Sample records for national incident management

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

    ERIC Educational Resources Information Center

    Naradko, Anthony M.

    2017-01-01

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

  2. Incident Management: Process into Practice

    ERIC Educational Resources Information Center

    Isaac, Gayle; Moore, Brian

    2011-01-01

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

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

    PubMed Central

    Dainiak, Nicholas; Skudlarska, Beata; Albanese, Joseph

    2013-01-01

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

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

    PubMed

    Dainiak, Nicholas; Skudlarska, Beata; Albanese, Joseph

    2013-01-01

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

  5. Explaining implementation behaviour of the National Incident Management System (NIMS).

    PubMed

    Jensen, Jessica; Youngs, George

    2015-04-01

    This paper explains the perceived implementation behaviour of counties in the United States with respect to the National Incident Management System (NIMS). The system represents a massive and historic policy mandate designed to restructure, standardise and thereby unify the efforts of a wide variety of emergency management entities. Specifically, this study examined variables identified in the NIMS and policy literature that might influence the behavioural intentions and actual behaviour of counties. It found that three key factors limit or promote how counties intend to implement NIMS and how they actually implement the system: policy characteristics related to NIMS, implementer views and a measure of local capacity. One additional variable-inter-organisational characteristics-was found to influence only actual behaviour. This study's findings suggest that the purpose underlying NIMS may not be fulfilled and confirm what disaster research has long suggested: the potential for standardisation in emergency management is limited. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

  6. National Incident Management System (NIMS) Standards Review Panel Workshop Summary Report

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

    Stenner, Robert D.; Kirk, Jennifer L.; Stanton, James R.

    The importance and need for full compliant implementation of NIMS nationwide was clearly demonstrated during the Hurricane Katrina event, which was clearly expressed in Secretary Chertoff's October 4, 2005 letter addressed to the State's governors. It states, ''Hurricane Katrina was a stark reminder of how critical it is for our nation to approach incident management in a coordinated, consistent, and efficient manner. We must be able to come together, at all levels of government, to prevent, prepare for, respond to, and recover from any emergency or disaster. Our operations must be seamless and based on common incident management doctrine, becausemore » the challenges we face as a nation are far greater than capabilities of any one jurisdiction.'' The NIMS is a system/architecture for organizing response on a ''national'' level. It incorporations ICS as a main component of that structure (i.e., it institutionalizes ICS in NIMS). In a paper published on the NIMS Website, the following statements were made: ''NIMS represents a core set of doctrine, principles, terminology, and organizational processes to enable effective, efficient and collaborative incident management at all levels. To provide the framework for interoperability and compatibility, the NIMS is based on a balance between flexibility and standardization.'' Thus the NIC is challenged with the need to adopt quality SDO generated standards to support NIMS compliance, but in doing so maintain the flexibility necessary so that response operations can be tailored for the specific jurisdictional and geographical needs across the nation. In support of this large and complex challenge facing the NIC, the Pacific Northwest National Laboratory (PNNL) was asked to provide technical support to the NIC, through their DHS Science and Technology ? Standards Portfolio Contract, to help identify, review, and develop key standards for NIMS compliance. Upon examining the challenge, the following general process appears

  7. Incident Management Organization succession planning stakeholder feedback

    Treesearch

    Anne E. Black

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    US Department of Education, 2006

    2006-01-01

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

  9. Developing freeway and incident management systems using the national ITS architecture

    DOT National Transportation Integrated Search

    1998-08-01

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

  10. U.S. national response assets for radiological incidents.

    PubMed

    Remick, Alan L; Crapo, John L; Woodruff, Charles R

    2005-11-01

    The federal government has had the ability to respond to incidents of national significance for decades. Since 11 September 2001, there have been enhancements to existing federal assets and the creation of new federal assets. This presentation will provide an overview of the more significant federal assets. Pivotal to a response of national significance is the U.S. Department of Energy (DOE) Federal Radiological Monitoring and Assessment Center, which organizes and coordinates federal agency monitoring activities during an emergency. DOE manages the Federal Radiological Monitoring and Assessment Center during the emergency phase, and the Environmental Protection Agency (EPA) manages the response during the recovery phase once the emergency is terminated. EPA monitoring teams provide support during both the emergency and recovery phases of an emergency. Other DOE teams are available to respond to major nuclear power plant events, transportation accidents, or terrorism events involving the use of radiological materials, including the Radiological Assistance Program, the Aerial Measuring System, the National Atmospheric Release Advisory Center, and the Radiation Emergency Assistance Center/Training Site. For incidents involving a nuclear weapon, an improvised nuclear device, or a radiological dispersal device, DOE assets such as the Nuclear Emergency Support Team and the Accident Response Group could provide capabilities for weapon or device search, recovery, and removal. The Radiological Triage System harnesses the weapons scientists and engineers at the DOE national laboratories to provide gamma spectroscopy interpretation for agencies responding to an incident. In recent years, National Guard Weapons of Mass Destruction-Civil Support Teams have been created to support state and local response to terrorism events. The Civil Support Teams normally come under direct control of the state and can respond without requiring authorization from the U.S. Department of

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

    PubMed

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

    2017-01-01

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

  12. Cleanups In My Community (CIMC) - Incidents of National Significance, National Layer

    EPA Pesticide Factsheets

    This data layer provides access to Incidents of National Significance as part of the CIMC web service. Incidents of National Significance include all Presidentially-declared emergencies, major disasters, and catastrophes. Multiple federal departments and agencies, including EPA, coordinate actions to help prevent, prepare for, respond to, and recover from Incidents of National Significance. The Incidents of National Significance shown in this web service are derived from the epa.gov website and include links to the relevant web pages within the attribute table. Data about Incidents of National Significance are located on their own EPA web pages, and CIMC links to those pages. The CIMC web service was initially published in 2013, but the data are updated on the 18th of each month. The full schedule for data updates in CIMC is located here: https://iaspub.epa.gov/enviro/data_update_v2.

  13. Corridor incident management (CIM)

    DOT National Transportation Integrated Search

    2007-09-01

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

  14. Computer Simulation for Emergency Incident Management

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

    Brown, D L

    2004-12-03

    This report describes the findings and recommendations resulting from the Department of Homeland Security (DHS) Incident Management Simulation Workshop held by the DHS Advanced Scientific Computing Program in May 2004. This workshop brought senior representatives of the emergency response and incident-management communities together with modeling and simulation technologists from Department of Energy laboratories. The workshop provided an opportunity for incident responders to describe the nature and substance of the primary personnel roles in an incident response, to identify current and anticipated roles of modeling and simulation in support of incident response, and to begin a dialog between the incident responsemore » and simulation technology communities that will guide and inform planned modeling and simulation development for incident response. This report provides a summary of the discussions at the workshop as well as a summary of simulation capabilities that are relevant to incident-management training, and recommendations for the use of simulation in both incident management and in incident management training, based on the discussions at the workshop. In addition, the report discusses areas where further research and development will be required to support future needs in this area.« less

  15. Information sharing for traffic incident management.

    DOT National Transportation Integrated Search

    2009-01-01

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

  16. Traffic incident management resource management.

    DOT National Transportation Integrated Search

    2009-01-01

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

  17. Short Duration Emergency Incidents Managed as Projects

    NASA Astrophysics Data System (ADS)

    Nixon, Thomas J.

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

  18. 49 CFR 1542.307 - Incident management.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  19. 49 CFR 1542.307 - Incident management.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  20. 49 CFR 1542.307 - Incident management.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  1. 49 CFR 1542.307 - Incident management.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  2. Incident Management in Academic Information System using ITIL Framework

    NASA Astrophysics Data System (ADS)

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

    2018-02-01

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

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

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

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

    2009-03-24

    In an effort to locate potential law enforcement-related standards that support incident management, a team from the Pacific Northwest National Laboratory (PNNL) contacted representatives from the National Institute of Standards-Office of Law Enforcement Standards (NIST-OLES), National Institute of Justice (NIJ), Federal Bureau of Investigation (FBI), Secret Service, ASTM International committees that have a law enforcement focus, and a variety of individuals from local and regional law enforcement organizations. Discussions were held with various state and local law enforcement organizations. The NIJ has published several specific equipment-related law enforcement standards that were included in the review, but it appears that lawmore » enforcement program and process-type standards are developed principally by organizations that operate at the state and local level. Input is provided from state regulations and codes and from external non-government organizations (NGOs) that provide national standards. The standards that are adopted from external organizations or developed independently by state authorities are available for use by local law enforcement agencies on a voluntary basis. The extent to which they are used depends on the respective jurisdictions involved. In some instances, use of state and local disseminated standards is mandatory, but in most cases, use is voluntary. Usually, the extent to which these standards are used appears to depend on whether or not jurisdictions receive certification from a “governing” entity due to their use and compliance with the standards. In some cases, these certification-based standards are used in principal but without certification or other compliance monitoring. In general, these standards appear to be routinely used for qualification, selection for employment, and training. In these standards, the term “Peace Officer” is frequently used to refer to law enforcement personnel. This technical review of

  4. Improving freight crash incident management.

    DOT National Transportation Integrated Search

    2015-06-01

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

  5. Incident management program for Virginia.

    DOT National Transportation Integrated Search

    1988-01-01

    Freeways that are already operating at or near capacity are becoming more congested because of frequent incidents such as accidents, disabled vehicles, etc. In an effort to initiate an incident management program in Virginia, information from other s...

  6. Traffic Incident Management in the Presence of Hazards

    NASA Astrophysics Data System (ADS)

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

    2016-09-01

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

  7. Analysis and production of the traffic incident management state self-assessments (TIM SA) national report.

    DOT National Transportation Integrated Search

    2008-09-29

    The Traffic Incident Management Self-Assessment (TIM SA) provides a means for evaluating progress in achievement of individual TIM program components and overall TIM program success in three areas: Program and Institutional Issues; Operational Issues...

  8. Managing multiple-casualty incidents: a rural medical preparedness training assessment.

    PubMed

    Glow, Steven D; Colucci, Vincent J; Allington, Douglas R; Noonan, Curtis W; Hall, Earl C

    2013-08-01

    The objectives of this study were to develop a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together using Microsoft Visio, images from Google Earth and icons representing first responders, equipment resources, local hospital emergency department bed capacity, and trauma victims. The authors also tested participants' knowledge in the areas of communications, incident command systems (ICS), and triage. Participants attended Managing Multiple-Casualty Incidents (MCIs), a one-day training which offered pre- and post-tests, two one-hour functional exercises, and four distinct, one-hour didactic instructional periods. Two MCI functional exercises were conducted. The one-hour trainings focused on communications, National Incident Management Systems/Incident Command Systems (NIMS/ICS) and professional roles and responsibilities in NIMS and triage. The trainings were offered throughout communities in western Montana. First response resource inventories and general manpower statistics for fire, police, Emergency Medical Services (EMS), and emergency department hospital bed capacity were determined prior to MCI scenario construction. A test was given prior to and after the training activities. A total of 175 firefighters, EMS, law enforcement, hospital personnel or other first-responders completed the pre- and post-test. Firefighters produced higher baseline scores than all other disciplines during pre-test analysis. At the end of the training all disciplines demonstrated significantly higher scores on the post-test when compared with their respective baseline averages. Improvements in post-test scores were noted for participants from all disciplines and in all didactic areas: communications, NIMS/ICS, and triage. Mass-casualty incidents offer significant challenges for prehospital and emergency room workers. Fire, Police and EMS personnel must secure the scene, establish communications, define individuals

  9. Managing Materials and Wastes for Homeland Security Incidents

    EPA Pesticide Factsheets

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

  10. Cancer incidence estimates at the national and district levels in Colombia.

    PubMed

    Piñeros, Marion; Ferlay, Jacques; Murillo, Raúl

    2006-01-01

    To estimate national and district cancer incidence for 18 major cancer sites in Colombia. National and district incidence was estimated by applying a set of age, sex and site-specific incidence/mortality ratios, obtained from a population-based cancer registry, to national and regional mortality. The work was done in Bogotá (Colombia) and Lyon (France) between May 2003 and August 2004. The annual total number of cases expected (all cancers but skin) was 17 819 in men and 18 772 in women. Among males the most frequent cancers were those of the prostate (45.8 per 100 000), stomach (36.0), and lung (20.0). In females the most frequent were those of the cervix uteri (36.8 per 100 000), breast (30.0), and stomach (20.7). Districts with the lowest death certification coverage yielded the highest incidence rates. In the absence of national population-based cancer registry data, estimates of incidence provide valuable information at national and regional levels. As mortality data are an important source for the estimation,the quality of death certification should be considered as a possible cause of bias.

  11. Managing incidents on urban arterial roadways

    DOT National Transportation Integrated Search

    1997-01-01

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

  12. Enhancing the National Incident-Based Reporting System: A Policy Proposal.

    PubMed

    Bierie, David M

    2015-09-01

    The National Incident-Based Reporting System (NIBRS) is an important data set serving social scientists, policy makers, the business community, and the press. However, it is hampered by low participation rates among the nation's police agencies. This article outlines a strategy for enhancing NIBRS by (a) providing police agencies free and supported software to extract and transmit an agency's Record Management System (RMS) data in NIBRS format (or a data-entry system if an RMS does not exist), (b) including personal identifiers of arrestees, and (c) allowing police agencies to access the national data for routine police work. The article describes how taking these steps would decrease the costs of implementing and maintaining NIBRS, encourage widespread adoption, and increase data quality. These enhancements could foster substantial improvements in policing as well as other aspects of the criminal justice system. These changes would also open up new and exciting areas for academics and analysts, including the ability to study criminal careers over time as well as criminal networks within NIBRS. © The Author(s) 2014.

  13. Reported fatal and non-fatal incidents involving tourists in Hawaii Volcanoes National Park, 1992-2002.

    PubMed

    Heggie, Travis W

    2005-08-01

    Objectives. To examine fatal and non-fatal incidents involving tourists in Hawaii Volcanoes National Park. Methods. Official press releases from the public relations office at Hawaii Volcanoes National Park were examined for reports of fatal and non-fatal incidents involving tourists. Results. Between 1992 and 2002 there were 65 press releases reporting 40 fatalities, 45 serious injuries, 53 minor injuries, and 25 no injury events. Severity information was unavailable for four additional tourists. Aircraft and backcountry incidents each accounted for 30% of all incidents followed by road incidents (22%) and frontcountry incidents (17%). Aircraft incidents reported 17 fatalities, backcountry incidents accounted for 10 fatalities, frontcountry incidents reported seven fatalities, and road incidents totaled six fatalities. One fatality was classified as a suicide. Backcountry (23) and road (10) incidents had the highest number of serious incidents. Male tourists (62) were more frequently involved in incidents than female tourists (41) and tourists aged 20-29 years and 40-49 years accounted for the highest number of fatalities and total incidents. Conclusions. Helicopter tours, hiking in areas with active lava flows, falls into steam vents and earthcracks, and driving unfamiliar rental cars in unfamiliar locations are the major activities resulting in death and serious injury. Additional factors such as tourists ignoring warning signs, wandering off-trail or hiking at night, tourists misinformed by guidebooks and other tourists, and tourists with pre-existing heart and asthma conditions are contributing causes in many incidents. The findings of this study provide information that allows prospective tourists, tourism managers, and travel health providers make informed decisions that promote safe tourism and can aid future efforts in developing preventative strategies at tourist destinations with similar environments and activities. However, in order for preventative

  14. I-35w incident management and impact of incidents on freeway operations. Final report, 1976-1979

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

    Lari, A.; Christianson, D.; Porter, S.

    1982-01-01

    I-35W and I-94 Traffic Management System have been in operation since 1974. As of December 1979, the TMS operation included six principal functional subsystems. These are (1) a 24 camera closed circuit television network (2) 38 ramp meter signals, (3) eleven express bus and/or carpool meter bypass ramps, (4) a motorist information program including changeable message signs, lane control signals, highway advisory radio and a traffic grade information sign, (5) the Traffic Management Center and (6) an incident detection and response program. The purpose of this study was twofold: first, available incident records accumulated on the TMS were analyzed tomore » develop a comprehensive view of the types and quantities of incidents that have occurred. Second, the incident data base and companion volume and occupancy data was used to determine the impact of 'typical' incidents and the impact of the total incident problem. Included in the report is an analysis of incident types detected, mode of incident detection, duration of incidents, and incident response activities.« less

  15. A Profile of Criminal Incidents at School: Results from the 2003-05 National Crime Victimization Survey Crime Incident Report NCES 2010-318

    ERIC Educational Resources Information Center

    Ruddy, Sally A.; Bauer, Lynn; Neiman, Samantha

    2010-01-01

    This report provides estimates of criminal incidents that occur at school. Incident-level data were obtained from the National Crime Victimization Survey (NCVS), the nation's primary source of information on criminal victimization and criminal incidents in the United States. The NCVS collects demographic information on respondents in the NCVS…

  16. 49 CFR 1542.307 - Incident management.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  17. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

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

    Montgomery, Logan; Kildea, John

    We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosenmore » at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.« less

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

    PubMed

    Guenthner, Daniel H

    2012-01-01

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

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

    DOT National Transportation Integrated Search

    2009-08-01

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

  20. Do we need a national incident reporting system for medical imaging?

    PubMed

    Itri, Jason N; Krishnaraj, Arun

    2012-05-01

    The essential role of an incident reporting system as a tool to improve safety and reliability has been described in high-risk industries such as aviation and nuclear power, with anesthesia being the first medical specialty to successfully integrate incident reporting into a comprehensive quality improvement strategy. Establishing an incident reporting system for medical imaging that effectively captures system errors and drives improvement in the delivery of imaging services is a key component of developing and evaluating national quality improvement initiatives in radiology. Such a national incident reporting system would be most effective if implemented as one piece of a comprehensive quality improvement strategy designed to enhance knowledge about safety, identify and learn from errors, raise standards and expectations for improvement, and create safer systems through implementation of safe practices. The potential benefits of a national incident reporting system for medical imaging include reduced morbidity and mortality, improved patient and referring physician satisfaction, reduced health care expenses and medical liability costs, and improved radiologist satisfaction. The purposes of this article are to highlight the positive impact of external reporting systems, discuss how similar advancements in quality and safety can be achieved with an incident reporting system for medical imaging in the United States, and describe current efforts within the imaging community toward achieving this goal. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. Safer travel, improved economic productivity : incident management systems

    DOT National Transportation Integrated Search

    1999-01-01

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

  2. New York integrated incident management system evaluation project final report

    DOT National Transportation Integrated Search

    2007-03-23

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

  3. Kentucky's highway incident management strategic plan.

    DOT National Transportation Integrated Search

    2005-06-01

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

  4. Development of Incident Report Database for Organizational Learning

    NASA Astrophysics Data System (ADS)

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

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

  5. Resources planning for radiological incidents management

    NASA Astrophysics Data System (ADS)

    Hamid, Amy Hamijah binti Ab.; Rozan, Mohd Zaidi Abd; Ibrahim, Roliana; Deris, Safaai; Yunus, Muhd. Noor Muhd.

    2017-01-01

    Disastrous radiation and nuclear meltdown require an intricate scale of emergency health and social care capacity planning framework. In Malaysia, multiple agencies are responsible for implementing radiological and nuclear safety and security. This research project focused on the Radiological Trauma Triage (RTT) System. This system applies patient's classification based on their injury and level of radiation sickness. This classification prioritizes on the diagnostic and treatment of the casualties which include resources estimation of the medical delivery system supply and demand. Also, this system consists of the leading rescue agency organization and disaster coordinator, as well as the technical support and radiological medical response teams. This research implemented and developed the resources planning simulator for radiological incidents management. The objective of the simulator is to assist the authorities in planning their resources while managing the radiological incidents within the Internal Treatment Area (ITA), Reception Area Treatment (RAT) and Hospital Care Treatment (HCT) phases. The majority (75%) of the stakeholders and experts, who had been interviewed, witnessed and accepted that the simulator would be effective to resolve various types of disaster and resources management issues.

  6. Development of Kentucky's highway incident management strategic plan.

    DOT National Transportation Integrated Search

    2005-05-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  8. A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.

    PubMed

    Spano, Susanne J; Campagne, Danielle; Stroh, Geoff; Shalit, Marc

    2015-03-01

    Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations. An analysis of SEKI search and rescue data and a review of current literature were performed. A lightning strike at 10,600 feet elevation in the Sierra Nevada Mountains affected a party of 5 adults and 7 Boy Scouts (age range 12 to 17 years old). Resources mobilized for the rescue included 5 helicopters, 2 ambulances, 2 hospitals, and 15 field and 14 logistical support personnel. The incident was managed from strike to scene clearance in 4 hours and 20 minutes. There were 2 fatalities, 1 on scene and 1 in the hospital. Storm conditions complicated on-scene communication and evacuation efforts. Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  9. National cancer incidence and mortality in China, 2012.

    PubMed

    Chen, Wanqing; Zheng, Rongshou; Zuo, Tingting; Zeng, Hongmei; Zhang, Siwei; He, Jie

    2016-02-01

    Population-based cancer registration data in 2012 from all available cancer registries were collected by the National Central Cancer Registry (NCCR). NCCR estimated the numbers of new cancer cases and cancer deaths in China with compiled cancer incidence and mortality rates. In 2015, there were 261 cancer registries submitted cancer incidence and deaths occurred in 2012. All the data were checked and evaluated based on the NCCR criteria of data quality. Qualified data from 193 registries were used for cancer statistics analysis as national estimation. The pooled data were stratified by area (urban/rural), gender, age group [0, 1-4, 5-9, 10-14, …, 85+] and cancer type. New cancer cases and deaths were estimated using age-specific rates and corresponding national population in 2012. The Chinese census data in 2000 and Segi's population were applied for age-standardized rates. All the rates were expressed per 100,000 person-year. Qualified 193 cancer registries (74 urban and 119 rural registries) covered 198,060,406 populations (100,450,109 in urban and 97,610,297 in rural areas). The percentage of cases morphologically verified (MV%) and death certificate-only cases (DCO%) were 69.13% and 2.38%, respectively, and the mortality to incidence rate ratio (M/I) was 0.62. A total of 3,586,200 new cancer cases and 2,186,600 cancer deaths were estimated in China in 2012. The incidence rate was 264.85/100,000 (289.30/100,000 in males, 239.15/100,000 in females), the age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 191.89/100,000 and 187.83/100,000 with the cumulative incidence rate (0-74 age years old) of 21.82%. The cancer incidence, ASIRC and ASIRW in urban areas were 277.17/100,000, 195.56/100,000 and 190.88/100,000 compared to 251.20/100,000, 187.10/100,000 and 183.91/100,000 in rural areas, respectively. The cancer mortality was 161.49/100,000 (198.99/100,000 in males, 122.06/100,000 in females), the

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

    PubMed

    Tucker, J B

    1997-08-06

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

  11. National Response Framework (NRF)

    EPA Pesticide Factsheets

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

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

    DOT National Transportation Integrated Search

    2017-06-13

    In recent years, there has been an increased focus on Traffic Incident Management (TIM) and : incorporation of the Incident Command System (ICS) to reduce traffic congestion on the nation's : Interstates. In fact, studies show that for every minute a...

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

    DOT National Transportation Integrated Search

    2000-04-01

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

  14. Factors affecting fire suppression costs as identified by incident management teams

    Treesearch

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

    2006-01-01

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

  15. Regional Traffic Incident Management Programs : implementation guide

    DOT National Transportation Integrated Search

    2000-11-01

    The purpose of this document is to assist organizations and their leaders in implementing and sustaining regional traffic incident management programs, both by examining some successful models, and by considering some of the lessons learned by early ...

  16. National Patient Safety Program in Brazil: Incidents Reported Between 2014 and 2017.

    PubMed

    Faustino, Tássia Nery; Batalha, Edenise Maria Santos da Silva; Vieira, Silvana Lima; Nicole, Andressa Garcia; Morais, Alexandre Souza; Tronchin, Daisy Maria Rizatto; Melleiro, Marta Maria

    2018-05-16

    The aim of the study was to analyze the patient safety incidents reported to the Brazilian National Health Surveillance System from March 2014 to March 2017. A documentary study that used the records of the incidents published in the Reports of Adverse Events (AE) in Brazil. The following variables were selected: number of incidents by type, type of health service, hospital unit, and degree of harm. To find whether there was a significant difference across the Brazilian regions by notifications related to general incidents, AE, and deaths, the analysis of variance and the Tukey tests were used. A total of 109,082 incidents were reported, of which 75,088 were AE, with 649 deaths. In relation to the types of incidents reported, there was a higher frequency in the categories other (30.04%) and failures during health care (26.72%). A total of 93.90% of the incidents occurred in hospitals, with 54,950 cases registered in hospitalization units and 30,141 cases in intensive care units. Statistically significant differences across the Brazilian regions were observed in the number of incidents (P = 0.004), AE (P = 0.004), and deaths (P = 0.024). A significant underreporting of incidents was found in Brazil, demonstrating only the tip of a giant iceberg. More than half of the incidents were reported as AE and were registered in hospitals, reiterating the importance of establishing public health policies at national, state, and municipal levels, with adequate supervision of the health service regarding the implementation of the Patient Safety Nuclei and the preparation of new protocols based on the most prevalent incidents.

  17. 76 FR 22911 - National Advisory Council

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-25

    ... discussions on professionalism of emergency management, approaches for National Incident Management System... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2007-0008] National Advisory Council AGENCY: Federal Emergency Management Agency, DHS. ACTION: Committee Management...

  18. When Things Go Wrong: Managing Critical Incidents in Children's Services.

    ERIC Educational Resources Information Center

    Legg, Chris

    2001-01-01

    Critical incidents particular to an individual or family (such as parental divorce or death of a family member) and incidents of national or international significance (such as wars or terrorist attacks) effect those involved in children's services and can result in some children, families, or staff suffering long-term psychological effects. This…

  19. 76 FR 61371 - All-Hazard Position Task Books for Type 3 Incident Management Teams

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

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

  20. Acromioclavicular joint injuries in the National Football League: epidemiology and management.

    PubMed

    Lynch, T Sean; Saltzman, Matthew D; Ghodasra, Jason H; Bilimoria, Karl Y; Bowen, Mark K; Nuber, Gordon W

    2013-12-01

    Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position players in the National Football League (NFL). The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players; (2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to compare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention. Descriptive epidemiological study. All documented injuries of the AC joint were retrospectively analyzed using the NFL Injury Surveillance System (NFLISS) over a 12-season period from 2000 through 2011. The data were analyzed by the anatomic location, player position, field conditions, type of play, requirement of surgical management, days missed per injury, and injury incidence. Over 12 NFL seasons, there were a total of 2486 shoulder injuries, with 727 (29.2%) of these injuries involving the AC joint. The overall rate of AC joint injuries in these athletes was 26.1 injuries per 10,000 athlete exposures, with the majority of these injuries occurring during game activity on natural grass surfaces (incidence density ratio, 0.79) and most often during passing plays. These injuries occurred most frequently in defensive backs, wide receivers, and special teams players; however, the incidence of these injuries was greatest in quarterbacks (20.9 injuries per 100 players), followed by special teams players (20.7/100) and wide receivers (16.5/100). Overall, these athletes lost a mean of 9.8 days per injury, with quarterbacks losing the most time to injury (mean, 17.3 days). The majority of

  1. Modeling wildfire incident complexity dynamics.

    PubMed

    Thompson, Matthew P

    2013-01-01

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

  2. Supporting the Federal Emergency Management Agency Rescuers: a variation of critical incident stress management.

    PubMed

    Garcia, Evangeline; Horton, Denise A

    2003-02-01

    The purpose of this article was to document the efforts of two military installations in facilitating Critical Incident Stress Management teams for Federal Emergency Management Agency Rescue and Recovery Units following the attacks on the World Trade Center on September 11, 2001. McGuire Air Force Base accepted the mission to support the rotating task forces with emotional support, and Fort Dix offered temporary lodging while the teams were in-bound and out-bound to the "Ground Zero" site. A team, comprised of staff from both installations due to the configuration of professional and support staffs, does the Critical Incident Stress Management work. Both installations are within commuting distance of New York City and could provide adequate safety, security, and logistics to the teams. The classic crisis management models were not called into play, as that service was not asked for; however, it was clear to the McGuire Air Force Base/Fort Dix Critical Incident Stress Management team members that the rescue and recovery teams needed their physical presence. Many rescue organizations have their own "debriefing teams," yet it is believed that "outside teams" may be helpful as interim measures to demonstrate the universality of the process of coping with traumatic stress and grief management. It is hoped that this article honors the workers who came together to help in a very difficult time for our country. This article documents the interim measures that were taken for a group of people moving through crisis.

  3. Guidelines for developing traffic incident management plans for work zones

    DOT National Transportation Integrated Search

    2003-09-01

    The Colorado Department of Transportation (CDOT) has led the development of a number of traffic incident management plans and programs throughout the state. These programs address procedural and coordination aspects of managing unplanned events on th...

  4. Occupational Bloodborne Exposure Incident Survey & Management of Exposure Incidents in a Dental Teaching Environment

    PubMed Central

    Sedky, Nabila A.

    2013-01-01

    Objectives The purpose of this study was to investigate the prevalence of occupational exposure incidents among undergraduate dental students and the factors associated with it in the educational dental clinics at Pharos University in Alexandria – Egypt, and to measure the commitment with applying infection control policy in the form of compliance with post-exposure management protocol and reporting exposure incidents. Materials and Methods An anonymous self-administered questionnaire consisting of thirteen multiple-choice questions was distributed among 350 undergraduate dental students in mid-senior and senior levels during lectures at the end of the second semester of 2011, with a response rate of 90.00%. Results About 62.00% of the senior students reported that exposures occurred outside the patient’s mouth. A high percentage of both the mid-senior and senior students (74.70% and 70.70%, respectively) reported that they were exposed to multiple sources of incidents. The vast majority of studied groups stated that they didn’t follow Infection Control Protocol after Incident Exposure. Conclusion The findings of this study confirm that dental students experience exposure incidents but are not likely to report them, thus it is important that the principles of infection control training and reporting of all exposure incidents continue to be emphasized throughout undergraduate dental education. PMID:24421746

  5. Colonoscopic splenic injuries: incidence and management.

    PubMed

    Kamath, Ashwin S; Iqbal, Corey W; Sarr, Michael G; Cullinane, Daniel C; Zietlow, Scott P; Farley, David R; Sawyer, Mark D

    2009-12-01

    Splenic injuries that occur during colonoscopies are rare. There is no available incidence of this serious complication, and the literature is limited to case reports. Our study looks at single institution experience of splenic injuries during colonoscopy to define the incidence and management of this serious complication. All patients from 1980 through June 2008 sustaining a splenic injury during colonoscopy were reviewed. Four patients (of 296,248 colonoscopies) sustained a splenic injury directly from colonoscopy performed at our institution (incidence 0.001%). Three additional patients were treated at our tertiary referral center after splenic injury from colonoscopy performed elsewhere. The mean age at the time of colonoscopy was 54 years (range 40-70 years). The most common presenting symptom was abdominal pain (n = 4) with a mean decrease in hemoglobin of 6.5 g/dl (range 4.5-8.5 g/dl). Splenic injury was diagnosed by computed tomography in five patients. Six patients received a mean of 5.5 U of packed red blood cells (range 2-14 U). All patients were managed with splenectomy, six patients within 24 h of the index colonoscopy, and one patient presented more than 24 h after initial colonoscopy. There was no evidence of preexisting splenic disease in any of the patients by surgical pathology, and there were no postoperative complications or deaths. The mean duration of stay was 10 days (range 7-15 days). All patients are alive at a median follow up of 22 months (range 1-164 months). Splenic injury occurring during colonoscopy is a rare but serious complication. Patients presented with abdominal pain and a precipitous decrease in hemoglobin and have all required emergent splenectomy.

  6. Spills of National Significance Response Management System

    DOT National Transportation Integrated Search

    1997-07-15

    This Instruction contains guidance for establishing an Incident Command System : (ICS) Area Command Structure for a Spill of National Significance (SONS). : Reference (a), the National Contingency Plan (NCP), assigns responsibilities for : emergency ...

