized mortality ratios and standardized incidence ratios based on calculation of exact person-years at risk stratified by sex, age and calendar time. The program offers flexible import of different file formats for input data and easy handling of general population reference rate tables, such as mortality or incidence tables exported from cancer registry databases. The application of the program is illustrated with two examples using empirical data from the Bavarian Cancer Registry. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Training of medical staff positively influences postoperative pain management at home in children.

PubMed

Sepponen, K; Kokki, H; Ahonen, R

1999-08-01

The aim of this study was to describe how parents manage their child's postoperative pain at home following day-case surgery. The incidence of pain, different analgesics used and problems related to administering medications were the main interests of the study. A postal questionnaire was sent to the parents of 275 children who were under 8 years of age and had undergone an ear, nose and throat (ENT) day-case operation. The questionnaire was sent to the parents a week after discharge from hospital. Altogether, the parents of 227 children answered the questionnaire (response rate 83%). The study was divided into two phases (preintervention and postintervention), and incorporated a training program for doctors and nurses between these two phases. The training program aimed to improve the treatment practices of postoperative pain in children. Seventy-eight per cent of the children in the preintervention study and 75% in the postintervention study experienced at least mild pain after discharge. The training program for doctors and nurses affected the home treatment practices of postoperative pain. The proportion of parents treating their children increased from 68% to 80% after the training program (p = 0.028). Many parents faced problems while treating their children; for example, 19% (n = 30) of the children refused to take their medicine, and suppositories were regarded to be an especially unpleasant dosage form. However, no serious adverse effects were reported. We conclude that due to the pain experienced at home by the great majority of children following day-case ENT operations, parents need information on how to manage their child's pain. A training program for doctors and nurses can improve the treatment of children's pain even at home. Since some children dislike suppositories, it would be worth considering the use of small tablets or mixtures instead.

Decreased incidence of gout in diabetic patients using pioglitazone.

PubMed

Niu, Sheng-Wen; Chang, Kai-Ting; Lin, Hugo You-Hsien; Kuo, I-Ching; Chang, Yu-Han; Chen, Yu-Han; Hung, Chi-Chih; Chiu, Yi-Wen; Hwang, Shang-Jyh

2018-01-01

The incidence and prevalence of gout are increasing, but the management is poor. Considering the increased prevalence of gout in the diabetic population, this study evaluated the effects of pioglitazone, an insulin resistance inhibitor, on the incidence of gout in the diabetic population. We used data from the National Health Insurance program in Taiwan. The pioglitazone cohort contained 30 100 patients and each patient was age and sex matched with three non-pioglitazone users who were randomly selected from the diabetic population. Cox proportional hazards regression analysis was conducted to estimate the effects of pioglitazone on the incidence of gout in the diabetic population. The incidence of gout was significantly lower in pioglitazone users than in non-pioglitazone users [adjusted hazard ratio (aHR) 0.81 (95% CI 0.78, 0.85)]. The HR for the incidence of gout was lower in both male [aHR 0.80 (95% CI 0.75, 0.85)] and female [aHR 0.83 (95% CI 0.78, 0.88)] pioglitazone users than in non-pioglitazone users. An analysis of three age groups (<40, 40-59 and ⩾60 years) revealed that the HRs of both the 40-59 years [aHR 0.78 (95% CI 0.73, 0.83)] and the ⩾60 years [aHR 0.85 (95% CI 0.80, 0.91)] age groups were significantly lower among pioglitazone users than non-pioglitazone users. Compared with the non-pioglitazone users, the incidence of gout in the diabetic population using pioglitazone was less. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

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

PubMed

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

2018-01-01

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

A management plan for hospitals and medical centers facing radiation incidents.

PubMed

Davari, Fereshteh; Zahed, Arash

2015-09-01

Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

Incidence of laminitis and survey of dietary and management practices in pleasure horses and ponies in south-eastern Australia.

PubMed

Potter, S J; Bamford, N J; Harris, P A; Bailey, S R

2017-10-01

The aims of this study were to (1) report the incidence of laminitis among a population of horses and ponies attending Pony Clubs in Victoria, Australia, and (2) describe the dietary and management practices of the sample population. Researchers visited 10 Pony Clubs over a 10-month period. Horse and pony owners completed a questionnaire to provide information on management relating to diet and exercise. Owners were also asked to report their animal's history of laminitis, if any. From a survey population of 233 horses and ponies, 15.0% of animals (35 individuals) were reported to have suffered from at least one episode of laminitis. Of the animals that had suffered from laminitis, more than half had experienced multiple episodes. The majority of previously laminitic horses and ponies (71.4%) had not experienced an episode of laminitis within the past 12 months; however, 14.2% had experienced an incident within the past month. The proportion of ponies affected by laminitis (31/142; 21.8%) was significantly higher (P < 0.001) than the proportion of horses affected by laminitis (4/91; 4.4%). The incidence of laminitis within the pony group sampled was 6.5 cases per 100 pony years, while the incidence in horses was 0.55 cases per 100 horse years. This study provided information on the incidence of laminitis in the general population of pleasure horses and ponies in south-eastern Australia. It also provided an overview of dietary and management practices. Given the high incidence of animals that had been affected by laminitis (and the associated welfare implications), this study highlights the importance of owner education regarding appropriate feeding and management strategies to reduce the risk of laminitis. © 2017 Australian Veterinary Association.

Mass chemical casualties: treatment of 41 patients with burns by anhydrous ammonia.

PubMed

Zhang, Fang; Zheng, Xing-Feng; Ma, Bing; Fan, Xiao-Ming; Wang, Guang-Yi; Xia, Zhao-Fan

2015-09-01

This article reports a chemical burn incident that occurred on 31 August 2013 in Shanghai. We describe situations at the scene, emergency management, triage, evacuation, and follow-up of the victims. The scene of the incident and information on the 41 victims of this industrial chemical incident were investigated. The emergency management, triage, evacuation, and hospitalization data of the patients were summarized. At the time of the incident, 58 employees were working in a closed refrigerator workshop, 41 of whom sustained burns following the leakage of anhydrous ammonia. Ten victims died of severe inhalation injury at the scene, and another five victims died during the process of evacuation to the nearest hospital. After receiving information on the incident, a contingency plan for the burn disaster was launched immediately, and a first-aid group and an emergency and triage group were dispatched by the Changhai Hospital to the scene to aid the medical organization, emergency management, triage, and evacuation. All casualties were first rushed to the nearest hospital by ambulance. The six most serious patients with inhalation injuries were evacuated to the Changhai Hospital and admitted to the burn intensive care unit (BICU) for further treatment, one of whom died of respiratory failure and pulmonary infection. This mass casualty incident of anhydrous ammonia leakage caused potential devastating effects to the society, especially to the victims and their families. Early first-aid organization, emergency management, triage, and evacuation were of paramount importance, especially rapid evaluation of the severity of inhalation injury, and subsequent corresponding medical treatment. The prognosis of ammonia burns was poor and the sequelae were severe. Management and treatment lessons were drawn from this mass casualty chemical burn incident. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Dyslexic entrepreneurs: the incidence; their coping strategies and their business skills.

PubMed

Logan, Julie

2009-11-01

This comparative study explores the incidence of dyslexia in entrepreneurs, corporate managers and the general population. It examines the suggestion that dyslexic entrepreneurs develop coping strategies to manage their weaknesses, which are subsequently of benefit in the new venture creation process. Results of this study suggest that there is a significantly higher incidence of dyslexia in entrepreneurs than in the corporate management and general US and UK populations and some of the strategies they adopt to overcome dyslexia (such as delegation of tasks) may be useful in business. The study was undertaken in two parts. First, entrepreneurs and corporate managers completed an online questionnaire, which combined questions about their company, their management or leadership role and their business skills together with questions that were designed to explore the likely incidence of dyslexia. A follow-up study that made use of a semi-structured questionnaire explored business issues and educational experience in more depth with those who had been diagnosed as dyslexic and those who did not have any history of dyslexia or any other learning difficulty.

Applying Crowd Psychology to Develop Recommendations for the Management of Mass Decontamination

PubMed Central

Drury, John; Rubin, G. James; Williams, Richard; Amlôt, Richard

2015-01-01

Mass decontamination is a public health intervention employed by emergency responders following a chemical, biological, or radiological release. It involves a crowd of people whose interactions with each other and with the emergency responders managing the incident are likely to affect the success of the decontamination process. The way in which members of the public collectively experience decontamination is likely to affect their behavior and hence is crucial to the success of the decontamination process. Consequently, responders and the responsible authorities need to understand crowd psychology during mass emergencies and disasters. Recently, the social identity approach to crowd psychology has been applied to explain public perceptions and behavior during mass emergencies. This approach emphasizes that crowd events are characteristically intergroup encounters, in which the behavior of one group can affect the perceptions and behavior of another. We summarize the results from a program of research in which the social identity approach was applied to develop and test recommendations for the management of mass decontamination. The findings from this program of research show that (1) responders' perceptions of crowd behavior matter; (2) participants value greater communication and this affects their compliance; and (3) social identity processes explain the relationship between effective responder communication and relevant outcome variables, such as public compliance, public cooperation, and public anxiety. Based on this program of research, we recommend 4 responder management strategies that focus on increasing public compliance, increasing orderly and cooperative behavior among members of the public, reducing public anxiety, and respecting public needs for privacy. PMID:25812428

Applying crowd psychology to develop recommendations for the management of mass decontamination.

PubMed

Carter, Holly; Drury, John; Rubin, G James; Williams, Richard; Amlôt, Richard

2015-01-01

Mass decontamination is a public health intervention employed by emergency responders following a chemical, biological, or radiological release. It involves a crowd of people whose interactions with each other and with the emergency responders managing the incident are likely to affect the success of the decontamination process. The way in which members of the public collectively experience decontamination is likely to affect their behavior and hence is crucial to the success of the decontamination process. Consequently, responders and the responsible authorities need to understand crowd psychology during mass emergencies and disasters. Recently, the social identity approach to crowd psychology has been applied to explain public perceptions and behavior during mass emergencies. This approach emphasizes that crowd events are characteristically intergroup encounters, in which the behavior of one group can affect the perceptions and behavior of another. We summarize the results from a program of research in which the social identity approach was applied to develop and test recommendations for the management of mass decontamination. The findings from this program of research show that (1) responders' perceptions of crowd behavior matter; (2) participants value greater communication and this affects their compliance; and (3) social identity processes explain the relationship between effective responder communication and relevant outcome variables, such as public compliance, public cooperation, and public anxiety. Based on this program of research, we recommend 4 responder management strategies that focus on increasing public compliance, increasing orderly and cooperative behavior among members of the public, reducing public anxiety, and respecting public needs for privacy.

Practices, technologies, and usage of incident management and traveler information exchange and sharing in Texas

DOT National Transportation Integrated Search

2001-12-01

In this report, researchers present a review of the practices and technologies being used in Texas for incident management and traveler information exchange and sharing. Through interviews and site visits, researchers assimilated data from the Dallas...

A Simple Graphical Method for Quantification of Disaster Management Surge Capacity Using Computer Simulation and Process-control Tools.

PubMed

Franc, Jeffrey Michael; Ingrassia, Pier Luigi; Verde, Manuela; Colombo, Davide; Della Corte, Francesco

2015-02-01

Surge capacity, or the ability to manage an extraordinary volume of patients, is fundamental for hospital management of mass-casualty incidents. However, quantification of surge capacity is difficult and no universal standard for its measurement has emerged, nor has a standardized statistical method been advocated. As mass-casualty incidents are rare, simulation may represent a viable alternative to measure surge capacity. Hypothesis/Problem The objective of the current study was to develop a statistical method for the quantification of surge capacity using a combination of computer simulation and simple process-control statistical tools. Length-of-stay (LOS) and patient volume (PV) were used as metrics. The use of this method was then demonstrated on a subsequent computer simulation of an emergency department (ED) response to a mass-casualty incident. In the derivation phase, 357 participants in five countries performed 62 computer simulations of an ED response to a mass-casualty incident. Benchmarks for ED response were derived from these simulations, including LOS and PV metrics for triage, bed assignment, physician assessment, and disposition. In the application phase, 13 students of the European Master in Disaster Medicine (EMDM) program completed the same simulation scenario, and the results were compared to the standards obtained in the derivation phase. Patient-volume metrics included number of patients to be triaged, assigned to rooms, assessed by a physician, and disposed. Length-of-stay metrics included median time to triage, room assignment, physician assessment, and disposition. Simple graphical methods were used to compare the application phase group to the derived benchmarks using process-control statistical tools. The group in the application phase failed to meet the indicated standard for LOS from admission to disposition decision. This study demonstrates how simulation software can be used to derive values for objective benchmarks of ED surge capacity using PV and LOS metrics. These objective metrics can then be applied to other simulation groups using simple graphical process-control tools to provide a numeric measure of surge capacity. Repeated use in simulations of actual EDs may represent a potential means of objectively quantifying disaster management surge capacity. It is hoped that the described statistical method, which is simple and reusable, will be useful for investigators in this field to apply to their own research.

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

DOT National Transportation Integrated Search

2016-01-01

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

Classifying nursing errors in clinical management within an Australian hospital.

PubMed

Tran, D T; Johnson, M

2010-12-01

Although many classification systems relating to patient safety exist, no taxonomy was identified that classified nursing errors in clinical management. To develop a classification system for nursing errors relating to clinical management (NECM taxonomy) and to describe contributing factors and patient consequences. We analysed 241 (11%) self-reported incidents relating to clinical management in nursing in a metropolitan hospital. Descriptive analysis of numeric data and content analysis of text data were undertaken to derive the NECM taxonomy, contributing factors and consequences for patients. Clinical management incidents represented 1.63 incidents per 1000 occupied bed days. The four themes of the NECM taxonomy were nursing care process (67%), communication (22%), administrative process (5%), and knowledge and skill (6%). Half of the incidents did not cause any patient harm. Contributing factors (n=111) included the following: patient clinical, social conditions and behaviours (27%); resources (22%); environment and workload (18%); other health professionals (15%); communication (13%); and nurse's knowledge and experience (5%). The NECM taxonomy provides direction to clinicians and managers on areas in clinical management that are most vulnerable to error, and therefore, priorities for system change management. Any nurses who wish to classify nursing errors relating to clinical management could use these types of errors. This study informs further research into risk management behaviour, and self-assessment tools for clinicians. Globally, nurses need to continue to monitor and act upon patient safety issues. © 2010 The Authors. International Nursing Review © 2010 International Council of Nurses.

Development of a highway incident management operational and training guide for incident responders in Illinois.

DOT National Transportation Integrated Search

2011-08-01

Each year highway traffic incidents, such as crashes, place responders on and beside roadways with : dangerous high-speed traffic. The unexpected conditions of an incident scene have the potential to surprise : unsuspecting or inattentive drivers, po...

Nurse managers' perception of night-shift napping: A cross-sectional survey.

PubMed

Dalky, Heyam F; Raeda, AbuAlRub F; Esraa, Aldalqamouni A

2017-10-04

Night-shift work often results in sleep deprivation, and this in turn results in fatigue that jeopardizes both nurse and patient safety. Napping is considered a viable deterrent to fatigue, yet hospital administration has been slow to adopt napping. To identify nurse managers' knowledge and approval of napping practices for nurses on night shifts. Nurse managers at nine Jordanian hospitals (n = 129) were surveyed using an Arabic version of a questionnaire previously used in a Canadian study. Descriptive statistics were used to describe results, and a one-way ANOVA was used to determine if relationships existed among nurse manager's approval of napping and nurse demographic characteristics. The majority of nurse managers (61%) knew nurses were napping during breaks. However, the managers reported there was no written policy for napping. A majority thought there were more benefits to napping than drawbacks. Some 55% of nurse managers recognized fatigue as a cause of errors or incidents regarding patient safety, and 40% perceived fatigue to be a factor in staff injuries. This study supports an urgent need for shared responsibility among nursing administration, and bedside nurses to develop evidence-based programs to counteract the effects of nurse fatigue. © 2017 Wiley Periodicals, Inc.

Management of pediatric mandible fractures.

PubMed

Goth, Stephen; Sawatari, Yoh; Peleg, Michael

2012-01-01

The pediatric mandible fracture is a rare occurrence when compared with the number of mandible fractures that occur within the adult population. Although the clinician who manages facial fractures may never encounter a pediatric mandible fracture, it is a unique injury that warrants a comprehensive discussion. Because of the unique anatomy, dentition, and growth of the pediatric patient, the management of a pediatric mandible fracture requires true diligence with a variance in treatment ranging from soft diet to open reduction and internal fixation. In addition to the variability in treatment, any trauma to the face of a child requires additional management factors including child abuse issues and long-term sequelae involving skeletal growth, which may affect facial symmetry and occlusion. The following is a review of the incidence, relevant anatomy, clinical and radiographic examination, and treatment modalities for specific fracture types of the pediatric mandible based on the clinical experience at the University of Miami/Jackson Memorial Hospital Oral and Maxillofacial Surgery program. In addition, a review of the literature regarding the management of the pediatric mandible fracture was performed to offer a more comprehensive overview of this unique subset of facial fractures.

Incidence of fecal excretion of Mycobacterium avium subsp. paratuberculosis in dairy cows before and after the enrolment in the Québec voluntary program.

PubMed

Arango-Sabogal, J C; Paré, J; Labrecque, O; Côté, G; Roy, J P; Buczinski, S; Wellemans, V; Fecteau, G

2017-12-01

Paratuberculosis is a chronic and contagious enteric disease of ruminants caused by Mycobacterium avium subsp. paratuberculosis (MAP). This disease of worldwide distribution is responsible for significant economic losses and the bacteria itself has been linked to human Crohn's disease. Paratuberculosis control programs focus on reducing MAP transmission by implementing better management practices that target infection routes. In Québec, a Voluntary Paratuberculosis Prevention and Control Program (QVPPCP) was launched in 2007. The objectives of this prospective cohort study were threefold. The first was to describe the changes in the incidence of fecal excretion of MAP in cows born before and after farm enrolment in the QVPPCP. The second was to estimate the impact of the risk of within-herd transmission of MAP (measured by the risk assessment score (RAS)) on the incidence of fecal excretion of MAP. And the third was to evaluate the impact of calf rearing practices on the incidence of fecal excretion of MAP. Eighteen MAP-positive herds were visited annually from 2011 to 2015. At each visit, individual fecal samples from all adult cows were collected. MAP was cultured using liquid media and an automated system. A risk assessment questionnaire was completed upon enrolment in the QVPPCP and at each visit. The RAS of the farm was attributed to each cow according to its birthdate. Cox proportional hazards models were used to estimate the hazard ratios (HR) for the exposure variables. Herd clustering was taken into account using robust standard errors. A total of 2158 cows were included (cohort born before n=919; cohort born after n=1239). The incidence and hazard of fecal excretion were significantly lower for the cohort-after than the cohort-before (incidence rate ratio=0.38; 95% CI: 0.18-0.78 and HR=0.48; 95% CI: 0.23-0.98). The HR of fecal excretion for cows exposed to a high RAS was 2.20 times (95% CI: 1.21-3.99) that of cows exposed to a low RAS. Poor calving cow hygiene (HR=3.41; 95% CI: 1.40-8.31) and contact between pre-weaned heifers and adult cows or their feces were significantly associated with an increased hazard of fecal excretion of MAP (HR=2.66; 95% CI: 1.08-6.56). Our results suggest that enrolment in the QVPPCP reduces the risk of MAP fecal excretion. They support the hypothesis that contact between calves and adult cows or their feces increases MAP transmission. The incidence results also suggest that MAP prevalence could be reduced to low levels regardless of initial MAP prevalence. Copyright © 2017. Published by Elsevier B.V.

Near Misses in Financial Trading: Skills for Capturing and Averting Error.

PubMed

Leaver, Meghan; Griffiths, Alex; Reader, Tom

2018-05-01

The aims of this study were (a) to determine whether near-miss incidents in financial trading contain information on the operator skills and systems that detect and prevent near misses and the patterns and trends revealed by these data and (b) to explore if particular operator skills and systems are found as important for avoiding particular types of error on the trading floor. In this study, we examine a cohort of near-miss incidents collected from a financial trading organization using the Financial Incident Analysis System and report on the nontechnical skills and systems that are used to detect and prevent error in this domain. One thousand near-miss incidents are analyzed using distribution, mean, chi-square, and associative analysis to describe the data; reliability is provided. Slips/lapses (52%) and human-computer interface problems (21%) often occur alone and are the main contributors to error causation, whereas the prevention of error is largely a result of teamwork (65%) and situation awareness (46%) skills. No matter the cause of error, situation awareness and teamwork skills are used most often to detect and prevent the error. Situation awareness and teamwork skills appear universally important as a "last line" of defense for capturing error, and data from incident-monitoring systems can be analyzed in a fashion more consistent with a "Safety-II" approach. This research provides data for ameliorating risk within financial trading organizations, with implications for future risk management programs and regulation.

Strategic operations planning - it's not just for wilderness! How the Strategic Operations Planner can help

Treesearch

Charles W. McHugh; Stu Hoyt; Brett Fay

2015-01-01

The Strategic Operational Planner (SOPL) wildland fire management position was created in the United States in 2009 to reflect updated terminology. SOPL merges the former Fire Use Manager positions (FUM1 and FUM2) and is now an established position within the Incident Command System. Traditionally, the FUM positions and the SOPL have been used on incidents managed for...

Edema index-guided disease management improves 6-month outcomes of patients with acute heart failure.

