Harnessing Multiple Representations for Autonomous Full-Spectrum Political, Military, Economic, Social, Information and Infrastructure (PMESII) Reasoning

DTIC Science & Technology

2007-05-01

sufficient for explaining how theory -of- mind emerges in normally developing children . As confirmation of its plausibility, our theory explains the... autism . While there are a number of different substrate elements that we believe are operative during theory of mind computations, three elements in...15. SUBJECT TERMS PMESII, multiple representations, integrated reasoning, hybrid systems, social cognition, theory of mind 16. SECURITY

Emergence of dynamic cooperativity in the stochastic kinetics of fluctuating enzymes

NASA Astrophysics Data System (ADS)

Kumar, Ashutosh; Chatterjee, Sambarta; Nandi, Mintu; Dua, Arti

2016-08-01

Dynamic co-operativity in monomeric enzymes is characterized in terms of a non-Michaelis-Menten kinetic behaviour. The latter is believed to be associated with mechanisms that include multiple reaction pathways due to enzymatic conformational fluctuations. Recent advances in single-molecule fluorescence spectroscopy have provided new fundamental insights on the possible mechanisms underlying reactions catalyzed by fluctuating enzymes. Here, we present a bottom-up approach to understand enzyme turnover kinetics at physiologically relevant mesoscopic concentrations informed by mechanisms extracted from single-molecule stochastic trajectories. The stochastic approach, presented here, shows the emergence of dynamic co-operativity in terms of a slowing down of the Michaelis-Menten (MM) kinetics resulting in negative co-operativity. For fewer enzymes, dynamic co-operativity emerges due to the combined effects of enzymatic conformational fluctuations and molecular discreteness. The increase in the number of enzymes, however, suppresses the effect of enzymatic conformational fluctuations such that dynamic co-operativity emerges solely due to the discrete changes in the number of reacting species. These results confirm that the turnover kinetics of fluctuating enzyme based on the parallel-pathway MM mechanism switches over to the single-pathway MM mechanism with the increase in the number of enzymes. For large enzyme numbers, convergence to the exact MM equation occurs in the limit of very high substrate concentration as the stochastic kinetics approaches the deterministic behaviour.

Emergence of dynamic cooperativity in the stochastic kinetics of fluctuating enzymes.

PubMed

Kumar, Ashutosh; Chatterjee, Sambarta; Nandi, Mintu; Dua, Arti

2016-08-28

Dynamic co-operativity in monomeric enzymes is characterized in terms of a non-Michaelis-Menten kinetic behaviour. The latter is believed to be associated with mechanisms that include multiple reaction pathways due to enzymatic conformational fluctuations. Recent advances in single-molecule fluorescence spectroscopy have provided new fundamental insights on the possible mechanisms underlying reactions catalyzed by fluctuating enzymes. Here, we present a bottom-up approach to understand enzyme turnover kinetics at physiologically relevant mesoscopic concentrations informed by mechanisms extracted from single-molecule stochastic trajectories. The stochastic approach, presented here, shows the emergence of dynamic co-operativity in terms of a slowing down of the Michaelis-Menten (MM) kinetics resulting in negative co-operativity. For fewer enzymes, dynamic co-operativity emerges due to the combined effects of enzymatic conformational fluctuations and molecular discreteness. The increase in the number of enzymes, however, suppresses the effect of enzymatic conformational fluctuations such that dynamic co-operativity emerges solely due to the discrete changes in the number of reacting species. These results confirm that the turnover kinetics of fluctuating enzyme based on the parallel-pathway MM mechanism switches over to the single-pathway MM mechanism with the increase in the number of enzymes. For large enzyme numbers, convergence to the exact MM equation occurs in the limit of very high substrate concentration as the stochastic kinetics approaches the deterministic behaviour.

Emergence of dynamic cooperativity in the stochastic kinetics of fluctuating enzymes

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

Kumar, Ashutosh; Chatterjee, Sambarta; Nandi, Mintu

Dynamic co-operativity in monomeric enzymes is characterized in terms of a non-Michaelis-Menten kinetic behaviour. The latter is believed to be associated with mechanisms that include multiple reaction pathways due to enzymatic conformational fluctuations. Recent advances in single-molecule fluorescence spectroscopy have provided new fundamental insights on the possible mechanisms underlying reactions catalyzed by fluctuating enzymes. Here, we present a bottom-up approach to understand enzyme turnover kinetics at physiologically relevant mesoscopic concentrations informed by mechanisms extracted from single-molecule stochastic trajectories. The stochastic approach, presented here, shows the emergence of dynamic co-operativity in terms of a slowing down of the Michaelis-Menten (MM) kineticsmore » resulting in negative co-operativity. For fewer enzymes, dynamic co-operativity emerges due to the combined effects of enzymatic conformational fluctuations and molecular discreteness. The increase in the number of enzymes, however, suppresses the effect of enzymatic conformational fluctuations such that dynamic co-operativity emerges solely due to the discrete changes in the number of reacting species. These results confirm that the turnover kinetics of fluctuating enzyme based on the parallel-pathway MM mechanism switches over to the single-pathway MM mechanism with the increase in the number of enzymes. For large enzyme numbers, convergence to the exact MM equation occurs in the limit of very high substrate concentration as the stochastic kinetics approaches the deterministic behaviour.« less

Moral motivation based on multiple developmental structures: an exploration of cognitive and emotional dynamics.

PubMed

Kaplan, Ulas; Tivnan, Terrence

2014-01-01

Intrapersonal variability and multiplicity in the complexity of moral motivation were examined from Dynamic Systems and Self-Determination Theory perspectives. L. Kohlberg's (1969) stages of moral development are reconceptualized as soft-assembled and dynamically transformable process structures of motivation that may operate simultaneously within person in different degrees. Moral motivation is conceptualized as the real-time process of self-organization of cognitive and emotional dynamics out of which moral judgment and action emerge. A detailed inquiry into intrapersonal variation in moral motivation is carried out based on the differential operation of multiple motivational structures. A total of 74 high school students and 97 college students participated in the study by completing a new questionnaire, involving 3 different hypothetical moral judgments. As hypothesized, findings revealed significant multiplicity in the within-person operation of developmental stage structures, and intrapersonal variability in the degrees to which stages were used. Developmental patterns were found in terms of different distributions of multiple stages between high school and college samples, as well as the association between age and overall motivation scores. Differential relations of specific emotions to moral motivation revealed and confirmed the value of differentiating multiple emotions. Implications of the present theoretical perspective and the findings for understanding the complexity of moral judgment and motivation are discussed.

When disaster strikes, nobody can hear you scream, but a radio can help regaining your voice.

NASA Astrophysics Data System (ADS)

Radzikowski, J. R.

2017-12-01

During disaster situations, communicating with family members and authorities is a matter of priority for social tranquillity and safety. Amateur radio operators can provide a resilient and effective mean of two-way communications which remains operational even in the most damaging disasters due to the low power requirements, and the use of wireless radio signal. The standard means of communications, such as phone services and the internet might be compromised, congested or unavailable, eliminating or impairing the normal modes of communications. Even the most resilient telecommunication systems designed with failure in mind with multiple redundant mechanisms, can be shut down during extreme disasters. One of the most important factors in preparation of rescue and recovery operations during disasters, is communication on local, regional, and trans-regional levels. Professional emergency responders have access to specialized communication equipment, however these resources are not available for local emergency teams, and NGOs assisting in rescue and recovery operations. Among the statutory principles of amateur radio is providing emergency communications. Each year there are many training events where operators practice how to build and operate field communication stations, and to work with local first responders and emergency operations centers. These skills have been utilized many times during natural disaster situations in the past, and this year hurricane season was no different. When hurricane Maria caused havoc to the telephone network in Puerto Rico, radio communication organized and maintained by volunteers was crucial in relaying information from people living on the island to their families abroad, and in supporting relief operations. For several weeks after the hurricane, rescue operations organized by American Red Cross were relying on voice and digital communication provided by volunteers who responded to ARC's call for help.

Reconsidering the Resources Needed for Multiple Casualty Events: Lessons Learned From the Crash of Asiana Airlines Flight 214.

PubMed

Campion, Eric M; Juillard, Catherine; Knudson, M Margaret; Dicker, Rochelle; Cohen, Mitchell J; Mackersie, Robert; Campbell, Andre R; Callcut, Rachael A

2016-06-01

To date, a substantial portion of multiple casualty incident literature has focused exclusively on prehospital and emergency department resources needed for optimal disaster response. Thus, inpatient resources required to care for individuals injured in multiple casualty events are not well described. To highlight the resources beyond initial emergency department triage needed for multiple casualty events, using one of the largest commercial aviation disasters in modern US history as a case study. Prospective case series of injured individuals treated at an urban level I trauma center following the crash of Asiana Airlines flight 214 on July 6, 2013. This analysis was conducted between June 1, 2014, and December 1, 2015. Commercial jetliner crash. Medical records, imaging data, nursing overtime, blood bank records, and trauma registry data were analyzed. Disaster logs, patient injuries, and blood product data were prospectively collected during the incident. Among 307 people aboard the flight, 192 were injured; 63 of the injured patients were initially evaluated at San Francisco General Hospital and Trauma Center (the highest number at any of the receiving medical facilities; age range, 4-74 years [23 were aged <17 years and 3 were aged >60 years]; median injury severity score of 19 admitted patients, 9 [range, 9-45]), including the highest number of critically injured patients (10 of 12). Despite the high impact of the crash, only 3 persons (<1%) died, including 1 in-hospital death. Among the 63 patients, 32 (50.8%) underwent a computed tomographic imaging study, with imaging of the abdomen and pelvis being the most common. Sixteen of the 32 patients undergoing computed tomography (50.0%) had a positive finding on at least 1 scan. Nineteen patients had major injuries and required admission, with 5 taken directly from the emergency department to the operating room. The most frequent injury was spinal fracture (13 patients). In the first 48 hours, 15 operations were performed and 117 total units of blood products were transfused. A total of 370 nursing overtime hours were required to treat the injured patients on the day of the event. Proper disaster preparedness requires attention to hospital-level needs beyond initial emergency department triage. The Asiana Airlines flight 214 crash highlights the need to plan for high use of advanced imaging, blood products, operating room availability, nursing resources, and management of inpatient hospital beds.

Education and Training of Emergency Medical Teams: Recommendations for a Global Operational Learning Framework.

PubMed

Amat Camacho, Nieves; Hughes, Amy; Burkle, Frederick M; Ingrassia, Pier Luigi; Ragazzoni, Luca; Redmond, Anthony; Norton, Ian; von Schreeb, Johan

2016-10-21

An increasing number of international emergency medical teams are deployed to assist disaster-affected populations worldwide. Since Haiti earthquake those teams have been criticised for ill adapted care, lack of preparedness in addition to not coordinating with the affected country healthcare system. The Emergency Medical Teams (EMTs) initiative, as part of the Word Health Organization's Global Health Emergency Workforce program, aims to address these shortcomings by improved EMT coordination, and mechanisms to ensure quality and accountability of national and international EMTs. An essential component to reach this goal is appropriate education and training. Multiple disaster education and training programs are available. However, most are centred on individuals' professional development rather than on the EMTs operational performance. Moreover, no common overarching or standardised training frameworks exist. In this report, an expert panel review and discuss the current approaches to disaster education and training and propose a three-step operational learning framework that could be used for EMTs globally. The proposed framework includes the following steps: 1) ensure professional competence and license to practice, 2) support adaptation of technical and non-technical professional capacities into the low-resource and emergency context and 3) prepare for an effective team performance in the field. A combination of training methodologies is also recommended, including individual theory based education, immersive simulations and team training. Agreed curriculum and open access training materials for EMTs need to be further developed, ideally through collaborative efforts between WHO, operational EMT organizations, universities, professional bodies and training agencies.  Keywords: disasters; education; emergencies; global health; learning.

Education and Training of Emergency Medical Teams: Recommendations for a Global Operational Learning Framework

PubMed Central

Amat Camacho, Nieves; Hughes, Amy; Burkle, Frederick M.; Ingrassia, Pier Luigi; Ragazzoni, Luca; Redmond, Anthony; Norton, Ian; von Schreeb, Johan

2016-01-01

An increasing number of international emergency medical teams are deployed to assist disaster-affected populations worldwide. Since Haiti earthquake those teams have been criticised for ill adapted care, lack of preparedness in addition to not coordinating with the affected country healthcare system. The Emergency Medical Teams (EMTs) initiative, as part of the Word Health Organization’s Global Health Emergency Workforce program, aims to address these shortcomings by improved EMT coordination, and mechanisms to ensure quality and accountability of national and international EMTs. An essential component to reach this goal is appropriate education and training. Multiple disaster education and training programs are available. However, most are centred on individuals’ professional development rather than on the EMTs operational performance. Moreover, no common overarching or standardised training frameworks exist. In this report, an expert panel review and discuss the current approaches to disaster education and training and propose a three-step operational learning framework that could be used for EMTs globally. The proposed framework includes the following steps: 1) ensure professional competence and license to practice, 2) support adaptation of technical and non-technical professional capacities into the low-resource and emergency context and 3) prepare for an effective team performance in the field. A combination of training methodologies is also recommended, including individual theory based education, immersive simulations and team training. Agreed curriculum and open access training materials for EMTs need to be further developed, ideally through collaborative efforts between WHO, operational EMT organizations, universities, professional bodies and training agencies.  Keywords: disasters; education; emergencies; global health; learning PMID:27917306

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

Barnes, Scott V.

On August 1, 2014, Idaho National Laboratory (INL), in coordination with the State of Idaho, local jurisdictions, Department of Energy (DOE) Idaho Operations Office, and DOE Headquarters (DOE-HQ), conducted the annual emergency exercise to demonstrate the ability to implement the requirements of DOE O 151.1C, “Comprehensive Emergency Management System.” The INL contractor, Battelle Energy Alliance, LLC (BEA), in coordination with other INL contractors, conducted operations and demonstrated appropriate response measures to mitigate an event and protect the health and safety of personnel, the environment, and property. Offsite response organizations participated to demonstrate appropriate response measures. Report data were collected frommore » multiple sources, which included documentation generated during exercise response, player critiques conducted immediately after terminating the exercise, personnel observation sheets, and evaluation critiques. Evaluation of this exercise served as a management assessment of the performance of the INL Emergency Management Program (IAS141618).« less

Rib fractures in trauma patients: does operative fixation improve outcome?

PubMed

Majak, Peter; Næss, Pål A

2016-12-01

Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively. Although patient selection and timing of the operation seem crucial for successful outcome, no consensus exists. Mortality reduction has only been shown in a few studies. Most studies are retrospective cohort and case-control studies. Only four randomized control trials exist. Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.

Intelligent Middle-Ware Architecture for Mobile Networks

NASA Astrophysics Data System (ADS)

Rayana, Rayene Ben; Bonnin, Jean-Marie

Recent advances in electronic and automotive industries as well as in wireless telecommunication technologies have drawn a new picture where each vehicle became “fully networked”. Multiple stake-holders (network operators, drivers, car manufacturers, service providers, etc.) will participate in this emerging market, which could grow following various models. To free the market from technical constraints, it is important to return to the basics of the Internet, i.e., providing embarked devices with a fully operational Internet connectivity (IPv6).

Dynamic equilibrium strategy for drought emergency temporary water transfer and allocation management

NASA Astrophysics Data System (ADS)

Xu, Jiuping; Ma, Ning; Lv, Chengwei

2016-08-01

Efficient water transfer and allocation are critical for disaster mitigation in drought emergencies. This is especially important when the different interests of the multiple decision makers and the fluctuating water resource supply and demand simultaneously cause space and time conflicts. To achieve more effective and efficient water transfers and allocations, this paper proposes a novel optimization method with an integrated bi-level structure and a dynamic strategy, in which the bi-level structure works to deal with space dimension conflicts in drought emergencies, and the dynamic strategy is used to deal with time dimension conflicts. Combining these two optimization methods, however, makes calculation complex, so an integrated interactive fuzzy program and a PSO-POA are combined to develop a hybrid-heuristic algorithm. The successful application of the proposed model in a real world case region demonstrates its practicality and efficiency. Dynamic cooperation between multiple reservoirs under the coordination of a global regulator reflects the model's efficiency and effectiveness in drought emergency water transfer and allocation, especially in a fluctuating environment. On this basis, some corresponding management recommendations are proposed to improve practical operations.

Energy Management of Smart Distribution Systems

NASA Astrophysics Data System (ADS)

Ansari, Bananeh

Electric power distribution systems interface the end-users of electricity with the power grid. Traditional distribution systems are operated in a centralized fashion with the distribution system owner or operator being the only decision maker. The management and control architecture of distribution systems needs to gradually transform to accommodate the emerging smart grid technologies, distributed energy resources, and active electricity end-users or prosumers. The content of this document concerns with developing multi-task multi-objective energy management schemes for: 1) commercial/large residential prosumers, and 2) distribution system operator of a smart distribution system. The first part of this document describes a method of distributed energy management of multiple commercial/ large residential prosumers. These prosumers not only consume electricity, but also generate electricity using their roof-top solar photovoltaics systems. When photovoltaics generation is larger than local consumption, excess electricity will be fed into the distribution system, creating a voltage rise along the feeder. Distribution system operator cannot tolerate a significant voltage rise. ES can help the prosumers manage their electricity exchanges with the distribution system such that minimal voltage fluctuation occurs. The proposed distributed energy management scheme sizes and schedules each prosumer's ES to reduce the electricity bill and mitigate voltage rise along the feeder. The second part of this document focuses on emergency energy management and resilience assessment of a distribution system. The developed emergency energy management system uses available resources and redundancy to restore the distribution system's functionality fully or partially. The success of the restoration maneuver depends on how resilient the distribution system is. Engineering resilience terminology is used to evaluate the resilience of distribution system. The proposed emergency energy management scheme together with resilience assessment increases the distribution system operator's preparedness for emergency events.

[Operative treatment strategies for multiple trauma patients : early total care versus damage control].

PubMed

Klüter, T; Lippross, S; Oestern, S; Weuster, M; Seekamp, A

2013-09-01

The treatment of multiple trauma patients is a great challenge for an interdisciplinary team. After preclinical care and subsequent treatment in the emergency room the order of the interventions is prioritized depending of the individual risk stratification. For planning the surgery management it is essential to distinguish between absolutely essential operations to prevent life-threatening situations for the patient and interventions with shiftable indications, depending on the general condition of the patient. All interventions need to be done without causing significant secondary damage to prohibit hyperinflammation and systemic inflammatory response syndrome. The challenge consists in determination of the appropriate treatment at the right point in time. In general the early primary intervention, early total care, is differentiated from the damage control concept.

Federal Emergency Management Information System (FEMIS) system administration guide, version 1.4.5

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

Arp, J.A.; Burnett, R.A.; Carter, R.J.

The Federal Emergency Management Information Systems (FEMIS) is an emergency management planning and response tool that was developed by the Pacific Northwest National Laboratory (PNNL) under the direction of the US Army Chemical Biological Defense Command. The FEMIS System Administration Guide provides information necessary for the system administrator to maintain the FEMIS system. The FEMIS system is designed for a single Chemical Stockpile Emergency Preparedness Program (CSEPP) site that has multiple Emergency Operations Centers (EOCs). Each EOC has personal computers (PCs) that emergency planners and operations personnel use to do their jobs. These PCs are connected via a local areamore » network (LAN) to servers that provide EOC-wide services. Each EOC is interconnected to other EOCs via a Wide Area Network (WAN). Thus, FEMIS is an integrated software product that resides on client/server computer architecture. The main body of FEMIS software, referred to as the FEMIS Application Software, resides on the PC client(s) and is directly accessible to emergency management personnel. The remainder of the FEMIS software, referred to as the FEMIS Support Software, resides on the UNIX server. The Support Software provides the communication, data distribution, and notification functionality necessary to operate FEMIS in a networked, client/server environment. The UNIX server provides an Oracle relational database management system (RDBMS) services, ARC/INFO GIS (optional) capabilities, and basic file management services. PNNL developed utilities that reside on the server include the Notification Service, the Command Service that executes the evacuation model, and AutoRecovery. To operate FEMIS, the Application Software must have access to a site specific FEMIS emergency management database. Data that pertains to an individual EOC`s jurisdiction is stored on the EOC`s local server. Information that needs to be accessible to all EOCs is automatically distributed by the FEMIS database to the other EOCs at the site.« less

Caffeine accelerates recovery from general anesthesia via multiple pathways.

PubMed

Fong, Robert; Khokhar, Suhail; Chowdhury, Atif N; Xie, Kelvin G; Wong, Josiah Hiu-Yuen; Fox, Aaron P; Xie, Zheng

2017-09-01

Various studies have explored different ways to speed emergence from anesthesia. Previously, we have shown that three drugs that elevate intracellular cAMP (forskolin, theophylline, and caffeine) accelerate emergence from anesthesia in rats. However, our earlier studies left two main questions unanswered. First, were cAMP-elevating drugs effective at all anesthetic concentrations? Second, given that caffeine was the most effective of the drugs tested, why was caffeine more effective than forskolin since both drugs elevate cAMP? In our current study, emergence time from anesthesia was measured in adult rats exposed to 3% isoflurane for 60 min. Caffeine dramatically accelerated emergence from anesthesia, even at the high level of anesthetic employed. Caffeine has multiple actions including blockade of adenosine receptors. We show that the selective A 2a adenosine receptor antagonist preladenant or the intracellular cAMP ([cAMP] i )-elevating drug forskolin, accelerated recovery from anesthesia. When preladenant and forskolin were tested together, the effect on anesthesia recovery time was additive indicating that these drugs operate via different pathways. Furthermore, the combination of preladenant and forskolin was about as effective as caffeine suggesting that both A 2A receptor blockade and [cAMP] i elevation play a role in caffeine's ability to accelerate emergence from anesthesia. Because anesthesia in rodents is thought to be similar to that in humans, these results suggest that caffeine might allow for rapid and uniform emergence from general anesthesia in humans at all anesthetic concentrations and that both the elevation of [cAMP] i and adenosine receptor blockade play a role in this response. NEW & NOTEWORTHY Currently, there is no method to accelerate emergence from anesthesia. Patients "wake" when they clear the anesthetic from their systems. Previously, we have shown that caffeine can accelerate emergence from anesthesia. In this study, we show that caffeine is effective even at high levels of anesthetic. We also show that caffeine operates by both elevating intracellular cAMP levels and by blocking adenosine receptors. This complicated pharmacology makes caffeine especially effective in accelerating emergence from anesthesia. Copyright © 2017 the American Physiological Society.

"There Was Something about Aspiration": Widening Participation Policy Affects in England and Australia

ERIC Educational Resources Information Center

Sellar, Sam; Storan, John

2013-01-01

This paper discusses the emergence of aspiration as a keyword linked to higher education equity policy in England and Australia since 1997. Aspiration serves multiple purposes when constructed as a problematic site in which policy must intervene. For example, it can be understood as a vector for new technologies of governance that operate through…

Emergency material allocation and scheduling for the application to chemical contingency spills under multiple scenarios.

PubMed

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

2017-01-01

In the emergency management relevant to chemical contingency spills, efficiency emergency rescue can be deeply influenced by a reasonable assignment of the available emergency materials to the related risk sources. In this study, an emergency material scheduling model (EMSM) with time-effective and cost-effective objectives is developed to coordinate both allocation and scheduling of the emergency materials. Meanwhile, an improved genetic algorithm (IGA) which includes a revision operation for EMSM is proposed to identify the emergency material scheduling schemes. Then, scenario analysis is used to evaluate optimal emergency rescue scheme under different emergency pollution conditions associated with different threat degrees based on analytic hierarchy process (AHP) method. The whole framework is then applied to a computational experiment based on south-to-north water transfer project in China. The results demonstrate that the developed method not only could guarantee the implementation of the emergency rescue to satisfy the requirements of chemical contingency spills but also help decision makers identify appropriate emergency material scheduling schemes in a balance between time-effective and cost-effective objectives.

Reduction of operative mortality after implementation of Surgical Outcomes Monitoring and Improvement Programme by Hong Kong Hospital Authority.

PubMed

Yuen, W C; Wong, K; Cheung, Y S; Lai, P Bs

2018-04-01

Since 2008, the Hong Kong Hospital Authority has implemented a Surgical Outcomes Monitoring and Improvement Programme (SOMIP) at 17 public hospitals with surgical departments. This study aimed to assess the change in operative mortality rate after implementation of SOMIP. The SOMIP included all Hospital Authority patients undergoing major/ultra-major procedures in general surgery, urology, plastic surgery, and paediatric surgery. Patients undergoing liver or renal transplantation or who had multiple trauma or massive bowel ischaemia were excluded. In SOMIP, data retrieval from the Hospital Authority patient database was performed by six full-time nurse reviewers following a set of precise data definitions. A total of 230 variables were collected for each patient, on demographics, preoperative and operative variables, laboratory test results, and postoperative complications up to 30 days after surgery. In this study, we used SOMIP cumulative 5-year data to generate risk-adjusted 30-day mortality models by hierarchical logistic regression for both emergency and elective operations. The models expressed overall performance as an annual observed-to-expected mortality ratio. From 2009/2010 to 2015/2016, the overall crude mortality rate decreased from 10.8% to 5.6% for emergency procedures and from 0.9% to 0.4% for elective procedures. From 2011/2012 to 2015/2016, the risk-adjusted observed-to-expected mortality ratios showed a significant downward trend for both emergency and elective operations: from 1.126 to 0.796 and from 1.150 to 0.859, respectively (Mann- Kendall statistic = -0.8; P<0.05 for both). The Hospital Authority's overall crude mortality rates and risk-adjusted observed-to-expected mortality ratios for emergency and elective operations significantly declined after SOMIP was implemented.

Urban Resources Selection and Allocation for Emergency Shelters: In a Multi-Hazard Environment.

PubMed

Chen, Wei; Zhai, Guofang; Ren, Chongqiang; Shi, Yijun; Zhang, Jianxin

2018-06-14

This study explores how emergency shelters can adapt to a multi-hazard environment by geographic information system (GIS) and takes Guangzhou as a case for analysis. The physical suitability of the overall urban resources was first assessed by aiming to select the suitable resources and safe locations for emergency shelters in the context of multiple disasters. Afterward, by analyzing the scale and spatial distribution of affected areas and populations under different types of disaster scenarios, the demand for different kinds of shelters were predicted. Lastly, taking into account the coverage of the affected people, shelters were allocated according to different conditions in the districts. This work will hopefully provide a reference for the construction of emergency shelters and help form emergency operations in order to mitigate the impact of hazards. The issues identified in the study need to be further studied in medium or small-scale cities.

Post Accident Procedures for Chemicals and Propellants.

DTIC Science & Technology

1982-09-01

METHODS AND PROCEDURES ............ 4-1 4.1 Overview of Emergency Response Procedures " and Resources Available .......................... 4-1 L1 TABLE...7-1 7.1 Criteria forTwelve Critical Operations ........................ 7-1 7.1.1 On-Scene Methods for Identifying the Ingredients...Establishing A Protocol for Selecting the Hazards Mitigation and Cleanup Methods for Single Material Spills and Multiple Materials Mixing

[Estimation of surgical treatment capacity for managing mass casualty incidents based on time needed for life-saving emergency operations].

PubMed

Kanz, K-G; Huber-Wagner, S; Lefering, R; Kay, M; Qvick, M; Biberthaler, P; Mutschler, W

2006-04-01

The surgical treatment capacity of a hospital constitutes a significant restriction in the capability to deal with critically injured patients from multiple or mass casualty incidents (MCI). With regard to the time needed for life-saving operative interventions there are no basic reference values available in the literature, which can aid in detailed planning for management of mass casualty incidents. The data of 20,815 trauma patients, recorded in the trauma registry hosted by the German Association for Trauma Surgery DGU, were analyzed to extract the median duration of life-saving surgical interventions carried out in an operating theatre. Inclusion criteria were an ISS > or = 16 and the performance of relevant ICPM coded procedures within 6 h after trauma room admission. Orthopedic procedures as well as the placement of ICP catheters and chest tubes or performance of laparoscopies were not included. Complete data sets with the required variables were available from 9,988 trauma patients with an ISS > or = 16, and included 7,907 interventions that took place within 6 h after hospital admission. From among 1,228 patients 1,793 operations could be identified as relevant life-saving emergency operations. Acute injury to the abdomen was the major cause accounting for 54.1% of all emergency surgical procedures with a median intervention duration of 137 min followed by head injuries accounting for 26.3% with a median duration of 110 min. Interventions in the pelvis amounted to 11.5% taking an average of 136 min, 5.0% were in the thorax requiring 91 min and 3.1% major amputations with 142 min. The average cut to suture time for all emergency surgical interventions was 130 min. A prerequisite for estimating the surgical operation capacity for critically injured patients of an MCI is the number of OR teams available during and outside of the normal working hours of the hospital. The average operation time of 130 min calculated from investigation of 1,793 emergency life-saving surgical procedures provides a realistic guideline. Used in combination with the number of available OR teams the prospective treatment capacity can be estimated and projected into an actual incident admission capacity. The identification and numerical value of such significant variables are the basis for operations research and realistic planning in emergency and disaster medicine.

[Two Episodes of Colostomy-Associated Intestinal Perforation during Chemotherapy for Metastatic Rectal Cancer].

PubMed

Tamura, Hiroshi; Otani, Ayaka; Tsukui, Mizuki; Toge, Koji; Otani, Takahiro; Hirose, Yuki; Morimoto, Yuta; Yoshino, Kei; Kido, Tomoki; Endo, Kazuhiko; Kameyama, Hitoshi; Kobayashi, Takashi; Wakai, Toshifumi

2016-11-01

A 77-year-old woman with rectal cancer and synchronous liver metastasis underwent a Hartmann operation with D3 lymph node dissection in June 2014. mFOLFOX6 plus bevacizumab(bev)was then administered to treat the liver metastasis.In February 2015, multiple liver metastases were detected and the regimen was changed to FOLFIRI plus bev.After 3 courses, peritonitis due to intestinal perforation around the descending colostomy occurred, and an emergency operation(partial resection of the descending colon and transverse colostomy)was performed.FOLFIRI was then administered from 2 months after the operation.After 3 courses of this regimen, a CT scan showed progression of the hepatic metastases.The regimen was therefore changed to mFOLFOX6.Five months later, another CT scan showed an intestinal perforation of the transverse colostomy at the abdominal wall, and an emergency cecostomy was performed.At this stage, chemotherapy was ceased.This case highlights the risk of intestinal perforation during chemotherapy, regardless of the use of bev.

Predictive Value of Glasgow Coma Score and Full Outline of Unresponsiveness Score on the Outcome of Multiple Trauma Patients.

PubMed

Baratloo, Alireza; Shokravi, Masumeh; Safari, Saeed; Aziz, Awat Kamal

2016-03-01

The Full Outline of Unresponsiveness (FOUR) score was developed to compensate for the limitations of Glasgow coma score (GCS) in recent years. This study aimed to assess the predictive value of GCS and FOUR score on the outcome of multiple trauma patients admitted to the emergency department. The present prospective cross-sectional study was conducted on multiple trauma patients admitted to the emergency department. GCS and FOUR scores were evaluated at the time of admission and at the sixth and twelfth hours after admission. Then the receiver operating characteristic (ROC) curve, sensitivity, specificity, as well as positive and negative predictive value of GCS and FOUR score were evaluated to predict patients' outcome. Patients' outcome was divided into discharge with and without a medical injury (motor deficit, coma or death). Finally, 89 patients were studied. Sensitivity and specificity of GCS in predicting adverse outcome (motor deficit, coma or death) were 84.2% and 88.6% at the time of admission, 89.5% and 95.4% at the sixth hour and 89.5% and 91.5% at the twelfth hour, respectively. These values for the FOUR score were 86.9% and 88.4% at the time of admission, 89.5% and 100% at the sixth hour and 89.5% and 94.4% at the twelfth hour, respectively. Findings of this study indicate that the predictive value of FOUR score and GCS on the outcome of multiple trauma patients admitted to the emergency department is similar.

Evolution of surgical therapy for Stanford acute type A aortic dissection

PubMed Central

Chiu, Peter

2016-01-01

Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results. PMID:27563541

Oceanic Flights and Airspace: Improving Efficiency by Trajectory-Based Operations

NASA Technical Reports Server (NTRS)

Fernandes, Alicia Borgman; Rebollo, Juan; Koch, Michael

2016-01-01

Oceanic operations suffer from multiple inefficiencies, including pre-departure planning that does not adequately consider uncertainty in the proposed trajectory, restrictions on the routes that a flight operator can choose for an oceanic crossing, time-consuming processes and procedures for amending en route trajectories, and difficulties exchanging data between Flight Information Regions (FIRs). These inefficiencies cause aircraft to fly suboptimal trajectories, burning fuel and time that could be conserved. A concept to support integration of existing and emerging capabilities and concepts is needed to transition to an airspace system that employs Trajectory Based Operations (TBO) to improve efficiency and safety in oceanic operations. This paper describes such a concept and the results of preliminary activities to evaluate the concept, including a stakeholder feedback activity, user needs analysis, and high level benefits analysis.

The Journal of the Naval Postgraduate School Center for Homeland Defense and Security. Volume 6. Issue 3

DTIC Science & Technology

2010-09-01

genetic relationships between kin.33 Regardless of the underlying mechanism, individual symbiotic relationships can confer multiple benefits to the...allocation guidelines for homeland security and emergency management policymakers. The framework provides an operationally relevant rubric for...S. Wells, The Journey of Man: A Genetic Odyssey (Princeton, NJ: Princeton University Press, 2002). 4 A. Jakubowicz, “Anglo-multiculturalism

CAUSE Resiliency (West Coast) Experiment Final Report

DTIC Science & Technology

2012-10-01

implemented in BCeMap and can therefore consume alerting messages direct from MASAS. This would solve the issue with the update frequency and speed of the...in production for use by the Provincial Emergency Operations Centres and brings together multiple static layers together with several dynamic data...executive order established the requirement for an “effective, reliable, integrated, flexible, and comprehensive system to alert and warn the

Vehicle coordinated transportation dispatching model base on multiple crisis locations

NASA Astrophysics Data System (ADS)

Tian, Ran; Li, Shanwei; Yang, Guoying

2018-05-01

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

A resource management tool for public health continuity of operations during disasters.

PubMed

Turner, Anne M; Reeder, Blaine; Wallace, James C

2013-04-01

We developed and validated a user-centered information system to support the local planning of public health continuity of operations for the Community Health Services Division, Public Health - Seattle & King County, Washington. The Continuity of Operations Data Analysis (CODA) system was designed as a prototype developed using requirements identified through participatory design. CODA uses open-source software that links personnel contact and licensing information with needed skills and clinic locations for 821 employees at 14 public health clinics in Seattle and King County. Using a web-based interface, CODA can visualize locations of personnel in relationship to clinics to assist clinic managers in allocating public health personnel and resources under dynamic conditions. Based on user input, the CODA prototype was designed as a low-cost, user-friendly system to inventory and manage public health resources. In emergency conditions, the system can run on a stand-alone battery-powered laptop computer. A formative evaluation by managers of multiple public health centers confirmed the prototype design's usefulness. Emergency management administrators also provided positive feedback about the system during a separate demonstration. Validation of the CODA information design prototype by public health managers and emergency management administrators demonstrates the potential usefulness of building a resource management system using open-source technologies and participatory design principles.

A Resource Management Tool for Public Health Continuity of Operations During Disasters

PubMed Central

Turner, Anne M.; Reeder, Blaine; Wallace, James C.

2014-01-01

Objective We developed and validated a user-centered information system to support the local planning of public health continuity of operations for the Community Health Services Division, Public Health - Seattle & King County, Washington. Methods The Continuity of Operations Data Analysis (CODA) system was designed as a prototype developed using requirements identified through participatory design. CODA uses open-source software that links personnel contact and licensing information with needed skills and clinic locations for 821 employees at 14 public health clinics in Seattle and King County. Using a web-based interface, CODA can visualize locations of personnel in relationship to clinics to assist clinic managers in allocating public health personnel and resources under dynamic conditions. Results Based on user input, the CODA prototype was designed as a low-cost, user-friendly system to inventory and manage public health resources. In emergency conditions, the system can run on a stand-alone battery-powered laptop computer. A formative evaluation by managers of multiple public health centers confirmed the prototype design’s usefulness. Emergency management administrators also provided positive feedback about the system during a separate demonstration. Conclusions Validation of the CODA information design prototype by public health managers and emergency management administrators demonstrates the potential usefulness of building a resource management system using open-source technologies and participatory design principles. PMID:24618165

Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

NASA Technical Reports Server (NTRS)

Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis

2006-01-01

International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task completion and/or navigation, in particular the execution of the Surgeon call sequence. Debrief comments were used to analyze unclear procedural steps and to discern any discrepancies between the procedure and generally accepted BME actions. The sequence followed by BME participants differed considerably from the sequence intended by the procedure. Common deviations included the call sequence used to contact Surgeon, the content of BME and crew interaction and the gathering of pertinent console resources. Differing perceptions of task priority and imprecise language seem to have caused multiple deviations from the procedure s intended sequence. The study generated 40 recommendations for the procedure, of which 34 are being implemented. These recommendations address improving the clarity of the instructions, identifying training considerations, expediting Surgeon contact, improving cues for anticipated flight control team communication and identifying missing console tools.

Use of an automated drug distribution cabinet system in a disaster response mobile emergency department.

PubMed

Morchel, Herman; Ogedegbe, Chinwe; Desai, Nilesh; Faley, Brian; Mahmood, Nasir; Moro, Gary Del; Feldman, Joseph

2015-01-01

This article describes the innovative use of an automated drug distribution cabinet system for medication supply in a disaster response mobile Emergency Department vehicle. Prior to the use of the automated drug distribution cabinet system described in this article, the mobile hospitals were stocked as needed with drugs in individual boxes and draws. Experience with multiple deployments found this method to be very cumbersome and labor intensive, both in preparation, operational use, and demobilization. For a recent deployment to provide emergency medical care at the 2014 Super Bowl football event, the automated drug distribution cabinet system in the Institution's main campus Emergency Department was duplicated and incorporated into the mobile Emergency Department. This method of drug stocking and dispensing was found to be far more efficient than gathering and placing drugs in onboard draws and racks. Automated drug distribution cabinet systems can be used to significantly improve patient care and overall efficiency in mobile hospital deployments.

Exploring how surgeon teachers motivate residents in the operating room.

PubMed

Dath, Deepak; Hoogenes, Jen; Matsumoto, Edward D; Szalay, David A

2013-02-01

Motivation in teaching, mainly studied in disciplines outside of surgery, may also be an important part of intraoperative teaching. We explored techniques surgeons use to motivate learners in the operating room (OR). Forty-four experienced surgeon teachers from multiple specialties participated in 9 focus groups about teaching in the OR. Focus groups were transcribed and subjected to qualitative thematic analysis by 3 reviewers through an iterative, rigorous process. Analysis revealed 8 motivational techniques. Surgeons used motivation techniques tacitly, describing multiple ways that they facilitate resident motivation while teaching. Two major categories of motivational techniques emerged: (1) the facilitation of intrinsic motivation; and (2) the provision of factors to stimulate extrinsic motivation. Surgeons unknowingly but tacitly and commonly use motivation in intraoperative teaching and use a variety of techniques to foster learners' intrinsic and extrinsic motivation. Motivating learners is 1 vital role that surgeon teachers play in nontechnical intraoperative teaching. Copyright © 2013 Elsevier Inc. All rights reserved.

Acoustical Detection Of Leakage In A Combustor

NASA Technical Reports Server (NTRS)

Puster, Richard L.; Petty, Jeffrey L.

1993-01-01

Abnormal combustion excites characteristic standing wave. Acoustical leak-detection system gives early warning of failure, enabling operating personnel to stop combustion process and repair spray bar before leak grows large enough to cause damage. Applicable to engines, gas turbines, furnaces, and other machines in which acoustic emissions at known frequencies signify onset of damage. Bearings in rotating machines monitored for emergence of characteristic frequencies shown in previous tests associated with incipient failure. Also possible to monitor for signs of trouble at multiple frequencies by feeding output of transducer simultaneously to multiple band-pass filters and associated circuitry, including separate trigger circuit set to appropriate level for each frequency.

Operational Experience with Long Duration Wildfire Mapping: UAS Missions Over the Western United States

NASA Technical Reports Server (NTRS)

Hall, Philip; Cobleigh, Brent; Buoni, Greg; Howell, Kathleen

2008-01-01

The National Aeronautics and Space Administration, United States Forest Service, and National Interagency Fire Center have developed a partnership to develop and demonstrate technology to improve airborne wildfire imaging and data dissemination. In the summer of 2007, a multi-spectral infrared scanner was integrated into NASA's Ikhana Unmanned Aircraft System (UAS) (a General Atomics Predator-B) and launched on four long duration wildfire mapping demonstration missions covering eight western states. Extensive safety analysis, contingency planning, and mission coordination were key to securing an FAA certificate of authorization (COA) to operate in the national airspace. Infrared images were autonomously geo-rectified, transmitted to the ground station by satellite communications, and networked to fire incident commanders within 15 minutes of acquisition. Close coordination with air traffic control ensured a safe operation, and allowed real-time redirection around inclement weather and other minor changes to the flight plan. All objectives of the mission demonstrations were achieved. In late October, wind-driven wildfires erupted in five southern California counties. State and national emergency operations agencies requested Ikhana to help assess and manage the wildfires. Four additional missions were launched over a 5-day period, with near realtime images delivered to multiple emergency operations centers and fire incident commands managing 10 fires.

Operational Earthquake Forecasting and Earthquake Early Warning: The Challenges of Introducing Scientific Innovations for Public Safety

NASA Astrophysics Data System (ADS)

Goltz, J. D.

2016-12-01

Although variants of both earthquake early warning and short-term operational earthquake forecasting systems have been implemented or are now being implemented in some regions and nations, they have been slow to gain acceptance within the disciplines that produced them as well as among those for whom they were intended to assist. To accelerate the development and implementation of these technologies will require the cooperation and collaboration of multiple disciplines, some inside and others outside of academia. Seismologists, social scientists, emergency managers, elected officials and key opinion leaders from the media and public must be the participants in this process. Representatives of these groups come from both inside and outside of academia and represent very different organizational cultures, backgrounds and expectations for these systems, sometimes leading to serious disagreements and impediments to further development and implementation. This presentation will focus on examples of the emergence of earthquake early warning and operational earthquake forecasting systems in California, Japan and other regions and document the challenges confronted in the ongoing effort to improve seismic safety.

Planning and executing complex large-scale exercises.

PubMed

McCormick, Lisa C; Hites, Lisle; Wakelee, Jessica F; Rucks, Andrew C; Ginter, Peter M

2014-01-01

Increasingly, public health departments are designing and engaging in complex operations-based full-scale exercises to test multiple public health preparedness response functions. The Department of Homeland Security's Homeland Security Exercise and Evaluation Program (HSEEP) supplies benchmark guidelines that provide a framework for both the design and the evaluation of drills and exercises; however, the HSEEP framework does not seem to have been designed to manage the development and evaluation of multiple, operations-based, parallel exercises combined into 1 complex large-scale event. Lessons learned from the planning of the Mississippi State Department of Health Emergency Support Function--8 involvement in National Level Exercise 2011 were used to develop an expanded exercise planning model that is HSEEP compliant but accounts for increased exercise complexity and is more functional for public health. The Expanded HSEEP (E-HSEEP) model was developed through changes in the HSEEP exercise planning process in areas of Exercise Plan, Controller/Evaluator Handbook, Evaluation Plan, and After Action Report and Improvement Plan development. The E-HSEEP model was tested and refined during the planning and evaluation of Mississippi's State-level Emergency Support Function-8 exercises in 2012 and 2013. As a result of using the E-HSEEP model, Mississippi State Department of Health was able to capture strengths, lessons learned, and areas for improvement, and identify microlevel issues that may have been missed using the traditional HSEEP framework. The South Central Preparedness and Emergency Response Learning Center is working to create an Excel-based E-HSEEP tool that will allow practice partners to build a database to track corrective actions and conduct many different types of analyses and comparisons.

How are things adding up? Neural differences between arithmetic operations are due to general problem solving strategies.

PubMed

Tschentscher, Nadja; Hauk, Olaf

2014-05-15

A number of previous studies have interpreted differences in brain activation between arithmetic operation types (e.g. addition and multiplication) as evidence in favor of distinct cortical representations, processes or neural systems. It is still not clear how differences in general task complexity contribute to these neural differences. Here, we used a mental arithmetic paradigm to disentangle brain areas related to general problem solving from those involved in operation type specific processes (addition versus multiplication). We orthogonally varied operation type and complexity. Importantly, complexity was defined not only based on surface criteria (for example number size), but also on the basis of individual participants' strategy ratings, which were validated in a detailed behavioral analysis. We replicated previously reported operation type effects in our analyses based on surface criteria. However, these effects vanished when controlling for individual strategies. Instead, procedural strategies contrasted with memory retrieval reliably activated fronto-parietal and motor regions, while retrieval strategies activated parietal cortices. This challenges views that operation types rely on partially different neural systems, and suggests that previously reported differences between operation types may have emerged due to invalid measures of complexity. We conclude that mental arithmetic is a powerful paradigm to study brain networks of abstract problem solving, as long as individual participants' strategies are taken into account. Copyright © 2014 Elsevier Inc. All rights reserved.

Post-coma persons with extensive multiple disabilities use microswitch technology to access selected stimulus events or operate a radio device.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Oliva, Doretta; Megna, Gianfranco; Iliceto, Carla; Damiani, Sabino; Ricci, Irene; Spica, Antonella

2011-01-01

The present two studies extended research evidence on the use of microswitch technology by post-coma persons with multiple disabilities. Specifically, Study I examined whether three adults with a diagnosis of minimally conscious state and multiple disabilities could use microswitches as tools to access brief, selected stimulus events. Study II assessed whether an adult, who had emerged from a minimally conscious state but was affected by multiple disabilities, could manage the use of a radio device via a microswitch-aided program. Results showed that the participants of Study I had a significant increase of microswitch responding during the intervention phases. The participant of Study II learned to change radio stations and seemed to spend different amounts of session time on the different stations available (suggesting preferences among the programs characterizing them). The importance of microswitch technology for assisting post-coma persons with multiple disabilities to positively engage with their environment was discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

Self-adjoint realisations of the Dirac-Coulomb Hamiltonian for heavy nuclei

NASA Astrophysics Data System (ADS)

Gallone, Matteo; Michelangeli, Alessandro

2018-02-01

We derive a classification of the self-adjoint extensions of the three-dimensional Dirac-Coulomb operator in the critical regime of the Coulomb coupling. Our approach is solely based upon the Kreĭn-Višik-Birman extension scheme, or also on Grubb's universal classification theory, as opposite to previous works within the standard von Neumann framework. This let the boundary condition of self-adjointness emerge, neatly and intrinsically, as a multiplicative constraint between regular and singular part of the functions in the domain of the extension, the multiplicative constant giving also immediate information on the invertibility property and on the resolvent and spectral gap of the extension.

14 CFR 133.31 - Emergency operations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Emergency operations. 133.31 Section 133.31... OPERATIONS Operating Rules and Related Requirements § 133.31 Emergency operations. (a) In an emergency... Amdt. 133-11, 54 FR 39294, Sept. 25, 1989] ...

Modeling a Civil Event Case Study for Consequence Management Using the IMPRINT Forces Module

NASA Technical Reports Server (NTRS)

Gacy, Marc; Gosakan, Mala; Eckdahl, Angela; Miller, Jeffrey R.

2012-01-01

A critical challenge in the Consequence Management (CM) domain is the appropriate allocation of necessary and skilled military and civilian personnel and materiel resources in unexpected emergencies. To aid this process we used the Forces module in the Improved Performance Research Integration Tool (IMPRINT). This module enables analysts to enter personnel and equipment capabilities, prioritized schedules and numbers available, along with unexpected emergency requirements in order to assess force response requirements. Using a suspected terrorist threat on a college campus, we developed a test case model which exercised the capabilities of the module, including the scope and scale of operations. The model incorporates data from multiple sources, including daily schedules and frequency of events such as fire calls. Our preliminary results indicate that the model can predict potential decreases in civilian emergency response coverage due to an involved unplanned incident requiring significant portions of police, fire and civil responses teams.