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

    PubMed

    Davari, Fereshteh; Zahed, Arash

    2015-09-01

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

  8. The Benefits of Collaborative Processes for Establishing All Hazard Incident Management Teams in Urban Area Security Initiative Regions

    DTIC Science & Technology

    2013-09-01

    incidents beyond wild land fires.15 This journal article also noted that national IMTs provided command functions at the World Trade Center on September...11, 2001, Hurricane Katrina in 2005 and search and recovery efforts following the Space Shuttle Columbia disaster.16 Because of the utility and...Management Team SWA Southwest Area SWCC Southwest Coordination Center UASI Urban Area Security Initiative UAWG Urban Area Working Group

  9. Reflections on Leadership and Governance from the Incident Manager of Liberia's Ebola Response.

    PubMed

    Nyenswah, Tolbert

    The 2014-2016 epidemic of Ebola virus disease occurred in a region with a recent history of civil war, unstable health systems, and widespread poverty. Despite these contextual challenges, the national Ebola response in Liberia controlled transmission under strong leadership that was able to rapidly coordinate activities, to manage local and international players, and to adapt upon recognizing missteps. Such leadership has persisted to improve public health capacity in post-Ebola Liberia. This article highlights the progress made toward developing a resilient health security system with capacity to prevent, detect, and respond to disease threats before they reach epidemic level. In particular, Liberia's development of a Global Health Security Agenda roadmap, a Joint External Evaluation (JEE) report for International Health Regulation (2005) core capacities, and recent establishment of a National Public Health Institute are described. To better protect the country's population and the greater global community from health threats, emerging institutions and policies in Liberia will depend on leadership and governance that draws from the successes and lessons learned during the Ebola outbreak. The author provides insight based on his role as incident manager of Liberia's Ebola response.

  10. Major Incident Hospital: Development of a Permanent Facility for Management of Incident Casualties.

    PubMed

    Marres, Geertruid; Bemelman, Michael; van der Eijk, John; Leenen, Luke

    2009-06-01

    Preparation is essential to cope with the challenge of providing optimal care when there is a sudden, unexpected surge of casualties due to a disaster or major incident. By definition, the requirements of such cases exceed the standard care facilities of hospitals in qualitative or quantitative respects and interfere with the care of regular patients. To meet the growing demands to be prepared for disasters, a permanent facility to provide structured, prepared relief in such situations was developed. A permanent but reserved Major Incident Hospital (MIH) has been developed through cooperation between a large academic medical institution, a trauma center, a military hospital, and the National Poison Information Centre (NVIC). The infrastructure, organization, support systems, training and systematic working methods of the MIH are designed to create order in a chaotic, unexpected situation and to optimize care and logistics in any possible scenario. Focus points are: patient flow and triage, registration, communication, evaluation and training. Research and the literature are used to identify characteristic pitfalls due to the chaos associated with and the unexpected nature of disasters, and to adapt our organization. At the MIH, the exceptional has become the core business, and preparation for disaster and large-scale emergency care is a daily occupation. An Emergency Response Protocol enables admittance to the normally dormant hospital of up to 100 (in exceptional cases even 300) patients after a start-up time of only 15 min. The Patient Barcode Registration System (PBR) with EAN codes guarantees quick and adequate registration of patient data in order to facilitate good medical coordination and follow-up during a major incident. The fact that the hospital is strictly reserved for this type of care guarantees availability and minimizes impact on normal care. When it is not being used during a major incident, there is time to address training and research

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

    PubMed

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

    2015-01-01

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

  12. Aortic dissection in pregnancy in England: an incidence study using linked national databases

    PubMed Central

    Banerjee, Amitava; Begaj, Irena; Thorne, Sara

    2015-01-01

    Objectives To conduct the first population-level incidence study of aortic dissection in pregnancy using linked hospital-based data in England. Setting Hospital-based data (Hospital Episode Statistics (HES) linked with mortality data from the Office of National Statistics), national enquiries (Confidential Enquiries into Maternal Mortality) and surveys (UK Obstetric Surveillance System; UKOSS) of aortic dissection in pregnancy from 2003 to 2011 in England. Participants Between 2003 and 2011, all female patients admitted with diagnoses of aortic dissection (not necessarily as the primary cause of admission) and of pregnancy, childbirth and puerperium, were included. Outcome measures Diagnosis of aortic dissection during pregnancy, operated or not operated, with outcome of death or live patient from 2003 to 2011 in England. Results There were significant differences in characteristics of databases with respect to study population, time of study, recorded event and follow-up of outcomes. On the basis of HES, annual incidence of aortic dissection was 1.23 (95% CI 1.22 to 1.24) per 100 000 maternities. Incidence of aortic dissection with death within 1 year was 0.30 (0.29 to 0.31) per 100 000 maternities. Incidence of aortic dissection increased from 0.74 (0.73 to 0.75) per 100 000 maternities in 2003–2005 to 1.52 (1.51 to 1.53) per 100 000 maternities in 2009–2011. In the Confidential Enquiries into Maternal Deaths, incidence of deaths was highest for 2003–2005 (0.43/100 000 maternities) and lowest for 1997–1999 (0.21/100 000 maternities). In the UK Obstetric Surveillance System, national incidence of aortic dissection was 0.80 (0.50 to 1.50) per 100 000 maternities between 2009 and 2011. Conclusions The case of aortic dissection in pregnancy illustrates data limitations regarding complications in pregnancy from different sources in the UK, even for a diagnosis with seemingly few alternative coding and diagnostic possibilities. These limitations should be

  13. Mesothelioma incidence and asbestos exposure in Italian national priority contaminated sites.

    PubMed

    Binazzi, Alessandra; Marinaccio, Alessandro; Corfiati, Marisa; Bruno, Caterina; Fazzo, Lucia; Pasetto, Roberto; Pirastu, Roberta; Biggeri, Annibale; Catelan, Dolores; Comba, Pietro; Zona, Amerigo

    2017-11-01

    Objectives This study aimed to (i) describe mesothelioma incidence in the Italian national priority contaminated sites (NPCS) on the basis of data available from the Italian National Mesothelioma Registry (ReNaM) and (ii) profile NPCS using Bayesian rank analysis. Methods Incident cases of mesothelioma and standardized incidence ratios (SIR) were estimated for both genders in each of the 39 selected NPCS in the period 2000-2011. Age-standardized rates of Italian geographical macro areas were used to estimate expected cases. Rankings of areas were produced by a hierarchical Bayesian model. Asbestos exposure modalities were discussed for each site. Results In the study period, 2683 incident cases of mesothelioma (1998 men, 685 women) were recorded. An excess of mesothelioma incidence was confirmed in sites with a known past history of direct use of asbestos (among men) such as Balangero (SIR 197.1, 95% CI 82.0-473.6), Casale Monferrato (SIR 910.7, 95% CI 816.5-1012.8), and Broni (SIR 1288.5, 95% CI 981.9-1691.0), in sites with shipyards and harbors (eg, Trieste, La Spezia, Venice, and Leghorn), and in settings without documented direct use of asbestos. The analysis ranked the sites of Broni and Casale Monferrato (both genders) and Biancavilla (only for women) the highest. Conclusions The present study confirms that asbestos pollution is a risk for people living in polluted areas, due to not only occupational exposure in industrial settings with direct use of asbestos but also the presence of asbestos in the environment. Epidemiological surveillance of asbestos-related diseases is a fundamental tool for monitoring the health profile in NPCS.

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

    Treesearch

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

    2017-01-01

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

  15. Enhancement of freeway incident traffic management and resulting benefits.

    DOT National Transportation Integrated Search

    2012-04-01

    To improve traffic conditions on major highways plagued by non-recurrent congestion, most : highway agencies have invested their resources in two principal operational programs: incident response : and clearance, and traffic impact management. Howeve...

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

    DOT National Transportation Integrated Search

    2017-12-01

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

  17. [The German National Disease Management Guideline "Chronic Heart Failure"].

    PubMed

    Weinbrenner, S; Langer, T; Scherer, M; Störk, S; Ertl, G; Muth, Ch; Hoppe, U C; Kopp, I; Ollenschläger, G

    2012-02-01

    Chronic heart failure (CHF) is an illness mostly affecting elderly people. In Germany CHF is one of the most common causes of death and at the same time one of the most common diagnosis in inpatient care. Due to the expected increase in life expectancy in the next few years experts predict a further step-up of the incidence. Against this background development of a national guideline on chronic heart failure was prioritised and accordingly the National Disease Management Guideline (NDMG) Chronic Heart Failure was developed by a multi- and interdisciplinary group. The guideline group comprised experts from all relevant scientific medical societies as well as a patient expert. The National Disease Management Guideline (NDMG) on Chronic Heart Failure aims at supporting patients and health care providers with respect to decisions on a specific health care problem by giving recommendations for actions. Recommendations are informed by the best available scientific evidence on this topic.Patients with CHF often suffer from multiple conditions. Due to this fact and the old age patients do have very complex and demanding health care needs. Thus accounting for co-morbidities is paramount in planning and providing health care for theses patients and communication between doctor and patient but also between all health care providers is crucial.Basic treatment strategies in chronic heart failure comprise management of risk factors and prognostic factors as well as appropriate consideration of co-morbidities accompanied by measures empowering patients in establishing a healthy life style and a self-dependant management of their illness.Psycho-social aspects have a very strong influence on patients' acceptance of the disease and their self-management. In addition they have a strong influence on therapy management of the treating physician thus they have to be addressed adequately during the consultation.The National Disease Management Guideline (NDMG) Chronic Heart Failure (CHF

  18. Air quality evaluation of Rhode Island's incident management program

    DOT National Transportation Integrated Search

    1997-09-01

    The objective of this preliminary air quality analysis was to assess the potential air quality benefits associated with the implementation of Providence's Metropolitan portion of Rhode Island's Incident Management Program. Specifically, the air quali...

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  20. Incidence of Hospitalized Stroke in the Czech Republic: The National Registry of Hospitalized Patients.

    PubMed

    Sedova, Petra; Brown, Robert D; Zvolsky, Miroslav; Kadlecova, Pavla; Bryndziar, Tomas; Kubelka, Tomáš; Weiss, Viktor; Volný, Ondřej; Bednarik, Josef; Mikulik, Robert

    2017-05-01

    Contemporary stroke incidence data are not available in some countries and regions, including in Eastern Europe. Based on previous validation of the accuracy of the National Registry of Hospitalized Patients (NRHOSP), we report the incidence of hospitalized stroke in the Czech Republic (CR) using the NRHOSP. The results of the prior validation study assessing the accuracy of coding of stroke diagnoses in the NRHOSP were applied, and we calculated (1) the overall incidence of hospitalized stroke and (2) the incidence rates of hospitalized stroke for the three main stroke types: cerebral infarction (International Classification of Diseases Tenth Revision, CI I63), subarachnoid hemorrhage (SAH I60), and intracerebral hemorrhage (ICH I61). We calculated the average annual age- and sex-standardized incidence. The overall incidence of hospitalized stroke was 241 out of 100,000 individuals. The incidence of hospitalized stroke for the main stroke types was 8.2 cases in SAH, 29.5 in ICH, and 211 in CI per 100,000 individuals. The standardized annual stroke incidence adjusted to the 2000 World Health Organization population for overall stroke incidence of hospitalized stroke was 131 per 100,000 individuals. Standardized stroke incidence for stroke subtypes was 5.7 cases in SAH, 16.7 in ICH, and 113 in CI per 100,000 individuals. These studies provide an initial assessment of the burden of stroke in this part of the world. The estimates of hospitalized stroke in the CR and Eastern Europe suggest that ICH is about three times more common than SAH, and hemorrhagic stroke makes up about 18% of strokes. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Medical management of three workers following a radiation exposure incident

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

    House, R.A.; Sax, S.E.; Rumack, E.R.

    The medical management of three individuals involved in an exposure incident to whole-body radiation at a nuclear generating plant of a Canadian electrical utility is described. The exposure incident resulted in the two highest whole-body radiation doses ever received in a single event by workers in a Canadian nuclear power plant. The individual whole-body doses (127.4 mSv, 92.0 mSv, 22.4 mSv) were below the threshold for acute radiation sickness but the exposures still presented medical management problems related to assessment and counseling. Serial blood counting and lymphocyte cytogenetic analysis to corroborate the physical dosimetry were performed. All three employees experiencedmore » somatic symptoms due to stress and one employee developed post-traumatic stress disorder. This incident indicates that there is a need in such radiation exposure accidents for early and continued counseling of exposed employees to minimize the risk of development of stress-related symptoms.« less

  2. Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States.

    PubMed

    Suskind, Anne M; Saigal, Christopher S; Hanley, Janet M; Lai, Julie; Setodji, Claude M; Clemens, J Quentin

    2016-04-01

    To determine the incidence and characteristics of women with uncomplicated recurrent urinary tract infections (UTIs) and to explore whether the use of culture-driven treatment affects rates of UTI-related complications and resource utilization. Using MarketScan claims from 2003 to 2011, we identified UTI-naive women ages 18-64 with incident-uncomplicated recurrent UTIs. Recurrent UTIs were defined as 3 UTI visits associated with antibiotics during a 12-month period. Cases were excluded if they had a UTI in the preceding year, or if they had any complicating factors (eg, abnormality of the urinary tract, neurologic condition, pregnancy, diabetes, or currently taking immunosuppression). We next assessed use of urine cultures, imaging, and cystoscopy, and performed propensity score matching with logistic regression to determine whether having a urine culture associated with >50% of UTIs affected rates of complications and downstream resource utilization. We identified 48,283 women with incident-uncomplicated recurrent UTIs, accounting for an overall incidence of 102 per 100,000 women, highest among women ages 18-34 and 55-64. Sixty-one percent of these women had at least 1 urine culture, 6.9% had imaging, and 2.8% had cystoscopy. Having a urine culture >50% of the time was associated with fewer UTI-related hospitalizations and lower rates of intravenous antibiotic use, whereas demonstrating higher rates of UTI-related office visits and pyelonephritis. The incidence of uncomplicated recurrent UTIs increases with age. Urine culture-directed care is beneficial in reducing high-cost services including UTI-related hospitalizations and intravenous antibiotic use, making urine cultures a valuable component to management of these patients. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    DOT National Transportation Integrated Search

    2018-02-02

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

  4. Simulating traffic for incident management and ITS investment decisions

    DOT National Transportation Integrated Search

    1998-08-01

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

  5. Biological age as a health index for mortality and major age-related disease incidence in Koreans: National Health Insurance Service – Health screening 11-year follow-up study

    PubMed Central

    Kang, Young Gon; Suh, Eunkyung; Lee, Jae-woo; Kim, Dong Wook; Cho, Kyung Hee; Bae, Chul-Young

    2018-01-01

    Purpose A comprehensive health index is needed to measure an individual’s overall health and aging status and predict the risk of death and age-related disease incidence, and evaluate the effect of a health management program. The purpose of this study is to demonstrate the validity of estimated biological age (BA) in relation to all-cause mortality and age-related disease incidence based on National Sample Cohort database. Patients and methods This study was based on National Sample Cohort database of the National Health Insurance Service – Eligibility database and the National Health Insurance Service – Medical and Health Examination database of the year 2002 through 2013. BA model was developed based on the National Health Insurance Service – National Sample Cohort (NHIS – NSC) database and Cox proportional hazard analysis was done for mortality and major age-related disease incidence. Results For every 1 year increase of the calculated BA and chronological age difference, the hazard ratio for mortality significantly increased by 1.6% (1.5% in men and 2.0% in women) and also for hypertension, diabetes mellitus, heart disease, stroke, and cancer incidence by 2.5%, 4.2%, 1.3%, 1.6%, and 0.4%, respectively (p<0.001). Conclusion Estimated BA by the developed BA model based on NHIS – NSC database is expected to be used not only as an index for assessing health and aging status and predicting mortality and major age-related disease incidence, but can also be applied to various health care fields. PMID:29593385

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

    DOT National Transportation Integrated Search

    1991-01-01

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

  7. National disease management plans for key chronic non-communicable diseases in Singapore.

    PubMed

    Tan, C C

    2002-07-01

    In Singapore, chronic, non-communicable diseases, namely coronary heart disease, stroke and cancer, account for more than 60% of all deaths and a high burden of disability and healthcare expenditure. The burden of these diseases is likely to rise with our rapidly ageing population and changing lifestyles, and will present profound challenges to our healthcare delivery and financing systems over the next 20 to 30 years. The containment and optimal management of these conditions require a strong emphasis on patient education and the development of integrated models of healthcare delivery in place of the present uncoordinated, compartmentalised way of delivering healthcare. To meet these challenges, the Ministry of Health's major thrusts are disease control measures which focus mainly on primary prevention; and disease management, which coordinates the national effort to reduce the incidence of these key diseases and their predisposing factors and to ameliorate their long-term impact by optimising control to reduce mortality, morbidity and complications, and improving functional status through rehabilitation. The key initiatives include restructuring of the public sector healthcare institutions into two clusters, each comprising a network of primary health care polyclinics, regional hospitals and tertiary institutions. The functional integration of these healthcare elements within each cluster under a common senior administrative and professional management, and the development of common clinical IT systems will greatly facilitate the implementation of disease management programmes. Secondly, the Ministry is establishing National Disease Registries in coronary heart disease, cancer, stroke, myopia and kidney failure, which will be valuable sources of clinical and outcomes data. Thirdly, in partnership with expert groups, national committees and professional agencies, the Ministry will produce clinical practice guidelines which will assist doctors and healthcare

  8. Business continuity and disaster management within the public service in relation to a national development plan.

    PubMed

    Ferguson, Cliff

    2018-01-01

    Within South Africa, few public service departments understand the concepts of business continuity management (BCM) and what it takes to implement a well-constructed business continuity plan. Likewise, few of these entities understand the purpose of designing and maintaining resilient systems that are immune to incidents. This paper discusses the integration of the South African Disaster Management Act 2002, the Disaster Management Framework and the National Development Plan, linking these to BCM, through a resilience period model, as a means for the implementation of resilience strategies. The goals of the National Development Plan are outlined with a view to how resilience can be achieved in each. A resilience period model has been advocated for the implementation of projects within the public sector in order to provide continuity and sustainability.

  9. Treated prevalence and incidence of dementia among National Health Insurance enrollees in Taiwan, 1996-2003.

    PubMed

    Chien, I-Chia; Lin, Yu-Chung; Chou, Yiing-Jenq; Lin, Ching-Heng; Bih, Shin-Huey; Lee, Cheng-Hua; Chou, Pesus

    2008-06-01

    The National Health Insurance database to determine the treated prevalence and incidence of dementia in Taiwan was used in this study. A population-based random sample of 22 118 subjects aged 65 or older was obtained as a dynamic cohort. Those study subjects who had filed at least one service claim from 1996 to 2003 for either outpatient care or inpatient care with a principal diagnosis of dementia were identified. The annual treated prevalence increased from 0.71% to 1.92% from 1996 to 2003. The annual treated incidence rates were around 0.76% to 1.04% per year from 1997 to 2003. The annual treated incidence rates for the 5-year age groups, from 65 to 90 years and older, were 0.44%, 0.65%, 0.98%, 1.46%, 1.81%, and 1.80%, respectively. Both the treated prevalence and incidence rates of dementia in National Health Insurance were lower than those of community studies.

  10. Elevated incidence rates of diabetes in Peru: report from PERUDIAB, a national urban population-based longitudinal study

    PubMed Central

    Seclen, Segundo Nicolas; Rosas, Moises Ernesto; Arias, Arturo Jaime; Medina, Cecilia Alexandra

    2017-01-01

    Objective A recent report from a non-nationally representative, geographically diverse sample in four separate communities in Peru suggests an unusually high diabetes incidence. We aimed to estimate the national diabetes incidence rate using PERUDIAB, a probabilistic, national urban population-based longitudinal study. Research design and methods 662 subjects without diabetes, selected by multistage, cluster, random sampling of households, representing the 24 administrative and the 3 (coast, highlands and jungle) natural regions across the country, from both sexes, aged 25+ years at baseline, enrolled in 2010–2012, were followed for 3.8 years. New diabetes cases were defined as fasting blood glucose ≥126 mg/dL or on medical diabetes treatment. Results There were 49 cases of diabetes in 2408 person-years follow-up. The weighted cumulative incidence of diabetes was 7.2% while the weighted incidence rate was estimated at 19.5 (95% CI 13.9 to 28.3) new cases per 1000 person-years. Older age, obesity and technical or higher education were statistically associated with the incidence of diabetes. Conclusion Our results confirm that the incidence of diabetes in Peru is among the highest reported globally. The fast economic growth in the last 20 years, high overweight and obesity rates may have triggered this phenomenon. PMID:28878935

  11. Elevated incidence rates of diabetes in Peru: report from PERUDIAB, a national urban population-based longitudinal study.

    PubMed

    Seclen, Segundo Nicolas; Rosas, Moises Ernesto; Arias, Arturo Jaime; Medina, Cecilia Alexandra

    2017-01-01

    A recent report from a non-nationally representative, geographically diverse sample in four separate communities in Peru suggests an unusually high diabetes incidence. We aimed to estimate the national diabetes incidence rate using PERUDIAB, a probabilistic, national urban population-based longitudinal study. 662 subjects without diabetes, selected by multistage, cluster, random sampling of households, representing the 24 administrative and the 3 (coast, highlands and jungle) natural regions across the country, from both sexes, aged 25+ years at baseline, enrolled in 2010-2012, were followed for 3.8 years. New diabetes cases were defined as fasting blood glucose ≥126 mg/dL or on medical diabetes treatment. There were 49 cases of diabetes in 2408 person-years follow-up. The weighted cumulative incidence of diabetes was 7.2% while the weighted incidence rate was estimated at 19.5 (95% CI 13.9 to 28.3) new cases per 1000 person-years. Older age, obesity and technical or higher education were statistically associated with the incidence of diabetes. Our results confirm that the incidence of diabetes in Peru is among the highest reported globally. The fast economic growth in the last 20 years, high overweight and obesity rates may have triggered this phenomenon.

  12. Gastric Cancer Incidence Estimation in a Resource-Limited Nation: Use of Endoscopy Registry Methodology

    PubMed Central

    Dominguez, Ricardo L.; Crockett, Seth D.; Lund, Jennifer L.; Suazo, Lia P.; Heidt-Davis, Paris; Martin, Christopher; Morgan, Douglas R.

    2013-01-01

    Purpose Cancer epidemiology is challenging in developing nations, in the absence of reliable pathology-based cancer registries. Clinical experience suggests that the incidence of gastric cancer is high in Honduras, in contrast to the limited available national statistics at the time of study initiation (IARC GLOBOCAN 2002: males 15.2, females 10.8). We estimate the incidence of gastric cancer for Honduras using an endoscopy registry as a complimentary resource. Methods We conducted a retrospective analysis of incident noncardia gastric adenocarcinoma cases in Western Honduras for the period 2000–2009. This region is well circumscribed geopolitically with a single district hospital and established referral patterns, to provide a unique epidemiological niche to facilitate estimation of incidence rates. A prospective, comprehensive database of all endoscopy procedures from this hospital was utilized at the primary data source. The catchment area for gastroenterology services for the at-risk population was validated by calculating the overall endoscopy utilization rates for each municipality in western Honduras. Incident cases of gastric adenocarcinoma were determined by the endoscopic diagnosis. Pathology services are not financed by the Ministry of Health, and histology data was incorporated when available. Population statistics were obtained from the Honduras National Statistics Institute (INE). Age standardized incidence rates (ASIRs) were calculated using world standard population fractions. Results The catchment area for Western Honduras was validated with the municipality threshold of 30 endoscopies per 106 person-years, with inclusion of a total of 40 municipalities. In the Western Honduras catchment area, there were 670 incident cases (439 M, 231 F) of noncardia gastric adenocarcinoma during the study decade 2000–2009. Notably, 67 (10.0%) and 165 (24.6%) of cases were under the ages of 45 and 55, respectively. The case-finding rate was 5.1 endoscopies

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

    DOT National Transportation Integrated Search

    2009-12-01

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

  14. Developing an incident management system to support Ebola response -- Liberia, July-August 2014.

    PubMed

    Pillai, Satish K; Nyenswah, Tolbert; Rouse, Edward; Arwady, M Allison; Forrester, Joseph D; Hunter, Jennifer C; Matanock, Almea; Ayscue, Patrick; Monroe, Benjamin; Schafer, Ilana J; Poblano, Luis; Neatherlin, John; Montgomery, Joel M; De Cock, Kevin M

    2014-10-17

    The ongoing Ebola virus disease (Ebola) outbreak in West Africa is the largest and most sustained Ebola epidemic recorded, with 6,574 cases. Among the five affected countries of West Africa (Liberia, Sierra Leone, Guinea, Nigeria, and Senegal), Liberia has had the highest number cases (3,458). This epidemic has severely strained the public health and health care infrastructure of Liberia, has resulted in restrictions in civil liberties, and has disrupted international travel. As part of the initial response, the Liberian Ministry of Health and Social Welfare (MOHSW) developed a national task force and technical expert committee to oversee the management of the Ebola-related activities. During the third week of July 2014, CDC deployed a team of epidemiologists, data management specialists, emergency management specialists, and health communicators to assist MOHSW in its response to the growing Ebola epidemic. One aspect of CDC's response was to work with MOHSW in instituting incident management system (IMS) principles to enhance the organization of the response. This report describes MOHSW's Ebola response structure as of mid-July, the plans made during the initial assessment of the response structure, the implementation of interventions aimed at improving the system, and plans for further development of the response structure for the Ebola epidemic in Liberia.

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

    DOT National Transportation Integrated Search

    2007-10-01

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

  16. Deaths following prehospital safety incidents: an analysis of a national database.

    PubMed

    Yardley, Iain E; Donaldson, Liam J

    2016-10-01

    Ensuring patient safety in the prehospital environment is difficult due to the unpredictable nature of the workload and the uncontrolled situations that care is provided in. Studying previous safety incidents can help understand risks and take action to mitigate them. We present an analysis of safety incidents related to patient deaths in ambulance services in England. All incidents related to a patient death reported to the National Reporting and Learning System from an ambulance service between 1 June 2010 and 31 October 2012 were subjected to thematic analysis to identify the failings that led to the incident. Sixty-nine incidents were analysed, equating to one safety incident-related death per 168 000 calls received. Just three event categories were identified: delayed response (59%, 41/69), shortfalls in clinical care (35%, 24/69) and injury during transit (6%, 4/69). Primary failures differed for the categories: problems with dispatch caused the majority of delays in response, with equipment problems and bad weather accounting for the remainder. Failure to provide necessary care was predominantly caused by clinical misjudgements by ambulance staff and equipment issues underlay incidents that led to a patient injury. Improvements intended to address safety related mortality in the ambulance service should include ensuring adequate equipping and resourcing of ambulance services, improving coordination and decision-making during dispatch and supporting individual staff members in the difficult decisions they are faced with. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Using a competency-based approach to identify the management behaviours required to manage workplace stress in nursing: a critical incident study.

    PubMed

    Lewis, Rachel; Yarker, Joanna; Donaldson-Feilder, Emma; Flaxman, Paul; Munir, Fehmidah

    2010-03-01

    To identify the specific management behaviours associated with the effective management of stress in nursing; and to build a stress management competency framework that can be integrated and compared with nurse management frameworks. Workplace stress is a significant problem in healthcare, especially within nursing. While there is a reasonable consensus regarding the sources of stress and its impact on health and well-being, little is known about the specific line manager behaviours that are associated with the effective and ineffective management of stress. Semi-structured interviews using critical incident technique were conducted with 41 employees working within 5 National Health Service (NHS) trusts within the United Kingdom. Data were transcribed and analysed using content analysis. 19 competencies (or sets of behaviour) were identified in the management of stress in employees. The 3 most frequently reported competencies: managing workload and resources, individual consideration and participative approach, are discussed in detail with illustrative quotes. Managers are vital in the reduction and management of stress at work. Importantly, the 2 of the 3 dominant competencies, managing workload and resources and individual consideration, do not feature in the UK's NHS Knowledge and Skills Framework, suggesting there are important skills gaps with regard to managing workplace stress. The implications of this approach for training and development, performance appraisal and assessment are discussed. Interventions to support managers develop effective behaviours are required to help reduce and manage stress at work. Copyright 2009 Elsevier Ltd. All rights reserved.

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

    DOT National Transportation Integrated Search

    1999-01-05

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

  19. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

    PubMed

    Blancher, Marc; Albasini, François; Elsensohn, Fidel; Zafren, Ken; Hölzl, Natalie; McLaughlin, Kyle; Wheeler, Albert R; Roy, Steven; Brugger, Hermann; Greene, Mike; Paal, Peter

    2018-06-01

    Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131-140, 2018. Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.

  20. Work site stress management: national survey results.

    PubMed

    Fielding, J E

    1989-12-01

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

  1. Critical Incident Stress Debriefing as a Trauma Intervention in First Nation Communities

    ERIC Educational Resources Information Center

    Hughes, Megan L.

    2006-01-01

    This study examines the appropriateness of a cross-cultural application of Critical Incident Stress Debriefing (CISD). Participant/observations were made of CISD workshops conducted for First Nations participants. The facilitator and five participants were interviewed using narrative methodology. Observations and interview data were examined using…

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

    PubMed

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

    2017-01-01

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

  3. Fasting triglycerides as a predictor of incident diabetes, insulin resistance and β-cell function in a Canadian First Nation.

    PubMed

    Riediger, Natalie D; Clark, Kirsten; Lukianchuk, Virginia; Roulette, Joanne; Bruce, Sharon

    2017-01-01

    Diabetes prevalence is substantially higher among Canadian First Nations populations than the non-First Nation population. Fasting serum triglycerides have been found to be an important predictor of incident diabetes among non-indigenous populations. However, there is a great need to understand diabetes progression within specific ethnic groups, particularly First Nations populations. The purpose of this study was to test for an association between fasting serum triglycerides and incident diabetes, changes in insulin resistance and changes in β-cell function in a Manitoba First Nation cohort. Study data were from two diabetes screening studies in Sandy Bay First Nation in Manitoba, Canada, collected in 2002/2003 and 2011/2012. The cohort was composed of respondents to both screening studies (n=171). Fasting blood samples and anthropometric, health and demographic data were collected. A generalised linear model with Poisson distribution was used to test for an association between fasting triglycerides and incident diabetes. There were 35 incident cases of diabetes among 128 persons without diabetes at baseline. Participants who developed incident type 2 diabetes were significantly older and had significantly higher body mass index (BMI; p=0.012), total cholesterol (p=0.007), fasting triglycerides (p<0.001), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (p<0.001). Fasting triglyceride level was found to be a statistically significant positive predictor of incident diabetes independent of age, sex and waist circumference at baseline. Participants with triglycerides in the highest tertile (≥2.11 mmol/l) had a 4.0-times higher risk of developing incident diabetes compared to those in the lowest tertile (p=0.03). Notably, neither waist circumference nor BMI were significant predictors of incident diabetes independent of age, sex and triglycerides. Fasting triglycerides may be useful as a clinical predictor of insulin resistance and diabetes

  4. Fasting triglycerides as a predictor of incident diabetes, insulin resistance and β-cell function in a Canadian First Nation

    PubMed Central

    Riediger, Natalie D.; Clark, Kirsten; Lukianchuk, Virginia; Roulette, Joanne; Bruce, Sharon

    2017-01-01

    ABSTRACT Background: Diabetes prevalence is substantially higher among Canadian First Nations populations than the non-First Nation population. Fasting serum triglycerides have been found to be an important predictor of incident diabetes among non-indigenous populations. However, there is a great need to understand diabetes progression within specific ethnic groups, particularly First Nations populations. Objective: The purpose of this study was to test for an association between fasting serum triglycerides and incident diabetes, changes in insulin resistance and changes in β-cell function in a Manitoba First Nation cohort. Methods: Study data were from two diabetes screening studies in Sandy Bay First Nation in Manitoba, Canada, collected in 2002/2003 and 2011/2012. The cohort was composed of respondents to both screening studies (n=171). Fasting blood samples and anthropometric, health and demographic data were collected. A generalised linear model with Poisson distribution was used to test for an association between fasting triglycerides and incident diabetes. Results: There were 35 incident cases of diabetes among 128 persons without diabetes at baseline. Participants who developed incident type 2 diabetes were significantly older and had significantly higher body mass index (BMI; p=0.012), total cholesterol (p=0.007), fasting triglycerides (p<0.001), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (p<0.001). Fasting triglyceride level was found to be a statistically significant positive predictor of incident diabetes independent of age, sex and waist circumference at baseline. Participants with triglycerides in the highest tertile (≥2.11 mmol/l) had a 4.0-times higher risk of developing incident diabetes compared to those in the lowest tertile (p=0.03). Notably, neither waist circumference nor BMI were significant predictors of incident diabetes independent of age, sex and triglycerides. Conclusion: Fasting triglycerides may be useful as a

  5. National Economic Conditions and Patient Insurance Status Predict Prostate Cancer Diagnosis Rates and Management Decisions.