PubMed

Liu, Min-Hui; Wang, Chao-Hung; Huang, Yu-Yen; Tung, Tao-Hsin; Lee, Chii-Ming; Yang, Ning-I; Wang, Jong-Shyan; Kuo, Li-Tang; Cherng, Wen-Jin

2012-01-01

The efficacy of heart failure (HF) management programs is compromised by the challenge of early identification of patients at imminent risk. Segmental multifrequency bioelectrical impedance analysis can generate an "edema index" (EI) as a surrogate for the body fluid status. In this study, we tested whether integration of EI-guided management improved the 6-month outcomes of HF patients under multidisciplinary care. In total, 159 patients with acute HF were randomized into control, case management (CM), and EI-guided CM (EI) groups (n = 53 in each group). In the EI group, a management algorithm was designed based on the measured EI. The analyzed endpoints included HF-related and all cause-related events during the 6-month follow-up period. In the 6 months, there were 11 (6.9%) deaths, 19 (11.9%) HF-related rehospitalizations, and 45 (28.3%) all-cause-related rehospitalizations. Compared to the control (26.4%) and CM groups (15.1%), the EI group had a lower rate of HF-related death and rehospitalization (3.8%, P = 0.004). Multivariate analysis revealed that EI-guided management was an independent predictor of a lower HF-related event rate (hazard ratio = 0.15, 95%CI = 0.03~0.66, P = 0.012). Patients with a higher pre-discharge EI were older, had lower blood albumin and hemoglobin levels, and had a higher functional class and incidences of diabetes mellitus and chronic kidney disease. An increase in the pre-discharge EI by 0.001 increased the HF-related event rate by 6% (P = 0.002). Use of EI-guided management lowered this risk (P = 0.03). In conclusion, an EI-based HF management program demonstrated an event-lowering effect superior to traditional nurse-led multidisciplinary care in 6 months after an acute HF episode.

The unified approach of management and critical incident stress management: helping flight attendants and pilots in the aftermath of September 11.

PubMed

McIntosh, Tania

2006-01-01

Experience suggests that effective and appropriate responses of an organization's management after a traumatic incident can help mitigate the reactions of primary, secondary, and tertiary victims. This commentary addresses the managerial response of Southwest Airlines to the trauma induced by September 11. It highlights the effectiveness of the unity between the company, the unions, and the Critical Incident Response Team, as well as the types of interventions that were highly regarded by flight attendants and pilots who received such services. This commentary also defines the phenomenon known as fear of flight.

Measuring and improving performance in incident management.

DOT National Transportation Integrated Search

2010-03-01

Traffic incidents account for about 25 percent of traffic congestion and delay. Clearing incidents rapidly is crucial in : minimizing congestion, reducing secondary crashes and improving safety for both emergency responders and : travelers. Especiall...

Risk analysis of Safety Service Patrol (SSP) systems in Virginia.

PubMed

Dickey, Brett D; Santos, Joost R

2011-12-01

The transportation infrastructure is a vital backbone of any regional economy as it supports workforce mobility, tourism, and a host of socioeconomic activities. In this article, we specifically examine the incident management function of the transportation infrastructure. In many metropolitan regions, incident management is handled primarily by safety service patrols (SSPs), which monitor and resolve roadway incidents. In Virginia, SSP allocation across highway networks is based typically on average vehicle speeds and incident volumes. This article implements a probabilistic network model that partitions "business as usual" traffic flow with extreme-event scenarios. Results of simulated network scenarios reveal that flexible SSP configurations can improve incident resolution times relative to predetermined SSP assignments. © 2011 Society for Risk Analysis.

ERCMExpress. Volume 2, Issue 6

ERIC Educational Resources Information Center

US Department of Education, 2006

2006-01-01

This issue of ERCMExpress presents "The National Incident Management System" (NIMS) is the United States' uniform system for managing domestic incidents and is suitable for schools to implement in the four phases of their crisis planning: (1) prevention-mitigation; (2) preparedness; (4) recovery. The NIMS is a comprehensive approach to…

An e-learning program to prevent pressure ulcers in adults with spinal cord injury: a pre- and post- pilot test among rehabilitation patients following discharge to home.

PubMed

Schubart, Jane

2012-10-01

Pressure ulcers (PrUs) are the most common medical complication following spinal cord injury (SCI), as well as costly and potentially life-threatening. Every individual with SCI is at life-long risk for developing PrUs, yet many lack access to readily available, understandable, and effective PrU prevention strategies and practices. To address barriers to adequate PrU prevention education, an interactive e-learning program to educate adults with SCI about PrU prevention and management was developed and previously pilot-tested among inpatients. This recent pilot study was conducted to evaluate the feasibility of using the learning portion of the program by adults with SCI following discharge to home among 15 outpatients with SCI. Fourteen patients (nine men, five women, median age 37 years) completed the program intervention and pre- and follow-up questionnaires. The median score for pre-program knowledge and skin care management practice was 96 (possible score: 0 to 120; range 70-100). Post-program use median score was 107 (range 97-114). The greatest improvement was in the responses to knowledge and practice questions about skin checks and preventing skin problems (P <0.005). In terms of their experiences and perceptions, the program was well received by the study participants. Further evaluation involving large samples is necessary to confirm these findings and ascertain the effect of this e-learning program on PrU incidence. Internet interventions that are proven effective hold tremendous potential for bringing prevention education to groups who would otherwise not receive it.

Selenium contamination and remediation at Stewart Lake Waterfowl Management Area and Ashley Creek, middle Green River basin, Utah

USGS Publications Warehouse

Rowland, Ryan C.; Stephens, Doyle W.; Waddell, Bruce; Naftz, David L.

2003-01-01

Selenium is an element required in trace amounts for human and animal health, but it can cause health problems for livestock, wildlife, and humans when ingested in higher-than-required concentrations. Incidences of mortality, birth defects, and reproductive failure in waterfowl were discovered at Kesterson National Wildlife Refuge, San Joaquin Valley, California, by the U.S. Fish and Wildlife Service (USFWS) in 1983 (Presser, 1994). These problems were attributed to elevated concentrations of selenium in irrigation drainage that discharged to the refuge. Because of concern about possible adverse effects from irrigation drainage on Department of the Interior (DOI) projects elsewhere in the United States, the DOI organized scientists from the U.S. Geological Survey (USGS), USFWS, Bureau of Reclamation (BOR), and Bureau of Indian Affairs (BIA) to form the National Irrigation Water-Quality Program (NIWQP). The objectives of the program are to investigate DOI-managed lands for potential contamination related to irrigation drainage, conduct studies to identify the problems, investigate methodologies to remediate those problems, and implement remediation plans (U.S. Department of the Interior, 2002).

Efficacy of a chronic disease management model for patients with chronic liver failure.

PubMed

Wigg, Alan J; McCormick, Rosemary; Wundke, Rachel; Woodman, Richard J

2013-07-01

Despite the economic impacts of chronic liver failure (CLF) and the success of chronic disease management (CDM) programs in routine clinical practice, there have been no randomized controlled trials of CDM for CLF. We investigated the efficacy of CDM programs for CLF patients in a prospective, controlled trial. Sixty consecutive patients with cirrhosis and complications from CLF were assigned randomly to groups given intervention (n = 40) or usual care (n = 20), from 2009 to 2010. The 12-month intervention comprised 4 CDM components: delivery system redesign, self-management support, decision support, and clinical information systems. The primary outcome was the number of days spent in a hospital bed for liver-related reasons. Secondary outcomes were rates of other hospital use measures, rate of attendance at planned outpatient care, disease severity, quality of life, and quality of care. The intervention did not reduce the number of days patients spent in hospital beds for liver-related reasons, compared with usual care (17.8 vs 11.0 bed days/person/y, respectively; incidence rate ratio, 1.6; 95% confidence interval, 0.5-4.8; P = .39), or affect other measures of hospitalization. Patients given the intervention had a 30% higher rate of attendance at outpatient care (incidence rate ratio, 1.3; 95% confidence interval, 1.1-1.5; P = .004) and significant increases in quality of care, based on adherence to hepatoma screening, osteoporosis and vaccination guidelines, and referral to transplant centers (P < .05 for all). In a pilot study to determine the efficacy of CDM for patients with CLF, patients receiving CDM had significant increases in attendance at outpatient centers and quality of care, compared with patients who did not receive CDM. However, CDM did not appear to reduce hospital admission rates or disease severity or improve patient quality of life. Larger trials with longer follow-up periods are required to confirm these findings and assess cost effectiveness. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

Toward a new paradigm in hospital-based pediatric education: the development of an onsite simulator program.

PubMed

Weinstock, Peter H; Kappus, Liana J; Kleinman, Monica E; Grenier, Barry; Hickey, Patricia; Burns, Jeffrey P

2005-11-01

The low incidence of crises in pediatrics, coupled with logistic issues and restricted work hours for trainees, hinders opportunities for frequent practice of crisis management and teamwork skills. We hypothesized that a dedicated simulator suite contiguous to the intensive care unit (ICU) would enhance the frequency and breadth of critical-incident training for a range of clinicians. Descriptive study. A tertiary-care pediatric teaching hospital. A realistic pediatric simulator suite was constructed 100 feet from the ICU, at a total base cost of $290,000. The simulation room is an exact replica of an ICU bed space, incorporating high-fidelity mannequin simulators. To capture an even wider audience, a portable unit was also created. Leaders from seven departments-critical care, cardiac intensive care, emergency medicine, transport medicine, anesthesia, respiratory care, and general pediatrics-completed instructor training to ensure effective debriefing techniques. Pediatric staff, including 100% of critical care fellows, 86% of nurses, 90% of respiratory therapists, and 74% of pediatric house staff, participated in >1500 learning encounters per year. All individuals were trained during their normal workday in the hospital. Courses in crisis resource management, skills acquisition, annual review, orientation, and trauma management (1,116, 98, 90, 60, and 60 encounters per year, respectively) were all designed by a multidisciplinary committee to ensure goal-directed education to a range of audiences. Annual costs were on par with those at other centers (approximately 44 dollars per trainee encounter). An onsite and comprehensive simulation program can significantly increase the opportunities for clinicians from multiple disciplines, in the course of their daily routines, to repetitively practice responses to pediatric medical crises. After an initial capital investment, the training appears to be cost-effective. Hospital-based simulator suites may point the way forward as a new paradigm for the effective education of today's busy clinicians.

Common variants in genes encoding adiponectin (ADIPOQ) and its receptors (ADIPOR1/2), adiponectin concentrations, and diabetes incidence in the Diabetes Prevention Program

PubMed Central

Mather, K. J.; Christophi, C. A.; Jablonski, K. A.; Knowler, W. C.; Goldberg, R. B.; Kahn, S. E.; Spector, T.; Dastani, Z.; Waterworth, D.; Richards, J. B.; Funahashi, T.; Pi-Sunyer, F. X.; Pollin, T. I.; Florez, J. C.; Franks, P. W.

2012-01-01

Aims Baseline adiponectin concentrations predict incident Type 2 diabetes mellitus in the Diabetes Prevention Program. We tested the hypothesis that common variants in the genes encoding adiponectin (ADIPOQ) and its receptors (ADIPOR1, ADIPOR2) would associate with circulating adiponectin concentrations and/or with diabetes incidence in the Diabetes Prevention Program population. Methods Seventy-seven tagging single-nucleotide polymorphisms (SNPs) in ADIPOQ (24), ADIPOR1 (22) and ADIPOR2 (31) were genotyped. Associations of SNPs with baseline adiponectin concentrations were evaluated using linear modelling. Associations of SNPs with diabetes incidence were evaluated using Cox proportional hazards modelling. Results Thirteen of 24 ADIPOQ SNPs were significantly associated with baseline adiponectin concentrations. Multivariable analysis including these 13 SNPs revealed strong independent contributions from rs17366568, rs1648707, rs17373414 and rs1403696 with adiponectin concentrations. However, no ADIPOQ SNPs were directly associated with diabetes incidence. Two ADIPOR1 SNPs (rs1342387 and rs12733285) were associated with ~18% increased diabetes incidence for carriers of the minor allele without differences across treatment groups, and without any relationship with adiponectin concentrations. Conclusions ADIPOQ SNPs are significantly associated with adiponectin concentrations in the Diabetes Prevention Program cohort. This observation extends prior observations from unselected populations of European descent into a broader multi-ethnic population, and confirms the relevance of these variants in an obese/dysglycaemic population. Despite the robust relationship between adiponectin concentrations and diabetes risk in this cohort, variants in ADIPOQ that relate to adiponectin concentrations do not relate to diabetes risk in this population. ADIPOR1 variants exerted significant effects on diabetes risk distinct from any effect of adiponectin concentrations. [Clinical Trials Registry Nos; NCT 00004992 (Diabetes Prevention Program) and NCT 00038727 (Diabetes Prevention Program Outcomes Study)] PMID:22443353

Realistic training for effective crew performance

NASA Technical Reports Server (NTRS)

Foushee, H. C.

1985-01-01

Evaluation of incident and accident statistics reveals that most problems occur not because of a lack of proficiency in pilot training, but because of the inability to coordinate skills into effective courses of action. Line-Oriented Flight Training (LOFT) and Cockpit Resource Management (CRM) programs provide training which will develop both individual crew member skills, as well as those associated with effective group function. A study conducted by NASA at the request of the U.S. Congress supports the argument for training that enhances crew performance in addition to providing individual technical skills, and is described in detail.

Impact of a community-based osteoporosis and fall prevention program on fracture incidence.

PubMed

Grahn Kronhed, Ann-Charlotte; Blomberg, Carina; Karlsson, Nadine; Löfman, Owe; Timpka, Toomas; Möller, Margareta

2005-06-01

Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Ostergotland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

Calculation of inviscid surface streamlines and heat transfer on shuttle type configurations. Part 2: Description of computer program

NASA Technical Reports Server (NTRS)

Dejarnette, F. R.; Jones, M. H.

1971-01-01

A description of the computer program used for heating rate calculation for blunt bodies in hypersonic flow is given. The main program and each subprogram are described by defining the pertinent symbols involved and presenting a detailed flow diagram and complete computer program listing. Input and output parameters are discussed in detail. Listings are given for the computation of heating rates on (1) a blunted 15 deg half-angle cone at 20 deg incidence and Mach 10.6, (2) a blunted 70 deg slab delta wing at 10 deg incidence and Mach 8, and (3) the HL-10 lifting body at 20 deg incidence and Mach 10. In addition, the computer program output for two streamlines on the blunted 15 deg half-angle cone is listed. For Part 1, see N71-36186.

Improving Freight Crash Incident Management : Research Project Capsule

DOT National Transportation Integrated Search

2012-10-01

Excessive delay, cost, : and adverse public : safety result from : major incidents that : occur along critical : segments of the : interstate system. : There is a high likelihood these types of incidents involve a commercial : vehicle. Several recent...

Integration of the incident command system (ICS) protocol for effective coordination of multi-agency response to traffic incidents : final report.

DOT National Transportation Integrated Search

2017-06-13

In recent years, there has been an increased focus on Traffic Incident Management (TIM) and : incorporation of the Incident Command System (ICS) to reduce traffic congestion on the nation's : Interstates. In fact, studies show that for every minute a...

Learning from Past Experiences

NASA Technical Reports Server (NTRS)

Hulet, Michael W.

2007-01-01

Space flight is a risky business. This truism has been bandied about since the earliest days of the space program. When asked by the young daughter of a coworker, one of the Mercury astronauts likened launching into space to "riding a Roman candle" -- it was both exciting and dangerous. Even in these more technologically advanced days, the solid rocket boosters and external tanks of the space shuttle provide a no less exciting, or dangerous, ride into space. However much the phrase "risk mitigation" is bandied about within the U.S. space program, there is still the history of the Apollo 1 fire during a ground test at Cape Canaveral, Fla., the loss of the shuttle Challenger during liftoff, and the loss of the shuttle Columbia when returning to Earth to remind us that while we give lip-service to risk management, we have not learned to manage risk as well as we ought. Moreover, there are many more less dramatic, but equally critical, incidents that have occurred in association with the space program that also highlight our inability to accurately gauge and manage risk. Why do we seem caught in a senseless spiral in which we focus most on risk only after a tragedy? Why do we repeat serious mishaps and not learn from our mistakes? This paper reviews some possible explanations for our risk-taking behavior and provides examples of interest to the NASA centers, while also discussing inter center and intra-center opportunities for sharing information to mitigate risk.

What have we learned about intelligent transportation systems? Chapter 2, What have we learned about freeway incident and emergency management and electronic toll collection?

DOT National Transportation Integrated Search

2000-12-01

The intelligent infrastructure is often the most visible manifestation of intelligent transportation systems (ITS) along with roads, freeways, and incident management is often among the first ITS elements implemented. They can significantly contribut...

Gender in the Management Education Classroom: A Collaborative Learning Journey

ERIC Educational Resources Information Center

Bilimoria, Diana; O'Neil, Deborah A.; Hopkins, Margaret M.; Murphy, Verena

2010-01-01

In this article, the authors describe a classroom incident and their subsequent learnings about effectively managing issues of gender diversity in an MBA course titled "Women in Organizations." The authors employ Kolb's learning cycle as a framework for describing the incident ("concrete experience"), reflecting on and discussing what occurred…

Military Personnel: DOD Has Processes for Operating and Managing Its Sexual Assault Incident Database

DTIC Science & Technology

2017-01-01

each change and its implementation status as well as supporting the audit of products to verify conformance to requirements. Through these change...management process for modifying DSAID aligns with information technology and project management industry standards. GAO reviewed DOD documents, and...Acknowledgments 32 Related GAO Products 33 Tables Table 1: Roles and Access Rights for Users of the Defense Sexual Assault Incident Database (DSAID

MO-E-9A-01: Risk Based Quality Management: TG100 In Action

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

Huq, M; Palta, J; Dunscombe, P

2014-06-15

One of the goals of quality management in radiation therapy is to gain high confidence that patients will receive the prescribed treatment correctly. To accomplish these goals professional societies such as the American Association of Physicists in Medicine (AAPM) has published many quality assurance (QA), quality control (QC), and quality management (QM) guidance documents. In general, the recommendations provided in these documents have emphasized on performing device-specific QA at the expense of process flow and protection of the patient against catastrophic errors. Analyses of radiation therapy incidents find that they are most often caused by flaws in the overall therapymore » process, from initial consult through final treatment, than by isolated hardware or computer failures detectable by traditional physics QA. This challenge is shared by many intrinsically hazardous industries. Risk assessment tools and analysis techniques have been developed to define, identify, and eliminate known and/or potential failures, problems, or errors, from a system, process and/or service before they reach the customer. These include, but are not limited to, process mapping, failure modes and effects analysis (FMEA), fault tree analysis (FTA), and establishment of a quality management program that best avoids the faults and risks that have been identified in the overall process. These tools can be easily adapted to radiation therapy practices because of their simplicity and effectiveness to provide efficient ways to enhance the safety and quality of treatment processes. Task group 100 (TG100) of AAPM has developed a risk-based quality management program that uses these tools. This session will be devoted to a discussion of these tools and how these tools can be used in a given radiotherapy clinic to develop a risk based QM program. Learning Objectives: Learn how to design a process map for a radiotherapy process. Learn how to perform a FMEA analysis for a given process. Learn what Fault tree analysis is all about. Learn how to design a quality management program based upon the information obtained from process mapping, FMEA and FTA.« less

Inborn errors of metabolism identified via newborn screening: Ten-year incidence data and costs of nutritional interventions for research agenda planning✰

PubMed Central

Therrell, Bradford L.; Lloyd-Puryear, Michele A.; Camp, Kathryn M.; Mann, Marie Y.

2014-01-01

Inborn errors of metabolism (IEM) are genetic disorders in which specific enzyme defects interfere with the normal metabolism of exogenous (dietary) or endogenous protein, carbohydrate, or fat. In the U.S., many IEM are detected through state newborn screening (NBS) programs. To inform research on IEM and provide necessary resources for researchers, we are providing: tabulation of ten-year state NBS data for selected IEM detected through NBS; costs of medical foods used in the management of IEM; and an assessment of corporate policies regarding provision of nutritional interventions at no or reduced cost to individuals with IEM. The calculated IEM incidences are based on analyses of ten-year data (2001–2011) from the National Newborn Screening Information System (NNSIS). Costs to feed an average person with an IEM were approximated by determining costs to feed an individual with an IEM, minus the annual expenditure for food for an individual without an IEM. Both the incidence and costs of nutritional intervention data will be useful in future research concerning the impact of IEM disorders on families, individuals and society. PMID:25085281

Effect of a multifactorial fall-and-fracture risk assessment and management program on gait and balance performances and disability in hospitalized older adults: a controlled study.

PubMed

Trombetti, A; Hars, M; Herrmann, F; Rizzoli, R; Ferrari, S

2013-03-01

This controlled intervention study in hospitalized oldest old adults showed that a multifactorial fall-and-fracture risk assessment and management program, applied in a dedicated geriatric hospital unit, was effective in improving fall-related physical and functional performances and the level of independence in activities of daily living in high-risk patients. Hospitalization affords a major opportunity for interdisciplinary cooperation to manage fall-and-fracture risk factors in older adults. This study aimed at assessing the effects on physical performances and the level of independence in activities of daily living (ADL) of a multifactorial fall-and-fracture risk assessment and management program applied in a geriatric hospital setting. A controlled intervention study was conducted among 122 geriatric inpatients (mean ± SD age, 84 ± 7 years) admitted with a fall-related diagnosis. Among them, 92 were admitted to a dedicated unit and enrolled into a multifactorial intervention program, including intensive targeted exercise. Thirty patients who received standard usual care in a general geriatric unit formed the control group. Primary outcomes included gait and balance performances and the level of independence in ADL measured 12 ± 6 days apart. Secondary outcomes included length of stay, incidence of in-hospital falls, hospital readmission, and mortality rates. Compared to the usual care group, the intervention group had significant improvements in Timed Up and Go (adjusted mean difference [AMD] = -3.7s; 95 % CI = -6.8 to -0.7; P = 0.017), Tinetti (AMD = -1.4; 95 % CI = -2.1 to -0.8; P < 0.001), and Functional Independence Measure (AMD = 6.5; 95 %CI = 0.7-12.3; P = 0.027) test performances, as well as in several gait parameters (P < 0.05). Furthermore, this program favorably impacted adverse outcomes including hospital readmission (hazard ratio = 0.3; 95 % CI = 0.1-0.9; P = 0.02). A multifactorial fall-and-fracture risk-based intervention program, applied in a dedicated geriatric hospital unit, was effective and more beneficial than usual care in improving physical parameters related to the risk of fall and disability among high-risk oldest old patients.