Affordable multisensor digital video architecture for 360° situational awareness displays

NASA Astrophysics Data System (ADS)

Scheiner, Steven P.; Khan, Dina A.; Marecki, Alexander L.; Berman, David A.; Carberry, Dana

2011-06-01

One of the major challenges facing today's military ground combat vehicle operations is the ability to achieve and maintain full-spectrum situational awareness while under armor (i.e. closed hatch). Thus, the ability to perform basic tasks such as driving, maintaining local situational awareness, surveillance, and targeting will require a high-density array of real time information be processed, distributed, and presented to the vehicle operators and crew in near real time (i.e. low latency). Advances in display and sensor technologies are providing never before seen opportunities to supply large amounts of high fidelity imagery and video to the vehicle operators and crew in real time. To fully realize the advantages of these emerging display and sensor technologies, an underlying digital architecture must be developed that is capable of processing these large amounts of video and data from separate sensor systems and distributing it simultaneously within the vehicle to multiple vehicle operators and crew. This paper will examine the systems and software engineering efforts required to overcome these challenges and will address development of an affordable, integrated digital video architecture. The approaches evaluated will enable both current and future ground combat vehicle systems the flexibility to readily adopt emerging display and sensor technologies, while optimizing the Warfighter Machine Interface (WMI), minimizing lifecycle costs, and improve the survivability of the vehicle crew working in closed-hatch systems during complex ground combat operations.

Emergent Literacy Supports for Students Who Are Deaf-Blind or Have Visual and Multiple Impairments: A Multiple-Case Study

ERIC Educational Resources Information Center

McKenzie, Amy R.

2009-01-01

Seven classrooms of students with deaf-blindness or visual and multiple impairments were observed to document the emergent literacy supports that were present, including environmental characteristics, strategies, or activities. The findings revealed that the majority of classrooms used emergent literacy supports that were previously documented for…

18 CFR 376.209 - Procedures during periods of emergency requiring activation of the Continuity of Operations Plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... periods of emergency requiring activation of the Continuity of Operations Plan. 376.209 Section 376.209... GENERAL RULES ORGANIZATION, MISSION, AND FUNCTIONS; OPERATIONS DURING EMERGENCY CONDITIONS Commission Operation During Emergency Conditions § 376.209 Procedures during periods of emergency requiring activation...

A new perspective on life-saving procedures in a battlefield setting: Emergency cricothyroidotomy, needle thoracostomy, and chest tube thoracostomy with night vision goggles.

PubMed

Bilge, Sedat; Aydın, Attila; Bilge, Meltem; Aydın, Cemile; Çevik, Erdem; Eryılmaz, Mehmet

2017-11-01

In the patients with multiple and serious trauma, early applications of life-saving procedures are related to improved survival. We tried to experimentally determine the feasibility of life-saving interventions that are performed with the aid of night vision goggles (NVG) in nighttime combat scenario. Chest tube thoracostomy (CTT), emergency cricothyroidotomy (EC), and needle thoracostomy (NT) interventions were performed by 10 combatant medical staff. The success and duration of interventions were explored in the study. Procedures were performed on the formerly prepared manikins/models in a bright room and in a dark room with the aid of NVG. Operators graded the ease of interventions. All interventions were found successful. Operators stated that both CTT and EC interventions were more difficult in dark than in daytime (p<0.05). No significant difference was observed in the difficulty in the NT interventions. No significant difference was observed in terms of completion times of interventions between in daytime and in dark scenario. The operators who use NVGs have to be aware of that they can perform their tactic and medical activities without taking off the NVGs and without the requirement of an extra light source.

Abdominal injuries in a low trauma volume hospital - a descriptive study from northern Sweden

PubMed Central

2014-01-01

Background Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital. Methods This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009. Results The median New Injury Severity Score was 9 (range: 1–57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT < 60 min after emergency room arrival. Penetrating trauma caused injuries in seven patients. Solid organ injuries constituted 78% of abdominal injuries. Non-operative management succeeded in 82 patients. Surgery was performed for 28 patients, either immediately (n = 17) as result of operative management or later (n = 11), due to non-operative management failure; the latter mainly occurred with hollow viscus injuries. Patients with multiple abdominal injuries, whether associated with multiple trauma or an isolated abdominal trauma, had significantly more non-operative failures than patients with a single abdominal injury. One death occurred within 30 days. Conclusions Non-operative management of patients with abdominal injuries, except for hollow viscus injuries, was highly successful in our low trauma volume hospital, even though surgeons receive low exposure to these patients. However, a growing proportion of surgeons lack experience in decision-making and performing trauma laparotomies. Quality assurance programmes must be emphasized to ensure future competence and quality of trauma care at low trauma volume hospitals. PMID:25124882

The Business Emergency Operations Center (BEOC) - A Model for Inter-Agency and Inter-Sector Communication and Collaboration

DTIC Science & Technology

2011-06-01

of Observe, Orient, Decide, Act (OODA) and Sense, Interpret, Decide, Act ( SIDA ) loops is important to understand and research as part of this...C2 process loops, OODA, developed by John Boyd, (Coram 2002, Lind 1985) and/or SIDA , (Haeckel 2001) are functioning at multiple levels and the...model of C2 is grounded in OODA and SIDA loops addressed earlier in this paper. During exercises, the salient activity of moving through the process

10 CFR 50.103 - Suspension and operation in war or national emergency.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Suspension and operation in war or national emergency. 50..., Emergency Operations by the Commission § 50.103 Suspension and operation in war or national emergency. (a) Whenever Congress declares that a state of war or national emergency exists, the Commission, if it finds it...

Preliminary Concept of Operations for the Spent Fuel Management System--WM2017

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

Cumberland, Riley M; Adeniyi, Abiodun Idowu; Howard, Rob L

The Nuclear Fuels Storage and Transportation Planning Project (NFST) within the U.S. Department of Energy s Office of Nuclear Energy is tasked with identifying, planning, and conducting activities to lay the groundwork for developing interim storage and transportation capabilities in support of an integrated waste management system. The system will provide interim storage for commercial spent nuclear fuel (SNF) from reactor sites and deliver it to a repository. The system will also include multiple subsystems, potentially including; one or more interim storage facilities (ISF); one or more repositories; facilities to package and/or repackage SNF; and transportation systems. The project teammore » is analyzing options for an integrated waste management system. To support analysis, the project team has developed a Concept of Operations document that describes both the potential integrated system and inter-dependencies between system components. The goal of this work is to aid systems analysts in the development of consistent models across the project, which involves multiple investigators. The Concept of Operations document will be updated periodically as new developments emerge. At a high level, SNF is expected to travel from reactors to a repository. SNF is first unloaded from reactors and placed in spent fuel pools for wet storage at utility sites. After the SNF has cooled enough to satisfy loading limits, it is placed in a container at reactor sites for storage and/or transportation. After transportation requirements are met, the SNF is transported to an ISF to store the SNF until a repository is developed or directly to a repository if available. While the high level operation of the system is straightforward, analysts must evaluate numerous alternative options. Alternative options include the number of ISFs (if any), ISF design, the stage at which SNF repackaging occurs (if any), repackaging technology, the types of containers used, repository design, component sizing, and timing of events. These alternative options arise due to technological, economic, or policy considerations. As new developments regularly emerge, the operational concepts will be periodically updated. This paper gives an overview of the different potential alternatives identified in the Concept of Operations document at a conceptual level.« less

Generalized Cartographic and Simultaneous Representation of Utility Networks for Decision-Support Systems and Crisis Management in Urban Environments

NASA Astrophysics Data System (ADS)

Becker, T.; König, G.

2015-10-01

Cartographic visualizations of crises are used to create a Common Operational Picture (COP) and enforce Situational Awareness by presenting relevant information to the involved actors. As nearly all crises affect geospatial entities, geo-data representations have to support location-specific analysis throughout the decision-making process. Meaningful cartographic presentation is needed for coordinating the activities of crisis manager in a highly dynamic situation, since operators' attention span and their spatial memories are limiting factors during the perception and interpretation process. Situational Awareness of operators in conjunction with a COP are key aspects in decision-making process and essential for making well thought-out and appropriate decisions. Considering utility networks as one of the most complex and particularly frequent required systems in urban environment, meaningful cartographic presentation of multiple utility networks with respect to disaster management do not exist. Therefore, an optimized visualization of utility infrastructure for emergency response procedures is proposed. The article will describe a conceptual approach on how to simplify, aggregate, and visualize multiple utility networks and their components to meet the requirements of the decision-making process and to support Situational Awareness.

Smart repeater system for communications interoperability during multiagency law enforcement operations

NASA Astrophysics Data System (ADS)

Crutcher, Richard I.; Jones, R. W.; Moore, Michael R.; Smith, S. F.; Tolley, Alan L.; Rochelle, Robert W.

1997-02-01

A prototype 'smart' repeater that provides interoperability capabilities for radio communication systems in multi-agency and multi-user scenarios is being developed by the Oak Ridge National Laboratory. The smart repeater functions as a deployable communications platform that can be dynamically reconfigured to cross-link the radios of participating federal, state, and local government agencies. This interconnection capability improves the coordination and execution of multi-agency operations, including coordinated law enforcement activities and general emergency or disaster response scenarios. The repeater provides multiple channels of operation in the 30-50, 118-136, 138-174, and 403-512 MHz land mobile communications and aircraft bands while providing the ability to cross-connect among multiple frequencies, bands, modulation types, and encryption formats. Additionally, two telephone interconnects provide links to the fixed and cellular telephone networks. The 800- and 900-MHz bands are not supported by the prototype, but the modular design of the system accommodates future retrofits to extend frequency capabilities with minimal impact to the system. Configuration of the repeater is through a portable personal computer with a Windows-based graphical interface control screen that provides dynamic reconfiguration of network interconnections and formats.

48 CFR 252.232-7011 - Payments in Support of Emergencies and Contingency Operations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Emergencies and Contingency Operations. 252.232-7011 Section 252.232-7011 Federal Acquisition Regulations... Emergencies and Contingency Operations. As prescribed in section 232.908, use the following clause: PAYMENTS IN SUPPORT OF EMERGENCIES AND CONTINGENCY OPERATIONS (JUL 2010) (a) Definitions of pertinent terms...

Improving Emergency Response and Human-Robotic Performance

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

David I. Gertman; David J. Bruemmer; R. Scott Hartley

2007-08-01

Preparedness for chemical, biological, and radiological/nuclear incidents at nuclear power plants (NPPs) includes the deployment of well trained emergency response teams. While teams are expected to do well, data from other domains suggests that the timeliness and accuracy associated with incident response can be improved through collaborative human-robotic interaction. Many incident response scenarios call for multiple, complex procedure-based activities performed by personnel wearing cumbersome personal protective equipment (PPE) and operating under high levels of stress and workload. While robotic assistance is postulated to reduce workload and exposure, limitations associated with communications and the robot’s ability to act independently have servedmore » to limit reliability and reduce our potential to exploit human –robotic interaction and efficacy of response. Recent work at the Idaho National Laboratory (INL) on expanding robot capability has the potential to improve human-system response during disaster management and recovery. Specifically, increasing the range of higher level robot behaviors such as autonomous navigation and mapping, evolving new abstractions for sensor and control data, and developing metaphors for operator control have the potential to improve state-of-the-art in incident response. This paper discusses these issues and reports on experiments underway intelligence residing on the robot to enhance emergency response.« less

Firefighter noise exposure during training activities and general equipment use.

PubMed

Root, Kyle S; Schwennker, Catherine; Autenrieth, Daniel; Sandfort, Delvin R; Lipsey, Tiffany; Brazile, William J

2013-01-01

Multiple noise measurements were taken on 6 types of fire station equipment and 15 types of emergency response vehicle-related equipment used by firefighters during routine and emergency operations at 10 fire stations. Five of the six types of fire station equipment, when measured at a distance of one meter and ear level, emitted noise equal to or greater than 85 dBA, including lawn maintenance equipment, snow blowers, compressors, and emergency alarms. Thirteen of 15 types of equipment located on the fire engines emitted noise levels equal to or greater than 85 dBA, including fans, saws, alarms, and extrication equipment. In addition, noise measurements were taken during fire engine operations, including the idling vehicle, vehicle sirens, and water pumps. Results indicated that idling fire-engine noise levels were below 85 dBA; however, during water pump and siren use, noise levels exceeded 85 dBA, in some instances, at different locations around the trucks where firefighters would be stationed during emergency operations. To determine if the duration and use of fire fighting equipment was sufficient to result in overexposures to noise during routine training activities, 93 firefighter personal noise dosimetry samples were taken during 10 firefighter training activities. Two training activities per sampling day were monitored during each sampling event, for a mean exposure time of 70 min per day. The noise dosimetry samples were grouped based on job description to compare noise exposures between the different categories of job tasks commonly associated with fire fighting. The three job categories were interior, exterior, and engineering. Mean personal dosimetry results indicated that the average noise exposure was 78 dBA during the training activities that lasted 70 min on average. There was no significant difference in noise exposure between each of the three job categories. Although firefighters routinely use equipment and emergency response vehicles that can produce hazardous levels of noise, this study showed that the average noise levels experienced by firefighters was below generally accepted guidelines.

Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications.

PubMed

Guha, Daipayan; Alotaibi, Naif M; Nguyen, Nhu; Gupta, Shaurya; McFaul, Christopher; Yang, Victor X D

2017-05-01

Augmented reality (AR) superimposes computer-generated virtual objects onto the user's view of the real world. Among medical disciplines, neurosurgery has long been at the forefront of image-guided surgery, and it continues to push the frontiers of AR technology in the operating room. In this systematic review, we explore the history of AR in neurosurgery and examine the literature on current neurosurgical applications of AR. Significant challenges to surgical AR exist, including compounded sources of registration error, impaired depth perception, visual and tactile temporal asynchrony, and operator inattentional blindness. Nevertheless, the ability to accurately display multiple three-dimensional datasets congruently over the area where they are most useful, coupled with future advances in imaging, registration, display technology, and robotic actuation, portend a promising role for AR in the neurosurgical operating room.

The role of shock index as a predictor of multiple-trauma patients' pathways.

PubMed

Toccaceli, Andrea; Giampaoletti, Andrea; Dignani, Lucia; Lucertini, Carla; Petrucci, Cristina; Lancia, Loreto

2016-03-01

This research was conducted with the aim of investigating the accuracy of the shock index (SI) in distinguishing which multiple-trauma patients should be admitted to an intensive care unit (ICU) after treatment in an emergency room (ER). The SI is an easily obtained indicator, as it corresponds to an arithmetic ratio between the two parameters that are always measured during the first-aid treatment of multiple-trauma patients: heart rate (HR) and systolic blood pressure (SBP). There are many studies examining the SI in the multiple-trauma patients as a possible predictor of the destination unit. The SI is evaluated both at the trauma scene (pre-hospital SI-pH) and in the emergency room (SI-ER). An observational study with a retrospective approach was conducted on 158 adult patients with multiple trauma. The mean SI-pH and SI-ER values were higher in ICU patients than in-patients discharged or admitted to a normal ward, but the difference between these two patient groups was significant only for the SI-ER. Analysis of the receiver operating characteristic (ROC) curves confirmed that only the SI-ER is significant as a reliable indicator for ICU admission with a best cut-off of 1·05. However, a threshold value of 0·75 was still able to establish the correct type of destination for multiple-trauma patients, with a sensitivity of 57·3% and a specificity of 62·5%. This research showed that the SI-pH and SI-ER values are correlated, but only the SI-ER has shown statistical significance in terms of distinguishing the type of destination of multiple-trauma patient (ICU, ordinary ward or discharge) after initial treatment in the ER. The results of this study suggest the possibility of using SI in multiple-trauma patients as a triage indicator to assess the patients' care complexity and to guide the choice of proper clinical paths. © 2015 British Association of Critical Care Nurses.

Patient experience in the emergency department: inconsistencies in the ethic and duty of care.

PubMed

Moss, Cheryle; Nelson, Katherine; Connor, Margaret; Wensley, Cynthia; McKinlay, Eileen; Boulton, Amohia

2015-01-01

To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for 'people who present on multiple occasions' ongoing choices in care. People (n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health-illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care. Qualitative description of interview data (stage 3 of a multimethod study). The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences. Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: 'sustained and enmeshed ethic and duty of care', 'consistent duty of care', 'interrupted or mixed duty and ethic of care', and 'care in breach of both the ethic and duty of care'. People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed. Findings carry implications for emergency department care of people who present on multiple occasions and for emergency department health professionals to increase awareness of their moral comportment in care. © 2014 John Wiley & Sons Ltd.

Metabolic pathways for the whole community.

PubMed

Hanson, Niels W; Konwar, Kishori M; Hawley, Alyse K; Altman, Tomer; Karp, Peter D; Hallam, Steven J

2014-07-22

A convergence of high-throughput sequencing and computational power is transforming biology into information science. Despite these technological advances, converting bits and bytes of sequence information into meaningful insights remains a challenging enterprise. Biological systems operate on multiple hierarchical levels from genomes to biomes. Holistic understanding of biological systems requires agile software tools that permit comparative analyses across multiple information levels (DNA, RNA, protein, and metabolites) to identify emergent properties, diagnose system states, or predict responses to environmental change. Here we adopt the MetaPathways annotation and analysis pipeline and Pathway Tools to construct environmental pathway/genome databases (ePGDBs) that describe microbial community metabolism using MetaCyc, a highly curated database of metabolic pathways and components covering all domains of life. We evaluate Pathway Tools' performance on three datasets with different complexity and coding potential, including simulated metagenomes, a symbiotic system, and the Hawaii Ocean Time-series. We define accuracy and sensitivity relationships between read length, coverage and pathway recovery and evaluate the impact of taxonomic pruning on ePGDB construction and interpretation. Resulting ePGDBs provide interactive metabolic maps, predict emergent metabolic pathways associated with biosynthesis and energy production and differentiate between genomic potential and phenotypic expression across defined environmental gradients. This multi-tiered analysis provides the user community with specific operating guidelines, performance metrics and prediction hazards for more reliable ePGDB construction and interpretation. Moreover, it demonstrates the power of Pathway Tools in predicting metabolic interactions in natural and engineered ecosystems.

Debate: the per rectal/digital rectal examination exam in the emergency department, still best practice?

PubMed

Quinn, John; Zeleny, Tomas; Rajaratnam, Venu; Ghiurluc, Dan-Lucian; Bencko, Vladimir

2018-03-27

Emergency medicine practice in the UK and Ireland offers a junior and middle grade doctor great learning opportunities that force engagement with multiple specialties, life-saving procedures, exposure to a myriad of patient presentations, and opportunities for best practices in medicine. The emergency department (ED) can be a hectic and dynamic environment; communication from the ED to specialists is essential to ensure best clinical outcomes for patients. The "per rectal" (PR) or "digital rectal exam" (DRE) can be a very difficult diagnostic test for even the most skilled operator to discern pathological versus normal; we propose this is especially the case in the emergency department patient population. Some specialists require this exam performed by an unskilled junior doctor with varying results prior to reviewing a referred and sick patient. The PR/DRE benefits may be limited in the ED setting for some pathologies, and the result of the exam may have limited impact in the overall treatment plan in the ED. This short paper reviews the indications, benefits, shortfalls, and limitations of the PR/DRE in the emergency department setting and offers novel alternatives to maximize best practice, ensure best clinical outcomes for patients, and, to first, do no harm.

Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases.

PubMed

Ghazi, Sam; Berg, Elisabeth; Lindblom, Annika; Lindforss, Ulrik

2013-06-11

Approximately 15 to 30% of colorectal cancers present as an emergency, most often as obstruction or perforation. Studies report poorer outcome for patients who undergo emergency compared with elective surgery, both for their initial hospital stay and their long-term survival. Advanced tumor pathology and tumors with unfavorable histologic features may provide the basis for the difference in outcome. The aim of this study was to compare the clinical and pathologic profiles of emergency and elective surgical cases for colorectal cancer, and relate these to gender, age group, tumor location, and family history of the disease. The main outcome measure was the difference in morphology between elective and emergency surgical cases. In total, 976 tumors from patients treated surgically for colorectal cancer between 2004 and 2006 in Stockholm County, Sweden (8 hospitals) were analyzed in the study. Seventeen morphological features were examined and compared with type of operation (elective or emergency), gender, age, tumor location, and family history of colorectal cancer by re-evaluating the histopathologic features of the tumors. In a univariate analysis, the following characteristics were found more frequently in emergency compared with elective cases: multiple tumors, higher American Joint Committee on Cancer (AJCC), tumor (T) and node (N) stage, peri-tumor lymphocytic reaction, high number of tumor-infiltrating lymphocytes, signet-ring cell mucinous carcinoma, desmoplastic stromal reaction, vascular and perineural invasion, and infiltrative tumor margin (P<0.0001 for AJCC stage III to IV, N stage 1 to 2/3, and vascular invasion). In a multivariate analysis, all these differences, with the exception of peri-tumor lymphocytic reaction, remained significant (P<0.0001 for multiple tumors, perineural invasion, infiltrative tumor margin, AJCC stage III, and N stage 1 to 2/3). Colorectal cancers that need surgery as an emergency case generally show a more aggressive histopathologic profile and a more advanced stage than do elective cases. Essentially, no difference was seen in location, and therefore it is likely there would be no differences in macro-environment either. Our results could indicate that colorectal cancers needing emergency surgery belong to an inherently specific group with a different etiologic or genetic background.

Breakdowns in coordinated decision making at and above the incident management team level: an analysis of three large scale Australian wildfires.

PubMed

Bearman, Chris; Grunwald, Jared A; Brooks, Benjamin P; Owen, Christine

2015-03-01

Emergency situations are by their nature difficult to manage and success in such situations is often highly dependent on effective team coordination. Breakdowns in team coordination can lead to significant disruption to an operational response. Breakdowns in coordination were explored in three large-scale bushfires in Australia: the Kilmore East fire, the Wangary fire, and the Canberra Firestorm. Data from these fires were analysed using a top-down and bottom-up qualitative analysis technique. Forty-four breakdowns in coordinated decision making were identified, which yielded 83 disconnects grouped into three main categories: operational, informational and evaluative. Disconnects were specific instances where differences in understanding existed between team members. The reasons why disconnects occurred were largely consistent across the three sets of data. In some cases multiple disconnects occurred in a temporal manner, which suggested some evidence of disconnects creating states that were conducive to the occurrence of further disconnects. In terms of resolution, evaluative disconnects were nearly always resolved however operational and informational disconnects were rarely resolved effectively. The exploratory data analysis and discussion presented here represents the first systematic research to provide information about the reasons why breakdowns occur in emergency management and presents an account of how team processes can act to disrupt coordination and the operational response. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Assessing anesthesiology residents' out-of-the-operating-room (OOOR) emergent airway management.

PubMed

Rochlen, Lauryn R; Housey, Michelle; Gannon, Ian; Mitchell, Shannon; Rooney, Deborah M; Tait, Alan R; Engoren, Milo

2017-07-15

At many academic institutions, anesthesiology residents are responsible for managing emergent intubations outside of the operating room (OOOR), with complications estimated to be as high as 39%. In order to create an OOOR training curriculum, we evaluated residents' familiarity with the content and correct adherence to the American Society of Anesthesiologists' Difficult Airway Algorithm (ASA DAA). Residents completed a pre-simulation multiple-choice survey measuring their understanding and use of the DAA. Residents then managed an emergent, difficult OOOR intubation in the simulation center, where two trained reviewers assessed performance using checklists. Post-simulation, the residents completed a survey rating their behaviors during the simulation. The primary outcome was comprehension and adherence to the DAA as assessed by survey responses and behavior in the simulation. Sixty-three residents completed both surveys and the simulation. Post-survey responses indicated a shift toward decreased self-perceived familiarity with the DAA content compared to pre-survey responses. During the simulation, 22 (35%) residents were unsuccessful with intubation. Of these, 46% placed an LMA and 46% prepared for cricothyroidotomy. Nineteen residents did not attempt intubation. Of these, only 31% considered LMA placement, and 26% initiated cricothyroidotomy. Many anesthesiology residency training programs permit resident autonomy in managing emergent intubations OOOR. Residents self-reported familiarity with the content of and adherence to the DAA was higher than that observed during the simulation. Curriculum focused on comprehension of the DAA, as well as improving communication with higher-level physicians and specialists, may improve outcomes during OOORs.

Prehospital Dextrose Extravasation Causing Forearm Compartment Syndrome: A Case Report.

PubMed

Chinn, Matthew; Colella, M Riccardo

2017-01-01

A 57-year-old woman was found at home by paramedics to be hypoglycemic with altered mental status. She had multiple attempts at IV access and eventually a 22G IV was established and D50 was infused into her right forearm. Extravasation of the dextrose was noted after approximately 12 g of the medication was infused. She was given a dose of glucagon intramuscularly and her mental status improved. Shortly after her arrival to the emergency department, she was noted to have findings of compartment syndrome of her forearm at the site of the dextrose extravasation. She was evaluated by plastic surgery and taken to the operating room for emergent fasciotomy. She recovered well from the operation. D50 is well known to cause phlebitis and local skin necrosis as a complication. This case illustrates the danger of compartment syndrome after D50 extravasation. It is the first documented case of prehospital dextrose extravasation leading to compartment syndrome. There may be safer alternatives to D50 administration and providers must be acutely aware to monitor for D50 infusion complications.

Mexico City's Petroleos Mexicanos explosion: disaster management and air medical transport.

PubMed

Urquieta, Emmanuel; Varon, Joseph

2014-01-01

Mexico City is the largest metropolitan area in the Americas and 1 of the largest in the world; its geographic location and uncontrolled population and industrial growth make this metropolis prone to natural and human-made disasters. Mass casualty disaster responses in Mexico City tend to have complications from multiple logistical and operational challenges. This article focuses on the experiences and lessons learned from an explosion that occurred in a government building in Mexico City and the current status of mass casualty disaster risks and response strategies in Mexico City as well as air medical evacuation, which is a critical component and was shown to be extremely useful in the evacuation of 15 critically ill and polytraumatized patients (Injury Severity Score > 15). Several components of the public and privately owned emergency medical services and health care systems among Mexico City pose serious logistical and operational complications, which finally will be addressed by a joint emergency preparedness council to unify criteria in communications, triage, and incident/disaster command post establishment. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

General Household Emergency Preparedness: A Comparison Between Veterans and Nonveterans

PubMed Central

Der-Martirosian, Claudia; Strine, Tara; Atia, Mangwi; Chu, Karen; Mitchell, Michael N.; Dobalian, Aram

2015-01-01

Background Despite federal and local efforts to educate the public to prepare for major emergencies, many US households remain unprepared for such occurrences. United States Armed Forces veterans are at particular risk during public health emergencies as they are more likely than the general population to have multiple health conditions. Methods This study compares general levels of household emergency preparedness between veterans and nonveterans by focusing on seven surrogate measures of household emergency preparedness (a 3-day supply of food, water, and prescription medications, a battery-operated radio and flashlight, a written evacuation plan, and an expressed willingness to leave the community during a mandatory evacuation). This study used data from the 2006 through 2010 Behavioral Risk Factor Surveillance System (BRFSS), a state representative, random sample of adults aged 18 and older living in 14 states. Results The majority of veteran and nonveteran households had a 3-day supply of food (88% vs 82%, respectively) and prescription medications (95% vs 89%, respectively), access to a working, battery-operated radio (82% vs 77%, respectively) and flashlight (97% vs 95%, respectively), and were willing to leave the community during a mandatory evacuation (91% vs 96%, respectively). These populations were far less likely to have a 3-day supply of water (61% vs 52%, respectively) and a written evacuation plan (24% vs 21%, respectively). After adjusting for various sociodemographic covariates, general health status, and disability status, households with veterans were significantly more likely than households without veterans to have 3-day supplies of food, water, and prescription medications, and a written evacuation plan; less likely to indicate that they would leave their community during a mandatory evacuation; and equally likely to have a working, battery-operated radio and fiashlight. Conclusion These findings suggest that veteran households appear to be better prepared for emergencies than do nonveteran households, although the lower expressed likelihood of veterans households to evacuate when ordered to do so may place them at a somewhat greater risk of harm during such events. Further research should examine household preparedness among other vulnerable groups including subgroups of veteran populations and the reasons why their preparedness may differ from the general population. PMID:24642181

General household emergency preparedness: a comparison between veterans and nonveterans.

PubMed

Der-Martirosian, Claudia; Strine, Tara; Atia, Mangwi; Chu, Karen; Mitchell, Michael N; Dobalian, Aram

2014-04-01

Despite federal and local efforts to educate the public to prepare for major emergencies, many US households remain unprepared for such occurrences. United States Armed Forces veterans are at particular risk during public health emergencies as they are more likely than the general population to have multiple health conditions. This study compares general levels of household emergency preparedness between veterans and nonveterans by focusing on seven surrogate measures of household emergency preparedness (a 3-day supply of food, water, and prescription medications, a battery-operated radio and flashlight, a written evacuation plan, and an expressed willingness to leave the community during a mandatory evacuation). This study used data from the 2006 through 2010 Behavioral Risk Factor Surveillance System (BRFSS), a state representative, random sample of adults aged 18 and older living in 14 states. The majority of veteran and nonveteran households had a 3-day supply of food (88% vs 82%, respectively) and prescription medications (95% vs 89%, respectively), access to a working, battery-operated radio (82% vs 77%, respectively) and flashlight (97% vs 95%, respectively), and were willing to leave the community during a mandatory evacuation (91% vs 96%, respectively). These populations were far less likely to have a 3-day supply of water (61% vs 52%, respectively) and a written evacuation plan (24% vs 21%, respectively). After adjusting for various sociodemographic covariates, general health status, and disability status, households with veterans were significantly more likely than households without veterans to have 3-day supplies of food, water, and prescription medications, and a written evacuation plan; less likely to indicate that they would leave their community during a mandatory evacuation; and equally likely to have a working, battery-operated radio and flashlight. These findings suggest that veteran households appear to be better prepared for emergencies than do nonveteran households, although the lower expressed likelihood of veterans households to evacuate when ordered to do so may place them at a somewhat greater risk of harm during such events. Further research should examine household preparedness among other vulnerable groups including subgroups of veteran populations and the reasons why their preparedness may differ from the general population.

[Kidney traumatism in general surgery (65 cases)].

PubMed

Brunet, C; Sielezneff, I; Voinchet, V; Rosset, E; Grégoire, R; Thirion, X; Ugarte, S; Farisse, J

1995-01-01

From September 1989 to September 1994, 65 patients, 15 females and 50 males, with a mean age of 32 +/- 14 years were admitted in the emergency unit for renal trauma. In 38.5% of cases multiple trauma was present. Lesional mechanism was most frequently contusions (49.2%) and deceleration injuries (43.1%). Gross hematuria or microscopic hematuria were presents in 72.3% of cases. The sensibility of systematic abdominal echography was 100% in case of perirenal hematoma and 65% in case of parenchymatous lesions. Only 23 patients were operated (35.3%) because of low blood pressure. None secondary operation was necessary in abstention group. Global mortality was 7.7%. Postoperative morbidity was 20% and specific morbidity in abstention group was 10.7%.

Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU).

PubMed

Chertoff, Jason; Khullar, Vikas; Burke, Lucas

2015-01-01

The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

47 CFR 101.205 - Operation during emergency.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Operation during emergency. 101.205 Section 101.205 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Operational Requirements § 101.205 Operation during emergency. The licensee of...

47 CFR 101.205 - Operation during emergency.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Operation during emergency. 101.205 Section 101.205 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Operational Requirements § 101.205 Operation during emergency. The licensee of...

47 CFR 101.205 - Operation during emergency.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Operation during emergency. 101.205 Section 101.205 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Operational Requirements § 101.205 Operation during emergency. The licensee of...

47 CFR 101.205 - Operation during emergency.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Operation during emergency. 101.205 Section 101.205 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Operational Requirements § 101.205 Operation during emergency. The licensee of...

47 CFR 101.205 - Operation during emergency.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Operation during emergency. 101.205 Section 101.205 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Operational Requirements § 101.205 Operation during emergency. The licensee of...

An application of Six Sigma methodology to turnover intentions in health care.

PubMed

Taner, Mehmet

2009-01-01

The purpose of this study is to show how the principles of Six Sigma can be applied to the high turnover problem of doctors in medical emergency services and paramedic backup. Six Sigma's define-measure-analyse-improve-control (DMAIC) is applied for reducing the turnover rate of doctors in an organisation operating in emergency services. Variables of the model are determined. Explanatory factor analysis, multiple regression, analysis of variance (ANOVA) and Gage R&R are employed for the analysis. Personal burnout/stress and dissatisfaction from salary were found to be the "vital few" variables. The organisation took a new approach by improving its initiatives to doctors' working conditions. Sigma level of the process is increased. New policy and process changes have been found to effectively decrease the incidence of turnover intentions. The improved process is gained, standardised and institutionalised. This study is one of the few papers in the literature that elaborates the turnover problem of doctors working in the emergency and paramedic backup services.

Synchronous male breast and colon cancer presenting with ileus: A case report.

PubMed

Ari, Aziz; Tatar, Cihad; Buyukasik, Kenan; Segmen, Ozgur; Cakir, Coskun; Arikan, Soykan

2016-01-01

Cancer developing from more than one origin is called multiple primary cancer (MPC) and is a rare situation. In this article, we report a case presenting to the Emergency Clinic with symptoms of ileus who was diagnosed with synchronous colon and breast cancer. A 57year old male patient presented to the Emergency Clinic with abdominal pain, vomiting, constipation and lack of flatulence. The patient was taken to the operating room for emergency surgery with the diagnosis of intestinal obstruction. While still hospitalized, breast ultrasound was performed, revealing a mass lesion in the right breast measuring 2cm. The core biopsy result was suggestive of invasive ductal adenocarcinoma. Right modified radical mastectomy with removal of the level 2 axillary lymph nodes was performed. The result of the histopathological investigation of the right hemicolectomy specimen was reported as moderately differentiated adenocarcinoma, while that of the mastectomy material was invasive ductal adenocarcinoma. Synchronous colorectal cancer is recognized as an important clinical entity, its clinical and pathological properties as well as prognosis are still undetermined. A family history of cancer might be a significant factor in synchronous cancers. Many of the theories about the etiology of multiple primary malignant neoplasia suggest the role of genetic, hormonal, environmental and immunological factors as well as iatrogenic causes. Especially for patients whose treatment begins in the emergency settings, meticulous systemic physical examination is recommended to initiate treatment of a possible synchronous tumor at an earlier stage. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

47 CFR 87.43 - Operation during emergency.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Operation during emergency. 87.43 Section 87.43 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AVIATION SERVICES Applications and Licenses § 87.43 Operation during emergency. A station may be used for emergency...

Ka-band Technologies for Small Spacecraft Communications via Relays and Direct Data Downlink

NASA Technical Reports Server (NTRS)

Budinger, James M.; Niederhaus, Charles; Reinhart, Richard; Downey, Joe; Roberts, Anthony

2016-01-01

As the scientific capabilities and number of small spacecraft missions in the near Earth region increase, standard yet configurable user spacecraft terminals operating in Ka-band are needed to lower mission cost and risk and enable significantly higher data return than current UHF or S-band terminals. These compact Ka-band terminals are intended to operate with both the current and next generation of Ka-band relay satellites and via direct data communications with near Earth tracking terminals. This presentation provides an overview of emerging NASA-sponsored and commercially provided technologies in software defined radios (SDRs), transceivers, and electronically steered antennas that will enable data rates from hundreds of kbps to over 1 Gbps and operate in multiple frequency bands (such as S- and X-bands) and expand the use of NASA's common Ka-bands frequencies: 22.55-23.15 GHz for forward data or uplink; and 25.5-27.0 GHz for return data or downlink. Reductions in mass, power and volume come from integration of multiple radio functions, operations in Ka-band, high efficiency amplifiers and receivers, and compact, flat and vibration free electronically steered narrow beam antennas for up to + 60 degrees field of regard. The software defined near Earth space transceiver (SD-NEST) described in the presentation is intended to be compliant with NASA's space telecommunications radio system (STRS) standard for communications waveforms and hardware interoperability.

Multi-team dynamics and distributed expertise in imission operations.

PubMed

Caldwell, Barrett S

2005-06-01

The evolution of space exploration has brought an increased awareness of the social and socio-technical issues associated with team performance and task coordination, both for the onboard astronauts and in mission control. Spaceflight operations create a unique environment in which to address classic group dynamics topics including communication, group process, knowledge development and sharing, and time-critical task performance. Mission operations in the early years of the 21st century have developed into a set of complex, multi-team task settings incorporating multiple mission control teams and flight crews interacting in novel ways. These more complex operational settings help highlight the emergence of a new paradigm of distributed supervisory coordination, and the need to consider multiple dimensions of expertise being supported and exchanged among team members. The creation of new mission profiles with very long-duration time scales (months, rather than days) for the International Space Station, as well as planned exploration missions to the Moon and Mars, emphasize fundamental distinctions from the 40 yr from Mercury to the Space Shuttle. Issues in distributed expertise and information flow in mission control settings from two related perspectives are described. A general conceptual view of knowledge sharing and task synchronization is presented within the context of the mission control environment. This conceptual presentation is supplemented by analysis of quasi-experimental data collected from actual flight controllers at NASA-Johnson Space Center, Houston, TX.

A traffic-light coding system to organize emergency surgery across surgical disciplines.

PubMed

Leppäniemi, A; Jousela, I

2014-01-01

Emergency surgery is associated with night-time procedures and disruption of elective surgery. An analysis was undertaken of the effect of classifying emergency operations uniformly with a three-tier urgency colour code and the use of dedicated daytime operating rooms. Observed changes from 2001 to 2012 in the number, timing and ability to meet the urgency-designated colour code deadline were retrieved from the computer-based operating theatre organization system for all emergency operations. The number of emergency operations performed annually ranged from 3330 to 4341, with an increasing trend. The proportion of night-time emergency operations decreased from 27.4 per cent (2563 of 9347) before to 23.5 per cent (7731 of 32,959) after introduction of the colour coding system in 2004 (χ2  = 61.94, 1 d.f., P < 0.001). In 2007, owing to long preoperative delays in patients with acute appendicitis and acute cholecystitis, colour codes for these patients were upgraded from 'orange' to 'red' and from 'yellow' to 'orange' respectively. The proportion of patients operated on with a red code before and after this change increased from 45.2 per cent (5831 of 12,907 operations) to 62.7 per cent (13,020 of 20,778 operations; χ2  = 986.99, 1 d.f., P < 0.001). In 2012, the office-hours raw utilization time for the principal emergency operation theatre was 85.4 per cent. The structural separation of elective and emergency surgery, the use of dedicated daytime operating theatres and the implementation of a universal classification of emergency operations reduced night-time surgery, improved the efficiency of operating theatre utilization during daytime, shortened preoperative delay in patients requiring urgent surgery, and enabled monitoring and corrective actions for providing emergency surgery services. © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Civil Defense, U. S. A.: A Programmed Orientation to Civil Defense. Unit 4. Warning, Emergency Operations, and Support Programs.

ERIC Educational Resources Information Center

Defense Civil Preparedness Agency (DOD), Battle Creek, MI.

The need for, and a description of, emergency functions required to save lives and protect property in nuclear or natural disasters are presented. Topics discussed include: (1) The Civil Defense Warning System, (2) Introduction to the Emergency Operations Program, (3) Five subprograms of the Emergency Operations Program, (4) Emergency Operations…

Implementation of a Publish-Subscribe Protocol in Microgrid Islanding and Resynchronization with Self-Discovery

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

Starke, M.; Herron, A.; King, D.

Communications systems and protocols are becoming second nature to utilities operating distribution systems. Traditionally, centralized communication approaches are often used, while recently in microgrid applications, distributed communication and control schema emerge offering several advantages such as improved system reliability, plug-and-play operation and distributed intelligence. Still, operation and control of microgrids including distributed communication schema have been less of a discussion in the literature. To address the challenge of multiple-inverter microgrid synchronization, a publish-subscribe protocol based, Data Distribution Service (DDS), communication schema for microgrids is proposed in this paper. The communication schema is discussed in details for individual devices such asmore » generators, photovoltaic systems, energy storage systems, microgrid point of common coupling switch, and supporting applications. In conclusion, islanding and resynchronization of a microgrid are demonstrated on a test-bed utilizing this schema.« less

Implementation of a Publish-Subscribe Protocol in Microgrid Islanding and Resynchronization with Self-Discovery

DOE PAGES

Starke, M.; Herron, A.; King, D.; ...

2017-08-24

Communications systems and protocols are becoming second nature to utilities operating distribution systems. Traditionally, centralized communication approaches are often used, while recently in microgrid applications, distributed communication and control schema emerge offering several advantages such as improved system reliability, plug-and-play operation and distributed intelligence. Still, operation and control of microgrids including distributed communication schema have been less of a discussion in the literature. To address the challenge of multiple-inverter microgrid synchronization, a publish-subscribe protocol based, Data Distribution Service (DDS), communication schema for microgrids is proposed in this paper. The communication schema is discussed in details for individual devices such asmore » generators, photovoltaic systems, energy storage systems, microgrid point of common coupling switch, and supporting applications. In conclusion, islanding and resynchronization of a microgrid are demonstrated on a test-bed utilizing this schema.« less

Balancing exploration, uncertainty and computational demands in many objective reservoir optimization

NASA Astrophysics Data System (ADS)

Zatarain Salazar, Jazmin; Reed, Patrick M.; Quinn, Julianne D.; Giuliani, Matteo; Castelletti, Andrea

2017-11-01

Reservoir operations are central to our ability to manage river basin systems serving conflicting multi-sectoral demands under increasingly uncertain futures. These challenges motivate the need for new solution strategies capable of effectively and efficiently discovering the multi-sectoral tradeoffs that are inherent to alternative reservoir operation policies. Evolutionary many-objective direct policy search (EMODPS) is gaining importance in this context due to its capability of addressing multiple objectives and its flexibility in incorporating multiple sources of uncertainties. This simulation-optimization framework has high potential for addressing the complexities of water resources management, and it can benefit from current advances in parallel computing and meta-heuristics. This study contributes a diagnostic assessment of state-of-the-art parallel strategies for the auto-adaptive Borg Multi Objective Evolutionary Algorithm (MOEA) to support EMODPS. Our analysis focuses on the Lower Susquehanna River Basin (LSRB) system where multiple sectoral demands from hydropower production, urban water supply, recreation and environmental flows need to be balanced. Using EMODPS with different parallel configurations of the Borg MOEA, we optimize operating policies over different size ensembles of synthetic streamflows and evaporation rates. As we increase the ensemble size, we increase the statistical fidelity of our objective function evaluations at the cost of higher computational demands. This study demonstrates how to overcome the mathematical and computational barriers associated with capturing uncertainties in stochastic multiobjective reservoir control optimization, where parallel algorithmic search serves to reduce the wall-clock time in discovering high quality representations of key operational tradeoffs. Our results show that emerging self-adaptive parallelization schemes exploiting cooperative search populations are crucial. Such strategies provide a promising new set of tools for effectively balancing exploration, uncertainty, and computational demands when using EMODPS.

14 CFR 125.209 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Emergency equipment: Extended overwater... Equipment Requirements § 125.209 Emergency equipment: Extended overwater operations. (a) No person may operate an airplane in extended overwater operations unless it carries, installed in conspicuously marked...

14 CFR 125.209 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Emergency equipment: Extended overwater... Equipment Requirements § 125.209 Emergency equipment: Extended overwater operations. (a) No person may operate an airplane in extended overwater operations unless it carries, installed in conspicuously marked...

14 CFR 125.209 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Emergency equipment: Extended overwater... Equipment Requirements § 125.209 Emergency equipment: Extended overwater operations. (a) No person may operate an airplane in extended overwater operations unless it carries, installed in conspicuously marked...

14 CFR 125.209 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Emergency equipment: Extended overwater... Equipment Requirements § 125.209 Emergency equipment: Extended overwater operations. (a) No person may operate an airplane in extended overwater operations unless it carries, installed in conspicuously marked...

14 CFR 125.209 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Emergency equipment: Extended overwater... Equipment Requirements § 125.209 Emergency equipment: Extended overwater operations. (a) No person may operate an airplane in extended overwater operations unless it carries, installed in conspicuously marked...

Complete resection of hypervascularised extraventricular neurocytoma after preoperative embolisation.

PubMed

Katati, Majed; Ortiz García, Isabel; Chamorro, Clara Isabel; Horcajadas, Ángel; Hurtado, Alicia; Sánchez, Carlos; Iañez, Benjamín; Saura, Enrique; García, Ernesto; Busquier, Heriberto

2018-04-18

A 13-year-old female arrived at the Emergency Department with a two-week history of headache, and bilateral papilloedema on examination. The initial study with CT and MRI showed a large multicystic left frontal mass with calcification surrounded by peripheral oedema, subacute intralesional bleeding and association of multiple large vessels. She was initially operated on in another centre where a subacute haematoma was found, evacuating to multiple vessels and arteriolised veins. Despite the earlier neuroimaging findings, arteriovenous malformation (AVM) was suspected, so she was referred to our centre for further treatment. We performed angiography, MR angiography and MRI with advanced sequences, diagnosing a highly vascularised intra-axial tumour which was embolised. The patient was then definitively operated on, with the resulting finding of extraventricular neurocytoma (EVN). EVN are extremely rare lesions, not previously described in the literature as hypervascularised lesions, which in our case required prior angiography and embolisation for proper diagnosis and adequate management. Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

War stories: a qualitative analysis of narrative teaching strategies in the operating room.

PubMed

Hu, Yue-Yung; Peyre, Sarah E; Arriaga, Alexander F; Roth, Emilie M; Corso, Katherine A; Greenberg, Caprice C

2012-01-01

"War stories" are commonplace in surgical education, yet little is known about their purpose, construct, or use in the education of trainees. Ten complex operations were videotaped and audiotaped. Narrative stories were analyzed using grounded theory to identify emergent themes in both the types of stories being told and the teaching objectives they illustrated. Twenty-four stories were identified in 9 of the 10 cases (mean, 2.4/case). They were brief (mean, 58 seconds), illustrative of multiple teaching points (mean, 1.5/story), and appeared throughout the operations. Anchored in personal experience, these stories taught both clinical (eg, operative technique, decision making, error identification) and programmatic (eg, resource management, professionalism) topics. Narrative stories are used frequently and intuitively by physicians to emphasize a variety of intraoperative teaching points. They socialize trainees in the culture of surgery and may represent an underrecognized approach to teaching the core competencies. More understanding is needed to maximize their potential. Copyright © 2012 Elsevier Inc. All rights reserved.

War stories: a qualitative analysis of narrative teaching strategies in the operating room

PubMed Central

Hu, Yue-Yung; Peyre, Sarah E.; Arriaga, Alexander F.; Roth, Emilie M.; Corso, Katherine A.; Greenberg, Caprice C.

2015-01-01

BACKGROUND “War stories” are commonplace in surgical education, yet little is known about their purpose, construct, or use in the education of trainees. METHODS Ten complex operations were videotaped and audiotaped. Narrative stories were analyzed using grounded theory to identify emergent themes in both the types of stories being told and the teaching objectives they illustrated. RESULTS Twenty-four stories were identified in 9 of the 10 cases (mean, 2.4/case). They were brief (mean, 58 seconds), illustrative of multiple teaching points (mean, 1.5/story), and appeared throughout the operations. Anchored in personal experience, these stories taught both clinical (eg, operative technique, decision making, error identification) and programmatic (eg, resource management, professionalism) topics. CONCLUSIONS Narrative stories are used frequently and intuitively by physicians to emphasize a variety of intraoperative teaching points. They socialize trainees in the culture of surgery and may represent an underrecognized approach to teaching the core competencies. More understanding is needed to maximize their potential. PMID:22088266

A Personnel Launch System for safe and efficient manned operations

NASA Astrophysics Data System (ADS)

Petro, Andrew J.; Andrews, Dana G.; Wetzel, Eric D.

1990-10-01

Several Conceptual designs for a simple, rugged Personnel Launch System (PLS) are presented. This system could transport people to and from Low Earth Orbit (LEO) starting in the late 1990's using a new modular Advanced Launch System (ALS) developed for the Space Exploration Initiative (SEI). The PLS is designed to be one element of a new space transportation architecture including heavy-lift cargo vehicles, lunar transfer vehicles, and multiple-role spcecraft such as the current Space Shuttle. The primary role of the PLS would be to deliver crews embarking on lunar or planetary missions to the Space Station, but it would also be used for earth-orbit sortie missions, space rescue missions, and some satellite servicing missions. The PLS design takes advantage of emerging electronic and structures technologies to offer a robust vehicle with autonomous operating and quick turnaround capabilities. Key features include an intact abort capability anywhere in the operating envelope, and elimination of all toxic propellants to streamline ground operations.

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

PubMed

Schweigkofler, U; Hoffmann, R

2013-09-01

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

20 CFR 375.7 - Operating regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Operating regulations. 375.7 Section 375.7 Employees' Benefits RAILROAD RETIREMENT BOARD EMERGENCY REGULATIONS PLAN OF OPERATION DURING A NATIONAL EMERGENCY § 375.7 Operating regulations. (a) Retirement claims. (1) In a national emergency as defined in...