    PubMed

    Weiner, Adam B; Conti, Rena M; Eggener, Scott E

    2016-05-01

    The recent Great Recession from December 2007 to June 2009 presents a unique opportunity to examine whether the incidence of nonpalpable prostate cancer decreases while conservative management for nonpalpable prostate cancer increases during periods of national economic hardship. We derived rates of national monthly diagnosis and conservative management for screen detected, nonpalpable prostate cancer and patient level insurance status from the SEER (Surveillance, Epidemiology and End Results) database from 2004 to 2011. We derived monthly statistics on national unemployment rates, inflation, median household income and S&P 500® closing values from government sources. Using linear and logistic multivariable regression we measured the correlation of national macroeconomic conditions with prostate cancer diagnosis and treatment patterns. We evaluated patient level predictors of conservative management to determine whether being insured by Medicaid or uninsured increased the use of conservative management. Diagnosis rates correlated positively with the S&P 500 monthly close (coefficient 24.90, 95% CI 6.29-43.50, p = 0.009). Conservative management correlated negatively with median household income (coefficient -49.13, 95% CI -69.29--28.98, p <0.001). In a nonMedicare eligible population having Medicaid (OR 1.51, 95% CI 1.32-1.73, p <0.001) or no insurance (OR 2.27, 95% CI 1.93-2.67, p <0.001) increased the use of conservative management compared to that in men with private insurance. As indicated by a significant interaction term being diagnosed during the Great Recession increased the Medicaid insurance predictive value of conservative management (OR 1.30, 95% CI 1.02-1.68, p = 0.037). National economic hardship was associated with decreased diagnosis rates of nonpalpable prostate cancer and increased conservative management. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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

    PubMed

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

    2018-01-26

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

  7. Analysis of Incident and Accident Reports and Risk Management in Spine Surgery.

    PubMed

    Kobayashi, Kazuyoshi; Imagama, Shiro; Ando, Kei; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Ishikawa, Yoshimoto; Matsumoto, Akiyuki; Morozumi, Masayoshi; Nishida, Yoshihiro; Nagao, Yoshimasa; Ishiguro, Naoki

    2017-08-01

    A review of accident and incident reports. To analyze prevalence, characteristics, and details of perioperative incidents and accidents in patients receiving spine surgery. In our institution, a clinical error that potentially results in an adverse event is usually submitted as an incident or accident report through a web database, to ensure anonymous and blame-free reporting. All reports are analyzed by a medical safety management group. These reports contain valuable data for management of medical safety, but there have been no studies evaluating such data for spine surgery. A total of 320 incidents and accidents that occurred perioperatively in 172 of 415 spine surgeries were included in the study. Incidents were defined as events that were "problematic, but with no damage to the patient," and accidents as events "with damage to the patient." The details of these events were analyzed. There were 278 incidents in 137 surgeries and 42 accidents in 35 surgeries, giving prevalence of 33% (137/415) and 8% (35/415), respectively. The proportion of accidents among all events was significantly higher for doctors than non-doctors [68.0% (17/25) vs. 8.5% (25/295), P < 0.01] and in the operating room compared with outside the operating room [40.5% (15/37) vs. 9.5% (27/283), P < 0.01]. There was no significant difference in years of experience among personnel involved in all events. The major types of events were medication-related, line and tube problems, and falls and slips. Accidents also occurred because of a long-term prone position, with complications such as laryngeal edema, ulnar nerve palsy, and tooth damage. Surgery and procedures in the operating room always have a risk of complications. Therefore, a particular effort is needed to establish safe management of this environment and to provide advice on risk to the doctor and medical care team. 4.

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

    PubMed

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

    2017-01-01

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

  9. Performance evaluation of chart : an incident management program : in 1997

    DOT National Transportation Integrated Search

    2000-05-01

    CHART is the highway incident management program of the Maryland State Highway Administration (MSHA). Initiated in the mid 80 as Reach the Beach, it has extended into a statewide program headquartered in Hanover, Maryland where the newly bui...

  10. Reporting of Child Maltreatment: A Secondary Analysis of the National Incidence Surveys.

    ERIC Educational Resources Information Center

    Ards, Sheila; Harrell, Adele

    1993-01-01

    Data from the National Study of the Incidence and Prevalence of Child Abuse and Neglect were analyzed concerning kinds of cases underreported, overreported, or not reported. The analysis examined age, family income, sex, race, urban or rural, and type of abuse from sexual abuse to educational neglect. (JDD)

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

    PubMed

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

    2013-09-01

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

  12. User-friendly traffic incident management (TIM) program benefit-cost estimation tool, Version 1.2

    DOT National Transportation Integrated Search

    2016-01-01

    Traffic incidents contribute significantly to the deterioration of the level of service of both freeways and arterials. Traffic Incident Management (TIM) programs have been introduced worldwide with the aim of mitigating the impact of traffic inciden...

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

    ERIC Educational Resources Information Center

    Brunton, Margaret Ann; Jeffrey, Lynn Maud

    2010-01-01

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

  14. Incident chronic kidney disease: trends in management and outcomes.

    PubMed

    Perkins, Robert M; Chang, Alex R; Wood, Kenneth E; Coresh, Josef; Matsushita, Kunihiro; Grams, Morgan

    2016-06-01

    Management trends in early chronic kidney disease (CKD) and their associations with clinical outcomes have not previously been reported. We evaluated incident (Stage G3A) CKD patients from an integrated health care system in 2004-06, 2007-09 and 2010-12 to determine adjusted trends in screening (urinary protein quantification), treatment [prescription for angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and statin] and nephrology referral. For the same time periods, adjusted rates for mortality, progression to Stage G4 CKD and hospitalization for myocardial infarction or heart failure were calculated and compared across time periods. There were 728, 788 and 956 patients with incident CKD in 2004-06, 2007-09 and 2010-12, respectively. Adjusted rates of proteinuria quantification (31, 39 and 51 screens/100 person-years), statin prescription (53, 63 and 64 prescriptions/100 person-years) and nephrology referral (2, 3 and 5 referrals/100 person-years) all increased over time (P for trend <0.001 in all cases). ACEI/ARB prescription rates did not change (88, 83 and 80 prescriptions/100 person-years, P = 0.68). Adjusted death rates (7, 5 and 6 deaths/100 person-years), CKD progression (9, 10 and 7 progressors/100 person-years) and cardiovascular hospitalization (10, 8 and 9 hospitalizations per 100/person-years) did not change (P for trend >0.4 in all cases). In this integrated health care system, management of incident CKD over the past decade has intensified.

  15. [Rules and regulations applying to incidents in radiotherapy].

    PubMed

    Lohr, F; Baus, W; Vorwerk, H; Schlömp, B; André, L; Georg, D; Hodapp, N

    2012-07-01

    Radiotherapy is an essential and reliable element of the treatment armamentarium in oncology. Numerous rules, regulations, and protocols minimize the associated risks. It can, however, never be excluded that errors in the treatment delivery chain result in inadequate tumor doses or unnecessary damage to organs at risk. A legal framework governs the management of such incidents. The most important European and North American regulations are reported. Various directives issued by the European Union are differently implemented nationally. This applies particularly to the characterization of incidents that must be reported to authorities. Reporting thresholds, audit systems, and the extent of the integration of voluntary reporting systems vary. Radiotherapy incidents are dealt with differently on an international level. Changes are to be expected based on the European Basic Safety Standards Directive that is currently being prepared and will have to be implemented nationally in due course.

  16. How The Australian National University's emergency management and continuity plans responded to a large-scale fire.

    PubMed

    Meehan, Bart

    2008-01-01

    On 18th January, 2003, one of the worst bushfires in the history of Australia hit the capital city, Canberra. By the time it was under control, four people were dead and more than 500 homes were destroyed. The fire also destroyed the Mount Stromlo campus of the Australian National University, the location of the Research School of Astronomy and Astrophysics. In response to the fires, the University initiated its emergency management strategy and business continuity plans. These allowed the School to recommence limited operations within two weeks of the disaster. This paper details a case study of the impact of the fire (in part using personal recollections of staff and students), and the emergency response implemented by the University. It describes the development of the University's emergency management strategy, with its emphasis on the key elements of clear chain of command and flexibility in developing an incident-specific response. The paper also provides an assessment of how the plan worked during an actual incident and some of the lessons learned, including the importance of the early response, managing the impact on people, media management, insurance and communications.

  17. Pattern of Hepatitis A Incidence According to Area Characteristics Using National Health Insurance Data

    PubMed Central

    Seo, Joo Youn; Seo, Jae Hee; Kim, Myoung Hee; Ki, Moran; Park, Hee Suk

    2012-01-01

    Objectives Over the past several years, the incidence of hepatitis A infection has been increasing rapidly in the young-adult population in Korea. We examined the effects of area-level socioeconomic status and environmental hygiene on the incidence of hepatitis A. Methods This study is based on the registered national population of Korea and the national health insurance data from 2004 to 2008. A total of 73 459 individuals were confirmed to have had hepatitis A. The standardized incidences of hepatitis A in 232 districts adjusted for sex and age of people were calculated for each year, and the rate ratios of the incidence rates were estimated according to area-level socioeconomic status and environmental hygiene using multiple Poisson regression models. Results The incidence rates of hepatitis A infection were 15.6 (per 100 000) in 2004, 19.0 (per 100 000) in 2005, 27.2 (per 100 000) in 2006, 25.1 (per 100 000) in 2007, and 61.7 (per 100 000) in 2008. The analysis of the area-level effects showed that residential areas of the less deprived than other regions, areas with higher levels of education, and heavily populated areas were significantly associated with increased risk. Conclusions There is a very strong possibility that both area-level socioeconomic status and environmental hygiene play a role in increasing the risk of hepatitis A infection in Korea. Therefore, to reduce hepatitis A infection, we need a nationwide strategy that considers these area-level characteristics. PMID:22712043

  18. Cancer incidence and mortality in Mongolia - National Registry Data.

    PubMed

    Sandagdorj, Tuvshingerel; Sanjaajamts, Erdenechimeg; Tudev, Undarmaa; Oyunchimeg, Dondov; Ochir, Chimedsuren; Roder, David

    2010-01-01

    The National Cancer Registry of Mongolia began as a hospital-based registry in the early 1960s but then evolved to have a population-wide role. The Registry provides the only cancer data available from Mongolia for international comparison. The descriptive data presented in this report are the first to be submitted on cancer incidence in Mongolia to a peer-reviewed journal. The purpose was to describe cancer incidence and mortality for all invasive cancers collectively, individual primary sites, and particularly leading sites, and consider cancer control opportunities. This study includes data on new cancer cases registered in Mongolia in 2003-2007. Incidence and mortality rates were calculated as mean annual numbers per 100,000 residents. Age-standardized incidence (ASR) and age-standardized mortality (ASMR) rates were calculated from age-specific rates by weighting directly to the World Population standard. Between 2003 and 2007, 17,271 new cases of invasive cancer were recorded (52.2% in males, 47.7% in females). The five leading primary sites in males were liver, stomach, lung, esophagus, and colon/rectum; whereas in females they were liver, cervix, stomach, esophagus and breast. ASRs were lower in females than males for cancers of the liver at 63.0 and 99.1 per 100,000 respectively; cancers of the stomach at 19.1 and 42.1 per 100,000 respectively; and cancers of the lung at 8.3 and 33.2 per 100,000 respectively. Liver cancer was the most common cause of death in each gender, the ASMR being lower for females than males at 60.6 compared with 94.8 per 100,000. In females the next most common sites of cancer death were the stomach and esophagus, whereas in males, they were the stomach and lung. Available data indicate that ASRs of all cancers collectively have increased over the last 20 years. Rates are highest for liver cancer, at about four times the world average. The most common cancers are those with a primary site of liver, stomach and esophagus, for which

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

    PubMed

    DeFraia, Gary S

    2013-01-01

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

  20. National HIV/AIDS mortality, prevalence, and incidence rates are associated with the Human Development Index.

    PubMed

    Lou, Li-Xia; Chen, Yi; Yu, Chao-Hui; Li, You-Ming; Ye, Juan

    2014-10-01

    HIV/AIDS is a worldwide threat to human health with mortality, prevalence, and incidence rates varying widely. We evaluated the association between the global HIV/AIDS epidemic and national socioeconomic development. We obtained global age-standardized HIV/AIDS mortality, prevalence, and incidence rates from World Health Statistics Report of the World Health Organization. The human development indexes (HDIs) of 141 countries were obtained from a Human Development Report. Countries were divided into 4 groups according to the HDI distribution. We explored the association between HIV/AIDS epidemic and HDI information using Spearman correlation analysis, regression analysis, and the Kruskal-Wallis test. HIV/AIDS mortality, prevalence, and incidence rates were inversely correlated with national HDI (r = -0.675, -0.519, and -0.398, respectively; P < .001), as well as the 4 indicators of HDI (ie, life expectancy at birth, mean years of schooling, expected years of schooling, and gross national income per capita). Low HDI countries had higher HIV/AIDS mortality, prevalence, and incidence rates than that of medium, high, and very high HDI countries. Quantile regression results indicated that HDI had a greater negative effect on the HIV/AIDS epidemic in countries with more severe HIV/AIDS epidemic. Less-developed countries are likely to have more severe HIV/AIDS epidemic. There is a need to pay more attention to HIV/AIDS control in less-developed countries, where lower socioeconomic status might have accelerated the HIV/AIDS epidemic more rapidly. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

    PubMed

    Panzica, M; Krettek, C; Cartes, M

    2011-09-01

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

  2. National and regional breast cancer incidence and mortality trends in Mexico 2001-2011: Analysis of a population-based database.

    PubMed

    Soto-Perez-de-Celis, Enrique; Chavarri-Guerra, Yanin

    2016-04-01

    Breast cancer is the most common malignancy in Mexican women since 2006. However, due to a lack of cancer registries, data is scarce. We sought to describe breast cancer trends in Mexico using population-based data from a national database and to analyze geographical and age-related differences in incidence and mortality rates. All incident breast cancer cases reported to the National Epidemiological Surveillance System and all breast cancer deaths registered by the National Institute of Statistics and Geography in Mexico from 2001 to 2011 were included. Incidence and mortality rates were calculated for each age group and for 3 geographic regions of the country. Joinpoint regression analysis was performed to examine trends in BC incidence and mortality. We estimated annual percentage change (APC) using weighted least squares log-linear regression. We found an increase in the reported national incidence, with an APC of 5.9% (95% CI 4.1-7.7, p<0.05). Women aged 60-65 had the highest increase in incidence (APC 7.89%; 95% CI 5.5 -10.3, p<0.05). Reported incidence rates were significantly increased in the Center and in the South of the country, while in the North they remained stable. Mortality rates also showed a significant increase, with an APC of 0.4% (95% CI 0.1-0.7, p<0.05). Women 85 and older had the highest increase in mortality (APC 2.99%, 95% CI 1.9-4.1; p<0.05). The reporting of breast cancer cases in Mexico had a continuous increase, which could reflect population aging, increased availability of screening, an improvement in the number of clinical facilities and better reporting of cases. Although an improvement in the detection of cases is the most likely explanation for our findings, our results point towards an epidemiological transition in Mexico and should help in guiding national policy in developing countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. 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...

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

    PubMed

    Loop, Carole

    2013-01-01

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

  5. Adult Perpetrator Gender Asymmetries in Child Sexual Assault Victim Selection: Results from the 2000 National Incident-Based Reporting System

    ERIC Educational Resources Information Center

    McCloskey, Kathy A.; Raphael, Desreen N.

    2005-01-01

    Data from the 2000 National Incident-Based Reporting System (NIBRS) show that while males make up about nine out of every 10 adult sexual assault perpetrators, totaling about 26,878 incidents within the reporting period, females account for about one out of 10 perpetrators, totaling about 1,162 incidents. Male sexual assault perpetrators offend…

  6. Radiological Laboratory Sample Analysis Guide for Incidents of National Significance – Radionuclides in Air

    EPA Science Inventory

    [The document describes the likely analytical decision paths that would be made by personnel at a radioanalytical laboratory following a radiological or nuclear incident, such as that caused by a terrorist attack. EPA’s responsibilities, as outlined in the National Response Frame...

  7. School Crisis Teams within an Incident Command System

    ERIC Educational Resources Information Center

    Nickerson, Amanda B.; Brock, Stephen E.; Reeves, Melissa A.

    2006-01-01

    Despite the increasing attention given to the need for schools to be prepared to respond in a variety of crisis situations, there is a lack of information about how to coordinate with multiple agencies following a crisis. This article describes the U. S. Department of Homeland Security's (2004) National Incident Management System and its Incident…

  8. Making the connection: advancing traffic incident management in transportation planning : a primer.

    DOT National Transportation Integrated Search

    2013-07-01

    "The intent of this primer is to inform and guide traffic incident management (TIM) professionals and transportation planners to initiate and develop collaborative relationships and advance TIM programs through the metropolitan planning process. The ...

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

    PubMed

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

    2008-09-01

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

  10. Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites

    PubMed Central

    McClure, Leslie A.; Kleindorfer, Dawn O.; Cunningham, Solveig A.; Thrift, Amanda G.; Diez Roux, Ana V.; Howard, George

    2016-01-01

    Objective: To assess the relationship between neighborhood socioeconomic characteristics and incident stroke in a national cohort of black and white participants. Methods: The study comprised black (n = 10,274, 41%) and white (n = 14,601) stroke-free participants, aged 45 and older, enrolled in 2003–2007 in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort. A neighborhood socioeconomic score (nSES) was constructed using 6 neighborhood variables. Incident stroke was defined as first occurrence of stroke over an average 7.5 (SD 3.0) years of follow-up. Proportional hazards models were used to estimate associations between nSES score and incident stroke, adjusted for demographics (age, race, sex, region), individual socioeconomic status (SES) (education, household income), and other risk factors for stroke. Results: After adjustment for demographics, compared to the highest nSES quartile, stroke incidence increased with each decreasing nSES quartile. The hazard ratio (95% confidence interval) ranged from 1.28 (1.05–1.56) in quartile 3 to 1.38 (1.13–1.68) in quartile 2 to 1.56 (1.26–1.92) in quartile 1 (p < 0.0001 for linear trend). After adjustment for individual SES, the trend remained marginally significant (p = 0.085). Although there was no evidence of a differential effect by race or sex, adjustment for stroke risk factors attenuated the association between nSES and stroke in both black and white participants, with greater attenuation in black participants. Conclusions: Risk of incident stroke increased with decreasing nSES but the effect of nSES is attenuated through individual SES and stroke risk factors. The effect of neighborhood socioeconomic characteristics that contribute to increased stroke risk is similar in black and white participants. PMID:27742815

  11. Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites.

    PubMed

    Howard, Virginia J; McClure, Leslie A; Kleindorfer, Dawn O; Cunningham, Solveig A; Thrift, Amanda G; Diez Roux, Ana V; Howard, George

    2016-11-29

    To assess the relationship between neighborhood socioeconomic characteristics and incident stroke in a national cohort of black and white participants. The study comprised black (n = 10,274, 41%) and white (n = 14,601) stroke-free participants, aged 45 and older, enrolled in 2003-2007 in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort. A neighborhood socioeconomic score (nSES) was constructed using 6 neighborhood variables. Incident stroke was defined as first occurrence of stroke over an average 7.5 (SD 3.0) years of follow-up. Proportional hazards models were used to estimate associations between nSES score and incident stroke, adjusted for demographics (age, race, sex, region), individual socioeconomic status (SES) (education, household income), and other risk factors for stroke. After adjustment for demographics, compared to the highest nSES quartile, stroke incidence increased with each decreasing nSES quartile. The hazard ratio (95% confidence interval) ranged from 1.28 (1.05-1.56) in quartile 3 to 1.38 (1.13-1.68) in quartile 2 to 1.56 (1.26-1.92) in quartile 1 (p < 0.0001 for linear trend). After adjustment for individual SES, the trend remained marginally significant (p = 0.085). Although there was no evidence of a differential effect by race or sex, adjustment for stroke risk factors attenuated the association between nSES and stroke in both black and white participants, with greater attenuation in black participants. Risk of incident stroke increased with decreasing nSES but the effect of nSES is attenuated through individual SES and stroke risk factors. The effect of neighborhood socioeconomic characteristics that contribute to increased stroke risk is similar in black and white participants. © 2016 American Academy of Neurology.

  12. Traffic incident management in hazardous materials spills in incident clearance.

    DOT National Transportation Integrated Search

    2009-01-01

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

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

    PubMed

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

    2015-01-01

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

  14. Lessons learnt from the development of the Patient Safety Incidents Reporting an Learning System for the Spanish National Health System: SiNASP.

    PubMed

    Vallejo-Gutiérrez, Paula; Bañeres-Amella, Joaquim; Sierra, Eduardo; Casal, Jesús; Agra, Yolanda

    2014-01-01

    To describe the development process and characteristics of a patient safety incidents reporting system to be implemented in the Spanish National Health System, based on the context and the needs of the different stakeholders. Literature review and analysis of most relevant reporting systems, identification of more than 100 stakeholder's (patients, professionals, regional governments representatives) expectations and requirements, analysis of the legal context, consensus of taxonomy, development of the software and pilot test. Patient Safety Events Reporting and Learning system (Sistema de Notificación y Aprendizajepara la Seguridad del Paciente, SiNASP) is a generic reporting system for all types of incidents related to patient safety, voluntary, confidential, non punitive, anonymous or nominative with anonimization, system oriented, with local analysis of cases and based on the WHO International Classification for Patient Safety. The electronic program has an on-line form for reporting, a software to manage the incidents and improvement plans, and a scoreboard with process indicators to monitor the system. The reporting system has been designed to respond to the needs and expectations identified by the stakeholders, taking into account the lessons learned from the previous notification systems, the characteristics of the National Health System and the existing legal context. The development process presented and the characteristics of the system provide a comprehensive framework that can be used for future deployments of similar patient safety systems. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  15. Major chemical incidents--a response, the role of the Consultant in Communicable Disease Control and the case of need for a national surveillance-resource centre.

    PubMed

    Ayres, P J

    1995-06-01

    The aim of this study is to discuss the adequacy of current arrangements for dealing with major chemical incidents through the offices of the Consultant in Communicable Disease Control (CCDC). This paper describes the public health response to an explosion at a chemical works which was followed by illnesses of unknown aetiology in emergency service workers and other people. An outline of the circumstances as they presented themselves and a description of the lessons learned from the management of this disaster are presented alongside an overview of the prevailing infrastructure of advice, support and training available to CsCDC. Key issues relevant to these areas are discussed. A total of 181 potential cases were notified to the investigating team, of whom 115 had an illness possibly associated with the explosion. Of these, 93 suffered a gastrointestinal illness and 68 had so-called 'toxic' symptoms (eye, skin and bronchopulmonary irritation). Forty-six people had both sets of symptoms at the same time. Current arrangements dictate that public health physicians have a role in incidents such as this, whether they seek such a position or not. The specialty would do well to consider developing formal disaster training schemes for those likely to have to manage major incidents (usually the CCDC), and would benefit from the setting up of a chemical-environmental incident surveillance-resource centre. Such a centre should have a remit for teaching and training, information support, incident recording, coordination of expert resources, and liaison between interested bodies both nationally and internationally.

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

    DOT National Transportation Integrated Search

    1995-02-01

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

  17. Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database.

    PubMed

    Cooper, Jennifer; Edwards, Adrian; Williams, Huw; Sheikh, Aziz; Parry, Gareth; Hibbert, Peter; Butlin, Amy; Donaldson, Liam; Carson-Stevens, Andrew

    2017-09-01

    A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident reports. We characterized a random sample of family practice patient safety incident reports from the England and Wales National Reporting and Learning System. Reports were analyzed according to prespecified classification systems to describe the incident type, contributory factors, outcomes, and severity of harm. We developed a taxonomy of blame attribution, and we then used descriptive statistical analyses to identify the proportions of blame types and to explore associations between incident characteristics and one type of blame. Health care professionals making family practice incident reports attributed blame to a person in 45% of cases (n = 975 of 2,148; 95% CI, 43%-47%). In 36% of cases, those who reported the incidents attributed fault to another person, whereas 2% of those reporting acknowledged personal responsibility. Blame was commonly associated with incidents where a complaint was anticipated. The high frequency of blame in these safety, incident reports may reflect a health care culture that leads to blame and retribution, rather than to identifying areas for learning and improvement, and a failure to appreciate the contribution of system factors in others' behavior. Successful improvement in patient safety through the analysis of incident reports is unlikely without achieving a blame-free culture. © 2017 Annals of Family Medicine, Inc.

  18. Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database

    PubMed Central

    Cooper, Jennifer; Edwards, Adrian; Williams, Huw; Sheikh, Aziz; Parry, Gareth; Hibbert, Peter; Butlin, Amy; Donaldson, Liam; Carson-Stevens, Andrew

    2017-01-01

    PURPOSE A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident reports. METHODS We characterized a random sample of family practice patient safety incident reports from the England and Wales National Reporting and Learning System. Reports were analyzed according to prespecified classification systems to describe the incident type, contributory factors, outcomes, and severity of harm. We developed a taxonomy of blame attribution, and we then used descriptive statistical analyses to identify the proportions of blame types and to explore associations between incident characteristics and one type of blame. RESULTS Health care professionals making family practice incident reports attributed blame to a person in 45% of cases (n = 975 of 2,148; 95% CI, 43%–47%). In 36% of cases, those who reported the incidents attributed fault to another person, whereas 2% of those reporting acknowledged personal responsibility. Blame was commonly associated with incidents where a complaint was anticipated. CONCLUSIONS The high frequency of blame in these safety, incident reports may reflect a health care culture that leads to blame and retribution, rather than to identifying areas for learning and improvement, and a failure to appreciate the contribution of system factors in others’ behavior. Successful improvement in patient safety through the analysis of incident reports is unlikely without achieving a blame-free culture. PMID:28893816

  19. 77 FR 7171 - Agency Information Collection Activities: Proposed Collection; Comment Request, National Fire...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-10

    ..., National Fire Incident Reporting System (NFIRS) v5.0 AGENCY: Federal Emergency Management Agency, DHS... accordance with the Paperwork Reduction Act of 1995, this notice seeks comments concerning National Fire... standardized reporting methods, to collect and analyze fire incident data at the Federal, State, and local...

  20. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit.

    PubMed

    Nolan, Jerry P; Soar, Jasmeet; Smith, Gary B; Gwinnutt, Carl; Parrott, Francesca; Power, Sarah; Harrison, David A; Nixon, Edel; Rowan, Kathryn

    2014-08-01

    To report the incidence, characteristics and outcome of adult in-hospital cardiac arrest in the United Kingdom (UK) National Cardiac Arrest Audit database. A prospectively defined analysis of the UK National Cardiac Arrest Audit (NCAA) database. 144 acute hospitals contributed data relating to 22,628 patients aged 16 years or over receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a 2222 call. The main outcome measures were incidence of adult in-hospital cardiac arrest and survival to hospital discharge. The overall incidence of adult in-hospital cardiac arrest was 1.6 per 1000 hospital admissions with a median across hospitals of 1.5 (interquartile range 1.2-2.2). Incidence varied seasonally, peaking in winter. Overall unadjusted survival to hospital discharge was 18.4%. The presenting rhythm was shockable (ventricular fibrillation or pulseless ventricular tachycardia) in 16.9% and non-shockable (asystole or pulseless electrical activity) in 72.3%; rates of survival to hospital discharge associated with these rhythms were 49.0% and 10.5%, respectively, but varied substantially across hospitals. These first results from the NCAA database describing the current incidence and outcome of adult in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Appraisal of snakebite incidence and mortality in Bolivia.

    PubMed

    Chippaux, Jean-Philippe; Postigo, Jorge R

    2014-06-01

    No information has been yet published on snakebite in Bolivia. The country includes very different ecological situations leading to various epidemiological risks. A study has been carried out to evaluate the incidence and location of snakebite, particularly in relation with altitude, in order to improve management. Investigations on snakebite epidemiology were based on a) cases treated in health facilities as reported by health authorities and b) household surveys carried out in areas with high variations of altitude, in various regions of Bolivia. An average of 700 bites was treated each year in Bolivia (national annual incidence = 8 bites per 100,000 people) with a great disparity between districts. Household surveys showed annual incidences ranged from 30 to 110 bites per 100,000 inhabitants depending on location. Annual mortality ranged 0.1-3.9 per 100,000 people. A significant and constant inverse correlation was shown between snakebite incidence and altitude, which may be explained by both snake and human distributions and activities. Notification of snakebite is useful for improving patient management and informing antivenom distribution. It should also involve the report of deaths and clinical details of envenomation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Diabetes and work: 12-year national follow-up study of the association of diabetes incidence with socioeconomic group, age, gender and country of origin.

    PubMed

    Poulsen, Kjeld; Cleal, Bryan; Willaing, Ingrid

    2014-12-01

    To investigate the extent and socioeconomic distribution of incident diabetes among the Danish working-age population. The Danish National Diabetes Register was linked with socioeconomic and population-based registers covering the entire population. We analysed the 12-year diabetes incidence using multivariate Poisson regression for 2,086,682 people, adjusting for gender, 10-year age groups, main population groups defined by country of origin, and seven socioeconomic groups: professionals, managers, technicians, workers skilled at basic level, unskilled workers, unemployed and pensioners. The crude 12-year incidence of diabetes was 5.8%. The saturated multivariate model, adjusted for gender, age, country of origin and socioeconomic status; showed a relative risk (RR) for diabetes incidence of 1.44 for male (reference: female), 3.95 for the age range of 50-59 years (reference: 30-39 years), 2.07 for unskilled workers (reference: professionals) and 2.15 for people from countries of 'non-Western origin' (reference: Danish origin). Diabetes incidence increases with age, male gender and low socioeconomic status; and also among people from countries of 'non-Western origin'. The results indicate that getting a more senior workforce will substantially increase the proportion of workers with diabetes, especially among already vulnerable groups. © 2014 the Nordic Societies of Public Health.

  3. Lead shot incidence on a New Mexico public hunting area

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

    Schranck, B.W.; Dollahon, G.R.

    The incidence of lead shot was investigated on a 20.2-ha (50-acre) seasonal marsh used for waterfowl hunting at the Bitter Lake National Wildlife Refuge, Roswell, New Mexico. Of the 162 soil samples taken randomly, 59% contained 1 to 5 lead shot. A minimum lead shot incidence of 98,985 shot per ha (40,075 per acre) was calculated. More shot was found in firm than in mucky soils. Management recommendations to limit waterfowl exposure to lead ingestion are offered.