Sexually transmitted infections: prevention and management.

PubMed

Jackson, Denis; Dallabetta, Gina; Steen, Richard

2004-02-01

In the early 21st century, STI and HIV have been linked inextricably. Although the focus of this article is STI, some discussion on the diagnosis and management of individuals with HIV infection is necessary. The history of HIV diagnosis in the workplace is checkered. The authors have seen cases of prospective workers being subjected to HIV testing without their knowledge as part of a pre-employment medical examination. If the test came back positive, the men were told that they would not be employed without explanation. This approach is a breech of the human rights of the individual being tested and cannot be condoned. Any HIV testing must be done with the full and informed consent of the individual, with counseling given before and after testing to enable individuals with HIV infection to seek care and protect their families and to give individuals without HIV infection counseling on risk reduction. Men and women who present with an STI are at risk for HIV infection. With increasing options for management and secondary prevention, it is important to recognize people who are at risk. This identification should be done through HIV VCT. The location, funding, and supervision of VCT sites related to workplace populations should be a subject for serious debate. Although fears of mass layoffs after HIV testing largely have been unfounded, it is natural for workers to be fearful, unless there is a clearly articulated policy stating that the company observes and enforces nondiscriminatory practices. The workplace examples show that syndromic STI management, allied to comprehensive prevention programs, can have a genuine and measurable impact on STI prevalence. The potential interventions and partners are listed in Table 2. A community-based, randomized study in Tanzania showed that the institution of a well-managed STI syndromic management program can reduce HIV incidence by up to 40%, in the context of a rising HIV epidemic. Presumptive STI treatment for female sex workers (see Box 1) may prove useful as a short-term measure to reduce high STI prevalence rates while more sustainable preventive and curative services are established. The laboratory diagnosis of STIs remains problematic in the face of commonly available technologies of limited sensitivity and specificity and often substandard quality-assurance practices. For these and other reasons, syndromic management became the recommended strategy for treating STIs. The availability of rapid, accurate, and inexpensive diagnostics, especially for cervical infections for women, would alter management recommendations. Work is being done by the WHO and others to develop and assess low-cost diagnostics. Managing STIs and altering the behavior that leads to STIs are essential elements of any HIV prevention and management program. The issues surrounding a practical, compassionate, and comprehensive HIV program can be difficult. Numerous publications exist to help program managers navigate these issues and appropriately tailor a program to the needs of individual organizations. Some of these publications are listed in the next section.

Experience with Canada's First Policy on Concussion Education and Management in Schools.

PubMed

Hachem, Laureen D; Kourtis, George; Mylabathula, Swapna; Tator, Charles H

2016-07-01

In response to the rising incidence of concussions among children and adolescents, the province of Ontario recently introduced the Ontario Policy/Program Memorandum on Concussions (PPM No. 158) requiring school boards to develop a concussion protocol. As this is the first policy of its kind in Canada, the impact of the PPM is not yet known. An electronic survey was sent to all high school principals in the Toronto District School Board 1 year after announcement of the PPM. Questions covered extent of student, parent, and staff concussion education along with concussion management protocols. Of 109 high school principals contacted, 39 responded (36%). Almost all schools provided concussion education to students (92%), with most education delivered through physical education classes. Nearly all schools had return to play (92%) and return to learn (77%) protocols. Although 85% of schools educated staff on concussions, training was aimed at individuals involved in sports/physical education. Only 43.6% of schools delivered concussion education to parents, and many principals requested additional resources in this area. One year after announcement of the PPM, high schools in the Toronto District School Board implemented significant student concussion education programs and management protocols. Staff training and parent education required further development. A series of recommendations are provided to aid in future concussion policy development.

Evaluation of functional outcomes of physical rehabilitation and medical complications in spinal cord injury victims of the Sichuan earthquake.

PubMed

Li, Yongqiang; Reinhardt, Jan D; Gosney, James E; Zhang, Xia; Hu, Xiaorong; Chen, Sijing; Ding, Mingpu; Li, Jianan

2012-06-01

To characterize a spinal cord injury (SCI) population from the 2008 Sichuan earthquake in China; to evaluate functional outcomes of physical rehabilitation interventions; to assess potential determinants of rehabilitation effectiveness; and to assess medical complications and management outcomes. A total of 51 earthquake victims with SCI were enrolled and underwent rehabilitation programming. Functional rehabilitation outcomes included ambulation ability, wheelchair mobility and activities of daily living (ADL) assessed with the Modified Barthel Index at the beginning and end of rehabilitation. Effectiveness of rehabilitation and the effect of other predictors were evaluated by mixed effects regression. Outcomes of medical complication management were determined by comparison of the incidence of respective complications at the beginning and end of rehabilitation. Ambulation, wheelchair mobility and ADL were significantly improved with rehabilitation programming. Both earlier rescue and earlier onset of rehabilitation were significant positive predictors of rehabilitation effectiveness, whereas delayed onset of rehabilitation combined with prolonged time to rescue resulted in a lesser positive effect. Medical complications were managed effectively in 63% (pressure ulcers) to 85% (deep vein thrombosis) of patients during rehabilitation. Earthquake victims with SCI may achieve significantly improved functional rehabilitation functional outcomes on a formal, institutional-based physical rehabilitation programme.

Supporting the Federal Emergency Management Agency Rescuers: a variation of critical incident stress management.

PubMed

Garcia, Evangeline; Horton, Denise A

2003-02-01

The purpose of this article was to document the efforts of two military installations in facilitating Critical Incident Stress Management teams for Federal Emergency Management Agency Rescue and Recovery Units following the attacks on the World Trade Center on September 11, 2001. McGuire Air Force Base accepted the mission to support the rotating task forces with emotional support, and Fort Dix offered temporary lodging while the teams were in-bound and out-bound to the "Ground Zero" site. A team, comprised of staff from both installations due to the configuration of professional and support staffs, does the Critical Incident Stress Management work. Both installations are within commuting distance of New York City and could provide adequate safety, security, and logistics to the teams. The classic crisis management models were not called into play, as that service was not asked for; however, it was clear to the McGuire Air Force Base/Fort Dix Critical Incident Stress Management team members that the rescue and recovery teams needed their physical presence. Many rescue organizations have their own "debriefing teams," yet it is believed that "outside teams" may be helpful as interim measures to demonstrate the universality of the process of coping with traumatic stress and grief management. It is hoped that this article honors the workers who came together to help in a very difficult time for our country. This article documents the interim measures that were taken for a group of people moving through crisis.

Evaluation of Incident Detection Methodologies

DOT National Transportation Integrated Search

1999-10-01

Original Report Date: October 1998. The detection of freeway incidents is an essential element of an area's traffic management system. Incidents need to be detected and handled as promptly as possible to minimize delay to the public. Various algorith...

Associations between national tuberculosis program budgets and tuberculosis outcomes: an ecological study.

PubMed

Chapple, Will; Katz, Alan Roy; Li, Dongmei

2012-01-01

The objective of this study is to explore the associations between national tuberculosis program (NTP) budget allocation and tuberculosis related outcomes in the World Health Organization's 22 high burden countries from 2007-2009. This ecological study used mixed effects and generalized estimating equation models to identify independent associations between NTP budget allocations and various tuberculosis related outcomes. Models were adjusted for a number of independent variables previously noted to be associated with tuberculosis incidence. Increasing the percent of the NTP budget for advocacy, communication and social mobilization was associated with an increase in the case detection rate. Increasing TB-HIV funding was associated with an increase in HIV testing among TB patients. Increasing the percent of the population covered by the Directly Observed Therapy (DOT) program was associated with an increase in drug susceptibility testing. Laboratory funding was positively associated with tuberculosis notification. Increasing the budgets for first line drugs, management and multi-drug resistant tuberculosis (MDR-TB) was associated with a decrease in smear positive deaths. Effective TB control is a complex and multifaceted challenge. This study revealed a number of budget allocation related factors associated with improved TB outcome parameters. If confirmed with future longitudinal studies, these findings could help guide NTP managers with allocation decisions.

Associations between national tuberculosis program budgets and tuberculosis outcomes: an ecological study

PubMed Central

Chapple, Will; Katz, Alan Roy; Li, Dongmei

2012-01-01

Introduction The objective of this study is to explore the associations between national tuberculosis program (NTP) budget allocation and tuberculosis related outcomes in the World Health Organization's 22 high burden countries from 2007–2009. Methods This ecological study used mixed effects and generalized estimating equation models to identify independent associations between NTP budget allocations and various tuberculosis related outcomes. Models were adjusted for a number of independent variables previously noted to be associated with tuberculosis incidence. Results Increasing the percent of the NTP budget for advocacy, communication and social mobilization was associated with an increase in the case detection rate. Increasing TB-HIV funding was associated with an increase in HIV testing among TB patients. Increasing the percent of the population covered by the Directly Observed Therapy (DOT) program was associated with an increase in drug susceptibility testing. Laboratory funding was positively associated with tuberculosis notification. Increasing the budgets for first line drugs, management and multi-drug resistant tuberculosis (MDR-TB) was associated with a decrease in smear positive deaths. Conclusion Effective TB control is a complex and multifaceted challenge. This study revealed a number of budget allocation related factors associated with improved TB outcome parameters. If confirmed with future longitudinal studies, these findings could help guide NTP managers with allocation decisions. PMID:23024825

[Psychoeducational intervention in high ability: intellectual functioning and extracurricular enrichment].

PubMed

Sastre-Riba, Sylvia

2014-02-24

The 'new paradigm' defines the high intellectual ability as a potential that should crystallize progressively throughout development. Its main feature is a high intellectual initial multidimensional potential, which is transformed so that, being a person with high intellectual ability is the result of a developmental process from a neurobiological substrate and the incidence of variables (psychosocial and education) which determines its manifestation more or less stable and optimal to excellence. It is interesting to know the effectiveness of psychoeducational intervention of the extracurricular enrichment programs and their effects on the expression of differential functioning and the optimization of the management of cognitive resources that lead to excellence. An extracurricular enrichment program is described and evaluated through: 1) the stability of the intellectual measures; 2) the satisfaction level of participants and families. Participants are 58 high ability students on the enrichment program and 25 parents. Intellectual profiles are obtained on T1-T2 and calculated their stability by regression analysis, the CSA and CSA-P questionnaires were applied in order to know the participants and families' satisfaction measure. Results show the basic stability of intellectual profiles with five cases of instability among the 58 profiles obtained, and a high satisfaction with the results obtained in the domain of cognitive and personal management among the participants.

An Assessment of Drug Testing within the Construction Industry.

ERIC Educational Resources Information Center

Gerber, Jonathan K.; Yacoubian, George S., Jr.

2002-01-01

Investigates the efficacy of workplace drug-testing programs in reducing injury incident rates and workers' compensation experience-rating modification factors within the construction industry. Analyses indicate that companies with drug-testing programs experienced a 51 percent reduction in incident rates within two years of implementation.…

Development of artificial intelligence approach to forecasting oyster norovirus outbreaks along Gulf of Mexico coast.

PubMed

Chenar, Shima Shamkhali; Deng, Zhiqiang

2018-02-01

This paper presents an artificial intelligence-based model, called ANN-2Day model, for forecasting, managing and ultimately eliminating the growing risk of oyster norovirus outbreaks. The ANN-2Day model was developed using Artificial Neural Network (ANN) Toolbox in MATLAB Program and 15-years of epidemiological and environmental data for six independent environmental predictors including water temperature, solar radiation, gage height, salinity, wind, and rainfall. It was found that oyster norovirus outbreaks can be forecasted with two-day lead time using the ANN-2Day model and daily data of the six environmental predictors. Forecasting results of the ANN-2Day model indicated that the model was capable of reproducing 19years of historical oyster norovirus outbreaks along the Northern Gulf of Mexico coast with the positive predictive value of 76.82%, the negative predictive value of 100.00%, the sensitivity of 100.00%, the specificity of 99.84%, and the overall accuracy of 99.83%, respectively, demonstrating the efficacy of the ANN-2Day model in predicting the risk of norovirus outbreaks to human health. The 2-day lead time enables public health agencies and oyster harvesters to plan for management interventions and thus makes it possible to achieve a paradigm shift of their daily management and operation from primarily reacting to epidemic incidents of norovirus infection after they have occurred to eliminating (or at least reducing) the risk of costly incidents. Copyright © 2017 Elsevier Ltd. All rights reserved.

National survey of outcomes and practices in acute respiratory distress syndrome in Singapore.

PubMed

Siddiqui, Shahla; Puthucheary, Zudin; Phua, Jason; Ho, Benjamin; Tan, Jonathan; Chuin, Siau; Lim, Noelle Louise; Soh, Chai Rick; Loo, Chian Min; Tan, Addy Y H; Mukhopadhyay, Amartya; Khan, Faheem Ahmed; Johan, Azman; Tan, Aik Hau; MacLaren, Graeme; Taculod, Juvel; Ramos, Blesilda; Han, Tun Aung; Cove, Matthew E

2017-01-01

In the past 20 years, our understanding of acute respiratory distress syndrome (ARDS) management has improved, but the worldwide incidence and current outcomes are unclear. The reported incidence is highly variable, and no studies specifically characterise ARDS epidemiology in Asia. This observation study aims to determine the incidence, mortality and management practices of ARDS in a high income South East Asian country. We conducted a prospective, population based observational study in 6 public hospitals. During a one month period, we identified all ARDS patients admitted to public hospital intensive care units (ICU) in Singapore, according to the Berlin definition. Demographic information, clinical management data and ICU outcome data was collected. A total of 904 adult patients were admitted to ICU during the study period and 15 patients met ARDS criteria. The unadjusted incidence of ARDS was 4.5 cases per 100,000 population, accounting for 1.25% of all ICU patients. Most patients were male (75%), Chinese (62%), had pneumonia (73%), and were admitted to a Medical ICU (56%). Management strategies varied across all ICUs. In-hospital mortality was 40% and median length of ICU stay was 7 days. The incidence of ARDS in a developed S.E Asia country is comparable to reported rates in European studies.

National survey of outcomes and practices in acute respiratory distress syndrome in Singapore

PubMed Central

Puthucheary, Zudin; Phua, Jason; Ho, Benjamin; Tan, Jonathan; Chuin, Siau; Lim, Noelle Louise; Soh, Chai Rick; Loo, Chian Min; Tan, Addy Y. H.; Mukhopadhyay, Amartya; Khan, Faheem Ahmed; Johan, Azman; Tan, Aik Hau; MacLaren, Graeme; Taculod, Juvel; Ramos, Blesilda; Han, Tun Aung; Cove, Matthew E.

2017-01-01

Introduction In the past 20 years, our understanding of acute respiratory distress syndrome (ARDS) management has improved, but the worldwide incidence and current outcomes are unclear. The reported incidence is highly variable, and no studies specifically characterise ARDS epidemiology in Asia. This observation study aims to determine the incidence, mortality and management practices of ARDS in a high income South East Asian country. Methods We conducted a prospective, population based observational study in 6 public hospitals. During a one month period, we identified all ARDS patients admitted to public hospital intensive care units (ICU) in Singapore, according to the Berlin definition. Demographic information, clinical management data and ICU outcome data was collected. Results A total of 904 adult patients were admitted to ICU during the study period and 15 patients met ARDS criteria. The unadjusted incidence of ARDS was 4.5 cases per 100,000 population, accounting for 1.25% of all ICU patients. Most patients were male (75%), Chinese (62%), had pneumonia (73%), and were admitted to a Medical ICU (56%). Management strategies varied across all ICUs. In-hospital mortality was 40% and median length of ICU stay was 7 days. Conclusion The incidence of ARDS in a developed S.E Asia country is comparable to reported rates in European studies. PMID:28622342

Implementation of a standardized out-of-hospital management method for Parkinson dysphagia.

PubMed

Wei, Hongying; Sun, Dongxiu; Liu, Meiping

2017-12-01

Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia. Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01). Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

Sickle cell disease incidence among newborns in New York State by maternal race/ethnicity and nativity.

PubMed

Wang, Ying; Kennedy, Joseph; Caggana, Michele; Zimmerman, Regina; Thomas, Sanil; Berninger, John; Harris, Katharine; Green, Nancy S; Oyeku, Suzette; Hulihan, Mary; Grant, Althea M; Grosse, Scott D

2013-03-01

Sickle cell disease is estimated to occur in 1:300-400 African-American births, with higher rates among immigrants from Africa and the Caribbean, and is less common among Hispanic births. This study determined sickle cell disease incidence among New York State newborns stratified by maternal race/ethnicity and nativity. Newborns with confirmed sickle cell disease born to New York State residents were identified by the New York State newborn screening program for the years 2000-2008 and matched to birth records to obtain birth and maternal information. Annual incidence rates were computed and bivariate analyses were conducted to examine associations with maternal race/ethnicity and nativity. From 2000 to 2008, 1,911 New York State newborns were diagnosed with sickle cell disease and matched to the birth certificate files. One in every 1,146 live births was diagnosed with sickle cell disease. Newborns of non-Hispanic black mothers accounted for 86% of sickle cell disease cases whereas newborns of Hispanic mothers accounted for 12% of cases. The estimated incidence was 1:230 live births for non-Hispanic black mothers, 1:2,320 births for Hispanic mothers, and 1:41,647 births for non-Hispanic white mothers. Newborns of foreign-born non-Hispanic black mothers had a twofold higher incidence of sickle cell disease than those born to US-born non-Hispanic black mothers (P < 0.001). This study provides the first US estimates of sickle cell disease incidence by maternal nativity. Women born outside the United States account for the majority of children with sickle cell disease born in New York State. Such findings identify at-risk populations and inform outreach activities that promote ongoing, high-quality medical management to affected children.

Biological age as a health index for mortality and major age-related disease incidence in Koreans: National Health Insurance Service – Health screening 11-year follow-up study

PubMed Central

Kang, Young Gon; Suh, Eunkyung; Lee, Jae-woo; Kim, Dong Wook; Cho, Kyung Hee; Bae, Chul-Young

2018-01-01

Purpose A comprehensive health index is needed to measure an individual’s overall health and aging status and predict the risk of death and age-related disease incidence, and evaluate the effect of a health management program. The purpose of this study is to demonstrate the validity of estimated biological age (BA) in relation to all-cause mortality and age-related disease incidence based on National Sample Cohort database. Patients and methods This study was based on National Sample Cohort database of the National Health Insurance Service – Eligibility database and the National Health Insurance Service – Medical and Health Examination database of the year 2002 through 2013. BA model was developed based on the National Health Insurance Service – National Sample Cohort (NHIS – NSC) database and Cox proportional hazard analysis was done for mortality and major age-related disease incidence. Results For every 1 year increase of the calculated BA and chronological age difference, the hazard ratio for mortality significantly increased by 1.6% (1.5% in men and 2.0% in women) and also for hypertension, diabetes mellitus, heart disease, stroke, and cancer incidence by 2.5%, 4.2%, 1.3%, 1.6%, and 0.4%, respectively (p<0.001). Conclusion Estimated BA by the developed BA model based on NHIS – NSC database is expected to be used not only as an index for assessing health and aging status and predicting mortality and major age-related disease incidence, but can also be applied to various health care fields. PMID:29593385

Epidemiology of invasive pneumococcal infections: manifestations, incidence and case fatality rate correlated to age, gender and risk factors.

PubMed

Backhaus, Erik; Berg, Stefan; Andersson, Rune; Ockborn, Gunilla; Malmström, Petter; Dahl, Mats; Nasic, Salmir; Trollfors, Birger

2016-08-03

Incidence, manifestations and case-fatality rate (CFR) of invasive pneumococcal disease (IPD) vary with age and comorbidities. New vaccines, changing age distribution, prolonged survival among immunocompromised patients and improved sepsis management have created a need for an update of basic facts to inform vaccine recommendations. Age, gender and comorbidities were related to manifestations and death for 2977 consecutive patients with IPD in a Swedish region with 1.5 million inhabitants during 13 years before introduction of pneumococcal conjugate vaccines (PCV) in the infant vaccination program. These data were related to population statistics and prevalence of several comorbidities, and compared with two previous studies giving a total follow-up of 45 years in the same area. The annual incidence was 15/100,000 for any IPD and 1.1/100,000 for meningitis; highest among elderly followed by children < 2 years. It was 2238/100,000 among myeloma patients, followed by chronic lymphatic leukemia, hemodialysis and lung cancer, but not elevated among asthma patients. CFR was 10 % among all patients, varying from 3 % below 18 years to 22 % ≥ 80 years. During 45 years, the IPD incidence increased threefold and CFR dropped from 20 to 10 %. Meningitis incidence remained stable (1.1/100,000/year) but CFR dropped from 33 to 13 %. IPD-specific mortality decreased among children <2 years from 3.1 to 0.46/100,000/year but tripled among those ≥65 years. IPD incidence and CFR vary widely between age and risk groups and over time even without general infant vaccination. Knowledge about specific epidemiological characteristics is important for informing and evaluating vaccination policies.