20 CFR 375.7 - Operating regulations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Operating regulations. 375.7 Section 375.7 Employees' Benefits RAILROAD RETIREMENT BOARD EMERGENCY REGULATIONS PLAN OF OPERATION DURING A NATIONAL EMERGENCY § 375.7 Operating regulations. (a) Retirement claims. (1) In a national emergency as defined in...

The current status of emergency operations at a high-volume cancer center.

PubMed

Komori, Koji; Kimura, Kenya; Kinoshita, Takashi; Ito, Seiji; Abe, Tetsuya; Senda, Yoshiki; Misawa, Kazunari; Ito, Yuichi; Uemura, Norihisa; Natsume, Seiji; Kawai, Ryosuke; Kawakami, Jiro; Asano, Tomonari; Iwata, Yoshinori; Kurahashi, Shintaro; Tsutsuyama, Masayuki; Shigeyoshi, Itaru; Shimizu, Yasuhiro

2014-01-01

This study aimed to assess the pathogenic causes, clinical conditions, surgical procedures, in-hospital mortality, and operative death associated with emergency operations at a high-volume cancer center. Although many reports have described the contents, operative procedures, and prognosis of elective surgeries in high-volume cancer centers, emergency operations have not been studied in sufficient detail. We retrospectively enrolled 28 consecutive patients who underwent emergency surgery. Cases involving operative complications were excluded. The following surgical procedures were performed during emergency operations: closure in 3 cases (10.7%), diversion in 22 cases (78.6%), ileus treatment in 2 cases (7.1%), and hemostasis in 1 case (3.6%). Closure alone was performed only once for peritonitis. Diversion was performed in 17 cases (77.3%) of peritonitis, 4 cases (18.2%) of stenosis of the gastrointestinal tract, and 1 case (4.5%) of bleeding. There was a significant overall difference (P = 0.001). The frequency of emergency operations was very low at a high-volume cancer center. However, the recent shift in treatment approaches toward nonoperative techniques may enhance the status of emergency surgical procedures. The results presented in this study will help prepare for emergency situations and resolve them as quickly and efficiently as possible.

Characteristics of emergency pages using a computer-based anesthesiology paging system in children and adults undergoing procedures at a tertiary care medical center.

PubMed

Weingarten, Toby N; Abenstein, John P; Dutton, Claire H; Kohn, Melinda A; Lee, Elizabeth A; Mullenbach, Tami E; Narr, Bradly J; Schroeder, Darrell R; Sprung, Juraj

2013-04-01

In our large academic supervisory practice, attending anesthesiologists concomitantly care for multiple patients. To manage communications within the procedural environment, we use a proprietary electronic computer-based anesthesiology visual paging system. This system can send an emergency page that instantly alerts the attending anesthesiologist and other available personnel that immediate help is needed. We analyzed the characteristics of intraoperative emergency pages in children and adults. We identified all emergency page activations between January 1, 2005 and July 31, 2010 in our main operating rooms. Electronic medical records were reviewed for rates and characteristics of pages such as primary etiology, performed interventions, and outcomes. During the study period, 258,135 anesthetics were performed (n = 32,103 children, younger than 18 years) and 370 emergency pages (n = 309 adults, n = 61 children) were recorded (1.4 per 1000 cases; 95% confidence interval, 1.3-1.6). Infants had the highest rates (9.4 per 1000; 95% confidence interval, 5.7-14.4) of emergency page activations (P < 0.001 compared with each other age group). In adults, the most frequent causes were hemodynamic (55%), and in children respiratory and airway (60.7%) events. Emergency pages were rare in patients older than 2 years. Infants were more likely than children 1 to 2 years of age to have emergency page activation, despite both groups being cared for by pediatric fellowship trained anesthesiologists.

Modeling operators' emergency response time for chemical processing operations.

PubMed

Murray, Susan L; Harputlu, Emrah; Mentzer, Ray A; Mannan, M Sam

2014-01-01

Operators have a crucial role during emergencies at a variety of facilities such as chemical processing plants. When an abnormality occurs in the production process, the operator often has limited time to either take corrective actions or evacuate before the situation becomes deadly. It is crucial that system designers and safety professionals can estimate the time required for a response before procedures and facilities are designed and operations are initiated. There are existing industrial engineering techniques to establish time standards for tasks performed at a normal working pace. However, it is reasonable to expect the time required to take action in emergency situations will be different than working at a normal production pace. It is possible that in an emergency, operators will act faster compared to a normal pace. It would be useful for system designers to be able to establish a time range for operators' response times for emergency situations. This article develops a modeling approach to estimate the time standard range for operators taking corrective actions or following evacuation procedures in emergency situations. This will aid engineers and managers in establishing time requirements for operators in emergency situations. The methodology used for this study combines a well-established industrial engineering technique for determining time requirements (predetermined time standard system) and adjustment coefficients for emergency situations developed by the authors. Numerous videos of workers performing well-established tasks at a maximum pace were studied. As an example, one of the tasks analyzed was pit crew workers changing tires as quickly as they could during a race. The operations in these videos were decomposed into basic, fundamental motions (such as walking, reaching for a tool, and bending over) by studying the videos frame by frame. A comparison analysis was then performed between the emergency pace and the normal working pace operations to determine performance coefficients. These coefficients represent the decrease in time required for various basic motions in emergency situations and were used to model an emergency response. This approach will make hazardous operations requiring operator response, alarm management, and evacuation processes easier to design and predict. An application of this methodology is included in the article. The time required for an emergency response was roughly a one-third faster than for a normal response time.

10 CFR 70.82 - Suspension and operation in war or national emergency.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Suspension and operation in war or national emergency. 70... NUCLEAR MATERIAL Modification and Revocation of Licenses § 70.82 Suspension and operation in war or national emergency. Whenever Congress declares that a state of war or national emergency exists, the...

10 CFR 63.161 - Emergency plan for the geologic repository operations area through permanent closure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Emergency plan for the geologic repository operations area... OF HIGH-LEVEL RADIOACTIVE WASTES IN A GEOLOGIC REPOSITORY AT YUCCA MOUNTAIN, NEVADA Emergency Planning Criteria § 63.161 Emergency plan for the geologic repository operations area through permanent...

Worse outcomes among uninsured general surgery patients: does the need for an emergency operation explain these disparities?

PubMed

Schwartz, Diane A; Hui, Xuan; Schneider, Eric B; Ali, Mays T; Canner, Joseph K; Leeper, William R; Efron, David T; Haut, Elliot; Haut, Elliot R; Velopulos, Catherine G; Pawlik, Timothy M; Haider, Adil H

2014-08-01

We hypothesize that lack of access to care results in propensity toward emergent operative management and may be an important factor in worse outcomes for the uninsured population. The objective of this study is to investigate a possible link to worse outcomes in patients without insurance who undergo an emergent operation. A retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample (NIS) 2005-2011 dataset. Patients who underwent biliary, hernia, and colorectal operations were evaluated. Multivariate analyses were performed to assess the associations between insurance status, urgency of operation, and outcome. Covariates of age, sex, race, and comorbidities were controlled. The uninsured group had greatest odds ratios of undergoing emergent operative management in biliary (OR 2.43), colorectal (3.54), and hernia (3.95) operations, P < .001. Emergent operation was most likely in the 25- to 34-year age bracket, black and Hispanic patients, men, and patients with at least one comorbidity. Postoperative complications in emergencies, however, were appreciated most frequently in the populations with government coverage. Although the uninsured more frequently underwent emergent operations, patients with coverage through the government had more complications in most categories investigated. Young patients also carried significant risk of emergent operations with increased complication rates. Patients with government insurance tended toward worse outcomes, suggesting disparity for programs such as Medicaid. Disparity related to payor status implies need for policy revisions for equivalent health care access. Copyright © 2014 Mosby, Inc. All rights reserved.

Deterrence of ballistic missile systems and their effects on today's air operations

NASA Astrophysics Data System (ADS)

Durak, Hasan

2015-05-01

Lately, the effect-based approach has gained importance in executing air operations. Thus, it makes more successful in obtaining the desired results by breaking the enemy's determination in a short time. Air force is the first option to be chosen in order to defuse the strategic targets. However, the problems such as the defense of targets and country, radars, range…etc. becoming serious problems. At this level ballistic missiles emerge as a strategic weapon. Ultimate emerging technologies guided by the INS and GPS can also be embedded with multiple warheads and reinforced with conventional explosive, ballistic missiles are weapons that can destroy targets with precision. They have the advantage of high speed, being easily launched from every platform and not being easily detected by air defense systems contrary to other air platforms. While these are the advantages, there are also disadvantages of the ballistic missiles. The high cost, unavailability of nuclear, biological and chemical weapons, and its limited effect while using conventional explosives against destroying the fortified targets are the disadvantages. The features mentioned above should be considered as limitation to the impact of the ballistic missiles. The aim is to impose the requests on enemies without starting a war with all components and to ensure better implementation of the operation functions during the air operations. In this study, effects of ballistic missiles in the future on air battle theatre will be discussed in the beginning, during the process and at the end phase of air operations within the scope of an effect-based approach.

Real-Time Visualization of Network Behaviors for Situational Awareness

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

Best, Daniel M.; Bohn, Shawn J.; Love, Douglas V.

Plentiful, complex, and dynamic data make understanding the state of an enterprise network difficult. Although visualization can help analysts understand baseline behaviors in network traffic and identify off-normal events, visual analysis systems often do not scale well to operational data volumes (in the hundreds of millions to billions of transactions per day) nor to analysis of emergent trends in real-time data. We present a system that combines multiple, complementary visualization techniques coupled with in-stream analytics, behavioral modeling of network actors, and a high-throughput processing platform called MeDICi. This system provides situational understanding of real-time network activity to help analysts takemore » proactive response steps. We have developed these techniques using requirements gathered from the government users for which the tools are being developed. By linking multiple visualization tools to a streaming analytic pipeline, and designing each tool to support a particular kind of analysis (from high-level awareness to detailed investigation), analysts can understand the behavior of a network across multiple levels of abstraction.« less

Mission operations technology

NASA Astrophysics Data System (ADS)

Varsi, Giulio

In the last decade, the operation of a spacecraft after launch has emerged as a major component of the total cost of the mission. This trend is sustained by the increasing complexity, flexibility, and data gathering capability of the space assets and by their greater reliability and consequent longevity. The trend can, however, be moderated by the progressive transfer of selected functions from the ground to the spacecraft and by application, on the ground, of new technology. Advances in ground operations derive from the introduction in the mission operations environment of advanced microprocessor-based workstations in the class of a few million instructions per second and from the selective application of artificial intelligence technology. In the last few years a number of these applications have been developed, tested in operational settings and successfully demonstrated to users. Some are now being integrated in mission operations facilities. An analysis of mission operations indicates that the key areas are: concurrent control of multiple missions; automated/interactive production of command sequences of high integrity at low cost; automated monitoring of spacecraft health and automated aides for fault diagnosis; automated allocation of resources; automated processing of science data; and high-fidelity, high-speed spacecraft simulation. Examples of major advances in selected areas are described.

Multiple Exemplar Instruction and the Emergence of Generative Production of Suffixes as Autoclitic Frames

ERIC Educational Resources Information Center

Speckman, JeanneMarie; Greer, R. Douglas; Rivera-Valdes, Celestina

2012-01-01

We report 2 experiments that tested the effects of multiple exemplar instruction (MEI) across training sets on the emergence of productive autoclitic frames (suffixes) for 6 preschoolers with and without language-based disabilities. We implemented multiple exemplar tact instruction with subsets of stimuli whose "names" contained the suffix "-er"…

The Effects of Clinically Relevant Multiple-Choice Items on the Statistical Discrimination of Physician Clinical Competence.

ERIC Educational Resources Information Center

Downing, Steven M.; Maatsch, Jack L.

To test the effect of clinically relevant multiple-choice item content on the validity of statistical discriminations of physicians' clinical competence, data were collected from a field test of the Emergency Medicine Examination, test items for the certification of specialists in emergency medicine. Two 91-item multiple-choice subscales were…

Use of a Flexible Intubating Scope in Combination with a Channeled Video Laryngoscope for Managing a Difficult Airway in the Emergency Department.

PubMed

Sowers, Nicholas; Kovacs, George

2016-02-01

Difficulty with intubation is not uncommon in the emergency setting. Video laryngoscopes (VLs) are commonly used to manage the difficult airway in the emergency department (ED). Intubation using a flexible bronchoscope, while considered the gold standard for managing the anticipated difficult airway in the operating room, is not commonly used in the ED. We present a case describing VL-assisted flexible scope intubation performed in the ED as a novel feasible approach to managing the difficult airway. A 65-year-old male, post cardiac arrest, with multiple unsuccessful attempts at prehospital intubation had rapid sequence intubation (RSI) performed and, despite obtaining a view with a King Vision™ VL, the skilled operator was unable to advance the endotracheal tube (ETT). An Ambu™ aScope3 flexible intubating scope (FIS) was placed through the ETT loaded in the channel of the King Vision and advanced through the cords to a position proximal to the carina. The ETT was then advanced easily over the FIS and down the trachea. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although video laryngoscopy is commonly used in the ED, intubation can prove difficult, despite having an adequate view of the glottis. Use of an FIS, however, through a channeled VL makes navigation of the ETT easier and facilitates tube advancement, which can be difficult with VL. Channeled VL-assisted use of an FIS is a viable option for managing the difficult airway. Copyright © 2016 Elsevier Inc. All rights reserved.

33 CFR 150.510 - How must tested emergency equipment be operated?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false How must tested emergency equipment be operated? 150.510 Section 150.510 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... Operational Tests and Inspections (general) § 150.510 How must tested emergency equipment be operated? The...

33 CFR 150.510 - How must tested emergency equipment be operated?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false How must tested emergency equipment be operated? 150.510 Section 150.510 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... Operational Tests and Inspections (general) § 150.510 How must tested emergency equipment be operated? The...

Applying advanced analytics to guide emergency department operational decisions: A proof-of-concept study examining the effects of boarding.

PubMed

Andrew Taylor, R; Venkatesh, Arjun; Parwani, Vivek; Chekijian, Sharon; Shapiro, Marc; Oh, Andrew; Harriman, David; Tarabar, Asim; Ulrich, Andrew

2018-01-04

Emergency Department (ED) leaders are increasingly confronted with large amounts of data with the potential to inform and guide operational decisions. Routine use of advanced analytic methods may provide additional insights. To examine the practical application of available advanced analytic methods to guide operational decision making around patient boarding. Retrospective analysis of the effect of boarding on ED operational metrics from a single site between 1/2015 and 1/2017. Times series were visualized through decompositional techniques accounting for seasonal trends, to determine the effect of boarding on ED performance metrics and to determine the impact of boarding "shocks" to the system on operational metrics over several days. There were 226,461 visits with the mean (IQR) number of visits per day was 273 (258-291). Decomposition of the boarding count time series illustrated an upward trend in the last 2-3 quarters as well as clear seasonal components. All performance metrics were significantly impacted (p<0.05) by boarding count, except for overall Press Ganey scores (p<0.65). For every additional increase in boarder count, overall length-of-stay (LOS) increased by 1.55min (0.68, 1.50). Smaller effects were seen for waiting room LOS and treat and release LOS. The impulse responses indicate that the boarding shocks are characterized by changes in the performance metrics within the first day that fade out after 4-5days. In this study regarding the use of advanced analytics in daily ED operations, time series analysis provided multiple useful insights into boarding and its impact on performance metrics. Copyright © 2018. Published by Elsevier Inc.

Emergency Medical Services - Multiple Languages

MedlinePlus

... Section Health and Well-Being 11 - Emergency Room - English PDF Health and Well-Being 11 - Emergency Room - ... Section Health and Well-Being 11 - Emergency Room - English PDF Health and Well-Being 11 - Emergency Room - ...

Organizational Communication in Emergencies: Using Multiple Channels and Sources to Combat Noise and Capture Attention

ERIC Educational Resources Information Center

Stephens, Keri K.; Barrett, Ashley K.; Mahometa, Michael J.

2013-01-01

This study relies on information theory, social presence, and source credibility to uncover what best helps people grasp the urgency of an emergency. We surveyed a random sample of 1,318 organizational members who received multiple notifications about a large-scale emergency. We found that people who received 3 redundant messages coming through at…

Miniature EVA Software Defined Radio

NASA Technical Reports Server (NTRS)

Pozhidaev, Aleksey

2012-01-01

As NASA embarks upon developing the Next-Generation Extra Vehicular Activity (EVA) Radio for deep space exploration, the demands on EVA battery life will substantially increase. The number of modes and frequency bands required will continue to grow in order to enable efficient and complex multi-mode operations including communications, navigation, and tracking applications. Whether conducting astronaut excursions, communicating to soldiers, or first responders responding to emergency hazards, NASA has developed an innovative, affordable, miniaturized, power-efficient software defined radio that offers unprecedented power-efficient flexibility. This lightweight, programmable, S-band, multi-service, frequency- agile EVA software defined radio (SDR) supports data, telemetry, voice, and both standard and high-definition video. Features include a modular design, an easily scalable architecture, and the EVA SDR allows for both stationary and mobile battery powered handheld operations. Currently, the radio is equipped with an S-band RF section. However, its scalable architecture can accommodate multiple RF sections simultaneously to cover multiple frequency bands. The EVA SDR also supports multiple network protocols. It currently implements a Hybrid Mesh Network based on the 802.11s open standard protocol. The radio targets RF channel data rates up to 20 Mbps and can be equipped with a real-time operating system (RTOS) that can be switched off for power-aware applications. The EVA SDR's modular design permits implementation of the same hardware at all Network Nodes concept. This approach assures the portability of the same software into any radio in the system. It also brings several benefits to the entire system including reducing system maintenance, system complexity, and development cost.

Closing emergency operating rooms improves efficiency.

PubMed

Wullink, Gerhard; Van Houdenhoven, Mark; Hans, Erwin W; van Oostrum, Jeroen M; van der Lans, Marieke; Kazemier, Geert

2007-12-01

Long waiting times for emergency operations increase a patient's risk of postoperative complications and morbidity. Reserving Operating Room (OR) capacity is a common technique to maximize the responsiveness of an OR in case of arrival of an emergency patient. This study determines the best way to reserve OR time for emergency surgery. In this study two approaches of reserving capacity were compared: (1) concentrating all reserved OR capacity in dedicated emergency ORs, and (2) evenly reserving capacity in all elective ORs. By using a discrete event simulation model the real situation was modelled. Main outcome measures were: (1) waiting time, (2) staff overtime, and (3) OR utilisation were evaluated for the two approaches. Results indicated that the policy of reserving capacity for emergency surgery in all elective ORs led to an improvement in waiting times for emergency surgery from 74 (+/-4.4) minutes to 8 (+/-0.5) min. Working in overtime was reduced by 20%, and overall OR utilisation can increase by around 3%. Emergency patients are operated upon more efficiently on elective Operating Rooms instead of a dedicated Emergency OR. The results of this study led to closing of the Emergency OR in the Erasmus MC (Rotterdam, The Netherlands).

Complicated jejunal diverticula as surgical emergency: experience at a tertiary care hospital in Peshawar, Pakistan.

PubMed

Ahmed, Ijaz; Naeem, Mohammad; Samad, Ambreen; Nasir, Amir; Aman, Zahid; Ahmed, Siddique; Manan, Fazal

2010-01-01

Diverticula of small intestine are rare. Jejunal diverticula can be single or multiple. Diverticula in the jejunum tend to be large and multiple. Clinically they may be asymptomatic or may give rise to symptoms like pain, flatulence and borborygmi, may produce malabsorption syndrome or may present in emergency with different acute pathologies like perforation, haemorrhage, obstruction, enterolith formation and inflammation. The Objective was to see the pattern of complications in jejunal diverticula presenting as a surgical emergency. This descriptive study was conducted at Surgical Units of the 3 tertiary care Hospitals of Peshawar, for 7 years from January 1, 2002 to December 31, 2008. Study included all patients presenting to and admitted in Surgical Unit, Hayatabad Medical Complex, Peshawar with complicated jejunal diverticula during the above mentioned period. Name, age, sex, other relevant data, history and examination findings and results of investigation were recorded. Uncomplicated jejuna diverticula were excluded from study. The operative findings and the type of complication were recorded. Ten patients were admitted during 7 years of study. Out of all patients 9 were male and 1 was female. Eight out of 10 patients presented with perforation of diverticula while 1 patient had severe inflammation of diverticulum causing pain, ileus and acute abdomen. One patient had acute pain due to adhesion formation. It is seen that complicated jejunal diverticulae are quite rare and the most common complication is perforation. Inflammation and adhesion are other complications with which jejunal diverticula presented during this study.

The optimization of nuclear power plants operation modes in emergency situations

NASA Astrophysics Data System (ADS)

Zagrebayev, A. M.; Trifonenkov, A. V.; Ramazanov, R. N.

2018-01-01

An emergency situations resulting in the necessity for temporary reactor trip may occur at the nuclear power plant while normal operating mode. The paper deals with some of the operation c aspects of nuclear power plant operation in emergency situations and during threatened period. The xenon poisoning causes limitations on the variety of statements of the problem of calculating characteristics of a set of optimal reactor power off controls. The article show a possibility and feasibility of new sets of optimization tasks for the operation of nuclear power plants under conditions of xenon poisoning in emergency circumstances.

The potential benefit of a home fire safety intervention during emergency medical services calls.

PubMed

Pirrallo, R G; Rubin, J M; Murawsky, G A

1998-03-01

To determine how often house fires occur at 1- and 2-family dwellings visited previously by emergency medical services (EMS) personnel and whether these visits were missed opportunities for a point-of-contact home fire safety intervention. A retrospective, consecutive, case series analysis of all Milwaukee Fire Department alarm responses during 1994 was performed. Measurements included date of service, type of response, property type, dollar loss estimate, number of injuries and fatalities, cause of alarm, and presence of an operational smoke detector. Descriptive, chi2, and relative risk statistics were used to describe the relationship between EMS responses and fire responses at 1- and 2-family dwellings. The Milwaukee Fire Department dispatched 94,378 requests for service to 43,556 addresses. 16,150 addresses generated multiple requests; 7.2% (1,162/16,150) were for an "alarm of fire" response [relative risk 1.83 (95% CI: 1.69-1.99) for addresses with multiple requests vs those with a single request for service]. Most [62% (721/1,162)] of the addresses were visited by EMS personnel prior to the alarm; 28% (205/721) were 1- and 2-family dwellings. A mean of 1.8 (376/205) EMS responses occurred prior to the "alarm of fire" response; 121 addresses received 1 response, 46 received 2, 18 received 3, and 20 received > or = 4 responses. Of 169 addresses with complete data, there was a total fire dollar loss of $1,963,020 (1994) along with 32 injuries and 0 fatalities. While 47% (80/169) of the 1- and 2-family dwellings had a smoke detector present, only 17% (29/169) of the dwellings had an operational smoke detector. A point-of-contact home fire safety intervention appears of potential benefit for frequent users of EMS care. Determination of the presence of an operational smoke detector in 1- and 2-family dwellings may be a useful injury prevention act during such EMS calls.

Man-Machine Interaction Design and Analysis System (MIDAS): Memory Representation and Procedural Implications for Airborne Communication Modalities

NASA Technical Reports Server (NTRS)

Corker, Kevin M.; Pisanich, Gregory M.; Lebacqz, Victor (Technical Monitor)

1996-01-01

The Man-Machine Interaction Design and Analysis System (MIDAS) has been under development for the past ten years through a joint US Army and NASA cooperative agreement. MIDAS represents multiple human operators and selected perceptual, cognitive, and physical functions of those operators as they interact with simulated systems. MIDAS has been used as an integrated predictive framework for the investigation of human/machine systems, particularly in situations with high demands on the operators. Specific examples include: nuclear power plant crew simulation, military helicopter flight crew response, and police force emergency dispatch. In recent applications to airborne systems development, MIDAS has demonstrated an ability to predict flight crew decision-making and procedural behavior when interacting with automated flight management systems and Air Traffic Control. In this paper we describe two enhancements to MIDAS. The first involves the addition of working memory in the form of an articulatory buffer for verbal communication protocols and a visuo-spatial buffer for communications via digital datalink. The second enhancement is a representation of multiple operators working as a team. This enhanced model was used to predict the performance of human flight crews and their level of compliance with commercial aviation communication procedures. We show how the data produced by MIDAS compares with flight crew performance data from full mission simulations. Finally, we discuss the use of these features to study communications issues connected with aircraft-based separation assurance.

Escalation of drug self-administration as a hallmark of persistent addiction liability

PubMed Central

Edwards, Scott; Koob, George F.

2013-01-01

Drug addiction is a progressive, relapsing disease comprised of interlocking stages of disordered motivation. Numerous animal models describing various stages of the addiction process have been developed over the past few decades, providing considerable advantages for the modeling of drug addiction compared with other complex psychiatric disease states. Escalation of drug self-administration has emerged as a widely accepted operant conditioning model of excessive drug intake. We further argue here that drug-escalated animals represent a comprehensive model of addiction according to the manifestations of behavioral neuroadaptations resulting directly or indirectly from excessive drug consumption. In particular, drug-escalated animals exhibit a host of symptoms in line with multiple Diagnostic and Statistical Manual of Mental Disorders criteria for substance dependence, which can be summarized as an emergence of uncontrollable drug-taking and drug-seeking behaviors as a consequence of within-circuit and between-circuit neuroadaptations. Such a transition from impulsive drug sampling to compulsive intake represents a highly valid conceptualization of the addiction timeline in humans, and further investigation of persistent or near-permanent (e.g. epigenetic) neuroadaptations generated by operant drug intake escalation models will continue to provide mechanisms and therapeutic interventions for reversing the aberrant neuroplasticity underlying addiction. PMID:23839030

One Health: a perspective from the human health sector.

PubMed

Kakkar, M; Hossain, S S; Abbas, S S

2014-08-01

Despite emerging consensus that the One Health concept involves multiple stakeholders, the human health sector has continued to view it from a predominantly human health security perspective. It has often ignored the concerns of other sectors, e.g. concerns that relate to trade, commerce, livelihoods and sustainable development, all of which are important contributors to societal well-being. In the absence of a culture of collaboration, clear One Health goals, conceptual clarity and operating frameworks, this disconnect between human health and One Health efforts has often impeded the translation of One Health from concept to reality, other than during emergency situations. If there are to be effective and sustainable One Health partnerships we must identify clear operating principles that allow flexible approaches to intersectoral collaborations. To convince technical experts and political leaders in the human health sector of the importance of intersectoral cooperation, and to make the necessary structural adjustments, we need examples of best practice models and trans-sectoral methods for measuring the risks, burden and costs across sectors. Informal collaborations between researchers and technical experts will play a decisive role in developing these methods and models and instilling societal well-being into the human health sector's view of One Health.

Implications of Preference and Problem Formulation on the Operating Policies of Complex Multi-Reservoir Systems

NASA Astrophysics Data System (ADS)

Quinn, J.; Reed, P. M.; Giuliani, M.; Castelletti, A.

2016-12-01

Optimizing the operations of multi-reservoir systems poses several challenges: 1) the high dimension of the problem's states and controls, 2) the need to balance conflicting multi-sector objectives, and 3) understanding how uncertainties impact system performance. These difficulties motivated the development of the Evolutionary Multi-Objective Direct Policy Search (EMODPS) framework, in which multi-reservoir operating policies are parameterized in a given family of functions and then optimized for multiple objectives through simulation over a set of stochastic inputs. However, properly framing these objectives remains a severe challenge and a neglected source of uncertainty. Here, we use EMODPS to optimize operating policies for a 4-reservoir system in the Red River Basin in Vietnam, exploring the consequences of optimizing to different sets of objectives related to 1) hydropower production, 2) meeting multi-sector water demands, and 3) providing flood protection to the capital city of Hanoi. We show how coordinated operation of the reservoirs can differ markedly depending on how decision makers weigh these concerns. Moreover, we illustrate how formulation choices that emphasize the mean, tail, or variability of performance across objective combinations must be evaluated carefully. Our results show that these choices can significantly improve attainable system performance, or yield severe unintended consequences. Finally, we show that satisfactory validation of the operating policies on a set of out-of-sample stochastic inputs depends as much or more on the formulation of the objectives as on effective optimization of the policies. These observations highlight the importance of carefully considering how we abstract stakeholders' objectives and of iteratively optimizing and visualizing multiple problem formulation hypotheses to ensure that we capture the most important tradeoffs that emerge from different stakeholder preferences.

Hurricane risk mitigation - Emergency Operations Center

NASA Image and Video Library

2008-07-29

Construction work on a new Emergency Operations Center at Stennis Space Center is nearing completion. Construction is expected to be complete by February 2009, with actual occupancy of the building planned for later that year. The new building will house fire, medical and security teams and will provide a top-grade facility to support storm emergency responder teams and emergency management operations for the south Mississippi facility.

A bioethics for all seasons

PubMed Central

Chan, Sarah

2015-01-01

The last four decades have seen the emergence and flourishing of the field of bioethics and its incorporation into wide-ranging aspects of society, from the clinic or laboratory through to public policy and the media. Yet considerable debate still exists over what bioethics is and how it should be done. In this paper I consider the question of what makes good bioethics. Drawing on historical and contemporary examples, I suggest that bioethics encompasses multiple modes of responding to moral disagreement, and that an awareness of which mode is operational in a given context is essential to doing good bioethics. PMID:25516926

40 CFR 60.4237 - What are the monitoring requirements if I am an owner or operator of an emergency stationary SI...

Code of Federal Regulations, 2010 CFR

2010-07-01

... I am an owner or operator of an emergency stationary SI internal combustion engine? 60.4237 Section... Internal Combustion Engines Other Requirements for Owners and Operators § 60.4237 What are the monitoring requirements if I am an owner or operator of an emergency stationary SI internal combustion engine? (a...

40 CFR 60.4237 - What are the monitoring requirements if I am an owner or operator of an emergency stationary SI...

Code of Federal Regulations, 2012 CFR

2012-07-01

... I am an owner or operator of an emergency stationary SI internal combustion engine? 60.4237 Section... Internal Combustion Engines Other Requirements for Owners and Operators § 60.4237 What are the monitoring requirements if I am an owner or operator of an emergency stationary SI internal combustion engine? (a...

40 CFR 60.4237 - What are the monitoring requirements if I am an owner or operator of an emergency stationary SI...

Code of Federal Regulations, 2013 CFR

2013-07-01

... I am an owner or operator of an emergency stationary SI internal combustion engine? 60.4237 Section... Internal Combustion Engines Other Requirements for Owners and Operators § 60.4237 What are the monitoring requirements if I am an owner or operator of an emergency stationary SI internal combustion engine? (a...

40 CFR 60.4237 - What are the monitoring requirements if I am an owner or operator of an emergency stationary SI...

Code of Federal Regulations, 2014 CFR

2014-07-01

... I am an owner or operator of an emergency stationary SI internal combustion engine? 60.4237 Section... Internal Combustion Engines Other Requirements for Owners and Operators § 60.4237 What are the monitoring requirements if I am an owner or operator of an emergency stationary SI internal combustion engine? (a...

40 CFR 60.4237 - What are the monitoring requirements if I am an owner or operator of an emergency stationary SI...

Code of Federal Regulations, 2011 CFR

2011-07-01

... I am an owner or operator of an emergency stationary SI internal combustion engine? 60.4237 Section... Internal Combustion Engines Other Requirements for Owners and Operators § 60.4237 What are the monitoring requirements if I am an owner or operator of an emergency stationary SI internal combustion engine? (a...

Matrix multiplication operations with data pre-conditioning in a high performance computing architecture

DOEpatents

Eichenberger, Alexandre E; Gschwind, Michael K; Gunnels, John A

2013-11-05

Mechanisms for performing matrix multiplication operations with data pre-conditioning in a high performance computing architecture are provided. A vector load operation is performed to load a first vector operand of the matrix multiplication operation to a first target vector register. A load and splat operation is performed to load an element of a second vector operand and replicating the element to each of a plurality of elements of a second target vector register. A multiply add operation is performed on elements of the first target vector register and elements of the second target vector register to generate a partial product of the matrix multiplication operation. The partial product of the matrix multiplication operation is accumulated with other partial products of the matrix multiplication operation.

Disabilities - Multiple Languages

MedlinePlus

... for Emergencies Now: Information for People with Disabilities - English PDF Prepare for Emergencies Now: Information for People ... for Emergencies Now: Information for People with Disabilities - English PDF Prepare for Emergencies Now: Information for People ...

47 CFR 87.43 - Operation during emergency.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AVIATION SERVICES Applications and Licenses § 87.43 Operation during emergency. A station may be used for emergency communications in a manner other than that specified in the station license or in the operating rules when normal...

49 CFR 192.615 - Emergency plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 3 2010-10-01 2010-10-01 false Emergency plans. 192.615 Section 192.615... BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Operations § 192.615 Emergency plans. (a) Each operator... notifies the officials; and (4) Plan how the operator and officials can engage in mutual assistance to...

We still need to operate at night!

PubMed Central

Faiz, Omar; Banerjee, Saswata; Tekkis, Paris; Papagrigoriadis, Savvas; Rennie, John; Leather, Andrew

2007-01-01

Introduction In the past the National Confidential Enquiry into Peri-operative deaths (NCEPOD) have advocated a reduction in non-essential night-time operating in NHS hospitals. In this study a retrospective analysis of the emergency general surgical operative workload at a London Teaching centre was performed. Methods All general surgical and vascular emergency operations recorded prospectively on the theatre database between 1997 and 2004 were included in the study. Operations were categorised according to whether they commenced during the daytime(08:01–18:00 hours), evening(18:01–00:00 hours) or night-time(00:01–08:00 hours). The procedure type and grade of the participating surgical personnel were also recorded. Bivariate correlation was used to analyse changing trends in the emergency workload. Results In total 5,316 emergency operations were performed over the study period. The numbers of daytime, evening and night-time emergency procedures performed were 2,963(55.7%), 1,832(34.5%), and 521(9.8%) respectively. Laparotomies and complex vascular procedures collectively accounted for half of all cases performed after midnight whereas they represented only 30% of the combined daytime and evening emergency workload. Thirty-two percent (n = 166) of all night-time operations were supervised or performed by a consultant surgeon. The annual volume of emergency cases performed increased significantly throughout the study period. Enhanced daytime (r = 0.741, p < 0.01) and evening (r = 0.548, p < 0.01) operating absorbed this increase in workload. There was no significant change in the absolute number of cases performed at night but the proportion of the emergency workload that took place after midnight decreased significantly throughout the study (r = -0.742, p < 0.01). Conclusion A small but consistent volume of complex cases require emergency surgery after midnight. Provision of an emergency general surgical service must incorporate this need. PMID:17973987

CDC's Early Response to a Novel Viral Disease, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), September 2012-May 2014.

PubMed

Williams, Holly Ann; Dunville, Richard L; Gerber, Susan I; Erdman, Dean D; Pesik, Nicki; Kuhar, David; Mason, Karen A; Haynes, Lia; Rotz, Lisa; St Pierre, Jeanette; Poser, Sarah; Bunga, Sudhir; Pallansch, Mark A; Swerdlow, David L

2015-01-01

The first ever case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was reported in September 2012. This report describes the approaches taken by CDC, in collaboration with the World Health Organization (WHO) and other partners, to respond to this novel virus, and outlines the agency responses prior to the first case appearing in the United States in May 2014. During this time, CDC's response integrated multiple disciplines and was divided into three distinct phases: before, during, and after the initial activation of its Emergency Operations Center. CDC's response to MERS-CoV required a large effort, deploying at least 353 staff members who worked in the areas of surveillance, laboratory capacity, infection control guidance, and travelers' health. This response built on CDC's experience with previous outbreaks of other pathogens and provided useful lessons for future emerging threats.

CDC's Early Response to a Novel Viral Disease, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), September 2012–May 2014

PubMed Central

Dunville, Richard L.; Gerber, Susan I.; Erdman, Dean D.; Pesik, Nicki; Kuhar, David; Mason, Karen A.; Haynes, Lia; Rotz, Lisa; St. Pierre, Jeanette; Poser, Sarah; Bunga, Sudhir; Pallansch, Mark A.; Swerdlow, David L.

2015-01-01

The first ever case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was reported in September 2012. This report describes the approaches taken by CDC, in collaboration with the World Health Organization (WHO) and other partners, to respond to this novel virus, and outlines the agency responses prior to the first case appearing in the United States in May 2014. During this time, CDC's response integrated multiple disciplines and was divided into three distinct phases: before, during, and after the initial activation of its Emergency Operations Center. CDC's response to MERS-CoV required a large effort, deploying at least 353 staff members who worked in the areas of surveillance, laboratory capacity, infection control guidance, and travelers' health. This response built on CDC's experience with previous outbreaks of other pathogens and provided useful lessons for future emerging threats. PMID:26345122

Unprotected intercourse in the 2 weeks prior to requesting emergency intrauterine contraception.

PubMed

Sanders, Jessica N; Howell, Laura; Saltzman, Hanna M; Schwarz, E Bimla; Thompson, Ivana S; Turok, David K

2016-11-01

Previous emergency contraception studies have excluded women who report >1 episode of unprotected or underprotected intercourse. Thus, clinical recommendations are based on exposure to a single episode of underprotected intercourse. We sought to assess the prevalence and timing of underprotected intercourse episodes among women requesting emergency contraception and to examine the probability of pregnancy following an emergency contraception regimen including placement of either a copper intrauterine device or a levonorgestrel intrauterine device with simultaneous administration of an oral levonorgestrel pill in women reporting multiple underprotected intercourse episodes, including episodes beyond the Food and Drug Administration-approved emergency contraception time frame (6-14 days). Women seeking emergency contraception who had a negative pregnancy test and desired either a copper intrauterine device or levonorgestrel emergency contraception regimen enrolled in this prospective observational study. At enrollment, participants reported the number and timing of underprotected intercourse episodes in the previous 14 days. Two weeks later, participants reported the results of a self-administered home pregnancy test. Of the 176 women who presented for emergency contraception and received a same-day intrauterine device, 43% (n = 76) reported multiple underprotected intercourse episodes in the 14 days prior to presenting for emergency contraception. Women with multiple underprotected intercourse episodes reported a median of 3 events (range 2-20). Two-week pregnancy data were available for 172 (98%) participants. Only 1 participant had a positive pregnancy test. Pregnancy occurred in 0 of 97 (0%; 95% confidence interval, 0-3.7%) women with a single underprotected intercourse episode and 1 of 75 (1.3%; 95% confidence interval, 0-7.2%) women reporting multiple underprotected intercourse episodes; this includes 1 of 40 (2.5%; 95% confidence interval, 0-13.2%) women reporting underprotected intercourse 6-14 days prior to intrauterine device insertion. Women seeking emergency contraception from clinics commonly reported multiple recent underprotected intercourse episodes, including episodes occurring beyond the Food and Drug Administration-approved emergency contraception time frame. However, the probability of pregnancy was low following same-day intrauterine device placement. Copyright © 2016 Elsevier Inc. All rights reserved.

A task analysis of emergency physician activities in academic and community settings.

PubMed

Chisholm, Carey D; Weaver, Christopher S; Whenmouth, Laura; Giles, Beverly

2011-08-01

We characterize and compare the work activities, including peak patient loads, associated with the workplace in the academic and community emergency department (ED) settings. This allows assessment of the effect of future ED system operational changes and identifies potential sources contributing to medical error. This was an observational, time-motion study. Trained observers shadowed physicians, recording activities. Data included total interactions, distances walked, time sitting, patients concurrently treated, interruptions, break in tasks, physical contact with patients, hand washing, diagnostic tests ordered, and therapies rendered. Activities were classified as direct patient care, indirect patient care, or personal time with a priori definitions. There were 203 2-hour observation periods of 85 physicians at 2 academic EDs with 100,000 visits per year at each (N=160) and 2 community EDs with annual visits of 19,000 and 21,000 (N=43). Reported data present the median and minimum-maximum values per 2-hour period. Emergency physicians spent the majority of time on indirect care activities (academic 64 minutes, 29 to 91 minutes; community 55 min, 25 to 95 minutes), followed by direct care activities (academic 36 minutes, 6 to 79 minutes; community 41 minutes, 5 to 60 minutes). Personal time differed by location type (academic 6 minutes, 0 to 66 minutes; community 13 minutes, 0 to 69 minutes). All physicians simultaneously cared for multiple patients, with a median number of patients greater than 5 (academic 7 patients, 2 to 16 patients; community 6 patients, 2 to 12 patients). Emergency physicians spend the majority of their time involved in indirect patient care activities. They are frequently interrupted and interact with a large number of individuals. They care for a wide range of patients simultaneously, with surges in multiple patient care responsibilities. Physicians working in academic settings are interrupted at twice the rate of their community counterparts. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

44 CFR 15.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... GENERAL CONDUCT AT THE MT. WEATHER EMERGENCY ASSISTANCE CENTER AND AT THE NATIONAL EMERGENCY TRAINING.... Weather means the Mt. Weather Emergency Operations Center, Bluemont, Virginia. Mt. Weather Executive Director means the Executive Director of the Mt. Weather Emergency Operations Center. NETC means the...

44 CFR 15.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SECURITY GENERAL CONDUCT AT THE MT. WEATHER EMERGENCY ASSISTANCE CENTER AND AT THE NATIONAL EMERGENCY.... Weather means the Mt. Weather Emergency Operations Center, Bluemont, Virginia. Mt. Weather Executive Director means the Executive Director of the Mt. Weather Emergency Operations Center. NETC means the...

44 CFR 15.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SECURITY GENERAL CONDUCT AT THE MT. WEATHER EMERGENCY ASSISTANCE CENTER AND AT THE NATIONAL EMERGENCY.... Weather means the Mt. Weather Emergency Operations Center, Bluemont, Virginia. Mt. Weather Executive Director means the Executive Director of the Mt. Weather Emergency Operations Center. NETC means the...

44 CFR 15.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SECURITY GENERAL CONDUCT AT THE MT. WEATHER EMERGENCY ASSISTANCE CENTER AND AT THE NATIONAL EMERGENCY.... Weather means the Mt. Weather Emergency Operations Center, Bluemont, Virginia. Mt. Weather Executive Director means the Executive Director of the Mt. Weather Emergency Operations Center. NETC means the...

44 CFR 15.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SECURITY GENERAL CONDUCT AT THE MT. WEATHER EMERGENCY ASSISTANCE CENTER AND AT THE NATIONAL EMERGENCY.... Weather means the Mt. Weather Emergency Operations Center, Bluemont, Virginia. Mt. Weather Executive Director means the Executive Director of the Mt. Weather Emergency Operations Center. NETC means the...

A Methodology for Training International Space Station Crews to Respond to On-Orbit Emergencies

NASA Technical Reports Server (NTRS)

Balmain, Clinton; Fleming, Mark

2009-01-01

Most spaceflight crewmembers agree that emergency training is among the most important training they receive. If an emergency event occurs on-orbit crewmembers want to be able to rely on a thorough and proficient knowledge of emergency operations and procedures. The inherent complexity of ISS and the international nature of the onboard operations have resulted in emergency procedures that are complex by any measure; as a result, a very robust apparatus has been developed to give crewmembers initial training on emergency procedures and ensure proficiency up to (and even after) launch. One of the most important aspects of complex onboard operations in general, and emergency operations specifically, is learning how to coordinate roles and responsibilities with fellow crewmembers. A primary goal of NASA s emergency training program is to allow the crewmembers who will actually be together on-orbit to practice executing the emergency responses together before they fly. As with any operation that includes the use of software and hardware, the fidelity of the simulation environment is a critical element to successful training. The NASA training division has spent considerable time and effort to develop a simulator that addresses the most important aspects of emergency response, working within very difficult space and budgetary constraints.

14 CFR 121.339 - Emergency equipment for extended over-water operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Emergency equipment for extended over-water... § 121.339 Emergency equipment for extended over-water operations. (a) Except where the Administrator, by... certificate holder, the Administrator allows deviation for a particular extended overwater operation, no...

14 CFR 121.339 - Emergency equipment for extended over-water operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Emergency equipment for extended over-water... § 121.339 Emergency equipment for extended over-water operations. (a) Except where the Administrator, by... certificate holder, the Administrator allows deviation for a particular extended overwater operation, no...

14 CFR 121.339 - Emergency equipment for extended over-water operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Emergency equipment for extended over-water... § 121.339 Emergency equipment for extended over-water operations. (a) Except where the Administrator, by... certificate holder, the Administrator allows deviation for a particular extended overwater operation, no...

14 CFR 121.339 - Emergency equipment for extended over-water operations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Emergency equipment for extended over-water... § 121.339 Emergency equipment for extended over-water operations. (a) Except where the Administrator, by... certificate holder, the Administrator allows deviation for a particular extended overwater operation, no...

14 CFR 121.339 - Emergency equipment for extended over-water operations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Emergency equipment for extended over-water... § 121.339 Emergency equipment for extended over-water operations. (a) Except where the Administrator, by... certificate holder, the Administrator allows deviation for a particular extended overwater operation, no...

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

The Small Aircraft Transportation System (SATS), Higher Volume Operations (HVO) Off-Nominal Operations

NASA Technical Reports Server (NTRS)

Baxley, B.; Williams, D.; Consiglio, M.; Conway, S.; Adams, C.; Abbott, T.

2005-01-01

The ability to conduct concurrent, multiple aircraft operations in poor weather, at virtually any airport, offers an important opportunity for a significant increase in the rate of flight operations, a major improvement in passenger convenience, and the potential to foster growth of charter operations at small airports. The Small Aircraft Transportation System, (SATS) Higher Volume Operations (HVO) concept is designed to increase traffic flow at any of the 3400 nonradar, non-towered airports in the United States where operations are currently restricted to one-in/one-out procedural separation during Instrument Meteorological Conditions (IMC). The concept's key feature is pilots maintain their own separation from other aircraft using procedures, aircraft flight data sent via air-to-air datalink, cockpit displays, and on-board software. This is done within the Self-Controlled Area (SCA), an area of flight operations established during poor visibility or low ceilings around an airport without Air Traffic Control (ATC) services. The research described in this paper expands the HVO concept to include most off-nominal situations that could be expected to occur in a future SATS environment. The situations were categorized into routine off-nominal operations, procedural deviations, equipment malfunctions, and aircraft emergencies. The combination of normal and off-nominal HVO procedures provides evidence for an operational concept that is safe, requires little ground infrastructure, and enables concurrent flight operations in poor weather.

Appraisal of the Operation Respond Emergency Information System (OREIS)

DOT National Transportation Integrated Search

1998-04-01

The Operation Respond Institute has been instrumental in developing the Operation Respond Emergency Information System (OREIS) for first responders to hazardous material incidents in transportation. The Operation Respond system aims to facilitate rap...

Health care logistics: who has the ball during disaster?

PubMed

Vanvactor, Jerry D

2011-05-10

In contemporary organizations, a wide gamut of options is available for sustaining and supporting health care operations. When disaster strikes, despite having tenable plans for routine replenishment and operations, many organizations find themselves ill-prepared, ill-equipped, and without effective mechanisms in place to sustain operations during the immediate aftermath of a crisis. Health care operations can be abruptly halted due to the non-availability of supply. The purpose of this work is to add to a necessary, growing body of works related specifically to health care logistics preparedness and disaster mitigation. Logistics management is a specialized genre of expertise within the health care industry and is largely contributive to the success or failure of health care organizations. Logistics management requires extensive collaboration among multiple stakeholders-internal and external to an organization. Effective processes and procedures can be largely contributive to the success or failure of organizational operations. This article contributes to the closure of an obvious gap in professional and academic literature related to disaster health care logistics management and provides timely insight into a potential problem for leaders industry-wide. One critical aspect of disaster planning is regard for competent logistics management and the effective provision of necessary items when they are needed most. In many communities, there seems to be little evidence available regarding health care logistics involvement in disaster planning; at times, evidence of planning efforts perceptibly end at intra-organizational doors within facilities. Strategic planners are being continually reminded that health care organizations serve a principal role in emergency preparedness planning and must be prepared to fulfill the associated possibilities without notification. The concern is that not enough attention is being paid to repeated lessons being observed in disasters and emergency events.

Health care logistics: who has the ball during disaster?

PubMed Central

VanVactor, Jerry D.