  4. Management of obstetric postpartum hemorrhage: a national service evaluation of current practice in the UK

    PubMed Central

    Al Wattar, Bassel H; Tamblyn, Jennifer A; Parry-Smith, William; Prior, Mathew; Van Der Nelson, Helen

    2017-01-01

    Background Postpartum hemorrhage (PPH) continues to be one of the major causes of maternal mortality and morbidity in obstetrics. Variations in practice often lead to adverse maternity outcomes following PPH. Our objective was to assess the current practice in managing PPH in the UK. Methods We performed a national multicenter prospective service evaluation study over one calendar month and compared the current performance to national standards for managing PPH. We used a standardized data collection tool and collected data on patients’ demographics, incidence of PPH, estimated blood loss (EBL), prophylactic and treatment measures, onset of labor, and mode of delivery. Results We collected data from 98 obstetric units, including 3663 cases of primary PPH. Fifty percent of cases were minor PPH (EBL 500–1000 mL, n=1900/3613, 52.6%) and the remaining were moderate PPH (EBL >1000 to <2000 mL, n=1424/3613, 39.4%) and severe PPH (EBL >2000 mL, n=289/3613, 8%). The majority of women received active management of the third stage of labor (3504/3613, 97%) most commonly with Syntometrine intramuscular (1479/3613, 40.9%). More than half required one additional uterotonic agent (2364/3613, 65.4%) most commonly with Syntocinon intravenous infusion (1155/2364, 48.8%). There was a poor involvement of consultant obstetricians and anesthetists in managing PPH cases, which was more prevalent when managing major PPH (p=0.0001). Conclusion There are still variations in managing PPH in the UK against national guidelines. More senior doctor involvement and regular service evaluation are needed to improve maternal outcomes following PPH. PMID:28176919

  5. Target Capabilities List: A Companion to the National Preparedness Guidelines

    DTIC Science & Technology

    2007-09-01

    lowest possible geographic, organizational, and jurisdictional level using the principles in the National Incident Management System (NIMS). The...Response Plan. U.S. Department of Homeland Security. December 2004. 3. Biological Incident Annex. In the National Response Plan. U.S. Department of...elements of the continuum and improve interoperability, public safety and service agency practitioners should observe the following principles : Gain

  6. 77 FR 50985 - National Advisory Committee for Implementation of the National Forest System Land Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-23

    ... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... implementation of the National Forest System Land Management Rule. The meeting is open to the public. The purpose...

  7. Incidence of chemotherapy-related tumour lysis syndrome at Kenyatta National Hospital, Nairobi.

    PubMed

    Busakhala, W; Joshi, M D; Abinya, N O; Amayo, A; Abwao, H O

    2007-03-01

    To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. Prospective patient-treatment cohort study. Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. One hundred and forty two patients receiving first course chemotherapy. Laboratory defined Tumour Lysis Syndrome (TLS). One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non-haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.

  8. Incidence and mortality due to snakebite in the Americas

    PubMed Central

    2017-01-01

    Background Better knowledge of the epidemiological characteristics of snakebites could help to take measures to improve their management. The incidence and mortality of snakebites in the Americas are most often estimated from medical and scientific literature, which generally lack precision and representativeness. Methodology/Principal findings Authors used the notifications of snakebites treated in health centers collected by the Ministries of Health of the American countries to estimate their incidence and mortality. Data were obtained from official reports available on-line at government sites, including those of the Ministry of Health in each country and was sustained by recent literature obtained from PubMed. The average annual incidence is about 57,500 snake bites (6.2 per 100,000 population) and mortality is close to 370 deaths (0.04 per 100,000 population), that is, between one third and half of the previous estimates. The incidence of snakebites is influenced by the abundance of snakes, which is related to (i) climate and altitude, (ii) specific preferences of the snake for environments suitable for their development, and (iii) human population density. Recent literature allowed to notice that the severity of the bites depends mainly on (i) the snake responsible for the bite (species and size) and (ii) accessibility of health care, including availability of antivenoms. Conclusions/Significances The main limitation of this study could be the reliability and accuracy of the notifications by national health services. However, the data seemed consistent considering the similarity of the incidences on each side of national boundaries while the sources are distinct. However, snakebite incidence could be underestimated due to the use of traditional medicine by the patients who escaped the reporting of cases. However, gathered data corresponded to the actual use of the health facilities, and therefore to the actual demand for antivenoms, which should make it

  9. Characteristics of bias-based harassment incidents reported by a national sample of U.S. adolescents.

    PubMed

    Jones, Lisa M; Mitchell, Kimberly J; Turner, Heather A; Ybarra, Michele L

    2018-06-01

    Using a national sample of youth from the U.S., this paper examines incidents of bias-based harassment by peers that include language about victims' perceived sexual orientation, race/ethnicity, religion, weight or height, or intelligence. Telephone interviews were conducted with youth who were 10-20 years old (n = 791). One in six youth (17%) reported at least one experience with bias-based harassment in the past year. Bias language was a part of over half (52%) of all harassment incidents experienced by youth. Perpetrators of bias-based harassment were similar demographically to perpetrators of non-biased harassment. However, bias-based incidents were more likely to involve multiple perpetrators, longer timeframes and multiple harassment episodes. Even controlling for these related characteristics, the use of bias language in incidents of peer harassment resulted in significantly greater odds that youth felt sad as a result of the victimization, skipped school, avoided school activities, and lost friends, compared to non-biased harassment incidents. Copyright © 2018 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  10. Urinary stones in Malaysia--its incidence and management.

    PubMed

    Sreenevasan, G

    1990-06-01

    The life of Lord Moynihan is briefly reviewed. Incidence of stones in Peninsular Malaysia appears to show the same trend as in other industrialised countries. Management of urinary calculi both prior to and after the introduction of ESWL in a personal series is discussed. More than 90% of urinary stones are now treated by ESWL threatening the place of surgery in Urology. The pattern of incorporating renal transplantation into the urological training programme as practised in the Institute of Urology and Nephrology in Malaysia is suggested as a way to assure a place for surgery in Urology.

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

    DOT National Transportation Integrated Search

    2017-12-01

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

  12. Concussion Incidence and Return-to-Play Time in National Basketball Association Players: Results From 2006 to 2014.

    PubMed

    Padaki, Ajay S; Cole, Brian J; Ahmad, Christopher S

    2016-09-01

    Various research efforts have studied concussions in the National Football League, Major League Baseball, and the National Hockey League. However, no study has investigated the incidence and return-to-play trends in the National Basketball Association (NBA), which this study aims to do. Increased media scrutiny and public awareness, in addition to the institution of a league-wide concussion protocol, may have resulted in more conservative return-to-play practices. Descriptive epidemiology study. All concussions to NBA players that were publicly reported in the media from the beginning of the 2006 NBA season to the end of the 2014 season were included. The incidence and return-to-play statistics were generated by synthesizing information from publicly available records. There were 134 publicly reported concussions to NBA players from the beginning of the 2006 season to the conclusion of the 2014 season, resulting in an average of 14.9 concussions per season. The incidence has not changed significantly during this time span. The average games missed after a concussion from 2006 to 2010 was 1.6, significantly less than the 5.0 games missed from 2011 to 2014, following the institution of the NBA concussion protocol (P = .023). Although the incidence of publicly reported concussions in the NBA has not changed appreciably over the past 9 seasons, the time missed after a concussion has. While players often returned in the same game in the 2006 season, the combination of implemented policy, national coverage, medical staff awareness, and player education may have contributed to players now missing an average of 4 to 6 games after a concussion. A multitude of factors has resulted in more conservative return-to-play practices for NBA players after concussions. © 2016 The Author(s).

  13. Mortality from and Incidence of Pesticide Poisoning in South Korea: Findings from National Death and Health Utilization Data between 2006 and 2010

    PubMed Central

    Cha, Eun Shil; Khang, Young-Ho; Lee, Won Jin

    2014-01-01

    Pesticide poisoning has been recognized as an important public health issue around the world. The objectives of this study were to report nationally representative figures on mortality from and the incidence of pesticide poisoning in South Korea and to describe their epidemiologic characteristics. We calculated the age-standardized rates of mortality from and the incidence of pesticide poisoning in South Korea by gender and region from 2006 through 2010 using registered death data obtained from Statistics Korea and national healthcare utilization data obtained from the National Health Insurance Review and Assessment Service of South Korea. During the study period of 2006 through 2010, a total of 16,161 deaths and 45,291 patients related to pesticide poisoning were identified, marking respective mortality and incidence rates of 5.35 and 15.37 per 100,000 population. Intentional self-poisoning was identified as the major cause of death due to pesticides (85.9%) and accounted for 20.8% of all recorded suicides. The rates of mortality due to and incidence of pesticide poisoning were higher in rural than in urban areas, and this rural-urban discrepancy was more pronounced for mortality than for incidence. Both the rate of mortality due to pesticide poisoning and its incidence rate increased with age and were higher among men than women. This study provides the magnitude and epidemiologic characteristics for mortality from and the incidence of pesticide poisoning at the national level, and strongly suggests the need for further efforts to prevent pesticide self-poisonings, especially in rural areas in South Korea. PMID:24743877

  14. Mortality from and incidence of pesticide poisoning in South Korea: findings from National Death and Health Utilization Data between 2006 and 2010.

    PubMed

    Cha, Eun Shil; Khang, Young-Ho; Lee, Won Jin

    2014-01-01

    Pesticide poisoning has been recognized as an important public health issue around the world. The objectives of this study were to report nationally representative figures on mortality from and the incidence of pesticide poisoning in South Korea and to describe their epidemiologic characteristics. We calculated the age-standardized rates of mortality from and the incidence of pesticide poisoning in South Korea by gender and region from 2006 through 2010 using registered death data obtained from Statistics Korea and national healthcare utilization data obtained from the National Health Insurance Review and Assessment Service of South Korea. During the study period of 2006 through 2010, a total of 16,161 deaths and 45,291 patients related to pesticide poisoning were identified, marking respective mortality and incidence rates of 5.35 and 15.37 per 100,000 population. Intentional self-poisoning was identified as the major cause of death due to pesticides (85.9%) and accounted for 20.8% of all recorded suicides. The rates of mortality due to and incidence of pesticide poisoning were higher in rural than in urban areas, and this rural-urban discrepancy was more pronounced for mortality than for incidence. Both the rate of mortality due to pesticide poisoning and its incidence rate increased with age and were higher among men than women. This study provides the magnitude and epidemiologic characteristics for mortality from and the incidence of pesticide poisoning at the national level, and strongly suggests the need for further efforts to prevent pesticide self-poisonings, especially in rural areas in South Korea.

  15. An Evaluation of Departmental Radiation Oncology Incident Reports: Anticipating a National Reporting System

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

    Terezakis, Stephanie A., E-mail: stereza1@jhmi.edu; Harris, Kendra M.; Ford, Eric

    Purpose: Systems to ensure patient safety are of critical importance. The electronic incident reporting systems (IRS) of 2 large academic radiation oncology departments were evaluated for events that may be suitable for submission to a national reporting system (NRS). Methods and Materials: All events recorded in the combined IRS were evaluated from 2007 through 2010. Incidents were graded for potential severity using the validated French Nuclear Safety Authority (ASN) 5-point scale. These incidents were categorized into 7 groups: (1) human error, (2) software error, (3) hardware error, (4) error in communication between 2 humans, (5) error at the human-software interface,more » (6) error at the software-hardware interface, and (7) error at the human-hardware interface. Results: Between the 2 systems, 4407 incidents were reported. Of these events, 1507 (34%) were considered to have the potential for clinical consequences. Of these 1507 events, 149 (10%) were rated as having a potential severity of ≥2. Of these 149 events, the committee determined that 79 (53%) of these events would be submittable to a NRS of which the majority was related to human error or to the human-software interface. Conclusions: A significant number of incidents were identified in this analysis. The majority of events in this study were related to human error and to the human-software interface, further supporting the need for a NRS to facilitate field-wide learning and system improvement.« less

  16. [Incidence of phlebitis due to peripherally inserted venous catheters: impact of a catheter management protocol].

    PubMed

    Ferrete-Morales, C; Vázquez-Pérez, M A; Sánchez-Berna, M; Gilabert-Cerro, I; Corzo-Delgado, J E; Pineda-Vergara, J A; Vergara-López, S; Gómez-Mateos, J

    2010-01-01

    To assess the impact on the incidence of PPIVC by implementing a catheter management protocol and to determine risk factors for PPIVC development in hospitalized patients. A total of 3978 episodes of venous catheterization were prospectively included from September 2002 to December 2007. A catheter management protocol was implemented during this period of time. The incidence and variables associated to the occurrence of PPIVC were determined. The incidence of PPIVC from 2002 to 2007 was 4.8%, 4.3%, 3.6%, 2.5%, 1.3% and 1.8% (p<0.001). Perfusion of amiodarone [adjusted OR (AOR) 25.97; 95% CI=7.29-92.55, p=0.0001] and cefotaxime (AOR 2.90; 95% CI=1.29-6.52, p=0.01) and the shift when the catheters were placed (AOR for morning vs. night shift 0.60; 95% CI=0.35-1.02, p=0.063) were independently associated to the development of PPIVC. A history of phlebitis was the only factor independently associated to phlebitis due to peripherally inserted central venous catheters (AOR 3.24; CI at 95% CI= 1.05-9.98, p=0.04). A catheter management protocol decreases the incidence of PPIVC in hospitalized patients. The risk of PPIVC increases for peripherally inserted central venous catheters when the patients have a history of phlebitis and for peripheral venous catheters when amiodarone or cefotaxime are infused. Catheterization of peripheral veins performed during morning shifts is associated with a lower incidence of PPIVC when compared with night shift catheterizations.

  17. Managing chronic conditions in college: Findings from prompted health incidents diaries.

    PubMed

    Ravert, Russell D; Russell, Luke T; O'Guin, Monica B

    2017-04-01

    This pilot study assessed an electronic health diary method designed to collect data about critical health incidents experienced by college students who have chronic health conditions. Nine university students with chronic medical conditions were recruited to complete a series of e-mail-based surveys, sent once every 3 days across the fall 2014 semester. In each survey, participants described a health-related incident that occurred within the past day and cited resources that helped or could have helped in that situation. They completed follow-up interviews and ranked the importance of cited resources. The diary completion rate was 78.3% (141/180). Most frequently affected management areas were activities (61.3%), monitoring (34.9%), and problem-solving (34.3%). Resources considered helpful included situational knowledge, campus health professionals, peer support, and relaxation opportunities. Prompted health incidents diary method achieved a high completion rate and provided data that could be useful for college health researchers and practitioners.

  18. Comparing badger (Meles meles) management strategies for reducing tuberculosis incidence in cattle.

    PubMed

    Smith, Graham C; McDonald, Robbie A; Wilkinson, David

    2012-01-01

    Bovine tuberculosis (bTB), caused by Mycobacterium bovis, continues to be a serious economic problem for the British cattle industry. The Eurasian badger (Meles meles) is partly responsible for maintenance of the disease and its transmission to cattle. Previous attempts to manage the disease by culling badgers have been hampered by social perturbation, which in some situations is associated with increases in the cattle herd incidence of bTB. Following the licensing of an injectable vaccine, we consider the relative merits of management strategies to reduce bTB in badgers, and thereby reduce cattle herd incidence. We used an established simulation model of the badger-cattle-TB system and investigated four proposed strategies: business as usual with no badger management, large-scale proactive badger culling, badger vaccination, and culling with a ring of vaccination around it. For ease of comparison with empirical data, model treatments were applied over 150 km(2) and were evaluated over the whole of a 300 km(2) area, comprising the core treatment area and a ring of approximately 2 km. The effects of treatment were evaluated over a 10-year period comprising treatment for five years and the subsequent five year period without treatment. Against a background of existing disease control measures, where 144 cattle herd incidents might be expected over 10 years, badger culling prevented 26 cattle herd incidents while vaccination prevented 16. Culling in the core 150 km(2) plus vaccination in a ring around it prevented about 40 cattle herd breakdowns by partly mitigating the negative effects of culling, although this approach clearly required greater effort. While model outcomes were robust to uncertainty in parameter estimates, the outcomes of culling were sensitive to low rates of land access for culling, low culling efficacy, and the early cessation of a culling strategy, all of which were likely to lead to an overall increase in cattle disease.

  19. New challenges for grizzly bear management in Yellowstone National Park

    USGS Publications Warehouse

    van Manen, Frank T.; Gunther, Kerry A.

    2016-01-01

    A key factor contributing to the success of grizzly bear Ursus arctos conservation in the Greater Yellowstone Ecosystem has been the existence of a large protected area, Yellowstone National Park. We provide an overview of recovery efforts, how demographic parameters changed as the population increased, and how the bear management program in Yellowstone National Park has evolved to address new management challenges over time. Finally, using the management experiences in Yellowstone National Park, we present comparisons and perspectives regarding brown bear management in Shiretoko National Park.

  20. Managing Transnational Education: Does National Culture Really Matter?

    ERIC Educational Resources Information Center

    Eldridge, Kaye; Cranston, Neil

    2009-01-01

    This article reports on an exploratory study that examined the effect of national culture upon the management of Australia's provision of transnational higher education in Thailand. In particular, using Hofstede's national cultural value dimensions as an analytical tool, interviews with managers responsible for Australia's provision of…

  1. Several problems in regard to national land management

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

    Dong Wenlang

    1983-09-21

    This article examines several problems with regard to land management in China. National land management is defined as development of the territorial land (including the earth's surface and underground), territorial waters and territorial air space under the jurisdiction of a sovereign country. The Chinese State Council established the Bureau of National Land Management in 1981. Areas of concern include natural resources, or land resources (including continental land, rivers and lakes, territorial waters and what is beneath the waters and the airspace above the waters, also the continental shelves), mineral resources and biological resources; social resources, which include human resources, intellectualmore » resources, social and cultural traditions, and the material and technical foundations of a society. Untapped resources of land, waters, forests, grasslands and minerals are to be developed through reclamation, mining, and engineering projects. Geography and national land economics are the theoretical and applied sciences directly related to national land management.« less

  2. NATIONAL SURVEY ON ENVIRONMENTAL MANAGEMENT OF ASTHMA

    EPA Science Inventory

    The National Survey on Environmental Management of Asthma is a nation-wide survey on awareness of and existing attitudes toward asthma and its environmental triggers. The survey will generate data which can be used as a benchmark to measure national awareness and action related ...

  3. Occult pneumothorax in Chinese patients with significant blunt chest trauma: incidence and management.

    PubMed

    Lee, Ka L; Graham, Colin A; Yeung, Janice H H; Ahuja, Anil T; Rainer, Timothy H

    2010-05-01

    Occult pneumothorax (OP) is a pneumothorax not visualised on a supine chest X-ray (CXR) but detected on computed tomography (CT) scanning. With increasing CT use for trauma, more OP may be detected. Management of OP remains controversial, especially for patients undergoing mechanical ventilation. This study aimed to identify the incidence of OP using thoracic CT as the gold standard and describe its management amongst Hong Kong Chinese trauma patients. Analysis of prospectively collected trauma registry data. Consecutive significantly injured trauma patients admitted through the emergency department (ED) suffering from blunt chest trauma who underwent thoracic computed tomography (TCT) between in calendar years 2007 and 2008 were included. An OP was defined as the identification (by a specialist radiologist) of a pneumothorax on TCT that had not been previously detected on supine CXR. 119 significantly injured patients were included. 56 patients had a pneumothorax on CXR and a further 36 patients had at least one OP [OP incidence 30% (36/119)]. Bilateral OP was present in 8/36 patients, so total OP numbers were 44. Tube thoracostomy was performed for 8/44 OP, all were mechanically ventilated in the ED. The remaining 36 OP were managed expectantly. No patients in the expectant group had pneumothorax progression, even though 8 patients required subsequent ventilation in the operating room for extrathoracic surgery. The incidence of OP (seen on TCT) in Chinese patients in Hong Kong after blunt chest trauma is higher than that typically reported in Caucasians. Most OP were managed expectantly without significant complications; no pneumothorax progressed even though some patients were mechanically ventilated. (c) 2010 Elsevier Ltd. All rights reserved.

  4. 31 CFR 500.566 - Certain transactions authorized on behalf of North Korean nationals incident to their travel and...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... behalf of North Korean nationals incident to their travel and maintenance expenses. 500.566 Section 500..., Authorizations and Statements of Licensing Policy § 500.566 Certain transactions authorized on behalf of North... (b) of this section, the following transactions are authorized by or on behalf of a national of North...

  5. Critical Incident Stress Management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare.

    PubMed

    Müller-Leonhardt, Alice; Mitchell, Shannon G; Vogt, Joachim; Schürmann, Tim

    2014-07-01

    In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the "sharp end" who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. A review of medication incidents reported to the National Reporting and Learning System in England and Wales over 6 years (2005–2010)

    PubMed Central

    Cousins, David H; Gerrett, David; Warner, Bruce

    2012-01-01

    A review of all medication incidents reported to the National Reporting and Learning System (NRLS) in England in Wales between 1 January 2005 and 31 December 2010 was undertaken. The 526 186 medication incident reports represented 9.68% of all patient safety incidents. Medication incidents from acute general hospitals (394 951) represented 75% of reports. There were relatively smaller numbers of medication incident reports (44 952) from primary care, representing 8.5% of the total. Of 86 821 (16%) medication incidents reporting actual patient harm, 822 (0.9%) resulted in death or severe harm. The incidents involving medicine administration (263 228; 50%) and prescribing (97 097; 18%) were the process steps with the largest number of reports. Omitted and delayed medicine (82 028; 16%) and wrong dose (80 170; 15%) represented the largest error categories. Thirteen medicines or therapeutic groups accounted for 377 (46%) of the incidents with outcomes of death or severe harm. The National Patient Safety Agency (NPSA) has issued guidance to help minimize incidents with many of these medicines. Many recent incidents could have been prevented if the NPSA guidance had been better implemented. It is recommended that healthcare organizations in all sectors establish an effective infrastructure to oversee and promote safe medication practice, including an annual medication safety report. In the future, preventable harms from medication incidents can be further minimized by; the continued use of the NRLS to identify and prioritize important actions to improve medication safety, a central organization continuing to issue medication safety guidance to the service and better methods to ensure that the National Health Service has implemented this guidance. PMID:22188210

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

    DOT National Transportation Integrated Search

    1996-01-01

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

  8. A national database of incidence and treatment outcomes of status epilepticus in Thailand.

    PubMed

    Tiamkao, Somsak; Pranbul, Sineenard; Sawanyawisuth, Kittisak; Thepsuthammarat, Kaewjai

    2014-06-01

    Status epilepticus (SE) is a serious neurological condition. The national database of SE in Thailand and other developing countries is limited in terms of incidence and treatment outcomes. This study was conducted on the prevalence of status epilepticus (SE). The study group comprised of adult inpatients (over 18 years old) with SE throughout Thailand. SE patients were diagnosed and searched based on ICD 10 (G41) from the national database. The database used was from reimbursement documents submitted by the hospitals under the three health insurance systems, namely, the universal health coverage insurance, social security, and government health welfare system during the fiscal year 2010. We found 2190 SE patients receiving treatment at hospitals (5.10/100 000 population). The average age was 50.5 years and 1413 patients were males (64.5%). Mortality rate was 0.6 death/100 000 population or 11.96% of total patients. Significant factors associated with death or a nonimproved status at discharge were type of insurance, hospital level, chronic kidney disease, having pneumonia, having shock, on mechanical ventilator, and having cardiopulmonary resuscitation. In conclusion, the incidence of SE in Thailand was 5.10/100 000 population with mortality rate of 0.6/100 000 population.

  9. National Athletic Trainers' Association Position Statement: Preventing and Managing Sport-Related Dental and Oral Injuries

    PubMed Central

    Gould, Trenton E.; Piland, Scott G.; Caswell, Shane V.; Ranalli, Dennis; Mills, Stephen; Ferrara, Michael S.; Courson, Ron

    2016-01-01

    Objective: To provide athletic trainers, health care professionals, and all those responsible for the care of athletes with clinical recommendations for preventing and managing sport-related dental and oral injuries. Background: Participation in competitive sports continues to grow at both the interscholastic and intercollegiate levels. Therefore, exposure to, and the incidence of athletic-related injury, including orofacial injury, will also likely increase. At the time of this writing, the leading governing agencies for interscholastic (National Federation of State High School Associations) and intercollegiate (National Collegiate Athletic Association) sports require only protective orofacial equipment (eg, mouthguards) for 5 and 4, respectively, of their sanctioned sports. Although orofacial injuries represent a small percentage of all sport-related injuries, the financial burden associated with these injuries (eg, tooth avulsion) can exceed $15 000 over an adult life. Therefore, effective management of sport-related dental injuries is critical to the long-term financial, physical, and emotional health of people who have experienced dental trauma. Recommendations: Based upon the current evidence regarding sport-related orofacial injury, we provide recommendations related to planning considerations, education, and mouthguard efficacy, material, fabrication, and care considerations. Additionally, suggested best practices for managing sport-related dental injury are also given for athletic trainers and other health care professionals. PMID:27875057

  10. Personality and diabetes mellitus incidence in a national sample.

    PubMed

    Cukić, Iva; Weiss, Alexander

    2014-09-01

    To test whether personality traits were prospectively associated with type 2 diabetes incidence. The sample (n=6798) was derived from the National Health and Nutrition Examination Survey Epidemiological Follow-up Study cohort. We fit four logistic regression models to test whether neuroticism, extraversion, openness to experience, or the Type A behavior pattern predicted type 2 diabetes incidence. Model 1 included sex, age, and race/ethnicity. Model 2 added personality traits, Model 3 added depressive symptoms, and Model 4 added body mass index (BMI), hypertension, and cigarette smoking status as predictors. In Model 1 age was associated with increased risk of diabetes (2% per year); being black as opposed to white was associated with a three-fold increase in risk. In Model 2 age and being black were still significant and extraversion was associated with decreased risk (17% per standard deviation [SD]). In Model 3 age, being black, and extraversion were still significant. In addition, neuroticism was associated with decreased risk (26% per SD) and depressive symptoms were associated with increased risk (28% per SD). In Model 4 age, being black, neuroticism, and depressive symptoms were still significant. BMI was associated with increased risk (14% per SD) and extraversion was no longer significant. Higher neuroticism was associated with reduced type 2 diabetes risk even after controlling for race/ethnicity, age, depressive symptoms, and BMI. Extraversion and Type A behavior were not significant after including covariates. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. 76 FR 39857 - Alaska Coastal Management Program Withdrawal From the National Coastal Management Program Under...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-07

    .... SUMMARY: By operation of Alaska State law, the federally approved Alaska Coastal Management Program... partner in the National Coastal Management Program. The ACMP expired by operation of Alaska Statutes 44.66... DEPARTMENT OF COMMERCE National Oceanic Atmospheric Administration Alaska Coastal Management...

  12. Incident management assistance patrols - assessment of benefits/costs, route selection, and prioritization : final report.

    DOT National Transportation Integrated Search

    2016-09-21

    The North Carolina Department of Transportation's (NCDOTs) Incident Management Assistance Patrol (IMAP) program provides a critically important service to North Carolinas traveling public. The highly trained and well-equipped IMAP operators pro...

  13. National trends of incidence, treatment, and hospital charges of isolated C-2 fractures in three different age groups.

    PubMed

    Kukreja, Sunil; Kalakoti, Piyush; Murray, Richard; Nixon, Menarvia; Missios, Symeon; Guthikonda, Bharat; Nanda, Anil

    2015-04-01

    Incidence of C-2 fracture is increasing in elderly patients. Patient age also influences decision making in the management of these fractures. There are very limited data on the national trends of incidence, treatment interventions, and resource utilization in patients in different age groups with isolated C-2 fractures. The aim of this study is to investigate the incidence, treatment, complications, length of stay, and hospital charges of isolated C-2 fracture in patients in 3 different age groups by using the Nationwide Inpatient Sample (NIS) database. The data were obtained from NIS from 2002 to 2011. Data on patients with closed fractures of C-2 without spinal cord injury were extracted using ICD-9-CM diagnosis code 805.02. Patients with isolated C-2 fractures were identified by excluding patients with other associated injuries. The cohort was divided into 3 age groups: < 65 years, 65-80 years, and > 80 years. Incidence, treatment characteristics, inpatient/postoperative complications, and hospital charges (mean and total annual charges) were compared between the 3 age groups. A total of 10,336 patients with isolated C-2 fractures were identified. The majority of the patients were in the very elderly age group (> 80 years; 42.3%) followed by 29.7% in the 65- to 80-year age group and 28% in < 65-year age group. From 2002 to 2011, the incidence of hospitalization significantly increased in the 65- to 80-year and > 80-year age groups (p < 0.001). However, the incidence did not change substantially in the < 65-year age group (p = 0.287). Overall, 21% of the patients were treated surgically, and 12.2% of the patients underwent nonoperative interventions (halo and spinal traction). The rate of nonoperative interventions significantly decreased over time in all age groups (p < 0.001). Regardless of treatment given, patients in older age groups had a greater risk of inpatient/postoperative complications, nonroutine discharges, and longer hospitalization. The mean

  14. Mantram repetition for stress management in veterans and employees: a critical incident study.

    PubMed

    Bormann, Jill E; Oman, Doug; Kemppainen, Jeanne K; Becker, Sheryl; Gershwin, Madeline; Kelly, Ann

    2006-03-01

    This paper reports a study assessing the usefulness of a mantram repetition programme. Complementary/alternative therapies are becoming commonplace, but more research is needed to assess their benefits. A 5-week programme teaching a 'mind-body-spiritual' technique of silently repeating a mantram - a word or phrase with spiritual meaning - to manage stress was developed. A mantram was chosen by individuals, who were taught to repeat it silently throughout the day or night to interrupt unwanted thoughts and elicit the relaxation response. Participants who attended a 5-week course were invited to participate in the study. Of those who consented, a randomly selected subset (n = 66) was contacted approximately 3 months after the course for a telephone interview using the critical incident interviewing technique. Participants were asked whether the intervention was helpful or not, and if helpful, to identify situations where it was applied. Interviews were transcribed and incidents were identified and categorized to create a taxonomy of uses. The data were collected in 2001-2002. Participants included 30 veterans, mostly males (97%), and 36 hospital employees, mostly females (86%). Mean age was 56 years (sd = 12.94). Fifty-five participants (83.3%) practiced the technique and reported 147 incidents where the programme was helpful. Outcomes were organized into a taxonomy of incidents using four major categories that included managing: (a) emotions other than stress (51%); (b) stress (23.8%); (c) insomnia (12.9%); and (d) unwanted thoughts (12.3%). A group of raters reviewed the categories for inter-rater reliability. The majority of participants from two distinct samples reported that the mantram programme was helpful in a variety of situations. The critical incident interviewing method was found to be practical, efficient, and thorough in collecting and analyzing data. Such qualitative methods contribute to understanding the benefits of mind-body complementary therapies.

  15. Childhood asthma management pre- and post-incident asthma hospitalization.

    PubMed

    Bianchi, Marina; Clavenna, Antonio; Sequi, Marco; Bortolotti, Angela; Fortino, Ida; Merlino, Luca; Bonati, Maurizio

    2013-01-01

    Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6-17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004-2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient's asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55%) received therapy before hospitalization and 82 (45%) did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.

  16. Homeland security: sharing and managing critical incident information

    NASA Astrophysics Data System (ADS)

    Ashley, W. R., III

    2003-09-01

    Effective critical incident response for homeland security requires access to real-time information from many organizations. Command and control, as well as basic situational awareness, are all dependant on quickly communicating a dynamically changing picture to a variety of decision makers. For the most part, critical information management is not unfamiliar or new to the public safety community. However, new challenges present themselves when that information needs to be seamlessly shared across multiple organizations at the local, state and federal level in real-time. The homeland security problem does not lend itself to the traditional military joint forces planning model where activities shift from a deliberate planning process to a crisis action planning process. Rather, the homeland security problem is more similar to a traditional public safety model where the current activity state moves from complete inactivity or low-level attention to immediate crisis action planning. More often than not the escalation occurs with no warning or baseline information. This paper addresses the challenges of sharing critical incident information and the impacts new technologies will have on this problem. The value of current and proposed approaches will be critiqued for operational value and areas will be identified for further development.

  17. International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process.

    PubMed

    Howell, Ann-Marie; Burns, Elaine M; Hull, Louise; Mayer, Erik; Sevdalis, Nick; Darzi, Ara

    2017-02-01

    Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care. To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role. After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised. Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally. We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. 76 FR 75860 - National Forest System Invasive Species Management Policy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-05

    ..., scope, roles, principles, and responsibilities associated with NFS invasive species management for... threatening the National Forest System. Final Policy or Principles The management of aquatic and terrestrial...-AC77 National Forest System Invasive Species Management Policy AGENCY: Forest Service, USDA. ACTION...