Stable isotopes to detect food-conditioned bears and to evaluate human-bear management

USGS Publications Warehouse

Hopkins, John B.; Koch, Paul L.; Schwartz, Charles C.; Ferguson, Jake M.; Greenleaf, Schuyler S.; Kalinowski, Steven T.

2012-01-01

We used genetic and stable isotope analysis of hair from free-ranging black bears (Ursus americanus) in Yosemite National Park, California, USA to: 1) identify bears that consume human food, 2) estimate the diets of these bears, and 3) evaluate the Yosemite human–bear management program. Specifically, we analyzed the isotopic composition of hair from bears known a priori to be food-conditioned or non-food-conditioned and used these data to predict whether bears with an unknown management status were food-conditioned (FC) or non-food-conditioned (NFC). We used a stable isotope mixing model to estimate the proportional contribution of natural foods (plants and animals) versus human food in the diets of FC bears. We then used results from both analyses to evaluate proactive (population-level) and reactive (individual-level) human–bear management, and discussed new metrics to evaluate the overall human–bear management program in Yosemite. Our results indicated that 19 out of 145 (13%) unknown bears sampled from 2005 to 2007 were food-conditioned. The proportion of human food in the diets of known FC bears likely declined from 2001–2003 to 2005–2007, suggesting proactive management was successful in reducing the amount of human food available to bears. In contrast, reactive management was not successful in changing the management status of known FC bears to NFC bears, or in reducing the contribution of human food to the diets of FC bears. Nine known FC bears were recaptured on 14 occasions from 2001 to 2007; all bears were classified as FC during subsequent recaptures, and human–bear management did not reduce the amount of human food in the diets of FC bears. Based on our results, we suggest Yosemite continue implementing proactive human–bear management, reevaluate reactive management, and consider removing problem bears (those involved in repeated bear incidents) from the population.

Review article: A systematic review of emergency department incident classification frameworks.

PubMed

Murray, Matthew; McCarthy, Sally

2018-06-01

As in any part of the hospital system, safety incidents can occur in the ED. These incidents arguably have a distinct character, as the ED involves unscheduled flows of urgent patients who require disparate services. To aid understanding of safety issues and support risk management of the ED, a comparison of published ED specific incident classification frameworks was performed. A review of emergency medicine, health management and general medical publications, using Ovid SP to interrogate Medline (1976-2016) was undertaken to identify any type of taxonomy or classification-like framework for ED related incidents. These frameworks were then analysed and compared. The review identified 17 publications containing an incident classification framework. Comparison of factors and themes making up the classification constituent elements revealed some commonality, but no overall consistency, nor evolution towards an ideal framework. Inconsistency arises from differences in the evidential basis and design methodology of classifications, with design itself being an inherently subjective process. It was not possible to identify an 'ideal' incident classification framework for ED risk management, and there is significant variation in the selection of categories used by frameworks. The variation in classification could risk an unbalanced emphasis in findings through application of a particular framework. Design of an ED specific, ideal incident classification framework should be informed by a much wider range of theories of how organisations and systems work, in addition to clinical and human factors. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Annual Site Environmental Report: 2006

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

Nuckolls, H.; /SLAC

2008-02-22

This report provides information about environmental programs during the calendar year (CY) of 2006 at the Stanford Linear Accelerator Center (SLAC), Menlo Park, California. Activities that span the calendar year; i.e., stormwater monitoring covering the winter season of 2006/2007 (October 2006 through May 2007), are also included. Production of an annual site environmental report (ASER) is a requirement established by the United States Department of Energy (DOE) for all management and operating (M&O) contractors throughout the DOE complex. SLAC is a federally-funded research and development center with Stanford University as the M&O contractor. SLAC continued to follow the path tomore » self-declare an environmental management system under DOE Order 450.1, 'Environmental Protection Program' and effectively applied environmental management in meeting the site's integrated safety and environmental management system goals. For normal daily activities, all SLAC managers and supervisors are responsible for ensuring that proper procedures are followed so that Worker safety and health are protected; The environment is protected; and Compliance is ensured. Throughout 2006, SLAC focused on these activities through the SLAC management systems. These systems were also the way SLAC approached implementing 'greening of the government' initiatives such as Executive Order 13148. The management systems at SLAC are effective, supporting compliance with all relevant statutory and regulatory requirements. The SLAC Office of Assurance was created during 2006 in response to DOE Order 226.1. During 2006, there were no reportable releases to the environment from SLAC operations, and there were no Notice of Violations issued to SLAC from any of the regulatory agencies that oversee SLAC. In addition, many improvements in waste minimization, recycling, stormwater drain system, groundwater restoration, and SLAC's chemical management system (CMS) were continued during 2006 to better manage chemical use. Program-specific details are discussed below. SLAC operates its air quality management program in compliance with its established permit conditions. The Bay Area Air Quality Management District (BAAQMD) did not conduct a facility inspection of SLAC during 2006, though it did visit the site on four different occasions. The BAAQMD did compliment SLAC for the overall configuration of SLAC's gasoline dispensing facility and of SLAC's asbestos/demolition notification program during two of the visits. DOE awarded SLAC the 2006 Best in Class for Pollution Prevention and Environmental Stewardship Accomplishment in recognition of SLAC's CMS program which manages the procurement and use of chemicals. As an example of the efficiency of the CMS, SLAC reviewed its use of gases and associated tanks and phased out numerous gas tanks that were no longer needed or were not acceptable for long-term storage, in turn, reducing SLAC's on-site chemical inventory. As part of SLAC's waste minimization and management efforts, more than one thousand tons of municipal solid waste was recycled by SLAC during 2006. SLAC operates its industrial and sanitary wastewater management program in compliance with established permit conditions. During 2006, SLAC obtained a new facility-wide wastewater discharge permit which replaced four separate permits that were previously issued to SLAC. In 2006, no radiological incidents occurred that increased radiation levels or released radioactivity to the environment. In addition to managing its radioactive wastes safely and responsibly, SLAC worked to reduce the amount of waste generated. SLAC has implemented programs and systems to ensure compliance with all radiological requirements related to the environment. The Environmental Restoration Program continued work on site characterization and evaluation of remedial alternatives at four sites with volatile organic compounds in groundwater and several areas with polychlorinated biphenyls and low concentrations of lead in soil. SLAC is regulated under a site cleanup requirements order (board order) issued by the California Regional Water Quality Control Board, San Francisco Bay Region (RWQCB) for the investigation and remediation of impacted soil and groundwater at SLAC. The new board order lists specific tasks and deadlines for groundwater and soil remedial investigation. All 2006 submittals to the board were completed on time.« less

Reduction of the incidence of pressure sores by an education program on nursing care.

PubMed

Srisupan, Vijitr; Senaratana, Wilawan; Picheansatian, Wilawan; Chittreecheur, Jittaporn; Watanakool, Malinee; Chaisri, Pratin; Singhakumfu, Laddawan; Tribuddharat, Chanwit; Danchaivijitr, Somwang

2005-12-01

To determine whether an education and campaign program would reduce the incidence of pressure sores. The study was performed in a 1,400-bed teaching hospital in Thailand with a total number of 697patients from 47 wards for a point prevalence study; 1,201 and 1,268 patients from 12 wards to determine whether reduction of pressure sore occurrence would be obtained by an education program. The point prevalence of pressure sores was 10.8%. The significant risk factors were age older than 60 years, fecal incontinence, and history of diarrhea. The occurrence of pressure sores was significantly reduced after the educational program from 9.91% to 5. 76%. The education on patient care aiming at reduction of the occurrence of pressure sores could be adopted nation-wide in order to reduce the morbidity, mortality and expenses. The education program was effective in reducing the incidence of pressure sores.

Advanced patrol routing with on-call response for effective resource management.

DOT National Transportation Integrated Search

2011-12-01

Traffic incidents not only greatly impact individuals, but also affect the general population. : Depending on the incident severity, incidents are likely to cause both private and public property : damage and possibly cause injury and fatalities. Due...

Subacute Sclerosing Panencephalitis: Results of the Canadian Paediatric Surveillance Program and review of the literature

PubMed Central

Campbell, Craig; Levin, Simon; Humphreys, Peter; Walop, Wikke; Brannan, Renee

2005-01-01

Background Subacute Sclerosing Panencephalitis (SSPE) is so rare in developed countries with measles immunization programs that national active surveillance is now needed to capture sufficient number of cases for meaningful analysis of data. Through the Canadian Paediatric Surveillance Program (CPSP), the SSPE study was able to document a national incidence and determine the epidemiology of affected Canadian children. Methods Between 1997 and 2000, the CPSP surveyed monthly 1978 to 2294 Canadian pediatricians and sub-specialists for SSPE cases. The response rate varied from 82–86% over those years. Results Altogether, four SSPE cases were reported to the CPSP: one case before, two during and one after the study period. The incidence of SSPE in Canadian children was 0.06/million children/year. Of the four cases, diagnosed between ages four and 17 years, three children had measles infection in infancy. All children showed a progressive course of dementia, loss of motor skills and epilepsy. Two children were treated with isoprinosine and intraventricular interferon but died in less than three years from disease onset. One child did not have any treatment and died after seven years of illness. One child received intraventricular ribavirin and remains alive, but markedly impaired, nine years following diagnosis. Conclusion The CPSP has demonstrated that Canadian paediatricians and paediatric neurologists may encounter cases of SSPE. This report highlights the clinical course of affected Canadian children and provides a review of the disease and its management. PMID:16356180

The discourses of incidents: Cougars on Mt. Elden and in Sabino Canyon, Arizona

USGS Publications Warehouse

Mattson, David J.; Clark, Susan G.

2012-01-01

Incidents are relatively short periods of intensified discourse that arise from public responses to symbolically important actions by public officials, and an important part of the conflict that increasingly surrounds state wildlife management in the West. In an effort to better understand incidents as a facet of this conflict, we analyzed the discourses of two incidents in Arizona that were precipitated by the intended removal of cougars by managers in response to public safety concerns. We used newspaper content, 1999–2007, to elucidate seminal patterns of public discourses and discourse coalitions as well as differences in discursive focus between incident periods and background periods. Cougars were mentioned in newspaper articles 13–33 times more often during incidents compared with background periods. State wildlife agency commissioners and hunters were part of a discourse coalition that advocated killing cougars to solve problems, blamed cougars and those who promoted the animals’ intrinsic value and sought to retain power to define and solve cougar-related problems. Personnel from affected state and federal agencies expressed a similar discourse. Environmentalists, animal protection activists, and some elected officials were of a coalition that defined “the problem” primarily in terms of people’s behaviors, including behaviors associated with current institutional arrangements. This discourse advocated decentralizing power over cougar management. The discourses reflected different preferences for the allocations of power and use of lethal versus non-lethal methods, which aligned with apparent core beliefs and participants’ enfranchisement or disenfranchisement by current state-level management power arrangements.

UAB UTC domain 2 : development of a dynamic traffic assignment and simulation model for incident and emergency management applications in the Birmingham Region (Aim 1).

DOT National Transportation Integrated Search

2010-12-01

A number of initiatives were undertaken to support education, training, and technology transfer objectives related to UAB UTC Domain 2 Project: Development of a Dynamic Traffic Assignment and Simulation Model for Incident and Emergency Management App...

Dyslexic Entrepreneurs: The Incidence; Their Coping Strategies and Their Business Skills

ERIC Educational Resources Information Center

Logan, Julie

2009-01-01

This comparative study explores the incidence of dyslexia in entrepreneurs, corporate managers and the general population. It examines the suggestion that dyslexic entrepreneurs develop coping strategies to manage their weaknesses, which are subsequently of benefit in the new venture creation process. Results of this study suggest that there is a…

Making Mathematics Placement Decisions for High School Students with High Incidence Disabilities: A Collective Case Study

ERIC Educational Resources Information Center

Murzyn, Amy; Hughes, Trudie

2015-01-01

This multiple case study described the experiences of case managers making mathematics placement decisions for high school students with high incidence disabilities. Participants included three parents, three students, three case managers, three mathematics teachers, and three administrators from different high schools across rural, suburban and…

Disasters and mass casualties: I. General principles of response and management.

PubMed

Born, Christopher T; Briggs, Susan M; Ciraulo, David L; Frykberg, Eric R; Hammond, Jeffrey S; Hirshberg, Asher; Lhowe, David W; O'Neill, Patricia A

2007-07-01

Disaster planning and response to a mass casualty incident pose unique demands on the medical community. Because they would be required to confront many casualties with bodily injury and surgical problems, surgeons in particular must become better educated in disaster management. Compared with routine practice, triage principles in disasters require an entirely different approach to evaluation and care and often run counter to training and ethical values. An effective response to disaster and mass casualty events should focus on an "all hazards" approach, defined as the ability to adapt and apply fundamental disaster management principles universally to any mass casualty incident, whether caused by people or nature. Organizational tools such as the Incident Command System and the Hospital Incident Command System help to effect a rapid and coordinated response to specific situations. The United States federal government, through the National Response Plan, has the responsibility to respond quickly and efficiently to catastrophic incidents and to ensure critical life-saving assistance. International medical surgical response teams are capable of providing medical, surgical, and intensive care services in austere environments anywhere in the world.

Using a business rule management system to improve disposition of traumatized patients.

PubMed

Neuhaus, Philipp; Noack, Oliver; Majchrzak, Tim; Uckert, Frank

2010-01-01

We propose a business rule management system that is used to optimize the dispatchment on a mass casualty incident. Using geospatial information from available ambulances and rescue helicopters, a business rule engine calculates an optimized transportation plan for injured persons. It automatically considers special needs like ambulances equipped for baby transportation or special decontamination equipment, e.g. to deal with an accident in a chemical factory. The rules used in the system are not hardcoded; thus, it is possible to redefine them on the fly without changing the program's source code. It is possible to load and save a rule set in case of a catastrophe. Furthermore, it is possible to automatically recalculate an already planned operation if it becomes clear that the rescue vehicles assigned are needed by a person with life-threatening injuries.

Achieving the HIV Prevention Impact of Voluntary Medical Male Circumcision: Lessons and Challenges for Managing Programs

PubMed Central

Sgaier, Sema K.; Reed, Jason B.; Thomas, Anne; Njeuhmeli, Emmanuel

2014-01-01

Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009–2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection “Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up.” The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform. PMID:24800840

Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

PubMed

Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel

2014-05-01

Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.

Post-event reviews: Using a quantitative approach for analysing incident response to demonstrate the value of business continuity programmes and increase planning efficiency.

PubMed

Vaidyanathan, Karthik

2017-01-01

Business continuity management is often thought of as a proactive planning process for minimising impact from large-scale incidents and disasters. While this is true, and it is critical to plan for the worst, consistently validating plan effectiveness against smaller disruptions can enable an organisation to gain key insights about its business continuity readiness, drive programme improvements, reduce costs and provide an opportunity to quantitatively demonstrate the value of the programme to management. This paper describes a post mortem framework which is used as a continuous improvement mechanism for tracking, reviewing and learning from real-world events at Microsoft Customer Service & Support. This approach was developed and adopted because conducting regular business continuity exercises proved difficult and expensive in a complex and distributed operations environment with high availability requirements. Using a quantitative approach to measure response to incidents, and categorising outcomes based on such responses, enables business continuity teams to provide data-driven insights to leadership, change perceptions of incident root cause, and instil a higher level of confidence towards disaster response readiness and incident management. The scope of the framework discussed here is specific to reviewing and driving improvements from operational incidents. However, the concept can be extended to learning and evolving readiness plans for other types of incidents.

The Effect of Physical Therapist Involvement in the Diagnosis and Treatment of Youth and Adolescent Dancers' Injuries.

PubMed

Kinney, Susan; McCrystal, Tara; Owen, Michael; Stracciolini, Andrea; Meehan Iii, William P

2018-06-15

In studies of major dance companies that employ mostly adult dancers, measuring the effect of comprehensive medical management that includes daily on-site physical therapy has shown a decrease in the incidence of dance injuries, days missed from dance, injury-related costs, and Workers Compensation claims. As no comparable data have been collected with regard to youth and adolescent dancers, we sought to assess the effect of physical therapist involvement in the care of injuries sustained by young dancers on the incidence and amount of time missed from dancing. A cross sectional study was conducted by questionnaire of 55 students attending a US school for the arts summer dance program. Dancers ranged in age from 13 to 17 years, with a mean age of 15.0 ± 1.0. Most (87.3%) were female. Participants reported dancing a mean of 4.4 ± 2.6 hours per day prior to arrival at the program. They recorded 37 prior injuries, most of which (51.4%) were diagnosed by a physician, although a substantial proportion were diagnosed by a physical therapist (43.2%). Dancers whose injuries were diagnosed by a physician were more likely to miss dance class than those diagnosed by a physical therapist (100% vs. 50%; p = 0.014). When an injury did result in missed dance time, the median number of days missed was greater when the diagnosis was made by a physician as opposed to a physical therapist, although this finding was not statistically significant (6.0 vs. 2.5 days; p = 0.203). This supports previous literature showing a beneficial effect of health care management that involves physical therapists, especially those with expertise in dance injuries, on outcomes from dance injuries sustained by adult dancers.

Interim Consequence Management Guidance for a Wide-Area Biological Attack

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

Raber, Ellen; Kirvel, Robert; MacQueen, Don

2011-05-17

The Interagency Biological Restoration Demonstration (IBRD) program is a collaborative, interagency effort co-chaired by the Department of Homeland Security and Department of Defense aimed at improving the nation‘s ability to respond to and recover from a large-scale, wide-area, domestic attack involving the release of an environmentally persistent biological warfare agent. The program is focused on understanding interactions between the civilian and military sectors, and in building mutual support to carry out such remediations. This Interim Consequence Management Guidance document provides guidance for decisionmakers in executing activities required to respond to and recover from a biological incident affecting a wide urbanmore » area insofar as information is currently available. The spore-forming bacterium Bacillus anthracis is discussed as the biological agent of primary concern because it is the most difficult of known bioterrorism agents to inactivate and is considered to be one of the key threat agents. Most other biological threat agents are much easier to remediate, and in many cases, inactivation would occur naturally within days as a result of environmental exposure; however, the framework and operational questions that need to be addressed are expected to remain the same. The guidance in this document is applicable to (1) enclosed facilities, such as commercial, residential, and continental U.S. military facilities; (2) semi-enclosed facilities, such as subways and public transit facilities; (3) outdoor areas (both localized and wide area), such as building exteriors, streets, parks, and other open spaces; (4) drinking water facilities; and (5) drinking water sources. This document follows an interagency framework [Planning Guidance for Recovery Following Biological Incidents (DHS and EPA 2009)]—which considered Raber et al. (2002) in its development—but takes the framework to a more operational level and provides guidance at key action and decision points.« less

State-space forecasting of Schistosoma haematobium time-series in Niono, Mali.

PubMed

Medina, Daniel C; Findley, Sally E; Doumbia, Seydou

2008-08-13

Much of the developing world, particularly sub-Saharan Africa, exhibits high levels of morbidity and mortality associated with infectious diseases. The incidence of Schistosoma sp.-which are neglected tropical diseases exposing and infecting more than 500 and 200 million individuals in 77 countries, respectively-is rising because of 1) numerous irrigation and hydro-electric projects, 2) steady shifts from nomadic to sedentary existence, and 3) ineffective control programs. Notwithstanding the colossal scope of these parasitic infections, less than 0.5% of Schistosoma sp. investigations have attempted to predict their spatial and or temporal distributions. Undoubtedly, public health programs in developing countries could benefit from parsimonious forecasting and early warning systems to enhance management of these parasitic diseases. In this longitudinal retrospective (01/1996-06/2004) investigation, the Schistosoma haematobium time-series for the district of Niono, Mali, was fitted with general-purpose exponential smoothing methods to generate contemporaneous on-line forecasts. These methods, which are encapsulated within a state-space framework, accommodate seasonal and inter-annual time-series fluctuations. Mean absolute percentage error values were circa 25% for 1- to 5-month horizon forecasts. The exponential smoothing state-space framework employed herein produced reasonably accurate forecasts for this time-series, which reflects the incidence of S. haematobium-induced terminal hematuria. It obliquely captured prior non-linear interactions between disease dynamics and exogenous covariates (e.g., climate, irrigation, and public health interventions), thus obviating the need for more complex forecasting methods in the district of Niono, Mali. Therefore, this framework could assist with managing and assessing S. haematobium transmission and intervention impact, respectively, in this district and potentially elsewhere in the Sahel.

Current practice of thoracic outlet decompression surgery in the United States.