2011-01-01

In contemporary organizations, a wide gamut of options is available for sustaining and supporting health care operations. When disaster strikes, despite having tenable plans for routine replenishment and operations, many organizations find themselves ill-prepared, ill-equipped, and without effective mechanisms in place to sustain operations during the immediate aftermath of a crisis. Health care operations can be abruptly halted due to the non-availability of supply. The purpose of this work is to add to a necessary, growing body of works related specifically to health care logistics preparedness and disaster mitigation. Logistics management is a specialized genre of expertise within the health care industry and is largely contributive to the success or failure of health care organizations. Logistics management requires extensive collaboration among multiple stakeholders—internal and external to an organization. Effective processes and procedures can be largely contributive to the success or failure of organizational operations. This article contributes to the closure of an obvious gap in professional and academic literature related to disaster health care logistics management and provides timely insight into a potential problem for leaders industry-wide. One critical aspect of disaster planning is regard for competent logistics management and the effective provision of necessary items when they are needed most. In many communities, there seems to be little evidence available regarding health care logistics involvement in disaster planning; at times, evidence of planning efforts perceptibly end at intra-organizational doors within facilities. Strategic planners are being continually reminded that health care organizations serve a principal role in emergency preparedness planning and must be prepared to fulfill the associated possibilities without notification. The concern is that not enough attention is being paid to repeated lessons being observed in disasters and emergency events. PMID:24149034

Integrated Data Modeling and Simulation on the Joint Polar Satellite System Program

NASA Technical Reports Server (NTRS)

Roberts, Christopher J.; Boyce, Leslye; Smith, Gary; Li, Angela; Barrett, Larry

2012-01-01

The Joint Polar Satellite System is a modern, large-scale, complex, multi-mission aerospace program, and presents a variety of design, testing and operational challenges due to: (1) System Scope: multi-mission coordination, role, responsibility and accountability challenges stemming from porous/ill-defined system and organizational boundaries (including foreign policy interactions) (2) Degree of Concurrency: design, implementation, integration, verification and operation occurring simultaneously, at multiple scales in the system hierarchy (3) Multi-Decadal Lifecycle: technical obsolesce, reliability and sustainment concerns, including those related to organizational and industrial base. Additionally, these systems tend to become embedded in the broader societal infrastructure, resulting in new system stakeholders with perhaps different preferences (4) Barriers to Effective Communications: process and cultural issues that emerge due to geographic dispersion and as one spans boundaries including gov./contractor, NASA/Other USG, and international relationships.

A method to perform a fast fourier transform with primitive image transformations.

PubMed

Sheridan, Phil

2007-05-01

The Fourier transform is one of the most important transformations in image processing. A major component of this influence comes from the ability to implement it efficiently on a digital computer. This paper describes a new methodology to perform a fast Fourier transform (FFT). This methodology emerges from considerations of the natural physical constraints imposed by image capture devices (camera/eye). The novel aspects of the specific FFT method described include: 1) a bit-wise reversal re-grouping operation of the conventional FFT is replaced by the use of lossless image rotation and scaling and 2) the usual arithmetic operations of complex multiplication are replaced with integer addition. The significance of the FFT presented in this paper is introduced by extending a discrete and finite image algebra, named Spiral Honeycomb Image Algebra (SHIA), to a continuous version, named SHIAC.

Indoor imagery with a 3D through-wall synthetic aperture radar

NASA Astrophysics Data System (ADS)

Sévigny, Pascale; DiFilippo, David J.; Laneve, Tony; Fournier, Jonathan

2012-06-01

Through-wall radar imaging is an emerging technology with great interest to military and police forces operating in an urban environment. A through-wall imaging radar can potentially provide interior room layouts as well as detection and localization of targets of interest within a building. In this paper, we present our through-wall radar system mounted on the side of a vehicle and driven along a path in front of a building of interest. The vehicle is equipped with a LIDAR (Light Detection and Ranging) and motion sensors that provide auxiliary information. The radar uses an ultra wideband frequency-modulated continuous wave (FMCW) waveform to obtain high range resolution. Our system is composed of a vertical linear receive array to discriminate targets in elevation, and two transmit elements operated in a slow multiple-input multiple output (MIMO) configuration to increase the achievable elevation resolution. High resolution in the along-track direction is obtained through synthetic aperture radar (SAR) techniques. We present experimental results that demonstrate the 3-D capability of the radar. We further demonstrate target detection behind challenging walls, and imagery of internal wall features. Finally, we discuss future work.

29 CFR 1910.120 - Hazardous waste operations and emergency response.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 5 2014-07-01 2014-07-01 false Hazardous waste operations and emergency response. 1910.120 Section 1910.120 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Hazardous Materials § 1910.120 Hazardous waste operations and emergency...

29 CFR 1910.120 - Hazardous waste operations and emergency response.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 5 2012-07-01 2012-07-01 false Hazardous waste operations and emergency response. 1910.120 Section 1910.120 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Hazardous Materials § 1910.120 Hazardous waste operations and emergency...

29 CFR 1910.120 - Hazardous waste operations and emergency response.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 5 2013-07-01 2013-07-01 false Hazardous waste operations and emergency response. 1910.120 Section 1910.120 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Hazardous Materials § 1910.120 Hazardous waste operations and emergency...

A statistical model to estimate the local vulnerability to severe weather

NASA Astrophysics Data System (ADS)

Pardowitz, Tobias

2018-06-01

We present a spatial analysis of weather-related fire brigade operations in Berlin. By comparing operation occurrences to insured losses for a set of severe weather events we demonstrate the representativeness and usefulness of such data in the analysis of weather impacts on local scales. We investigate factors influencing the local rate of operation occurrence. While depending on multiple factors - which are often not available - we focus on publicly available quantities. These include topographic features, land use information based on satellite data and information on urban structure based on data from the OpenStreetMap project. After identifying suitable predictors such as housing coverage or local density of the road network we set up a statistical model to be able to predict the average occurrence frequency of local fire brigade operations. Such model can be used to determine potential hotspots for weather impacts even in areas or cities where no systematic records are available and can thus serve as a basis for a broad range of tools or applications in emergency management and planning.

Optimization of shared autonomy vehicle control architectures for swarm operations.

PubMed

Sengstacken, Aaron J; DeLaurentis, Daniel A; Akbarzadeh-T, Mohammad R

2010-08-01

The need for greater capacity in automotive transportation (in the midst of constrained resources) and the convergence of key technologies from multiple domains may eventually produce the emergence of a "swarm" concept of operations. The swarm, which is a collection of vehicles traveling at high speeds and in close proximity, will require technology and management techniques to ensure safe, efficient, and reliable vehicle interactions. We propose a shared autonomy control approach, in which the strengths of both human drivers and machines are employed in concert for this management. Building from a fuzzy logic control implementation, optimal architectures for shared autonomy addressing differing classes of drivers (represented by the driver's response time) are developed through a genetic-algorithm-based search for preferred fuzzy rules. Additionally, a form of "phase transition" from a safe to an unsafe swarm architecture as the amount of sensor capability is varied uncovers key insights on the required technology to enable successful shared autonomy for swarm operations.

Multi Ray Model for Near-Ground Millimeter Wave Radar

PubMed Central

Litvak, Boris; Pinhasi, Yosef

2017-01-01

A quasi-optical multi-ray model for a short-range millimeter wave radar is presented. The model considers multi-path effects emerging while multiple rays are scattered from the target and reflected to the radar receiver. Among the examined scenarios, the special case of grazing ground reflections is analyzed. Such a case becomes relevant when short range anti-collision radars are employed in vehicles. Such radars operate at millimeter wavelengths, and are aimed at the detection of targets located several tens of meters from the transmitter. Reflections from the road are expected to play a role in the received signal strength, together with the direct line-of-sight beams illuminated and scattered from the target. The model is demonstrated experimentally using radar operating in the W-band. Controlled measurements were done to distinguish between several scattering target features. The experimental setup was designed to imitate vehicle near-ground millimeter wave radars operating in vehicles. A comparison between analytical calculations and experimental results is made and discussed. PMID:28867776

3 Echo: concept of operations for early care and evacuation of victims of mass violence.

PubMed

Autrey, Allen W; Hick, John L; Bramer, Kurtis; Berndt, Jeremy; Bundt, Jonathan

2014-08-01

This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance. This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event.

A case of acute onset postoperative gas gangrene caused by Clostridium perfringens.

PubMed

Takazawa, Tomonori; Ohta, Jou; Horiuchi, Tatsuo; Hinohara, Hiroshi; Kunimoto, Fumio; Saito, Shigeru

2016-08-03

Gas gangrene is a necrotic infection of soft tissue associated with high mortality rates. We report a case of postoperative gas gangrene with very acute onset and rapid progression of symptoms. To our knowledge, this case is the most acute onset of postoperative gas gangrene ever reported. A 65-year-old Japanese female patient developed a shock state 16 h after radical cystectomy with ileal conduit reconstruction. Two days after the operation, she was transferred to the intensive care unit because of deterioration in her respiratory and circulatory condition. Soon after moving her to the ICU, a subcutaneous hemorrhage-like skin rash appeared and extended rapidly over her left side. Blood tests performed on admission to the ICU indicated severe metabolic acidosis, liver and renal dysfunction, and signs of disseminated intravascular coagulation. Suspecting necrotizing fasciitis or gas gangrene, we performed emergency fasciotomy. Subsequently, multidisciplinary treatment, including empirical therapy using multiple antibiotics, mechanical ventilation, hyperbaric oxygen therapy, polymyxin B-immobilized fiber column direct hemoperfusion, and continuous hemodiafiltration, was commenced. Culture of the debris from a wound abscess removed by emergency fasciotomy detected the presence of Clostridium perfringens. We hypothesized that the source of infection in this case may have been the ileum used for bladder reconstruction. Although the initial treatment prevented further clinical deterioration, she developed secondary infection from the 3rd week onward, due to infection with multiple pathogenic bacteria. Despite prompt diagnosis and intensive therapy, the patient died 38 days after the operation. Although the patient did not have any specific risk factors for postsurgical infection, she developed a shock state only 16 h after surgery due to gas gangrene. Our experience highlights the fact that physicians should be aware that any patient could possibly develop gas gangrene postoperatively.

Urgent surgery for complicated colonic diverticula.

PubMed

Funariu, Gheorghe; Binţinţan, Vasile; Seicean, Radu

2006-03-01

The AIM of this retrospective study was to evaluate the emergency surgical treatment of life-threatening complications of colonic diverticula. In the last 11 years, 22 of 101 patients with colonic diverticula (22.1%) underwent urgent surgery for acute complications: perforated gangrenous diverticulitis with generalized peritonitis (n=8) or pericolic abscess (n=8), acute bowel obstruction (n=4) and severe diverticular bleeding (n=2). In all patients with diffuse peritonitis or acute obstruction the indication for surgery was decided on clinical basis and the complicated diverticula were recognized only intra-operatively. Emergency surgical strategy differed according to the type of complication and the biologic condition of the patient: segmental colectomy and primary anastomosis for diverticular perforation (n=4), colonic stenosis (n=3) or diverticular bleeding (n=2); Hartmann resection with late reconnecting anastomosis in patients with diverticular perforation (n=5) or colonic obstruction (n=1); diverticulectomy with peritoneal drainage (n=2) and colostomy and drainage followed by secondary colectomy (n=5) for diverticular perforations in patients with poor general condition. Only one patient (4.5%) died post-operatively of multiple organ failure from generalized peritonitis. There was no anastomotic leakage in patients with primary anastomosis. Six patients (27.2%) developed wound infection. Hospital stay ranged between 11 and 60 days, significantly longer in cases with two-stage operations. Primary colectomy with immediate or delayed anastomosis is the best surgical procedure for acute divericular complications in patients with good biologic status. Two-stage operations such as colostomy and drainage coupled with late colectomy remain the viable alternative in patients with advanced disease and critical biologic condition.

Multiple-relaxation-time lattice Boltzmann method for immiscible fluids at high Reynolds numbers.

PubMed

Fakhari, Abbas; Lee, Taehun

2013-02-01

The lattice Boltzmann method for immiscible multiphase flows with large density ratio is extended to high Reynolds number flows using a multiple-relaxation-time (MRT) collision operator, and its stability and accuracy are assessed by simulating the Kelvin-Helmholtz instability. The MRT model is successful at damping high-frequency oscillations in the kinetic energy emerging from traveling waves generated by the inclusion of curvature. Numerical results are shown to be in good agreement with prior studies using adaptive mesh refinement techniques applied to the Navier-Stokes equations. Effects of viscosity and surface tension, as well as density ratio, are investigated in terms of the Reynolds and Weber numbers. It is shown that increasing the Reynolds number results in a more chaotic interface evolution and eventually shattering of the interface, while surface tension is shown to have a stabilizing effect.

Clinical cognition and diagnostic error: applications of a dual process model of reasoning.

PubMed

Croskerry, Pat

2009-09-01

Both systemic and individual factors contribute to missed or delayed diagnoses. Among the multiple factors that impact clinical performance of the individual, the caliber of cognition is perhaps the most relevant and deserves our attention and understanding. In the last few decades, cognitive psychologists have gained substantial insights into the processes that underlie cognition, and a new, universal model of reasoning and decision making has emerged, Dual Process Theory. The theory has immediate application to medical decision making and provides an overall schema for understanding the variety of theoretical approaches that have been taken in the past. The model has important practical applications for decision making across the multiple domains of healthcare, and may be used as a template for teaching decision theory, as well as a platform for future research. Importantly, specific operating characteristics of the model explain how diagnostic failure occurs.

Quantitative, spectrally-resolved intraoperative fluorescence imaging

PubMed Central

Valdés, Pablo A.; Leblond, Frederic; Jacobs, Valerie L.; Wilson, Brian C.; Paulsen, Keith D.; Roberts, David W.

2012-01-01

Intraoperative visual fluorescence imaging (vFI) has emerged as a promising aid to surgical guidance, but does not fully exploit the potential of the fluorescent agents that are currently available. Here, we introduce a quantitative fluorescence imaging (qFI) approach that converts spectrally-resolved data into images of absolute fluorophore concentration pixel-by-pixel across the surgical field of view (FOV). The resulting estimates are linear, accurate, and precise relative to true values, and spectral decomposition of multiple fluorophores is also achieved. Experiments with protoporphyrin IX in a glioma rodent model demonstrate in vivo quantitative and spectrally-resolved fluorescence imaging of infiltrating tumor margins for the first time. Moreover, we present images from human surgery which detect residual tumor not evident with state-of-the-art vFI. The wide-field qFI technique has broad implications for intraoperative surgical guidance because it provides near real-time quantitative assessment of multiple fluorescent biomarkers across the operative field. PMID:23152935

Application of Multiple Categories of Unmanned Aircraft Systems (uas) in Different Airspaces for Bushfire Monitoring and Response

NASA Astrophysics Data System (ADS)

Homainejad, N.; Rizos, C.

2015-08-01

Demand and interest in Unmanned Aircraft Systems (UAS) for civilian applications, and advances in technology such as development of sense-and-avoid systems, will soon allow UAS to be flown alongside manned aircrafts in non-segregated airspace. An area that can benefit from the application of UAS is the bushfire services sector. Currently such services rely on watchtowers, fixed-wing manned aircrafts and satellite data for reliable information. UAS are a promising alternative to traditional methods of collecting bushfire data. There are several varieties of UAS and each category has certain limitations, hence a combination of multiple UAS with features appropriate for bushfire emergencies can be used simultaneously for collecting valuable data. This paper will describe the general UAS categories, some characteristics of Australian bushfires, and speculate on how a combination of several UAS operating in different airspaces can be of benefit for bushfire response personnel and firefighters.

epiDMS: Data Management and Analytics for Decision-Making From Epidemic Spread Simulation Ensembles.

PubMed

Liu, Sicong; Poccia, Silvestro; Candan, K Selçuk; Chowell, Gerardo; Sapino, Maria Luisa

2016-12-01

Carefully calibrated large-scale computational models of epidemic spread represent a powerful tool to support the decision-making process during epidemic emergencies. Epidemic models are being increasingly used for generating forecasts of the spatial-temporal progression of epidemics at different spatial scales and for assessing the likely impact of different intervention strategies. However, the management and analysis of simulation ensembles stemming from large-scale computational models pose challenges, particularly when dealing with multiple interdependent parameters, spanning multiple layers and geospatial frames, affected by complex dynamic processes operating at different resolutions. We describe and illustrate with examples a novel epidemic simulation data management system, epiDMS, that was developed to address the challenges that arise from the need to generate, search, visualize, and analyze, in a scalable manner, large volumes of epidemic simulation ensembles and observations during the progression of an epidemic. epiDMS is a publicly available system that facilitates management and analysis of large epidemic simulation ensembles. epiDMS aims to fill an important hole in decision-making during healthcare emergencies by enabling critical services with significant economic and health impact. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

14 CFR 121.803 - Emergency medical equipment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Emergency medical equipment. 121.803... REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Emergency Medical Equipment and Training § 121.803 Emergency medical equipment. (a) No person may operate a passenger-carrying airplane under this part unless...

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2013 CFR

2013-07-01

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

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2014 CFR

2014-07-01

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

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2012 CFR

2012-07-01

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

29 CFR 1915.508 - Training.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

46 CFR 112.05-3 - Main-emergency bus-tie.

Code of Federal Regulations, 2010 CFR

2010-10-01

... emergency switchboard; (b) Be arranged to prevent parallel operation of an emergency power source with any other source of electric power, except for interlock systems for momentary transfer of loads; and (c) If arranged for feedback operation, open automatically upon overload of the emergency power source before the...

The Effect of Childhood Supervisory Neglect on Emerging Adults’ Drinking

PubMed Central

Snyder, Susan M.; Merritt, Darcey H.

2016-01-01

This study investigated the effect of childhood supervisory neglect on emerging adults’ drinking. Child supervisory neglect is the most common form of child maltreatment in the United States, but few studies explore supervisory neglect separate from other forms of maltreatment among emerging adults, 18–25 years old. The study sample included (n = 11,117) emerging adults, 18–25 years old who participated in Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health). We conducted separate analyses for male and female emerging adults, because they have different rates of alcohol consumption and alcohol risk behaviors. Our study used latent class analysis to understand how patterns of alcohol risk behaviors clustered together. For males, we found the following four classes: (1) multiple-risk drinkers, (2) moderate-risk drinkers, (3) binge-drinkers, and (4) low-risk drinkers or abstainers. For females, we found the following three classes: (1) multiple-risk drinkers, (2) moderate-risk drinkers, and (3) low-risk drinkers or abstainers. For both males and females, supervisory neglect increased the odds of membership in the multiple-risk drinkers’ class compared to the low-risk drinkers or abstainers’ class. Single males who did not live with their parents, and who were white had increased odds of being in the multiple-risk drinkers. For females, being more educated, or in a serious romantic relationship increased the odds of membership in the multiple-risk drinkers’ class. Practitioners should ask about histories of supervisory neglect among emerging adults who engage in alcohol risk behaviors. PMID:26771736

Bradford Hill's criteria, emerging zoonoses, and One Health.

PubMed

Asokan, G V; Asokan, Vanitha

2016-09-01

Zoonoses constitute more than 60% of infectious diseases and 75% of emerging infectious diseases. Inappropriate overemphasis of specialization of disciplines has ignored public health. Identifying the causes of disease and determining how exposures are related to outcomes in "emerging zoonoses" affecting multiple species are considered to be the hallmarks of public health research and practice that compels the adoption of "One Health". The interactions within and among populations of vertebrates in the causation and transmissions of emerging zoonotic diseases are inherently dynamic, interdependent, and systems based. Disease causality theories have moved from one or several agents causing disease in a single species, to one infectious agent causing disease in multiple species-emerging zoonoses. Identification of the causative pathogen components or structures, elucidating the mechanisms of species specificity, and understanding the natural conditions of emergence would facilitate better derivation of the causal mechanism. Good quality evidence on causation in emerging zoonoses affecting multiple species makes a strong recommendation under the One Health approach for disease prevention and control from diagnostic tests, treatment, antimicrobial resistance, preventive vaccines, and evidence informed health policies. In the tenets of One Health, alliances work best when the legitimate interests of the different partners combine to prevent and control emerging zoonoses. Copyright © 2015 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Training Program for Operation of Emergency Vehicles. Trainee Study Guide.

ERIC Educational Resources Information Center

INNOVATRIX, Inc., Ingomar, PA.

A two-part trainee study guide for use in the classroom phase of the Emergency Vehicle Operation (EVO) training program is provided. Part 1, to be taken by all trainees, contains seven units organized into various subunits and includes the following: (1) introduction to the course; (2) some legal aspects of emergency vehicle operation (state…

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2011 CFR

2011-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2010 CFR

2010-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2012 CFR

2012-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2014 CFR

2014-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2013 CFR

2013-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

Teaching customer-centric operations management - evidence from an experiential learning-oriented mass customisation class

NASA Astrophysics Data System (ADS)

Medini, Khaled

2018-01-01

The increase of individualised customer demands and tough competition in the manufacturing sector gave rise to more customer-centric operations management such as products and services (mass) customisation. Mass customisation (MC), which inherits the 'economy of scale' from mass production (MP), aims to meet specific customer demands with near MP efficiency. Such an overarching concept has multiple impacts on operations management. This requires highly qualified and multi-skilled engineers who are well prepared for managing MC. Therefore, this concept should be properly addressed by engineering education curricula which needs to keep up with the emerging business trends. This paper introduces a novel course about MC and variety in operations management which recalls several Experiential Learning (EL) practices consistently with the principle of an active learning. The paper aims to analyse to which extent EL can improve the efficiency of the teaching methods and the retention rate in the context of operations management. The proposed course is given to engineering students whose' perceptions are collected using semi-structured questionnaires and analysed quantitatively and qualitatively. The paper highlights the relevance (i) of teaching MC, and (ii) of active learning in engineering education, through the specific application in the domain of MC.

Emergency department management of shoulder dystocia.

PubMed

Del Portal, Daniel A; Horn, Amanda E; Vilke, Gary M; Chan, Theodore C; Ufberg, Jacob W

2014-03-01

Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency with significant risk of adverse outcome. To review multiple techniques for managing a shoulder dystocia in the ED. We review various techniques and approaches for achieving delivery in the setting of shoulder dystocia. These include common maneuvers, controversial interventions, and interventions of last resort. Emergency physicians should be familiar with multiple techniques for managing a shoulder dystocia to reduce the chances of fetal and maternal morbidity and mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection.

PubMed

Kasatpibal, Nongyao; Whitney, Joanne D; Dellinger, E Patchen; Nair, Bala G; Pike, Kenneth C

Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk. A retrospective cohort study was conducted among patients having general surgery between May 2012 and June 2015 at the University of Washington Medical Center. Peri-operative data extracted from hospital databases included patient and operation characteristics, intra-operative medication and fluid administration, and survival outcome. The effects of antibiotic prophylaxis and potential factors on SSI risk were estimated using multiple logistic regression and were expressed as risk ratios (RRs). A total of 4,078 patients were eligible for analysis. Of these, 180 had an SSI. Mortality rates within and after 30 days were 0.8% and 0.3%, respectively. Improper antibiotic redosing increased the risk of SSI (RR 4.61; 95% confidence interval [CI] 1.33-15.91). Other risk factors were in-patient status (RR 4.05; 95% CI 1.69-9.66), smoking (RR 1.63; 95% CI 1.03-2.55), emergency surgery (RR 1.97; 95% CI 1.26-3.08), colectomy (RR 3.31; 95% CI 1.19-9.23), pancreatectomy (RR 4.52; 95% CI 1.53-13.39), proctectomy (RR 5.02; 95% CI 1.72-14.67), small bowel surgery (RR 6.16; 95% CI 2.13-17.79), intra-operative blood transfusion >500 mL (RR 2.76; 95% CI 1.45-5.26), and multiple procedures (RR 1.40; 95% CI 1.01-1.95). These data demonstrate that failure to redose prophylactic antibiotic during long operations increases the risk of SSI. Strengthening a collaborative surgical quality improvement program may help to eradicate this risk.

Simulation for Operational Readiness in a New Freestanding Emergency Department

PubMed Central

Kerner, Robert L.; Gallo, Kathleen; Cassara, Michael; D'Angelo, John; Egan, Anthony; Simmons, John Galbraith

2016-01-01

Summary Statement Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together. Methods throughout the preoperational term included predominantly hands-on skills review, high-fidelity simulation, and simulation with standardized patients. We also used simulation during instruction in disaster preparedness, sexual assault forensics, and community outreach. Our program culminated with 2 days of in-situ simulation deployed in simultaneous and overlapping timeframes to challenge system response capabilities, resilience, and flexibility; this work revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies. PMID:27607095

Group selection on population size affects life-history patterns in the entomopathogenic nematode Steinernema carpocapsae.

PubMed

Bashey, Farrah; Lively, Curtis M

2009-05-01

Selection is recognized to operate on multiple levels. In disease organisms, selection among hosts is thought to provide an important counterbalance to selection for faster growth within hosts. We performed three experiments, each selecting for a divergence in group size in the entomopathogenic nematode, Steinernema carpocapsae. These nematodes infect and kill insect larvae, reproduce inside the host carcass, and emerge as infective juveniles. We imposed selection on group size by selecting among hosts for either high or low numbers of emerging nematodes. Our goal was to determine whether this trait could respond to selection at the group level, and if so, to examine what other traits would evolve as correlated responses. One of the three experiments showed a significant response to group selection. In that experiment, the high-selected treatment consistently produced more emerging nematodes per host than the low-selected treatment. In addition, nematodes were larger and they emerged later from hosts in the low-selected lines. Despite small effective population sizes, the effects of inbreeding were small in this experiment. Thus, selection among hosts can be effective, leading to both a direct evolutionary response at the population level, as well as to correlated responses in populational and individual traits.

Impact of the 80-hour work week on resident emergency operative experience.

PubMed

Feanny, Mark A; Scott, Bradford G; Mattox, Kenneth L; Hirshberg, Asher

2005-12-01

The goal of this study was to analyze the impact of the 80-hour work week on the emergency operative experience of surgical residents. A 2-year retrospective comparison of the operative experience in emergency abdominal procedures of postgraduate year 4 and 5 residents in a city hospital before (group 1) and after (group 2) duty hour restriction. There was no difference between groups in the mean number of procedures performed as the primary surgeon, but group 2 showed a 40% decrease in technically advanced procedures with a 44% increase in basic procedures. The study also demonstrated a 54% decrease in the operative volume as first assistant. Operative continuity of care by residents decreased from 60% to 26% of cases. The ACGME regulatory environment is adversely affecting the emergency operative experience of surgical residents. Our findings underscore the need to develop alternative methods to augment the residents' operative experience.

Pseudologia Fantastica in the Emergency Department: A Case Report and Review of the Literature

PubMed Central

Teslyar, Polina; Friedman, Rohn

2017-01-01

Psychiatrists commonly encounter deception in the emergency department. This article presents the case of a patient who presents to the emergency department with an unusual and elaborate web of deceptions along multiple themes including feigning medical illness, multiple losses, and grandiose academic and athletic achievements. We review the clinical characteristics of pseudologia fantastica and discuss how this patient's constellation of malingering, factitious disorder, and personality disorder suggests this diagnosis. PMID:28573061

48 CFR 18.201 - Contingency operation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Contingency operation. 18.201 Section 18.201 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES EMERGENCY ACQUISITIONS Emergency Acquisition Flexibilities 18.201 Contingency operation. (a) Contingency operation is...

Increased risk environment for emergency general surgery in the context of regionalization and specialization.

PubMed

Beecher, S; O'Leary, D P; McLaughlin, R

2015-09-01

The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p < 0.0001). The majority of major emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

The Best Anticoagulation Therapy in Multiple-Trauma Patients with Mechanical Heart Valves: Evaluation of Latest Guidelines and Studies.

PubMed

Moeinipour, Aliasghar; Zarifian, Ahmadreza; Sheikh Andalibi, Mohammad Sobhan; Shamloo, Alireza Sepehri; Ahmadabadi, Ali; Amouzeshi, Ahmad; Hoseinikhah, Hamid

2015-12-22

It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medical management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagulation therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement. We searched electronic databases PubMed/Medline, Scopus, Embase, and Google Scholar using the following terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review. For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anesthesiologists, and cardiologists is essential. For optimal medical management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is important to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices. The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).

A Risk Management Architecture for Emergency Integrated Aircraft Control

NASA Technical Reports Server (NTRS)

McGlynn, Gregory E.; Litt, Jonathan S.; Lemon, Kimberly A.; Csank, Jeffrey T.

2011-01-01

Enhanced engine operation--operation that is beyond normal limits--has the potential to improve the adaptability and safety of aircraft in emergency situations. Intelligent use of enhanced engine operation to improve the handling qualities of the aircraft requires sophisticated risk estimation techniques and a risk management system that spans the flight and propulsion controllers. In this paper, an architecture that weighs the risks of the emergency and of possible engine performance enhancements to reduce overall risk to the aircraft is described. Two examples of emergency situations are presented to demonstrate the interaction between the flight and propulsion controllers to facilitate the enhanced operation.

Software systems for operation, control, and monitoring of the EBEX instrument

NASA Astrophysics Data System (ADS)

Milligan, Michael; Ade, Peter; Aubin, François; Baccigalupi, Carlo; Bao, Chaoyun; Borrill, Julian; Cantalupo, Christopher; Chapman, Daniel; Didier, Joy; Dobbs, Matt; Grainger, Will; Hanany, Shaul; Hillbrand, Seth; Hubmayr, Johannes; Hyland, Peter; Jaffe, Andrew; Johnson, Bradley; Kisner, Theodore; Klein, Jeff; Korotkov, Andrei; Leach, Sam; Lee, Adrian; Levinson, Lorne; Limon, Michele; MacDermid, Kevin; Matsumura, Tomotake; Miller, Amber; Pascale, Enzo; Polsgrove, Daniel; Ponthieu, Nicolas; Raach, Kate; Reichborn-Kjennerud, Britt; Sagiv, Ilan; Tran, Huan; Tucker, Gregory S.; Vinokurov, Yury; Yadav, Amit; Zaldarriaga, Matias; Zilic, Kyle

2010-07-01

We present the hardware and software systems implementing autonomous operation, distributed real-time monitoring, and control for the EBEX instrument. EBEX is a NASA-funded balloon-borne microwave polarimeter designed for a 14 day Antarctic flight that circumnavigates the pole. To meet its science goals the EBEX instrument autonomously executes several tasks in parallel: it collects attitude data and maintains pointing control in order to adhere to an observing schedule; tunes and operates up to 1920 TES bolometers and 120 SQUID amplifiers controlled by as many as 30 embedded computers; coordinates and dispatches jobs across an onboard computer network to manage this detector readout system; logs over 3 GiB/hour of science and housekeeping data to an onboard disk storage array; responds to a variety of commands and exogenous events; and downlinks multiple heterogeneous data streams representing a selected subset of the total logged data. Most of the systems implementing these functions have been tested during a recent engineering flight of the payload, and have proven to meet the target requirements. The EBEX ground segment couples uplink and downlink hardware to a client-server software stack, enabling real-time monitoring and command responsibility to be distributed across the public internet or other standard computer networks. Using the emerging dirfile standard as a uniform intermediate data format, a variety of front end programs provide access to different components and views of the downlinked data products. This distributed architecture was demonstrated operating across multiple widely dispersed sites prior to and during the EBEX engineering flight.

Digital Avionics

NASA Technical Reports Server (NTRS)

Koelbl, Terry G.; Ponchak, Denise; Lamarche, Teresa

2003-01-01

Digital Avionics activities played an important role in the advancements made in civil aviation, military systems, and space applications. This document profiles advances made in each of these areas by the aerospace industry, NASA centers, and the U.S. military. Emerging communication technologies covered in this document include Internet connectivity onboard aircraft, wireless broadband communication for aircraft, and a mobile router for aircraft to communicate in multiple communication networks over the course of a flight. Military technologies covered in this document include avionics for unmanned combat air vehicles and microsatellites, and head-up displays. Other technologies covered in this document include an electronic flight bag for the Boeing 777, and surveillance systems for managing airport operations.

Changing physiological status predicts severe injury and need for specialized trauma center resources.

PubMed

Talbert, Steven

2009-01-01

This study evaluated the association between changing physiological status (delta data) with severe injury (SI) or need for trauma center resources (TCR). Prehospital and emergency department arrival weighted RTS (RTSw) were computed for patients with complete records entered into the registry from 2002 to 2004 (n = 23,753). Physiological change was classified as unchanged, deteriorated, or improved (PreRTSw vs EDRTSw). Performance of delta data was evaluated using standard epidemiological approaches and multiple logistic regression. Deterioration status predicted SI (operating room [OR] = 1.38) and TCR (OR = 2.09). Improved status predicted TCR (OR = 1.27). Delta data independently predicted both SI and TCR.

40 CFR 68.52 - Operating procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) Initial startup; (2) Normal operations; (3) Temporary operations; (4) Emergency shutdown and operations; (5) Normal shutdown; (6) Startup following a normal or emergency shutdown or a major change that... are updated, if necessary, whenever a major change occurs and prior to startup of the changed process. ...

40 CFR 68.52 - Operating procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Initial startup; (2) Normal operations; (3) Temporary operations; (4) Emergency shutdown and operations; (5) Normal shutdown; (6) Startup following a normal or emergency shutdown or a major change that... are updated, if necessary, whenever a major change occurs and prior to startup of the changed process. ...

40 CFR 68.52 - Operating procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Initial startup; (2) Normal operations; (3) Temporary operations; (4) Emergency shutdown and operations; (5) Normal shutdown; (6) Startup following a normal or emergency shutdown or a major change that... are updated, if necessary, whenever a major change occurs and prior to startup of the changed process. ...

40 CFR 68.52 - Operating procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) Initial startup; (2) Normal operations; (3) Temporary operations; (4) Emergency shutdown and operations; (5) Normal shutdown; (6) Startup following a normal or emergency shutdown or a major change that... are updated, if necessary, whenever a major change occurs and prior to startup of the changed process. ...

75 FR 65365 - Disaster Temporary Housing Operational Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2010-0062] Disaster Temporary Housing Operational Guide AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice of availability; request for comments. SUMMARY: The Federal Emergency Management Agency (FEMA) is...

14 CFR 91.503 - Flying equipment and operating information.

Code of Federal Regulations, 2010 CFR

2010-01-01

... each flight at the pilot station of the airplane: (1) A flashlight having at least two size “D” cells...) Emergency operation of fuel, hydraulic, electrical, and mechanical systems. (2) Emergency operation of...

14 CFR 91.503 - Flying equipment and operating information.

Code of Federal Regulations, 2011 CFR

2011-01-01

... each flight at the pilot station of the airplane: (1) A flashlight having at least two size “D” cells...) Emergency operation of fuel, hydraulic, electrical, and mechanical systems. (2) Emergency operation of...

Emergency Plan for the Locks and Dams at St. Anthony Falls Minneapolis, Minnesota

DTIC Science & Technology

1987-03-01

Identification Subplan APPENDIX B Emergency Operations and Repair Subplan APPENDIX C Emergency Notification Subplan APPENDIX D Inundation Map Package...Emergency Operations and Repair Subplan 3) Appendix C , Emergency Notification Subplan 4) Appendix D , Inundation Maps and Hydraulic Data b. AP...which were selected for planning include: a. Structural Damage b. Sabotage c . Extreme Storm d . Excess Seepage e. Failure Due to Scouring A brief dis

Clinical findings provide criteria to evaluate priorities of ophthalmologic intervention in conscious multiple trauma patients.

PubMed

Shams-Vahdati, Samad; Gholipour, Changiz; Jalilzadeh-Binazar, Mehran; Moharamzadeh, Payman; Sorkhabi, Rana; Jalilian, Respina

2015-07-01

Multiple trauma patients frequently suffer eye injuries, especially those patients with head traumas. We evaluated the accuracy of physical findings to determine the priorities of emergency ophthalmologic intervention in these patients. This study included all multiple trauma patients with ophthalmic trauma who had a GCS of 15 when they arrived at the emergency department during the period of March, 2008-March, 2009. First, we evaluated the patients according to the criteria of the study. Then, an ophthalmologist evaluated them. From March 2008-March 2009, 306 multiple trauma patients with ocular trauma came to our ED. The sensitivity and accuracy of emergency physicians in diagnosing the priority of ophthalmologic treatment were comparable to an ophthalmologist (measure of agreement in kappa=0.967). The ability of an emergency physician or general surgeon to determine the actual need of early ophthalmologist intervention can improve decision making and saving both time and money. Our study suggests that it is possible to determine according to clinical findings the need of the patient to have ophthalmologic intervention without referring the patient to ophthalmologist examination. Defining specific criteria of ophthalmologic examinations can clarify the necessity of emergency ophthalmologic examination and intervention. Copyright © 2014 Elsevier Ltd. All rights reserved.

Traumatic and non-traumatic adrenal emergencies.

PubMed

Chernyak, Victoria; Patlas, Michael N; Menias, Christine O; Soto, Jorge A; Kielar, Ania Z; Rozenblit, Alla M; Romano, Luigia; Katz, Douglas S

2015-12-01

Multiple traumatic and non-traumatic adrenal emergencies are occasionally encountered during the cross-sectional imaging of emergency department patients. Traumatic adrenal hematomas are markers of severe polytrauma, and can be easily overlooked due to multiple concomitant injuries. Patients with non-traumatic adrenal emergencies usually present to an emergency department with a non-specific clinical picture. The detection and management of adrenal emergencies is based on cross-sectional imaging. Adrenal hemorrhage, adrenal infection, or rupture of adrenal neoplasm require immediate detection to avoid dire consequences. More often however, adrenal emergencies are detected incidentally in patients being investigated for non-specific acute abdominal pain. A high index of suspicion is required for the establishment of timely diagnosis and to avert potentially life-threatening complications. We describe cross-sectional imaging findings in patients with traumatic and non-traumatic adrenal hemorrhage, adrenal infarctions, adrenal infections, and complications of adrenal masses.

Biosensors with Built-In Biomolecular Logic Gates for Practical Applications

PubMed Central

Lai, Yu-Hsuan; Sun, Sin-Cih; Chuang, Min-Chieh

2014-01-01

Molecular logic gates, designs constructed with biological and chemical molecules, have emerged as an alternative computing approach to silicon-based logic operations. These molecular computers are capable of receiving and integrating multiple stimuli of biochemical significance to generate a definitive output, opening a new research avenue to advanced diagnostics and therapeutics which demand handling of complex factors and precise control. In molecularly gated devices, Boolean logic computations can be activated by specific inputs and accurately processed via bio-recognition, bio-catalysis, and selective chemical reactions. In this review, we survey recent advances of the molecular logic approaches to practical applications of biosensors, including designs constructed with proteins, enzymes, nucleic acids, nanomaterials, and organic compounds, as well as the research avenues for future development of digitally operating “sense and act” schemes that logically process biochemical signals through networked circuits to implement intelligent control systems. PMID:25587423

Teaching complex verbal operants to children with autism and establishing generalization using the peak curriculum.

PubMed

Dixon, Mark R; Peach, Jacqueline; Daar, Jacob H; Penrod, Cindy

2017-04-01

The present study evaluated the feasibility of the PEAK Relational Training System's Generalization Module (Dixon, 2014b) to teach and establish generalization of autoclitic mands, distorted tacts, and creative path finding in three children diagnosed with autism spectrum disorder. Using a multiple-baseline design across behaviors, each participant was provided with differential reinforcement and a least-to-most prompting hierarchy for correct responses to a subset of stimuli, and responses to other similar stimulus sets were probed for emergent generalization. Following training, each participant successfully acquired the directly trained behaviors and demonstrated generalization to the nonreinforced test exemplars. These data support the utility of Skinner's (1957) analysis to teach complex forms of verbal operants, and suggest that a manualized curriculum such as PEAK may have utility for promoting skill development and generalization for front line staff and caregivers of children with autism. © 2017 Society for the Experimental Analysis of Behavior.

NASA Airborne Science Program: NASA Stratospheric Platforms

NASA Technical Reports Server (NTRS)

Curry, Robert E.

2010-01-01

The National Aeronautics and Space Administration conducts a wide variety of remote sensing projects using several unique aircraft platforms. These vehicles have been selected and modified to provide capabilities that are particularly important for geophysical research, in particular, routine access to very high altitudes, long range, long endurance, precise trajectory control, and the payload capacity to operate multiple, diverse instruments concurrently. While the NASA program has been in operation for over 30 years, new aircraft and technological advances that will expand the capabilities for airborne observation are continually being assessed and implemented. This presentation will review the current state of NASA's science platforms, recent improvements and new missions concepts as well as provide a survey of emerging technologies unmanned aerial vehicles for long duration observations (Global Hawk and Predator). Applications of information technology that allow more efficient use of flight time and the ability to rapidly reconfigure systems for different mission objectives are addressed.

Scalable architecture for a room temperature solid-state quantum information processor.

PubMed

Yao, N Y; Jiang, L; Gorshkov, A V; Maurer, P C; Giedke, G; Cirac, J I; Lukin, M D

2012-04-24

The realization of a scalable quantum information processor has emerged over the past decade as one of the central challenges at the interface of fundamental science and engineering. Here we propose and analyse an architecture for a scalable, solid-state quantum information processor capable of operating at room temperature. Our approach is based on recent experimental advances involving nitrogen-vacancy colour centres in diamond. In particular, we demonstrate that the multiple challenges associated with operation at ambient temperature, individual addressing at the nanoscale, strong qubit coupling, robustness against disorder and low decoherence rates can be simultaneously achieved under realistic, experimentally relevant conditions. The architecture uses a novel approach to quantum information transfer and includes a hierarchy of control at successive length scales. Moreover, it alleviates the stringent constraints currently limiting the realization of scalable quantum processors and will provide fundamental insights into the physics of non-equilibrium many-body quantum systems.

Telerobotic management system: coordinating multiple human operators with multiple robots

NASA Astrophysics Data System (ADS)

King, Jamie W.; Pretty, Raymond; Brothers, Brendan; Gosine, Raymond G.

2003-09-01

This paper describes an application called the Tele-robotic management system (TMS) for coordinating multiple operators with multiple robots for applications such as underground mining. TMS utilizes several graphical interfaces to allow the user to define a partially ordered plan for multiple robots. This plan is then converted to a Petri net for execution and monitoring. TMS uses a distributed framework to allow robots and operators to easily integrate with the applications. This framework allows robots and operators to join the network and advertise their capabilities through services. TMS then decides whether tasks should be dispatched to a robot or a remote operator based on the services offered by the robots and operators.

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

DOT National Transportation Integrated Search

1998-09-01

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

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

DOT National Transportation Integrated Search

2006-01-01

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

Tackling Complex Emergency Response Solutions Evaluation Problems in Sustainable Development by Fuzzy Group Decision Making Approaches with Considering Decision Hesitancy and Prioritization among Assessing Criteria.

PubMed

Qi, Xiao-Wen; Zhang, Jun-Ling; Zhao, Shu-Ping; Liang, Chang-Yong

2017-10-02

In order to be prepared against potential balance-breaking risks affecting economic development, more and more countries have recognized emergency response solutions evaluation (ERSE) as an indispensable activity in their governance of sustainable development. Traditional multiple criteria group decision making (MCGDM) approaches to ERSE have been facing simultaneous challenging characteristics of decision hesitancy and prioritization relations among assessing criteria, due to the complexity in practical ERSE problems. Therefore, aiming at the special type of ERSE problems that hold the two characteristics, we investigate effective MCGDM approaches by hiring interval-valued dual hesitant fuzzy set (IVDHFS) to comprehensively depict decision hesitancy. To exploit decision information embedded in prioritization relations among criteria, we firstly define an fuzzy entropy measure for IVDHFS so that its derivative decision models can avoid potential information distortion in models based on classic IVDHFS distance measures with subjective supplementing mechanism; further, based on defined entropy measure, we develop two fundamental prioritized operators for IVDHFS by extending Yager's prioritized operators. Furthermore, on the strength of above methods, we construct two hesitant fuzzy MCGDM approaches to tackle complex scenarios with or without known weights for decision makers, respectively. Finally, case studies have been conducted to show effectiveness and practicality of our proposed approaches.

Tackling Complex Emergency Response Solutions Evaluation Problems in Sustainable Development by Fuzzy Group Decision Making Approaches with Considering Decision Hesitancy and Prioritization among Assessing Criteria

PubMed Central

Qi, Xiao-Wen; Zhang, Jun-Ling; Zhao, Shu-Ping; Liang, Chang-Yong

2017-01-01

In order to be prepared against potential balance-breaking risks affecting economic development, more and more countries have recognized emergency response solutions evaluation (ERSE) as an indispensable activity in their governance of sustainable development. Traditional multiple criteria group decision making (MCGDM) approaches to ERSE have been facing simultaneous challenging characteristics of decision hesitancy and prioritization relations among assessing criteria, due to the complexity in practical ERSE problems. Therefore, aiming at the special type of ERSE problems that hold the two characteristics, we investigate effective MCGDM approaches by hiring interval-valued dual hesitant fuzzy set (IVDHFS) to comprehensively depict decision hesitancy. To exploit decision information embedded in prioritization relations among criteria, we firstly define an fuzzy entropy measure for IVDHFS so that its derivative decision models can avoid potential information distortion in models based on classic IVDHFS distance measures with subjective supplementing mechanism; further, based on defined entropy measure, we develop two fundamental prioritized operators for IVDHFS by extending Yager’s prioritized operators. Furthermore, on the strength of above methods, we construct two hesitant fuzzy MCGDM approaches to tackle complex scenarios with or without known weights for decision makers, respectively. Finally, case studies have been conducted to show effectiveness and practicality of our proposed approaches. PMID:28974045

International Space Station Environmental Control and Life Support Emergency Response Verification for Node 1

NASA Technical Reports Server (NTRS)

Williams, David E.

2008-01-01

The International Space Station (ISS) Node 1 Environmental Control and Life Support (ECLS) System is comprised of five subsystems: Atmosphere Control and Supply (ACS), Atmosphere Revitalization (AR), Fire Detection and Suppression (FDS), Temperature and Humidity Control (THC), and Water Recovery and Management (WRM). This paper provides a summary of the Node 1 Emergency Response capability, which includes nominal and off-nominal FDS operation, off nominal ACS operation, and off-nominal THC operation. These subsystems provide the capability to help aid the crew members during an emergency cabin depressurization, a toxic spill, or a fire. The paper will also provide a discussion of the detailed Node 1 ECLS Element Verification methodologies for operation of the Node 1 Emergency Response hardware operations utilized during the Qualification phase.

Dynamic remedial action scheme using online transient stability analysis

NASA Astrophysics Data System (ADS)

Shrestha, Arun

Economic pressure and environmental factors have forced the modern power systems to operate closer to their stability limits. However, maintaining transient stability is a fundamental requirement for the operation of interconnected power systems. In North America, power systems are planned and operated to withstand the loss of any single or multiple elements without violating North American Electric Reliability Corporation (NERC) system performance criteria. For a contingency resulting in the loss of multiple elements (Category C), emergency transient stability controls may be necessary to stabilize the power system. Emergency control is designed to sense abnormal conditions and subsequently take pre-determined remedial actions to prevent instability. Commonly known as either Remedial Action Schemes (RAS) or as Special/System Protection Schemes (SPS), these emergency control approaches have been extensively adopted by utilities. RAS are designed to address specific problems, e.g. to increase power transfer, to provide reactive support, to address generator instability, to limit thermal overloads, etc. Possible remedial actions include generator tripping, load shedding, capacitor and reactor switching, static VAR control, etc. Among various RAS types, generation shedding is the most effective and widely used emergency control means for maintaining system stability. In this dissertation, an optimal power flow (OPF)-based generation-shedding RAS is proposed. This scheme uses online transient stability calculation and generator cost function to determine appropriate remedial actions. For transient stability calculation, SIngle Machine Equivalent (SIME) technique is used, which reduces the multimachine power system model to a One-Machine Infinite Bus (OMIB) equivalent and identifies critical machines. Unlike conventional RAS, which are designed using offline simulations, online stability calculations make the proposed RAS dynamic and adapting to any power system configuration and operating state. The generation-shedding cost is calculated using pre-RAS and post-RAS OPF costs. The criteria for selecting generators to trip is based on the minimum cost rather than minimum amount of generation to shed. For an unstable Category C contingency, the RAS control action that results in stable system with minimum generation shedding cost is selected among possible candidate solutions. The RAS control actions update whenever there is a change in operating condition, system configuration, or cost functions. The effectiveness of the proposed technique is demonstrated by simulations on the IEEE 9-bus system, the IEEE 39-bus system, and IEEE 145-bus system. This dissertation also proposes an improved, yet relatively simple, technique for solving Transient Stability-Constrained Optimal Power Flow (TSC-OPF) problem. Using the SIME method, the sets of dynamic and transient stability constraints are reduced to a single stability constraint, decreasing the overall size of the optimization problem. The transient stability constraint is formulated using the critical machines' power at the initial time step, rather than using the machine rotor angles. This avoids the addition of machine steady state stator algebraic equations in the conventional OPF algorithm. A systematic approach to reach an optimal solution is developed by exploring the quasi-linear behavior of critical machine power and stability margin. The proposed method shifts critical machines active power based on generator costs using an OPF algorithm. Moreover, the transient stability limit is based on stability margin, and not on a heuristically set limit on OMIB rotor angle. As a result, the proposed TSC-OPF solution is more economical and transparent. The proposed technique enables the use of fast and robust commercial OPF tool and time-domain simulation software for solving large scale TSC-OPF problem, which makes the proposed method also suitable for real-time application.