  19. 12 CFR 250.181 - Reports of change in control of bank management incident to a merger.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  20. 12 CFR 250.181 - Reports of change in control of bank management incident to a merger.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  1. 12 CFR 250.181 - Reports of change in control of bank management incident to a merger.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  2. 12 CFR 250.181 - Reports of change in control of bank management incident to a merger.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  3. 12 CFR 250.181 - Reports of change in control of bank management incident to a merger.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  4. Patient safety in palliative care: A mixed-methods study of reports to a national database of serious incidents.

    PubMed

    Yardley, Iain; Yardley, Sarah; Williams, Huw; Carson-Stevens, Andrew; Donaldson, Liam J

    2018-06-01

    Patients receiving palliative care are vulnerable to patient safety incidents but little is known about the extent of harm caused or the origins of unsafe care in this population. To quantify and qualitatively analyse serious incident reports in order to understand the causes and impact of unsafe care in a population receiving palliative care. A mixed-methods approach was used. Following quantification of type of incidents and their location, a qualitative analysis using a modified framework method was used to interpret themes in reports to examine the underlying causes and the nature of resultant harms. Reports to a national database of 'serious incidents requiring investigation' involving patients receiving palliative care in the National Health Service (NHS) in England during the 12-year period, April 2002 to March 2014. A total of 475 reports were identified: 266 related to pressure ulcers, 91 to medication errors, 46 to falls, 21 to healthcare-associated infections (HCAIs), 18 were other instances of disturbed dying, 14 were allegations against health professions, 8 transfer incidents, 6 suicides and 5 other concerns. The frequency of report types differed according to the care setting. Underlying causes included lack of palliative care experience, under-resourcing and poor service coordination. Resultant harms included worsened symptoms, disrupted dying, serious injury and hastened death. Unsafe care presents a risk of significant harm to patients receiving palliative care. Improvements in the coordination of care delivery alongside wider availability of specialist palliative care support may reduce this risk.

  5. Geographic variation in the age- and gender-specific prevalence and incidence of epilepsy: analysis of Taiwanese National Health Insurance-based data.

    PubMed

    Chen, Chih-Chuan; Chen, Li-Sheng; Yen, Ming-Fang; Chen, Hsiu-Hsi; Liou, Horng-Huei

    2012-02-01

    We studied geographic variation in age- and gender-specific prevalence and incidence of epilepsy in four different areas of Taiwan. By using large-scale, National Health Insurance (NHI)-based data from 2000-2003 in Taiwan, we identified 131,287 patients diagnosed with epilepsy (ICD code 345) receiving at least of one of 11 antiepileptic drugs (AEDs). Information on age, gender, and location were also collected. The multivariable Poisson regression analysis was used to assess the heterogeneity of the morbidity of epilepsy in different regions. External data validation was also performed to assess the accuracy of capturing epilepsy cases through our NHI data set. The age-adjusted prevalence and incidence of epilepsy were 5.85 (per 1,000) between 2000 and 2003 and 97 (per 100,000 person-years) during the follow-up time from 2001 to 2003 in Taiwan. The sensitivity and specificity of ICD-9 coding for epilepsy in the NHI data set were 83.91% and 99.83%, respectively, resulting in a slight overestimation. Male patients had a higher probability of having epilepsy than did females. East Taiwan had significantly higher prevalence and incidence than did other areas. The age-specific incidence pattern in east Taiwan was atypical in that it revealed clustering in young and middle-aged groups. Our study demonstrated geographic variation in epidemiologic patterns of epilepsy within Taiwan. The findings are informative and provide insight into the clinical management of epilepsy based on consideration of different target groups in different areas. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  6. Military Personnel: DOD Has Processes for Operating and Managing Its Sexual Assault Incident Database

    DTIC Science & Technology

    2017-01-01

    each change and its implementation status as well as supporting the audit of products to verify conformance to requirements. Through these change...management process for modifying DSAID aligns with information technology and project management industry standards. GAO reviewed DOD documents, and...Acknowledgments 32 Related GAO Products 33 Tables Table 1: Roles and Access Rights for Users of the Defense Sexual Assault Incident Database (DSAID

  7. 75 FR 6700 - National Park Service Concessions Management Advisory Board Reestablishment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-10

    ... DEPARTMENT OF THE INTERIOR National Park Service Concessions Management Advisory Board Reestablishment AGENCY: National Park Service, Interior. ACTION: Notice of reestablishment of the National Park... administratively reestablish the National Park Service Concessions Management Advisory Board. This action is...

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

    PubMed

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

    2016-03-01

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

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

    DOT National Transportation Integrated Search

    2013-12-01

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

  10. Mass Casualty Decontamination Guidance and Psychosocial Aspects of CBRN Incident Management: A Review and Synthesis

    PubMed Central

    Carter, Holly; Amlôt, Richard

    2016-01-01

    Introduction: Mass casualty decontamination is an intervention employed by first responders at the scene of an incident involving noxious contaminants.  Many countries have sought to address the challenge of decontaminating large numbers of affected casualties through the provision of rapidly deployable temporary showering structures, with accompanying decontamination protocols.  In this paper we review decontamination guidance for emergency responders and associated research evidence, in order to establish to what extent psychosocial aspects of casualty management have been considered within these documents. The review focuses on five psychosocial aspects of incident management: likely public behaviour; responder management style; communication strategy; privacy/ modesty concerns; and vulnerable groups. Methods: Two structured literature reviews were carried out; one to identify decontamination guidance documents for first responders, and another to identify evidence which is relevant to the understanding of the psychosocial aspects of mass decontamination.  The guidance documents and relevant research were reviewed to identify whether the guidance documents contain information relating to psychosocial issues and where it exists, that the guidance is consistent with the existing evidence-base. Results: Psychosocial aspects of incident management receive limited attention in current decontamination guidance.  In addition, our review has identified a number of gaps and inconsistencies between guidance and research evidence.  For each of the five areas we identify: what is currently presented in guidance documents, to what extent this is consistent with the existing research evidence and where it diverges.  We present a series of evidence-based recommendations for updating decontamination guidance to address the psychosocial aspects of mass decontamination. Conclusions: Effective communication and respect for casualties’ needs are critical in ensuring

  11. Campsite impact management: A survey of National Park Service backcountry managers

    USGS Publications Warehouse

    Marion, J.L.; Stubbs, C.J.; Vander Stoep, Gail A.

    1993-01-01

    Though a central purpose for the creation and management of parks, visitation inevitably affects the natural resources of parks. This is particularly true at campsites, where visitation and its effects are concentrated. This paper presents partial results from a survey of National Park Service managers regarding general strategies and specific actions implemented by park managers to address campsite impact problems.

  12. A national cohesive wildland fire management strategy

    Treesearch

    Forest Service U.S. Department of Agriculture; Office of Wildland Fire Coordination Department of the Interior

    2011-01-01

    Addressing wildfire is not simply a fire management, fire operations, or wildland-urban interface problem - it is a larger, more complex land management and societal issue. The vision for the next century is to: Safely and effectively extinguish fire, when needed; use fire where allowable; manage our natural resources; and as a Nation, live with wildland fire. Three...

  13. The national incidence and clinical picture of SLE in children in Australia - a report from the Australian Paediatric Surveillance Unit.

    PubMed

    Mackie, F E; Kainer, G; Adib, N; Boros, C; Elliott, E J; Fahy, R; Munro, J; Murray, K; Rosenberg, A; Wainstein, B; Ziegler, J B; Singh-Grewal, D

    2015-01-01

    The objectives of this paper are to prospectively determine the incidence of paediatric systemic lupus erythematosus (pSLE) in Australia as well as describe the demographics, clinical presentation and one-year outcome. Newly diagnosed cases of pSLE were ascertained prospectively from October 2009 to October 2011 through the Australian Paediatric Surveillance Unit (a national monthly surveillance scheme for notification of childhood rare diseases) as well as national subspecialty groups. Questionnaires were sent to notifying physicians at presentation and at one year. The annual incidence rate was 0.32 per 10(5) children aged less than 16 years. The incidence was significantly higher in children of Asian or Australian Aboriginal and Torres Strait Islander parents. Approximately one-third of children underwent a renal biopsy at presentation and 7% required dialysis initially although only one child had end-stage kidney disease (ESKD) at one-year follow-up. The incidence of pSLE in Australia is comparable to that worldwide with a significantly higher incidence seen in children of Asian and Australian Aboriginal and Torres Strait Islander backgrounds. Renal involvement is common but progression to ESKD, at least in the short term, is rare. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  14. Relevance of Lick Creek ecosystem-based management treatments to National Forest management

    Treesearch

    Cathy Stewart

    1999-01-01

    Treatments applied at Lick Creek were the first landscape-scale applications of ecosystem management on the Bitterroot National Forest. The coordinated effort between educators, researchers, resource managers, and the public helped gain acceptance and understanding of new approaches to management, both internally and externally. The longer skidding distances, high...

  15. Manual handling incident claims in the healthcare sector: Factors and outcomes.

    PubMed

    Dockrell, Sara; Johnson, Muriel; Ganly, Joe; Bennett, Kathleen

    2011-01-01

    Manual handling (MH) incidents may result in injury, absenteeism and/or compensation claim. This study investigated the factors associated with MH incidents among healthcare workers who had made a claim, and the management and outcome of those workers. A national sample of healthcare sector MH incident claim files (n=247) were accessed and 35~files met the inclusion criteria. Data were collected and presented graphically or descriptively using percentages (and 95% Confidence intervals, CI). Chi-square (χ2) tests were used for comparing proportions between groups. SPSS (v14.0) was used for analysis. Significance at p<0.05 is assumed. Attendants accounted for the highest number of claimants. The majority of claims (74%, 95% CI 68%, 81%) were for back injury; 11% (8%, 15%) for neck injury. Fifty-one percent (43%, 60%) involved patient-handling tasks at the time of incident; 46% (37%, 54%) involved inanimate handling. Ninety-one percent (89%, 94%) took sick leave, with 52% (43%, 60%) taking > 52 weeks. Only 58% (49%, 65%) returned to work. Claimants who had been in communication with employers were significantly more likely to return to work than those who did not (χ2 test, p=0.017). Improved management of MH incidents and injured workers are recommended.

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

    PubMed

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

    2008-01-01

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

  17. Incidence and Mortality Rates of Disasters and Mass Casualty Incidents in Korea: A Population-Based Cross-Sectional Study, 2000-2009

    PubMed Central

    Kim, Soo Jin; Shin, Sang Do; Lee, Seung Chul; Park, Ju Ok; Sung, Joohon

    2013-01-01

    The objective of study was to evaluate the incidence and mortality rates of disasters and mass casualty incidents (MCIs) over the past 10 yr in the administrative system of Korea administrative system and to examine their relationship with population characteristics. This was a population-based cross-sectional study. We calculated the nationwide incidence, as well as the crude mortality and injury incidence rates, of disasters and MCIs. The data were collected from the administrative database of the National Emergency Management Agency (NEMA) and from provincial fire departments from January 2000 to December 2009. A total of 47,169 events were collected from the NEMA administrative database. Of these events, 115 and 3,079 cases were defined as disasters and MCIs that occurred in Korea, respectively. The incidence of technical disasters/MCIs was approximately 12.7 times greater than that of natural disasters/MCIs. Over the past 10 yr, the crude mortality rates for disasters and MCIs were 2.36 deaths per 100,000 persons and 6.78 deaths per 100,000 persons, respectively. The crude injury incidence rates for disasters and MCIs were 25.47 injuries per 100,000 persons and 152 injuries per 100,000 persons, respectively. The incidence and mortality of disasters/MCIs in Korea seem to be low compared to that of trend around the world. PMID:23678255

  18. U.S. National forests adapt to climate change through science-management partnerships

    Treesearch

    Jeremy S. Littell; David L. Peterson; Constance I. Millar; Kathy A. O' Halloran

    2011-01-01

    Developing appropriate management options for adapting to climate change is a new challenge for land managers, and integration of climate change concepts into operational management and planning on United States national forests is just starting. We established science-management partnerships on the Olympic National Forest (Washington) and Tahoe National Forest (...

  19. Ecological modeling for forest management in the Shawnee National Forest

    Treesearch

    Richard G. Thurau; J.F. Fralish; S. Hupe; B. Fitch; A.D. Carver

    2008-01-01

    Land managers of the Shawnee National Forest in southern Illinois are challenged to meet the needs of a diverse populace of stakeholders. By classifying National Forest holdings into management units, U.S. Forest Service personnel can spatially allocate resources and services to meet local management objectives. Ecological Classification Systems predict ecological site...

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

    DOT National Transportation Integrated Search

    2012-07-01

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

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

    EPA Pesticide Factsheets

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

  2. 78 FR 34034 - National Advisory Committee for Implementation of the National Forest System Land Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-06

    ... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... purpose of the Committee is to provide advice and recommendations on the implementation of the National...

  3. Incidence, predictive factors, management, and survival impact of atrial fibrillation in non-Hodgkin lymphoma.

    PubMed

    Sorigue, Marc; Gual-Capllonch, Francisco; Garcia, Olga; Sarrate, Edurne; Franch-Sarto, Mireia; Ibarra, Gladys; Grau, Javier; Orna, Elisa; Ribera, Josep-Maria; Sancho, Juan-Manuel

    2018-05-04

    Atrial fibrillation (AF) and cancer are common disorders in the general population but there are few studies in patients with both diseases. More specifically, there are scarce data on AF in patients with non-Hodgkin lymphoma (NHL). We assessed the incidence, predictive factors, management, and survival impact of AF in a cohort of patients with NHL from a single institution between 2002 and 2016 (n = 747). Twenty-three patients were diagnosed with AF before and 40 after the diagnosis of NHL (of the later, 16 were secondary to an extracardiac comorbidity and 24 unrelated to any triggering event [primary AF]). The 5-year cumulative incidence of new-onset AF was 4% (95% confidence interval [CI] 3-6%). Age and hypertension were the only predictive factors for the development of AF. Management of AF was heterogeneous, primarily with anti-vitamin K agents but also antiplatelet therapy in a significant proportion of patients. Among the 63 patients, there were six episodes of ischemic stroke/transient ischemic attack and four venous thromboembolic events, with four major bleeding episodes. Overall survival (OS) was inferior in patients with AF (HR 0.1, 95% CI 0.01-0.7, p = 0.02), largely due to secondary AF. We conclude that the incidence of new-onset AF in NHL patients seemed somewhat higher than in the general population, although with similar predictive factors. The management was heterogeneous, and the risk of ischemic and hemorrhagic events did not seem higher than in cancer-free patients. Survival was particularly poor for patients with secondary AF.

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

    PubMed

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

    2017-10-01

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

  5. Measuring and improving performance in incident management.

    DOT National Transportation Integrated Search

    2010-03-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  8. Pediatric facial fractures: current national incidence, distribution, and health care resource use.

    PubMed

    Vyas, Raj M; Dickinson, Brian P; Wasson, Kristy L; Roostaeian, Jason; Bradley, James P

    2008-03-01

    To date, reports on the incidence and distribution of pediatric facial fractures have been inconsistent and have originated only from institutional studies. The need for current national data exists. We examined the Kids' Inpatient Database and the Nationwide Inpatient Sample to obtain national information on facial fracture discharges from 1997 to 2003. Data showed that pediatric patients (age, 0-17 years) make up 14.7% of all facial fractures, with children aged 1 to 4 years comprising only 5.6% of the total and children 15 to 17 years old making up more than half the group. The male-to-female ratio was 2.5. Significantly lengthier hospitalizations were observed with female patients, Medicaid insurance, teaching hospitals, government hospitals, and metropolitan hospitals. Significantly higher charges were associated with patients aged 1 to 4 years, Medicaid insurance, Western US geography, teaching hospitals, metropolitan hospitals, and children's hospitals. During the 6-year period of this study, there was a trend toward (1) increased hospital charges (with stable costs), (2) more patients treated at teaching hospitals, and (3) a convergence in length of stay between hospitals with differing ownerships (with government hospitals having progressively shorter hospitalizations, whereas private for-profit hospitals have progressively lengthier hospitalizations). The incidence of facial fractures in children is small yet significant and has remained stable during the past few decades. Certain patient populations are prone to facial fractures, and various patient and hospital factors are associated with lengthier and more expensive hospitalizations. An understanding of disparities in resource use among various patient, hospital, and geographic settings is critical for physicians and policy makers.

  9. Management of dairy heifers and its relationships with the incidence of clinical mastitis.

    PubMed

    Parker, K I; Compton, C W R; Anniss, F M; Weir, A M; McDougal, S

    2007-10-01

    To describe aspects of management of dairy heifers before calving and determine risk factors for clinical mastitis postpartum in heifers, at the herd level, under pasture-based management systems in the Waikato and Taranaki regions of New Zealand. Dairy herdowners (n=578) provided information via a prospective survey about their practices for rearing heifers and management of mastitis. A proportion of herdowners (n=250) subsequently provided data on the cases of clinical mastitis in their herds, including the date, cow identification, age and quarter affected from cases occurring in the 4 months after the planned start of calving (PSC) in the subsequent lactation. The relationship between management factors and the proportion of heifers diagnosed with clinical mastitis within a herd was examined using bivariate and multivariate analyses. The herd average percentage of heifers with clinical mastitis was 13.6 (95% confidence interval (CI)=12.3-14.9)%, and multiparous cows with clinical mastitis was 9.0 (95% CI=8.2-9.8)% in the first 4 months of lactation. There were positive relationships between the proportion of heifers with clinical mastitis and average milk production per cow (kg milksolids/ lactation; p<0.001), number of cows milked per labour unit (p=0.003), stocking rate (<> 3.30 cows/ha; p=0.002), and incidence of clinical mastitis in multiparous cows (%/120 days; p<0.04), in the final multivariate model. The proportion of heifers with clinical mastitis per herd was lower in herds that milked their lactating cows in multiple groups (p=0.02). The risk of clinical mastitis in heifers was significantly associated with management practices. It may be possible to reduce the incidence of clinical mastitis in heifers by modification of management practices at the herd level, and further studies are required to investigate this.

  10. Collaboration in national forest management

    Treesearch

    Susan Charnley; Jonathan W. Long; Frank K. Lake

    2014-01-01

    National forest management efforts have generally moved toward collaborative and participatory approaches at a variety of scales. This includes, at a larger scale, greater public participation in transparent and inclusive democratic processes and, at a smaller scale, more engagement with local communities. Participatory approaches are especially important for an all-...

  11. BROOKHAVEN NATIONAL LABORATORY WILDLIFE MANAGEMENT PLAN.

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

    NAIDU,J.R.

    2002-10-22

    The purpose of the Wildlife Management Plan (WMP) is to promote stewardship of the natural resources found at the Brookhaven National Laboratory (BNL), and to integrate their protection with pursuit of the Laboratory's mission.

  12. National trends in incidence rates of hospitalization for stroke in children with sickle cell disease.

    PubMed

    McCavit, Timothy L; Xuan, Lei; Zhang, Song; Flores, Glenn; Quinn, Charles T

    2013-05-01

    The success of primary stroke prevention for children with sickle cell disease (SCD) throughout the United States is unknown. Therefore, we aimed to generate national incidence rates of hospitalization for stroke in children with sickle cell disease (SCD) before and after publication of the Stroke Prevention Trial in Sickle Cell Anemia (STOP trial) in 1998. We performed a retrospective trend analysis of the 1993-2009 Nationwide Inpatient Sample and Kids' Inpatient Databases. Hospitalizations for SCD patients 0-18 years old with stroke were identified by ICD-9CM code. The primary outcome, the trend in annual incidence rate of hospitalization for stroke in children with SCD, was analyzed by linear regression. Incidence rates of hospitalization for stroke before and after 1998 were compared by the Wilcoxon rank-sum test. From 1993 to 2009, 2,024 hospitalizations were identified for stroke. Using the mean annual incidence rate of hospitalization for stroke from 1993 to 1998 as the baseline, the rate decreased from 1993 to 2009 (point estimate = -0.022/100 patient years [95% CI, -0.039, -0.005], P = 0.027). The mean annual incidence rate of hospitalization stroke decreased by 45% from 0.51 per 100 patient years in 1993-1998 to 0.28 per 100 patient years in 1999-2009 (P = 0.008). Total hospital days and charges attributed to stroke also decreased by 45% and 24%, respectively. After publication of the STOP trial and hydroxyurea licensure in 1998, the incidence of hospitalization for stroke in children with SCD decreased across the United States, suggesting that primary stroke prevention has been effective nationwide, but opportunity for improvement remains. Copyright © 2012 Wiley Periodicals, Inc.

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

    DOT National Transportation Integrated Search

    2001-12-01

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

  14. Results From the 2014 National Wilderness Manager Survey

    Treesearch

    Ramesh Ghimire; Ken Cordell; Alan Watson; Chad Dawson; Gary T. Green

    2015-01-01

    A national survey of managers was developed to support interagency wilderness strategic planning. The focus was on major challenges, perceived needs for science and training, and accomplishments of 1995 Strategic Plan objectives. The survey was administered to managers at the four federal agencies with wilderness management responsibilities: the Bureau of Land...

  15. National Security Management Correspondence Course.

    ERIC Educational Resources Information Center

    Industrial Coll. of the Armed Forces (DOD), Washington, DC.

    A course of study on the fundamental aspects of the areas of knowledge which are essential to effective management of national security is presented. The course presents the substance of the Industrial College resident curriculum adapted to the correspondence method of study. The subject matter is designed to impart knowledge and understanding of…

  16. 78 FR 19523 - General Management Plan, Draft Environmental Impact Statement, Lake Meredith National Recreation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-01

    ... Management Plan, Draft Environmental Impact Statement, Lake Meredith National Recreation Area and Alibates... Management Plan, Lake Meredith National Recreation Area and Alibates Flint Quarries National Monument, Texas... management alternatives for Lake Meredith National Recreation Area and three management alternatives for...

  17. 77 FR 65374 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-26

    ... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... management in the areas of environmental restoration, waste management, and related activities. Tentative...

  18. National Airspace System interface management plan

    DOT National Transportation Integrated Search

    1986-01-01

    This document is intended to implement Interface Management for interfacing subsystems of the National Airspace System (NAS) and for external NAS interfaces by establishing a process which assures that: Interface requirements are agreed to by interfa...

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

    PubMed

    McIntosh, Tania

    2006-01-01

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

  20. Changing incidence and management of penetrating neck injuries in the South East London trauma centre.

    PubMed

    Harris, R; Olding, C; Lacey, C; Bentley, R; Schulte, K M; Lewis, D; Kandasamy, N; Oakley, R

    2012-05-01

    A total of 17 cases of penetrating neck injury were managed by the otolaryngology team at King's College Hospital over a 3-year period in the 1980s. In April 2010 King's College Hospital became the major trauma centre for South East London. This prospective cohort study compares the incidence, changing demographic features and treatment outcomes of penetrating neck trauma in South East London over the previous 23 years. Data were collected over a 12-month period (April 2010 to March 2011) and a selective management protocol was introduced to standardise initial investigations and further treatment. The past 23 years have seen a 550% increase in the incidence of penetrating neck injuries in South East London, with a marked increase in gun crime. Only 38% of cases underwent negative neck exploration in 2011 compared with 65% in 1987. Selective conservative management based on the absence of haemodynamic instability or radiological findings reduces length of hospital stay, lightens surgical workload and cuts costs without affecting morbidity or mortality. The increased incidence of penetrating neck injury is a reflection of more interpersonal violence rather than a consequence of the larger South East London trauma centre catchment area. Tackling this problem requires focus on wider issues of community prevention. Sharing of data between the four London trauma centres and the police is needed to help prevent interpersonal violence and develop a universal treatment algorithm for other institutions to follow.

  1. Incidence of and risk for post-traumatic stress disorder and depression in a representative sample of US Reserve and National Guard.

    PubMed

    Fink, David S; Cohen, Gregory H; Sampson, Laura A; Gifford, Robert K; Fullerton, Carol S; Ursano, Robert J; Galea, Sandro

    2016-03-01

    We aim to determine the incidence rates (IR) of first-ever post-traumatic stress disorder (PTSD) and depression in a population-based cohort of US Reserve and National Guard service members. We used data from the US Reserve and National Guard Study (n = 2003) to annually investigate incident and recurrent PTSD and depression symptoms from 2010 to 2013. We estimated the IR and recurrence rate over 4 years and according to several sociodemographic and military characteristics. From 2010 to 2013, IRs were 4.7 per 100 person-years for both PTSD and depression symptoms using the sensitive criteria, 2.9 per 100 person-years using the more specific criteria, recurrence rates for both PTSD and depression were more than 4 times as high as IRs, and IRs were higher among those with past-year civilian trauma, but not past-year deployment. The finding that civilian trauma, but not past-year military deployment, is associated with an increased risk of PTSD and depression incidence suggest that Reserve National Guard psychopathology could be driven by other, nonmilitary, traumatic experiences. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. 76 FR 39080 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-05

    ... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... recommendations to DOE-EM and site management in the areas of environmental restoration, waste management, and...

  3. Values, Ethics, and Attitudes Toward National Forest Management: An Empirical Study

    Treesearch

    Robert Manning; William Valliere; Ben Minteer

    1999-01-01

    This study measures environmental values and ethics and explores their relationships to attitudes toward national forest management. The principal research methods were literature review and a survey of Vermont residents concerning management of the Green Mountain National Forest. Descriptive findings suggest respondents (1) favor nonmaterial values of national forests...

  4. Cancer incidence and mortality in Serbia 1999-2009.

    PubMed

    Mihajlović, Jovan; Pechlivanoglou, Petros; Miladinov-Mikov, Marica; Zivković, Snežana; Postma, Maarten J

    2013-01-15

    Despite the increase in cancer incidence in the last years in Serbia, no nation-wide, population-based cancer epidemiology data have been reported. In this study cancer incidence and mortality rates for Serbia are presented using nation-wide data from two population-based cancer registries. These rates are additionally compared to European and global cancer epidemiology estimates. Finally, predictions on Serbian cancer incidence and mortality rates are provided. Cancer incidence and mortality was collected from the cancer registries of Central Serbia and Vojvodina from 1999 to 2009. Using age-specific regression models, we estimated time trends and predictions for cancer incidence and mortality for the following five years (2010-2014). The comparison of Serbian with European and global cancer incidence/mortality rates, adjusted to the world population (ASR-W) was performed using Serbian population-based data and estimates from GLOBOCAN 2008. Increasing trends in both overall cancer incidence and mortality rates were identified for Serbia. In men, lung cancer showed the highest incidence (ASR-W 2009: 70.8/100,000), followed by colorectal (ASR-W 2009: 39.9/100,000), prostate (ASR-W 2009: 29.1/100,000) and bladder cancer (ASR-W 2009: 16.2/100,000). Breast cancer was the most common form of cancer in women (ASR-W 2009: 70.8/100,000) followed by cervical (ASR-W 2009: 25.5/100,000), colorectal (ASR-W 2009: 21.1/100,000) and lung cancer (ASR-W 2009: 19.4/100,000). Prostate and colorectal cancers have been significantly increasing over the last years in men, while this was also observed for breast cancer incidence and lung cancer mortality in women. In 2008 Serbia had the highest mortality rate from breast cancer (ASR-W 2008: 22.7/100,000), among all European countries while incidence and mortality of cervical, lung and colorectal cancer were well above European estimates. Cancer incidence and mortality in Serbia has been generally increasing over the past years. For a

  5. Incidence of Artifacts and Deviating Values in Research Data Obtained from an Anesthesia Information Management System in Children.

    PubMed

    Hoorweg, Anne-Lee J; Pasma, Wietze; van Wolfswinkel, Leo; de Graaff, Jurgen C

    2018-02-01

    Vital parameter data collected in anesthesia information management systems are often used for clinical research. The validity of this type of research is dependent on the number of artifacts. In this prospective observational cohort study, the incidence of artifacts in anesthesia information management system data was investigated in children undergoing anesthesia for noncardiac procedures. Secondary outcomes included the incidence of artifacts among deviating and nondeviating values, among the anesthesia phases, and among different anesthetic techniques. We included 136 anesthetics representing 10,236 min of anesthesia time. The incidence of artifacts was 0.5% for heart rate (95% CI: 0.4 to 0.7%), 1.3% for oxygen saturation (1.1 to 1.5%), 7.5% for end-tidal carbon dioxide (6.9 to 8.0%), 5.0% for noninvasive blood pressure (4.0 to 6.0%), and 7.3% for invasive blood pressure (5.9 to 8.8%). The incidence of artifacts among deviating values was 3.1% for heart rate (2.1 to 4.4%), 10.8% for oxygen saturation (7.6 to 14.8%), 14.1% for end-tidal carbon dioxide (13.0 to 15.2%), 14.4% for noninvasive blood pressure (10.3 to 19.4%), and 38.4% for invasive blood pressure (30.3 to 47.1%). Not all values in anesthesia information management systems are valid. The incidence of artifacts stored in the present pediatric anesthesia practice was low for heart rate and oxygen saturation, whereas noninvasive and invasive blood pressure and end-tidal carbon dioxide had higher artifact incidences. Deviating values are more often artifacts than values in a normal range, and artifacts are associated with the phase of anesthesia and anesthetic technique. Development of (automatic) data validation systems or solutions to deal with artifacts in data is warranted.

  6. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

    PubMed Central

    Webb, Roger T; Carr, Matthew J; Kontopantelis, Evangelos; Green, Jonathan; Chew-Graham, Carolyn A; Kapur, Nav; Ashcroft, Darren M

    2017-01-01

    Objectives To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age. Design Population based cohort study. Setting UK Clinical Practice Research Datalink—electronic health records from 674 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records. Participants For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274). Main outcome measures In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort. Results The annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even

  7. Development and implementation of a radiation therapy incident learning system compatible with local workflow and a national taxonomy.

    PubMed

    Montgomery, Logan; Fava, Palma; Freeman, Carolyn R; Hijal, Tarek; Maietta, Ciro; Parker, William; Kildea, John

    2018-01-01

    Collaborative incident learning initiatives in radiation therapy promise to improve and standardize the quality of care provided by participating institutions. However, the software interfaces provided with such initiatives must accommodate all participants and thus are not optimized for the workflows of individual radiation therapy centers. This article describes the development and implementation of a radiation therapy incident learning system that is optimized for a clinical workflow and uses the taxonomy of the Canadian National System for Incident Reporting - Radiation Treatment (NSIR-RT). The described incident learning system is a novel version of an open-source software called the Safety and Incident Learning System (SaILS). A needs assessment was conducted prior to development to ensure SaILS (a) was intuitive and efficient (b) met changing staff needs and (c) accommodated revisions to NSIR-RT. The core functionality of SaILS includes incident reporting, investigations, tracking, and data visualization. Postlaunch modifications of SaILS were informed by discussion and a survey of radiation therapy staff. There were 240 incidents detected and reported using SaILS in 2016 and the number of incidents per month tended to increase throughout the year. An increase in incident reporting occurred after switching to fully online incident reporting from an initial hybrid paper-electronic system. Incident templating functionality and a connection with our center's oncology information system were incorporated into the investigation interface to minimize repetitive data entry. A taskable actions feature was also incorporated to document outcomes of incident reports and has since been utilized for 36% of reported incidents. Use of SaILS and the NSIR-RT taxonomy has improved the structure of, and staff engagement with, incident learning in our center. Software and workflow modifications informed by staff feedback improved the utility of SaILS and yielded an efficient

  8. National Trends in Incidence Rates of Hospitalization for Stroke in Children With Sickle Cell Disease

    PubMed Central

    McCavit, Timothy L.; Xuan, Lei; Zhang, Song; Flores, Glenn; Quinn, Charles T.