PubMed

Rinehardt, Elena K; Scarborough, John E; Bennett, Kyla M

2017-09-01

Thoracic outlet syndrome (TOS) and its management are relatively controversial topics. Most of the literature reporting the outcomes of surgical decompression for TOS derives from single-center experiences. The objective of our study was to describe the current state of TOS surgery among hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program database. Our study sample consisted of patients from the 2005 to 2014 American College of Surgeons National Surgical Quality Improvement Program database who underwent first or cervical rib resection as their index procedure and whose constellation of diagnosis and procedure codes identified them as having neurogenic, arterial, or venous TOS. Patient and procedure characteristics were determined, as were the 30-day incidence of specific complications including nerve injury. Multimodel inference was used for multivariable analysis of the composite outcome of readmission or reoperation ≤30 days. We identified 1431 patients undergoing operation for TOS: 83% for neurogenic TOS, 3% for arterial TOS, and 12% for venous TOS. Vascular surgeons performed 90% of procedures. Only four patients (0.3%) demonstrated evidence of nerve injury. The rate of bleeding complication requiring transfusion was also quite low, at 1.4%. The 30-day incidence of readmission or reoperation, or both, in our study cohort was 8.6%. The risk of this outcome was increased in patients with a higher American Society of Anesthesiologists Physical Status Classification, those whose procedure was for non-neurogenic symptoms, and those whose procedure took longer to complete. The findings of our study will provide surgeons who advocate for the surgical management of TOS with reassurance that such intervention is associated with an extremely low risk of disability resulting from iatrogenic nerve injury and major bleeding events. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

State–Space Forecasting of Schistosoma haematobium Time-Series in Niono, Mali

PubMed Central

Medina, Daniel C.; Findley, Sally E.; Doumbia, Seydou

2008-01-01

Background Much of the developing world, particularly sub-Saharan Africa, exhibits high levels of morbidity and mortality associated with infectious diseases. The incidence of Schistosoma sp.—which are neglected tropical diseases exposing and infecting more than 500 and 200 million individuals in 77 countries, respectively—is rising because of 1) numerous irrigation and hydro-electric projects, 2) steady shifts from nomadic to sedentary existence, and 3) ineffective control programs. Notwithstanding the colossal scope of these parasitic infections, less than 0.5% of Schistosoma sp. investigations have attempted to predict their spatial and or temporal distributions. Undoubtedly, public health programs in developing countries could benefit from parsimonious forecasting and early warning systems to enhance management of these parasitic diseases. Methodology/Principal Findings In this longitudinal retrospective (01/1996–06/2004) investigation, the Schistosoma haematobium time-series for the district of Niono, Mali, was fitted with general-purpose exponential smoothing methods to generate contemporaneous on-line forecasts. These methods, which are encapsulated within a state–space framework, accommodate seasonal and inter-annual time-series fluctuations. Mean absolute percentage error values were circa 25% for 1- to 5-month horizon forecasts. Conclusions/Significance The exponential smoothing state–space framework employed herein produced reasonably accurate forecasts for this time-series, which reflects the incidence of S. haematobium–induced terminal hematuria. It obliquely captured prior non-linear interactions between disease dynamics and exogenous covariates (e.g., climate, irrigation, and public health interventions), thus obviating the need for more complex forecasting methods in the district of Niono, Mali. Therefore, this framework could assist with managing and assessing S. haematobium transmission and intervention impact, respectively, in this district and potentially elsewhere in the Sahel. PMID:18698361

International Monetary Fund Programs and Tuberculosis Outcomes in Post-Communist Countries

PubMed Central

Stuckler, David; King, Lawrence P; Basu, Sanjay

2008-01-01

Background Previous studies have indicated that International Monetary Fund (IMF) economic programs have influenced health-care infrastructure in recipient countries. The post-communist Eastern European and former Soviet Union countries experienced relatively similar political and economic changes over the past two decades, and participated in IMF programs of varying size and duration. We empirically examine how IMF programs related to changes in tuberculosis incidence, prevalence, and mortality rates among these countries. Methods and Findings We performed multivariate regression of two decades of tuberculosis incidence, prevalence, and mortality data against variables potentially influencing tuberculosis program outcomes in 21 post-communist countries for which comparative data are available. After correcting for confounding variables, as well as potential detection, selection, and ecological biases, we observed that participating in an IMF program was associated with increased tuberculosis incidence, prevalence, and mortality rates by 13.9%, 13.2%, and 16.6%, respectively. Each additional year of participation in an IMF program was associated with increased tuberculosis mortality rates by 4.1%, and each 1% increase in IMF lending was associated with increased tuberculosis mortality rates by 0.9%. On the other hand, we estimated a decrease in tuberculosis mortality rates of 30.7% (95% confidence interval, 18.3% to 49.5%) associated with exiting the IMF programs. IMF lending did not appear to be a response to worsened health outcomes; rather, it appeared to be a precipitant of such outcomes (Granger- and Sims-causality tests), even after controlling for potential political, socioeconomic, demographic, and health-related confounders. In contrast, non-IMF lending programs were connected with decreased tuberculosis mortality rates (−7.6%, 95% confidence interval, −1.0% to −14.1%). The associations observed between tuberculosis mortality and IMF programs were similar to those observed when evaluating the impact of IMF programs on tuberculosis incidence and prevalence. While IMF programs were connected with large reductions in generalized government expenditures, tuberculosis program coverage, and the number of physicians per capita, non-IMF lending programs were not significantly associated with these variables. Conclusions IMF economic reform programs are associated with significantly worsened tuberculosis incidence, prevalence, and mortality rates in post-communist Eastern European and former Soviet countries, independent of other political, socioeconomic, demographic, and health changes in these countries. Future research should attempt to examine how IMF programs may have related to other non-tuberculosis–related health outcomes. PMID:18651786

Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy: a world-wide survey.

PubMed

Cheah, Yee Lee; Simpson, Mary Ann; Pomposelli, James J; Pomfret, Elizabeth A

2013-05-01

The incidence of morbidity and mortality after living donor liver transplantation (LDLT) is not well understood because reporting is not standardized and relies on single-center reports. Aborted hepatectomies (AHs) and potentially life-threatening near-miss events (during which a donor's life may be in danger but after which there are no long-term sequelae) are rarely reported. We conducted a worldwide survey of programs performing LDLT to determine the incidence of these events. A survey instrument was sent to 148 programs performing LDLT. The programs were asked to provide donor demographics, case volumes, and information about graft types, operative morbidity and mortality, near-miss events, and AHs. Seventy-one programs (48%), which performed donor hepatectomy 11,553 times and represented 21 countries, completed the survey. The average donor morbidity rate was 24%, with 5 donors (0.04%) requiring transplantation. The donor mortality rate was 0.2% (23/11,553), with the majority of deaths occurring within 60 days, and all but 4 deaths were related to the donation surgery. The incidences of near-miss events and AH were 1.1% and 1.2%, respectively. Program experience did not affect the incidence of donor morbidity or mortality, but near-miss events and AH were more likely in low-volume programs (≤50 LDLT procedures). In conclusion, it appears that independently of program experience, there is a consistent donor mortality rate of 0.2% associated with LDLT donor procedures, yet increased experience is associated with lower rates of AH and near-miss events. Potentially life-threatening near-miss events and AH are underappreciated complications that must be discussed as part of the informed consent process with any potential living liver donor. Copyright © 2012 American Association for the Study of Liver Diseases.

An aggression policy that works.

PubMed

Kitchener, Denby A; Sykes, Sharon R; McEwan, Allan G

2004-12-13

In 1999, a survey of the clinical staff in Royal Darwin Hospital showed that most instances of aggressive and abusive behaviour by patients or visitors occurring in the hospital went unreported because staff believed there would not be any follow-up investigation or action taken by management, Australia. In response, a hospital working party was formed to develop and implement an aggression management policy with practical effective strategies. The principal tool used was an Action Plan that delineated an immediate response to the aggression, as well as long-term strategies such as negotiated care and behaviour modification programs. An advocate is provided for the patient and debriefing for staff members. If the aggressive behaviour continues, early discharge of the patient could be initiated. The fundamental principle of the policy is to prevent fostering a culture of acceptance of aggressive behaviour through appropriate early intervention. In 2002, a follow-up survey showed that 82% of aggressive incidents were being reported and dealt with by management in a timely manner -- a significant improvement.

Crisis management during anaesthesia: obstruction of the natural airway.

PubMed

Visvanathan, T; Kluger, M T; Webb, R K; Westhorpe, R N

2005-06-01

Obstruction of the natural airway, while usually easily recognised and managed, may present simply as desaturation, have an unexpected cause, be very difficult to manage, and have serious consequences for the patient. To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for obstruction of the natural airway, in the management of acute airway obstruction occurring in association with anaesthesia. The potential performance for this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. There were 62 relevant incidents among the first 4000 reports to the AIMS. It was considered that the correct use of the structured approach would have led to earlier recognition of the problem and/or better management in 11% of cases. Airway management is a fundamental anaesthetic responsibility and skill. Airway obstruction demands a rapid and organised approach to its diagnosis and management and undue delay usually results in desaturation and a potential threat to life. An uncomplicated pre-learned sequence of airway rescue instructions is an essential part of every anaesthetist's clinical practice requirements.

Final Documentation: Incident Management And Probabilities Courses of action Tool (IMPACT).

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

Edwards, Donna M.; Ray, Jaideep; Tucker, Mark D.

This report pulls together the documentation produced for the IMPACT tool, a software-based decision support tool that provides situational awareness, incident characterization, and guidance on public health and environmental response strategies for an unfolding bio-terrorism incident.

Providing Health Care in the Shadow of Violence: Does Emotion Regulation Vary Among Hospital Workers From Different Professions?

PubMed

Goldblatt, Hadass; Freund, Anat; Drach-Zahavy, Anat; Enosh, Guy; Peterfreund, Ilana; Edlis, Neomi

2017-03-01

Research into violence against health care staff by patients and their families within the health care services shows a rising frequency of incidents. The potentially damaging effects on health care staff are extensive, including diverse negative psychological and physical symptoms. The aim of this qualitative study was to examine how hospital workers from different professions reacted to patients' and visitors' violence against them or their colleagues, and how they regulated their emotional reactions during those incidents. The research question was as follows: How do different types of hospital workers regulate the range of their emotional reactions during and after violent events? Participants were 34 hospital workers, representing several professional sectors. Data were collected through in-depth semistructured interviews, which were later transcribed and thematically content analyzed. Five themes were revealed, demonstrating several tactics that hospital workers used to regulate their emotions during incidents of violent outbursts by patients or visitors: (1) Inability to Manage Emotion Regulation, (2) Emotion Regulation by Distancing and Disengagement Tactics, (3) Emotion Regulation Using Rationalization and Splitting Tactics, (4) Emotion Regulation via the Use of Organizational Resources, and (5) Controlling Emotions by Suppression. Hospital workers who experienced dissonance between their professional expectations and their emotional reactions to patients' violence reported using various emotion regulation tactics, consequently managing to fulfill their duty competently. Workers who did not experience such dissonance felt in full control of their emotions and did not manifest responses of emotion regulation. Others, however, experienced intense emotional flooding and failed to regulate their emotions. We recommend developing health care staff's awareness of possible emotional implications of violent incidents, for themselves as people and for their intact functioning at work. In addition, we recommend further development of health care staff training programs for coping with violent patients and enhancement of formal and informal organizational support.

The Evolution of the Federal Monitoring and Assessment Center

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

NSTec Aerial Measurement System

2012-07-31

The Federal Radiological Monitoring and Assessment Center (FRMAC) is a federal emergency response asset whose assistance may be requested by the Department of Homeland Security (DHS), the Department of Defense (DoD), the Environmental Protection Agency (EPA), the Nuclear Regulatory Commission (NRC), and state and local agencies to respond to a nuclear or radiological incident. It is an interagency organization with representation from the Department of Energy’s National Nuclear Security Administration (DOE/NNSA), the Department of Defense (DoD), the Environmental Protection Agency (EPA), the Department of Health and Human Services (HHS), the Federal Bureau of Investigation (FBI), and other federal agencies. FRMAC,more » in its present form, was created in 1987 when the radiological support mission was assigned to the DOE’s Nevada Operations Office by DOE Headquarters. The FRMAC asset, including its predecessor entities, was created, grew, and evolved to function as a response to radiological incidents. Radiological emergency response exercises showed the need for a coordinated approach to managing federal emergency monitoring and assessment activities. The mission of FRMAC is to coordinate and manage all federal radiological environmental monitoring and assessment activities during a nuclear or radiological incident within the United States in support of state,local, tribal governments, DHS, and the federal coordinating agency. Radiological emergency response professionals with the DOE’s national laboratories support the Radiological Assistance Program (RAP), National Atmospheric Release Advisory Center (NARAC), the Aerial MeasuringSystem (AMS), and the Radiation Emergency Assistance Center/Training Site (REAC/TS). These teams support the FRMAC to provide: Atmospheric transport modeling; Radiation monitoring; Radiological analysis and data assessments; and Medical advice for radiation injuries In support of field operations, the FRMAC provides geographic information systems, communications, mechanical, electrical, logistics, and administrative support. The size of the FRMAC is tailored to the incident and is comprised of emergency response professionals drawn from across the federal government. State and local emergency response teams may also integrate their operations with FRMAC, but are not required to.« less

Risk management of extravasation of cytostatic drugs at the Adult Chemotherapy Outpatient Clinic of a university hospital.

PubMed

Adami, Nilce Piva; de Gutiérrez, Maria Gaby Rivero; da Fonseca, Selma Montosa; de Almeida, Elizabeth Pinto Magalhães

2005-08-01

To verify the incidence of extravasation of cytostatic drugs in patients treated on an outpatient basis at a university hospital in the city of São Paulo, Brazil, during the period from 1998 to 2002, and to assess the quality of care provided by the nursing team using a protocol adopted for the treatment of this adverse event as a parameter. The movement for quality in healthcare services has been a recent event in Brazil, mainly as the result of the Brazilian Program of Hospital Accreditation instituted in 1998. Considering the emphasis on risk management, it is important to mention the monitoring of the occurrence of extravasations of cytostatic drugs in order to improve the quality of nursing care provided to cancer patients. An evaluative study with a descriptive, prospective and longitudinal design was conducted, based on the documentary analysis of the notification of 216 extravasations of vesicant and irritant drugs that occurred between 1998 and 2002 and the corresponding prescriptions of cold or hot compresses. The mean incidence of extravasations ranged from 0.2 to 1.4% over the five years of the study. Incorrect prescription of the type of compress was observed for three patients. Undesired effects were ulcers caused by the extravasation of vinblastine and dacarbazine in two cases. The low incidence of both extravasation and tissue damage demonstrates the adequate quality of nursing care provided to cancer patients at the outpatient clinic studied. However, the identification of the lack of 12 records of thermal treatment and of three erroneous prescriptions requires the implementation of educational measures to prevent these types of incident. The relevance of this study to clinical practice is to increase the awareness and involvement of the nursing team in the maintenance of a continuous surveillance system of the process and results of chemotherapy administration in order to increase the quality of care and the safety of the patient.

WSES guidelines for management of Clostridium difficile infection in surgical patients.

PubMed

Sartelli, Massimo; Malangoni, Mark A; Abu-Zidan, Fikri M; Griffiths, Ewen A; Di Bella, Stefano; McFarland, Lynne V; Eltringham, Ian; Shelat, Vishal G; Velmahos, George C; Kelly, Ciarán P; Khanna, Sahil; Abdelsattar, Zaid M; Alrahmani, Layan; Ansaloni, Luca; Augustin, Goran; Bala, Miklosh; Barbut, Frédéric; Ben-Ishay, Offir; Bhangu, Aneel; Biffl, Walter L; Brecher, Stephen M; Camacho-Ortiz, Adrián; Caínzos, Miguel A; Canterbury, Laura A; Catena, Fausto; Chan, Shirley; Cherry-Bukowiec, Jill R; Clanton, Jesse; Coccolini, Federico; Cocuz, Maria Elena; Coimbra, Raul; Cook, Charles H; Cui, Yunfeng; Czepiel, Jacek; Das, Koray; Demetrashvili, Zaza; Di Carlo, Isidoro; Di Saverio, Salomone; Dumitru, Irina Magdalena; Eckert, Catherine; Eckmann, Christian; Eiland, Edward H; Enani, Mushira Abdulaziz; Faro, Mario; Ferrada, Paula; Forrester, Joseph Derek; Fraga, Gustavo P; Frossard, Jean Louis; Galeiras, Rita; Ghnnam, Wagih; Gomes, Carlos Augusto; Gorrepati, Venkata; Ahmed, Mohamed Hassan; Herzog, Torsten; Humphrey, Felicia; Kim, Jae Il; Isik, Arda; Ivatury, Rao; Lee, Yeong Yeh; Juang, Paul; Furuya-Kanamori, Luis; Karamarkovic, Aleksandar; Kim, Peter K; Kluger, Yoram; Ko, Wen Chien; LaBarbera, Francis D; Lee, Jae Gil; Leppaniemi, Ari; Lohsiriwat, Varut; Marwah, Sanjay; Mazuski, John E; Metan, Gokhan; Moore, Ernest E; Moore, Frederick Alan; Nord, Carl Erik; Ordoñez, Carlos A; Júnior, Gerson Alves Pereira; Petrosillo, Nicola; Portela, Francisco; Puri, Basant K; Ray, Arnab; Raza, Mansoor; Rems, Miran; Sakakushev, Boris E; Sganga, Gabriele; Spigaglia, Patrizia; Stewart, David B; Tattevin, Pierre; Timsit, Jean Francois; To, Kathleen B; Tranà, Cristian; Uhl, Waldemar; Urbánek, Libor; van Goor, Harry; Vassallo, Angela; Zahar, Jean Ralph; Caproli, Emanuele; Viale, Pierluigi

2015-01-01

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

Managing multiple-casualty incidents: a rural medical preparedness training assessment.

PubMed

Glow, Steven D; Colucci, Vincent J; Allington, Douglas R; Noonan, Curtis W; Hall, Earl C

2013-08-01

The objectives of this study were to develop a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together using Microsoft Visio, images from Google Earth and icons representing first responders, equipment resources, local hospital emergency department bed capacity, and trauma victims. The authors also tested participants' knowledge in the areas of communications, incident command systems (ICS), and triage. Participants attended Managing Multiple-Casualty Incidents (MCIs), a one-day training which offered pre- and post-tests, two one-hour functional exercises, and four distinct, one-hour didactic instructional periods. Two MCI functional exercises were conducted. The one-hour trainings focused on communications, National Incident Management Systems/Incident Command Systems (NIMS/ICS) and professional roles and responsibilities in NIMS and triage. The trainings were offered throughout communities in western Montana. First response resource inventories and general manpower statistics for fire, police, Emergency Medical Services (EMS), and emergency department hospital bed capacity were determined prior to MCI scenario construction. A test was given prior to and after the training activities. A total of 175 firefighters, EMS, law enforcement, hospital personnel or other first-responders completed the pre- and post-test. Firefighters produced higher baseline scores than all other disciplines during pre-test analysis. At the end of the training all disciplines demonstrated significantly higher scores on the post-test when compared with their respective baseline averages. Improvements in post-test scores were noted for participants from all disciplines and in all didactic areas: communications, NIMS/ICS, and triage. Mass-casualty incidents offer significant challenges for prehospital and emergency room workers. Fire, Police and EMS personnel must secure the scene, establish communications, define individuals' roles and responsibilities, allocate resources, triage patients, and assign transport priorities. After emergency department notification and in advance of arrival, emergency department personnel must assess available physical resources and availability and type of manpower, all while managing patients already under their care. Mass-casualty incident trainings should strengthen the key, individual elements essential to well-coordinated response such as communications, incident management system and triage. The practice scenarios should be matched to the specific resources of the community. The authors also believe that these trainings should be provided with all disciplines represented to eliminate training "silos," to allow for discussion of overlapping jurisdictional or organizational responsibilities, and to facilitate team building.

Organization, relational justice and absenteeism.

PubMed

Stoetzer, Ulrich; Åborg, Carl; Johansson, Gun; Svartengren, Magnus

2014-01-01

There is a need for more knowledge on how to manage companies towards healthier and more prosperous organizations with low levels of absenteeism. Relational Justice can be a useful concept when managing such organizations. Organizational factors can help to explain why some companies have relatively low absenteeism rates, even though they are equal to other companies in many other aspects. Previous studies suggest that management may be one important factor. Efficient management may depend on good relations between the leaders and the employees. The concept of Relational Justice is designed to capture these relations. Consequently, a Relational Justice framework may be used to understand why some companies have a low incidence of absenteeism. Managers from a representative body of Swedish companies. Interviews were analyzed to explore whether the items representing the concept of Relational Justice can be used to further understand the strategies, procedures and structures that characterize organizations and management in companies with a low incidence of absenteeism. Strategies, procedures or principles related to Relational Justice were common and highlighted in companies with an incidence of absenteeism. The most frequently occurring factors were; to be treated with kindness and consideration, personal viewpoint considered and to be treated impartially. The results suggested that a Relational Justice framework could be used to increase understanding of the organizational and managerial factors typical for companies with a low incidence of absenteeism. A Relational Justice approach to organizational management may be used to successfully lower absenteeism, change organizations and promote healthy and prosperous companies.

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

NASA Technical Reports Server (NTRS)

Reynard, W. D.

1983-01-01

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

Note on the artefacts in SRIM simulation of sputtering

NASA Astrophysics Data System (ADS)

Shulga, V. I.

2018-05-01

The computer simulation program SRIM, unlike other well-known programs (MARLOWE, TRIM.SP, etc.), predicts non-zero values of the sputter yield at glancing ion bombardment of smooth amorphous targets and, for heavy ions, greatly underestimates the sputter yield at normal incidence. To understand the reasons for this, the sputtering of amorphous silicon bombarded with different ions was modeled here using the author's program OKSANA. Most simulations refer to 1 keV Xe ions, and angles of incidence cover range from 0 (normal incidence) to almost 90°. It has been shown that SRIM improperly simulates the initial stage of the sputtering process. Some other artefacts in SRIM calculations of sputtering are also revealed and discussed.

A phase II study of HMB/Arg/Gln against oral mucositis induced by chemoradiotherapy for patients with head and neck cancer.