78 FR 20330 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-04

... instruction of emergency preparedness officials and other persons in the organization, operation, and techniques of emergency preparedness, and to conduct or operate schools or classes. The Administrator... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID: FEMA-2013-0009...

Language Multiplicity and Dynamism: Emergent Bilinguals Taking Ownership of Language Use in a Hybrid Curricular Space

ERIC Educational Resources Information Center

Martínez-Álvarez, Patricia

2017-01-01

This study explores the impact of hybrid instructional spaces on the purposeful and expansive use of translanguaging practices. Utilizing technology, the study explores the role of multimodality in bilinguals' language multiplicity and dynamism. The research addresses: (a) how do emergent bilinguals in dual language programs deploy their full…

Cost comparison and safety of emergency department conscious sedation for the removal of ear foreign bodies.

PubMed

Olson, Michael D; Saw, Jessica; Visscher, Sue L; Balakrishnan, Karthik

2018-07-01

The purpose of this study is to investigate the relative cost and safety of ear foreign body (FB) removal via conscious sedation in the emergency department. A retrospective review of patients presenting from 2000 to 2015 to the emergency department at Mayo Clinic, Rochester, Minnesota was performed. 63 patients requiring sedation for ear foreign body removal were identified. Descriptive data, safety data, and costs were obtained for the study. There were no appreciable differences in patient safety outcomes and otologic outcomes in patients who received sedation in the emergency department or anesthesia in the operating room for FB removal. Cost analysis demonstrated increased cost associated with operating room utilization verses conscious sedation in the emergency department, with the greatest cost increase being in patients evaluated first in the emergency department and then sent to the operating room. Ear foreign body removal in the emergency department is shows a similar safety profile to removal in the operating room, but at a markedly lower cost. Emergency department conscious sedation should be considered a viable option in appropriately selected patients with this common problem given these results. Copyright © 2018. Published by Elsevier B.V.

Strengthening the Federal Emergency Management Agency's disaster response capabilities.

PubMed

Cannon, Glenn M

2008-04-01

The Federal Emergency Management Agency's (FEMA) Disaster Operations Directorate provides the core federal response capability to save lives and to protect property in US communities that have been overwhelmed by the impact of a major disaster or emergency. The directorate executes its mission through three main programme areas: operational direction, command and control; operational teams; and operational planning. Based on lessons learned from years of disaster response experience, FEMA is now taking a more proactive and collaborative approach with its partners. This paper discusses how FEMA is placing a greater emphasis on response operations and strengthening capabilities across the full range of operational and support missions by comprehensively revamping its disaster operations model; enhancing its headquarters and regional operations centres; enhancing its headquarters and regional operational planning capabilities; and addressing catastrophic disaster planning and related critical preparedness issues.

Incidence and risk factors of emergence agitation in pediatric patients after general anesthesia.

PubMed

Saringcarinkul, Ananchanok; Manchupong, Sithapan; Punjasawadwong, Yodying

2008-08-01

To study the incidence and evaluate factors associated with emergence agitation (EA) in pediatrics after general anesthesia. A prospective observational study was conducted in 250 pediatric patients aged 2-9 years, who received general anesthesia for various operative procedures in Maharaj Nakorn Chiang Mai Hospital between October 2006 and September 2007. The incidence of EA was assessed Difficult parental-separation behavior, pharmacologic and non-pharmacologic interventions, and adverse events were also recorded Univariate and multivariate analysis were used to determine the factors associated with EA. A p-value of less than 0.05 was considered significant. One hundred and eight children (43.2%) had EA, with an average duration of 9.6 +/- 6.8 minutes. EA associated with adverse events occurred in 32 agitated children (29.6%). From univariate analysis, factors associated with EA were difficult parental-separation behavior, preschool age (2-5 years), and general anesthesia with sevoflurane. However; difficult parental-separation behavior; and preschool age were the only factors significantly associated with EA in the multiple logistic regression analysis with OR = 3.021 (95% CI = 1.680, 5.431, p < 0.001) and OR = 1.857 (95% CI = 1.075, 3.206, p = 0.026), respectively. The present study indicated that the incidence of EA was high in PACU. Preschool children and difficult parental-separation behavior were the predictive factors of agitation on emergence. Therefore, anesthesia personnel responsible for pediatric anesthesia should have essential skills and knowledge to effectively care for children before, during, and after an operation, including implementing the methods that minimize incidence of EA.

VD hotline: an evaluation.

PubMed Central

Bryant, N H; Stender, W; Frist, W; Somers, A R

1976-01-01

A VD hotline started in January 1973 at Monmouth Medical Center, Long Branch, N.J., was evaluated with the following results. Hotline operators handled 260 calls in 1973. The typical caller was a 20-year-old employed male who heard about the hotline from a friend, wanted information about clinic hours and costs, and had questions about symptoms of venereal disease. At Monmouth Medical Center, venereal disease patients who go to the emergency room receive specific diagnosis and therapy, and in the clinic they receive broader medical care. The hotline encourages patients to go to the clinic or to their private physicians. Visits to Monmouth Medical Center for venereal disease increased during the second half of 1972 from 356 to 545 (53%). For the emergency room alone, the rise was 17% and for the clinic, 68%. There was an increase of 20% in the number of patients treated in the emergency room, but the number treated in the clinic leveled. Thus, there was a substantial increase in visits, especially to the clinics where the most care is provided, and a modest increase in treated patients. The causal contribution of the hotline to these increases cannot be stated with certainty. The cost of operating the hotline was $14.70 per call. While high, it might be defended on the basis of avoiding the higher costs of untreated disease. The cost can be reduced by making the hotline serve multiple health purposes. The hotline appeared useful but costly. This retrospective evaluation was hampered by the unavailability of some critical data. PMID:818661

Uncertainty and operational considerations in mass prophylaxis workforce planning.

PubMed

Hupert, Nathaniel; Xiong, Wei; King, Kathleen; Castorena, Michelle; Hawkins, Caitlin; Wu, Cindie; Muckstadt, John A

2009-12-01

The public health response to an influenza pandemic or other large-scale health emergency may include mass prophylaxis using multiple points of dispensing (PODs) to deliver countermeasures rapidly to affected populations. Computer models created to date to determine "optimal" staffing levels at PODs typically assume stable patient demand for service. The authors investigated POD function under dynamic and uncertain operational environments. The authors constructed a Monte Carlo simulation model of mass prophylaxis (the Dynamic POD Simulator, or D-PODS) to assess the consequences of nonstationary patient arrival patterns on POD function under a variety of POD layouts and staffing plans. Compared are the performance of a standard POD layout under steady-state and variable patient arrival rates that may mimic real-life variation in patient demand. To achieve similar performance, PODs functioning under nonstationary patient arrival rates require higher staffing levels than would be predicted using the assumption of stationary arrival rates. Furthermore, PODs may develop severe bottlenecks unless staffing levels vary over time to meet changing patient arrival patterns. Efficient POD networks therefore require command and control systems capable of dynamically adjusting intra- and inter-POD staff levels to meet demand. In addition, under real-world operating conditions of heightened uncertainty, fewer large PODs will require a smaller total staff than many small PODs to achieve comparable performance. Modeling environments that capture the effects of fundamental uncertainties in public health disasters are essential for the realistic evaluation of response mechanisms and policies. D-PODS quantifies POD operational efficiency under more realistic conditions than have been modeled previously. The authors' experiments demonstrate that effective POD staffing plans must be responsive to variation and uncertainty in POD arrival patterns. These experiments highlight the need for command and control systems to be created to manage emergency response successfully.

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

14 CFR 135.167 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Emergency equipment: Extended overwater... Aircraft and Equipment § 135.167 Emergency equipment: Extended overwater operations. (a) Except where the... of the certificate holder, the Administrator allows deviation for a particular extended overwater...

14 CFR 135.167 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Emergency equipment: Extended overwater... Aircraft and Equipment § 135.167 Emergency equipment: Extended overwater operations. (a) Except where the... of the certificate holder, the Administrator allows deviation for a particular extended overwater...

14 CFR 135.167 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Emergency equipment: Extended overwater... Aircraft and Equipment § 135.167 Emergency equipment: Extended overwater operations. (a) Except where the... of the certificate holder, the Administrator allows deviation for a particular extended overwater...

14 CFR 135.167 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Emergency equipment: Extended overwater... Aircraft and Equipment § 135.167 Emergency equipment: Extended overwater operations. (a) Except where the... of the certificate holder, the Administrator allows deviation for a particular extended overwater...

14 CFR 135.167 - Emergency equipment: Extended overwater operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Emergency equipment: Extended overwater... Aircraft and Equipment § 135.167 Emergency equipment: Extended overwater operations. (a) Except where the... of the certificate holder, the Administrator allows deviation for a particular extended overwater...

An Operational Definition of the Emergence Criterion

ERIC Educational Resources Information Center

Pallotti, Gabriele

2007-01-01

Although acquisition criteria are a fundamental issue for SLA research, they have not always been adequately defined or elaborated in the literature. This article critically scrutinizes one such criterion, the emergence criterion, proposing an explicit, operational definition. After discussing emergence as a theoretical construct, the article…

Emergence of multiple ocean ecosystem drivers in a large ensemble suite with an Earth system model

NASA Astrophysics Data System (ADS)

Rodgers, K. B.; Lin, J.; Frölicher, T. L.

2015-06-01

Marine ecosystems are increasingly stressed by human-induced changes. Marine ecosystem drivers that contribute to stressing ecosystems - including warming, acidification, deoxygenation and perturbations to biological productivity - can co-occur in space and time, but detecting their trends is complicated by the presence of noise associated with natural variability in the climate system. Here we use large initial-condition ensemble simulations with an Earth system model under a historical/RCP8.5 (representative concentration pathway 8.5) scenario over 1950-2100 to consider emergence characteristics for the four individual and combined drivers. Using a 1-standard-deviation (67% confidence) threshold of signal to noise to define emergence with a 30-year trend window, we show that ocean acidification emerges much earlier than other drivers, namely during the 20th century over most of the global ocean. For biological productivity, the anthropogenic signal does not emerge from the noise over most of the global ocean before the end of the 21st century. The early emergence pattern for sea surface temperature in low latitudes is reversed from that of subsurface oxygen inventories, where emergence occurs earlier in the Southern Ocean. For the combined multiple-driver field, 41% of the global ocean exhibits emergence for the 2005-2014 period, and 63% for the 2075-2084 period. The combined multiple-driver field reveals emergence patterns by the end of this century that are relatively high over much of the Southern Ocean, North Pacific, and Atlantic, but relatively low over the tropics and the South Pacific. For the case of two drivers, the tropics including habitats of coral reefs emerges earliest, with this driven by the joint effects of acidification and warming. It is precisely in the regions with pronounced emergence characteristics where marine ecosystems may be expected to be pushed outside of their comfort zone determined by the degree of natural background variability to which they are adapted. The results underscore the importance of sustained multi-decadal observing systems for monitoring multiple ecosystems drivers.

Extracorporeal cardiopulmonary resuscitation for blunt cardiac rupture.

PubMed

Kudo, Shunsuke; Tanaka, Keiji; Okada, Kunihiko; Takemura, Takahiro

2017-11-01

Extracorporeal cardiopulmonary resuscitation (ECPR) followed by operating room sternotomy, rather than resuscitative thoracotomy, might be life-saving for patients with blunt cardiac rupture and cardiac arrest who do not have multiple severe traumatic injuries. A 49-year-old man was injured in a vehicle crash and transferred to the emergency department. On admission, he was hemodynamically stable, but a plain chest radiograph revealed a widened mediastinum, and echocardiography revealed hemopericardium. A computed tomography scan revealed hemopericardium and mediastinal hematoma, without other severe traumatic injuries. However, the patient's pulse was lost soon after he was transferred to the intensive care unit, and cardiopulmonary resuscitation was initiated. We initiated ECPR using femorofemoral veno-arterial extracorporeal membrane oxygenation (ECMO) with heparin administration, which achieved hemodynamic stability. He was transferred to the operating room for sternotomy and cardiac repair. Right ventricular rupture and pericardial sac laceration were identified intraoperatively, and cardiac repair was performed. After repairing the cardiac rupture, the cardiac output recovered spontaneously, and ECMO was discontinued intraoperatively. The patient recovered fully and was discharged from the hospital on postoperative day 7. In this patient, ECPR rapidly restored brain perfusion and provided enough time to perform operating room sternotomy, allowing for good surgical exposure of the heart. Moreover, open cardiac massage was unnecessary. ECPR with sternotomy and cardiac repair is advisable for patients with blunt cardiac rupture and cardiac arrest who do not have severe multiple traumatic injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

Integrated Baseline System (IBS), Version 1. 03. [Chemical Stockpile Emergency Preparedness Program

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

Bailey, B.M.; Burford, M.J.; Downing, T.R.

The Integrated Baseline System (IBS), operated by the Federal Emergency Management Agency (FEMA), is a system of computerized tools for emergency planing and analysis. This document is the user guide for the IBS and explains how to operate the IBS system. The fundamental function of the IBS is to provide tools that civilian emergency management personnel can use in developing emergency plans and in supporting emergency management activities to cope with a chemical-releasing event at a military chemical stockpile. Emergency management planners can evaluate concepts and ideas using the IBS system. The results of that experience can then be factoredmore » into refining requirements and plans. This document provides information for the general system user, and is the primary reference for the system features of the IBS. It is designed for persons who are familiar with general emergency management concepts, operations, and vocabulary. Although the IBS manual set covers basic and advanced operations, it is not a complete reference document set. Emergency situation modeling software in the IBS is supported by additional technical documents. Some of the other LBS software is commercial software for which more complete documentation is available. The IBS manuals reference such documentation where necessary. IBS is a dynamic system. Its capabilities are in a state of continuing expansion and enhancement.« less

[Predictors of drug-resistant pathogens in community-onset pneumonia: Are factors considered in health-care-associated pneumonia useful in the emergency department?

PubMed

Torres Bonafonte, Olga H; Gil Olivas, Eva; Pérez Macho, Estefanía; Pacho Pacho, Cristina; Mateo Roca, Miriam; Casademont Pou, Jordi; Ruiz Hidalgo, Domingo

2017-10-01

To analyze factors related to drug-resistant pathogens (DRPs) in community-onset pneumonia (COP) and whether previously suggested criteria are useful in our emergency-department. Prospective 1-year study of adults coming to the emergency department for COP. We assessed the usefulness of criteria used in health-care-associated pneumonia (HCAP), as well the Shorr index, the Barthel index, and clinical suspicion of resistant pathogens. Data were analyzed by multiple logistic regression and the area under the receiver operating characteristic curve (AUC). We included 139 patients with a mean (SD) age of 75.9 (15.3) years; 63.3% were men. Forty-nine COP patients (35.2%) were at risk for DRP-caused pneumonia according to HCAP criteria; 43 (30.9%) according to the Shorr index, and 56 (40.3%) according to the Aliberti index. A score of less than 60 derived from the Barthel index was recorded for 25 patients (18%). Clinical suspicion of a DRP was recorded for 11 (7.9%). A DRP was isolated in 5 patients (3.6%) (3, Pseudomonas aeruginosa; 2, methicillin-resistant Staphylococcus aureus). Multiple logistic regression analysis identified 2 predictors of DRP-caused COP: hospital admission within the last 90 days (odds ratio [OR], 8.92; 95% CI, 1.92-41.45) and initial arterial blood oxygen saturation (OR, 0.85; 95% CI, 0.74-0.98). The AUC was 0.91 (95% CI, 0.85-0.98). The model identified 22 patients (16.8%) at risk for DRP-caused pneumonia. The positive and negative predictive values were 20% and 99.1%, respectively, for the model 90-day period (vs 8.7% and 98.9%, respectively, for criteria used in HCAP). Hospitalization within the 90-day period before a COP emergency and arterial blood oxygen saturation were good predictors of DRP in our setting. Criteria of DRP in HCAP, on the other hand, had lower ability to identify patients at risk in COP.

A Successful Model for a Comprehensive Patient Flow Management Center at an Academic Health System.

PubMed

Lovett, Paris B; Illg, Megan L; Sweeney, Brian E

2016-05-01

This article reports on an innovative approach to managing patient flow at a multicampus academic health system, integrating multiple services into a single, centralized Patient Flow Management Center that manages supply and demand for inpatient services across the system. Control of bed management was centralized across 3 campuses and key services were integrated, including bed management, case management, environmental services, patient transport, ambulance and helicopter dispatch, and transfer center. A single technology platform was introduced, as was providing round-the-clock patient placement by critical care nurses, and adding medical directors. Daily bed meetings with nurse managers and charge nurses drive action plans. This article reports immediate improvements in the first year of operations in emergency department walkouts, emergency department boarding, ambulance diversion, growth in transfer volume, reduction in lost transfers, reduction in time to bed assignment, and bed turnover time. The authors believe theirs is the first institution to integrate services and centralize bed management so comprehensively. © The Author(s) 2014.

Emergency Planning for Municipal Wastewater Treatment Facilities.

ERIC Educational Resources Information Center

Lemon, R. A.; And Others

This manual for the development of emergency operating plans for municipal wastewater treatment systems was compiled using information provided by over two hundred municipal treatment systems. It covers emergencies caused by natural disasters, civil disorders and strikes, faulty maintenance, negligent operation, and accidents. The effects of such…

Clinical review: the Israeli experience: conventional terrorism and critical care.

PubMed

Aschkenasy-Steuer, Gabriella; Shamir, Micha; Rivkind, Avraham; Mosheiff, Rami; Shushan, Yigal; Rosenthal, Guy; Mintz, Yoav; Weissman, Charles; Sprung, Charles L; Weiss, Yoram G

2005-10-05

Over the past four years there have been 93 multiple-casualty terrorist attacks in Israel, 33 of them in Jerusalem. The Hadassah-Hebrew University Medical Center is the only Level I trauma center in Jerusalem and has therefore gained important experience in caring for critically injured patients. To do so we have developed a highly flexible operational system for managing the general intensive care unit (GICU). The focus of this review will be on the organizational steps needed to provide operational flexibility, emphasizing the importance of forward deployment of intensive care unit personnel to the trauma bay and emergency room and the existence of a chain of command to limit chaos. A retrospective review of the hospital's response to multiple-casualty terror incidents occurring between 1 October 2000 and 1 September 2004 was performed. Information was assembled from the medical center's trauma registry and from GICU patient admission and discharge records. Patients are described with regard to the severity and type of injury. The organizational work within intensive care is described. Finally, specific issues related to the diagnosis and management of lung, brain, orthopedic and abdominal injuries, caused by bomb blast events associated with shrapnel, are described. This review emphasizes the importance of a multidisciplinary team approach in caring for these patients.

49 CFR 239.301 - Operational (efficiency) tests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PASSENGER TRAIN EMERGENCY PREPAREDNESS Operational (Efficiency...-board and control center employees to determine the extent of compliance with its emergency preparedness...

[Acute appendicitis: clinico-diagnostic and therapeutic considerations].

PubMed

Carditello, A; Bartolotta, M; Bonavita, G; Lentini, B; Sturniolo, G

1985-04-01

Since january 1970-december 1982, 58 patients underwent emergently appendectomy for acute appendicitis. 31 (53,4 percent) where males; the average age was 21 +/- 2,3 years (M +/- SEM). The duration of symptoms ranged from 1-6 hours (10,3 percent of cases) to over 48 hours, before the hospital admission (15,4 percent of cases). 27 patients (46,5 percent) had a clinical examination at home by a physician. 21 patients (36,4 percent) came to hospital emergency unit without previous physical examination; 10 (17,2 percent) were transferred from other departments. In 6,9 percent of cases was present a perforated appendicitis with peritonitis. During operation, in 50 percent of patients was performed a therapeutic peritoneal lavage. In 63,7 percent of cases multiple drains were placed in peritoneal cavity. In all patients was effected postoperative antibiotic profilaxis. The mortality rate was 3,4 percent. General complications were observed more in patients with perforated appendicitis. This review suggests the following remarcable data: morbidity of this disease is still high; the physical examination is more important than laboratory work (especially in the elderly patients, which are often immunodepressed and in children, with leucocitosis-lack at hospital admission); early surgery is the most important factor to the improvement of prognosis in these cases and the results of surgical treatment are improved by large vertical incisions, peritoneal lavage and application of multiple intracavitary drains.

Agriculture and forestry work-related injuries among farmers admitted to an Emergency Department.

PubMed

Nogalski, Adam; Lübek, Tomasz; Sompor, Jacek; Karski, Jerzy

2007-01-01

The objective of the study was to describe the characteristics of agriculture and forestry related injury cases admitted to an Emergency Department (ED), and to asses factors related to injury severity and hospital admission. Retrospective analysis of ED case records in Teaching Hospital No 1 in Lublin, from January 2004 to December 2005 were utilized. patient>14 years old, with agriculture and forestry related injuries. Univariate and bivariate descriptive analyses and multiple logistic regressions were performed. 3791 cases were included, 63.1% males, 53.3% cases younger than 30 years and 47.1% of the patients sustained injuries related to machines or falls. After adjusting for age, sex and the presence of multiple injuries, animal related injuries, followed by machine related injuries and falls, were at higher risk of a more severe injury (OR: 1.77, 1.61 and 1.50, respectively). This groups also showed a higher likelihood of hospital admission (OR: 2.03, 192 and 2.00, respectively). Patients attended to in the ED during night hours (OR: 2.06) were also at a higher risk of hospitalization. It was concluded that animal related injuries, agriculture machine operators, and falls, besides accounting for two thirds of analyzed cases, are the mechanism of injury with a greater risk of a more severe injury and higher likelihood of a hospitalization.

A Mutator Phenotype Promoting the Emergence of Spontaneous Oxidative Stress-Resistant Mutants in Campylobacter jejuni.

PubMed

Dai, Lei; Sahin, Orhan; Tang, Yizhi; Zhang, Qijing

2017-12-15

Campylobacter jejuni is a leading cause of foodborne illnesses worldwide. As a microaerophilic organism, C. jejuni must be able to defend against oxidative stress encountered both in the host and in the environment. How Campylobacter utilizes a mutation-based mechanism for adaptation to oxidative stress is still unknown. Here we present a previously undescribed phenotypic and genetic mechanism that promotes the emergence of oxidative stress-resistant mutants. Specifically, we showed that a naturally occurring mutator phenotype, resulting from a loss of function mutation in the DNA repair enzyme MutY, increased oxidative stress resistance (OX R ) in C. jejuni We further demonstrated that MutY malfunction did not directly contribute to the OX R phenotype but increased the spontaneous mutation rate in the peroxide regulator gene perR , which functions as a repressor for multiple genes involved in oxidative stress resistance. Mutations in PerR resulted in loss of its DNA binding function and derepression of PerR-controlled oxidative stress defense genes, thereby conferring an OX R phenotype and facilitating Campylobacter survival under oxidative stress. These findings reveal a new mechanism that promotes the emergence of spontaneous OX R mutants in bacterial organisms. IMPORTANCE Although a mutator phenotype has been shown to promote antibiotic resistance in many bacterial species, little is known about its contribution to the emergence of OX R mutants. This work describes the link between a mutator phenotype and the enhanced emergence of OX R mutants as well as its underlying mechanism involving DNA repair and mutations in PerR. Since DNA repair systems and PerR are well conserved in many bacterial species, especially in Gram positives, the same mechanism may operate in multiple bacterial species. Additionally, we developed a novel method that allows for rapid quantification of spontaneous OX R mutants in a bacterial population. This method represents a technical innovation and may also be applied to other bacterial species. These findings significantly advance our understanding of bacterial mechanisms for survival under oxidative stress. Copyright © 2017 American Society for Microbiology.

Multiple pathways to sustainability in the city: the case of San Juan, Puerto Rico

Treesearch

Tischa A. Munoz

2014-01-01

I examined the multiple visions of the future of the city that can emerge when city actors and organizations reconfigure themselves to address sustainability. In various cities worldwide, novel ideas, initiatives, and networks are emerging in governance to address social and ecological conditions in urban areas. However, cities can be contested spaces, bringing a...

Dealing with Emergence, Diversity and Multiplicity of Grammar and Interaction: The Japanese Clause-Ending Form TE

ERIC Educational Resources Information Center

Hashimoto, Yuria

2011-01-01

Grammar in natural interaction is an emergent, dynamic and adaptive system that is consistently subject to change. It is understood as a collection of open multiple subsystems, each of which is activated as the language users recurrently participate in a particular linguistic, interactional and social activity. When a certain linguistic form or…

Analysis of the resilience of team performance during a nuclear emergency response exercise.

PubMed

Gomes, José Orlando; Borges, Marcos R S; Huber, Gilbert J; Carvalho, Paulo Victor R

2014-05-01

The current work presents results from a cognitive task analysis (CTA) of a nuclear disaster simulation. Audio-visual records were collected from an emergency room team composed of individuals from 26 different agencies as they responded to multiple scenarios in a simulated nuclear disaster. This simulation was part of a national emergency response training activity for a nuclear power plant located in a developing country. The objectives of this paper are to describe sources of resilience and brittleness in these activities, identify cues of potential improvements for future emergency simulations, and leveraging the resilience of the emergency response system in case of a real disaster. Multiple CTA techniques were used to gain a better understanding of the cognitive dimensions of the activity and to identify team coordination and crisis management patterns that emerged from the simulation exercises. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force.

PubMed

Marsh, Kevin; IJzerman, Maarten; Thokala, Praveen; Baltussen, Rob; Boysen, Meindert; Kaló, Zoltán; Lönngren, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Devlin, Nancy

2016-01-01

Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Consensus statement on advancing research in emergency department operations and its impact on patient care.

PubMed

Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

2015-06-01

The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications. © 2015 by the Society for Academic Emergency Medicine.

A simulator-based nuclear reactor emergency response training exercise.

PubMed

Waller, Edward; Bereznai, George; Shaw, John; Chaput, Joseph; Lafortune, Jean-Francois

Training offsite emergency response personnel basic awareness of onsite control room operations during nuclear power plant emergency conditions was the primary objective of a week-long workshop conducted on a CANDU® virtual nuclear reactor simulator available at the University of Ontario Institute of Technology, Oshawa, Canada. The workshop was designed to examine both normal and abnormal reactor operating conditions, and to observe the conditions in the control room that may have impact on the subsequent offsite emergency response. The workshop was attended by participants from a number of countries encompassing diverse job functions related to nuclear emergency response. Objectives of the workshop were to provide opportunities for participants to act in the roles of control room personnel under different reactor operating scenarios, providing a unique experience for participants to interact with the simulator in real-time, and providing increased awareness of control room operations during accident conditions. The ability to "pause" the simulator during exercises allowed the instructors to evaluate and critique the performance of participants, and to provide context with respect to potential offsite emergency actions. Feedback from the participants highlighted (i) advantages of observing and participating "hands-on" with operational exercises, (ii) their general unfamiliarity with control room operational procedures and arrangements prior to the workshop, (iii) awareness of the vast quantity of detailed control room procedures for both normal and transient conditions, and (iv) appreciation of the increased workload for the operators in the control room during a transient from normal operations. Based upon participant feedback, it was determined that the objectives of the training had been met, and that future workshops should be conducted.

Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises.

PubMed

Goldhaber-Fiebert, Sara N; Macrae, Carl

2018-03-01

How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care. Copyright © 2017 Sara N. Goldhaber-Fiebert, Carl Macrae. Published by Elsevier Inc. All rights reserved.

14 CFR 91.139 - Emergency air traffic rules.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Emergency air traffic rules. 91.139 Section...) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Flight Rules General § 91.139 Emergency air traffic rules. (a) This section prescribes a process for utilizing Notices to Airmen...

14 CFR 91.139 - Emergency air traffic rules.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Emergency air traffic rules. 91.139 Section...) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Flight Rules General § 91.139 Emergency air traffic rules. (a) This section prescribes a process for utilizing Notices to Airmen...

14 CFR 91.139 - Emergency air traffic rules.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Emergency air traffic rules. 91.139 Section...) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Flight Rules General § 91.139 Emergency air traffic rules. (a) This section prescribes a process for utilizing Notices to Airmen...

IFR Operations at Non-Towered, Non-Radar Airports: Can we do Better Than One-at-a-Time?

NASA Technical Reports Server (NTRS)

Jones, K.; Williams, D.; Consiglio, M.; Adams, C.; Abbott, T.

2003-01-01

This paper describes a new concept for operations in non-radar terminal airspace around small, nontowered airports. Currently, air traffic operations in instrument meteorological conditions (IMC) at airfields without control towers and radar service are severely constrained by what is known as the one-in/one-out paradigm. Under these conditions only one operation (either arrival or departure) is allowed to occur at a time. Since these operations can take over 15 minutes to complete, capacity at these airports is severely restricted in IMC. The proposed concept is an attempt to break this current paradigm by applying emerging airborne and ground-based technologies to enable simultaneous operations by multiple aircraft in nonradar terminal airspace around small non-towered airports in IMC. The general philosophy underlying this concept of operations is the establishment of a newly defined area surrounding these airports called a Self-Controlled Area (SCA). Aircraft operating within the SCA are required to have a specified minimum level of equipage. Within the SCA, pilots are responsible for separating themselves from other similarly equipped aircraft through the use of new onboard systems and procedures. This concept also takes advantage of newly developed automation at the airport, which provides appropriate sequencing information to the pilots for safe and improved operations. Such operations would enhance the opportunity for point-to-point air taxi or charter operations into smaller airfields that are closer to a traveler s origin and destination. A description of this concept of operations and a simulation environment used for evaluation is provided in this paper.

Distributed controller clustering in software defined networks.

PubMed

Abdelaziz, Ahmed; Fong, Ang Tan; Gani, Abdullah; Garba, Usman; Khan, Suleman; Akhunzada, Adnan; Talebian, Hamid; Choo, Kim-Kwang Raymond

2017-01-01

Software Defined Networking (SDN) is an emerging promising paradigm for network management because of its centralized network intelligence. However, the centralized control architecture of the software-defined networks (SDNs) brings novel challenges of reliability, scalability, fault tolerance and interoperability. In this paper, we proposed a novel clustered distributed controller architecture in the real setting of SDNs. The distributed cluster implementation comprises of multiple popular SDN controllers. The proposed mechanism is evaluated using a real world network topology running on top of an emulated SDN environment. The result shows that the proposed distributed controller clustering mechanism is able to significantly reduce the average latency from 8.1% to 1.6%, the packet loss from 5.22% to 4.15%, compared to distributed controller without clustering running on HP Virtual Application Network (VAN) SDN and Open Network Operating System (ONOS) controllers respectively. Moreover, proposed method also shows reasonable CPU utilization results. Furthermore, the proposed mechanism makes possible to handle unexpected load fluctuations while maintaining a continuous network operation, even when there is a controller failure. The paper is a potential contribution stepping towards addressing the issues of reliability, scalability, fault tolerance, and inter-operability.

Radiology diagnostic devices under emergency electric power at disaster base hospitals during the acute phase of the Great East Japan Earthquake: results of a survey of all disaster base hospitals in Miyagi Prefecture.

PubMed

Maezawa, Shota; Kudo, Daisuke; Furukawa, Hajime; Nakagawa, Atsuhiro; Yamanouchi, Satoshi; Matsumura, Takashi; Egawa, Shinichi; Tominaga, Teiji; Kushimoto, Shigeki

2014-12-01

This study aimed to clarify the management of emergency electric power and the operation of radiology diagnostic devices after the Great East Japan Earthquake. Timing of electricity restoration, actual emergency electric power generation, and whether radiology diagnostic devices were operational and the reason if not were investigated through a questionnaire submitted to all 14 disaster base hospitals in Miyagi Prefecture in February and March 2013. Commercial electricity supply resumed within 3 days after the earthquake at 13 of 14 hospitals. Actual emergency electric power generation was lower than pre-disaster estimates at most of the hospitals. Only 4 of 11 hospitals were able to generate 60% of the power normally consumed. Under emergency electric power, conventional X-ray and computed tomography (CT) scanners worked in 9 of 14 (64%) and 8 of 14 (57%) hospitals, respectively. The main reason conventional X-ray and CT scanners did not operate was that hospitals had not planned to use these devices under emergency electric power. Only 2 of the 14 hospitals had a pre-disaster plan to allocate emergency electric power, and all devices operated at these 2 hospitals. Pre-disaster plans to allocate emergency electric power are required for disaster base hospitals to effectively operate radiology diagnostic devices after a disaster. (Disaster Med Public Health Preparedness. 2014;8:548-552).

46 CFR 112.43-11 - Illumination for launching operations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 112.43-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Lighting Systems § 112.43-11 Illumination for launching operations. Branch circuits supplying power to lights for survival craft launching operations must supply no...

46 CFR 112.43-11 - Illumination for launching operations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 112.43-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Lighting Systems § 112.43-11 Illumination for launching operations. Branch circuits supplying power to lights for survival craft launching operations must supply no...

46 CFR 112.43-11 - Illumination for launching operations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 112.43-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Lighting Systems § 112.43-11 Illumination for launching operations. Branch circuits supplying power to lights for survival craft launching operations must supply no...

46 CFR 112.43-11 - Illumination for launching operations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 112.43-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Lighting Systems § 112.43-11 Illumination for launching operations. Branch circuits supplying power to lights for survival craft launching operations must supply no...

46 CFR 112.43-11 - Illumination for launching operations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 112.43-11 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Lighting Systems § 112.43-11 Illumination for launching operations. Branch circuits supplying power to lights for survival craft launching operations must supply no...

The emergence of autoclitic frames in atypically and typically developing children as a function of multiple exemplar instruction.

PubMed

Luke, Nicole; Greer, R Douglas; Singer-Dudek, Jessica; Keohane, Dolleen-Day

2011-01-01

In two experiments, we tested the effect of multiple exemplar instruction (MEI) for training sets on the emergence of autoclitic frames for spatial relations for novel tacts and mands. In Experiment 1, we used a replicated pre- and post-intervention probe design with four students with significant learning disabilities to test for acquisition of four autoclitic frames with novel tacts and mands before and after MEI. The untaught topographies emerged for all participants. In Experiment 2, we used a multiple probe design to test the effects of the MEI procedures on the same responses in four typically developing, bilingual students. The novel usage emerged for all participants. In the latter experiment, the children demonstrated untaught usage of mand or tact frames regardless of whether they were taught to respond in either listener or speaker functions alone or across listener and speaker functions. The findings are discussed in terms of the role of MEI in the formation of abstractions.

Matrix multiplication operations using pair-wise load and splat operations

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

Eichenberger, Alexandre E.; Gschwind, Michael K.; Gunnels, John A.

Mechanisms for performing a matrix multiplication operation are provided. A vector load operation is performed to load a first vector operand of the matrix multiplication operation to a first target vector register. A pair-wise load and splat operation is performed to load a pair of scalar values of a second vector operand and replicate the pair of scalar values within a second target vector register. An operation is performed on elements of the first target vector register and elements of the second target vector register to generate a partial product of the matrix multiplication operation. The partial product is accumulatedmore » with other partial products and a resulting accumulated partial product is stored. This operation may be repeated for a second pair of scalar values of the second vector operand.« less

40 CFR 60.153 - Monitoring of operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) The owner or operator of any multiple hearth, fluidized bed, or electric sludge incinerator subject to...) Install, calibrate, maintain and operate temperature measuring devices at every hearth in multiple hearth... zones of electric incinerators. For multiple hearth furnaces, a minimum of one temperature measuring...

Successful non-surgical treatment of endocarditis caused by Staphylococcus haemolyticus following transcatheter aortic valve implantation (TAVI).

PubMed

Loverix, L; Timmermans, P; Benit, E

2013-01-01

We describe a case of a 79-year-old male patient with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) at our institution. He presented at the emergency department with dyspnea and fatigue 7 months after implantation. The diagnosis of early prosthetic valve endocarditis (PVE) caused by Staphylococcus haemolyticus was made by transesophageal echocardiography (TEE) and multiple positive blood cultures. Since our patient was considered inoperable due to a history of coronary artery bypass graft (CABG) surgery with patent bypasses, high peri-operative mortality including renal failure and a poor general prognosis, surgical removal of the valve was not an option. The patient was successfully treated with antibiotic therapy.

The day that the START triage system came to a STOP: observations from the World Trade Center disaster.

PubMed

Asaeda, Glenn

2002-03-01

The Fire Department of the City of New York--Emergency Medical Services (EMS) Operations is one of the largest EMS systems in the country. On a daily basis, this system responds to approximately 3,000 to 3,500 calls for ambulance requests. This equates to 1.2 to 1.5 million calls annually. As part of its response, EMS deals on a daily basis with multiple casualty and disaster-type situations. The magnitude of the attacks on the World Trade Center, however, was on a scale not previously seen by any system. This article is a case report of the September 11, 2001, incident.

Genes from scratch--the evolutionary fate of de novo genes.

PubMed

Schlötterer, Christian

2015-04-01

Although considered an extremely unlikely event, many genes emerge from previously noncoding genomic regions. This review covers the entire life cycle of such de novo genes. Two competing hypotheses about the process of de novo gene birth are discussed as well as the high death rate of de novo genes. Despite the high death rate, some de novo genes are retained and remain functional, even in distantly related species, through their integration into gene networks. Further studies combining gene expression with ribosome profiling in multiple populations across different species will be instrumental for an improved understanding of the evolutionary processes operating on de novo genes. Copyright © 2015 The Author. Published by Elsevier Ltd.. All rights reserved.

Integrated Baseline System (IBS), Version 1.03. User guide: Chemical Stockpile Emergency Preparedness Program

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

Bailey, B.M.; Burford, M.J.; Downing, T.R.

The Integrated Baseline System (IBS), operated by the Federal Emergency Management Agency (FEMA), is a system of computerized tools for emergency planing and analysis. This document is the user guide for the IBS and explains how to operate the IBS system. The fundamental function of the IBS is to provide tools that civilian emergency management personnel can use in developing emergency plans and in supporting emergency management activities to cope with a chemical-releasing event at a military chemical stockpile. Emergency management planners can evaluate concepts and ideas using the IBS system. The results of that experience can then be factoredmore » into refining requirements and plans. This document provides information for the general system user, and is the primary reference for the system features of the IBS. It is designed for persons who are familiar with general emergency management concepts, operations, and vocabulary. Although the IBS manual set covers basic and advanced operations, it is not a complete reference document set. Emergency situation modeling software in the IBS is supported by additional technical documents. Some of the other LBS software is commercial software for which more complete documentation is available. The IBS manuals reference such documentation where necessary. IBS is a dynamic system. Its capabilities are in a state of continuing expansion and enhancement.« less

Bidirectional associations in multiplication memory: conditions of negative and positive transfer.

PubMed

Campbell, Jamie I D; Robert, Nicole D

2008-05-01

A variety of experimental evidence indicates that the memory representation for multiplication facts (e.g., 6 x 9 = 54) incorporates bidirectional links with a forward association from factors to product and a reverse association from product to factors. Surprisingly, the authors did not find evidence in Experiment 1 of facilitative transfer-of-practice from multiplication (6 x 9 = ?) to factoring (54 = ? x ?); in fact, multiplication practice produced item-specific interference with factoring. Similarly, the authors found no evidence in Experiment 2 that repetition of specific factoring problems (54 = ? x ?) facilitated performance of corresponding multiplication problems (6 x 9 = ?). In Experiment 3, participants practiced both multiplication and factoring and presented facilitative transfer in both directions. Thus, bidirectional facilitation occurred if both operations were practiced, but interference occurred when only one operation was practiced. We propose that this seemingly paradoxical behavior occurs because it is adaptive for the bidirectional retrieval structure to retain operational flexibility in the context of practicing both operations, whereas it is adaptive to specialize the memory representation for the practiced operation (i.e., factoring or multiplication) when only one operation is practiced.

The impact of a large-scale power outage on hemodialysis center operations.

PubMed

Abir, Mahshid; Jan, Sophia; Jubelt, Lindsay; Merchant, Raina M; Lurie, Nicole

2013-12-01

On June 29, 2012, mid-Atlantic storms resulted in a large-scale power outage affecting up to three million people across multiple (US) states. Hemodialysis centers are dependent on electricity to provide dialysis care to end-stage renal disease patients. The objective of this study was to determine how the power outage impacted operations in a sample of hemodialysis centers in the impacted regions. The sample consisted of all hemodialysis centers located in the District of Columbia and a total of five counties with the largest power losses in West Virginia, Virginia, and Maryland. A semi-structured interview guide was developed, and the charge nurse or supervisor in each facility was interviewed. The survey questions addressed whether their centers lost power, if so, for how long, where their patients received dialysis, whether their centers had backup generators, and if so, whether they had any problems operating them, and whether their center received patients from other centers if they had power. Calls were placed to 90 dialysis centers in the sampled areas and a 90% response rate was achieved. Overall, hemodialysis operations at approximately 30% (n = 24) of the centers queried were impacted by the power outage. Of the 36 centers that lost power, 31% (n = 11) referred their patients to other dialysis centers, 22% (n = 8) accommodated their patients during a later shift or on a different day; the rest of the centers either experienced brief power outages that did not affect operations or experienced a power outage on days that the center is usually closed. Some centers in the study cohort reported receiving patients from other centers for dialysis 33% (n = 27). Thirty-two percent (n = 26) of the centers queried had backup generators on site. Eleven percent (n = 4) of the centers experiencing power outages reported that backup generators were brought in by their parent companies. Comprehensive emergency planning for dialysis centers should include provisions for having backup generators on site, having plans in place for the timely delivery of a generator during a power outage, or having predesignated backup dialysis centers for patients to receive dialysis during emergencies. Most dialysis centers surveyed in this study were able to sustain continuity of care by implementing such pre-existing emergency plans.

49 CFR 239.107 - Emergency exits.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Marking. Each railroad operating passenger train service shall determine for each passenger car that is in... requirements of part 223 of this chapter, each railroad operating passenger train service shall: (1) Provide... operating properly; and (3) Repair each inoperative emergency window and door exit on a car before returning...

49 CFR 239.107 - Emergency exits.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Marking. Each railroad operating passenger train service shall determine for each passenger car that is in... requirements of part 223 of this chapter, each railroad operating passenger train service shall: (1) Provide... operating properly; and (3) Repair each inoperative emergency window and door exit on a car before returning...

49 CFR 239.107 - Emergency exits.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Marking. Each railroad operating passenger train service shall determine for each passenger car that is in... requirements of part 223 of this chapter, each railroad operating passenger train service shall: (1) Provide... operating properly; and (3) Repair each inoperative emergency window and door exit on a car before returning...

49 CFR 239.107 - Emergency exits.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Marking. Each railroad operating passenger train service shall determine for each passenger car that is in... requirements of part 223 of this chapter, each railroad operating passenger train service shall: (1) Provide... operating properly; and (3) Repair each inoperative emergency window and door exit on a car before returning...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

10 CFR 34.81 - Copies of operating and emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Copies of operating and emergency procedures. 34.81 Section 34.81 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.81 Copies of...

Rapid emergence of climate change in environmental drivers of marine ecosystems.

PubMed

Henson, Stephanie A; Beaulieu, Claudie; Ilyina, Tatiana; John, Jasmin G; Long, Matthew; Séférian, Roland; Tjiputra, Jerry; Sarmiento, Jorge L

2017-03-07

Climate change is expected to modify ecological responses in the ocean, with the potential for important effects on the ecosystem services provided to humankind. Here we address the question of how rapidly multiple drivers of marine ecosystem change develop in the future ocean. By analysing an ensemble of models we find that, within the next 15 years, the climate change-driven trends in multiple ecosystem drivers emerge from the background of natural variability in 55% of the ocean and propagate rapidly to encompass 86% of the ocean by 2050 under a 'business-as-usual' scenario. However, we also demonstrate that the exposure of marine ecosystems to climate change-induced stress can be drastically reduced via climate mitigation measures; with mitigation, the proportion of ocean susceptible to multiple drivers within the next 15 years is reduced to 34%. Mitigation slows the pace at which multiple drivers emerge, allowing an additional 20 years for adaptation in marine ecological and socio-economic systems alike.

Rapid emergence of climate change in environmental drivers of marine ecosystems

PubMed Central

Henson, Stephanie A.; Beaulieu, Claudie; Ilyina, Tatiana; John, Jasmin G.; Long, Matthew; Séférian, Roland; Tjiputra, Jerry; Sarmiento, Jorge L.

2017-01-01

Climate change is expected to modify ecological responses in the ocean, with the potential for important effects on the ecosystem services provided to humankind. Here we address the question of how rapidly multiple drivers of marine ecosystem change develop in the future ocean. By analysing an ensemble of models we find that, within the next 15 years, the climate change-driven trends in multiple ecosystem drivers emerge from the background of natural variability in 55% of the ocean and propagate rapidly to encompass 86% of the ocean by 2050 under a ‘business-as-usual' scenario. However, we also demonstrate that the exposure of marine ecosystems to climate change-induced stress can be drastically reduced via climate mitigation measures; with mitigation, the proportion of ocean susceptible to multiple drivers within the next 15 years is reduced to 34%. Mitigation slows the pace at which multiple drivers emerge, allowing an additional 20 years for adaptation in marine ecological and socio-economic systems alike. PMID:28267144

Rapid emergence of climate change in environmental drivers of marine ecosystems

NASA Astrophysics Data System (ADS)

Henson, Stephanie A.; Beaulieu, Claudie; Ilyina, Tatiana; John, Jasmin G.; Long, Matthew; Séférian, Roland; Tjiputra, Jerry; Sarmiento, Jorge L.

2017-03-01

Climate change is expected to modify ecological responses in the ocean, with the potential for important effects on the ecosystem services provided to humankind. Here we address the question of how rapidly multiple drivers of marine ecosystem change develop in the future ocean. By analysing an ensemble of models we find that, within the next 15 years, the climate change-driven trends in multiple ecosystem drivers emerge from the background of natural variability in 55% of the ocean and propagate rapidly to encompass 86% of the ocean by 2050 under a `business-as-usual' scenario. However, we also demonstrate that the exposure of marine ecosystems to climate change-induced stress can be drastically reduced via climate mitigation measures; with mitigation, the proportion of ocean susceptible to multiple drivers within the next 15 years is reduced to 34%. Mitigation slows the pace at which multiple drivers emerge, allowing an additional 20 years for adaptation in marine ecological and socio-economic systems alike.

Satanism, ritual abuse, and multiple personality disorder: a sociohistorical perspective.

PubMed

Mulhern, S

1994-10-01

During the past decade in North America, a growing number of mental health professionals have reported that between 25% and 50% of their patients in treatment for multiple personality disorder (MPD) have recovered early childhood traumatic memories of ritual torture, incestuous rape, sexual debauchery, sacrificial murder, infanticide, and cannibalism perpetrated by members of clandestine satanic cults. Although hundreds of local and federal police investigations have failed to corroborate patients' therapeutically constructed accounts, because the satanic etiology of MPD is logically coherent with the neodissociative, traumatic theory of psychopathology, conspiracy theory has emerged as the nucleus of a consistent pattern of contemporary clinical interpretation. Resolutely logical and thoroughly operational, ultrascientific psychodemonology remains paradoxically oblivious to its own irrational premises. When the hermetic logic of conspiracy theory is stripped away by historical and socio/psychological analysis, however, the hypothetical perpetrators of satanic ritual abuse simply disappear, leaving in their wake the very real human suffering of all those who have been caught up in the social delusion.

The promise of N-acetylcysteine in neuropsychiatry.

PubMed

Berk, Michael; Malhi, Gin S; Gray, Laura J; Dean, Olivia M

2013-03-01

N-Acetylcysteine (NAC) targets a diverse array of factors germane to the pathophysiology of multiple neuropsychiatric disorders including glutamatergic transmission, the antioxidant glutathione, neurotrophins, apoptosis, mitochondrial function, and inflammatory pathways. This review summarises the areas where the mechanisms of action of NAC overlap with known pathophysiological elements, and offers a précis of current literature regarding the use of NAC in disorders including cocaine, cannabis, and smoking addictions, Alzheimer's and Parkinson's diseases, autism, compulsive and grooming disorders, schizophrenia, depression, and bipolar disorder. There are positive trials of NAC in all these disorders, and although many of these require replication and are methodologically preliminary, this makes it one of the most promising drug candidates in neuropsychiatric disorders. The efficacy pattern of NAC interestingly shows little respect for the current diagnostic systems. Its benign tolerability profile, its action on multiple operative pathways, and the emergence of positive trial data make it an important target to investigate. Copyright © 2013 Elsevier Ltd. All rights reserved.