    2014-01-01

    Background The success of primary stroke prevention for children with sickle cell disease (SCD) throughout the United States is unknown. Therefore, we aimed to generate national incidence rates of hospitalization for stroke in children with sickle cell disease (SCD) before and after publication of the Stroke Prevention Trial in Sickle Cell Anemia (STOP trial) in 1998. Procedure We performed a retrospective trend analysis of the 1993–2009 Nationwide Inpatient Sample and Kids’ Inpatient Databases. Hospitalizations for SCD patients 0–18 years old with stroke were identified by ICD-9CM code. The primary outcome, the trend in annual incidence rate of hospitalization for stroke in children with SCD, was analyzed by linear regression. Incidence rates of hospitalization for stroke before and after 1998 were compared by the Wilcoxon rank-sum test. Results From 1993 to 2009, 2,024 hospitalizations were identified for stroke. Using the mean annual incidence rate of hospitalization for stroke from 1993 to 1998 as the baseline, the rate decreased from 1993 to 2009 (point estimate = −0.022/100 patient years [95% CI, −0.039, −0.005], P = 0.027). The mean annual incidence rate of hospitalization stroke decreased by 45% from 0.51 per 100 patient years in 1993–1998 to 0.28 per 100 patient years in 1999–2009 (P = 0.008). Total hospital days and charges attributed to stroke also decreased by 45% and 24%, respectively. Conclusions After publication of the STOP trial and hydroxyurea licensure in 1998, the incidence of hospitalization for stroke in children with SCD decreased across the United States, suggesting that primary stroke prevention has been effective nationwide, but opportunity for improvement remains. PMID:23151905

  9. 78 FR 23219 - National Advisory Committee for Implementation of the National Forest System Land Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-18

    ... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... Federal Advisory Committee Act. The purpose of the committee is to provide advice and recommendations on...

  10. 76 FR 81911 - National Advisory Committee for Implementation of the National Forest System Land Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-29

    ... National Forest System Land Management Planning Rule AGENCY: USDA Forest Service. ACTION: Notice of intent... intends to establish the National Advisory Committee for Implementation of the National Forest System Land... (FACA), the Committee is being established to provide advice and recommendations on the implementation...

  11. 78 FR 9883 - National Advisory Committee for Implementation of the National Forest System Land Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-12

    ... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... Advisory Committee Act. The purpose of the committee is to provide advice and recommendations on the...

  12. Real Time Data Management for Estimating Probabilities of Incidents and Near Misses

    NASA Astrophysics Data System (ADS)

    Stanitsas, P. D.; Stephanedes, Y. J.

    2011-08-01

    Advances in real-time data collection, data storage and computational systems have led to development of algorithms for transport administrators and engineers that improve traffic safety and reduce cost of road operations. Despite these advances, problems in effectively integrating real-time data acquisition, processing, modelling and road-use strategies at complex intersections and motorways remain. These are related to increasing system performance in identification, analysis, detection and prediction of traffic state in real time. This research develops dynamic models to estimate the probability of road incidents, such as crashes and conflicts, and incident-prone conditions based on real-time data. The models support integration of anticipatory information and fee-based road use strategies in traveller information and management. Development includes macroscopic/microscopic probabilistic models, neural networks, and vector autoregressions tested via machine vision at EU and US sites.

  13. Idaho National Laboratory Cultural Resource Management Plan

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

    Julie Braun Williams

    As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Officemore » will meet these responsibilities at Idaho National Laboratory in southeastern Idaho. The Idaho National Laboratory is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable, bear valuable physical and intangible legacies, and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through regular reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of

  14. Medication Incidents Involving Antiepileptic Drugs in Canadian Hospitals: A Multi-Incident Analysis.

    PubMed

    Cheng, Roger; Yang, Yu Daisy; Chan, Matthew; Patel, Tejal

    2017-01-01

    Medication errors involving antiepileptic drugs (AEDs) are not well studied but have the potential to cause significant harm. We investigated the occurrence of medication incidents in Canadian hospitals that involve AEDs, their severity and contributing factors by analyzing data from two national databases. Our multi-incident analysis revealed that while medication errors were rarely fatal, errors do occur of which some are serious. Medication incidents were most commonly caused by dose omissions, the dose or its frequency being incorrect and the wrong AED being given. Our analysis could augment quality-improvement initiatives by medication safety administrators to reduce AED medication incidents in hospitals.

  15. Epidemiology of Inherited Epidermolysis Bullosa Based on Incidence and Prevalence Estimates From the National Epidermolysis Bullosa Registry.

    PubMed

    Fine, Jo-David

    2016-11-01

    Accurate estimation of the incidence and prevalence of each subtype of epidermolysis bullosa (EB) is essential before clinical trials can be designed and sufficient funding allocated by government agencies and third-party insurers for the care of these individuals. To determine the incidence and prevalence of inherited EB stratified by subtype in the United States during a 16-year period. Prospective cross-sectional and longitudinal study. Data were obtained from 3271 patients consecutively enrolled in the National Epidermolysis Bullosa Registry from January 1, 1986, through December 31, 2002, using a detailed instrument created with the assistance of the National Institutes of Health. Analyses were performed in January 1999 and April 2015. Participants were patients of all ages with EB. Extensive clinical and laboratory data were collected on patients who were subclassified and serially revalidated based on published diagnostic recommendations by an international panel of experts. Pertinent to this report, estimates were made of the incidence and prevalence during 2 time frames. During the first 5 years of funding of the registry, the overall incidence and prevalence of inherited EB were 19.60 and 8.22 per 1 million live births, respectively. When reassessed over the entire 16 years of the study, the prevalence rose to 11.07, whereas the overall incidence remained unchanged at 19.57 cases. Changes were also observed within some disease subsets as increased numbers of patients were identified, recruited, followed up longitudinally, and resubclassified as needed over time. For example, in 2002, the prevalence of EBS overall and localized EBS had increased considerably by 30.4% and 25.5%, respectively, whereas the prevalence of generalized intermediate EBS declined by 76.7% as a result of later subclassification of some of those patients into other subtypes. In contrast, no significant change was noted in the overall prevalence of JEB or generalized severe JEB

  16. National information network and database system of hazardous waste management in China

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

    Ma Hongchang

    1996-12-31

    Industries in China generate large volumes of hazardous waste, which makes it essential for the nation to pay more attention to hazardous waste management. National laws and regulations, waste surveys, and manifest tracking and permission systems have been initiated. Some centralized hazardous waste disposal facilities are under construction. China`s National Environmental Protection Agency (NEPA) has also obtained valuable information on hazardous waste management from developed countries. To effectively share this information with local environmental protection bureaus, NEPA developed a national information network and database system for hazardous waste management. This information network will have such functions as information collection, inquiry,more » and connection. The long-term objective is to establish and develop a national and local hazardous waste management information network. This network will significantly help decision makers and researchers because it will be easy to obtain information (e.g., experiences of developed countries in hazardous waste management) to enhance hazardous waste management in China. The information network consists of five parts: technology consulting, import-export management, regulation inquiry, waste survey, and literature inquiry.« less

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

    DTIC Science & Technology

    2015-06-01

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

  18. Nontimber forest products management on national forests in the United States.

    Treesearch

    Rebecca J. McLain; Eric T. Jones

    2005-01-01

    This study provides an overview of nontimber forest products (NTFP) programs on national forests in the United States. We conducted an email survey in 2003 to obtain data on NTFP management activities on national forests across the country. Program characteristics examined in the study included important NTFPs managed on national forests, presence of NTFP coordinators...

  19. 78 FR 68811 - National Advisory Committee for Implementation of the National Forest System Land Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-15

    ... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... (FACA) (Pub. L. 92-463). The purpose of the Committee is to provide advice and recommendations on the...

  20. 78 FR 46565 - National Advisory Committee for Implementation of the National Forest System Land Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-01

    ... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... Committee Act (FACA) (Pub. L. 92-463). The purpose of the Committee is to provide advice and recommendations...

  1. Volunteer First Responders for Optimizing Management of Mass Casualty Incidents.

    PubMed

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

    2018-06-04

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

  2. Toward a national health risk management approach in Australia.

    PubMed

    O'Donnell, Carol

    2002-01-01

    There has been increasing international consensus about the importance of competition for achieving national growth and community well-being. The Australian government accordingly has introduced policies to promote such competition. Major legislative review and many public inquiries have assisted implementation of national competition policy and the development of national goals and standards related to international agreements to promote health and sustainable development. Since the 1980s, Australia has had legislation that requires the identification and control of health risks arising at work. The management structures necessary for coordinated delivery of national programs designed for effective identification and control of health risks arising in communities to achieve national health and development goals are still being developed, however. Major difficulties related to this development are discussed. National health development programs should be approached primarily through establishment of regional partnerships between bodies responsible for managing community health, local government, and employment placement, in consultation with other relevant organizations and the community. Related research and evaluation programs are required.

  3. Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time-series analysis.

    PubMed

    McAuley, Andrew; Bouttell, Janet; Barnsdale, Lee; Mackay, Daniel; Lewsey, Jim; Hunter, Carole; Robinson, Mark

    2017-02-01

    It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid-related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid-related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call-outs to opioid-related overdose incidents and the cumulative number of 'take-home naloxone' (THN) kits in issue; and is there evidence of an association between ambulance call-outs to opioid-related overdose incidents in early adopter (pilot) or later adopting (non-pilot) regions and the cumulative number of THN kits issued in those areas? Controlled time-series analysis. Scotland, UK, 2008-15. Pre-NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post-implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid-related overdose were recorded for the pre-NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post-implementation period (mean 24.8 attendances per week). Scotland's NNP; formally implemented on 1 April 2011. Primary outcome measure was weekly incidence (counts) of call-outs to opioid-related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call-outs to heroin-related overdose in the London Borough area acquired

  4. Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time–series analysis

    PubMed Central

    Bouttell, Janet; Barnsdale, Lee; Mackay, Daniel; Lewsey, Jim; Hunter, Carole; Robinson, Mark

    2016-01-01

    Abstract Background and Aims It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid‐related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid‐related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call‐outs to opioid‐related overdose incidents and the cumulative number of ‘take‐home naloxone’ (THN) kits in issue; and is there evidence of an association between ambulance call‐outs to opioid‐related overdose incidents in early adopter (pilot) or later adopting (non‐pilot) regions and the cumulative number of THN kits issued in those areas? Design Controlled time–series analysis. Setting Scotland, UK, 2008–15. Participants Pre‐NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post‐implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid‐related overdose were recorded for the pre‐NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post‐implementation period (mean 24.8 attendances per week). Intervention Scotland's NNP; formally implemented on 1 April 2011. Measurements Primary outcome measure was weekly incidence (counts) of call‐outs to opioid‐related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further

  5. Marketing a national forest: the resource manager's dilemma

    Treesearch

    Howard A. Clonts; Jeffrey R. Hibbert

    1995-01-01

    National Forests throughout the United States are facing critical management decisions regarding optimal resource use amidst strong countervailing pressures for access. Visitors to Talladega National Forest in Alabama were surveyed to develop appropriate marketing strategies. Cluster analysis showed that separate homogeneous user groups exist. This information was...

  6. User-managed inventory: an approach to forward-deployment of urgently needed medical countermeasures for mass-casualty and terrorism incidents.

    PubMed

    Coleman, C Norman; Hrdina, Chad; Casagrande, Rocco; Cliffer, Kenneth D; Mansoura, Monique K; Nystrom, Scott; Hatchett, Richard; Caro, J Jaime; Knebel, Ann R; Wallace, Katherine S; Adams, Steven A

    2012-12-01

    The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use ("dual utility") and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement.

  7. Validating the Hamilton Anatomy of Risk Management-Forensic Version and the Aggressive Incidents Scale.

    PubMed

    Cook, Alana N; Moulden, Heather M; Mamak, Mini; Lalani, Shams; Messina, Katrina; Chaimowitz, Gary

    2018-06-01

    The Hamilton Anatomy of Risk Management-Forensic Version (HARM-FV) is a structured professional judgement tool of violence risk developed for use in forensic inpatient psychiatric settings. The HARM-FV is used with the Aggressive Incidents Scale (AIS), which provides a standardized method of recording aggressive incidents. We report the findings of the concurrent validity of the HARM-FV and the AIS with widely used measures of violence risk and aggressive acts, the Historical, Clinical, Risk Management-20, Version 3 (HCR-20 V3 ) and a modified version of the Overt Aggression Scale. We also present findings on the predictive validity of the HARM-FV in the short term (1-month follow-up periods) for varying severities of aggressive acts. The results indicated strong support for the concurrent validity of the HARM-FV and AIS and promising support for the predictive accuracy of the tool for inpatient aggression. This article provides support for the continued clinical use of the HARM-FV within an inpatient forensic setting and highlights areas for further research.

  8. Nipple Pain Incidence, the Predisposing Factors, the Recovery Period After Care Management, and the Exclusive Breastfeeding Outcome.

    PubMed

    Puapornpong, Pawin; Paritakul, Panwara; Suksamarnwong, Maysita; Srisuwan, Siriwan; Ketsuwan, Sukwadee

    2017-04-01

    Nipple pain is the most common complaint of breastfeeding mothers during the immediate postpartum period. Persistent nipple pain is associated with low breastfeeding rate at 6 months postpartum. To further explore the incidence of nipple pain, associated predisposing factors, time for recovery after management, and the impact on exclusive breastfeeding rates. Included in this study were 1,649 singleton, pregnant women who delivered and had their 1-week follow-up at the breastfeeding clinic during the period of January 2013 to December 2015. The mothers who experienced nipple pain were analyzed for the incidence, the predisposing factors, and the recovery period after care management. The breastfeeding outcome comparison of both, mothers with and without pain, was measured by the exclusive breastfeeding rate at the sixth week postpartum. The incidence of nipple pain was at 9.6% by day 7. A predisposing factor of nipple pain was primiparity (relative risk = 1.8, 95% confidence interval 1.3-2.5). The reasons for nipple pain were inappropriate positioning and latching (72.3%), tongue-tie (23.2%), and oversupply (4.4%). The recovery period after care management was 1-2 weeks. There were no statistically significant differences between the 6-week exclusive breastfeeding rates of the mothers with nipple pain with treatment and the mothers without nipple pain. Persistent nipple pain was a common problem. The active management, including early detection and treatment, would help the mothers recover within a 2-week period and there was no significant difference of exclusive breastfeeding rates between the mothers who had early care management and the mothers without nipple pain.

  9. Policy Options to Address Crucial Communication Gaps in the Incident Command System

    DTIC Science & Technology

    2012-09-01

    California Department of Forestry and Fire Protection COML Communications Unit Leader COMT Communication Technician EBRPD East Bay Regional Parks...Laguna Fire 1970 - One of California’s Worst Wildfires.” Available at http://www.cccarto.com/cal_wildfire/laguna/fire.html, Accessed August 10, 2012...NIMS - The Evolution of the National Incident Management System.” Fire Rescue Magazine, August 2011. 15 compatibility, and department emergency

  10. National economic and development indicators and international variation in prostate cancer incidence and mortality: an ecological analysis.

    PubMed

    Neupane, Subas; Bray, Freddie; Auvinen, Anssi

    2017-06-01

    Macroeconomic indicators are likely associated with prostate cancer (PCa) incidence and mortality globally, but have rarely been assessed. Data on PCa incidence in 2003-2007 for 49 countries with either nationwide cancer registry or at least two regional registries were obtained from Cancer Incidence in Five Continents Vol X and national PCa mortality for 2012 from GLOBOCAN 2012. We compared PCa incidence and mortality rates with various population-level indicators of health, economy and development in 2000. Poisson and linear regression methods were used to quantify the associations. PCa incidence varied more than 15-fold, being highest in high-income countries. PCa mortality exhibited less variation, with higher rates in many low- and middle-income countries. Healthcare expenditure (rate ratio, RR 1.46, 95 % CI 1.45-1.47) and population growth (RR 1.15, 95 % CI 1.14-1.16), as well as computer and mobile phone density, were associated with a higher PCa incidence, while gross domestic product, GDP (RR 0.94, 95 % CI 0.93-0.95) and overall mortality (RR 0.72, 95 % CI 0.71-0.73) were associated with a low incidence. GDP (RR 0.55, 95 % CI 0.46-0.66) was also associated with a low PCa mortality, while life expectancy (RR 3.93, 95 % CI 3.22-4.79) and healthcare expenditure (RR 1.20, 95 % CI 1.09-1.32) were associated with an elevated mortality. Our results show that healthcare expenditure and, thus, the availability of medical resources are an important contributor to the patterns of international variation in PCa incidence. This suggests that there is an iatrogenic component in the current global epidemic of PCa. On the other hand, higher healthcare expenditure is associated with lower PCa death rates.

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

    PubMed

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

    2016-07-08

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

  12. Incidence of Helicobacter pylori in operatively managed acute nonvariceal upper gastrointestinal bleeding.

    PubMed

    Callicutt, C S; Behrman, S W

    2001-01-01

    Helicobacter pylori is a known contributor to ulcerogenesis and nonvariceal acute upper gastrointestinal hemorrhage. Its incidence in operatively managed patients with upper gastrointestinal hemorrhage is ill defined. Patients undergoing surgery for upper gastrointestinal hemorrhage secondary to gastroduodenal ulceration between 1993 and 1998 at the University of Tennessee were retrospectively reviewed. Factors examined included age, nonsteroidal drug use, endoscopic intervention, urgency of operation, and H. pylori status confirmed by histologic examination. Forty-two patients had surgery with three excluded because of a lack of histologic evaluation. The site of bleeding was gastric in 23 and duodenal in 14. H. pylori infection was present in nine (39.1%) gastric and 11 (68.7%) duodenal ulcers. The incidence of H. pylori infection was reduced in those over 60 years of age (28.6%). Endoscopy was performed in all patients, but only two had biopsies for assessment of H. pylori. Operative morbidity was 17.9% and mortality was 5.1%. No patient had rebleeding following surgery. The incidence of H. pylori in this population is less than that reported in uncomplicated ulcer disease. Those older than 60 tended to be H. pylori negative. Endoscopic assessment for H. pylori was infrequent. Traditional indications for surgical intervention in ulcer hemorrhage should not be altered based on H. pylori status.

  13. 76 FR 62433 - Delegation of Authority to the Office of Disaster Management and National Security

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-07

    ... the Office of Disaster Management and National Security AGENCY: Office of the Secretary, HUD. ACTION... Disaster and National Security Officer, Office of Disaster Management and National Security. DATES... and National Security Officer, Office of Disaster Management and National Security, Department of...

  14. Management advisory memorandum on National Airspace System infrastructure management system prototype, Federal Aviation Administration

    DOT National Transportation Integrated Search

    1997-03-01

    This is our Management Advisory Memorandum on the National Airspace : System (NAS) Infrastructure Management System (NIMS) prototype : project in the Federal Aviation Administration (FAA). Our review was : initiated in response to a hotline complaint...

  15. 50 CFR 600.320 - National Standard 3-Management Units.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Government, international commissions, foreign nations) are vital to effective management. Where management... scope to that portion of the stock found in U.S. waters; (ii) By estimating MSY for the entire stock and...

  16. 50 CFR 600.320 - National Standard 3-Management Units.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Government, international commissions, foreign nations) are vital to effective management. Where management... scope to that portion of the stock found in U.S. waters; (ii) By estimating MSY for the entire stock and...

  17. 50 CFR 600.320 - National Standard 3-Management Units.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Government, international commissions, foreign nations) are vital to effective management. Where management... scope to that portion of the stock found in U.S. waters; (ii) By estimating MSY for the entire stock and...

  18. 50 CFR 600.320 - National Standard 3-Management Units.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... comprehensive approach to fishery management. The geographic scope of the fishery, for planning purposes, should....320 National Standard 3—Management Units. (a) Standard 3. To the extent practicable, an individual... portion of a fishery identified in an FMP as relevant to the FMP's management objectives. (1) Basis. The...

  19. 50 CFR 600.320 - National Standard 3-Management Units.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... comprehensive approach to fishery management. The geographic scope of the fishery, for planning purposes, should....320 National Standard 3—Management Units. (a) Standard 3. To the extent practicable, an individual... portion of a fishery identified in an FMP as relevant to the FMP's management objectives. (1) Basis. The...

  20. Cancer incidence and mortality in Serbia 1999–2009

    PubMed Central

    2013-01-01

    Background Despite the increase in cancer incidence in the last years in Serbia, no nation-wide, population-based cancer epidemiology data have been reported. In this study cancer incidence and mortality rates for Serbia are presented using nation-wide data from two population-based cancer registries. These rates are additionally compared to European and global cancer epidemiology estimates. Finally, predictions on Serbian cancer incidence and mortality rates are provided. Methods Cancer incidence and mortality was collected from the cancer registries of Central Serbia and Vojvodina from 1999 to 2009. Using age-specific regression models, we estimated time trends and predictions for cancer incidence and mortality for the following five years (2010–2014). The comparison of Serbian with European and global cancer incidence/mortality rates, adjusted to the world population (ASR-W) was performed using Serbian population-based data and estimates from GLOBOCAN 2008. Results Increasing trends in both overall cancer incidence and mortality rates were identified for Serbia. In men, lung cancer showed the highest incidence (ASR-W 2009: 70.8/100,000), followed by colorectal (ASR-W 2009: 39.9/100,000), prostate (ASR-W 2009: 29.1/100,000) and bladder cancer (ASR-W 2009: 16.2/100,000). Breast cancer was the most common form of cancer in women (ASR-W 2009: 70.8/100,000) followed by cervical (ASR-W 2009: 25.5/100,000), colorectal (ASR-W 2009: 21.1/100,000) and lung cancer (ASR-W 2009: 19.4/100,000). Prostate and colorectal cancers have been significantly increasing over the last years in men, while this was also observed for breast cancer incidence and lung cancer mortality in women. In 2008 Serbia had the highest mortality rate from breast cancer (ASR-W 2008: 22.7/100,000), among all European countries while incidence and mortality of cervical, lung and colorectal cancer were well above European estimates. Conclusion Cancer incidence and mortality in Serbia has been generally

  1. [Critical incidents].

    PubMed

    Scheidegger, D

    2005-03-01

    In medicine real severe mishaps are rare. On the other hand critical incidents are frequent. Anonymous critical incident reporting systems allow us to learn from these mishaps. This learning process will make our daily clinical work safer Unfortunately, before these systems can be used efficiently our professional culture has to be changed. Everyone in medicine has to admit that errors do occur to see the need for an open discussion. If we really want to learn from errors, we cannot punish the individual, who reported his or her mistake. The interest is primarily in what has happened and why it has happened and not who has committed this mistake. The cause for critical incidents in medicine is in over 80% the human factor Poor communication, work under enormous stress, conflicts and hierarchies are the main cause. This has been known for many years, therefore have already 15 years ago high-tech industries, like e.g. aviation, started to invest in special courses on team training. Medicine is a typical profession were until now only the individual performance decided about the professional career Communication, conflict management, stress management, decision making, risk management, team and team resource management were subjects that have never been taught during our preor postgraduate education. These points are the most important ones for an optimal teamwork. A multimodular course designed together with Swissair (Human Aspect Development medical, HADmedical) helps to cover, as in aviation, the soft factor and behavioural education in medicine and to prepare professionals in health care to work as a real team.

  2. space technology and nigerian national challenges in disaster management

    NASA Astrophysics Data System (ADS)

    O. Akinyede, J., , Dr.; Abdullahi, R.

    One of the sustainable development challenges of any nation is the nation s capacity and capabilities to manage its environment and disaster According to Abiodun 2002 the fundamental life support systems are air clean water and food or agricultural resources It also includes wholesome environment shelter and access to energy health and education All of these constitute the basic necessities of life whose provision and preservation should be a pre-occupation of the visionary leaders executive legislative and judiciary of any nation and its people in order to completely eradicate ignorance unemployment poverty and disease and also increase life expectancy Accordingly many societies around the globe including Nigeria are embarking on initiatives and developing agenda that could address redress the threats to the life supporting systems Disaster prevention management and reduction therefore present major challenges that require prompt attention locally nationally regionally and globally Responses to disasters vary from the application of space-derived data for disaster management to the disbursement of relief to the victims and the emplacement of recovery measures The role of space technology in particular in all the phases of disaster management planning against disaster disaster early warning risk reduction preparedness crises and damage assessment response and relief disbursement and recovery and reconstruction cannot be overemphasized Akinyede 2005 Therefore this paper seeks to focus on space

  3. Analysis of eighty-four commercial aviation incidents - Implications for a resource management approach to crew training

    NASA Technical Reports Server (NTRS)

    Murphy, M. R.

    1980-01-01

    A resource management approach to aircrew performance is defined and utilized in structuring an analysis of 84 exemplary incidents from the NASA Aviation Safety Reporting System. The distribution of enabling and associated (evolutionary) and recovery factors between and within five analytic categories suggests that resource management training be concentrated on: (1) interpersonal communications, with air traffic control information of major concern; (2) task management, mainly setting priorities and appropriately allocating tasks under varying workload levels; and (3) planning, coordination, and decisionmaking concerned with preventing and recovering from potentially unsafe situations in certain aircraft maneuvers.

  4. Acceptance and utilisation of the Incident Command System in first response and allied disciplines: an Ohio study.

    PubMed

    Decker, Russell J

    2011-10-01

    In response to the terrorist attacks of September 11th, 2001, an effort was made to establish a common and uniform command structure for use by the nation's first responder organisations, as well as those disciplines generally expected to assist first responders during a major incident or disaster. The result was the issuance of the National Incident Management System1 or NIMS by the US Department of Homeland Security in 2004. Included in the NIMS document was an embracing of the Incident Command System or ICS, long utilised in the fire service for the effective management of emergency response. The NIMS doctrine also identified certain allied disciplines that needed to adopt this new system for responding to major events. Some of these disciplines included specialised first response units, such as, bomb squads and hazardous materials teams. Other partner disciplines not usually associated with emergency response to include public health and public works were also included. This study will attempt to look at a single component of NIMS, specifically the Incident Command System, and measure its acceptance and utilisation by first responder organisations and selected allied disciplines in the state of Ohio. This is particularly important at this time since the US government is being forced to reduce budgets significantly and determine which laudable policies and programmes will be cut.

  5. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State.

    PubMed

    Kohler, Betsy A; Sherman, Recinda L; Howlader, Nadia; Jemal, Ahmedin; Ryerson, A Blythe; Henry, Kevin A; Boscoe, Francis P; Cronin, Kathleen A; Lake, Andrew; Noone, Anne-Michelle; Henley, S Jane; Eheman, Christie R; Anderson, Robert N; Penberthy, Lynne

    2015-06-01

    The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) collaborate annually to produce updated, national cancer statistics. This Annual Report includes a focus on breast cancer incidence by subtype using new, national-level data. Population-based cancer trends and breast cancer incidence by molecular subtype were calculated. Breast cancer subtypes were classified using tumor biomarkers for hormone receptor (HR) and human growth factor-neu receptor (HER2) expression. Overall cancer incidence decreased for men by 1.8% annually from 2007 to 2011 [corrected]. Rates for women were stable from 1998 to 2011. Within these trends there was racial/ethnic variation, and some sites have increasing rates. Among children, incidence rates continued to increase by 0.8% per year over the past decade while, like adults, mortality declined. HR+/HER2- breast cancers, the subtype with the best prognosis, were the most common for all races/ethnicities with highest rates among non-Hispanic white women, local stage cases, and low poverty areas (92.7, 63.51, and 98.69 per 100000 non-Hispanic white women, respectively). HR+/HER2- breast cancer incidence rates were strongly, positively correlated with mammography use, particularly for non-Hispanic white women (Pearson 0.57, two-sided P < .001). Triple-negative breast cancers, the subtype with the worst prognosis, were highest among non-Hispanic black women (27.2 per 100000 non-Hispanic black women), which is reflected in high rates in southeastern states. Progress continues in reducing the burden of cancer in the United States. There are unique racial/ethnic-specific incidence patterns for breast cancer subtypes; likely because of both biologic and social risk factors, including variation in mammography use. Breast cancer subtype analysis confirms the capacity of cancer registries to adjust national collection

  6. National Ignition Facility Construction Safety Management Review

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

    Warner, B.E.

    2000-02-01

    An accident occurred at the NIF construction site on January 13, 2000, in which a worker sustained a serious injury when a 42-inch-diameter duct fell during installation. Following the accident, NIF Project Management chartered two review teams: (1) an Incident Analysis Team to independently assess the direct and root causes of the accident, and (2) a Management Review Team to review the roles and responsibilities of the line, support, and construction management organizations involved. This report provides a discussion of the information gathered by the Management Review Team and provides a list of observations and recommendations based on an analysismore » of the information. The Management Review Team includes senior managers who represent several Directorates within LLNL and DOE OAK: Dick Billia representing Engineering; Dave Leary representing Business Services and Public Affairs; Jim Jackson representing Hazards Control; Chuck Taylor representing DOE OAK; Arnie Clobes representing the ICF/NIF Program; and Jon Yatabe and Bruce Warner (Chairperson) representing the NIF Project. The attached letter from the NIF Project Manager, Ed Moses, to the Management Review Team contains the team's Charter. The team was asked to evaluate the effectiveness of the line management and its supporting safety functions in managing safety during NIF construction. The evaluation was to include the current conventional facility construction, which is 85% complete, and upcoming activities such as Beampath Infrastructure System installation, which will begin in the next six months and which represents a significant amount of work over the next two to three years. The remainder of this document describes the Management Review Team's review process (Section 2), its observations gathered during the review (Section 3), and its recommendations to the NIF Project Manager based on those observations (Section 4).« less

  7. Incidences of Waterborne and Foodborne Diseases After Meteorologic Disasters in South Korea.

    PubMed

    Na, Wonwoong; Lee, Kyeong Eun; Myung, Hyung-Nam; Jo, Soo-Nam; Jang, Jae-Yeon

    Climate change could increase the number of regions affected by meteorologic disasters. Meteorologic disasters can increase the risk of infectious disease outbreaks, including waterborne and foodborne diseases. Although many outbreaks of waterborne diseases after single disasters have been analyzed, there have not been sufficient studies reporting comprehensive analyses of cases occurring during long-term surveillance after multiple disasters, which could provide evidence of whether meteorologic disasters cause infectious disease outbreaks. This study aimed to assess the nationwide short-term changes in waterborne and foodborne disease incidences after a meteorologic disaster. We analyzed cases after all 65 floods and typhoons between 2001 and 2009 using the Korean National Emergency Management Agency's reports. Based on these data, we compared the weekly incidences of Vibrio vulnificus septicemia (VVS), shigellosis, typhoid fever, and paratyphoid fever before, during, and after the disasters, using multivariate Poisson regression models. We also analyzed the interactions between disaster characteristics and the relative risk of each disease. Compared with predisaster incidences, the incidences of VVS and shigellosis were 2.49-fold (95% confidence interval, 1.47-4.22) and 3.10-fold (95% confidence interval, 1.21-7.92) higher, respectively, the second week after the disaster. The incidences of VVS and shigellosis peaked the second week postdisaster and subsequently decreased. The risks of typhoid and paratyphoid fever did not significantly increase throughout the 4 weeks postdisaster. The daily average precipitation interacted with VVS and shigellosis incidences, whereas disaster type only interacted with VVS incidence patterns. The incidences of VVS and shigellosis were associated with meteorologic disasters, and disaster characteristics were associated with the disease incidence patterns postdisaster. These findings provide important comprehensive evidence to

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

    PubMed

    Bruce, D; Dickmeyer, J

    2001-01-01

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

  9. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care.

    PubMed

    Morgan, Catharine; Webb, Roger T; Carr, Matthew J; Kontopantelis, Evangelos; Green, Jonathan; Chew-Graham, Carolyn A; Kapur, Nav; Ashcroft, Darren M

    2017-10-18

    Objectives  To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age. Design  Population based cohort study. Setting  UK Clinical Practice Research Datalink-electronic health records from 647 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records. Participants  For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274). Main outcome measures  In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort. Results  The annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even

  10. Improving Freight Crash Incident Management : Research Project Capsule

    DOT National Transportation Integrated Search

    2012-10-01

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

  11. Environmental management for dredging sediments - the requirement of developing nations.

    PubMed

    Manap, Norpadzlihatun; Voulvoulis, Nikolaos

    2015-01-01

    Scientific research has characterized the effects of dredging, an underwater excavation process for navigational purposes or material extraction, and has shown its association with a number of chemical, physical and biological impacts. Due to this, much environmental management has been applied in the dredging industry in order to manage its detrimental effects. However, developing nations may have different approaches towards their dredging environmental management to compare to their companions with higher economic strength. Moreover, scientific evidence to make an informed decision is often lacking, hence affecting the number of research executed at these nations, limiting their efforts to preserve the environment. This paper reviews the dredging environmental impacts and its two important factors, dredging technology and sediment characteristic, that determine the magnitude of impacts through literature review, and discusses the need for a more integrated dredging environmental management to be developed for developing nations. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. 78 FR 13376 - Chronic Wasting Disease Management Plan/Environmental Impact Statement, Shenandoah National Park

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ...] Chronic Wasting Disease Management Plan/Environmental Impact Statement, Shenandoah National Park AGENCY... National Park Service (NPS) is preparing a Chronic Wasting Disease Management Plan and Environmental Impact Statement (CWD Management Plan/EIS) for Shenandoah National Park, Virginia. Action is needed at this time...