PubMed

Yokota, Tomoya; Hamauchi, Satoshi; Yoshida, Yukio; Yurikusa, Takashi; Suzuki, Miho; Yamashita, Aiko; Ogawa, Hirofumi; Onoe, Tsuyoshi; Mori, Keita; Onitsuka, Tetsuro

2018-04-07

This phase II trial assessed the clinical benefit of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine (HMB/Arg/Gln) for preventing chemoradiotherapy (CRT)-induced oral mucositis (OM) in patients with head and neck cancer (HNC). Patients with HNC receiving definitive or postoperative cisplatin-based CRT were enrolled. HMB/Arg/Gln was administered orally or per percutaneous endoscopic gastrostomy from the first day of CRT up to its completion. All patients received opioid-based pain control and oral care programs that we previously reported. The primary endpoint was the incidence of grade ≥ 3 OM (functional/symptomatic) according to the Common Terminology Criteria of Adverse Events version 3.0. Quality of life (EORTC QLQ-C30/PROMS) at baseline and upon radiotherapy at a dosage of 50 Gy were assessed. Thirty-five patients with HNC were enrolled. Sixteen of them (45.7%) developed grade ≥ 3 OM (i.e., functional/symptomatic). The incidence of grade ≤ 1 OM (functional/symptomatic) was 51.5% at 2 weeks and 82.9% at 4 weeks after radiotherapy completion. Clinical examination revealed that 10 patients (28.6%) developed grade ≥ 3 OM. The incidence of grade ≤ 1 OM (clinical exam) was 80.0% at 2 weeks and 100% at 4 weeks after radiotherapy completion. Adverse events related to HMB/Arg/Gln were an increase in blood urea nitrogen and diarrhea, but were easily managed. The addition of HMB/Arg/Gln to opioid-based pain control and oral care programs was feasible but still insufficient at reducing the incidence of CRT-induced severe OM. However, the benefit of HMB/Arg/Gln should not be neglected given the findings of clinical examinations and the rapid recovery from severe OM. UMIN000016453.

Reducing hospital-acquired heel ulcer rates in an acute care facility: an evaluation of a nurse-driven performance improvement project.

PubMed

McElhinny, Mary Louise; Hooper, Christine

2008-01-01

A nurse-driven performance improvement project designed to reduce the incidence of hospital-acquired ulcers of the heel in an acute care setting was evaluated. This was a descriptive evaluative study using secondary data analysis. Data were collected in 2004, prior to implementation of the prevention project and compared to results obtained in 2006, after the project was implemented. Data were collected in a 172-bed, not-for-profit inpatient acute care facility in North Central California. All medical-surgical inpatients aged 18 years and older were included in the samples. Data were collected on 113 inpatients prior to implementation of the project in 2004. Data were also collected on a sample of 124 inpatients in 2006. The prevalence and incidence of heel pressure ulcers were obtained through skin surveys prior to implementation of the prevention program and following its implementation. Results from 2004 were compared to data collected in 2006 after introduction of the Braden Scale for Predicting Pressure Sore Risk. Heel pressure ulcers were staged using the National Pressure Ulcer Advisory Panel (NPUAP) staging system and recommendations provided by the Agency for Health Care Quality Research (AHRQ) clinical practice guidelines. The incidence of hospital-acquired heel pressure ulcers in 2004 was 13.5% (4 of 37 patients). After implementation of the program in 2006, the incidence of hospital-acquired heel pressure ulcers was 13.8% (5 of 36 patients). The intervention did not appear to receive adequate staff nurse support needed to make the project successful. Factors that influenced the lack of support may have included: (1) educational method used, (2) lack of organization approved, evidenced-based standardized protocols for prevention and treatment of heel ulcers, and (3) failure of facility management to convey the importance as well as their support for the project.

APA national audit of pediatric opioid infusions.

PubMed

Morton, Neil S; Errera, Agata

2010-02-01

A prospective audit of neonates, infants, and children receiving opioid infusion techniques managed by pediatric acute pain teams from across the United Kingdom and Eire was undertaken over a period of 17 months. The aim was to determine the incidence, nature, and severity of serious clinical incidents (SCIs) associated with the techniques of continuous opioid infusion, patient-controlled analgesia, and nurse-controlled analgesia in patients aged 0-18. The audit was funded by the Association of Paediatric Anaesthetists (APA) and performed by the acute pain services of 18 centers throughout the United Kingdom. Data were submitted weekly via a web-based return form designed by the Document Capture Company that documented data on all patients receiving opioid infusions and any SCIs. Eight categories of SCI were identified in advance, and the reported SCIs were graded in terms of severity (Grade 1 (death/permanent harm); Grade 2 (harm but full recovery and resulting in termination of the technique or needing significant intervention); Grade 3 (potential but no actual harm). Data were collected over a period of 17 months (25/06/07-25/11/08) and stored on a secure server for analysis. Forty-six SCIs were reported in 10 726 opioid infusion techniques. One Grade 1 incident (1 : 10,726) of cardiac arrest occurred and was associated with aspiration pneumonitis and the underlying neurological condition, neurocutaneous melanosis. Twenty-eight Grade 2 incidents (1 : 383) were reported of which half were respiratory depression. The seventeen Grade 3 incidents (1 : 631) were all drug errors because of programming or prescribing errors and were all reported by one center. The overall incidence of 1 : 10,000 of serious harm with opioid infusion techniques in children is comparable to the risks with pediatric epidural infusions and central blocks identified by two recent UK national audits (1,2). Avoidable factors were identified including prescription and pump programming errors, use of concurrent sedatives or opioids by different routes and overgenerous dosing in infants. Early respiratory depression in patients with specific risk factors, such as young age, neurodevelopmental, respiratory, or cardiac comorbidities, who are receiving nurse-controlled analgesia or continuous opioid infusion suggests that closer monitoring for at least 2 h is needed for these cases. As a result of this audit, we can provide parents with better information on relative risks to help the process of informed consent.

Soccer Injuries in Players Aged 7 to 12 Years: A Descriptive Epidemiological Study Over 2 Seasons.

PubMed

Rössler, Roland; Junge, Astrid; Chomiak, Jiri; Dvorak, Jiri; Faude, Oliver

2016-02-01

As part of a risk-management approach, sound epidemiological data are needed to develop prevention programs. A recent review on soccer injuries of players younger than 19 years concluded that prospective data concerning children are lacking. To analyze the incidence and characteristics of soccer injuries in children aged 7 to 12 years. Descriptive epidemiological study. The present survey was a prospective descriptive epidemiological study on soccer injuries over 2 seasons in the Czech Republic and Switzerland. Exposure of players during training and match play (in hours) and injury data were reported by coaches via an Internet-based registration system. Location, type, and severity of injuries were classified according to an established consensus. Injury characteristics are presented as absolute numbers and injury incidence rates (injuries per 1000 hours of soccer exposure). An injury was defined as any physical complaint sustained during a scheduled training session or match play resulting in at least 1 of the following: (1) inability to complete the current match or training session, (2) absence from subsequent training sessions or matches, and (3) injury requiring medical attention. In total, 6038 player-seasons with 395,295 hours of soccer exposure were recorded. The mean (±SD) age of the players was 9.5 ± 2.0 years, and 3.9% of the participants were girls. A total of 417 injuries were reported. Most (76.3%) injuries were located in the lower limbs, with 15.6% located in the upper limbs. Joint and ligament injuries comprised 30.5%, contusions 22.5%, muscle and tendon injuries 18.5%, and fractures and bone injuries 15.4% of all injuries; 23.7% of injuries led to more than 28 days of absence from sport participation. The overall injury incidence was 0.61 (95% CI, 0.53-0.69) injuries per 1000 hours of soccer exposure during training sessions and 4.57 (95% CI, 4.00-5.23) during match play. Injury incidence rates increased with increasing age. The observed injury incidences were lower compared with studies in youth players. Children showed a relatively high proportion of fractures and bone stress and of injuries to the upper limbs. The study provides an evidence base for injury incidence rates and injury characteristics in children's soccer. These data are the basis to develop an age-specific injury-prevention program. © 2015 The Author(s).

Student Incivility in Radiography Education.

PubMed

Clark, Kevin R

2017-07-01

To examine student incivility in radiography classrooms by exploring the prevalence of uncivil behaviors along with the classroom management strategies educators use to manage and prevent classroom disruptions. A survey was designed to collect data on the severity and frequency of uncivil student behaviors, classroom management strategies used to address minor and major behavioral issues, and techniques to prevent student incivility. The participants were educators in radiography programs accredited by the Joint Review Committee on Education in Radiologic Technology. Findings indicated that severe uncivil student behaviors in radiography classrooms do not occur as often as behaviors classified as less severe. Radiography educators in this study used a variety of strategies and techniques to manage and prevent student incivility; however, radiography educators who received formal training in classroom management reported fewer incidents of student incivility than those who had not received formal training. The participants in this study took a proactive approach to addressing severe behavioral issues in the classroom. Many radiography educators transition from the clinical environment to the classroom setting with little to no formal training in classroom management. Radiography educators are encouraged to attend formal training sessions to learn how to manage the higher education classroom effectively. Student incivility is present in radiography classrooms. This study provides a foundation for future research on incivility. ©2017 American Society of Radiologic Technologists.

Problem solving for breast health care delivery in low and middle resource countries (LMCs): consensus statement from the Breast Health Global Initiative.

PubMed

Harford, Joe B; Otero, Isabel V; Anderson, Benjamin O; Cazap, Eduardo; Gradishar, William J; Gralow, Julie R; Kane, Gabrielle M; Niëns, Laurens M; Porter, Peggy L; Reeler, Anne V; Rieger, Paula T; Shockney, Lillie D; Shulman, Lawrence N; Soldak, Tanya; Thomas, David B; Thompson, Beti; Winchester, David P; Zelle, Sten G; Badwe, Rajendra A

2011-04-01

International collaborations like the Breast Health Global Initiative (BHGI) can help low and middle income countries (LMCs) to establish or improve breast cancer control programs by providing evidence-based, resource-stratified guidelines for the management and control of breast cancer. The Problem Solving Working Group of the BHGI 2010 Global Summit met to develop a consensus statement on problem-solving strategies addressing breast cancer in LMCs. To better assess breast cancer burden in poorly studied populations, countries require accurate statistics regarding breast cancer incidence and mortality. To better identify health care system strengths and weaknesses, countries require reasonable indicators of true health system quality and capacity. Using qualitative and quantitative research methods, countries should formulate cancer control strategies to identify both system inefficiencies and patient barriers. Patient navigation programs linked to public advocacy efforts feed and strengthen functional early detection and treatment programs. Cost-effectiveness research and implementation science are tools that can guide and expand successful pilot programs. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Impact of Local Environmental Health Capacity on Foodborne Illness Morbidity in Maryland

PubMed Central

Resnick, Beth A.; Fox, Mary A.; McGready, John; Yager, James P.; Burke, Thomas A.

2011-01-01

Objectives. We evaluated the relationship between local food protection capacity and service provision in Maryland's 24 local food protection programs (FPPs) and incidence of foodborne illness at the county level. Methods. We conducted regression analyses to determine the relationship between foodborne illness and local FPP characteristics. We used the Centers for Disease Control and Prevention's FoodNet and Maryland Department of Health and Mental Hygiene outbreak data set, along with data on Maryland's local FPP capacity (workforce size and experience levels, budget) and service provision (food service facility inspections, public notification programs). Results. Counties with higher capacity, such as larger workforce, higher budget, and greater employee experience, had fewer foodborne illnesses. Counties with better performance and county-level regulations, such as high food service facility inspection rates and requiring certified food manager programs, respectively, had lower rates of illness. Conclusions. Counties with strong local food protection capacity and services can protect the public from foodborne illness. Research on public health services can enhance our understanding of the food protection infrastructure, and the effectiveness of food protection programs in preventing foodborne illness. PMID:21750282

The Effects of a Home-Based Connective Tissue Targeting Therapy on Hip Development in Children With Cerebral Palsy: Six Case Reports.

PubMed

Drewes, Erika; Driscoll, Mark; Blyum, Leonid; Vincentz, Diane

2016-01-01

Hip subluxation in children with Cerebral Palsy (CP) has an incidence of 10-30 %, and children with severe CP having the highest incidence. The condition deteriorates if left untreated. Surgery is the most common method used in managing hip subluxation because standard conservative therapies do not improve it. Surgery may have to be repeated and comes at a biological cost to the child. A new home-based CAM, Advanced Biomechanical Rehabilitation (ABR), has shown encouraging results leading to improved spinal stability and stability in sitting in children with severe CP. This case report examines hip development over time in six children with severe CP in the ABR Program. Changes in their clinical picture and pelvic X-Rays are reported. ABR appeared to help stabilize and improve hip subluxation, resulting in these children not requiring further surgical intervention. These findings warrant further investigation of ABR as a noninvasive therapy for hip subluxation. Copyright © 2016 Elsevier Inc. All rights reserved.

The Impact of Colorectal Cancer (CRC) in Mississippi, and the need for Mississippi to Eliminate its CRC Burden.

PubMed

Duhé, Roy J

2016-03-01

Colorectal cancer (CRC), while highly preventable and highly treatable, is a major public health problem in Mississippi. This article reviews solutions to this problem, beginning with the relationship between modifiable behavioral risk factors and CRC incidence. It then describes the impact of CRC screening on national downward trends in CRC incidence and mortality and summarizes recent data on the burden of CRC in Mississippi. While other states have created Comprehensive Colorectal Cancer Control Programs in an organized effort to manage this public health problem, Mississippi has not. Responding to Mississippi's situation, the 70x2020 Colorectal Cancer Screening Initiative arose as an unconventional approach to increase CRC screening rates throughout the state. This article concludes by considering the current limits of CRC treatment success and proposes that improved clinical outcomes should result from research to translate recently-identified colorectal cancer subtype information into novel clinical paradigms for the treatment of early-stage colorectal cancer.

[Design and implementation of Geographical Information System on prevention and control of cholera].

PubMed

Li, Xiu-jun; Fang, Li-qun; Wang, Duo-chun; Wang, Lu-xi; Li, Ya-pin; Li, Yan-li; Yang, Hong; Kan, Biao; Cao, Wu-chun

2012-04-01

To build the Geographical Information System (GIS) database for prevention and control of cholera programs as well as using management analysis and function demonstration to show the spatial attribute of cholera. Data from case reporting system regarding diarrhoea, vibrio cholerae, serotypes of vibrio cholerae at the surveillance spots and seafoods, as well as surveillance data on ambient environment and climate were collected. All the data were imported to system database to show the incidence of vibrio cholerae in different provinces, regions and counties to support the spatial analysis through the spatial analysis of GIS. The epidemic trends of cholera, seasonal characteristics of the cholera and the variation of the vibrio cholerae with times were better understood. Information on hotspots, regions and time of epidemics was collected, and helpful in providing risk prediction on the incidence of vibrio cholerae. The exploitation of the software can predict and simulate the spatio-temporal risks, so as to provide guidance for the prevention and control of the disease.

End-stage renal failure in type 2 diabetes: A medical catastrophe of worldwide dimensions.

PubMed

Ritz, E; Rychlík, I; Locatelli, F; Halimi, S

1999-11-01

The incidence of patients with end-stage renal failure and diabetes mellitus type 2 as a comorbid condition has increased progressively in the past decades, first in the United States and Japan, but subsequently in all countries with a western lifestyle. Although there are explanations for this increase, the major factor is presumably diminishing mortality from hypertension and cardiovascular causes, so that patients survive long enough to develop nephropathy and end-stage renal failure. This review summarizes the striking differences between countries against the background of a similar tendency of an increasing incidence in all countries. Survival on renal replacement therapy continues to be substantially worse for patients with type 2 diabetes. A major reason for this observation is that patients enter renal replacement programs with cardiovascular morbidity acquired in the preterminal phase of renal failure. It is argued that the challenge for the future will be better patient management in earlier phases of diabetic nephropathy to attenuate or prevent progression, as well as cardiovascular complications.

An Examination of Bias Incident Response at Postsecondary Institutions

ERIC Educational Resources Information Center

Gonyer, Howard A.

2017-01-01

The purpose of this general inductive study was to understand how senior student affairs officers (SSAOs) have managed the response to bias on college campuses. The literature is clear about the negative effects of bias on targeted populations; however, there is a large gap in the literature when it comes to how bias incidents are managed. The…

Corporate crisis management managing a major crisis in a chemical facility.

PubMed

Marwitz, Steve; Maxson, Neil; Koch, Bill; Aukerman, Todd; Cassidy, Jim; Belonger, David

2008-11-15

Chemical sites should have well trained and organized emergency response plans to manage an incident within the plant or during transport. The implementation of an incident command system utilizing either internal resources or external response through mutual aid agreements is generally sufficient to address the direct impact of an event on the site. When the site resources become overwhelmed in addressing resulting issues such as press releases, medical advice/support, employees and family support, Agency notifications, etc, Corporate should be ready and able to respond. This paper, taken from an in-depth CCPS workshop led by the author, describes an outline for corporate assistance in the event of a major incident at a site or during transportation.

[Breast cancer incidence related with a population-based screening program].

PubMed

Natal, Carmen; Caicoya, Martín; Prieto, Miguel; Tardón, Adonina

2015-02-20

To compare breast cancer cumulative incidence, time evolution and stage at diagnosis between participants and non-participant women in a population-based screening program. Cohort study of breast cancer incidence in relation to participation in a population screening program. The study population included women from the target population of the screening program. The source of information for diagnostics and stages was the population-based cancer registry. The analysis period was 1999-2010. The Relative Risk for invasive, in situ, and total cancers diagnosed in participant women compared with non-participants were respectively 1.16 (0.94-1.43), 2.98 (1.16-7.62) and 1.22 (0.99-1.49). The Relative Risk for participants versus non-participants was 2.47 (1.55-3.96) for diagnosis at stagei, 2.58 (1.67-3.99) for T1 and 2.11 (1.38-3.23) for negative lymph node involvement. The cumulative incidence trend had two joint points in both arms, with an Annual Percent of Change of 92.3 (81.6-103.5) between 1999-2001, 18.2 (16.1-20.3) between 2001-2005 and 5.9 (4.0-7.8) for the last period in participants arm, and 72.6 (58.5-87.9) between 1999-2001, 12.6 (7.9-17.4) between 2001-2005, and 8.6 (6.5-10.6) in the last period in the non-participant arm. Participating in the breast cancer screening program analyzed increased the in situ cumulative cancer incidence, but not the invasive and total incidence. Diagnoses were earlier in the participant arm. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

[Evaluation of the incidence of dental caries in patients with Down syndrome after their insertion in a preventive program].

PubMed

Castilho, Aline Rogéria Freire de; Marta, Sara Nader

2010-10-01

The objective of this work was to verify the incidence of dental caries by means of the CPO-D, CPO-S, ceo-d and ceo-s indexes in patients with Down syndrome regularly enrolled in a preventive program. Twenty four Down syndrome patients of both sexes age range of one to 48 years were examined. The prevalence (initial experimental situation) and incidence (final experimental situation) of dental caries were verified using of the initial and final CPO-D, CPO-S, ceo-d and ceo-s indexes of the participants. From 24 individual examined, 10 (42.0%) were free of caries. The prevalence of dental caries showed values of CPO-D= 2.33; CPO-S= 3.60; ceo-d= 1.75 e ceo-s= 2.80; while the incidence of caries showed values of 2.33; 3.80; 1.10 e 1.90, respectively. Down syndrome individuals evaluated in this study presented low level of caries and small incidence of new lesions, emphasizing the importance of the maintenance of these patients at preventive programs.

Intraoperative crisis resource management during a non-intubated video-assisted thoracoscopic surgery

PubMed Central

Gálvez, Carlos; Rivera-Cogollos, María Jesus; Galiana-Ivars, María; Bolufer, Sergio; Martínez-Adsuar, Francisco

2015-01-01

The management of surgical and medical intraoperative emergencies are included in the group of high acuity (high potential severity of an event and the patient impact) and low opportunity (the frequency in which the team is required to manage the event). This combination places the patient into a situation where medical errors could happen more frequently. Although medical error are ubiquitous and inevitable we should try to establish the necessary knowledge, skills and attitudes needed for effective team performance and to guide the development of a critical event. This strategy would probably reduce the incidence of error and improve decision-making. The way to apply it comes from the application of the management of critical events in the airline industry. Its use in a surgical environment is through the crisis resource management (CRM) principles. The CRM tries to develop all the non-technical skills necessary in a critical situation, but not only that, also includes all the tools needed to prevent them. The purpose of this special issue is to appraise and summarize the design, implementation, and efficacy of simulation-based CRM training programs for a specific surgery such as the non-intubated video-assisted thoracoscopic surgery. PMID:26046052

Lessons learnt from a factory fire with asbestos-containing fallout.

PubMed

Bridgman, S A

1999-06-01

Fallout containing asbestos from a factory fire at Tranmere, Wirral, England, landed on a highly populated urban area with an estimated 16000 people living in the area worst affected, which included a shipbuilding community. There was considerable public concern over the health impact of the acute environmental incident, and great media interest. A descriptive study was carried out of the acute environmental incident and its management, and the difficulties encountered. Practical lessons learnt include need for: increased fire-fighter awareness of potential adverse health effects from asbestos in the structure of buildings; early involvement of both Local Authority environmental health and National Health Service public health departments; creation of a systematic local database of potential environmental health hazards in the structure of buildings as well as their contents; 24 hour on-call arrangements with laboratories expert in analyses of fire fallout; rapid quantitative analyses of multiple environmental samples; district written policy on handling asbestos incidents; systematic assessment of fright and media factors in public impact of an incident; dedicated public help-lines open long hours; consistent evidence-based public messages from all those communicating with the public; measurement of asbestos levels in the street and homes for public reassurance; local and health authorities' subscription to an environmental incident support service; formation of an acute environmental incident team to jointly manage and publicly report on airborne acute environmental incidents; clear government definition of responsibilities of different agencies. This paper provides a description of important lessons learnt during an acute environmental incident with asbestos-containing fallout. It will be helpful to those involved in the practical planning for and management of future incidents.