Risks, Health Consequences, and Response Challenges for Small-Island-Based Populations: Observations From the 2017 Atlantic Hurricane Season.

PubMed

Shultz, James M; Kossin, James P; Shepherd, J Marshall; Ransdell, Justine M; Walshe, Rory; Kelman, Ilan; Galea, Sandro

2018-04-06

ABSTRACTThe intensely active 2017 Atlantic basin hurricane season provided an opportunity to examine how climate drivers, including warming oceans and rising seas, exacerbated tropical cyclone hazards. The season also highlighted the unique vulnerabilities of populations residing on Small Island Developing States (SIDS) to the catastrophic potential of these storms. During 2017, 22 of the 29 Caribbean SIDS were affected by at least one named storm, and multiple SIDS experienced extreme damage. This paper aims to review the multiplicity of storm impacts on Caribbean SIDS throughout the 2017 season, to explicate the influences of climate drivers on storm formation and intensity, to explore the propensity of SIDS to sustain severe damage and prolonged disruption of essential services, to document the spectrum of public health consequences, and to delineate the daunting hurdles that challenged emergency response and recovery operations for island-based, disaster-affected populations. (Disaster Med Public Health Preparedness. 2018;page 1 of 13).

[The five commandments for preparing the Israeli healthcare system for emergencies].

PubMed

Adini, Bruria; Laor, Danny; Cohen, Robert; Lev, Boaz; Israeli, Avi

2010-07-01

In the last decade, the Israeli healthcare system dealt with many casualties that resulted from terrorist actions and at the same time maintained preparedness for other potential hazards such as natural disasters, toxicological, chemical, radiological and biological events. There are various models for emergency preparedness that are utilized in different countries. The aim of the article is to present the structure and the methodology of the Israeli healthcare system for emergencies. Assuring emergency preparedness for the different scenarios is based on 5 major components that include: comprehensive contingency planning; control and command of operations; central control of readiness; capacity building; coordination and collaboration among the numerous emergency agencies. CLose working relationships between the military and civilian systems characterize the operations of the emergency system. There is a mutual sharing of information, coordinated operations to achieve risk assessment and determine priorities, and consensual allocation of resources. The ability of the medical system to operate in optimal coordination with interface bodies, including the Israel Defense Forces, is derived from three main elements: the shortage of resources necessitate that all agencies work together to develop an effective response to emergencies; the Israeli society is characterized by transition of personnel from the military to the civilian system which promotes joint operations, whereas in most other countries these systems are completely separated; and also developing mechanisms for continuous and coordinated operation in routine and emergency times, such as the Supreme Health Authority. The Israeli healthcare system was put to the test several times in the Last decade, during the terror wave that occurred between 2001-2006, the 2nd Lebanon War and in operation "Cast Lead". An extensive process of learning lessons, conducted during and following each of these periods, and the existence of a mechanism which facilitated the definition of a systematic policy and the examination of its implementation, enabled the healthcare system to provide medical services to the population and to improve its preparedness by an ongoing process.

An innovative approach to capability-based emergency operations planning

PubMed Central

Keim, Mark E

2013-01-01

This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible method for writing and improving evidence-based emergency operations plans. This process is used to identify all key objectives of the emergency response according to capabilities of the institution, community or society. The approach then uses a standardized, objective-based format, along with a consensus-based method for drafting capability-based operational-level plans. This information is then integrated within a relational database to allow for ease of access and enhanced functionality to search, sort and filter and emergency operations plan according to user need and technological capacity. This integrated approach is offered as an effective option for integrating best practices of planning with the efficiency, scalability and flexibility of modern information and communication technology. PMID:28228987

An innovative approach to capability-based emergency operations planning.

PubMed

Keim, Mark E

2013-01-01

This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible method for writing and improving evidence-based emergency operations plans. This process is used to identify all key objectives of the emergency response according to capabilities of the institution, community or society. The approach then uses a standardized, objective-based format, along with a consensus-based method for drafting capability-based operational-level plans. This information is then integrated within a relational database to allow for ease of access and enhanced functionality to search, sort and filter and emergency operations plan according to user need and technological capacity. This integrated approach is offered as an effective option for integrating best practices of planning with the efficiency, scalability and flexibility of modern information and communication technology.

Using Simulation to Examine the Effect of Physician Heterogeneity on the Operational Efficiency of an Overcrowded Hospital Emergency Department

NASA Astrophysics Data System (ADS)

Kuo, Y.-H.; Leung, J. M. Y.; Graham, C. A.

2015-05-01

In this paper, we present a case study of modelling and analyzing the patient flow of a hospital emergency department in Hong Kong. The emergency department is facing the challenge of overcrowding and the patients there usually experience a long waiting time. Our project team was requested by a senior consultant of the emergency department to analyze the patient flow and provide a decision support tool to help improve their operations. We adopt a simulation approach to mimic their daily operations. With the simulation model, we conduct a computational study to examine the effect of physician heterogeneity on the emergency department performance. We found that physician heterogeneity has a great impact on the operational efficiency and thus should be considered when developing simulation models. Our computational results show that, with the same average of service rates among the physicians, variation in the rates can improve overcrowding situation. This suggests that emergency departments may consider having some efficient physicians to speed up the overall service rate in return for more time for patients who need extra medical care.

Technology-Aided Leisure and Communication Opportunities for Two Post-Coma Persons Emerged from a Minimally Conscious State and Affected by Multiple Disabilities

ERIC Educational Resources Information Center

Lancioni, Giulio E.; O'Reilly, Mark F.; Singh, Nirbhay N.; Sigafoos, Jeff; Buonocunto, Francesca; Sacco, Valentina; Navarro, Jorge; Lanzilotti, Crocifissa; De Tommaso, Marina; Megna, Marisa; Oliva, Doretta

2013-01-01

This study assessed technology-aided programs for helping two post-coma persons, who had emerged from a minimally conscious state and were affected by multiple disabilities, to (a) engage with leisure stimuli and request caregiver's procedures, (b) send out and listen to text messages for communication with distant partners, and (c) combine…

The Emergence of Autoclitic Frames in Atypically and Typically Developing Children as a Function of Multiple Exemplar Instruction

ERIC Educational Resources Information Center

Luke, Nicole; Greer, R. Douglas; Singer-Dudek, Jessica; Keohane, Dolleen-Day

2011-01-01

In two experiments, we tested the effect of multiple exemplar instruction (MEI) for training sets on the emergence of autoclitic frames for spatial relations for novel tacts and mands. In Experiment 1, we used a replicated pre- and post-intervention probe design with four students with significant learning disabilities to test for acquisition of…

40 CFR 60.155 - Reporting.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (a) The owner or operator of any multiple hearth, fluidized bed, or electric sludge incinerator... than 3 percent. (b) The owner or operator of any multiple hearth, fluidized bed, or electric sludge... over each 1-hour incinerator operating period. (3) Temperatures of every hearth in multiple hearth...

10 CFR Appendix N to Part 52 - Standardization of Nuclear Power Plant Designs: Combined Licenses To Construct and Operate...

Code of Federal Regulations, 2011 CFR

2011-01-01

... Licenses To Construct and Operate Nuclear Power Reactors of Identical Design at Multiple Sites N Appendix N... Designs: Combined Licenses To Construct and Operate Nuclear Power Reactors of Identical Design at Multiple... construct and operate nuclear power reactors of identical design (“common design”) to be located at multiple...

Visualization of Spatio-Temporal Relations in Movement Event Using Multi-View

NASA Astrophysics Data System (ADS)

Zheng, K.; Gu, D.; Fang, F.; Wang, Y.; Liu, H.; Zhao, W.; Zhang, M.; Li, Q.

2017-09-01

Spatio-temporal relations among movement events extracted from temporally varying trajectory data can provide useful information about the evolution of individual or collective movers, as well as their interactions with their spatial and temporal contexts. However, the pure statistical tools commonly used by analysts pose many difficulties, due to the large number of attributes embedded in multi-scale and multi-semantic trajectory data. The need for models that operate at multiple scales to search for relations at different locations within time and space, as well as intuitively interpret what these relations mean, also presents challenges. Since analysts do not know where or when these relevant spatio-temporal relations might emerge, these models must compute statistical summaries of multiple attributes at different granularities. In this paper, we propose a multi-view approach to visualize the spatio-temporal relations among movement events. We describe a method for visualizing movement events and spatio-temporal relations that uses multiple displays. A visual interface is presented, and the user can interactively select or filter spatial and temporal extents to guide the knowledge discovery process. We also demonstrate how this approach can help analysts to derive and explain the spatio-temporal relations of movement events from taxi trajectory data.

Generating clock signals for a cycle accurate, cycle reproducible FPGA based hardware accelerator

DOEpatents

Asaad, Sameth W.; Kapur, Mohit

2016-01-05

A method, system and computer program product are disclosed for generating clock signals for a cycle accurate FPGA based hardware accelerator used to simulate operations of a device-under-test (DUT). In one embodiment, the DUT includes multiple device clocks generating multiple device clock signals at multiple frequencies and at a defined frequency ratio; and the FPG hardware accelerator includes multiple accelerator clocks generating multiple accelerator clock signals to operate the FPGA hardware accelerator to simulate the operations of the DUT. In one embodiment, operations of the DUT are mapped to the FPGA hardware accelerator, and the accelerator clock signals are generated at multiple frequencies and at the defined frequency ratio of the frequencies of the multiple device clocks, to maintain cycle accuracy between the DUT and the FPGA hardware accelerator. In an embodiment, the FPGA hardware accelerator may be used to control the frequencies of the multiple device clocks.

Integrated vector management: a critical strategy for combating vector-borne diseases in South Sudan.

PubMed

Chanda, Emmanuel; Govere, John M; Macdonald, Michael B; Lako, Richard L; Haque, Ubydul; Baba, Samson P; Mnzava, Abraham

2013-10-25

Integrated vector management (IVM) based vector control is encouraged by the World Health Organization (WHO). However, operational experience with the IVM strategy has mostly come from countries with relatively well-established health systems and with malaria control focused programmes. Little is known about deployment of IVM for combating multiple vector-borne diseases in post-emergency settings, where delivery structures are less developed or absent. This manuscript reports on the feasibility of operational IVM for combating vector-borne diseases in South Sudan. A methodical review of published and unpublished documents on vector-borne diseases for South Sudan was conducted via systematic literature search of online electronic databases, Google Scholar, PubMed and WHO, using a combination of search terms. Additional, non-peer reviewed literature was examined for information related to the subject. South Sudan is among the heartlands of vector-borne diseases in the world, characterized by enormous infrastructure, human and financial resource constraints and a weak health system against an increasing number of refugees, returnees and internally displaced people. The presence of a multiplicity of vector-borne diseases in this post-conflict situation presents a unique opportunity to explore the potential of a rational IVM strategy for multiple disease control and optimize limited resource utilization, while maximizing the benefits and providing a model for countries in a similar situation. The potential of integrating vector-borne disease control is enormous in South Sudan. However, strengthened coordination, intersectoral collaboration and institutional and technical capacity for entomological monitoring and evaluation, including enforcement of appropriate legislation are crucial.

Integrated vector management: a critical strategy for combating vector-borne diseases in South Sudan

PubMed Central

2013-01-01

Background Integrated vector management (IVM) based vector control is encouraged by the World Health Organization (WHO). However, operational experience with the IVM strategy has mostly come from countries with relatively well-established health systems and with malaria control focused programmes. Little is known about deployment of IVM for combating multiple vector-borne diseases in post-emergency settings, where delivery structures are less developed or absent. This manuscript reports on the feasibility of operational IVM for combating vector-borne diseases in South Sudan. Case description A methodical review of published and unpublished documents on vector-borne diseases for South Sudan was conducted via systematic literature search of online electronic databases, Google Scholar, PubMed and WHO, using a combination of search terms. Additional, non-peer reviewed literature was examined for information related to the subject. Discussion South Sudan is among the heartlands of vector-borne diseases in the world, characterized by enormous infrastructure, human and financial resource constraints and a weak health system against an increasing number of refugees, returnees and internally displaced people. The presence of a multiplicity of vector-borne diseases in this post-conflict situation presents a unique opportunity to explore the potential of a rational IVM strategy for multiple disease control and optimize limited resource utilization, while maximizing the benefits and providing a model for countries in a similar situation. Conclusion The potential of integrating vector-borne disease control is enormous in South Sudan. However, strengthened coordination, intersectoral collaboration and institutional and technical capacity for entomological monitoring and evaluation, including enforcement of appropriate legislation are crucial. PMID:24156749

Environmental Assessment for the NASA First Response Facility

NASA Technical Reports Server (NTRS)

Kennedy, Carolyn

2003-01-01

NASA intends to construct a First Response Facility for integrated emergency response and health management. This facility will consolidate the Stennis Space Center fire department, medical clinic, security operations, emergency operations and the energy management and control center. The alternative considered is the "No Action Alternative". The proposed action will correct existing operational weaknesses and enhance capabilities to respond to medical emergencies and mitigate any other possible threats. Environmental impacts include are emissions, wetlands disturbance, solid waste generation, and storm water control.

Skylab IMSS checklist application study for emergency medical care. [emergency medical care operations involving the use and operation of the portable ambulance module

NASA Technical Reports Server (NTRS)

Carl, J. G.; Furukawa, S.

1975-01-01

A manual is presented that provides basic technical documentation to support the operation and utilization of the Portable Ambulance Module (PAM) in the field. The PAM is designed to be used for emergency resuscitation and victim monitoring. The functions of all the controls, displays, and stowed equipment of the unit are defined. Supportive medical and physiological data in those areas directly related to the uses of the PAM unit are presented.

Comprehensive mitigation framework for concurrent application of multiple clinical practice guidelines.

PubMed

Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Rosu, Daniela; Carrier, Marc; Kezadri-Hamiaz, Mounira

2017-02-01

In this work we propose a comprehensive framework based on first-order logic (FOL) for mitigating (identifying and addressing) interactions between multiple clinical practice guidelines (CPGs) applied to a multi-morbid patient while also considering patient preferences related to the prescribed treatment. With this framework we respond to two fundamental challenges associated with clinical decision support: (1) concurrent application of multiple CPGs and (2) incorporation of patient preferences into the decision making process. We significantly expand our earlier research by (1) proposing a revised and improved mitigation-oriented representation of CPGs and secondary medical knowledge for addressing adverse interactions and incorporating patient preferences and (2) introducing a new mitigation algorithm. Specifically, actionable graphs representing CPGs allow for parallel and temporal activities (decisions and actions). Revision operators representing secondary medical knowledge support temporal interactions and complex revisions across multiple actionable graphs. The mitigation algorithm uses the actionable graphs, revision operators and available (and possibly incomplete) patient information represented in FOL. It relies on a depth-first search strategy to find a valid sequence of revisions and uses theorem proving and model finding techniques to identify applicable revision operators and to establish a management scenario for a given patient if one exists. The management scenario defines a safe (interaction-free) and preferred set of activities together with possible patient states. We illustrate the use of our framework with a clinical case study describing two patients who suffer from chronic kidney disease, hypertension, and atrial fibrillation, and who are managed according to CPGs for these diseases. While in this paper we are primarily concerned with the methodological aspects of mitigation, we also briefly discuss a high-level proof of concept implementation of the proposed framework in the form of a clinical decision support system (CDSS). The proposed mitigation CDSS "insulates" clinicians from the complexities of the FOL representations and provides semantically meaningful summaries of mitigation results. Ultimately we plan to implement the mitigation CDSS within our MET (Mobile Emergency Triage) decision support environment. Copyright © 2016 Elsevier Inc. All rights reserved.

75 FR 40711 - Defense Federal Acquisition Regulation Supplement; Payments in Support of Emergencies and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-13

... with the cognizant comptroller, as the operational area evolves into a more stable business environment... conditions exist that limit normal business operations during emergencies and contingency operations. It also... review under Section 6(b) of Executive Order 12866, Regulatory Planning and Review, dated September 30...

10 CFR 36.53 - Operating and emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Operating and emergency procedures. 36.53 Section 36.53 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR IRRADIATORS Operation... the source storage pool; (6) A prolonged loss of electrical power; (7) A fire alarm or explosion in...

10 CFR 36.53 - Operating and emergency procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Operating and emergency procedures. 36.53 Section 36.53 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR IRRADIATORS Operation... the source storage pool; (6) A prolonged loss of electrical power; (7) A fire alarm or explosion in...

10 CFR 36.53 - Operating and emergency procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Operating and emergency procedures. 36.53 Section 36.53 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR IRRADIATORS Operation... the source storage pool; (6) A prolonged loss of electrical power; (7) A fire alarm or explosion in...

75 FR 63209 - Indiana Michigan Power Company; Notice of Consideration of Issuance of Amendment to Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-14

... emergency operating procedures (EOP), and site survey monitoring that support modification of emergency plan... Power Company; Notice of Consideration of Issuance of Amendment to Facility Operating License, Proposed... Regulatory Commission (the Commission) is considering issuance of an amendment to Facility Operating License...

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

A Study on the Validity of a Task Complexity Measure for Emergency Operating Procedures of Nuclear Power Plants—Comparing With a Subjective Workload

NASA Astrophysics Data System (ADS)

Park, J.; Jung, W.

2006-10-01

In this study, the appropriateness of the task complexity (TACOM) measure that can quantify the complexity of emergency tasks was investigated by comparing subjective workload scores with the associated TACOM scores. To this end, based on the NASA-TLX (task load index) technique, 18 operators were asked to subjectively estimate perceived workload for 23 emergency tasks that were specified in the emergency operating procedures of the reference nuclear power plants. As the result of comparisons, it was observed that subjective workload scores increase in proportion to the increase of TACOM scores. Therefore, it is expect that the TACOM measure can be used as a serviceable method to quantify the complexity of emergency tasks

System-wide versus component-specific trust using multiple aids.

PubMed

Keller, David; Rice, Stephen

2010-01-01

Previous research in operator trust toward automated aids has focused primarily on single aids. The current study focuses on how operator trust is affected by the presence of multiple aids. Two competing theories of multiple-trust are presented. A component-specific trust theory predicts that operators will differentially place their trust in automated aids that vary in reliability. A system-wide trust theory predicts that operators will treat multiple imperfect aids as one "system" and merge their trust across aids despite differences in the aids' reliability. A simulated flight task was used to test these theories, whereby operators performed a pursuit tracking task while concurrently monitoring multiple system gauges that were augmented with perfect or imperfect automated aids. The data revealed that a system-wide trust theory best predicted the data; operators merged their trust across both aids, behaving toward a perfectly reliable aid in the same manner as they did towards unreliable aids.

Emerging viruses in Florida and the Caribbean

USDA-ARS?s Scientific Manuscript database

Multiple thrips-, whitefly- and aphid-transmitted viruses have recently emerged or re-emerged in vegetable and ornamental crops in Florida and the Caribbean. Tomato spotted wilt virus (a thrips-transmitted tospovirus) and Tomato yellow leaf curl virus (a whitefly-transmitted begomovirus) have histor...

Assessment of operative times of multiple surgical specialties in a public university hospital

PubMed Central

Costa, Altair da Silva

2017-01-01

ABSTRACT Objective To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. Methods It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. Results The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. Conclusion This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. PMID:28767919

Structure D'Ensemble, Multiple Classification, Multiple Seriation and Amount of Irrelevant Information

ERIC Educational Resources Information Center

Hamel, B. Remmo; Van Der Veer, M. A. A.

1972-01-01

A significant positive correlation between multiple classification was found, in testing 65 children aged 6 to 8 years, at the stage of concrete operations. This is interpreted as support for the existence of a structure d'ensemble of operational schemes in the period of concrete operations. (Authors)

Emergency Procedure Training for Reactor Operators at the High Flux Beam Reactor for Brookhaven National Laboratory.

ERIC Educational Resources Information Center

Reyer, Ronald

A project was conducted to analyze, design, develop, implement, and evaluate an instructional unit intended to improve the diagnostic skills of operating personnel in responding to abnormal and emergency conditions at the High Flux Beam Reactor at Brookhaven National Laboratory. Research was conducted on the occurrence of emergencies at similar…

Assessment of Emerging Networks to Support Future NASA Space Operations

NASA Technical Reports Server (NTRS)

Younes, Badri; Chang, Susan; Berman, Ted; Burns, Mark; LaFontaine, Richard; Lease, Robert

1998-01-01

Various issues associated with assessing emerging networks to support future NASA space operations are presented in viewgraph form. Specific topics include: 1) Emerging commercial satellite systems; 2) NASA LEO satellite support through commercial systems; 3) Communications coverage, user terminal assessment and regulatory assessment; 4) NASA LEO missions overview; and 5) Simulation assumptions and results.

A Study of Failure Events in Drinking Water Systems As a Basis for Comparison and Evaluation of the Efficacy of Potable Reuse Schemes

PubMed Central

Onyango, Laura A.; Quinn, Chloe; Tng, Keng H.; Wood, James G.; Leslie, Greg

2015-01-01

Potable reuse is implemented in several countries around the world to augment strained water supplies. This article presents a public health perspective on potable reuse by comparing the critical infrastructure and institutional capacity characteristics of two well-established potable reuse schemes with conventional drinking water schemes in developed nations that have experienced waterborne outbreaks. Analysis of failure events in conventional water systems between 2003 and 2013 showed that despite advances in water treatment technologies, drinking water outbreaks caused by microbial contamination were still frequent in developed countries and can be attributed to failures in infrastructure or institutional practices. Numerous institutional failures linked to ineffective treatment protocols, poor operational practices, and negligence were detected. In contrast, potable reuse schemes that use multiple barriers, online instrumentation, and operational measures were found to address the events that have resulted in waterborne outbreaks in conventional systems in the past decade. Syndromic surveillance has emerged as a tool in outbreak detection and was useful in detecting some outbreaks; increases in emergency department visits and GP consultations being the most common data source, suggesting potential for an increasing role in public health surveillance of waterborne outbreaks. These results highlight desirable characteristics of potable reuse schemes from a public health perspective with potential for guiding policy on surveillance activities. PMID:27053920

A Study of Failure Events in Drinking Water Systems As a Basis for Comparison and Evaluation of the Efficacy of Potable Reuse Schemes.

PubMed

Onyango, Laura A; Quinn, Chloe; Tng, Keng H; Wood, James G; Leslie, Greg

2015-01-01

Potable reuse is implemented in several countries around the world to augment strained water supplies. This article presents a public health perspective on potable reuse by comparing the critical infrastructure and institutional capacity characteristics of two well-established potable reuse schemes with conventional drinking water schemes in developed nations that have experienced waterborne outbreaks. Analysis of failure events in conventional water systems between 2003 and 2013 showed that despite advances in water treatment technologies, drinking water outbreaks caused by microbial contamination were still frequent in developed countries and can be attributed to failures in infrastructure or institutional practices. Numerous institutional failures linked to ineffective treatment protocols, poor operational practices, and negligence were detected. In contrast, potable reuse schemes that use multiple barriers, online instrumentation, and operational measures were found to address the events that have resulted in waterborne outbreaks in conventional systems in the past decade. Syndromic surveillance has emerged as a tool in outbreak detection and was useful in detecting some outbreaks; increases in emergency department visits and GP consultations being the most common data source, suggesting potential for an increasing role in public health surveillance of waterborne outbreaks. These results highlight desirable characteristics of potable reuse schemes from a public health perspective with potential for guiding policy on surveillance activities.

Female Genital Mutilation as a Concern for Special Operations and Tactical Emergency Medical Support Medics.

PubMed

Wittich, Arthur C

Female genital mutilation (FGM), frequently called female genital cutting or female circumcision, is the intentional disfigurement of the external genitalia in young girls and women for the purpose of reducing libido and ensuring premarital virginity. This traditional, nontherapeutic procedure to suppress libido and prevent sexual intercourse before marriage has been pervasive in Northern Africa, the Middle East, and the Arabian peninsula for over 2,500 years. FGM permanently destroys the genital anatomy while frequently causing multiple and serious complications. The International Federation of Gynecology and Obstetrics proposed a classification system of FGM according to the specific genital anatomy removed and the extensiveness of genital disfigurement. Although it has been ruled illegal in most countries, FGM continues to be performed worldwide. With African, Asian, and Middle Eastern immigration to the United States and Europe, western countries are experiencing FGM in regions where these immigrants have concentrated. As deployments of Special Operations Forces (SOF) increase to regions in which FGM is pervasive, and as African, Asian, and Middle Eastern immigration to the United States increases, SOF and Tactical Emergency Medical Support (TEMS) medics will necessarily be called upon to evaluate and treat complications resulting from FGM. The purpose of this article is to educate SOF/TEMS medical personnel about the history, geographic regions, classification of procedures, complications, and medical treatment of patients with FGM. 2017.

Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data.

PubMed

Abel, Gary A; Mendonca, Silvia C; McPhail, Sean; Zhou, Yin; Elliss-Brookes, Lucy; Lyratzopoulos, Georgios

2017-06-01

Emergency diagnosis of cancer is common and aetiologically complex. The proportion of emergency presenters who have consulted previously with relevant symptoms is uncertain. To examine how many patients with cancer, who were diagnosed as emergencies, have had previous primary care consultations with relevant symptoms; and among those, to examine how many had multiple consultations. Secondary analysis of patient survey data from the 2010 English Cancer Patient Experience Survey (CPES), previously linked to population-based data on diagnostic route. For emergency presenters with 18 different cancers, associations were examined for two outcomes (prior GP consultation status; and 'three or more consultations' among prior consultees) using logistic regression. Among 4647 emergency presenters, 1349 (29%) reported no prior consultations, being more common in males (32% versus 25% in females, P <0.001), older (44% in ≥85 versus 30% in 65-74-year-olds, P <0.001), and the most deprived (35% versus 25% least deprived, P = 0.001) patients; and highest/lowest for patients with brain cancer (46%) and mesothelioma (13%), respectively ( P <0.001 for overall variation by cancer site). Among 3298 emergency presenters with prior consultations, 1356 (41%) had three or more consultations, which were more likely in females ( P <0.001), younger ( P <0.001), and non-white patients ( P = 0.017) and those with multiple myeloma, and least likely for patients with leukaemia ( P <0.001). Contrary to suggestions that emergency presentations represent missed diagnoses, about one-third of emergency presenters (particularly those in older and more deprived groups) have no prior GP consultations. Furthermore, only about one-third report multiple (three or more) consultations, which are more likely in 'harder-to-suspect' groups. © British Journal of General Practice 2017.

Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data

PubMed Central

Abel, Gary A; Mendonca, Silvia C; McPhail, Sean; Zhou, Yin; Elliss-Brookes, Lucy; Lyratzopoulos, Georgios

2017-01-01

Background Emergency diagnosis of cancer is common and aetiologically complex. The proportion of emergency presenters who have consulted previously with relevant symptoms is uncertain. Aim To examine how many patients with cancer, who were diagnosed as emergencies, have had previous primary care consultations with relevant symptoms; and among those, to examine how many had multiple consultations. Design and setting Secondary analysis of patient survey data from the 2010 English Cancer Patient Experience Survey (CPES), previously linked to population-based data on diagnostic route. Method For emergency presenters with 18 different cancers, associations were examined for two outcomes (prior GP consultation status; and ‘three or more consultations’ among prior consultees) using logistic regression. Results Among 4647 emergency presenters, 1349 (29%) reported no prior consultations, being more common in males (32% versus 25% in females, P<0.001), older (44% in ≥85 versus 30% in 65–74-year-olds, P<0.001), and the most deprived (35% versus 25% least deprived, P = 0.001) patients; and highest/lowest for patients with brain cancer (46%) and mesothelioma (13%), respectively (P<0.001 for overall variation by cancer site). Among 3298 emergency presenters with prior consultations, 1356 (41%) had three or more consultations, which were more likely in females (P<0.001), younger (P<0.001), and non-white patients (P = 0.017) and those with multiple myeloma, and least likely for patients with leukaemia (P<0.001). Conclusion Contrary to suggestions that emergency presentations represent missed diagnoses, about one-third of emergency presenters (particularly those in older and more deprived groups) have no prior GP consultations. Furthermore, only about one-third report multiple (three or more) consultations, which are more likely in ‘harder-to-suspect’ groups. PMID:28438775

About the National Center for Radiation Field Operations (NCRFO)

EPA Pesticide Factsheets

The National Center for Radiation Field Operations (NCRFO) is an essential component of EPA’s Radiological Emergency Response Team (RERT) and is key to EPA's response to radiological emergencies and accidents nationwide.

Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand.

PubMed

Suriyawongpaisal, Paibul; Aekplakorn, Wichai; Srithamrongsawat, Samrit; Srithongchai, Chaisit; Prasitsiriphon, Orawan; Tansirisithikul, Rassamee

2016-10-21

Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. We have identified 6 drivers of the copayment i.e., 1) perceived under payment, 2) unclear operational definitions of emergency conditions or 3) lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4) limited understanding by the service users of the policy-directed benefits, 5) weak regulatory mechanism as indicated by lack of information systems to trace private provider's practices, and 6) ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies.

Safe and sustainable increases in day case emergency surgery.

PubMed

Hotchen, Andrew J; Coleman, Grant; O'Callaghan, John M; McWhinnie, Doug

2016-03-01

Selected patients referred to emergency general surgery departments are suitable for day case emergency surgery with no overnight hospital stay. There are no well-described sustainable pathways for these expedited operations and in many hospitals patients undergo unnecessary admissions and experience long waiting times. The authors proposed a new, sustainable, day case emergency surgery pathway which was implemented to streamline the assessment, treatment and discharge of acute surgical referrals. It requires rapid assessment of the patient by a senior clinician, and ready availability of diagnostic services and operating facilities. To assess this pathway, the authors conducted a prospective audit of general surgical referrals to a district general hospital in the UK. During the inclusion period 746 emergency referrals were assessed, 281 (37%) of these underwent an operation. Over a 5-month investigation period, the audit found that approximately 27% of all emergency general surgery patients requiring an operation could be managed with day case emergency surgery. This figure was maintained throughout the duration of the study. Operations included incision and drainage of abscesses, incarcerated hernia repairs and appendicectomies. The average length of stay of all surgical admissions decreased from 5 days to less than 3 days and the median time to senior review was 30 minutes. The authors have developed a pathway involving permanent members of the surgical assessment team that is sustainable over a 5-month period. The pathway has allowed rapid assessment of patients and reduced unnecessary inpatient stay in a sustainable and reproducible manner.

Mortality characteristics of aortic root surgery in North America†

PubMed Central

Caceres, Manuel; Ma, Yicheng; Rankin, J. Scott; Saha-Chaudhuri, Paramita; Englum, Brian R.; Gammie, James S.; Suri, Rakesh M.; Thourani, Vinod H.; Esmailian, Fardad; Czer, Lawrence S.; Puskas, John D.; Svensson, Lars G.

2014-01-01

OBJECTIVES Aortic root surgery is transitioning to aortic valve sparing (AVS), but little is known about the relative early outcomes of AVS versus composite graft-valve replacement (CVR). This study assessed mortality differences for AVS versus CVR to guide future practice decisions. METHODS From January 2000 to June 2011, 31 747 patients had aortic root replacement with AVS (n = 3585; 11%) or CVR (n = 28 162; 89%). The cohort of Overall patients was divided into two subgroups: high-risk patients (n = 20 356; 6% AVS) having age >75 years, endocarditis, aortic stenosis, dialysis, multiple valves, reoperation or emergency/salvage status, and the remaining low-risk patients (n = 11 388; 21% AVS). Using logistic regression analysis, outcomes were presented as unadjusted operative mortality (UOM), risk-adjusted operative mortality (AOM) and adjusted odds ratio (AOR) for mortality. RESULTS Baseline characteristics for the Overall group (AVS versus CVR) were: mean age (52 vs 57 years), endocarditis (1 vs 11%), aortic stenosis (4 vs 36%), dialysis (1 vs 2%), multiple valves (7 vs 10%), reoperation (6 vs 17%) and emergency status (14 vs 12%) (all P < 0.0001). In high- and low-risk groups, baseline differences narrowed, and lower mortality was generally observed with AVS: (AVS versus CVR) UOM group Overall (4.5 vs 8.9%)*, group High-risk (10.5 vs 11.7%), group Low-risk (1.4 vs 3.1%)*; AOM group Overall (6.2 vs 8.6%), group High-risk (10.1 vs 11.7%), group Low-risk (2.2 vs 2.8%); AOR group Overall (0.59)*, group High-risk (0.62)*, group Low-risk (0.69). *P < 0.05. CONCLUSIONS Relative risk-adjusted mortality seemed comparable with AVS versus CVR in low- and high-risk subgroups. These data support judicious expansion of aortic valve repair in patients having aortic root replacement. PMID:24639452

Mortality characteristics of aortic root surgery in North America.

PubMed

Caceres, Manuel; Ma, Yicheng; Rankin, J Scott; Saha-Chaudhuri, Paramita; Englum, Brian R; Gammie, James S; Suri, Rakesh M; Thourani, Vinod H; Esmailian, Fardad; Czer, Lawrence S; Puskas, John D; Svensson, Lars G

2014-11-01

Aortic root surgery is transitioning to aortic valve sparing (AVS), but little is known about the relative early outcomes of AVS versus composite graft-valve replacement (CVR). This study assessed mortality differences for AVS versus CVR to guide future practice decisions. From January 2000 to June 2011, 31 747 patients had aortic root replacement with AVS (n = 3585; 11%) or CVR (n = 28 162; 89%). The cohort of Overall patients was divided into two subgroups: high-risk patients (n = 20 356; 6% AVS) having age >75 years, endocarditis, aortic stenosis, dialysis, multiple valves, reoperation or emergency/salvage status, and the remaining low-risk patients (n = 11 388; 21% AVS). Using logistic regression analysis, outcomes were presented as unadjusted operative mortality (UOM), risk-adjusted operative mortality (AOM) and adjusted odds ratio (AOR) for mortality. Baseline characteristics for the Overall group (AVS versus CVR) were: mean age (52 vs 57 years), endocarditis (1 vs 11%), aortic stenosis (4 vs 36%), dialysis (1 vs 2%), multiple valves (7 vs 10%), reoperation (6 vs 17%) and emergency status (14 vs 12%) (all P < 0.0001). In high- and low-risk groups, baseline differences narrowed, and lower mortality was generally observed with AVS: (AVS versus CVR) UOM group Overall (4.5 vs 8.9%)*, group High-risk (10.5 vs 11.7%), group Low-risk (1.4 vs 3.1%)*; AOM group Overall (6.2 vs 8.6%), group High-risk (10.1 vs 11.7%), group Low-risk (2.2 vs 2.8%); AOR group Overall (0.59)*, group High-risk (0.62)*, group Low-risk (0.69). *P < 0.05. Relative risk-adjusted mortality seemed comparable with AVS versus CVR in low- and high-risk subgroups. These data support judicious expansion of aortic valve repair in patients having aortic root replacement. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

An Adaptive Memory Interface Controller for Improving Bandwidth Utilization of Hybrid and Reconfigurable Systems

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

Castellana, Vito G.; Tumeo, Antonino; Ferrandi, Fabrizio

Emerging applications such as data mining, bioinformatics, knowledge discovery, social network analysis are irregular. They use data structures based on pointers or linked lists, such as graphs, unbalanced trees or unstructures grids, which generates unpredictable memory accesses. These data structures usually are large, but difficult to partition. These applications mostly are memory bandwidth bounded and have high synchronization intensity. However, they also have large amounts of inherent dynamic parallelism, because they potentially perform a task for each one of the element they are exploring. Several efforts are looking at accelerating these applications on hybrid architectures, which integrate general purpose processorsmore » with reconfigurable devices. Some solutions, which demonstrated significant speedups, include custom-hand tuned accelerators or even full processor architectures on the reconfigurable logic. In this paper we present an approach for the automatic synthesis of accelerators from C, targeted at irregular applications. In contrast to typical High Level Synthesis paradigms, which construct a centralized Finite State Machine, our approach generates dynamically scheduled hardware components. While parallelism exploitation in typical HLS-generated accelerators is usually bound within a single execution flow, our solution allows concurrently running multiple execution flow, thus also exploiting the coarser grain task parallelism of irregular applications. Our approach supports multiple, multi-ported and distributed memories, and atomic memory operations. Its main objective is parallelizing as many memory operations as possible, independently from their execution time, to maximize the memory bandwidth utilization. This significantly differs from current HLS flows, which usually consider a single memory port and require precise scheduling of memory operations. A key innovation of our approach is the generation of a memory interface controller, which dynamically maps concurrent memory accesses to multiple ports. We present a case study on a typical irregular kernel, Graph Breadth First search (BFS), exploring different tradeoffs in terms of parallelism and number of memories.« less

[The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI)--a case report].

PubMed

Gałazkowski, Robert; Wejnarski, Arkadiusz; Baumberg, Ignacy; Świeżewski, Stanisław; Timler, Dariusz

2014-01-01

In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Zyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI). Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary.

Manipulating Motivating Operations to Facilitate the Emergence of Mands for a Child with Autism

ERIC Educational Resources Information Center

Davis, Barbara Janine; Kahng, SungWoo; Coryat, Kaitlin

2012-01-01

Research on the functional independence of verbal operants (Skinner, 1957) has demonstrated inconsistent findings. One explanation may be that these studies have not manipulated the motivating operation (MO) to facilitate the emergence of mands (Hall & Sundberg, 1987; Lamarre & Holland, 1985). In the current study, 1 participant, diagnosed with…

49 CFR 393.62 - Emergency exits for buses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (including a school bus used in interstate commerce for non-school bus operations) with a GVWR of more than 4... manufacture. (2) Each bus (including a school bus used in interstate commerce for non-school bus operations... NECESSARY FOR SAFE OPERATION Glazing and Window Construction § 393.62 Emergency exits for buses. (a) Buses...

49 CFR 393.62 - Emergency exits for buses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (including a school bus used in interstate commerce for non-school bus operations) with a GVWR of more than 4... manufacture. (2) Each bus (including a school bus used in interstate commerce for non-school bus operations... NECESSARY FOR SAFE OPERATION Glazing and Window Construction § 393.62 Emergency exits for buses. (a) Buses...

49 CFR 393.62 - Emergency exits for buses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (including a school bus used in interstate commerce for non-school bus operations) with a GVWR of more than 4... manufacture. (2) Each bus (including a school bus used in interstate commerce for non-school bus operations... NECESSARY FOR SAFE OPERATION Glazing and Window Construction § 393.62 Emergency exits for buses. (a) Buses...

49 CFR 393.62 - Emergency exits for buses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (including a school bus used in interstate commerce for non-school bus operations) with a GVWR of more than 4... manufacture. (2) Each bus (including a school bus used in interstate commerce for non-school bus operations... NECESSARY FOR SAFE OPERATION Glazing and Window Construction § 393.62 Emergency exits for buses. (a) Buses...

77 FR 40647 - Biweekly Notice; Applications and Amendments to Facility Operating Licenses and Combined Licenses...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-10

... operation of the shared unit's diesel generator (emergency power) and to assure long term operation of the... actuation system limiting safety system settings, and emergency diesel generator surveillance start voltage... specification for the Vogtle Electric Generating Plant, Units 1 and 2, associated with the ``Steam Generator (SG...

Fire Safety for the Oral and Maxillofacial Surgeon and Surgical Staff.

PubMed

Di Pasquale, LisaMarie; Ferneini, Elie M

2017-05-01

Fire in the operating room is a life-threatening emergency that demands quick, efficient intervention. Because the circumstances surrounding fires are generally well-understood, virtually every operating room fire is preventable. Before every operating room case, thorough preprocedure "time outs" should address each team members' awareness of specific fire risks and agreement regarding fire concerns and emergency actions. Fire prevention centers on 3 constituent parts of the fire triad necessary for fire formation. Regular fire drills should guide policies and procedures to prevent surgical fires. Delivering optimal patient care in emergent situations requires surgical team training, practicing emergency roles, and specific actions. Copyright © 2016 Elsevier Inc. All rights reserved.

Cooperation evolution in random multiplicative environments

NASA Astrophysics Data System (ADS)

Yaari, G.; Solomon, S.

2010-02-01

Most real life systems have a random component: the multitude of endogenous and exogenous factors influencing them result in stochastic fluctuations of the parameters determining their dynamics. These empirical systems are in many cases subject to noise of multiplicative nature. The special properties of multiplicative noise as opposed to additive noise have been noticed for a long while. Even though apparently and formally the difference between free additive vs. multiplicative random walks consists in just a move from normal to log-normal distributions, in practice the implications are much more far reaching. While in an additive context the emergence and survival of cooperation requires special conditions (especially some level of reward, punishment, reciprocity), we find that in the multiplicative random context the emergence of cooperation is much more natural and effective. We study the various implications of this observation and its applications in various contexts.

Trauma and emergency surgery: an evolutionary direction for trauma surgeons.

PubMed

Scherer, Lynette A; Battistella, Felix D

2004-01-01

The success of nonoperative management of injuries has diminished the operative experience of trauma surgeons. To enhance operative experience, our trauma surgeons began caring for all general surgery emergencies. Our objective was to characterize and compare the experience of our trauma surgeons with that of our general surgeons. We reviewed records to determine case diversity, complexity, time of operation, need for intensive care unit care, and payor mix for patients treated by the trauma and emergency surgery (TES) surgeons and elective practice general surgery (ELEC) surgeons over a 1-year period. TES and ELEC surgeons performed 253 +/- 83 and 234 +/- 40 operations per surgeon, respectively (p = 0.59). TES surgeons admitted more patients and performed more after-hours operations than their ELEC colleagues. Both groups had a mix of cases that was diverse and complex. Combining the care of patients with trauma and general surgery emergencies resulted in a breadth and scope of practice for TES surgeons that compared well with that of ELEC surgeons.

Outcomes of hospitalized patients undergoing emergency general surgery remote from admission.

PubMed

Sharoky, Catherine E; Bailey, Elizabeth A; Sellers, Morgan M; Kaufman, Elinore J; Sinnamon, Andrew J; Wirtalla, Christopher J; Holena, Daniel N; Kelz, Rachel R

2017-09-01

Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications. Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes. Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]). Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only. Copyright © 2017 Elsevier Inc. All rights reserved.

Cytogenetics in the management of multiple myeloma: an update by the Groupe francophone de cytogénétique hématologique (GFCH).

PubMed

Daudignon, Agnès; Quilichini, Benoît; Ameye, Geneviève; Poirel, Hélène; Bastard, Christian; Terré, Christine

2016-10-01

Cytogenetics of multiple myeloma has evolved in recent years by the emergence of Interphasic fluorescence in situ hybridization (FISH) performed on sorted plasma cells detecting abnormalities independently of a proliferative and infiltrative index. Cytogenetic analysis plays a major part in the risk stratification of myeloma diagnosis due to prognostic impact of various cytogenetic abnormalities as well as to the association between emerging therapeutic approaches in MM. Thus, practice guidelines now recommend interphasic FISH or alternative molecular technics as the initial analysis for multiple myeloma. The Groupe francophone de cytogénétique hématologique (GFCH) proposes in this issue an update of managing multiple myeloma cytogenetics.

A critical assessment of outcomes in emergency versus nonemergency general surgery using the American College of Surgeons National Surgical Quality Improvement Program database.

PubMed

Becher, Robert D; Hoth, J Jason; Miller, Preston R; Mowery, Nathan T; Chang, Michael C; Meredith, J Wayne

2011-07-01

Emergent operations are thought to carry higher morbidity and mortality than nonemergent cases. However, there is a lack of specific outcomes data for emergent general surgery procedures. The objective of our study was to assess and quantify postoperative morbidity and mortality for emergency versus nonemergency general surgery operations. All general surgery inpatients were identified in the American College of Surgeons National Surgical Quality Improvement Program 2008 database. Preoperative, intraoperative, and postoperative clinical metrics and occurrences were assessed. A total of 25,770 emergent and 98,867 nonemergent cases were identified. Postoperative morbidity was significantly worse in the emergent group, including ventilation more than 48 hours, bleeding requiring transfusion, deep vein thrombosis, renal failure, and need for reoperation. Overall, emergent cases had significantly more postoperative complications (22.8% vs 14.2%) and higher mortality rates (6.5% vs 1.4%). General surgery patients who undergo emergent operations have significantly poorer outcomes when compared with nonemergent patients; our analysis has quantified these differences. Emergent patients seem to manifest unique clinical, pathophysiologic, and inflammatory responses to their surgical disease. This data suggests that there is a need for improvement in both methods and systems of care for the emergent population.

Agile supply chain capabilities: emerging patterns as a determinant of competitive objectives

NASA Astrophysics Data System (ADS)

Yusuf, Yahaya Y.; Adeleye, E. O.; Sivayoganathan, K.

2001-10-01

Turbulent change caused by factors such as changing customer and technological requirements threatens manufacturers through lower product life cycles, profits and bleak survival prospects. Therefore, several companies are stressing flexibility and agility in order to respond, real time, to the unique needs of customers and markets. However, the resource competencies required are often difficult to mobilise and retain by single companies. It is therefore imperative for companies to co-operate and leverage complementary competencies. To this end, legally separate and spatially distributed companies are becoming integrated through Internet-based technologies. The paper reviews emerging patterns in supply chain integration. It also explores the relationship between the emerging patterns and attainment of competitive objectives. The results reported in the paper are based on data from a survey by questionnaire. The survey involved 600 companies in the UK, as part of a larger study of agile manufacturing. The study was driven by a conceptual model, which relates supply chain practices to competitive objectives. The analysis involves the use of factor analysis to reduce research variables to a few principal components. Subsequently, multiple regression was conducted to study the relationship amongst the reduced variables. The results validate the proposed conceptual model and lend credence to current thinking that supply chain integration is a vital tool for competitive advantage.

Benefit of FOLFOX to unresectable liver metastases secondary from colorectal carcinoma in an oncologic emergency.

PubMed

Sugimoto, Maki; Yasuda, Hideki; Koda, Keiji; Yamazaki, Masato; Tezuka, Tohru; Takenoue, Tomohiro; Kosugi, Chihiro; Higuchi, Ryota; Yamamoto, Shiho; Watayo, Yoshihisa; Yagawa, Yohsuke; Suzuki, Masato

2007-09-01

Liver metastasis is an important prognostic factor in colorectal cancer. The efficacy of resection of metastatic lesions in liver metastasis of colorectal cancer is also widely recognized. However, studies on treatment methods of unresectable cases have not been sufficient and obtaining complete remission (CR) for liver metastasis is rare with chemotherapy. Selection of reliable chemotherapy for unresectable liver metastasis is an urgent necessity. The usefulness of oxaliplatin, 5-flurouracil and leucovorin combination therapy (FOLFOX) has recently been reported, but CR of liver metastasis is rare. The current status and new therapeutic significance of FOLFOX therapy are discussed based on the literature of colorectal cancer chemotherapy to date, and the clinical experience in which we obtained CR for liver metastasis is reported. The patient had stage IV rectal cancer, perforative peritonitis, pelvic abscess and simultaneous multiple liver metastasis. The patient underwent an emergency operation using the Hartmann's procedure. Liver metastasis is considered to be a prognostic factor and FOLFOX was selected as the postoperative chemotherapy, CR of the liver metastasis was obtained. FOLFOX was suggested to have new clinical significance in oncologic emergencies against unresectable liver metastasis in colorectal cancer and should serve as adjuvant chemotherapy that will contribute to improvement of treatment results.

Building a Better Trojan Horse: Emerging Army Roles in Joint Urban Operations

DTIC Science & Technology

2001-01-01

Building a Better Trojan Horse : Emerging Army Roles in Joint Urban Operations A Monograph by MAJ Christopher H. Beckert Infantry, U.S. Army School...xx-xx-2000 to xx-xx-2000 5a. CONTRACT NUMBER 5b. GRANT NUMBER 4. TITLE AND SUBTITLE Building a Better Trojan Horse : Emerging Army Roles in Joint...TELEPHONE NUMBER International Area Code Area Code Telephone Number 703 767-9007 DSN 427-9007 2 Abstract BUILDING A BETTER TROJAN HORSE : EMERGING ARMY

Learning from Fiction: Applications in Emerging Technologies

ERIC Educational Resources Information Center

Gordon, Ruthanna

2009-01-01

Understanding the development of public opinion about emerging technologies, when the scope of that emergence is still speculative, poses particular challenges. Opinions and beliefs may be drawn from conflicting experts in multiple fields, media portrayals with varying biases, and fictional narratives that portray diverse possible futures. This…

Strategies for Maximizing Successful Drug Substance Technology Transfer Using Engineering, Shake-Down, and Wet Test Runs.