  13. 75 FR 8649 - Evaluation of State Coastal Management Programs and National Estuarine Research Reserves

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-25

    ... Ocean and Coastal Resource Management (OCRM) announces a rescheduled site visit and time for a public... Management Programs and National Estuarine Research Reserves AGENCY: National Oceanic and Atmospheric Administration (NOAA), Office of Ocean and Coastal Resource Management, National Ocean Service, Commerce. ACTION...

  14. Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer.

    PubMed

    Ryerson, A Blythe; Eheman, Christie R; Altekruse, Sean F; Ward, John W; Jemal, Ahmedin; Sherman, Recinda L; Henley, S Jane; Holtzman, Deborah; Lake, Andrew; Noone, Anne-Michelle; Anderson, Robert N; Ma, Jiemin; Ly, Kathleen N; Cronin, Kathleen A; Penberthy, Lynne; Kohler, Betsy A

    2016-05-01

    Annual updates on cancer occurrence and trends in the United States are provided through an ongoing collaboration among the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This annual report highlights the increasing burden of liver and intrahepatic bile duct (liver) cancers. Cancer incidence data were obtained from the CDC, NCI, and NAACCR; data about cancer deaths were obtained from the CDC's National Center for Health Statistics (NCHS). Annual percent changes in incidence and death rates (age-adjusted to the 2000 US Standard Population) for all cancers combined and for the leading cancers among men and women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2012 and mortality for 1975-2012) and short-term trends (2008-2012). In-depth analysis of liver cancer incidence included an age-period-cohort analysis and an incidence-based estimation of person-years of life lost because of the disease. By using NCHS multiple causes of death data, hepatitis C virus (HCV) and liver cancer-associated death rates were examined from 1999 through 2013. Among men and women of all major racial and ethnic groups, death rates continued to decline for all cancers combined and for most cancer sites; the overall cancer death rate (for both sexes combined) decreased by 1.5% per year from 2003 to 2012. Overall, incidence rates decreased among men and remained stable among women from 2003 to 2012. Among both men and women, deaths from liver cancer increased at the highest rate of all cancer sites, and liver cancer incidence rates increased sharply, second only to thyroid cancer. Men had more than twice the incidence rate of liver cancer than women, and rates increased with age for both sexes. Among non-Hispanic (NH) white, NH black, and Hispanic men and women, liver cancer incidence rates were higher for persons born

  15. Strategies for job creation through national forest management

    Treesearch

    Susan Charnley

    2014-01-01

    This chapter explores the ways in which national forest managers may contribute to community well-being by designing projects that accomplish forest management in ways that not only meet their ecological goals, but also create economic opportunities for nearby communities. The chapter summarizes a number of strategies for enhancing the economic benefits to communities...

  16. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    PubMed Central

    Kwok, Wing-Yee; de Kwaadsteniet, Marjolein CE; Harmsen, Mirjam; van Suijlekom-Smit, Lisette WA; Schellevis, François G; van der Wouden, Johannes C

    2006-01-01

    Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral. PMID:16584577

  17. Nevada National Security Site Environmental Report 2016

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

    Wills

    This Nevada National Security Site Environmental Report (NNSSER) was prepared to satisfy DOE Order DOE O 231.1B, “Environment, Safety and Health Reporting.” Its purpose is to (1) report compliance status with environmental standards and requirements, (2) present results of environmental monitoring of radiological and nonradiological effluents, (3) report estimated radiological doses to the public from releases of radioactive material, (4) summarize environmental incidents of noncompliance and actions taken in response to them, (5) describe the National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Environmental Management System and characterize its performance, and (6) highlight significant environmental programs and efforts. This NNSSERmore » summarizes data and compliance status for calendar year 2016 at the Nevada National Security Site (NNSS) and its two Nevada-based support facilities, the North Las Vegas Facility (NLVF) and the Remote Sensing Laboratory–Nellis (RSL-Nellis). It also addresses environmental restoration (ER) projects conducted at the Tonopah Test Range (TTR) and the Nevada Test and Training Range (NTTR). NNSA/NFO directs the management and operation of the NNSS and six sites across the nation. In addition to the NNSA itself, the six sites include two in Nevada (NLVF and RSL-Nellis) and four in other states (RSL-Andrews in Maryland, Livermore Operations in California, Los Alamos Operations in New Mexico, and Special Technologies Laboratory in California). Los Alamos, Lawrence Livermore, and Sandia National Laboratories are the principal organizations that sponsor and implement the nuclear weapons programs at the NNSS. National Security Technologies, LLC (NSTec), is the current Management and Operating contractor accountable for the successful execution of work and ensuring that work is performed in compliance with environmental regulations. The six sites all provide support to enhance the NNSS as a location for its

  18. [Teaching non-technical skills for critical incidents: Crisis resource management training for medical students].

    PubMed

    Krüger, A; Gillmann, B; Hardt, C; Döring, R; Beckers, S K; Rossaint, R

    2009-06-01

    Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS, METI). The learning objectives of the course were defined according to the key points of Gaba's CRM concept. The training consisted of theoretical and practical parts (3 simulation scenarios with debriefing). Students' self-assessment before and after the training provided the data for evaluation of the training outcome. A total of 65 students took part in the training. The course was well received in terms of overall course quality, debriefings and didactic presentation, the mean overall mark being 1.4 (1: best, 6: worst). After the course students felt significantly more confident when facing incidents in clinical practice. The main learning objectives were achieved. The effectiveness of applying the widely used ECS full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills.

  19. 77 FR 472 - National Advisory Committee for Implementation of the National Forest System Land Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-05

    ... DEPARTMENT OF AGRICULTURE Forest Service National Advisory Committee for Implementation of the National Forest System Land Management Planning Rule; Correction AGENCY: USDA Forest Service. ACTION... for the deaf (TDD) may call the Federal Information Relay Service (FIRS) at 1 (800) 877-8339 between 8...

  20. Evaluation of Incident Detection Methodologies

    DOT National Transportation Integrated Search

    1999-10-01

    Original Report Date: October 1998. The detection of freeway incidents is an essential element of an area's traffic management system. Incidents need to be detected and handled as promptly as possible to minimize delay to the public. Various algorith...

  1. Connecting Our Nation’s Crisis Information Management Systems

    DTIC Science & Technology

    2008-12-01

    Voice Alert is a communications solution that uses a combination of database and GIS mapping technologies to deliver outbound notifications.85 EOC...needing to be accessed through an extension is necessary. With many businesses, hotels , and other locations requiring an extension to reach...built around five major management activities of an incident.130  Command  Operations  Planning  Logistics  Finance/administration. The new

  2. Incidence, risk factors, management, and outcomes of stroke in pregnancy.

    PubMed

    Scott, Catherine A; Bewley, Susan; Rudd, Anthony; Spark, Patsy; Kurinczuk, Jennifer J; Brocklehurst, Peter; Knight, Marian

    2012-08-01

    To estimate the incidence of antenatal stroke in the United Kingdom and to describe risk factors associated with stroke during pregnancy, management, and outcomes. A population-based (nationwide) cohort and nested case-control study was conducted using the UK Obstetric Surveillance System between October 2007 and March 2010. We investigated the potential factors associated with antenatal stroke using a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Thirty cases of antenatal stroke were reported giving an estimated incidence of 1.5 cases per 100,000 women delivering (95% CI 1.0-2.1). The incidences of nonhemorrhagic and hemorrhagic stroke were 0.9 (95% CI 0.5-1.3) and 0.6 (95% CI 0.3-1.0) per 100,000 women delivering. Factors associated with increased risk of antenatal stroke were history of migraine (adjusted OR 8.5, 95% CI 1.5-62.1), gestational diabetes (adjusted OR 26.8, 95% CI 3.2-∞), and preeclampsia or eclampsia (adjusted OR 7.7, 95% CI 1.3-55.7). There was wide variation in the use of pharmacologic, surgical, and organized stroke unit care. There were six stroke-related maternal deaths giving a case-fatality rate of 20% of all strokes, 50% of hemorrhagic strokes, and a mortality rate of 0.3 (95% CI 0.1-0.6) per 100,000 women delivering. The risk of a stroke during pregnancy is low; however, the poor outcomes in terms of morbidity and mortality and variations in care highlight the importance of such women receiving specialist stroke care. Clinicians should be aware of an association with a history of migraine, gestational diabetes, and preeclampsia or eclampsia. II.

  3. 76 FR 38685 - Draft General Management Plan Amendment/Environmental Impact Statement, Tumacacori National...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-01

    ... experience at Tumacacori by developing access to these associated mission resources. A general management... DEPARTMENT OF THE INTERIOR National Park Service Draft General Management Plan Amendment... Management Plan, Tumacacori National Historical Park, in favor of an Environmental Assessment. SUMMARY: The...

  4. 77 FR 44144 - National Forest System Land Management Planning; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-27

    ... Management Planning; Correction AGENCY: Forest Service, USDA. ACTION: Correcting amendments. SUMMARY: The Department of Agriculture (USDA) published a National Forest System land management planning rule in the... document may be sent to the Director, Ecosystem Management Coordination Staff, USDA Forest Service, 1400...

  5. Sandia National Laboratories, California Environmental Management System program manual.

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

    Larsen, Barbara L.

    2012-03-01

    The Sandia National Laboratories, California (SNL/CA) Environmental Management System (EMS) Program Manual documents the elements of the site EMS Program. The SNL/CA EMS Program conforms to the International Standard on Environmental Management Systems, ISO 14001:2004and Department of Energy (DOE) Order 436.1. Sandia National Laboratories, California (SNL/CA) has maintained functional environmental programs to assist with regulatory compliance for more than 30 years. During 2005, these existing programs were rolled into a formal environmental management system (EMS) that expands beyond the traditional compliance focus to managing and improving environmental performance and stewardship practices for all site activities. An EMS is a setmore » of inter-related elements that represent a continuing cycle of planning, implementing, evaluating, and improving processes and actions undertaken to achieve environmental policy and goals. The SNL/CA EMS Program conforms to the International Standard for Environmental Management Systems, ISO 14001:2004 (ISO 2004). The site first received ISO 14001 certification in September 2006 and recertification in 2009. SNL/CA's EMS Program is applicable to the Sandia, Livermore site only. Although SNL/CA operates as one organizational division of the overall Sandia National Laboratories, the EMS Program is site-specific, with site-specific objectives and targets. SNL/CA (Division 8000) benefits from the organizational structure as it provides corporate level policies, procedures, and standards, and established processes that connect to and support elements of the SNL/CA EMS Program. Additionally, SNL/CA's EMS Program benefits from two corporate functional programs (Facilities Energy and Water Resource Management and Fleet Services programs) that maintain responsibility for energy management and fleet services for all Sandia locations. Each EMS element is further enhanced with site-specific processes and standards. Division 8000 has

  6. Idaho National Laboratory Cultural Resource Management Plan

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

    Lowrey, Diana Lee

    As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Officemore » will meet these responsibilities at the Idaho National Laboratory. This Laboratory, which is located in southeastern Idaho, is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable; bear valuable physical and intangible legacies; and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through annual reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of

  7. Idaho National Laboratory Cultural Resource Management Plan

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

    Lowrey, Diana Lee

    2009-02-01

    As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Officemore » will meet these responsibilities at the Idaho National Laboratory. This Laboratory, which is located in southeastern Idaho, is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable; bear valuable physical and intangible legacies; and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through annual reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of

  8. Drinking Water State Revolving Fund National Information Management System Reports

    EPA Pesticide Factsheets

    The Drinking Water State Revolving Fund (DWSRF) National Information Management System collects information that provide a record of progress and accountability for the program at both the State and National level.

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

    PubMed

    Ojofeitimi, Sheyi; Bronner, Shaw

    2011-09-01

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

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

    DOT National Transportation Integrated Search

    2011-08-01

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

  11. 76 FR 68179 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-03

    ... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... November 14, 2011, of the Environmental Management Site-Specific Advisory Board, Idaho National Laboratory...: Robert L. Pence, Federal Coordinator, Department of Energy, Idaho Operations Office, 1955 Fremont Avenue...

  12. [The effect of colored syringes and a colored sheet on the incidence of syringe swaps during anesthetic management].

    PubMed

    Hirabayashi, Yoshihiro; Kawakami, Takayuki; Suzuki, Hideo; Igarashi, Takashi; Saitoh, Kazuhiko; Seo, Norimasa

    2005-09-01

    Syringe swap is an important problem in anesthetic care, causing harm to patients. We examined the effect of colored syringe and a colored sheet on the incidence of syringe swaps during anesthetic management. We determined the color code. The blue-syringe contains local anesthetics; yellow-syringe, sympathomimetic drugs; and white-syringe with a red label fixed opposite the scale, muscle relaxants. The colored sheet displays the photographs of the syringe with drug name, dose and volume. The colored syringe and colored sheet were supplied for use from February 2004. We compared the incidence of syringe swaps during the period from February 2004 to January 2005 with that from February 2003 to January 2004. Although five syringe swaps were recorded from February 2003 to January 2004, in 5901 procedures, we encountered no syringe swaps from February 2004 to January 2005, in 6078 procedures. The colored syringe and colored sheet significantly decreased the incidence of syringe swaps during anesthetic management (P <0.05). The use of the sheet together with colored syringes can prevent syringe swaps during anesthesia.

  13. Communicating the role of silviculture in managing the national forests: Proceedings of the National Silviculture Workshop

    Treesearch

    Northeastern Forest Experiment Station

    1997-01-01

    Contains 32 articles on communicating the values and benefits of silviculture in managing the national forests. Specific topics addressed are how communications affect: policymakers, inventory and monitoring, resource management, research, education and demonstration, and partnerships.

  14. Wildfire exposure and fuel management on western US national forests.

    PubMed

    Ager, Alan A; Day, Michelle A; McHugh, Charles W; Short, Karen; Gilbertson-Day, Julie; Finney, Mark A; Calkin, David E

    2014-12-01

    Substantial investments in fuel management activities on national forests in the western US are part of a national strategy to reduce human and ecological losses from catastrophic wildfire and create fire resilient landscapes. Prioritizing these investments within and among national forests remains a challenge, partly because a comprehensive assessment that establishes the current wildfire risk and exposure does not exist, making it difficult to identify national priorities and target specific areas for fuel management. To gain a broader understanding of wildfire exposure in the national forest system, we analyzed an array of simulated and empirical data on wildfire activity and fuel treatment investments on the 82 western US national forests. We first summarized recent fire data to examine variation among the Forests in ignition frequency and burned area in relation to investments in fuel reduction treatments. We then used simulation modeling to analyze fine-scale spatial variation in burn probability and intensity. We also estimated the probability of a mega-fire event on each of the Forests, and the transmission of fires ignited on national forests to the surrounding urban interface. The analysis showed a good correspondence between recent area burned and predictions from the simulation models. The modeling also illustrated the magnitude of the variation in both burn probability and intensity among and within Forests. Simulated burn probabilities in most instances were lower than historical, reflecting fire exclusion on many national forests. Simulated wildfire transmission from national forests to the urban interface was highly variable among the Forests. We discuss how the results of the study can be used to prioritize investments in hazardous fuel reduction within a comprehensive multi-scale risk management framework. Published by Elsevier Ltd.

  15. 75 FR 24685 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... prior to the meeting. ADDRESSES: Hilton Garden Inn, 700 Lindsay Boulevard, Idaho Falls, Idaho 83402. FOR...

  16. 77 FR 38276 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-27

    ... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... a meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National... times prior to the meeting. ADDRESSES: Red Lion Hotel, 1555 Pocatello Creek Road, Pocatello, Idaho 83201...

  17. Incidence and medical management of bisphosphonate-associated atypical femoral fractures in a major trauma centre: a retrospective observational study.

    PubMed

    Eisenstein, Neil; Kasavkar, Ganesh; Bhavsar, Dhruva; Khan, Faisal Shehzaad; Paskins, Zoe

    2017-01-23

    Atypical femoral fractures (AFFs) are rare events associated with increased duration of bisphosphonate exposure. Recommended management of AFFs include cessation of bisphosphonates and imaging of the contralateral femur. The aims of this study were to identify the local incidence of AFFs in bisphosphonate users and to audit the medical management of AFFs against published recommendations. A retrospective analysis of the admissions database for a major trauma centre identified all femoral fractures (3150) in a five-year period (July 2009 to June 2014). Electronic health records and radiographs were reviewed using the 2013 American Society for Bone and Mineral Research (ASBMR) diagnostic criteria for AFF to establish the number of cases. To estimate incidence, the total number of bisphosphonate users was derived from primary care prescription and secondary care day-case records. Medical management of cases with AFF on bisphosphonates was audited against guidance from ASBMR and Medicines & Healthcare Products Regulatory Agency. 10 out of 3150 femoral fractures met criteria for AFF; 7 of these patients had a history of exposure to bisphosphonates (6 oral, 1 intravenous). There were 19.1 AFFs per 100,000 years of bisphosphonate use in our region. Bisphosphonates were stopped and the contralateral femur imaged in only 2 of the 7 patients treated with bisphosphonates. Our local incidence is in line with published figures; however, this is the first published evidence suggesting that medical management and identification of AFF may be suboptimal. Managing these patients remains challenging due to their rarity and possible lack of awareness.

  18. Large-Scale Data Collection Metadata Management at the National Computation Infrastructure

    NASA Astrophysics Data System (ADS)

    Wang, J.; Evans, B. J. K.; Bastrakova, I.; Ryder, G.; Martin, J.; Duursma, D.; Gohar, K.; Mackey, T.; Paget, M.; Siddeswara, G.

    2014-12-01

    Data Collection management has become an essential activity at the National Computation Infrastructure (NCI) in Australia. NCI's partners (CSIRO, Bureau of Meteorology, Australian National University, and Geoscience Australia), supported by the Australian Government and Research Data Storage Infrastructure (RDSI), have established a national data resource that is co-located with high-performance computing. This paper addresses the metadata management of these data assets over their lifetime. NCI manages 36 data collections (10+ PB) categorised as earth system sciences, climate and weather model data assets and products, earth and marine observations and products, geosciences, terrestrial ecosystem, water management and hydrology, astronomy, social science and biosciences. The data is largely sourced from NCI partners, the custodians of many of the national scientific records, and major research community organisations. The data is made available in a HPC and data-intensive environment - a ~56000 core supercomputer, virtual labs on a 3000 core cloud system, and data services. By assembling these large national assets, new opportunities have arisen to harmonise the data collections, making a powerful cross-disciplinary resource.To support the overall management, a Data Management Plan (DMP) has been developed to record the workflows, procedures, the key contacts and responsibilities. The DMP has fields that can be exported to the ISO19115 schema and to the collection level catalogue of GeoNetwork. The subset or file level metadata catalogues are linked with the collection level through parent-child relationship definition using UUID. A number of tools have been developed that support interactive metadata management, bulk loading of data, and support for computational workflows or data pipelines. NCI creates persistent identifiers for each of the assets. The data collection is tracked over its lifetime, and the recognition of the data providers, data owners, data

  19. Translating national level forest service goals to local level land management: carbon sequestration

    Treesearch

    Steven McNulty; Emrys Treasure; Lisa Jennings; David Meriwether; David Harris; Paul Arndt

    2017-01-01

    The USDA Forest Service has many national level policies related to multiple use management. However, translating national policy to stand level forest management can be difficult. As an example of how a national policy can be put into action, we examined three case studies in which a desired future condition is evaluated at the national, region, and local scale. We...

  20. Exploring National Environmental Policy Act processes across federal land management agencies

    Treesearch

    Marc J. Stern; Michael J. Mortimer

    2009-01-01

    Broad discretion is granted at all levels throughout federal land management agencies regarding compliance with the National Environmental Policy Act (NEPA). We explored the diversity of procedures employed in NEPA processes across four agencies, the USDA Forest Service, The USDI National Park Service and Bureau of Land Management, and the U.S. Army Corps of Engineers...

  1. Wildfire exposure and fuel management on western US national forests

    Treesearch

    Alan A. Ager; Michelle A. Day; Charles W. McHugh; Karen Short; Julie Gilbertson-Day; Mark A. Finney; David E. Calkin

    2014-01-01

    Substantial investments in fuel management activities on national forests in the western US are part of a national strategy to reduce human and ecological losses from catastrophic wildfire and create fire resilient landscapes. Prioritizing these investments within and among national forests remains a challenge, partly because a comprehensive assessment that establishes...

  2. 78 FR 13316 - National Forest System Land Management Planning Directives

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ... responsibilities. It should be used in conjunction with the FSH. FSH 1909.12--Land Management Planning Handbook... management planning. Forest Service Handbook 1909.15, section 31.12 (57 FR 43208; September 18, 1992... DEPARTMENT OF AGRICULTURE Forest Service RIN 0596-AD06 National Forest System Land Management...

  3. 75 FR 56527 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-16

    ... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... prior to the meeting. ADDRESSES: Coeur d'Alene Resort, 115 South Second Street, Coeur d'Alene, Idaho...

  4. 75 FR 82004 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... Laboratory AGENCY: Department of Energy. ACTION: Notice of open meeting. SUMMARY: This notice announces a meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory...--Radioactive Waste Management. Public Participation: The EM SSAB, Idaho National Laboratory, welcomes the...

  5. 78 FR 12747 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... Laboratory AGENCY: Department of Energy. ACTION: Notice of open meeting. SUMMARY: This notice announces a meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... Management System Public Participation: The EM SSAB, Idaho National Laboratory, welcomes the attendance of...

  6. Incidence and Management of Glaucoma in Vogt Koyanagi Harada Disease.

    PubMed

    Pandey, Amit; Balekudaru, Shantha; Venkatramani, Devendra V; George, Amala E; Lingam, Vijaya; Biswas, Jyotirmay

    2016-08-01

    To analyse the prevalence, incidence, and risk factors of glaucoma in Vogt Koyanagi Harada (VKH) disease and study the changes in visual acuity and intraocular pressure (IOP) with treatment. Retrospective chart analysis of 448 eyes of 224 patients of Indian origin diagnosed with VKH disease from January 1990 to December 2013, who had a minimum follow-up of 3 months was performed. Seventy-one eyes (15.8%) developed sustained elevation in IOP. The prevalence of glaucoma at presentation was 15.8% and the cumulative incidence of glaucoma was 11.7%. The mechanisms of glaucoma were open-angle glaucoma in 46 eyes, (64.8%), angle closure in 21 eyes (29.6%), and of combined mechanisms in the remainder (4 eyes, 5.6%). Acute angle-closure crisis developed in 9 eyes (12.6%). Uveal effusion (odds ratio 9.47; confidence interval, 4.08-20.03) and increased number of recurrences (odds ratio 1.31; confidence interval, 1.13-1.53) were found to be significant risk factors for the development of glaucoma. Successful control of IOP was achieved in 64% at 12 months using medical/ laser treatment for glaucoma and was 50 % at 12 months following surgical management. Glaucoma is a frequent complication of uveitis in VKH disease. Presence of uveal effusion and increased number of recurrences of inflammation are significant risk factors.

  7. Incidence and management of dialysis patients with renal calculi.

    PubMed

    Viterbo, Rosalia; Mydlo, Jack H

    2002-01-01

    The incidence of renal stones in patients on dialysis, while lower in number compared to the general population because of decreased renal function, is nonetheless a clinical dilemma. We wanted to evaluate the incidence and management of stone disease in patients on hemodialysis. We reviewed the literature from 1966 to the present using Medline. Study inclusion criteria were detection and treatment of stone disease in both hemodialysis and peritoneal dialysis patients. It is estimated that between 5 and 13% of all dialysis patients will develop symptomatic renal calculi and many more asymptomatic calculi. Many of the stone-forming dialysis patients will have recurring stone disease with one study finding an 83.3% recurrence rate. Since dialysis patients have a wide range of urine output, the clinician should be alert to the possibility of stone formation. We recommend yearly ultrasound examinations on all dialysis patients as well as citrate and magnesium supplements with careful follow-up of laboratory results and urine electrolytes. We also recommend careful follow-up of all patients on aluminum-hydroxide phosphate binders as they are predisposed to form Al-Mg-urate stones. For those dialysis patients that form renal calculi, watchful waiting and symptomatic treatment is recommended since almost all patients will spontaneously pass their stones. However, ESWL and other current modalities may be used with no greater morbidity compared to nondialysis cohorts. We also suggest that patients with severe recurring intractable stone disease who are candidates for renal transplantation should be offered bilateral nephrectomies. Copyright 2002 S. Karger AG, Basel

  8. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State

    PubMed Central

    Sherman, Recinda L.; Howlader, Nadia; Jemal, Ahmedin; Ryerson, A. Blythe; Henry, Kevin A.; Boscoe, Francis P.; Cronin, Kathleen A.; Lake, Andrew; Noone, Anne-Michelle; Henley, S. Jane; Eheman, Christie R.; Anderson, Robert N.; Penberthy, Lynne

    2015-01-01

    Background: The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) collaborate annually to produce updated, national cancer statistics. This Annual Report includes a focus on breast cancer incidence by subtype using new, national-level data. Methods: Population-based cancer trends and breast cancer incidence by molecular subtype were calculated. Breast cancer subtypes were classified using tumor biomarkers for hormone receptor (HR) and human growth factor-neu receptor (HER2) expression. Results: Overall cancer incidence decreased for men by 1.8% annually from 2007 to 2011. Rates for women were stable from 1998 to 2011. Within these trends there was racial/ethnic variation, and some sites have increasing rates. Among children, incidence rates continued to increase by 0.8% per year over the past decade while, like adults, mortality declined. Overall mortality has been declining for both men and women since the early 1990’s and for children since the 1970’s. HR+/HER2- breast cancers, the subtype with the best prognosis, were the most common for all races/ethnicities with highest rates among non-Hispanic white women, local stage cases, and low poverty areas (92.7, 63.51, and 98.69 per 100000 non-Hispanic white women, respectively). HR+/HER2- breast cancer incidence rates were strongly, positively correlated with mammography use, particularly for non-Hispanic white women (Pearson 0.57, two-sided P < .001). Triple-negative breast cancers, the subtype with the worst prognosis, were highest among non-Hispanic black women (27.2 per 100000 non-Hispanic black women), which is reflected in high rates in southeastern states. Conclusions: Progress continues in reducing the burden of cancer in the United States. There are unique racial/ethnic-specific incidence patterns for breast cancer subtypes; likely because of both biologic and social risk

  9. Anatomy of an incident

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

    Cournoyer, Michael E.; Trujillo, Stanley; Lawton, Cindy M.

    A traditional view of incidents is that they are caused by shortcomings in human competence, attention, or attitude. It may be under the label of “loss of situational awareness,” procedure “violation,” or “poor” management. A different view is that human error is not the cause of failure, but a symptom of failure – trouble deeper inside the system. In this perspective, human error is not the conclusion, but rather the starting point of investigations. During an investigation, three types of information are gathered: physical, documentary, and human (recall/experience). Through the causal analysis process, apparent cause or apparent causes are identifiedmore » as the most probable cause or causes of an incident or condition that management has the control to fix and for which effective recommendations for corrective actions can be generated. A causal analysis identifies relevant human performance factors. In the following presentation, the anatomy of a radiological incident is discussed, and one case study is presented. We analyzed the contributing factors that caused a radiological incident. When underlying conditions, decisions, actions, and inactions that contribute to the incident are identified. This includes weaknesses that may warrant improvements that tolerate error. Measures that reduce consequences or likelihood of recurrence are discussed.« less

  10. Anatomy of an incident

    DOE PAGES

    Cournoyer, Michael E.; Trujillo, Stanley; Lawton, Cindy M.; ...

    2016-03-23

    A traditional view of incidents is that they are caused by shortcomings in human competence, attention, or attitude. It may be under the label of “loss of situational awareness,” procedure “violation,” or “poor” management. A different view is that human error is not the cause of failure, but a symptom of failure – trouble deeper inside the system. In this perspective, human error is not the conclusion, but rather the starting point of investigations. During an investigation, three types of information are gathered: physical, documentary, and human (recall/experience). Through the causal analysis process, apparent cause or apparent causes are identifiedmore » as the most probable cause or causes of an incident or condition that management has the control to fix and for which effective recommendations for corrective actions can be generated. A causal analysis identifies relevant human performance factors. In the following presentation, the anatomy of a radiological incident is discussed, and one case study is presented. We analyzed the contributing factors that caused a radiological incident. When underlying conditions, decisions, actions, and inactions that contribute to the incident are identified. This includes weaknesses that may warrant improvements that tolerate error. Measures that reduce consequences or likelihood of recurrence are discussed.« less

  11. Lake Mead National Recreational Area air tour management plan and planning and National Environmental Policy Act scoping document

    DOT National Transportation Integrated Search

    2004-04-19

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of an Air Tour Management Plan (ATMP) for Lake Mead National Recreation Area (LAME) pursuant to the National Parks Air Tour ...

  12. National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

    PubMed Central

    Swartz, Erik E; Boden, Barry P; Courson, Ronald W; Decoster, Laura C; Horodyski, MaryBeth; Norkus, Susan A; Rehberg, Robb S; Waninger, Kevin N

    2009-01-01

    Objective: To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. Background: The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. Recommendations: Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department. PMID:19478836

  13. Better Incident Response with SCOT

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

    Bruner, Todd

    2015-04-01

    SCOT is an incident response management system and knowledge base designed for incident responders by incident responders. SCOT increases the effectiveness of the team without adding undue burdens. Focused on reducing the friction between analysts and their tools, SCOT enables analysts to document and share their research and response efforts in near real time. Automatically identifying indicators and correlating those indicators, SCOT helps analysts discover and respond to advanced threats.

  14. The incidence and nature of injuries sustained on grass and 3rd generation artificial turf: a pilot study in elite Saudi National Team footballers.

    PubMed

    Almutawa, M; Scott, M; George, K P; Drust, B

    2014-02-01

    To compare the incidence, severity and nature of injuries sustained by Saudi National Team footballers during match-play and training on natural grass and 3rd generation (3G) artificial turf. Injury data was collected on all Saudi National Team players competing at the Gulf Cup (Yemen December 2010: 3G) and the Asian Cup (Qatar January 2011; grass). A total of 49 players were studied (mean ± SD; Age 27 ± 4 yr; body mass 71.4 ± 6.7 kg; height 176.8 ± 6.3 cm; professional playing experience 9 ± 3 yr) of which 31 competed at the Gulf Cup, 32 at the Asian Cup (14 at both). A prospective cohort design was used to investigate the incidence, nature and severity of injuries sustained with data collected using a standardised injury questionnaire. All data were collected by the team physiotherapist with the definition of injury set at any injury that required player and clinician contact. Injury and exposure data were collected and reported for games, training and all football activity. A total of 82 injuries [incidence - 56.1 per 1000 h total game and training exposure] were recorded at the Asian Cup (grass) and 72 injuries [incidence - 37.9 per 1000 h total game and training exposure] were recorded at the Gulf Cup (3G). Incidence data for training, game and all football exposure injury rates were higher when playing on grass. The vast majority of injuries on both surfaces were very minor that, whilst requiring medical attention, did not result in loss of match/training exposure. Injuries that resulted in 1-3 days absence from training or game play had similar incidence rates (Grass: 7.4 vs. 3G: 7.4 injuries per 1000 h exposure). More severe injuries were less frequent but with a higher incidence when playing on grass. Lower limb injuries were the most common in both tournaments with a higher incidence on grass (Grass: 14.2 vs. 3G: 7.9 injuries per 1000 h exposure). Muscle injuries were the most frequent of all injuries with similar incidence rates on

  15. HIV incidence and CDC's HIV prevention budget: an exploratory correlational analysis.

    PubMed

    Holtgrave, David R; Kates, Jennifer

    2007-01-01

    The central evaluative question about a national HIV prevention program is whether that program affects HIV incidence. Numerous factors may influence incidence, including public investment in HIV prevention. Few studies, however, have examined the relationship between public investment and the HIV epidemic in the United States. This 2006 exploratory analysis examined the period from 1978 through 2006 using a quantitative, lagged, correlational analysis to capture the relationship between national HIV incidence and Centers for Disease Control and Prevention's HIV prevention budget in the United States over time. The analyses suggest that early HIV incidence rose in advance of the nation's HIV prevention investment until the mid-1980s (1-year lag correlation, r=0.972, df=2, p <0.05). From that point on, it appears that the nation's investment in HIV prevention became a strong correlate of HIV incidence (1-year lag correlation, r=-0.905, df=18, p <0.05). This exploratory study provides correlational evidence of a relationship between U.S. HIV incidence and the federal HIV prevention budget over time, and calls for further analysis of the role of funding and other factors that may influence the direction of a nation's HIV epidemic.