Surveillance of laboratory exposures to human pathogens and toxins: Canada 2016.

PubMed

Bienek, A; Heisz, M; Su, M

2017-11-02

Canada recently enacted legislation to authorize the collection of data on laboratory incidents involving a biological agent. This is done by the Public Health Agency of Canada (PHAC) as part of a comprehensive national program that protects Canadians from the health and safety risks posed by human and terrestrial animal pathogens and toxins. To describe the first year of data on laboratory exposure incidents and/or laboratory-acquired infections in Canada since the Human Pathogens and Toxins Regulations came into effect. Incidents that occurred between January 1 and December 31, 2016 were self-reported by federally-regulated parties across Canada using a standardized form from the Laboratory Incident Notification Canada (LINC) surveillance system. Exposure incidents were described by sector, frequency of occurrence, timeliness of reporting, number of affected persons, human pathogens and toxins involved, causes and corrective actions taken. Microsoft Excel 2010 was used for basic descriptive analyses. In 2016, 46 exposure incidents were reported by holders of 835 active licences in Canada representing 1,352 physical areas approved for work involving a biological agent, for an overall incidence of 3.4%. The number of incidents was highest in the academic (n=16; 34.8%) and hospital (n=12; 26.1%) sectors, while the number of reported incidents was relatively low in the private industry sector. An average of four to five incidents occurred each month; the month of September presented as an outlier with 10 incidents. ​: A total of 100 people were exposed, with no reports of secondary exposure. Four incidents led to suspected (n=3) or confirmed (n=1) cases of laboratory-acquired infection. Most incidents involved pathogens classified at a risk group 2 level that were manipulated in a containment level 2 laboratory (91.3%). Over 22 different species of human pathogens and toxins were implicated, with bacteria the most frequent (34.8%), followed by viruses (26.1%). Eleven (23.9%) incidents involved a security sensitive biologic agent. Procedure breaches (n=15) and sharps-related incidents (n=14) were the most common antecedents to an exposure. In 10 (21.7%) cases, inadvertent possession (i.e., isolation of an unexpected biological agent during routine work) played a role. Possible improvements to standard operating procedures were cited in 71.7% of incidents. Improvements were also indicated for communication (26.1%) and management (23.9%). The Laboratory Incident Notification Canada is one of the first surveillance systems in the world to gather comprehensive data on laboratory incidents involving human pathogens and toxins. Exposure incidents reported in the first year were relatively rare, occurring in less than 4% of containment zones within laboratory settings.

Surveillance of laboratory exposures to human pathogens and toxins: Canada 2016

PubMed Central

Bienek, A; Heisz, M; Su, M

2017-01-01

Background Canada recently enacted legislation to authorize the collection of data on laboratory incidents involving a biological agent. This is done by the Public Health Agency of Canada (PHAC) as part of a comprehensive national program that protects Canadians from the health and safety risks posed by human and terrestrial animal pathogens and toxins. Objective To describe the first year of data on laboratory exposure incidents and/or laboratory-acquired infections in Canada since the Human Pathogens and Toxins Regulations came into effect. Methods Incidents that occurred between January 1 and December 31, 2016 were self-reported by federally-regulated parties across Canada using a standardized form from the Laboratory Incident Notification Canada (LINC) surveillance system. Exposure incidents were described by sector, frequency of occurrence, timeliness of reporting, number of affected persons, human pathogens and toxins involved, causes and corrective actions taken. Microsoft Excel 2010 was used for basic descriptive analyses. Results In 2016, 46 exposure incidents were reported by holders of 835 active licences in Canada representing 1,352 physical areas approved for work involving a biological agent, for an overall incidence of 3.4%. The number of incidents was highest in the academic (n=16; 34.8%) and hospital (n=12; 26.1%) sectors, while the number of reported incidents was relatively low in the private industry sector. An average of four to five incidents occurred each month; the month of September presented as an outlier with 10 incidents. ​ A total of 100 people were exposed, with no reports of secondary exposure. Four incidents led to suspected (n=3) or confirmed (n=1) cases of laboratory-acquired infection. Most incidents involved pathogens classified at a risk group 2 level that were manipulated in a containment level 2 laboratory (91.3%). Over 22 different species of human pathogens and toxins were implicated, with bacteria the most frequent (34.8%), followed by viruses (26.1%). Eleven (23.9%) incidents involved a security sensitive biologic agent. Procedure breaches (n=15) and sharps-related incidents (n=14) were the most common antecedents to an exposure. In 10 (21.7%) cases, inadvertent possession (i.e., isolation of an unexpected biological agent during routine work) played a role. Possible improvements to standard operating procedures were cited in 71.7% of incidents. Improvements were also indicated for communication (26.1%) and management (23.9%). Conclusions The Laboratory Incident Notification Canada is one of the first surveillance systems in the world to gather comprehensive data on laboratory incidents involving human pathogens and toxins. Exposure incidents reported in the first year were relatively rare, occurring in less than 4% of containment zones within laboratory settings. PMID:29770052

Optimizing bulk milk dioxin monitoring based on costs and effectiveness.

PubMed

Lascano-Alcoser, V H; Velthuis, A G J; van der Fels-Klerx, H J; Hoogenboom, L A P; Oude Lansink, A G J M

2013-07-01

Dioxins are environmental pollutants, potentially present in milk products, which have negative consequences for human health and for the firms and farms involved in the dairy chain. Dioxin monitoring in feed and food has been implemented to detect their presence and estimate their levels in food chains. However, the costs and effectiveness of such programs have not been evaluated. In this study, the costs and effectiveness of bulk milk dioxin monitoring in milk trucks were estimated to optimize the sampling and pooling monitoring strategies aimed at detecting at least 1 contaminated dairy farm out of 20,000 at a target dioxin concentration level. Incidents of different proportions, in terms of the number of contaminated farms, and concentrations were simulated. A combined testing strategy, consisting of screening and confirmatory methods, was assumed as well as testing of pooled samples. Two optimization models were built using linear programming. The first model aimed to minimize monitoring costs subject to a minimum required effectiveness of finding an incident, whereas the second model aimed to maximize the effectiveness for a given monitoring budget. Our results show that a high level of effectiveness is possible, but at high costs. Given specific assumptions, monitoring with 95% effectiveness to detect an incident of 1 contaminated farm at a dioxin concentration of 2 pg of toxic equivalents/g of fat [European Commission's (EC) action level] costs €2.6 million per month. At the same level of effectiveness, a 73% cost reduction is possible when aiming to detect an incident where 2 farms are contaminated at a dioxin concentration of 3 pg of toxic equivalents/g of fat (EC maximum level). With a fixed budget of €40,000 per month, the probability of detecting an incident with a single contaminated farm at a dioxin concentration equal to the EC action level is 4.4%. This probability almost doubled (8.0%) when aiming to detect the same incident but with a dioxin concentration equal to the EC maximum level. This study shows that the effectiveness of finding an incident depends not only on the ratio at which, for testing, collected truck samples are mixed into a pooled sample (aiming at detecting certain concentration), but also the number of collected truck samples. In conclusion, the optimal cost-effective monitoring depends on the number of contaminated farms and the concentration aimed at detection. The models and study results offer quantitative support to risk managers of food industries and food safety authorities. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Reducing Nurses’ Stress: A Randomized Controlled Trial of a Web-Based Stress Management Program for Nurses

PubMed Central

Hersch, Rebekah K.; Cook, Royer F.; Deitz, Diane K.; Kaplan, Seth; Hughes, Daniel; Friesen, Mary Ann; Vezina, Maria

2016-01-01

Background Nursing is a notoriously high-stress occupation emotionally taxing and physically draining, with a high incidence of burnout. In addition to the damaging effects of stress on nurses’ health and well being, stress is also a major contributor to attrition and widespread shortages in the nursing profession. Although there exist promising in-person interventions for addressing the problem of stress among nurses, the experience of our group across multiple projects in hospitals has indicated that the schedules and workloads of nurses can pose problems for implementing in-person interventions, and that web-based interventions might be ideally suited to addressing the high levels of stress among nurses. Purpose The purpose of this study was to evaluate the effectiveness of the web-based BREATHE: Stress Management for Nurses program. Methods The randomized controlled trial was conducted with 104 nurses in five hospitals in Virginia and one hospital in New York. The primary outcome measure was perceived nursing-related stress. Secondary measures included symptoms of distress, coping, work limitations, job satisfaction, use of substances to relieve stress, alcohol consumption, and understanding depression and anxiety. Results Program group participants experienced significantly greater reductions than the control group on the full Nursing Stress Scale, and six of the seven subscales. No other significant results were found. Moderator analysis found that nurses with greater experience benefitted more. Conclusion Using a web-based program holds tremendous promise for providing nurses with the tools they need to address nursing related stress. PMID:27969025

[Incidence of phlebitis due to peripherally inserted venous catheters: impact of a catheter management protocol].

PubMed

Ferrete-Morales, C; Vázquez-Pérez, M A; Sánchez-Berna, M; Gilabert-Cerro, I; Corzo-Delgado, J E; Pineda-Vergara, J A; Vergara-López, S; Gómez-Mateos, J

2010-01-01

To assess the impact on the incidence of PPIVC by implementing a catheter management protocol and to determine risk factors for PPIVC development in hospitalized patients. A total of 3978 episodes of venous catheterization were prospectively included from September 2002 to December 2007. A catheter management protocol was implemented during this period of time. The incidence and variables associated to the occurrence of PPIVC were determined. The incidence of PPIVC from 2002 to 2007 was 4.8%, 4.3%, 3.6%, 2.5%, 1.3% and 1.8% (p<0.001). Perfusion of amiodarone [adjusted OR (AOR) 25.97; 95% CI=7.29-92.55, p=0.0001] and cefotaxime (AOR 2.90; 95% CI=1.29-6.52, p=0.01) and the shift when the catheters were placed (AOR for morning vs. night shift 0.60; 95% CI=0.35-1.02, p=0.063) were independently associated to the development of PPIVC. A history of phlebitis was the only factor independently associated to phlebitis due to peripherally inserted central venous catheters (AOR 3.24; CI at 95% CI= 1.05-9.98, p=0.04). A catheter management protocol decreases the incidence of PPIVC in hospitalized patients. The risk of PPIVC increases for peripherally inserted central venous catheters when the patients have a history of phlebitis and for peripheral venous catheters when amiodarone or cefotaxime are infused. Catheterization of peripheral veins performed during morning shifts is associated with a lower incidence of PPIVC when compared with night shift catheterizations.

Lifting HOV/HOT lane eligibility and shoulder use restrictions for traffic incident management.

DOT National Transportation Integrated Search

2013-12-01

This report presents an investigation of the possibility of lifting HOV/HOT lane eligibility and shoulder : use restrictions during major incidents on general-purpose (GP) lanes. Using traffic data from FDOT : Districts 4 and 6, the impacts of incide...

76 FR 22911 - National Advisory Council

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

... discussions on professionalism of emergency management, approaches for National Incident Management System... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2007-0008] National Advisory Council AGENCY: Federal Emergency Management Agency, DHS. ACTION: Committee Management...

Management of In-Field Patient Tracking and Triage by Using Near-Field Communication in Mass Casualty Incidents.

PubMed

Cheng, Po-Liang; Su, Yung-Cheng; Hou, Chung-Hung; Chang, Po-Lun

2017-01-01

Near field communications (NFC) is an emerging technology that may potentialy assist with disaster management. A smartphone-based app was designed to help track patient flow in real time. A table-drill was held as a brief evaluation and it showed significant imporvement in both efficacy and accuracy of patient management. It is feasible to use NFC-embedded smartphones to clarify the ambiguous and chaotic patient flow in a mass casualty incident.

[Prevention of cardiovascular diseases].

PubMed

Prochaska, J H; Arnold, N; Jünger, C; Münzel, T; Wild, P S

2018-02-01

The incidence of cardiovascular diseases can be reduced by the early detection and targeted treatment of risk factors and subclinical forms of the disease. Primary prevention provides several opportunities for successful interventions. In addition to a drug-based therapy, especially life style-modifying measures, such as physical activity, normalization of body weight, consistent nicotine abstinence and the consideration of psychosocial aspects represent core components of prevention programs. Healthcare data indicate that risk factors still often remain undetected and that the full potential of risk factor management has not yet been fully exploited at a population level. Especially motivation of patients and adherence to therapy represent key elements of successful prevention efforts.

Psychophysiological and other factors affecting human performance in accident prevention and investigation. [Comparison of aviation with other industries

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

Klinestiver, L.R.

Psychophysiological factors are not uncommon terms in the aviation incident/accident investigation sequence where human error is involved. It is highly suspect that the same psychophysiological factors may also exist in the industrial arena where operator personnel function; but, there is little evidence in literature indicating how management and subordinates cope with these factors to prevent or reduce accidents. It is apparent that human factors psychophysological training is quite evident in the aviation industry. However, while the industrial arena appears to analyze psychophysiological factors in accident investigations, there is little evidence that established training programs exist for supervisors and operator personnel.

STS-121/Discovery: Imagery Quick-Look Briefing

NASA Technical Reports Server (NTRS)

2006-01-01

Kyle Herring (NASA Public Affairs) introduced Wayne Hale (Space Shuttle Program Manager) who stated that the imagery for the Space shuttle external tank showed the tank performed very well. Image analysis showed small pieces of foam falling off the rocket booster and external tank. There was no risk involved in these minor incidents. Statistical models were built to assist in risk analysis. The orbiter performed excellently. Wayne also provided some close-up pictures of small pieces of foam separating from the external tank during launching. He said the crew will also perform a 100% inspection of the heat shield. This flight showed great improvement over previous flights.

Nevada Test Site Environmental Report 2005

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

Cathy A. Wills

2006-10-01

The Nevada Test Site Environmental Report 2005 (NTSER) was prepared to meet the information needs of the public and the requirements and guidelines of the U.S. Department of Energy (DOE) for annual site environmental reports. Its purpose is to (1) report compliance status with environmental standards and requirements, (2) present results of environmental monitoring of radiological and nonradiological effluents, (3) report estimated radiological doses to the public from releases of radioactive material, (4) summarize environmental incidents of noncompliance and actions taken in response to them, (5) describe the NTS Environmental Management System and characterize its performance, and (6) highlight significantmore » environmental programs and efforts.« less

Analysis of eighty-four commercial aviation incidents - Implications for a resource management approach to crew training

NASA Technical Reports Server (NTRS)

Murphy, M. R.

1980-01-01

A resource management approach to aircrew performance is defined and utilized in structuring an analysis of 84 exemplary incidents from the NASA Aviation Safety Reporting System. The distribution of enabling and associated (evolutionary) and recovery factors between and within five analytic categories suggests that resource management training be concentrated on: (1) interpersonal communications, with air traffic control information of major concern; (2) task management, mainly setting priorities and appropriately allocating tasks under varying workload levels; and (3) planning, coordination, and decisionmaking concerned with preventing and recovering from potentially unsafe situations in certain aircraft maneuvers.

Implementation of a laboratory quality assurance program: the Louisville experience.

PubMed

Metz, Michael J; Abdel-Azim, Tamer; Miller, Cynthia J; Lin, Wei-Shao; ZandiNejad, Amirali; Oliveira, Gustavo M; Morton, Dean

2014-02-01

Remakes, or the refabrication of dental prostheses, can occur as a result of inherent inaccuracies in both clinical and laboratory procedures. Because dental schools manage large numbers of predoctoral dental students with limited familiarity and expertise as related to clinical prosthodontic techniques, it is likely these schools will experience an elevated incidence of laboratory remakes and their ramifications. The University of Louisville School of Dentistry, not unlike other dental schools, has experienced remakes associated with both fixed and removable prosthodontic procedures. Limitations in faculty standardization and variable enforcement of established preclinical protocols have been identified as variables associated with the high percentage of remakes documented. The purpose of this study was to introduce the implementation of a new multidepartmental quality assurance program designed to increase consistency and quality in both information provided to commercial dental laboratories and the prostheses returned. The program has shown to be advantageous in terms of cost-effectiveness and treatment outcomes. A statistically significant decrease in remake percentages has been recorded from inception of this program in December 2010 until December 2012. Furthermore, this program has resulted in more consistent communication between the dental school and commercial dental laboratories, among faculty members, and between faculty and students.

Medical management of three workers following a radiation exposure incident

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

House, R.A.; Sax, S.E.; Rumack, E.R.

The medical management of three individuals involved in an exposure incident to whole-body radiation at a nuclear generating plant of a Canadian electrical utility is described. The exposure incident resulted in the two highest whole-body radiation doses ever received in a single event by workers in a Canadian nuclear power plant. The individual whole-body doses (127.4 mSv, 92.0 mSv, 22.4 mSv) were below the threshold for acute radiation sickness but the exposures still presented medical management problems related to assessment and counseling. Serial blood counting and lymphocyte cytogenetic analysis to corroborate the physical dosimetry were performed. All three employees experiencedmore » somatic symptoms due to stress and one employee developed post-traumatic stress disorder. This incident indicates that there is a need in such radiation exposure accidents for early and continued counseling of exposed employees to minimize the risk of development of stress-related symptoms.« less

Experience with management of posterior urethral injury associated with pelvic fracture.

PubMed

Coffield, K S; Weems, W L

1977-06-01

Review of records from 205 patients with pelvic fracture and hematuria revealed that 121 underwent urologic and radiographic evaluation. Of these patients 20 had severe posterior urethral injuries documented by urethrography of voiding cystourethrography: 9 underwent primary repair and 11 had delayed scrotal-inlay urethroplasty after initial cystostomy alone. Patients who underwent primary repair had a 77 per cent incidence of stricture, a 22 per cent incidence of incontinence and a 33 per cent incidence of impotency. Patients who underwent delayed closure had no incidence of stricture, incontinence or impotence. Patients in both groups had urinary tract infections. Simple cystostomy followed by delayed scrotal-inlay urethroplasty appears superior to primary realignment in the management of patients with posterior urethral injuries.

Risk management systems for health care and safety development on transplantation: a review and a proposal.

PubMed

Pretagostini, R; Gabbrielli, F; Fiaschetti, P; Oliveti, A; Cenci, S; Peritore, D; Stabile, D

2010-05-01

Starting from the report on medical errors published in 1999 by the US Institute of Medicine, a number of different approaches to risk management have been developed for maximum risk reduction in health care activities. The health care authorities in many countries have focused attention on patient safety, employing action research programs that are based on quite different principles. We performed a systematic Medline research of the literature since 1999. The following key words were used, also combining boolean operators and medical subheading terms: "adverse event," "risk management," "error," and "governance." Studies published in the last 5 years were particularly classified in various groups: risk management in health care systems; safety in specific hospital activities; and health care institutions' official documents. Methods of action researches have been analysed and their characteristics compared. Their suitability for safety development in donation, retrieval, and transplantation processes were discussed in the reality of the Italian transplant network. Some action researches and studies were dedicated to entire national healthcare systems, whereas others focused on specific risks. Many research programs have undergone critical review in the literature. Retrospective analysis has centered on so-called sentinel events to particularly analyze only a minor portion of the organizational phenomena, which can be the origin of an adverse event, an incident, or an error. Sentinel events give useful information if they are studied in highly engineered and standardized organizations like laboratories or tissue establishments, but they show several limits in the analysis of organ donation, retrieval, and transplantation processes, which are characterized by prevailing human factors, with high intrinsic risk and variability. Thus, they are poorly effective to deliver sure elements to base safety management improvement programs, especially regarding multidisciplinary systems with high complexity. In organ transplantation, the possibility to increase safety seems greater using proactive research, mainly centred on organizational processes together with retrospective analyses but not limited to sentinel event reports. Copyright (c) 2010. Published by Elsevier Inc.

Effectiveness of a quality-improvement program in improving management of primary care practices.

PubMed

Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

2011-12-13

The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. In a before-after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group's second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the Europeaen Practice Assessment.

Effectiveness of a quality-improvement program in improving management of primary care practices

PubMed Central

Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

2011-01-01

Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the Europeaen Practice Assessment. PMID:22043000

Heart failure disease management program experience in 4,545 heart failure admissions to a community hospital.

PubMed

Pazin-Filho, Antonio; Peitz, Pamela; Pianta, Thomas; Carson, Kathryn A; Russell, Stuart D; Boulware, Leigh Ebony; Coresh, Josef

2009-09-01

Disease management programs (DMPs) are developed to address the high morbi-mortality and costs of congestive heart failure (CHF). Most studies have focused on intensive programs in academic centers. Washington County Hospital (WCH) in Hagerstown, MD, the primary reference to a semirural county, established a CHF DMP in 2001 with standardized documentation of screening and participation. Linkage to electronic records and state vital statistics enabled examination of the CHF population including individuals participating and those ineligible for the program. All WCH inpatients with CHF International Classification of Diseases, Ninth Revision code in any position of the hospital list discharged alive. Of 4,545 consecutive CHF admissions, only 10% enrolled and of those only 52.2% made a call. Enrollment in the program was related to: age (OR 0.64 per decade older, 95% CI 0.58-0.70), CHF as the main reason for admission (OR 3.58, 95% CI 2.4-4.8), previous admission for CHF (OR 1.14, 95% CI 1.09-1.2), and shorter hospital stay (OR 0.94 per day longer, 95% CI 0.87-0.99). Among DMP participants mortality rates were lowest in the first month (80/1000 person-years) and increased subsequently. The opposite mortality trend occurred in nonenrolled groups with mortality in the first month of 814 per 1000 person-years in refusers and even higher in ineligible (1569/1000 person-years). This difference remained significant after adjustment. Re-admission rates were lower among participants who called consistently (adjusted incidence rate ratio 0.62, 95% CI 0.52-0.77). Only a small and highly select group participated in a low-intensity DMP for CHF in a community-based hospital. Design of DMPs should incorporate these strong selective factors to maximize program impact.