PubMed

Abraham, Sushil; Bain, David; Bowers, John; Larivee, Victor; Leira, Francisco; Xie, Jasmina

2015-01-01

The technology transfer of biological products is a complex process requiring control of multiple unit operations and parameters to ensure product quality and process performance. To achieve product commercialization, the technology transfer sending unit must successfully transfer knowledge about both the product and the process to the receiving unit. A key strategy for maximizing successful scale-up and transfer efforts is the effective use of engineering and shake-down runs to confirm operational performance and product quality prior to embarking on good manufacturing practice runs such as process performance qualification runs. We consider key factors to consider in making the decision to perform shake-down or engineering runs. We also present industry benchmarking results of how engineering runs are used in drug substance technology transfers alongside the main themes and best practices that have emerged. Our goal is to provide companies with a framework for ensuring the "right first time" technology transfers with effective deployment of resources within increasingly aggressive timeline constraints. © PDA, Inc. 2015.

Blood, sweat and tears: androgenic-anabolic steroid misuse and recurrent primary post-tonsillectomy haemorrhage

PubMed Central

Fox, Richard; Varadharajan, Kiran; Patel, Bhavesh; Beegun, Issa

2014-01-01

A 30-year-old male body builder and androgenic-anabolic steroid and insulin abuser was admitted for day case elective tonsillectomy (bipolar). He returned with primary post-tonsillectomy haemorrhage 18 h after the operation and required bipolar cautery to the multiple small bleeding points in the right and left tonsillar fossa. Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3 h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation on the intensive treatment unit (ITU). Re-examination in theatre revealed a bleeding left superior pole that was under-run to achieve haemostasis and the patient returned to ITU. Hypertensive episodes were noted in the emergency department and intraoperatively including one recording >200 mm Hg. Haemostasis was eventually achieved once the blood pressure was adequately controlled. A slow wean of steroids was also instigated and the patient was managed on a surgical ward for 2 weeks post-tonsillectomy. PMID:25398921

Blood, sweat and tears: androgenic-anabolic steroid misuse and recurrent primary post-tonsillectomy haemorrhage.

PubMed

Fox, Richard; Varadharajan, Kiran; Patel, Bhavesh; Beegun, Issa

2014-11-14

A 30-year-old male body builder and androgenic-anabolic steroid and insulin abuser was admitted for day case elective tonsillectomy (bipolar). He returned with primary post-tonsillectomy haemorrhage 18 h after the operation and required bipolar cautery to the multiple small bleeding points in the right and left tonsillar fossa. Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3 h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation on the intensive treatment unit (ITU). Re-examination in theatre revealed a bleeding left superior pole that was under-run to achieve haemostasis and the patient returned to ITU. Hypertensive episodes were noted in the emergency department and intraoperatively including one recording >200 mm Hg. Haemostasis was eventually achieved once the blood pressure was adequately controlled. A slow wean of steroids was also instigated and the patient was managed on a surgical ward for 2 weeks post-tonsillectomy. 2014 BMJ Publishing Group Ltd.

Evaluation Aspects of Building Structures Reconstructed After a Failure or Catastrophe

NASA Astrophysics Data System (ADS)

Krentowski, Janusz R.; Knyziak, Piotr

2017-10-01

The article presents the characteristics of several steel structures, among others modernized industrial dye house, school sports hall, truck repair workshop, that have been rebuilt after a disaster or a catastrophe. The structures were analyzed in detail, and the evaluation and reconstruction processes were described. The emergencies that occurred during exploitation of the buildings were the result of multiple mistakes: incorrectly defined intervals between inspections, errors during periodic inspections, incorrect repair work recommendations. The concepts of reinforcement work implemented by the authors, enabling the long-term future failure-free operation of the objects, were presented. Recommendations for monitoring of the facilities, applied after reinforcement or reconstruction, have been formulated. The methodology for the implementation of specialized investigations, such as geodetic, optical, geological, chemical strength tests, both destructive and non-destructive, has been defined. The need to determine the limit values of deformations, deflections, damage or other faults of structural elements and the entire rebuilt facilities, as well as defining conditions for objects’ withdrawal from operation in subsequent exceptional situations was indicated.

Launch Control System Master Console Event Message Reduction

NASA Technical Reports Server (NTRS)

Nguyen, Uyen

2014-01-01

System monitoring and control (SMC) message browsers receive so many messages daily that operators do not need to see. Important messages are often mixed up among the less important ones. My job is to reduce the messages displayed in the message browser so that warning and emergency messages can be seen easily and therefore, responded promptly. There are multiple methods to achieve this. Firstly, duplicate messages should not appear many times in the message browser. Instead, the message should appear only once but with a number that counts the times that it appears. This method is called duplicate message suppression. Secondly, messages that update the most recent state (e.g. up/down) of a component should replace the old-state messages. This method is called state based message correlation. Thirdly, messages that display "normal" alarm level should be suppressed unless it's a response to an operator action. In addition to message reduction, I also work on correcting the severity level and text formats on messages.

The HARM score for gastrointestinal surgery: Application and validation of a novel, reliable and simple tool to measure surgical quality and outcomes.

PubMed

Crawshaw, Benjamin P; Keller, Deborah S; Brady, Justin T; Augestad, Knut M; Schiltz, Nicholas K; Koroukian, Siran M; Navale, Suparna M; Steele, Scott R; Delaney, Conor P

2017-03-01

The HospitAl length of stay, Readmissions and Mortality (HARM) score is a simple, inexpensive quality tool, linked directly to patient outcomes. We assess the HARM score for measuring surgical quality across multiple surgical populations. Upper gastrointestinal, hepatobiliary, and colorectal surgery cases between 2005 and 2009 were identified from the Healthcare Cost and Utilization Project California State Inpatient Database. Composite and individual HARM scores were calculated from length of stay, 30-day readmission and mortality, correlated to complication rates for each hospital and stratified by operative type. 71,419 admissions were analyzed. Higher HARM scores correlated with higher complication rates for all cases after risk adjustment and stratification by operation type, elective or emergent status. The HARM score is a simple and valid quality measurement for upper gastrointestinal, hepatobiliary and colorectal surgery. The HARM score could facilitate benchmarking to improve patient outcomes and resource utilization, and may facilitate outcome improvement. Copyright © 2016 Elsevier Inc. All rights reserved.

Quantum optical emulation of molecular vibronic spectroscopy using a trapped-ion device.

PubMed

Shen, Yangchao; Lu, Yao; Zhang, Kuan; Zhang, Junhua; Zhang, Shuaining; Huh, Joonsuk; Kim, Kihwan

2018-01-28

Molecules are one of the most demanding quantum systems to be simulated by quantum computers due to their complexity and the emergent role of quantum nature. The recent theoretical proposal of Huh et al. (Nature Photon., 9, 615 (2015)) showed that a multi-photon network with a Gaussian input state can simulate a molecular spectroscopic process. Here, we present the first quantum device that generates a molecular spectroscopic signal with the phonons in a trapped ion system, using SO 2 as an example. In order to perform reliable Gaussian sampling, we develop the essential experimental technology with phonons, which includes the phase-coherent manipulation of displacement, squeezing, and rotation operations with multiple modes in a single realization. The required quantum optical operations are implemented through Raman laser beams. The molecular spectroscopic signal is reconstructed from the collective projection measurements for the two-phonon-mode. Our experimental demonstration will pave the way to large-scale molecular quantum simulations, which are classically intractable, but would be easily verifiable by real molecular spectroscopy.

[Management committees in health services: an empirical study].

PubMed

Cecilio, Luiz Carlos de Oliveira

2010-03-01

The aim of the article, based on field data collected from a continuing education program for primary health clinic administrators, was to analyze the functioning of a health service management strategy called "management committees". Different meanings and operational modalities emerged in the committees. Various antimonies appeared in the way the committees operate (autonomy versus heteronomy, reproduction of "instituted" versus "instituting" processes, and communicative versus instrumental reasoning), thus reflecting the level of complexity in this management mechanism. Healthcare provision per se by the clinics only appeared occasionally on the committees' agenda, which mainly focused on administrative issues. The article suggests that further research is needed on the coordinator's involvement in the field of forces constituting the management committee, besides developing pedagogical strategies to support the clinic coordinators and health teams in building the committees. The primary data were submitted to an epistemological discussion anchored in the idea of double hermeneutics, multiple validation of research results, and the relationship between theory and practice.

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine

NASA Technical Reports Server (NTRS)

Rodenberg, H.; Myers, K. J.

1995-01-01

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine.

PubMed

Rodenberg, H; Myers, K J

1995-01-01

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

On the neural substrates leading to the emergence of mental operational structures

NASA Technical Reports Server (NTRS)

Ogmen, H.

1993-01-01

A developmental approach to the study of the emergence of mental operational structures in neural networks is presented. Neural architectures proposed to underlie the six stages of the sensory-motor period are discussed.

77 FR 282 - Proposed Settlement Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-04

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

14 CFR 91.1067 - Initial and recurrent flight attendant crewmember testing requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... emergency; (d) Briefing of passengers; (e) Location and operation of portable fire extinguishers and other... person to move rapidly to an exit in an emergency as prescribed by the program manager's operations...

14 CFR 91.1067 - Initial and recurrent flight attendant crewmember testing requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... emergency; (d) Briefing of passengers; (e) Location and operation of portable fire extinguishers and other... person to move rapidly to an exit in an emergency as prescribed by the program manager's operations...

Respondents, Operants, and Emergents: Toward an Integrated Perspective on Behavior

NASA Technical Reports Server (NTRS)

Rumbaugh, Daune M.; Washburn, David A.; Hillix, William A.

1996-01-01

A triarchic organization of behavior, building on Skinner's description of respondents and operants, is proposed by introducing a third class of behavior called 'emergents.' Emergents are new responses, never specifically reinforced, that require operations more complex than association. Some of these operations occur naturally only in animals above a minimum level of brain complexity, and are developed in an interaction between treatment and organismic variables. (Here complexity is defined in terms of relative levels of hierarchical integration made possible both by the amount of brain, afforded both by brain-body allometric relationships and by encephalization, and, also, the elaboration of dendritic and synaptic connections within the cortex and connections between various parts/regions of the brain.) Examples of emergents are discussed to advance this triarchic view, of behavior. The prime example is language. This triarchic view reflects both the common goals and the cumulative nature of psychological science.

Consensus Statement on Advancing Research in Emergency Department Operations and Its Impact on Patient Care

PubMed Central

Ward, Michael J.; Chang, Anna Marie; Pines, Jesse M.; Jouriles, Nick; Yealy, Donald M.

2016-01-01

The Consensus Conference on “Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care,” hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but underserved area. The EDOSG is a research consortium dedicated to promoting evidence based clinical practice in Emergency Medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we called for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multi-site clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence based research, 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system including observation units, fast tracks, waiting rooms, laboratories and radiology sub-units; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research and nontraditional publications. PMID:26014365

State of emergency medicine in Rwanda 2015: an innovative trainee and trainer model.

PubMed

Mbanjumucyo, Gabin; DeVos, Elizabeth; Pulfrey, Simon; Epino, Henry M

2015-01-01

The 1994 Rwandan war and genocide left more than 1 million people dead; millions displaced; and the country's economic, social, and health infrastructure destroyed. Despite remaining one of the poorest countries in the world, Rwanda has made remarkable gains in health, social, and economic development over the last 20 years, but modern emergency care has been slow to progress. Rwanda has recently established the Human Resources for Health program to rapidly build capacity in multiple sectors of its healthcare delivery system, including emergency medicine. This project involves multiple medical and surgical residencies, nursing programs, allied health professional trainings, and hospital administrative support. A real strength of the program is that trainers work with international faculty at Rwanda's referral hospital, but also as emergency medicine specialty trainers when returning to their respective district hospitals. Rwanda's first emergency medicine trainees are playing a unique and important role in the implementation of emergency care systems and education in the country's district hospitals. While there has been early vital progress in building emergency medicine's foundations in Rwanda, there remains much work to be done. This will be accomplished with careful planning and strong commitment from the country's healthcare and emergency medicine leaders.

A novel PON-based mobile distributed cluster of antennas approach to provide impartial and broadband services to end users

NASA Astrophysics Data System (ADS)

Sana, Ajaz; Saddawi, Samir; Moghaddassi, Jalil; Hussain, Shahab; Zaidi, Syed R.

2010-01-01

In this research paper we propose a novel Passive Optical Network (PON) based Mobile Worldwide Interoperability for Microwave Access (WiMAX) access network architecture to provide high capacity and performance multimedia services to mobile WiMAX users. Passive Optical Networks (PON) networks do not require powered equipment; hence they cost lower and need less network management. WiMAX technology emerges as a viable candidate for the last mile solution. In the conventional WiMAX access networks, the base stations and Multiple Input Multiple Output (MIMO) antennas are connected by point to point lines. Ideally in theory, the Maximum WiMAX bandwidth is assumed to be 70 Mbit/s over 31 miles. In reality, WiMAX can only provide one or the other as when operating over maximum range, bit error rate increases and therefore it is required to use lower bit rate. Lowering the range allows a device to operate at higher bit rates. Our focus in this research paper is to increase both range and bit rate by utilizing distributed cluster of MIMO antennas connected to WiMAX base stations with PON based topologies. A novel quality of service (QoS) algorithm is also proposed to provide admission control and scheduling to serve classified traffic. The proposed architecture presents flexible and scalable system design with different performance requirements and complexity.

Three-dimensional imaging through turbid media based on polarization-difference liquid-crystal microlens array

NASA Astrophysics Data System (ADS)

Xin, Zhaowei; Wei, Dong; Li, Dapeng; Xie, Xingwang; Chen, Mingce; Zhang, Xinyu; Wang, Haiwei; Xie, Changsheng

2018-02-01

In this paper, a polarization difference liquid-crystal microlens array (PD-LCMLA) for three dimensional imaging application through turbid media is fabricated and demonstrated. This device is composed of a twisted nematic liquidcrystal cell (TNLCC), a polarizer and a liquid-crystal microlens array. The polarizer is sandwiched between the TNLCC and LCMLA to help the polarization difference system achieving the orthogonal polarization raw images. The prototyped camera for polarization difference imaging has been constructed by integrating the PD-LCMLA with an image sensor. The orthogonally polarized light-field images are recorded by switching the working state of the TNLCC. Here, by using a special microstructure in conjunction with the polarization-difference algorithm, we demonstrate that the three-dimensional information in the scattering media can be retrieved from the polarization-difference imaging system with an electrically tunable PD-LCMLA. We further investigate the system's potential function based on the flexible microstructure. The microstructure provides a wide operation range in the manipulation of incident beams and also emerges multiple operation modes for imaging applications, such as conventional planar imaging, polarization imaging mode, and polarization-difference imaging mode. Since the PD-LCMLA demonstrates a very low power consumption, multiple imaging modes and simple manufacturing, this kind of device presents a potential to be used in many other optical and electro-optical systems.

Operation Windshield and the simplification of emergency management.

PubMed

Andrews, Michael

2016-01-01

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

Complex matrix multiplication operations with data pre-conditioning in a high performance computing architecture

DOEpatents

Eichenberger, Alexandre E; Gschwind, Michael K; Gunnels, John A

2014-02-11

Mechanisms for performing a complex matrix multiplication operation are provided. A vector load operation is performed to load a first vector operand of the complex matrix multiplication operation to a first target vector register. The first vector operand comprises a real and imaginary part of a first complex vector value. A complex load and splat operation is performed to load a second complex vector value of a second vector operand and replicate the second complex vector value within a second target vector register. The second complex vector value has a real and imaginary part. A cross multiply add operation is performed on elements of the first target vector register and elements of the second target vector register to generate a partial product of the complex matrix multiplication operation. The partial product is accumulated with other partial products and a resulting accumulated partial product is stored in a result vector register.

Hand trauma: A prospective observational study reporting diagnostic concordance in emergency hand trauma which supports centralised service improvements.

PubMed

Miranda, B H; Spilsbury, Z P; Rosala-Hallas, A; Cerovac, S

2016-10-01

Hand injuries are common, contributing up to 30% of accident and emergency (A&E) attendances. The aim of this study was to prospectively analyse the pathological demographics of hand injuries in a level 1 trauma centre with a Hand Trauma Unit and direct A&E links, and compare clinical and intra-operative findings. The null hypothesis was that there would be no differences between clinical and intra-operative findings (100% diagnostic concordance). Data were prospectively collected for referrals during 2012. Referral diagnosis, additional pathologies found on clinical assessment and intra-operative findings were documented on a live database accessible from both the Hand Unit and associated operating theatres. Odds ratios were calculated using SAS. Injuries (1526) were identified in 1308 patients included in the study. Diagnostic concordance between Hand Unit clinical examination and intra-operative findings was 92.5% ± 2.85% (mean ± SEM); this was lower for flexor tendon injuries (56.3%) because a greater number of additional pathologies were found intra-operatively (2.25 ± 0.10). This 'trend' was noted across multiple referral pathologies including phalangeal fractures (1.28 ± 0.02; 82.9%), lacerations (1.33 ± 0.04; 79.1%), extensor tendon injuries (1.30 ± 0.05; 87.8%) and dislocations (1.18 ± 0.05; 87.8%). Odds ratio analysis indicated a relationship between primary referral diagnoses that were more or less likely to be associated with additional injuries (p < 0.05); referral diagnoses of flexor tendon injuries and lacerations were most likely to be associated with additional injuries. As hand injuries are a common presentation to A&E departments, greater emphasis should be placed on training clinicians in the management of hand trauma. Our findings, coupled with the presented relevant literature reports, lead us to advocate that A&E departments should move towards a system wherein links to specialist hand trauma services are in place; we hereby present useful data for hospitals implementing such services. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Business continuity management in emerging markets: the case of Jordan.

PubMed

Sawalha, Ihab H; Anchor, John R

2012-01-01

Despite their considerable growth in last few decades, emerging markets (EM) face numerous risks that have the potential to slow down or obstruct their development. Three main issues are discussed in this paper: first, the risks facing organisations operating in emerging markets and Jordan in particular; secondly, the role of business continuity management (BCM) in emerging markets; and thirdly, potential factors that underpin the role of BCM in emerging markets. These issues are significant, as they represent the role of BCM in highly dynamic and fast changing business environments. The paper provides a discussion of the significance of BCM in reducing or preventing risks facing organisations operating in emerging markets, especially those in Jordan.

Isolated transient loss of consciousness is an indicator of significant injury.

PubMed

Owings, J T; Wisner, D H; Battistella, F D; Perlstein, J; Walby, W F; Tharratt, R S

1998-09-01

To determine if isolated transient loss of consciousness is an indicator of significant injury. University-based level I trauma center. Phase 1 retrospective case series of all patients with trauma admitted directly from the emergency department to the operating room or an intensive care unit who had transient loss of consciousness as their only trauma triage criterion. Phase 2 prospective case series of all trauma patients transported by emergency medical system personnel with transient loss of consciousness as their only trauma triage criterion. Emergency operation and intensive care unit admission. Phase 1: From January 1, 1992, to March 31, 1995, we admitted 10255 patients with trauma. Three hundred seven (3%) met the enrollment criteria and were admitted to the operating room (n = 168) or intensive care unit (n = 139). Of these, 58 (18.9%) were taken to the operating room emergently to manage life-threatening injuries: 11 (4%) had craniotomies and 47 (15%) had non-neurosurgical operations. Phase 2: From July 1 to December 31, 1996, 2770 trauma patients were transported to our facility; 135 (4.9%) met the enrollment criteria. Forty-one (30.4%) of these required admission, and 6 (4.4%) were taken emergently to the operating room from the emergency department (1 [1%] for a craniotomy, 3 [2.2%] for intra-abdominal bleeding, and 2 [1.5%] for other procedures). Two (1.5%) of the 135 patients died. Patients with isolated transient loss of consciousness are at significant risk of critical surgical and neurosurgical injuries. These patients should be triaged to trauma centers or hospitals with adequate imaging, surgical, and neurosurgical resources.

The MARS2013 Mars analog mission.

PubMed

Groemer, Gernot; Soucek, Alexander; Frischauf, Norbert; Stumptner, Willibald; Ragonig, Christoph; Sams, Sebastian; Bartenstein, Thomas; Häuplik-Meusburger, Sandra; Petrova, Polina; Evetts, Simon; Sivenesan, Chan; Bothe, Claudia; Boyd, Andrea; Dinkelaker, Aline; Dissertori, Markus; Fasching, David; Fischer, Monika; Föger, Daniel; Foresta, Luca; Fritsch, Lukas; Fuchs, Harald; Gautsch, Christoph; Gerard, Stephan; Goetzloff, Linda; Gołebiowska, Izabella; Gorur, Paavan; Groemer, Gerhard; Groll, Petra; Haider, Christian; Haider, Olivia; Hauth, Eva; Hauth, Stefan; Hettrich, Sebastian; Jais, Wolfgang; Jones, Natalie; Taj-Eddine, Kamal; Karl, Alexander; Kauerhoff, Tilo; Khan, Muhammad Shadab; Kjeldsen, Andreas; Klauck, Jan; Losiak, Anna; Luger, Markus; Luger, Thomas; Luger, Ulrich; McArthur, Jane; Moser, Linda; Neuner, Julia; Orgel, Csilla; Ori, Gian Gabriele; Paternesi, Roberta; Peschier, Jarno; Pfeil, Isabella; Prock, Silvia; Radinger, Josef; Ramirez, Barbara; Ramo, Wissam; Rampey, Mike; Sams, Arnold; Sams, Elisabeth; Sandu, Oana; Sans, Alejandra; Sansone, Petra; Scheer, Daniela; Schildhammer, Daniel; Scornet, Quentin; Sejkora, Nina; Stadler, Andrea; Stummer, Florian; Taraba, Michael; Tlustos, Reinhard; Toferer, Ernst; Turetschek, Thomas; Winter, Egon; Zanella-Kux, Katja

2014-05-01

We report on the MARS2013 mission, a 4-week Mars analog field test in the northern Sahara. Nineteen experiments were conducted by a field crew in Morocco under simulated martian surface exploration conditions, supervised by a Mission Support Center in Innsbruck, Austria. A Remote Science Support team analyzed field data in near real time, providing planning input for the management of a complex system of field assets; two advanced space suit simulators, four robotic vehicles, an emergency shelter, and a stationary sensor platform in a realistic work flow were coordinated by a Flight Control Team. A dedicated flight planning group, external control centers for rover tele-operations, and a biomedical monitoring team supported the field operations. A 10 min satellite communication delay and other limitations pertinent to human planetary surface activities were introduced. The fields of research for the experiments were geology, human factors, astrobiology, robotics, tele-science, exploration, and operations research. This paper provides an overview of the geological context and environmental conditions of the test site and the mission architecture, in particular the communication infrastructure emulating the signal travel time between Earth and Mars. We report on the operational work flows and the experiments conducted, including a deployable shelter prototype for multiple-day extravehicular activities and contingency situations.

Lunar Communication Terminals for NASA Exploration Missions: Needs, Operations Concepts and Architectures

NASA Technical Reports Server (NTRS)

Bhasin, Kul B.; Warner, Joseph D.; Anderson, Lynn M.

2008-01-01

NASA is conducting architecture studies prior to deploying a series of short- and long-duration human and robotic missions for the exploration of the Moon and Mars under the Vision for Space Exploration Initiative. A key objective of these missions is to establish and expand, through a series of launches, a system of systems approach to exploration capabilities and science return. The systems identified were Crew Exploration Vehicles, crew and cargo launch vehicles, crew EVA suits, crew and cargo landers, habitats, mobility carriers, and small, pressurized rovers. Multiple space communication networks and systems, deployed over time, will support these space exploration systems of systems. Each deployment phase will support interoperability of components and provide 20 years of legacy systems. In this paper, we describe the modular lunar communications terminals needed for the emerging lunar mission operational scenarios. These lunar communication terminals require flexibility for use in stationary, integrated, and mobile environments. They will support links directly to Earth, to lunar relay satellites, to astronauts and to fixed and mobile lunar surface systems. The operating concepts and traffic models are presented for these terminals within variety of lunar scenarios. A preliminary architecture is outlined, providing for suitable long-duration operations in the harsh lunar environment.

Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: operative capacities of 78 district hospitals in 7 low- and middle-income countries.

PubMed

LeBrun, Drake G; Chackungal, Smita; Chao, Tiffany E; Knowlton, Lisa M; Linden, Allison F; Notrica, Michelle R; Solis, Carolina V; McQueen, K A Kelly

2014-03-01

Surgery has been neglected in low- and middle-income countries for decades. It is vital that the Post-2015 Development Agenda reflect that surgery is an important part of a comprehensive global health care delivery model. We compare the operative capacities of multiple low- and middle-income countries and identify critical gaps in surgical infrastructure. The Harvard Humanitarian Initiative survey tool was used to assess the operative capacities of 78 government district hospitals in Bangladesh (n = 7), Bolivia (n = 11), Ethiopia (n = 6), Liberia (n = 11), Nicaragua (n = 10), Rwanda (n = 21), and Uganda (n = 12) from 2011 to 2012. Key outcome measures included infrastructure, equipment availability, physician and nonphysician surgical providers, operative volume, and pharmaceutical capacity. Seventy of 78 district hospitals performed operations. There was fewer than one surgeon or anesthesiologist per 100,000 catchment population in all countries except Bolivia. There were no physician anesthesiologists in any surveyed hospitals in Rwanda, Liberia, Uganda, or in the majority of hospitals in Ethiopia. Mean annual operations per hospital ranged from 374 in Nicaragua to 3,215 in Bangladesh. Emergency operations and obstetric operations constituted 57.5% and 40% of all operations performed, respectively. Availability of pulse oximetry, essential medicines, and key infrastructure (water, electricity, oxygen) varied widely between and within countries. The need for operative procedures is not being met by the limited operative capacity in numerous low- and middle-income countries. It is of paramount importance that this gap be addressed by prioritizing essential surgery and safe anesthesia in the Post-2015 Development Agenda. Copyright © 2014 Mosby, Inc. All rights reserved.

Facilitating Emergent Literacy Skills: A Literature-Based, Multiple Intelligence Approach

ERIC Educational Resources Information Center

Brand, Susan Trostle

2006-01-01

Educators have continually sought to achieve a balance between a phonics-based, code-emphasis program and a more holistic, meaning-based approach to emergent literacy instruction. This article describes an integrated phonics and literature-based approach to developing children's emergent literacy skills. These skills included alphabet knowledge,…

Assisting People with Multiple Disabilities to Use Computers with Multiple Mice

ERIC Educational Resources Information Center

Shih, Ching-Hsiang; Shih, Ching-Tien

2009-01-01

This study assessed the combination of multiple mice aid with two persons with multiple disabilities. Complete mouse operation which needed the physically functional sound, was distributed among their limbs with remaining ability. Through these decentralized operations, they could still reach complete mouse pointing control. Initially, both…

[Treatment of localized prostate cancer: the role of robotic radical prostatectomy].

PubMed

Iselin, C E

2008-12-03

Robotic prostatectomy has progressively emerged as an oncologic and functional equivalent to the gold standard of open surgery, with minimally invasive advantages such as a short hospital stay, less blood loss and early return to complete activity. However, mastering the technique remains delicate and requires regular and sufficient practice to reach the aforementionned advantages. Because of the marketing pressure, there is now a plethora of robots available in some areas. This will lead to the multiplication of occasional operators, whose negative impact on the efficiency of the procedure is demonstrated. The solution may be that of aviation: improve skills on a simulator in order to correctly perform clinically. It is now necessary to stimulate the elaboration of such a simulator.

[The protection of health in law enforcement].

PubMed

Pira, Enrico

2014-01-01

Herein the question of health protection/safety and well being in the Law Enforcement is introduced and includes examples of some particular risk conditions that may be multiple and polymorphous. Not only the "traditional" sources are involved in these risks, like chemical, physical and biological agents, but other issues emerge in these "new scenarios" connected to risk factors involving organization and/or psychosocial elements. From this, we may deduce that there is a specific need for all the operators involved in prevention/care in this particular sector to be well versed on the highest possible updated specialized knowledge along with having a complete and thorough mastery of the best practices in Occupational Medicine to face this task in the correct manner:

A bioethics for all seasons.

PubMed

Chan, Sarah

2015-01-01

The last four decades have seen the emergence and flourishing of the field of bioethics and its incorporation into wide-ranging aspects of society, from the clinic or laboratory through to public policy and the media. Yet considerable debate still exists over what bioethics is and how it should be done. In this paper I consider the question of what makes good bioethics. Drawing on historical and contemporary examples, I suggest that bioethics encompasses multiple modes of responding to moral disagreement, and that an awareness of which mode is operational in a given context is essential to doing good bioethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

BANANAS: providing child care services to a multi-ethnic community.

PubMed

Vu, Catherine M; Schwartz, Sara L; Austin, Michael J

2011-01-01

BANANAS, Inc. is a nonprofit organization that has provided child care resource and referral services for over 35 years. BANANAS emerged as a grassroots effort initiated by a group of female volunteers who sought to build a network of women with children who needed childcare. As the organization developed, its leaders recognized and responded to additional needs, including resource and information sharing, workshops and classes, and political advocacy. Beginning as a collective, BANANAS has grown into a multifaceted service delivery and advocacy nonprofit operating with an annual budget of $12 million. This history of the agency reflects the development of a unique community-based effort, its challenges and rewards, and the multiple successes that this pioneering nonprofit has experienced.

Attractive noncovalent interactions in asymmetric catalysis: Links between enzymes and small molecule catalysts

PubMed Central

Knowles, Robert R.; Jacobsen, Eric N.

2010-01-01

Catalysis by neutral, organic, small molecules capable of binding and activating substrates solely via noncovalent interactions—particularly H-bonding—has emerged as an important approach in organocatalysis. The mechanisms by which such small molecule catalysts induce high enantioselectivity may be quite different from those used by catalysts that rely on covalent interactions with substrates. Attractive noncovalent interactions are weaker, less distance dependent, less directional, and more affected by entropy than covalent interactions. However, the conformational constraint required for high stereoinduction may be achieved, in principle, if multiple noncovalent attractive interactions are operating in concert. This perspective will outline some recent efforts to elucidate the cooperative mechanisms responsible for stereoinduction in highly enantioselective reactions promoted by noncovalent catalysts. PMID:20956302

48 CFR 1318.201 - Contingency operation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contingency operation. 1318.201 Section 1318.201 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACTING METHODS AND CONTRACT TYPES EMERGENCY ACQUISITIONS Emergency Acquisition Flexibilities 1318.201 Contingency...

Usability verification of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) in patients with trauma: A retrospective cohort study.

PubMed

Park, Hyun Oh; Kim, Jong Woo; Kim, Sung Hwan; Moon, Seong Ho; Byun, Joung Hun; Kim, Ki Nyun; Yang, Jun Ho; Lee, Chung Eun; Jang, In Seok; Kang, Dong Hun; Kim, Seong Chun; Kang, Changwoo; Choi, Jun Young

2017-11-01

Early estimation of mortality risk in patients with trauma is essential. In this study, we evaluate the validity of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) for predicting in-hospital mortality in patients with trauma. Furthermore, we compared the REMS and the EMTRAS with 2 other scoring systems: the Revised Trauma Score (RTS) and Injury Severity score (ISS).We performed a retrospective chart review of 6905 patients with trauma reported between July 2011 and June 2016 at a large national university hospital in South Korea. We analyzed the associations between patient characteristics, treatment course, and injury severity scoring systems (ISS, RTS, EMTRAS, and REMS) with in-hospital mortality. Discriminating power was compared between scoring systems using the areas under the curve (AUC) of receiver operating characteristic (ROC) curves.The overall in-hospital mortality rate was 3.1%. Higher EMTRAS and REMS scores were associated with hospital mortality (P < .001). The ROC curve demonstrated adequate discrimination (AUC = 0.957 for EMTRAS and 0.9 for REMS). After performing AUC analysis followed by Bonferroni correction for multiple comparisons, EMTRAS was significantly superior to REMS and ISS in predicting in-hospital mortality (P < .001), but not significantly different from the RTS (P = .057). The other scoring systems were not significantly different from each other.The EMTRAS and the REMS are simple, accurate predictors of in-hospital mortality in patients with trauma.

Increase urban resilience by planning the public spaces uses for humanitarian interventions.

NASA Astrophysics Data System (ADS)

Delaitre, Maxime; Barroca, Bruno; Vargas, Jorge; Cornejo, Christian; Sierra, Alexis

2017-04-01

Challenges in post-disaster crisis of natural origin seem to have a strong relation with territory characteristics (location, habitat, propagation, etc.). Moreover, they determine those requirements needed for humanitarian interventions. Decision-making at response and recuperation stages are supported or limited depending on the availability of public spaces to be used for victims' accommodation, field hospitals and rubble deposits. In the case of Lima and Callao (Peru), the presence and superposition of multiple governmental levels - national, regional (1), provincial (2) and district (50) - result in a highly-complex local Disaster Risk Management system for response coordination. The diversity of actors, their responsibilities and individual initiative suggest competition for the resources available in an emergency situation. Resource location determines if humanitarian operations can be run in an effective and efficient way. In this context, public space is a fundamental resource; if it is well-selected, it will provide access to accumulated resources such as water, electricity and telecommunications for the affected population. To increase urban resilience, it requires previous planning and coordination for emergency response, where institutional and territorial configurations are decisive factors for the recuperation and rehabilitation processes performance. This communication will present the institutional and territorial dimensions of the Peruvian capital which condition emergency management performances to consider the crisis management opportunities, offered by territorial analysis and estimations of actors' needs. It would be a starting point for decision-making on emergence activities locations and for establishing coordination frameworks concerning territorial issues and challenges.

Subway emergency preparedness in Shanghai: A focused group and interview study exploring the perceived experiences of senior citizens and the disabled.

PubMed

Baffoe, Benjamin Ohene Kwapong; Shiyuan, Zheng

As Shanghai's population increases and currently being boosted by an influx of foreigners, there has been pressure on the subway system and this has led to a great concern for the aged and disabled people (including foreigners) who use the subway during emergency situations. The present study uses an exploratory research approach including a focus group discussion (FGD) and interviews to uncover the experiences, safety concerns, and challenges that the aged and disabled faces when using the subway. A total of 38 participants were involved in the study, which comprises of three FGDs and interviews conducted in the city of Shanghai. The findings reveal that most aged and disabled subway riders have little or no knowledge about emergency safety measures or safety symbols, the administering of first aid and have language barrier concerns. This study recommends that policy makers and sub-way operators should get the aged and disabled people involved in developing more educational programs that will help them to better the concept of safety prevention measures and it also suggests holding more emergency drills involving the aged and disabled. Braille language symbols, sign languages on TV screens, specially designed sub-way maps, low-frequency alarms with flashing lights, and information printed in multiple international languages should also be provided to help foreigners understand the instructions and information in the subways. Additionally, these measures could help all commuters to feel safer when using the subway.

Multiple bio-monitoring system using visible light for electromagnetic-wave free indoor healthcare

NASA Astrophysics Data System (ADS)

An, Jinyoung; Pham, Ngoc Quan; Chung, Wan-Young

2017-12-01

In this paper, a multiple biomedical data transmission system with visible light communication (VLC) is proposed for an electromagnetic-wave-free indoor healthcare. VLC technology has emerged as an alternative solution to radio-frequency (RF) wireless systems, due to its various merits, e.g., ubiquity, power efficiency, no RF radiation, and security. With VLC, critical bio-medical signals, including electrocardiography (ECG), can be transmitted in places where RF radiation is restricted. This potential advantage of VLC could save more lives in emergency situations. A time hopping (TH) scheme is employed to transfer multiple medical-data streams in real time with a simple system design. Multiple data streams are transmitted using identical color LEDs and go into an optical detector. The received multiple data streams are demodulated and rearranged using a TH-based demodulator. The medical data is then monitored and managed to provide the necessary medical care for each patient.

Emergency vehicle traffic signal preemption system

NASA Technical Reports Server (NTRS)

Bachelder, Aaron D. (Inventor); Foster, Conrad F. (Inventor)

2011-01-01

An emergency vehicle traffic light preemption system for preemption of traffic lights at an intersection to allow safe passage of emergency vehicles. The system includes a real-time status monitor of an intersection which is relayed to a control module for transmission to emergency vehicles as well as to a central dispatch office. The system also provides for audio warnings at an intersection to protect pedestrians who may not be in a position to see visual warnings or for various reasons cannot hear the approach of emergency vehicles. A transponder mounted on an emergency vehicle provides autonomous control so the vehicle operator can attend to getting to an emergency and not be concerned with the operation of the system. Activation of a priority-code (i.e. Code-3) situation provides communications with each intersection being approached by an emergency vehicle and indicates whether the intersection is preempted or if there is any conflict with other approaching emergency vehicles. On-board diagnostics handle various information including heading, speed, and acceleration sent to a control module which is transmitted to an intersection and which also simultaneously receives information regarding the status of an intersection. Real-time communications and operations software allow central and remote monitoring, logging, and command of intersections and vehicles.

Department of Energy Operational Readiness Review for the Waste Isolation Pilot Plant

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

None, None

The U.S. Department of Energy (DOE) has completed an Operational Readiness Review (ORR) for the restart of Contact Handled (CH) waste emplacement at the Waste Isolation Pilot Plant (WIPP) located near Carlsbad, New Mexico. The ORR team assessed the readiness of Nuclear Waste Partnership, LLC (NWP) to manage and perform receipt through CH waste emplacement, and associated waste handling and management activities, including the ability of the National TRU Program (NTP) to evaluate the waste currently stored at the WIPP site against the revised and enhanced Waste Acceptance Criteria (WAC). Field work for this review began on November 14, 2015more » and was completed on November 30, 2016. The DOE ORR was conducted in accordance with the Department of Energy Operational Readiness Review Implementation Plan for the Waste Isolation Pilot Plant, dated November 8, 2016, and DOE Order 425.1D, Verification of Readiness to Start Up or Restart Nuclear Facilities. The review activities included personnel interviews, record reviews, direct observation of operations and maintenance demonstrations, and observation of multiple operational and emergency drills/exercises. The DOE ORR also evaluated the adequacy of the contractor’s ORR (CORR) and the readiness of the DOE Carlsbad field Office (CBFO) to oversee the startup and execution of CH waste emplacement activities at the WIPP facility. The WIPP facility is categorized as a Hazard Category 2 DOE Nonreactor Nuclear Facility for all surface and Underground (UG) operations per DOE-STD-1027-92, Hazard Categorization and Accident Analysis Techniques for Compliance with DOE Order 5480.23, Nuclear Safety Analysis Reports. In addition, the WIPP experienced two events in February, 2014 that resulted in Accident Investigations being performed in accordance with the requirements of DOE Order 225.1B, Accident Investigations. Based upon the results of the accident investigations and hazard categorization of the facility, the team placed significant emphasis on the following areas: fire protection, emergency preparedness, radiological protection, nuclear safety, and operations. The identification of specific focus areas was not intended to diminish the importance of other areas of the review, but to ensure that these areas received a particularly thorough and in-depth evaluation due to their significance with respect to the safe operation of the facility.« less

Case management redesign in an urban facility.

PubMed

Almaden, Stefany; Freshman, Brenda; Quaye, Beverly

2011-01-01

To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.

Exploring the Feasibility of a DNA Computer: Design of an ALU Using Sticker-Based DNA Model.

PubMed

Sarkar, Mayukh; Ghosal, Prasun; Mohanty, Saraju P

2017-09-01

Since its inception, DNA computing has advanced to offer an extremely powerful, energy-efficient emerging technology for solving hard computational problems with its inherent massive parallelism and extremely high data density. This would be much more powerful and general purpose when combined with other existing well-known algorithmic solutions that exist for conventional computing architectures using a suitable ALU. Thus, a specifically designed DNA Arithmetic and Logic Unit (ALU) that can address operations suitable for both domains can mitigate the gap between these two. An ALU must be able to perform all possible logic operations, including NOT, OR, AND, XOR, NOR, NAND, and XNOR; compare, shift etc., integer and floating point arithmetic operations (addition, subtraction, multiplication, and division). In this paper, design of an ALU has been proposed using sticker-based DNA model with experimental feasibility analysis. Novelties of this paper may be in manifold. First, the integer arithmetic operations performed here are 2s complement arithmetic, and the floating point operations follow the IEEE 754 floating point format, resembling closely to a conventional ALU. Also, the output of each operation can be reused for any next operation. So any algorithm or program logic that users can think of can be implemented directly on the DNA computer without any modification. Second, once the basic operations of sticker model can be automated, the implementations proposed in this paper become highly suitable to design a fully automated ALU. Third, proposed approaches are easy to implement. Finally, these approaches can work on sufficiently large binary numbers.

The association between pediatric general emergency department visits and post operative adenotonsillectomy hospital return.

PubMed

Bangiyev, John N; Thottam, Prasad J; Christenson, Jennifer R; Metz, Christopher M; Haupert, Michael S

2015-02-01

To define the association between pre-operative general emergency department visits, gender, and pre-operative diagnosis with post-operative emergency department return following adenotonsillectomy. Retrospective chart review of 1468 pediatric patients who underwent adenotonsillectomy at a tertiary pediatric hospital between 2011 and 2013. There was a significant relationship between patients who visited the ED pre-operatively, 25% (N=96) returned to the ED post-procedure, compared to 10% who did not have a pre-operative ED visit. There was an overall significant relation between having a pre-operative visit (χ(2)=53.6, df=1, p<0.001), female gender (female=56.9%; male=43.1%; χ(2)=4.2, df=1, p=0.04), and having a preoperative diagnosis of recurrent strep tonsillitis (OSA and RST=18%; RST=17.5%; OSA=11.8%; χ(2)=12.8, p=0.002) and having a post-operative ED visit. Generalized pre-operative visits along with gender and diagnosis of recurrent streptococcal tonsillitis were found to be positively associated with post-operative ED visits for common post-operative complaints. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Graph Pattern Matching Workloads in Graph Analysis Systems

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

Hong, Seokyong; Lee, Sangkeun; Lim, Seung-Hwan

2016-01-01

Graph analysis has emerged as a powerful method for data scientists to represent, integrate, query, and explore heterogeneous data sources. As a result, graph data management and mining became a popular area of research, and led to the development of plethora of systems in recent years. Unfortunately, the number of emerging graph analysis systems and the wide range of applications, coupled with a lack of apples-to-apples comparisons, make it difficult to understand the trade-offs between different systems and the graph operations for which they are designed. A fair comparison of these systems is a challenging task for the following reasons:more » multiple data models, non-standardized serialization formats, various query interfaces to users, and diverse environments they operate in. To address these key challenges, in this paper we present a new benchmark suite by extending the Lehigh University Benchmark (LUBM) to cover the most common capabilities of various graph analysis systems. We provide the design process of the benchmark, which generalizes the workflow for data scientists to conduct the desired graph analysis on different graph analysis systems. Equipped with this extended benchmark suite, we present performance comparison for nine subgraph pattern retrieval operations over six graph analysis systems, namely NetworkX, Neo4j, Jena, Titan, GraphX, and uRiKA. Through the proposed benchmark suite, this study reveals both quantitative and qualitative findings in (1) implications in loading data into each system; (2) challenges in describing graph patterns for each query interface; and (3) different sensitivity of each system to query selectivity. We envision that this study will pave the road for: (i) data scientists to select the suitable graph analysis systems, and (ii) data management system designers to advance graph analysis systems.« less

Proposed energy conservation contingency plan: emergency restrictions on advertising lighting. Authorities, need, rationale, and operation

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

Not Available

The emergency restrictions on advertising lighting proposed in Energy Conservation Contingency Plan No. 5 of 1977 are presented. A statement is given on the need for rationale and operation of the Contingency Plan.

Emergency egress requirements for caution and warning, logistics, maintenance, and assembly stage MB-6 of Space Station Freedom

NASA Technical Reports Server (NTRS)

Ray, Paul S.

1992-01-01

The safety and survival of the crewmembers has been the prime concern of NASA. Previous studies have been conducted mainly for emergencies occurring during the operating mode of the fully assembled Station. The present study was conducted to evaluate the emergency requirements for the caution and warning, logistics, maintenance, and assembly stage MB-6 of the Station in space. Effective caution and warning is essential to achieve safe egress in emergencies. In order to survive a long period in space, the safety and emergency requirements for maintenance, logistics, and extravehicular assembly operation in space must be met.

Development of a Conceptual Chum Salmon Emergence Model for Ives Island

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

Murray, Christopher J.; Geist, David R.; Arntzen, Evan V.

2011-02-09

The objective of the study described herein was to develop a conceptual model of chum salmon emergence that was based on empirical water temperature of the riverbed and river in specific locations where chum salmon spawn in the Ives Island area. The conceptual model was developed using water temperature data that have been collected in the past and are currently being collected in the Ives Island area. The model will be useful to system operators who need to estimate the complete distribution of chum salmon emergence (first emergence through final emergence) in order to balance chum salmon redd protection andmore » power system operation.« less

A forward-adjoint operator pair based on the elastic wave equation for use in transcranial photoacoustic computed tomography

PubMed Central

Mitsuhashi, Kenji; Poudel, Joemini; Matthews, Thomas P.; Garcia-Uribe, Alejandro; Wang, Lihong V.; Anastasio, Mark A.

2017-01-01

Photoacoustic computed tomography (PACT) is an emerging imaging modality that exploits optical contrast and ultrasonic detection principles to form images of the photoacoustically induced initial pressure distribution within tissue. The PACT reconstruction problem corresponds to an inverse source problem in which the initial pressure distribution is recovered from measurements of the radiated wavefield. A major challenge in transcranial PACT brain imaging is compensation for aberrations in the measured data due to the presence of the skull. Ultrasonic waves undergo absorption, scattering and longitudinal-to-shear wave mode conversion as they propagate through the skull. To properly account for these effects, a wave-equation-based inversion method should be employed that can model the heterogeneous elastic properties of the skull. In this work, a forward model based on a finite-difference time-domain discretization of the three-dimensional elastic wave equation is established and a procedure for computing the corresponding adjoint of the forward operator is presented. Massively parallel implementations of these operators employing multiple graphics processing units (GPUs) are also developed. The developed numerical framework is validated and investigated in computer19 simulation and experimental phantom studies whose designs are motivated by transcranial PACT applications. PMID:29387291

Distributed controller clustering in software defined networks

PubMed Central

Gani, Abdullah; Akhunzada, Adnan; Talebian, Hamid; Choo, Kim-Kwang Raymond

2017-01-01

Software Defined Networking (SDN) is an emerging promising paradigm for network management because of its centralized network intelligence. However, the centralized control architecture of the software-defined networks (SDNs) brings novel challenges of reliability, scalability, fault tolerance and interoperability. In this paper, we proposed a novel clustered distributed controller architecture in the real setting of SDNs. The distributed cluster implementation comprises of multiple popular SDN controllers. The proposed mechanism is evaluated using a real world network topology running on top of an emulated SDN environment. The result shows that the proposed distributed controller clustering mechanism is able to significantly reduce the average latency from 8.1% to 1.6%, the packet loss from 5.22% to 4.15%, compared to distributed controller without clustering running on HP Virtual Application Network (VAN) SDN and Open Network Operating System (ONOS) controllers respectively. Moreover, proposed method also shows reasonable CPU utilization results. Furthermore, the proposed mechanism makes possible to handle unexpected load fluctuations while maintaining a continuous network operation, even when there is a controller failure. The paper is a potential contribution stepping towards addressing the issues of reliability, scalability, fault tolerance, and inter-operability. PMID:28384312

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...

Emergency Operation Center

NASA Technical Reports Server (NTRS)

Chinea, Anoushka Z.

1995-01-01

The Emergency Operation Center (EOC) is a site from which NASA LaRC Emergency Preparedness Officials exercise control and direction in an emergency. Research was conducted in order to determine what makes an effective EOC. Specifically information concerning the various types of equipment and communication capability that an efficient EOC should contain (i.e., computers, software, telephone systems, radio systems, etc.) was documented. With this information a requirements document was written stating a brief description of the equipment and required quantity to be used in an EOC and then compared to current capabilities at the NASA Langley Research Center.

Advanced missions safety. Volume 2: Technical discussion. Part 3: Emergency crew transfer

NASA Technical Reports Server (NTRS)

1972-01-01

An evaluation of methods for emergency rescue of space crews using the Earth Orbit Shuttle was conducted. Emergency situations were analyzed for the mission categories of extravehicular activity, space shuttle orbiter, space station, and research applications module (RAM). Five different transfer concept categories were analyzed and each was scored on the basis of its operational effectiveness. A cost analysis of the transfer operations was developed.

Chemical Manufacturing and Refining Industry Legitimacy: Reflective Management, Trust, Precrisis Communication to Achieve Community Efficacy.