Addressing Obesity in the Workplace: The Role of Employers

PubMed Central

Heinen, Luann; Darling, Helen

2009-01-01

Context: Employers have pursued many strategies over the years to control health care costs and improve care. Disappointed by efforts to manage costs through the use of insurance-related techniques (e.g., prior authorization, restricted provider networks), employers have also begun to try to manage health by addressing their employees' key lifestyle risks. Reducing obesity (along with tobacco use and inactivity) is a priority for employers seeking to lower the incidence and severity of chronic illness and the associated demand for health services. Methods: This article describes the employer's perspective on the cost impact of obesity, discusses current practices in employer-sponsored wellness and weight management programs, provides examples from U.S. companies illustrating key points of employers' leverage and opportunities, and suggests policy directions to support the expansion of employers' initiatives, especially for smaller employers. Findings: Researchers and policymakers often overlook the extensive efforts and considerable impact of employer-sponsored wellness and health improvement programs. Greater focus on opportunities in the workplace is merited, however, for the evidence base supporting the economic and health impacts of employer-sponsored health promotion and wellness is growing, although not as quickly as the experience base of large employers. Conclusions: Public and private employers can serve their own economic interests by addressing obesity. Health care organizations, particularly hospitals, as well as public employers can be important role models. Policy development is needed to accelerate change, especially for smaller employers (those with fewer than 500 employees), which represent the majority of U.S. employers and are far less likely to offer health promotion programs. PMID:19298417

Addressing obesity in the workplace: the role of employers.

PubMed

Heinen, LuAnn; Darling, Helen

2009-03-01

Employers have pursued many strategies over the years to control health care costs and improve care. Disappointed by efforts to manage costs through the use of insurance-related techniques (e.g., prior authorization, restricted provider networks), employers have also begun to try to manage health by addressing their employees' key lifestyle risks. Reducing obesity (along with tobacco use and inactivity) is a priority for employers seeking to lower the incidence and severity of chronic illness and the associated demand for health services. This article describes the employer's perspective on the cost impact of obesity, discusses current practices in employer-sponsored wellness and weight management programs, provides examples from U.S. companies illustrating key points of employers' leverage and opportunities, and suggests policy directions to support the expansion of employers' initiatives, especially for smaller employers. Researchers and policymakers often overlook the extensive efforts and considerable impact of employer-sponsored wellness and health improvement programs. Greater focus on opportunities in the workplace is merited, however, for the evidence base supporting the economic and health impacts of employer-sponsored health promotion and wellness is growing, although not as quickly as the experience base of large employers. Public and private employers can serve their own economic interests by addressing obesity. Health care organizations, particularly hospitals, as well as public employers can be important role models. Policy development is needed to accelerate change, especially for smaller employers (those with fewer than 500 employees), which represent the majority of U.S. employers and are far less likely to offer health promotion programs.

Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial

PubMed Central

Wang, Philip S.; Simon, Gregory E.; Avorn, Jerry; Azocar, Francisca; Ludman, Evette J.; McCulloch, Joyce; Petukhova, Maria Z.; Kessler, Ronald C.

2010-01-01

Context Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer-purchasers have been slow to demand these programs based on lack of evidence for cost-effectiveness from their perspective. Objective To evaluate the effects of a depression outreach-treatment program on workplace outcomes of concern to employers. Design Randomized controlled trial with allocation concealment and blinded assessment of depression severity and work performance at 6 and 12 months. Setting and Participants Two-stage screening of employees covered by a managed behavioral health plan identified 604 with clinically significant depression (excluding those with lifetime bipolar disorder, substance disorder, recent mental health specialty care, or suicidality). Intervention A telephonic outreach and care management program encouraged workers to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality-continuity, and attempted to improve treatment by giving recommendations to providers. Participants reluctant to enter treatment were offered a structured telephone cognitive-behavioral psychotherapy. Main Outcome Measures Depression severity (Quick Inventory of Depressive Symptomatology, QIDS-SR) and work performance (WHO Health and Productivity Questionnaire, HPQ, a validated self-report instrument assessing job retention, time missed from work, work performance, and critical workplace incidents). Results Combining data across 6-month and 12-month assessments, the intervention group had significantly lower QIDS-SR scores (1.4 relative-odds of recovery), significantly higher job retention (1.7 relative-odds), and significantly more hours worked among the employed (equivalent to an annualized effect of approximately 2.5 weeks of work) than usual care subjects. Conclusions A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also workplace outcomes. The financial value of the latter to employers in terms of recovered hiring-training and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers. PMID:17895456

40 CFR 68.81 - Incident investigation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Incident investigation. 68.81 Section 68.81 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED... appropriate knowledge and experience to thoroughly investigate and analyze the incident. (d) A report shall be...

30 CFR 285.831 - What incidents must I report, and when must I report them?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What incidents must I report, and when must I report them? 285.831 Section 285.831 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE RENEWABLE ENERGY ALTERNATE USES OF EXISTING FACILITIES ON THE OUTER CONTINENTAL SHELF Environmental and Safety Management,...

State Methods for a Cyber Incident

DTIC Science & Technology

2012-03-01

Glossary S905 - Incident Submission and Response Standard S910 - Data Breach Notification Standard E-5 Our state characterizes information system...Office of Management and Budget. (2011a). Legislative Language Data Breach Notification. Retrieved September 20, 2010, from http://www.whitehouse.gov...sites/default/files/omb/legislative/letters/ data - breach -notification.pdf Executive Office of the President. Office of Management and Budget

The Incidence and Management of Conflicts in Secular and Non-Secular Tertiary Institutions in South West Nigeria

ERIC Educational Resources Information Center

Ayodele, Joseph Babatola; Adewumi, Joseph Olukayode

2007-01-01

This paper compared the incidence and management of conflicts in secular and non-secular tertiary institutions in Nigeria. The sample of this study was made of sixty staff, and two hundred and forty students randomly selected each from two secular and two non-secular tertiary institutions in south western Nigeria. A validated questionnaire was…

Influence of occupational safety management on the incidence rate of occupational accidents in the Spanish industrial and ornamental stone mining.

PubMed

Sanmiquel, Lluís; Rossell, Josep M; Vintró, Carla; Freijo, Modesto

2014-01-01

Mines are hazardous and workers can suffer many types of accidents caused by fire, flood, explosion or collapse. Injury incidence rates in mining are considerably higher than those registered by other economic sectors. One of the main reasons for this high-level incidence rate is the existence of a large number of dangerous workplaces. This work analyzes the influence that occupational safety management had on the accidents that took place in Spanish mining of industrial and ornamental stone during the period 2007-2008. Primary data sources are: (a) Results from a statistical study of the occupational health and safety management practices of 71 quarries defined by a questionnaire of 41 items; and (b) Occupational accidents registered in the Spanish industrial and ornamental stone mining throughout the period 2007-2008. The obtained results indicate that workplaces with a low average score in the analysis of occupational safety management have a higher incidence rate of accidents. Studies on mining workplaces are very important to help detect occupational safety concerns. Results from this study help raise awareness and will encourage the adoption of appropriate measures to improve safety.

Management of ionizing radiation injuries and illnesses, part 4: acute radiation syndrome.

PubMed

Christensen, Doran M; Iddins, Carol J; Parrillo, Steven J; Glassman, Erik S; Goans, Ronald E

2014-09-01

To provide proper medical care for patients after a radiation incident, it is necessary to make the correct diagnosis in a timely manner and to ascertain the relative magnitude of the incident. The present article addresses the clinical diagnosis and management of high-dose radiation injuries and illnesses in the first 24 to 72 hours after a radiologic or nuclear incident. To evaluate the magnitude of a high-dose incident, it is important for the health physicist, physician, and radiobiologist to work together and to assess many variables, including medical history and physical examination results; the timing of prodromal signs and symptoms (eg, nausea, vomiting, diarrhea, transient incapacitation, hypotension, and other signs and symptoms suggestive of high-level exposure); and the incident history, including system geometry, source-patient distance, and the suspected radiation dose distribution. © 2014 The American Osteopathic Association.

Management of neurosurgical instruments and patients exposed to Creutzfeldt-Jakob disease.

PubMed

Belay, Ermias D; Blase, Jennifer; Sehulster, Lynne M; Maddox, Ryan A; Schonberger, Lawrence B

2013-12-01

To summarize the approaches used to manage exposure of patients to inadequately sterilized neurosurgical instruments contaminated as a result of Creutzfeldt-Jakob disease (CJD). Information on past CJD exposure incidents reported to the Centers for Disease Control and Prevention (CDC) was aggregated and summarized. In addition, inactivation studies were reviewed, and data from selected publications were provided for reference. Nineteen incidents of patient exposure to potentially CJD-contaminated instruments were reported to the CDC, including 17 that involved intracranial procedures and 2 that involved ophthalmologic procedures. In more than 50% of incidents, the neurosurgical procedures were performed for diagnostic work up of the index patients. At least 12 of the hospitals had multiple neurosurgical sets, and the CJD-contaminated instruments could not be identified in 11 of 19 hospitals. In 12 of 15 hospitals with neurosurgical incidents, a decision was made to notify patients of their potential exposure. Neurosurgical instruments used for treatment of patients with suspected or diagnosed CJD or patients whose diagnosis is unclear should be promptly identified and sterilized using recommended CJD decontamination protocols. Inability to trace instruments complicates appropriate management of exposure incidents. The feasibility of instituting instrument tracking procedures should be considered.

Management of Neurosurgical Instruments and Patients Exposed to Creutzfeldt-Jakob Disease

PubMed Central

Belay, Ermias D.; Blase, Jennifer; Sehulster, Lynne M.; Maddox, Ryan A.; Schonberger, Lawrence B.

2015-01-01

OBJECTIVE To summarize the approaches used to manage exposure of patients to inadequately sterilized neurosurgical instruments contaminated as a result of Creutzfeldt-Jakob disease (CJD). METHODS Information on past CJD exposure incidents reported to the Centers for Disease Control and Prevention (CDC) was aggregated and summarized. In addition, inactivation studies were reviewed, and data from selected publications were provided for reference. RESULTS Nineteen incidents of patient exposure to potentially CJD-contaminated instruments were reported to the CDC, including 17 that involved intracranial procedures and 2 that involved ophthalmologic procedures. In more than 50% of incidents, the neurosurgical procedures were performed for diagnostic work up of the index patients. At least 12 of the hospitals had multiple neurosurgical sets, and the CJD-contaminated instruments could not be identified in 11 of 19 hospitals. In 12 of 15 hospitals with neurosurgical incidents, a decision was made to notify patients of their potential exposure. CONCLUSIONS Neurosurgical instruments used for treatment of patients with suspected or diagnosed CJD or patients whose diagnosis is unclear should be promptiy identified and sterilized using recommended CJD decontamination protocols. Inability to trace instruments complicates appropriate management of exposure incidents. The feasibility of instituting instrument tracking procedures should be considered. PMID:24225612

Significance of Concussions in Hawai‘i: From Land to Sea

PubMed Central

Cifu, David X; Uchima, Olivia K; Lower, Amy E; Jin, Jingyu L; Lew, Henry L

2016-01-01

Head injuries are a particular concern in Hawai‘i given the large military population, the presence of many land and water sports such as football and surfing, and the lenient helmet laws for motorcycle and bicycle riders. Physical, psychological, and cognitive symptoms from single or repeated concussions can affect an individual's reentry to society and activity. Current literature indicates that repeated head injuries are associated with chronic traumatic encephalopathy (CTE) which is thought to lead to dementia. This paper reviews literature discussing causes of concussion including its incidence and prevalence in Hawai‘i. Furthermore, the neurophysiological and neurobiological etiologies are discussed followed by an overview of methods for identification and management of concussion. The paper serves as information for professionals in the community such as educators, military personnel, and healthcare workers to identify risks of concussion, management of symptoms, and to connect with resources and programs available in Hawai‘i. PMID:27688951

The automatic human

NASA Technical Reports Server (NTRS)

Billings, Charles

1991-01-01

An overview is presented of the growth and role of automation in civil aircraft operations for both cockpit management and ground control. NASA has initiated a research program centered on furthering automation and developing a consistent and rational philosophy of human centered aircraft and air traffic control automation. Introduction of the NASA Aviation Safety Reporting System (ASRS) has proved successful in bringing together pilots and ground controllers to report incidents of operational anomalies that can then be analyzed, leading to corrective action to prevent similar reoccurrences. Attention is given to the growing trend of extensive automation in the cockpit that appears to be leading to a diminution of management control of the aircraft by the decreasing number of flight crew members. A majority of reports indicate that there is a serious mismatch between new aircraft capabilities and ATC procedures, which were designed for older aircraft. ASRS has also kept research oriented toward real problems and community needs.

Significance of Concussions in Hawai'i: From Land to Sea.

PubMed

Cifu, David X; Uchima, Olivia K; Davis, Alaina S; Lower, Amy E; Jin, Jingyu L; Lew, Henry L

2016-09-01

Head injuries are a particular concern in Hawai'i given the large military population, the presence of many land and water sports such as football and surfing, and the lenient helmet laws for motorcycle and bicycle riders. Physical, psychological, and cognitive symptoms from single or repeated concussions can affect an individual's reentry to society and activity. Current literature indicates that repeated head injuries are associated with chronic traumatic encephalopathy (CTE) which is thought to lead to dementia. This paper reviews literature discussing causes of concussion including its incidence and prevalence in Hawai'i. Furthermore, the neurophysiological and neurobiological etiologies are discussed followed by an overview of methods for identification and management of concussion. The paper serves as information for professionals in the community such as educators, military personnel, and healthcare workers to identify risks of concussion, management of symptoms, and to connect with resources and programs available in Hawai'i.

Water-quality, water-level, and discharge data associated with the Mississippi embayment agricultural chemical-transport study, 2006-2008

USGS Publications Warehouse

Dalton, Melinda S.; Rose, Claire E.; Coupe, Richard H.

2010-01-01

In 2006, the Agricultural Chemicals: Sources, Transport and Fate study team (Agricultural Chemicals Team, ACT) of the U.S. Geological Survey National Water-Quality Assessment Program began a study in northwestern Mississippi to evaluate the influence of surface-water recharge on the occurrence of agriculturally related nutrients and pesticides in the Mississippi River Valley alluvial aquifer. The ACT study was composed in the Bogue Phalia Basin, an indicator watershed within the National Water-Quality Assessment Program Mississippi Embayment Study Unit and utilized several small, subbasins within the Bogue Phalia to evaluate surface and groundwater interaction and chemical transport in the Basin. Data collected as part of this ACT study include water-quality data from routine and incident-driven water samples evaluated for major ions, nutrients, organic carbon, physical properties, and commonly used pesticides in the area; discharge, gage height and water-level data for surface-water sites, the shallow alluvial aquifer, and hyporheic zone; additionally, agricultural data and detailed management activities were reported by land managers for farms within two subbasins of the Bogue Phalia Basin—Tommie Bayou at Pace, MS, and an unnamed tributary to Clear Creek near Napanee, MS.

Vision training methods for sports concussion mitigation and management.

PubMed

Clark, Joseph F; Colosimo, Angelo; Ellis, James K; Mangine, Robert; Bixenmann, Benjamin; Hasselfeld, Kimberly; Graman, Patricia; Elgendy, Hagar; Myer, Gregory; Divine, Jon

2015-05-05

There is emerging evidence supporting the use vision training, including light board training tools, as a concussion baseline and neuro-diagnostic tool and potentially as a supportive component to concussion prevention strategies. This paper is focused on providing detailed methods for select vision training tools and reporting normative data for comparison when vision training is a part of a sports management program. The overall program includes standard vision training methods including tachistoscope, Brock's string, and strobe glasses, as well as specialized light board training algorithms. Stereopsis is measured as a means to monitor vision training affects. In addition, quantitative results for vision training methods as well as baseline and post-testing *A and Reaction Test measures with progressive scores are reported. Collegiate athletes consistently improve after six weeks of training in their stereopsis, *A and Reaction Test scores. When vision training is initiated as a team wide exercise, the incidence of concussion decreases in players who participate in training compared to players who do not receive the vision training. Vision training produces functional and performance changes that, when monitored, can be used to assess the success of the vision training and can be initiated as part of a sports medical intervention for concussion prevention.

[Emphasis on promotion of the adaptive technology is the sky point of improving of treatment and prevention level of glaucoma].

PubMed

Wang, Ning-li

2013-11-01

Promoting the control of primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG) is most important prevention program of blindness in China. PACG has been incorporated into the prevention program of blindness in China based on the population-based screening studies. However, the clinical screening should be strengthened in POAG. The creation of a series of appropriate technologies suitable for glaucoma prevention and management has been achieved in China, especially for PACG. The technologies have been evaluated in the pilot areas and obtained very good results in China. It is recommended to develop new technology suitable for glaucoma management using the following workflow: research, development, and evaluation by large scale hospitals, and then clinical trial in the pilot areas. After a cost-benefit analysis is made, the new technology can be promoted and applied in clinical practice nationwide. We propose to gradually formed a strategical mode of "screening in township hospitals, intervention in county hospitals, and technical support and tackling in provincial hospitals" in order to improve the level of prevention and treatment of glaucoma and reduce the blindness incidence rate caused by glaucoma.

Lessons learnt from the development of the Patient Safety Incidents Reporting an Learning System for the Spanish National Health System: SiNASP.

PubMed

Vallejo-Gutiérrez, Paula; Bañeres-Amella, Joaquim; Sierra, Eduardo; Casal, Jesús; Agra, Yolanda

2014-01-01

To describe the development process and characteristics of a patient safety incidents reporting system to be implemented in the Spanish National Health System, based on the context and the needs of the different stakeholders. Literature review and analysis of most relevant reporting systems, identification of more than 100 stakeholder's (patients, professionals, regional governments representatives) expectations and requirements, analysis of the legal context, consensus of taxonomy, development of the software and pilot test. Patient Safety Events Reporting and Learning system (Sistema de Notificación y Aprendizajepara la Seguridad del Paciente, SiNASP) is a generic reporting system for all types of incidents related to patient safety, voluntary, confidential, non punitive, anonymous or nominative with anonimization, system oriented, with local analysis of cases and based on the WHO International Classification for Patient Safety. The electronic program has an on-line form for reporting, a software to manage the incidents and improvement plans, and a scoreboard with process indicators to monitor the system. The reporting system has been designed to respond to the needs and expectations identified by the stakeholders, taking into account the lessons learned from the previous notification systems, the characteristics of the National Health System and the existing legal context. The development process presented and the characteristics of the system provide a comprehensive framework that can be used for future deployments of similar patient safety systems. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Link state relationships under incident conditions : using a CTM-based linear programming dynamic traffic assignment model.

DOT National Transportation Integrated Search

2010-03-01

Urban transportation networks, consisting of numerous links and nodes, experience traffic incidents such as accidents and road : maintenance work. A typical consequence of incidents is congestion which results in long queues and causes high travel ti...

Link State Relationships Under Incident Conditions: Using a CTM-Based Linear Programming Dynamic Traffic Assignment Model

DOT National Transportation Integrated Search

2010-03-01

Urban transportation networks, consisting of numerous links and nodes, experience traffic incidents such as accidents and road maintenance work. A typical consequence of incidents is congestion which results in long queues and causes high travel time...

Saturday-morning television: do sponsors promote high-risk behavior for burn injury?

PubMed

Palmieri, Tina L; Aoki, Traci; Combs, Elena; Curri, Terese; Garma, Sylvia; Kaulkin, Cammie; Lawless, Mary Beth; Nelson, Kate; Sanders, Johanna; Warden, Nancy; Greenhalgh, David G

2004-01-01

Television has become an important tool for learning and socialization in children. Although television violence has been associated with adverse effects, data on depiction of fire and burn injury are lacking. We sought to determine whether Saturday-morning television programming, viewed primarily by children, depicts fire and burn injury as safe or without consequence, thus potentially increasing the incidence of burn injury in children. This was a prospective observational study. Saturday-morning children's television programs were videotaped from 7 AM to 11 AM for eight different television networks during a 6-month period. Tapes were scored for scenes depicting fire or smoke by independent observers. Recorded items included show category, scene type, gender target, context of fire, and outcome after exposure to flame. Fire events were documented during programs and their associated commercials. A total of 108 hours of children's programs, 16 hours per network, were recorded. Scenes depicting fire or smoke were identified 1960 times, with 39% of events occurring during the program itself and 61% in commercials. Fire was depicted as either safe or without consequence in 64% of incidents. Action adventure stories accounted for 56% of flame depictions. Overall, one incident involving flame and fire was portrayed for each 3 minutes of television programming. Saturday-morning television programming frequently depicts fire as safe, empowering, or exciting. The incidence of flame use in programming varies between stations but is most prevalent in action/adventure stories. Television commercials, although brief, provide the majority of the misinformation regarding fire. Medical professional societies should alert the public to this potential hazard and recommend responsible portrayal of fire in children's television programming.