PubMed

Heath, Robert L; Lee, Jaesub

2016-06-01

Calls for emergency right-to-know in the 1980s, and, in the 1990s, risk management planning, motivated U.S. chemical manufacturing and refining industries to operationalize a three-pronged approach to risk minimization and communication: reflective management to increase legitimacy, operational safety programs to raise trust, and community engagement designed to facilitate citizens' emergency response efficacy. To assess these management, operational, and communication initiatives, communities (often through Local Emergency Planning Committees) monitored the impact of such programs. In 2012, the fourth phase of a quasi-longitudinal study was conducted to assess the effectiveness of operational change and community outreach in one bellwether community. This study focuses on legitimacy, trust, and response efficacy to suggest that an industry can earn legitimacy credits by raising its safety and environmental impact standards, by building trust via that change, and by communicating emergency response messages to near residents to raise their response efficacy. As part of its campaign to demonstrate its concern for community safety through research, planning, and implementation of safe operations and viable emergency response systems, this industry uses a simple narrative of risk/emergency response-shelter-in-place-communicated by a spokes-character: Wally Wise Guy. © 2015 Society for Risk Analysis.

Managing Multiple Goals in Real Learning Contexts

ERIC Educational Resources Information Center

Mansfield, Caroline F.

2009-01-01

Understanding students' multiple goals in real learning contexts is an emerging area of importance for educators and researchers investigating student motivation in classrooms. This qualitative study conducted over an academic year investigates the multiple goals articulated by seven 11-year-old students and explores relationships between goals…

Food Safety - Multiple Languages

MedlinePlus

... dialect)) PDF Centers for Disease Control and Prevention French (français) Expand Section Keep Food and Water Safe After a Disaster or Emergency - ... Water Safe After a Disaster or Emergency - français (French) HTML ... Centers for Disease Control and Prevention Haitian Creole (Kreyol ayisyen) Expand Section Keep Food and Water Safe After a Disaster or Emergency - ...

Climate Modeling with a Million CPUs

NASA Astrophysics Data System (ADS)

Tobis, M.; Jackson, C. S.

2010-12-01

Michael Tobis, Ph.D. Research Scientist Associate University of Texas Institute for Geophysics Charles S. Jackson Research Scientist University of Texas Institute for Geophysics Meteorological, oceanographic, and climatological applications have been at the forefront of scientific computing since its inception. The trend toward ever larger and more capable computing installations is unabated. However, much of the increase in capacity is accompanied by an increase in parallelism and a concomitant increase in complexity. An increase of at least four additional orders of magnitude in the computational power of scientific platforms is anticipated. It is unclear how individual climate simulations can continue to make effective use of the largest platforms. Conversion of existing community codes to higher resolution, or to more complex phenomenology, or both, presents daunting design and validation challenges. Our alternative approach is to use the expected resources to run very large ensembles of simulations of modest size, rather than to await the emergence of very large simulations. We are already doing this in exploring the parameter space of existing models using the Multiple Very Fast Simulated Annealing algorithm, which was developed for seismic imaging. Our experiments have the dual intentions of tuning the model and identifying ranges of parameter uncertainty. Our approach is less strongly constrained by the dimensionality of the parameter space than are competing methods. Nevertheless, scaling up remains costly. Much could be achieved by increasing the dimensionality of the search and adding complexity to the search algorithms. Such ensemble approaches scale naturally to very large platforms. Extensions of the approach are anticipated. For example, structurally different models can be tuned to comparable effectiveness. This can provide an objective test for which there is no realistic precedent with smaller computations. We find ourselves inventing new code to manage our ensembles. Component computations involve tens to hundreds of CPUs and tens to hundreds of hours. The results of these moderately large parallel jobs influence the scheduling of subsequent jobs, and complex algorithms may be easily contemplated for this. The operating system concept of a "thread" re-emerges at a very coarse level, where each thread manages atomic computations of thousands of CPU-hours. That is, rather than multiple threads operating on a processor, at this level, multiple processors operate within a single thread. In collaboration with the Texas Advanced Computing Center, we are developing a software library at the system level, which should facilitate the development of computations involving complex strategies which invoke large numbers of moderately large multi-processor jobs. While this may have applications in other sciences, our key intent is to better characterize the coupled behavior of a very large set of climate model configurations.

Hesitant triangular fuzzy information aggregation operators based on Bonferroni means and their application to multiple attribute decision making.

PubMed

Wang, Chunyong; Li, Qingguo; Zhou, Xiaoqiang; Yang, Tian

2014-01-01

We investigate the multiple attribute decision-making (MADM) problems with hesitant triangular fuzzy information. Firstly, definition and some operational laws of hesitant triangular fuzzy elements are introduced. Then, we develop some hesitant triangular fuzzy aggregation operators based on Bonferroni means and discuss their basic properties. Some existing operators can be viewed as their special cases. Next, we apply the proposed operators to deal with multiple attribute decision-making problems under hesitant triangular fuzzy environment. Finally, an illustrative example is given to show the developed method and demonstrate its practicality and effectiveness.

Hesitant Triangular Fuzzy Information Aggregation Operators Based on Bonferroni Means and Their Application to Multiple Attribute Decision Making

PubMed Central

Zhou, Xiaoqiang; Yang, Tian

2014-01-01

We investigate the multiple attribute decision-making (MADM) problems with hesitant triangular fuzzy information. Firstly, definition and some operational laws of hesitant triangular fuzzy elements are introduced. Then, we develop some hesitant triangular fuzzy aggregation operators based on Bonferroni means and discuss their basic properties. Some existing operators can be viewed as their special cases. Next, we apply the proposed operators to deal with multiple attribute decision-making problems under hesitant triangular fuzzy environment. Finally, an illustrative example is given to show the developed method and demonstrate its practicality and effectiveness. PMID:25140338

Multiple operating system rotation environment moving target defense

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

Evans, Nathaniel; Thompson, Michael

Systems and methods for providing a multiple operating system rotation environment ("MORE") moving target defense ("MTD") computing system are described. The MORE-MTD system provides enhanced computer system security through a rotation of multiple operating systems. The MORE-MTD system increases attacker uncertainty, increases the cost of attacking the system, reduces the likelihood of an attacker locating a vulnerability, and reduces the exposure time of any located vulnerability. The MORE-MTD environment is effectuated by rotation of the operating systems at a given interval. The rotating operating systems create a consistently changing attack surface for remote attackers.

29 CFR 1926.65 - Hazardous waste operations and emergency response.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 1926.65 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Occupational Health and Environmental Controls § 1926.65 Hazardous waste operations and emergency response. (a) Scope...

Information sharing guidebook for transportation management centers, emergency operations centers, and fusion centers.

DOT National Transportation Integrated Search

2010-06-01

This guidebook provides an overview of the mission and functions of transportation management centers, emergency operations centers, and fusion centers. The guidebook focuses on the types of information these centers produce and manage and how the sh...

Information sharing guidebook for transportation management centers, emergency operations centers, and fusion centers

DOT National Transportation Integrated Search

2010-06-01

This guidebook provides an overview of the mission and functions of transportation management centers, emergency operations centers, and fusion centers. The guidebook focuses on the types of information these centers produce and manage and how the sh...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

10 CFR 39.63 - Operating and emergency procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and... radiation surveys, including surveys for detecting contamination, as required by § 39.67(c)-(e); (d...

48 CFR 1318.270 - Emergency acquisition flexibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Procurement Executive. (b) Continuity of Operations Plan. Each Contracting Activity shall have an updated Continuity of Operations Plan, in place designating emergency personnel with warrant levels. (c) Management... appropriate management controls are established and maintained to support the use of the increased thresholds...

Method of Data storing, collection and aggregation for definition of life-cycle resources of electromechanical equipment

NASA Astrophysics Data System (ADS)

Zhukovskiy, Y.; Koteleva, N.

2017-10-01

Analysis of technical and technological conditions for the emergence of emergency situations during the operation of electromechanical equipment of enterprises of the mineral and raw materials complex shows that when developing the basis for ensuring safe operation, it is necessary to take into account not only the technical condition, but also the non-stationary operation of the operating conditions of equipment, and the nonstationarity of operational operating parameters of technological processes. Violations of the operation of individual parts of the machine, not detected in time, can lead to severe accidents at work, as well as to unplanned downtime and loss of profits. That is why, the issues of obtaining and processing Big data obtained during the life cycle of electromechanical equipment, for assessing the current state of the electromechanical equipment used, timely diagnostics of emergency and pre-emergency modes of its operation, estimating the residual resource, as well as prediction the technical state on the basis of machine learning are very important. This article is dedicated to developing the special method of data storing, collection and aggregation for definition of life-cycle resources of electromechanical equipment. This method can be used in working with big data and can allow extracting the knowledge from different data types: the plants’ historical data and the factory historical data. The data of the plants contains the information about electromechanical equipment operation and the data of the factory contains the information about a production of electromechanical equipment.

Systems and Algorithms for Automated Collaborative Observation Using Networked Robotic Cameras

ERIC Educational Resources Information Center

Xu, Yiliang

2011-01-01

The development of telerobotic systems has evolved from Single Operator Single Robot (SOSR) systems to Multiple Operator Multiple Robot (MOMR) systems. The relationship between human operators and robots follows the master-slave control architecture and the requests for controlling robot actuation are completely generated by human operators. …

Flexible imaging payload for real-time fluorescent biological imaging in parabolic, suborbital and space analog environments

NASA Astrophysics Data System (ADS)

Bamsey, Matthew T.; Paul, Anna-Lisa; Graham, Thomas; Ferl, Robert J.

2014-10-01

Fluorescent imaging offers the ability to monitor biological functions, in this case biological responses to space-related environments. For plants, fluorescent imaging can include general health indicators such as chlorophyll fluorescence as well as specific metabolic indicators such as engineered fluorescent reporters. This paper describes the Flex Imager a fluorescent imaging payload designed for Middeck Locker deployment and now tested on multiple flight and flight-related platforms. The Flex Imager and associated payload elements have been developed with a focus on 'flexibility' allowing for multiple imaging modalities and change-out of individual imaging or control components in the field. The imaging platform is contained within the standard Middeck Locker spaceflight form factor, with components affixed to a baseplate that permits easy rearrangement and fine adjustment of components. The Flex Imager utilizes standard software packages to simplify operation, operator training, and evaluation by flight provider flight test engineers, or by researchers processing the raw data. Images are obtained using a commercial cooled CCD image sensor, with light-emitting diodes for excitation and a suite of filters that allow biological samples to be imaged over wavelength bands of interest. Although baselined for the monitoring of green fluorescent protein and chlorophyll fluorescence from Arabidopsis samples, the Flex Imager payload permits imaging of any biological sample contained within a standard 10 cm by 10 cm square Petri plate. A sample holder was developed to secure sample plates under different flight profiles while permitting sample change-out should crewed operations be possible. In addition to crew-directed imaging, autonomous or telemetric operation of the payload is also a viable operational mode. An infrared camera has also been integrated into the Flex Imager payload to allow concurrent fluorescent and thermal imaging of samples. The Flex Imager has been utilized to assess, in real-time, the response of plants to novel environments including various spaceflight analogs, including several parabolic flight environments as well as hypobaric plant growth chambers. Basic performance results obtained under these operational environments, as well as laboratory-based tests are described. The Flex Imager has also been designed to be compatible with emerging suborbital platforms.

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

Vardoyan, G.; Rao, Nageswara S; Towlsey, D.

In recent years, the computer networking community has seen a steady growth in bandwidth-delay products (BDPs). Several TCP variants were created to combat the shortcomings of legacy TCP when it comes to operation in high-BDP environments. These variants, among which are CUBIC, STCP, and H-TCP, have been extensively studied in some empirical contexts, and some analytical models exist for CUBIC and STCP. However, since these studies have been conducted, BDPs have risen even more, and new bulk data transfer tools have emerged that utilize multiple parallel TCP streams. In view of these new developments, it is imperative to revisit themore » question: Which congestion control algorithms are best adapted to current networking environments? In order to help resolve this question, we contribute the following: (i) using first principles, we develop a general throughput-prediction framework that takes into account buffer sizes and maximum window constraints; (ii) we validate the models using measurements and achieve low prediction errors; (iii) we note differences in TCP dynamics between two experimental configurations and find one of them to be significantly more deterministic than the other; we also find that CUBIC and H-TCP outperform STCP, especially when multiple streams are used; and (iv) we present preliminary results for modelling multiple TCP streams for CUBIC and STCP.« less

Parametric study of sensor placement for vision-based relative navigation system of multiple spacecraft

NASA Astrophysics Data System (ADS)

Jeong, Junho; Kim, Seungkeun; Suk, Jinyoung

2017-12-01

In order to overcome the limited range of GPS-based techniques, vision-based relative navigation methods have recently emerged as alternative approaches for a high Earth orbit (HEO) or deep space missions. Therefore, various vision-based relative navigation systems use for proximity operations between two spacecraft. For the implementation of these systems, a sensor placement problem can occur on the exterior of spacecraft due to its limited space. To deal with the sensor placement, this paper proposes a novel methodology for a vision-based relative navigation based on multiple position sensitive diode (PSD) sensors and multiple infrared beacon modules. For the proposed method, an iterated parametric study is used based on the farthest point optimization (FPO) and a constrained extended Kalman filter (CEKF). Each algorithm is applied to set the location of the sensors and to estimate relative positions and attitudes according to each combination by the PSDs and beacons. After that, scores for the sensor placement are calculated with respect to parameters: the number of the PSDs, number of the beacons, and accuracy of relative estimates. Then, the best scoring candidate is determined for the sensor placement. Moreover, the results of the iterated estimation show that the accuracy improves dramatically, as the number of the PSDs increases from one to three.

Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit.

PubMed

Wiler, Jennifer L; Welch, Shari; Pines, Jesse; Schuur, Jeremiah; Jouriles, Nick; Stone-Griffith, Suzanne

2015-05-01

The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers. © 2015 by the Society for Academic Emergency Medicine.

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

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

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

2000-09-27

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

Social media responses to the Annals of Emergency Medicine residents' perspective article on multiple mini-interviews.

PubMed

Joshi, Nikita K; Yarris, Lalena M; Doty, Christopher I; Lin, Michelle

2014-09-01

In May 2014, Annals of Emergency Medicine continued a successful collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM) to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Does the Multiple Mini-Interview Address Stakeholder Needs? An Applicant's Perspective" by Phillips and Garmel. This dialogue included Twitter conversations, a live videocast with the authors and other experts, and detailed discussions on the ALiEM Web site's comment section. This summary article serves the dual purpose of reporting the qualitative thematic analysis from a global online discussion and the Web analytics for our novel multimodal approach. Social media technologies provide a unique opportunity to engage with a diverse audience to detect existing and new emerging themes. Such technologies allow rapid hypothesis generation for future research and enable more accelerated knowledge translation. Copyright © 2014 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Implications and Constraints of Fiscal Laws in Contingency Contracting

DTIC Science & Technology

2013-08-30

earthquakes, and floods and are supported by U.S. military forces providing cleanup and humanitarian assistance (for example, after Hurricanes Hugo , Andrew...included operations in New Orleans in the aftermath of Hurricane Katrina and in New York after storm damage in 2012. The military has also supported...Emergency Relief Operations Domestic disaster and emergency relief operations focus on natural disasters such as hurricanes , weather storms

Mobile videoconferencing for enhanced emergency medical communication - a shot in the dark or a walk in the park? ‒‒ A simulation study.

PubMed

Melbye, Sigurd; Hotvedt, Martin; Bolle, Stein Roald

2014-06-02

Videoconferencing on mobile phones may enhance communication, but knowledge on its quality in various situations is needed before it can be used in medical emergencies. Mobile phones automatically activate loudspeaker functionality during videoconferencing, making calls particularly vulnerable to background noise. The aim of this study was to investigate if videoconferencing can be used between lay bystanders and Emergency Medical Dispatch (EMD) operators for initial emergency calls during medical emergencies, under suboptimal sound and light conditions. Videoconferencing was tested between 90 volunteers and an emergency medical dispatcher in a standardized scenario of a medical emergency. Three different environments were used for the trials: indoors with moderate background noise, outdoors with daylight and much background noise, and outdoors during nighttime with little background noise. Thirty participants were recruited for each of the three locations. After informed consent, each participant was asked to use a video mobile phone to communicate with an EMD operator. During the video call the EMD operator gave instructions for tasks to be performed by the participant. The video quality from the caller to the EMD was evaluated by the EMD operator and rated on a five step scale ranging from "not able to see" to "good video quality". Sound quality between participants and EMD operators was assessed by a method developed for this trial. Kruskal - Wallis and Chi-square tests were used for statistical analysis. Video quality was significantly different between the groups (p <0.001), and the nighttime group had lower video quality. For most sessions in the nighttime group it was still possible to see actions done at the simulated emergency site. All participants were able to perform their tasks according to the instructions given by dispatchers, although with a need for more repetitions during sessions with much background noise. No calls were rated by dispatchers as incomprehensible due to low sound quality and only 3% of the calls were considered somewhat difficult or very difficult to understand. Videoconferencing on mobile phones can be used for the initial emergency call during medical emergencies also in suboptimal conditions.

Mission Concepts and Operations for Asteroid Mitigation Involving Multiple Gravity Tractors

NASA Technical Reports Server (NTRS)

Foster, Cyrus; Bellerose, Julie; Jaroux, Belgacem; Mauro, David

2012-01-01

The gravity tractor concept is a proposed method to deflect an imminent asteroid impact through gravitational tugging over a time scale of years. In this study, we present mission scenarios and operational considerations for asteroid mitigation efforts involving multiple gravity tractors. We quantify the deflection performance improvement provided by a multiple gravity tractor campaign and assess its sensitivity to staggered launches. We next explore several proximity operation strategies to accommodate multiple gravity tractors at a single asteroid including formation-flying and mechanically-docked configurations. Finally, we utilize 99942 Apophis as an illustrative example to assess the performance of a multiple gravity tractor campaign.

BASIC Matrix Operations.

ERIC Educational Resources Information Center

Digital Equipment Corp., Maynard, MA.

The curriculum materials and computer programs in this booklet introduce the idea of a matrix. They go on to discuss matrix operations of addition, subtraction, multiplication by a scalar, and matrix multiplication. The last section covers several contemporary applications of matrix multiplication, including problems of communication…

Biofuel supply chain, market, and policy analysis

NASA Astrophysics Data System (ADS)

Zhang, Leilei

Renewable fuel is receiving an increasing attention as a substitute for fossil based energy. The US Department of Energy (DOE) has employed increasing effort on promoting the advanced biofuel productions. Although the advanced biofuel remains at its early stage, it is expected to play an important role in climate policy in the future in the transportation sector. This dissertation studies the emerging biofuel supply chain and markets by analyzing the production cost, and the outcomes of the biofuel market, including blended fuel market price and quantity, biofuel contract price and quantity, profitability of each stakeholder (farmers, biofuel producers, biofuel blenders) in the market. I also address government policy impacts on the emerging biofuel market. The dissertation is composed with three parts, each in a paper format. The first part studies the supply chain of emerging biofuel industry. Two optimization-based models are built to determine the number of facilities to deploy, facility locations, facility capacities, and operational planning within facilities. Cost analyses have been conducted under a variety of biofuel demand scenarios. It is my intention that this model will shed light on biofuel supply chain design considering operational planning under uncertain demand situations. The second part of the dissertation work focuses on analyzing the interaction between the key stakeholders along the supply chain. A bottom-up equilibrium model is built for the emerging biofuel market to study the competition in the advanced biofuel market, explicitly formulating the interactions between farmers, biofuel producers, blenders, and consumers. The model simulates the profit maximization of multiple market entities by incorporating their competitive decisions in farmers' land allocation, biomass transportation, biofuel production, and biofuel blending. As such, the equilibrium model is capable of and appropriate for policy analysis, especially for those policies that have complex ramifications and result in sophisticate interactions among multiple stakeholders. The third part of the dissertation investigates the impacts of flexible fuel vehicles (FFVs) market penetration levels on the market outcomes, including cellulosic biofuel production and price, blended fuel market price, and profitability of each stakeholder in the biofuel supply chain for imperfectly competitive biofuel markets. In this paper, I investigate the penetration levels of FFVs by incorporating the substitution among different fuels in blended fuel demand functions through "cross price elasticity" in a bottom-up equilibrium model framework. The complementarity based problem is solved by a Taylor expansion-based iterative procedure. At each step of the iteration, the highly nonlinear complementarity problems with constant elasticity of demand functions are linearized into linear complimentarity problems and solved until it converges. This model can be applied to investigate the interaction between the stakeholders in the biofuel market, and to assist decision making for both cellulosic biofuel investors and government.

A Profile of Indian Health Service Emergency Departments.

PubMed

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

2017-06-01

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

46 CFR 196.37-25 - Emergency lights.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Emergency lights. 196.37-25 Section 196.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS OPERATIONS Markings for Fire and Emergency Equipment, etc. § 196.37-25 Emergency lights. (a) All emergency lights...

46 CFR 196.37-25 - Emergency lights.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Emergency lights. 196.37-25 Section 196.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS OPERATIONS Markings for Fire and Emergency Equipment, etc. § 196.37-25 Emergency lights. (a) All emergency lights...

46 CFR 196.37-25 - Emergency lights.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Emergency lights. 196.37-25 Section 196.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS OPERATIONS Markings for Fire and Emergency Equipment, etc. § 196.37-25 Emergency lights. (a) All emergency lights...

46 CFR 196.37-25 - Emergency lights.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Emergency lights. 196.37-25 Section 196.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS OPERATIONS Markings for Fire and Emergency Equipment, etc. § 196.37-25 Emergency lights. (a) All emergency lights...

46 CFR 196.37-25 - Emergency lights.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Emergency lights. 196.37-25 Section 196.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS OPERATIONS Markings for Fire and Emergency Equipment, etc. § 196.37-25 Emergency lights. (a) All emergency lights...

14 CFR Appendix A to Part 141 - Recreational Pilot Certification Course

Code of Federal Regulations, 2012 CFR

2012-01-01

... navigation using pilotage with the aid of a magnetic compass; (e) Recognition of critical weather situations...) Ground reference maneuvers; (vii) Navigation; (viii) Slow flight and stalls; (ix) Emergency operations..., and go-arounds; (vi) Performance maneuvers; (vii) Navigation; (viii) Emergency operations; and (ix...

18 CFR 157.17 - Applications for temporary certificates in cases of emergency.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Amended, Concerning Any Operation, Sales, Service, Construction, Extension, Acquisition or Abandonment... temporary certificate authorizing the construction and operation of extensions of existing facilities... exact character of the emergency, the proposed method of meeting it, and the facts claimed to warrant...

18 CFR 157.17 - Applications for temporary certificates in cases of emergency.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Amended, Concerning Any Operation, Sales, Service, Construction, Extension, Acquisition or Abandonment... temporary certificate authorizing the construction and operation of extensions of existing facilities... exact character of the emergency, the proposed method of meeting it, and the facts claimed to warrant...

18 CFR 157.17 - Applications for temporary certificates in cases of emergency.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Amended, Concerning Any Operation, Sales, Service, Construction, Extension, Acquisition or Abandonment... temporary certificate authorizing the construction and operation of extensions of existing facilities... exact character of the emergency, the proposed method of meeting it, and the facts claimed to warrant...

18 CFR 157.17 - Applications for temporary certificates in cases of emergency.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Amended, Concerning Any Operation, Sales, Service, Construction, Extension, Acquisition or Abandonment... temporary certificate authorizing the construction and operation of extensions of existing facilities... exact character of the emergency, the proposed method of meeting it, and the facts claimed to warrant...

Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

PubMed

Fitzgerald, Anneke; Wu, Yong

2017-08-01

Objective This paper describes the perceptions of operating theatre staff in Australia and The Netherlands regarding the influence of logistical or operational reasons that may affect the scheduling of unplanned surgical cases. It is proposed that logistical or operational issues can influence the priority determination of queue position of surgical cases on the emergency waiting list. Methods A questionnaire was developed and conducted in 15 hospitals across The Netherlands and Australia, targeting anaesthetists, managers, nurses and surgeons. Statistical analyses revolved around these four professional groups. Six hypotheses were then developed and tested based on the responses collected from the participants. Results There were significant differences in perceptions of logistics delay factors across different professional groups when patients were waiting for unplanned surgery. There were also significant differences among different groups when setting logistical priority factors for planning and scheduling unplanned cases. The hypotheses tests confirm these differences, and the findings concur with the paradigmatic differences mentioned in the literature. These paradigmatic differences among the four professional groups may explain some of the tensions encountered when making decisions about scheduling emergency surgical queues, and therefore should be taken into consideration for management of operating theatres. Conclusions Queue positions of patients waiting for unplanned surgery, or emergency surgery, are determined by medical clinicians according to clinicians' indication of clinical priority. However, operating theatre managers are important in facilitating smooth operations when planning for emergency surgeries. It is necessary for surgeons to understand the logistical challenges faced by managers when requesting logistical priorities for their operations. What is known about the topic? Tensions exist about the efficient use of operating theatres and negotiating individual surgeon's demands, especially between surgeons and managers, because in many countries surgeons only work in the hospital and not for the hospital. What does this paper add? The present study examined the logistical effects on functionality and purports the notion that, while recognising the importance of clinical precedence, logistical factors influence queue order to ensure efficient use of operating theatre resources. What are the implications for practitioners? The results indicate that there are differences in the perceptions of healthcare professionals regarding the sequencing of emergency patients. These differences may lead to conflicts in the decision making process about triaging emergency or unplanned surgical cases. A clear understanding of the different perceptions of different functional groups may help address the conflicts that often arise in practice.

Multiple compliant processes: A reply to Haslam and Reicher on the engaged followership explanation of 'obedience' in Milgram's experiments.

PubMed

Hollander, Matthew M; Turowetz, Jason

2018-04-01

Haslam and Reicher (2018, Br. J. Soc. Psychol., 57, 292-300) offer a thoughtful rejoinder to our critique (Hollander & Turowetz, 2017, Br. J. Soc. Psychol, 56, 655-674) of their theory of engaged followership, currently the most important explanation of 'obedient' behaviour in the Milgram paradigm. Our immersion in Milgram's archived audio recordings has led us to new findings about participants' perspectives, as well as to dissatisfaction with the theory in its present version. Following a brief discussion of our findings, which cast the theory in doubt, we respond to Haslam and Reicher's argument that these data may in fact be consistent with it. Our response identifies three limitations of engaged followership emerging from this debate. Despite the strengths of the theory and these authors' impressive re-analysis of our findings, important reasons remain for scepticism that engaged followership operated in Milgram's experiments in the way, and to the extent, that they claim. Rather, 'obedience' appears amenable to multiple empirically grounded explanations, only one of which is engaged followership. © 2018 The British Psychological Society.

Multiple stakeholder views on changes in delivery of public health nursing services in Ireland.

PubMed

Hanafin, Sinead; Dwan O'Reilly, Emma

2015-08-01

In contrast with community nursing services in the UK and other parts of the world, the public health nursing service in the Republic of Ireland operates as a generalist service, providing both public health and wellbeing services in addition to clinical nursing services to a wide range of patient groups. While much discussion has taken place over the years about the benefits and challenges of a generalist service, little consensus has emerged about whether the current generalist approach should be maintained or whether a more specialised approach is required. This article presents key findings from an evaluation, using research methods, of a community nursing service that was restructured from a generalist, geographically based service, to a more specialist team-based model. The findings across multiple stakeholders show a number of positive effects in the areas of quality, safety, risk, governance, active caseload management, and finances. Some challenges were also identified, particularly with respect to continuity of services, loss of expertise, role of the team leader, and engagement in population-based activities.

Using complexity science and negotiation theory to resolve boundary-crossing water issues

NASA Astrophysics Data System (ADS)

Islam, Shafiqul; Susskind, Lawrence

2018-07-01

Many water governance and management issues are complex. The complexity of these issues is related to crossing of multiple boundaries: political, social and jurisdictional, as well as physical, ecological and biogeochemical. Resolution of these issues usually requires interactions of many parties with conflicting values and interests operating across multiple boundaries and scales to make decisions. The interdependence and feedback among interacting variables, processes, actors and institutions are hard to model and difficult to forecast. Thus, decision-making related to complex water problems needs be contingent and adaptive. This paper draws on a number of ideas from complexity science and negotiation theory that may make it easier to cope with the complexities and difficulties of managing boundary crossing water disputes. It begins with the Water Diplomacy Framework that was developed and tested over the past several years. Then, it uses three key ideas from complexity science (interdependence and interconnectedness; uncertainty and feedback; emergence and adaptation) and three from negotiation theory (stakeholder identification and engagement; joint fact finding; and value creation through option generation) to show how application of these ideas can help enhance effectiveness of water management.

Unleashing the power of human genetic variation knowledge: New Zealand stakeholder perspectives.

PubMed

Gu, Yulong; Warren, James Roy; Day, Karen Jean

2011-01-01

This study aimed to characterize the challenges in using genetic information in health care and to identify opportunities for improvement. Taking a grounded theory approach, semistructured interviews were conducted with 48 participants to collect multiple stakeholder perspectives on genetic services in New Zealand. Three themes emerged from the data: (1) four service delivery models were identified in operation, including both those expected models involving genetic counselors and variations that do not route through the formal genetic service program; (2) multiple barriers to sharing and using genetic information were perceived, including technological, organizational, institutional, legal, ethical, and social issues; and (3) impediments to wider use of genetic testing technology, including variable understanding of genetic test utilities among clinicians and the limited capacity of clinical genetic services. Targeting these problems, information technologies and knowledge management tools have the potential to support key tasks in genetic services delivery, improve knowledge processes, and enhance knowledge networks. Because of the effect of issues in genetic information and knowledge management, the potential of human genetic variation knowledge to enhance health care delivery has been put on a "leash."

Abnormal/Emergency Situations. Impact of Unmanned Aircraft Systems Emergency and Abnormal Events on the National Airspace System

NASA Technical Reports Server (NTRS)

2006-01-01

Access 5 analyzed the differences between UAS and manned aircraft operations under five categories of abnormal or emergency situations: Link Failure, Lost Communications, Onboard System Failures, Control Station Failures and Abnormal Weather. These analyses were made from the vantage point of the impact that these operations have on the US air traffic control system, with recommendations for new policies and procedures included where appropriate.

Orphan spin operators enable the acquisition of multiple 2D and 3D magic angle spinning solid-state NMR spectra

NASA Astrophysics Data System (ADS)

Gopinath, T.; Veglia, Gianluigi

2013-05-01

We propose a general method that enables the acquisition of multiple 2D and 3D solid-state NMR spectra for U-13C, 15N-labeled proteins. This method, called MEIOSIS (Multiple ExperIments via Orphan SpIn operatorS), makes it possible to detect four coherence transfer pathways simultaneously, utilizing orphan (i.e., neglected) spin operators of nuclear spin polarization generated during 15N-13C cross polarization (CP). In the MEIOSIS experiments, two phase-encoded free-induction decays are decoded into independent nuclear polarization pathways using Hadamard transformations. As a proof of principle, we show the acquisition of multiple 2D and 3D spectra of U-13C, 15N-labeled microcrystalline ubiquitin. Hadamard decoding of CP coherences into multiple independent spin operators is a new concept in solid-state NMR and is extendable to many other multidimensional experiments. The MEIOSIS method will increase the throughput of solid-state NMR techniques for microcrystalline proteins, membrane proteins, and protein fibrils.

Evolvable mathematical models: A new artificial Intelligence paradigm

NASA Astrophysics Data System (ADS)

Grouchy, Paul

We develop a novel Artificial Intelligence paradigm to generate autonomously artificial agents as mathematical models of behaviour. Agent/environment inputs are mapped to agent outputs via equation trees which are evolved in a manner similar to Symbolic Regression in Genetic Programming. Equations are comprised of only the four basic mathematical operators, addition, subtraction, multiplication and division, as well as input and output variables and constants. From these operations, equations can be constructed that approximate any analytic function. These Evolvable Mathematical Models (EMMs) are tested and compared to their Artificial Neural Network (ANN) counterparts on two benchmarking tasks: the double-pole balancing without velocity information benchmark and the challenging discrete Double-T Maze experiments with homing. The results from these experiments show that EMMs are capable of solving tasks typically solved by ANNs, and that they have the ability to produce agents that demonstrate learning behaviours. To further explore the capabilities of EMMs, as well as to investigate the evolutionary origins of communication, we develop NoiseWorld, an Artificial Life simulation in which interagent communication emerges and evolves from initially noncommunicating EMM-based agents. Agents develop the capability to transmit their x and y position information over a one-dimensional channel via a complex, dialogue-based communication scheme. These evolved communication schemes are analyzed and their evolutionary trajectories examined, yielding significant insight into the emergence and subsequent evolution of cooperative communication. Evolved agents from NoiseWorld are successfully transferred onto physical robots, demonstrating the transferability of EMM-based AIs from simulation into physical reality.

Recent Enhancements in NOAA's JPSS Land Product Suite and Key Operational Applications

NASA Astrophysics Data System (ADS)

Csiszar, I. A.; Yu, Y.; Zhan, X.; Vargas, M.; Ek, M. B.; Zheng, W.; Wu, Y.; Smirnova, T. G.; Benjamin, S.; Ahmadov, R.; James, E.; Grell, G. A.

2017-12-01

A suite of operational land products has been produced as part of NOAA's Joint Polar Satellite System (JPSS) program to support a wide range of operational applications in environmental monitoring, prediction, disaster management and mitigation, and decision support. The Visible Infrared Imaging Radiometer Suite (VIIRS) on the Suomi National Polar-orbiting Partnership (NPP) and the operational JPSS satellite series forms the basis of six fundamental and multiple additional added-value environmental data records (EDRs). A major recent improvement in the land-based VIIRS EDRs has been the development of global gridded products, providing a format and science content suitable for ingest into NOAA's operational land surface and coupled numerical weather prediction models. VIIRS near-real-time Green Vegetation Fraction is now in the process of testing for full operational use, while land surface temperature and albedo are under testing and evaluation. The operational 750m VIIRS active fire product, including fire radiative power, is used to support emission modeling and air quality applications. Testing the evaluation for operational NOAA implementation of the improved 375m VIIRS active fire product is also underway. Added-value and emerging VIIRS land products include vegetation health, phenology, near-real-time surface type and surface condition change, and other biogeophysical variables. As part of the JPSS program, a global soil moisture data product has also been generated from the Advanced Microwave Scanning Radiometer 2 (AMSR2) sensor on the GCOM-W1 (Global Change Observation Mission - Water 1) satellite since July 2012. This product is included in the blended NESDIS Soil Moisture Operational Products System, providing soil moisture data as a critical input for land surface modeling.

Effect of Air Pollution on Exacerbations of Bronchiectasis in Badalona, Spain, 2008-2016.

PubMed

Garcia-Olivé, Ignasi; Stojanovic, Zoran; Radua, Joaquim; Rodriguez-Pons, Laura; Martinez-Rivera, Carlos; Ruiz Manzano, Juan

2018-05-17

Air pollution has been widely associated with respiratory diseases. Nevertheless, the association between air pollution and exacerbations of bronchiectasis has been less studied. To analyze the effect of air pollution on exacerbations of bronchiectasis. This was a retrospective observational study conducted in Badalona. The number of daily hospital admissions and emergency room visits related to exacerbation of bronchiectasis (ICD-9 code 494.1) between 2008 and 2016 was obtained. We used simple Poisson regressions to test the effects of daily mean temperature, SO2, NO2, CO, and PM10 levels on bronchiectasis-related emergencies and hospitalizations on the same day and 1-4 days after. All p values were corrected for multiple comparisons. SO2 was significantly associated with an increase in the number of hospitalizations (lags 0, 1, 2, and 3). None of these associations remained significant after correcting for multiple comparisons. The number of emergency room visits was associated with higher levels of SO2 (lags 0-4). After correcting for multiple comparisons, the association between emergency room visits and SO2 levels was statistically significant for lag 0 (p = 0.043), lag 1 (p = 0.018), and lag 3 (p = 0.050). The number of emergency room visits for exacerbation of bronchiectasis is associated with higher levels of SO2. © 2018 S. Karger AG, Basel.

Interactive emergency communication involving persons in crisis.

PubMed

Nordby, Halvor; Nøhr, Øyvind

2009-01-01

We studied the dialogue between telephone operators at medical emergency communication centres in Norway and parents of children later diagnosed with sudden infant death syndrome. The aim was to understand how the parents experienced the communication with the telephone operators. The qualitative method involved semi-structured interviews. We interviewed six respondents from urban areas and five from rural areas. An important finding was that all the parents were satisfied with the resuscitation instructions they received. It was also perceived as important that the emergency operators expressed empathy and care. We believe that it is not merely the quality of the resuscitation attempts that the operators' efforts should be measured against. It is also important that the operators provide good explanations and express emotional support. Our findings indicate that this will be enormously appreciated, even if callers do not feel that they are capable of performing optimum resuscitation.

Operational Research during the Ebola Emergency.

PubMed

Fitzpatrick, Gabriel; Decroo, Tom; Draguez, Bertrand; Crestani, Rosa; Ronsse, Axelle; Van den Bergh, Rafael; Van Herp, Michel

2017-07-01

Operational research aims to identify interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programs where the research is taking place. Médecins Sans Frontières admitted ≈5,200 patients with confirmed Ebola virus disease during the Ebola outbreak in West Africa and from the beginning nested operational research within its emergency response. This research covered critical areas, such as understanding how the virus spreads, clinical trials, community perceptions, challenges within Ebola treatment centers, and negative effects on non-Ebola healthcare. Importantly, operational research questions were decided to a large extent by returning volunteers who had first-hand knowledge of the immediate issues facing teams in the field. Such a method is appropriate for an emergency medical organization. Many challenges were also identified while carrying out operational research across 3 different countries, including the basic need for collecting data in standardized format to enable comparison of findings among treatment centers.

Shared patients: multiple health and social care contact.

PubMed

Keene, J; Swift, L; Bailey, S; Janacek, G

2001-07-01

The paper describes results from the 'Tracking Project', a new method for examining agency overlap, repeat service use and shared clients/patients amongst social and health care agencies in the community. This is the first project in this country to combine total population databases from a range of social, health care and criminal justice agencies to give a multidisciplinary database for one county (n = 97,162 cases), through standardised anonymisation of agency databases, using SOUNDEX, a software programme. A range of 20 community social and health care agencies were shown to have a large overlap with each other in a two-year period, indicating high proportions of shared patients/clients. Accident and Emergency is used as an example of major overlap: 16.2% (n = 39,992) of persons who attended a community agency had attended Accident and Emergency as compared to 8.2% (n = 775,000) of the total population of the county. Of these, 96% who had attended seven or more different community agencies had also attended Accident and Emergency. Further statistical analysis of Accident and Emergency attendance as a characteristic of community agency populations (n = 39,992) revealed that increasing frequency of attendance at Accident and Emergency was very strongly associated with increasing use of other services. That is, the patients that repeatedly attend Accident and Emergency are much more likely to attend more other agencies, indicating the possibility that they share more problematic or difficult patients. Research questions arising from these data are discussed and future research methods suggested in order to derive predictors from the database and develop screening instruments to identify multiple agency attenders for targeting or multidisciplinary working. It is suggested that Accident and Emergency attendance might serve as an important predictor of multiple agency attendance.

Classificatory multiplicity: intimate partner violence diagnosis in emergency department consultations.

PubMed

Olive, Philippa

2017-08-01

To explore the naming, or classification, of physical assaults by a partner as 'intimate partner violence' during emergency department consultations. Research continues to evidence instances when intimate partner physical violence is 'missed' or unacknowledged during emergency department consultations. Theoretically, this research was approached through complexity theory and the sociology of diagnosis. Research design was an applied, descriptive and explanatory, multiple-method approach that combined qualitative semistructured interviews with service-users (n = 8) and emergency department practitioners (n = 9), and qualitative and quantitative document analysis of emergency department health records (n = 28). This study found that multiple classifications of intimate partner violence were mobilised during emergency department consultations and that these different versions of intimate partner violence held different diagnostic categories, processes and consequences. The construction of different versions of intimate partner violence in emergency department consultations could explain variance in people's experiences and outcomes of consultations. The research found that the classificatory threshold for 'intimate partner violence' was too high. Strengthening systems of diagnosis (identification and intervention) so that all incidents of partner violence are named as 'intimate partner violence' would reduce the incidence of missed cases and afford earlier specialist intervention to reduce violence and limit its harms. This research found that identification of and response to intimate partner violence, even in contexts of severe physical violence, was contingent. By lowering the classificatory threshold so that all incidents of partner violence are named as 'intimate partner violence', practitioners could make a significant contribution to reducing missed intimate partner violence during consultations and improving health outcomes for this population. This research has relevance for practitioners in any setting where service-user report of intimate partner violence is possible. © 2016 John Wiley & Sons Ltd.

Emergency preparedness for genetics centers, laboratories, and patients: the Southeast Region Genetics Collaborative strategic plan.

PubMed

Andersson, Hans C; Perry, William; Bowdish, Bruce; Floyd-Browning, Phaidra

2011-10-01

Emergencies occur unpredictably and interrupt routine genetic care. The events after hurricanes Katrina and Rita have led to the recognition that a coherent plan is necessary to ensure continuity of operations for genetic centers and laboratories, including newborn screening. No geographic region is protected from the effects of a variety of potential emergencies. Regional and national efforts have begun to address the need for such preparedness, but a plan for ensuring continuity of operations by creating an emergency preparedness plan must be developed for each genetic center and laboratory, with attention to the interests of patients. This article describes the first steps in development of an emergency preparedness plan for individual centers.

Prepare to protect: Operating and maintaining a tornado safe room.

PubMed

Herseth, Andrew; Goldsmith-Grinspoon, Jennifer; Scott, Pataya

2017-06-01

Operating and maintaining a tornado safe room can be critical to the effective continuity of business operations because a firm's most valuable asset is its people. This paper describes aspects of operations and maintenance (O&M) for existing tornado safe rooms as well as a few planning and design aspects that affect the ultimate operation of a safe room for situations where a safe room is planned, but not yet constructed. The information is based on several Federal Emergency Management Agency safe room publications that provide guidance on emergency management and operations, as well as the design and construction of tornado safe rooms.

36 CFR 4.3 - Authorized emergency vehicles.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 36 Parks, Forests, and Public Property 1 2014-07-01 2014-07-01 false Authorized emergency vehicles... INTERIOR VEHICLES AND TRAFFIC SAFETY § 4.3 Authorized emergency vehicles. (a) The operator of an authorized emergency vehicle, when responding to an emergency or when pursuing or apprehending an actual or suspected...

36 CFR 4.3 - Authorized emergency vehicles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Authorized emergency vehicles... INTERIOR VEHICLES AND TRAFFIC SAFETY § 4.3 Authorized emergency vehicles. (a) The operator of an authorized emergency vehicle, when responding to an emergency or when pursuing or apprehending an actual or suspected...

36 CFR 4.3 - Authorized emergency vehicles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false Authorized emergency vehicles... INTERIOR VEHICLES AND TRAFFIC SAFETY § 4.3 Authorized emergency vehicles. (a) The operator of an authorized emergency vehicle, when responding to an emergency or when pursuing or apprehending an actual or suspected...

36 CFR 4.3 - Authorized emergency vehicles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Authorized emergency vehicles... INTERIOR VEHICLES AND TRAFFIC SAFETY § 4.3 Authorized emergency vehicles. (a) The operator of an authorized emergency vehicle, when responding to an emergency or when pursuing or apprehending an actual or suspected...

29 CFR 1917.30 - Emergency action plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... emergency action and for reaction time for safe escape of employees from the workplace or the immediate work... 29 Labor 7 2010-07-01 2010-07-01 false Emergency action plans. 1917.30 Section 1917.30 Labor... (CONTINUED) MARINE TERMINALS Marine Terminal Operations § 1917.30 Emergency action plans. (a) Emergency...

46 CFR 78.47-33 - Emergency lights.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 3 2010-10-01 2010-10-01 false Emergency lights. 78.47-33 Section 78.47-33 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 78.47-33 Emergency lights. (a) All emergency lights shall be marked...

46 CFR 97.37-25 - Emergency lights.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Emergency lights. 97.37-25 Section 97.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 97.37-25 Emergency lights. (a) All emergency lights shall...

46 CFR 97.37-25 - Emergency lights.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Emergency lights. 97.37-25 Section 97.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 97.37-25 Emergency lights. (a) All emergency lights shall...

46 CFR 97.37-25 - Emergency lights.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Emergency lights. 97.37-25 Section 97.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 97.37-25 Emergency lights. (a) All emergency lights shall...

46 CFR 78.47-33 - Emergency lights.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 3 2012-10-01 2012-10-01 false Emergency lights. 78.47-33 Section 78.47-33 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 78.47-33 Emergency lights. (a) All emergency lights shall be marked...

46 CFR 97.37-25 - Emergency lights.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Emergency lights. 97.37-25 Section 97.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 97.37-25 Emergency lights. (a) All emergency lights shall...

46 CFR 78.47-33 - Emergency lights.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 3 2013-10-01 2013-10-01 false Emergency lights. 78.47-33 Section 78.47-33 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 78.47-33 Emergency lights. (a) All emergency lights shall be marked...

46 CFR 78.47-33 - Emergency lights.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 3 2014-10-01 2014-10-01 false Emergency lights. 78.47-33 Section 78.47-33 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 78.47-33 Emergency lights. (a) All emergency lights shall be marked...

46 CFR 97.37-25 - Emergency lights.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Emergency lights. 97.37-25 Section 97.37-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 97.37-25 Emergency lights. (a) All emergency lights shall...

46 CFR 78.47-33 - Emergency lights.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 3 2011-10-01 2011-10-01 false Emergency lights. 78.47-33 Section 78.47-33 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 78.47-33 Emergency lights. (a) All emergency lights shall be marked...

On the Emergence of Modern Humans

ERIC Educational Resources Information Center

Amati, Daniele; Shallice, Tim

2007-01-01

The emergence of modern humans with their extraordinary cognitive capacities is ascribed to a novel type of cognitive computational process (sustained non-routine multi-level operations) required for abstract projectuality, held to be the common denominator of the cognitive capacities specific to modern humans. A brain operation (latching) that…

Recent research on emergent verbal behavior: clinical applications and future directions.

PubMed

Grow, Laura L; Kodak, Tiffany

2010-01-01

This paper describes recent studies that have evaluated the functional independence of verbal operants. Procedures that facilitate the emergence of untrained verbal operants and important areas of future research to increase efficiency of language programs for children diagnosed with developmental disabilities are discussed.

75 FR 41389 - Emergency Conservation Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

... for authorized activities under the following emergency conservation (EC) practices: (EC 1) Removing..., operator, or tenant must contribute part of the cost for implementing the approved practice and must also... located in the county in which ECP has been approved, be normally used for farming or ranching operations...

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

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 4 2011-10-01 2011-10-01 false Operation near certain aeronautical and marine emergency radio frequencies. 76.616 Section 76.616 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Technical Standards § 76...

Emergency department operations dictionary: results of the second performance measures and benchmarking summit.

PubMed

Welch, Shari J; Stone-Griffith, Suzanne; Asplin, Brent; Davidson, Steven J; Augustine, James; Schuur, Jeremiah D

2011-05-01

The public, payers, hospitals, and Centers for Medicare and Medicaid Services (CMS) are demanding that emergency departments (EDs) measure and improve performance, but this cannot be done unless we define the terms used in ED operations. On February 24, 2010, 32 stakeholders from 13 professional organizations met in Salt Lake City, Utah, to standardize ED operations metrics and definitions, which are presented in this consensus paper. Emergency medicine (EM) experts attending the Second Performance Measures and Benchmarking Summit reviewed, expanded, and updated key definitions for ED operations. Prior to the meeting, participants were provided with the definitions created at the first summit in 2006 and relevant documents from other organizations and asked to identify gaps and limitations in the original work. Those responses were used to devise a plan to revise and update the definitions. At the summit, attendees discussed and debated key terminology, and workgroups were created to draft a more comprehensive document. These results have been crafted into two reference documents, one for metrics and the operations dictionary presented here. The ED Operations Dictionary defines ED spaces, processes, patient populations, and new ED roles. Common definitions of key terms will improve the ability to compare ED operations research and practice and provide a common language for frontline practitioners, managers, and researchers. © 2011 by the Society for Academic Emergency Medicine.

Urban Latina/o Undergraduate Students' Negotiations of Identities and Participation in an Emerging Scholars Calculus I Workshop

ERIC Educational Resources Information Center

Oppland-Cordell, Sarah B.

2014-01-01

In this article, the author presents a qualitative multiple case study that explored how two urban Latina/o undergraduate students' emerging mathematical and racial identity constructions influenced their participation in a culturally diverse, Emerging Scholars Program, Calculus I workshop at a predominately White urban university. Drawing on…