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

    PubMed

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

    2015-07-01

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

  17. Management of In-Field Patient Tracking and Triage by Using Near-Field Communication in Mass Casualty Incidents.

    PubMed

    Cheng, Po-Liang; Su, Yung-Cheng; Hou, Chung-Hung; Chang, Po-Lun

    2017-01-01

    Near field communications (NFC) is an emerging technology that may potentialy assist with disaster management. A smartphone-based app was designed to help track patient flow in real time. A table-drill was held as a brief evaluation and it showed significant imporvement in both efficacy and accuracy of patient management. It is feasible to use NFC-embedded smartphones to clarify the ambiguous and chaotic patient flow in a mass casualty incident.

  18. Characterization of post-disaster environmental management for Hazardous Materials Incidents: Lessons learnt from the Tianjin warehouse explosion, China.

    PubMed

    Zhang, Hui; Duan, Huabo; Zuo, Jian; Song, MingWei; Zhang, Yukui; Yang, Bo; Niu, Yongning

    2017-09-01

    Hazardous Materials Incidents (HMIs) have attracted a growing public concern worldwide. The health risks and environmental implications associated with HMIs are almost invariably severe, and underscore the urgency for sound management. Hazardous Materials Explosion incidents (HMEIs) belong to a category of extremely serious HMIs. Existing studies placed focuses predominately on the promptness and efficiency of emergency responses to HMIs and HMEIs. By contrast, post-disaster environmental management has been largely overlooked. Very few studies attempted to examine the post-disaster environmental management plan particularly its effectiveness and sufficiency. In the event of the Tianjin warehouse explosion (TWE), apart from the immediate emergency response, the post-disaster environmental management systems (P-EMSs) have been reported to be effective and sufficient in dealing with the environmental concerns. Therefore, this study aims to critically investigate the P-EMSs for the TWE, and consequently to propose a framework and procedures for P-EMSs in general for HMIs, particularly for HMEIs. These findings provide a useful reference to develop P-EMSs for HMIs in the future, not only in China but also other countries. Copyright © 2017. Published by Elsevier Ltd.

  19. Influence of occupational safety management on the incidence rate of occupational accidents in the Spanish industrial and ornamental stone mining.

    PubMed

    Sanmiquel, Lluís; Rossell, Josep M; Vintró, Carla; Freijo, Modesto

    2014-01-01

    Mines are hazardous and workers can suffer many types of accidents caused by fire, flood, explosion or collapse. Injury incidence rates in mining are considerably higher than those registered by other economic sectors. One of the main reasons for this high-level incidence rate is the existence of a large number of dangerous workplaces. This work analyzes the influence that occupational safety management had on the accidents that took place in Spanish mining of industrial and ornamental stone during the period 2007-2008. Primary data sources are: (a) Results from a statistical study of the occupational health and safety management practices of 71 quarries defined by a questionnaire of 41 items; and (b) Occupational accidents registered in the Spanish industrial and ornamental stone mining throughout the period 2007-2008. The obtained results indicate that workplaces with a low average score in the analysis of occupational safety management have a higher incidence rate of accidents. Studies on mining workplaces are very important to help detect occupational safety concerns. Results from this study help raise awareness and will encourage the adoption of appropriate measures to improve safety.

  20. The impact of national-level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996 to 2012 and interrupted times series analysis.

    PubMed

    Stocks, S J; McNamee, R; Turner, S; Carder, M; Agius, R M

    2015-07-01

    Reducing healthcare-associated infections (HCAI) has been a priority in the U.K. over recent decades and this has been reflected in interventions focusing on improving hygiene procedures. To evaluate whether these interventions coincided with an increased incidence of work-related irritant contact dermatitis (ICD) attributed to hand hygiene or/and other hygiene measures in healthcare workers (HCWs). A quasi-experimental (interrupted time series) design was used to compare trends in incidence of ICD in HCWs attributed to hygiene before and after interventions to reduce HCAI with trends in the same periods in control groups (ICD in other workers). Cases of ICD reported to a U.K. surveillance scheme from 1996 to 2012 were analysed. The time periods compared were defined objectively based on the dates of the publication of national evidence-based guidelines, the U.K. Health Act 2006 and the Cleanyourhands campaign. The reported incidence of ICD in HCWs attributed to hygiene has increased steadily from 1996 to 2012 [annual incidence rate ratio (95% confidence interval): hand hygiene only 1.10 (1.07-1.12); all hygiene 1.05 (1.03-1.07)], whereas the incidence in other workers is declining. An increase in incidence of ICD in HCWs attributed to hand hygiene was observed at the beginning of the Cleanyourhands campaign. The increasing incidence of ICD in HCWs combined with the popularity of interventions to reduce HCAI warrants increased efforts towards identifying products and implementing practices posing the least risk of ICD. © 2015 British Association of Dermatologists.

  1. Annual Report to the Nation on the Status of Cancer, 1975–2012, Featuring the Increasing Incidence of Liver Cancer

    PubMed Central

    Ryerson, A. Blythe; Eheman, Christie R.; Altekruse, Sean F.; Ward, John W.; Jemal, Ahmedin; Sherman, Recinda L.; Henley, S. Jane; Holtzman, Deborah; Lake, Andrew; Noone, Anne-Michelle; Anderson, Robert N.; Ma, Jiemin; Ly, Kathleen N.; Cronin, Kathleen A.; Penberthy, Lynne; Kohler, Betsy A.

    2016-01-01

    BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through an ongoing collaboration among the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This annual report highlights the increasing burden of liver and intrahepatic bile duct (liver) cancers. METHODS Cancer incidence data were obtained from the CDC, NCI, and NAACCR; data about cancer deaths were obtained from the CDC’s National Center for Health Statistics (NCHS). Annual percent changes in incidence and death rates (age-adjusted to the 2000 US Standard Population) for all cancers combined and for the leading cancers among men and women were estimated by joinpoint analysis of long-term trends (incidence for 1992–2012 and mortality for 1975–2012) and short-term trends (2008–2012). In-depth analysis of liver cancer incidence included an age-period-cohort analysis and an incidence-based estimation of person-years of life lost because of the disease. By using NCHS multiple causes of death data, hepatitis C virus (HCV) and liver cancer-associated death rates were examined from 1999 through 2013. RESULTS Among men and women of all major racial and ethnic groups, death rates continued to decline for all cancers combined and for most cancer sites; the overall cancer death rate (for both sexes combined) decreased by 1.5% per year from 2003 to 2012. Overall, incidence rates decreased among men and remained stable among women from 2003 to 2012. Among both men and women, deaths from liver cancer increased at the highest rate of all cancer sites, and liver cancer incidence rates increased sharply, second only to thyroid cancer. Men had more than twice the incidence rate of liver cancer than women, and rates increased with age for both sexes. Among non-Hispanic (NH) white, NH black, and Hispanic men and women, liver cancer incidence

  2. 50 CFR 70.3 - State cooperation in national fish hatchery area management.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false State cooperation in national fish hatchery area management. 70.3 Section 70.3 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) MANAGEMENT OF FISHERIES CONSERVATION AREAS NATIONAL FISH HATCHERIES...

  3. 50 CFR 70.3 - State cooperation in national fish hatchery area management.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false State cooperation in national fish hatchery area management. 70.3 Section 70.3 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) MANAGEMENT OF FISHERIES CONSERVATION AREAS NATIONAL FISH HATCHERIES...

  4. 50 CFR 70.3 - State cooperation in national fish hatchery area management.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 8 2011-10-01 2011-10-01 false State cooperation in national fish hatchery area management. 70.3 Section 70.3 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) MANAGEMENT OF FISHERIES CONSERVATION AREAS NATIONAL FISH HATCHERIES...

  5. 50 CFR 70.3 - State cooperation in national fish hatchery area management.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false State cooperation in national fish hatchery area management. 70.3 Section 70.3 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) MANAGEMENT OF FISHERIES CONSERVATION AREAS NATIONAL FISH HATCHERIES...

  6. 50 CFR 70.3 - State cooperation in national fish hatchery area management.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false State cooperation in national fish hatchery area management. 70.3 Section 70.3 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) MANAGEMENT OF FISHERIES CONSERVATION AREAS NATIONAL FISH HATCHERIES...

  7. Applying change management metaphors to a national e-Health strategy.

    PubMed

    Saunders, Chad; Scott, Richard E

    2014-01-01

    Recent attempts at a collective understanding of how to develop an e-Health strategy have addressed the individual organisation, collection of organisations, and national levels. At the national level the World Health Organisation's National eHealth Strategy Toolkit serves as an exemplar that consolidates knowledge in this area, guides practical implementations, and identifies areas for future research. A key implication of this toolkit is the considerable number of organisational changes required to successfully apply their ideas in practice. This study looks critically at the confluence of change management and e-Health strategy using metaphors that underpin established models of change management. Several of Morgan's organisational metaphors are presented (highlighting varied beliefs and assumptions regarding how change is enacted, who is responsible for the change, and guiding principles for that change), and used to provide a framework. Attention is then directed to several prominent models of change management that exemplify one or more of these metaphors, and these theoretical insights are applied to evaluate the World Health Organisation's National eHealth Strategy Toolkit. The paper presents areas for consideration when using the WHO/ITU toolkit, and suggestions on how to improve its use in practice. The goal is to seek insight regarding the optimal sequence of steps needed to ensure successful implementation and integration of e-health into health systems using change management models. No single model, toolkit, or guideline will offer all the needed answers, but clarity around the underlying metaphors informing the change management models being used provides valuable insight so potentially challenging areas can be avoided or mitigated.

  8. Haleakala National Park Air Tour Management Plan: Planning and NEPA Scoping Document

    DOT National Transportation Integrated Search

    2004-03-03

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of Air Tour Management Plans (ATMPs) for Haleakala National Park, Hawaii Volcanoes National Park and Kalaupapa National Hist...

  9. 75 FR 28055 - General Management Plan; Joshua Tree National Park; San Bernardino and Riverside Counties, CA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-19

    ... DEPARTMENT OF THE INTERIOR National Park Service General Management Plan; Joshua Tree National... National Park Service is updating the General Management Plan (GMP) for Joshua Tree National Park... park management and resource analysis, other designations such as establishment of 594,502 acres by...

  10. Socioeconomic status in relation to incident fracture risk in the Study of Women's Health Across the Nation.

    PubMed

    Crandall, C J; Han, W; Greendale, G A; Seeman, T; Tepper, P; Thurston, R; Karvonen-Gutierrez, C; Karlamangla, A S

    2014-04-01

    We examined baseline and annual follow-up data (through annual follow-up visit 9) from a cohort of 2,234 women aged 42 to 52 years at baseline. Independent of financial status, higher educational level was associated with lower fracture incidence among non-Caucasian women but not among Caucasian women. This study was conducted to determine the associations of education and income with fracture incidence among midlife women over 9 years of follow-up. We examined baseline and annual follow-up data (through annual follow-up visit 9) from 2,234 participants of the Study of Women's Health Across the Nation, a cohort of women aged 42 to 52 years at baseline. We used Cox proportional hazards regression models to examine the associations of socioeconomic predictors (education, family-adjusted poverty-to-income ratio, and difficulty paying for basics) with time to first incident nontraumatic, nondigital, noncraniofacial fracture. Independent of family-adjusted poverty-to-income ratio, higher educational level was associated with decreased time to first incident fracture among non-Caucasian women but not among Caucasian women (p(interaction) 0.02). Compared with non-Caucasian women who completed no more than high school education, non-Caucasian women who attained at least some postgraduate education had 87% lower rates of incident nontraumatic fracture (adjusted hazard ratio 0.13, 95% confidence interval [CI] 0.03-0.60). Among non-Caucasian women, each additional year of education was associated with a 16% lower odds of nontraumatic fracture (adjusted odds ratio 0.84, 95% CI 0.73-0.97). Income, family-adjusted poverty-to-income ratio, and degree of difficulty paying for basic needs were not associated with time to first fracture in Caucasian or non-Caucasian women. Among non-Caucasian midlife women, higher education, but not higher income, was associated with lower fracture incidence. Elucidation of the mechanisms underlying the possible protective effects of higher

  11. Los Alamos National Laboratory emergency management plan. Revision 1

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

    Ramsey, G.F.

    1998-07-15

    The Laboratory has developed this Emergency Management Plan (EMP) to assist in emergency planning, preparedness, and response to anticipated and actual emergencies. The Plan establishes guidance for ensuring safe Laboratory operation, protection of the environment, and safeguarding Department of Energy (DOE) property. Detailed information and specific instructions required by emergency response personnel to implement the EMP are contained in the Emergency Management Plan Implementing Procedure (EMPIP) document, which consists of individual EMPIPs. The EMP and EMPIPs may be used to assist in resolving emergencies including but not limited to fires, high-energy accidents, hazardous material releases (radioactive and nonradioactive), security incidents,more » transportation accidents, electrical accidents, and natural disasters.« less

  12. Inner Ear Disease and Benign Paroxysmal Positional Vertigo: A Critical Review of Incidence, Clinical Characteristics, and Management

    PubMed Central

    Riga, M.; Bibas, A.; Xenellis, J.; Korres, S.

    2011-01-01

    Background. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients. PMID:21837242

  13. [Extraction of management information from the national quality assurance program].

    PubMed

    Stausberg, Jürgen; Bartels, Claus; Bobrowski, Christoph

    2007-07-15

    Starting with clinically motivated projects, the national quality assurance program has established a legislative obligatory framework. Annual feedback of results is an important means of quality control. The annual reports cover quality-related information with high granularity. A synopsis for corporate management is missing, however. Therefore, the results of the University Clinics in Greifswald, Germany, have been analyzed and aggregated to support hospital management. Strengths were identified by the ranking of results within the state for each quality indicator, weaknesses by the comparison with national reference values. The assessment was aggregated per clinical discipline and per category (indication, process, and outcome). A composition of quality indicators was claimed multiple times. A coherent concept is still missing. The method presented establishes a plausible summary of strengths and weaknesses of a hospital from the point of view of the national quality assurance program. Nevertheless, further adaptation of the program is needed to better assist corporate management.

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

    PubMed

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

    2018-01-04

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

  15. Workload management and geographic disorientation in aviation incidents: A review of the ASRS data base

    NASA Technical Reports Server (NTRS)

    Williams, Henry P.; Tham, Mingpo; Wickens, Christopher D.

    1993-01-01

    NASA's Aviation Safety Reporting System (ASRS) incident reports are reviewed in two related areas: pilots' failures to appropriately manage tasks, and breakdowns in geographic orientation. Examination of 51 relevant reports on task management breakdowns revealed that altitude busts and inappropriate runway usee were the most frequently reported consequences. Task management breakdowns appeared to occur at all levels of expertise, and prominent causal factors were related to breakdowns in crew communications, over-involvement with the flight management system and, for small (general aviation) aircraft, preoccupation with weather. Analysis of the 83 cases of geographic disorientation suggested that these too occurred at all levels of pilot experience. With regard to causal factors, a majority was related to poor cockpit resource management, in which inattention led to a loss of geographic awareness. Other leading causes were related to poor weather and poor decision making. The potential of the ASRS database for contributing to research and design issues is addressed.

  16. 76 FR 56220 - Draft Environmental Impact Statement for General Management Plan for Golden Gate National...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-12

    ... Environmental Impact Statement for General Management Plan for Golden Gate National Recreation Area and Muir... Management Plan for Golden Gate National Recreation Area and Muir Woods National Monument. SUMMARY: In accord... Environmental Impact Statement (Draft EIS) for the updating the General Management Plan (GMP) for Golden Gate...

  17. Translating National Level Forest Service Goals to Local Level Land Management: Carbon Sequestration

    NASA Astrophysics Data System (ADS)

    McNulty, S.; Treasure, E.

    2017-12-01

    The USDA Forest Service has many national level policies related to multiple use management. However, translating national policy to stand level forest management can be difficult. As an example of how a national policy can be put into action, we examined three case studies in which a desired future condition is evaluated at the national, region and local scale. We chose to use carbon sequestration as the desired future condition because climate change has become a major area of concern during the last decade. Several studies have determined that the 193 million acres of US national forest land currently sequester 11% to 15% of the total carbon emitted as a nation. This paper provides a framework by which national scale strategies for maintaining or enhancing forest carbon sequestration is translated through regional considerations and local constraints in adaptive management practices. Although this framework used the carbon sequestration as a case study, this framework could be used with other national level priorities such as the National Environmental Protection Act (NEPA) or the Endangered Species Act (ESA).

  18. National briefing summaries: Nuclear fuel cycle and waste management

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

    Schneider, K.J.; Bradley, D.J.; Fletcher, J.F.

    Since 1976, the International Program Support Office (IPSO) at the Pacific Northwest Laboratory (PNL) has collected and compiled publicly available information concerning foreign and international radioactive waste management programs. This National Briefing Summaries is a printout of an electronic database that has been compiled and is maintained by the IPSO staff. The database contains current information concerning the radioactive waste management programs (with supporting information on nuclear power and the nuclear fuel cycle) of most of the nations (except eastern European countries) that now have or are contemplating nuclear power, and of the multinational agencies that are active in radioactivemore » waste management. Information in this document is included for three additional countries (China, Mexico, and USSR) compared to the prior issue. The database and this document were developed in response to needs of the US Department of Energy.« less

  19. Incidence trends and patterns of breast cancer in Sri Lanka: an analysis of the national cancer database.

    PubMed

    Fernando, Ashan; Jayarajah, Umesh; Prabashani, Saumyakala; Fernando, Eshani A; Seneviratne, Sanjeewa A

    2018-04-27

    A gradual decline in the incidence of breast cancer is documented in developed countries especially over last two decades, while in developing countries the incidence continues to rise. We conducted this study to examine trends in incidence of breast cancer in a developing country, Sri Lanka. A retrospective cohort evaluation of patients with breast cancer during 2001-2010 was performed using population based data from the Sri Lanka National Cancer Registry. Trends in incidence were analysed using Joinpoint regression analysis. The age standardized incidence of female breast cancer in Sri Lanka appears to have increased from 17.3 per 100,000 in 2001 (95% confidence interval [95% CI] 16.5-18.2) to 24.7 per 100,000 in 2010 (95% CI 23.7-25.7); a 1.4-fold increase (p < 0.05) with an estimated annual percentage change (EAPC) of 4.4 (95% CI 3.3-5.5). Highest incidence of breast cancer was seen among women of 60 to 64-year age group which has increased from 68.1 to 100.2 per 100,000 over this period (EAPC 4.6%, 95% CI 3.9-5.2, p < 0.001 for trend). A substantially greater increase was observed among women older than 50 years (from 50.4 to 76.9 per 100,000; EAPC 5.5, 95% CI 4.1-7.0, p < 0.05) compared with women younger than 50 years (from 32.0 to 39.6 per 100,000; EAPC 2.3, 95% CI 1.1-3.5, p < 0.05). A gradual but a significant increase in the incidence of female breast cancer is observed in Sri Lanka. A rapid rise in the breast cancer incidence among post-menopausal women appears to be the major contributor towards this increase. Improving cancer data collection appears to have been a contributor to the observed increase. However, an inherent increase is also likely as differential rates of increase were observed by age groups. Further research is needed to identify the reasons for the observed increase which may help with future cancer control efforts in Sri Lanka.

  20. Poster - 27: Incident Learning Practices in Ontario

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

    Angers, Crystal; Medlam, Gaylene; Liszewski, Brian

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

  1. Interface between hospital and fire authorities--a concept for management of incidents in hospitals.

    PubMed

    Gretenkort, Peter; Harke, Henning; Blazejak, Jan; Pache, Bernd; Leledakis, Georgios

    2002-01-01

    Although every hospital needs a security plan for the support of immobile patients who do not possess autonomous escape capabilities, little information exists to assist in the development of practical patient evacuation methods. 1) In hospitals during disasters, incident leadership of the fire authorities can be supported effectively by hospital executives experienced in the management of mass casualties; and 2) As an alternative for canvas carry sheets, rescue drag sheets can be employed for emergency, elevator-independent, patient evacuation. A hospital evacuation exercise was planned and performed to obtain experiences in incident command and to permit calculation of elevator-independent patient transport times. Performance of incident leadership was observed by means of pre-defined checklists. The effectiveness and efficiency of carrying teams with five persons each were compared to those with a rescue drag sheet employed by a single person. Incident command for hospitals during a disaster is enhanced considerably by pre-defined and trained executives who are placed at the immediate disposal of the fire authorities. For elevator-independent patient transport, the rescue drag sheet was superior to conventional carrying measures because of a reduced number of transport personnel required to move each patient. With this method, patient transport times averaged 54 m/min. flat and 18 seconds for one floor descent. Experiences from a hospital during an evacuation exercise provided decision criteria for changes in the disaster preparedness plan. Hospital incident leadership was assigned to executives-in-charge in close co-operation with the fire authorities. All beds were equipped with a rescue drag sheet. Both concepts may help to cope with an emergency evacuation of a hospital.

  2. Behavioral traits and airport type affect mammal incidents with U.S. civil aircraft.

    PubMed

    Schwarz, Kristin B; Belant, Jerrold L; Martin, James A; DeVault, Travis L; Wang, Guiming

    2014-10-01

    Wildlife incidents with aircraft cost the United States (U.S.) civil aviation industry >US$1.4 billion in estimated damages and loss of revenue from 1990 to 2009. Although terrestrial mammals represented only 2.3 % of wildlife incidents, damage to aircraft occurred in 59 % of mammal incidents. We examined mammal incidents (excluding bats) at all airports in the Federal Aviation Administration (FAA) National Wildlife Strike Database from 1990 to 2010 to characterize these incidents by airport type: Part-139 certified (certificated) and general aviation (GA). We also calculated relative hazard scores for species most frequently involved in incidents. We found certificated airports had more than twice as many incidents as GA airports. Incidents were most frequent in October (n = 215 of 1,764 total) at certificated airports and November (n = 111 of 741 total) at GA airports. Most (63.2 %) incidents at all airports (n = 1,523) occurred at night but the greatest incident rate occurred at dusk (177.3 incidents/hr). More incidents with damage (n = 1,594) occurred at GA airports (38.6 %) than certificated airports (19.0 %). Artiodactyla (even-toed ungulates) incidents incurred greatest (92.4 %) damage costs (n = 326; US$51.8 million) overall and mule deer (Odocoileus hemionus) was the most hazardous species. Overall, relative hazard score increased with increasing log body mass. Frequency of incidents was influenced by species relative seasonal abundance and behavior. We recommend airport wildlife officials evaluate the risks mammal species pose to aircraft based on the hazard information we provide and consider prioritizing management strategies that emphasize reducing their occurrence on airport property.

  3. Behavioral Traits and Airport Type Affect Mammal Incidents with U.S. Civil Aircraft

    NASA Astrophysics Data System (ADS)

    Schwarz, Kristin B.; Belant, Jerrold L.; Martin, James A.; DeVault, Travis L.; Wang, Guiming

    2014-10-01

    Wildlife incidents with aircraft cost the United States (U.S.) civil aviation industry >US1.4 billion in estimated damages and loss of revenue from 1990 to 2009. Although terrestrial mammals represented only 2.3 % of wildlife incidents, damage to aircraft occurred in 59 % of mammal incidents. We examined mammal incidents (excluding bats) at all airports in the Federal Aviation Administration (FAA) National Wildlife Strike Database from 1990 to 2010 to characterize these incidents by airport type: Part-139 certified (certificated) and general aviation (GA). We also calculated relative hazard scores for species most frequently involved in incidents. We found certificated airports had more than twice as many incidents as GA airports. Incidents were most frequent in October ( n = 215 of 1,764 total) at certificated airports and November ( n = 111 of 741 total) at GA airports. Most (63.2 %) incidents at all airports ( n = 1,523) occurred at night but the greatest incident rate occurred at dusk (177.3 incidents/hr). More incidents with damage ( n = 1,594) occurred at GA airports (38.6 %) than certificated airports (19.0 %). Artiodactyla (even-toed ungulates) incidents incurred greatest (92.4 %) damage costs ( n = 326; US51.8 million) overall and mule deer ( Odocoileus hemionus) was the most hazardous species. Overall, relative hazard score increased with increasing log body mass. Frequency of incidents was influenced by species relative seasonal abundance and behavior. We recommend airport wildlife officials evaluate the risks mammal species pose to aircraft based on the hazard information we provide and consider prioritizing management strategies that emphasize reducing their occurrence on airport property.

  4. Observational and ecological studies of dietary advanced glycation end products in national diets and Alzheimer's disease incidence and prevalence.

    PubMed

    Perrone, Lorena; Grant, William B

    2015-01-01

    Considerable evidence indicates that diet is an important risk-modifying factor for Alzheimer's disease (AD). Evidence is also mounting that dietary advanced glycation end products (AGEs) are important risk factors for AD. This study strives to determine whether estimated dietary AGEs estimated from national diets and epidemiological studies are associated with increased AD incidence. We estimated values of dietary AGEs using values in a published paper. We estimated intake of dietary AGEs from the Washington Heights-Inwood Community Aging Project (WHICAP) 1992 and 1999 cohort studies, which investigated how the Mediterranean diet (MeDi) affected AD incidence. Further, AD prevalence data came from three ecological studies and included data from 11 countries for 1977-1993, seven developing countries for 1995-2005, and Japan for 1985-2008. The analysis used dietary AGE values from 20 years before the AD prevalence data. Meat was always the food with the largest amount of AGEs. Other foods with significant AGEs included fish, cheese, vegetables, and vegetable oil. High MeDi adherence results in lower meat and dairy intake, which possess high AGE content. By using two different models to extrapolate dietary AGE intake in the WHICAP 1992 and 1999 cohort studies, we showed that reduced dietary AGE significantly correlates with reduced AD incidence. For the ecological studies, estimates of dietary AGEs in the national diets corresponded well with AD prevalence data even though the cooking methods were not well known. Dietary AGEs appear to be important risk factors for AD.

  5. 76 FR 50494 - Water Resources Management Plan/Environmental Impact Statement, Mojave National Preserve, San...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-15

    ... Resources Management Plan/Environmental Impact Statement, Mojave National Preserve, San Bernardino County... Resources Management Plan/Environmental Impact Statement for Mojave National Preserve. SUMMARY: Pursuant to... preparing a Water Resources Management Plan/Environmental Impact Statement (WRMP/EIS). This plan is intended...

  6. Results of the two incidence screenings in the National Lung Screening Trial.

    PubMed

    Aberle, Denise R; DeMello, Sarah; Berg, Christine D; Black, William C; Brewer, Brenda; Church, Timothy R; Clingan, Kathy L; Duan, Fenghai; Fagerstrom, Richard M; Gareen, Ilana F; Gatsonis, Constantine A; Gierada, David S; Jain, Amanda; Jones, Gordon C; Mahon, Irene; Marcus, Pamela M; Rathmell, Joshua M; Sicks, JoRean

    2013-09-05

    The National Lung Screening Trial was conducted to determine whether three annual screenings (rounds T0, T1, and T2) with low-dose helical computed tomography (CT), as compared with chest radiography, could reduce mortality from lung cancer. We present detailed findings from the first two incidence screenings (rounds T1 and T2). We evaluated the rate of adherence of the participants to the screening protocol, the results of screening and downstream diagnostic tests, features of the lung-cancer cases, and first-line treatments, and we estimated the performance characteristics of both screening methods. At the T1 and T2 rounds, positive screening results were observed in 27.9% and 16.8% of participants in the low-dose CT group and in 6.2% and 5.0% of participants in the radiography group, respectively. In the low-dose CT group, the sensitivity was 94.4%, the specificity was 72.6%, the positive predictive value was 2.4%, and the negative predictive value was 99.9% at T1; at T2, the positive predictive value increased to 5.2%. In the radiography group, the sensitivity was 59.6%, the specificity was 94.1%, the positive predictive value was 4.4%, and the negative predictive value was 99.8% at T1; both the sensitivity and the positive predictive value increased at T2. Among lung cancers of known stage, 87 (47.5%) were stage IA and 57 (31.1%) were stage III or IV in the low-dose CT group at T1; in the radiography group, 31 (23.5%) were stage IA and 78 (59.1%) were stage III or IV at T1. These differences in stage distribution between groups persisted at T2. Low-dose CT was more sensitive in detecting early-stage lung cancers, but its measured positive predictive value was lower than that of radiography. As compared with radiography, the two annual incidence screenings with low-dose CT resulted in a decrease in the number of advanced-stage cancers diagnosed and an increase in the number of early-stage lung cancers diagnosed. (Funded by the National Cancer Institute; NLST

  7. 77 FR 14568 - Environmental Impact Statement for Proposed General Management Plan, Pinnacles National Monument...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-12

    ...] Environmental Impact Statement for Proposed General Management Plan, Pinnacles National Monument, San Benito and... Environmental Impact Statement. SUMMARY: The National Park Service is terminating the preparation of an Environmental Impact Statement (EIS) for the General Management Plan, Pinnacles National Monument, California. A...

  8. Operation of emergency operating centers during mass casualty incidents in taiwan: a disaster management perspective.

    PubMed

    Wen, Jet-Chau; Tsai, Chia-Chou; Chen, Mei-Hsuan; Chang, Wei-Ta

    2014-10-01

    On April 27, 2011, a train derailed and crashed in Taiwan, causing a mass casualty incident (MCI) that was similar to a previous event and with similar consequences. In both disasters, the emergency operating centers (EOCs) could not effectively integrate associated agencies to deal with the incident. The coordination and utilization of resources were inefficient, which caused difficulty in command structure operation and casualty evacuation. This study was designed to create a survey questionnaire with problem items using disaster management phases mandated by Taiwan's Emergency Medical Care Law (EMCL), use statistical methods (t test) to analyze the results and issues the EOCs encountered during the operation, and propose solutions for those problems. Findings showed that EOCs lacked authority to intervene or coordinate with associated agencies. Also, placing emphasis on the recovery phase should improve future prevention and response mechanisms. To improve the response to MCIs, the EMCL needs to be amended to give EOCs the lead during disasters; use feedback from the recovery phase to improve future disaster management and operation coordination; and establish an information-sharing platform across agencies to address all aspects of relief work.(Disaster Med Public Health Preparedness. 2014;0:1-6).

  9. Application of Incident Command Structure to clinical trial management in the academic setting: principles and lessons learned.

    PubMed

    Reynolds, Penny S; Michael, Mary J; Spiess, Bruce D

    2017-02-09

    Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the 'gold standard' management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration. Large clinical trials will require a separate Regulatory Administrative arm, and an Information arm, consisting of dedicated data management and information technology staff. We applied ICS principles to organisation and management of the Prehospital Use of Plasma in Traumatic Haemorrhage (PUPTH) trial. This trial was a multidepartmental, multiagency, randomised clinical trial investigating prehospital administration of thawed plasma on mortality and coagulation response in severely injured trauma patients. We describe the ICS system as it would apply to large clinical trials in general, and the benefits, barriers, and lessons learned in utilising ICS principles to reorganise and coordinate the PUPTH trial. Without a formal trial management structure, early stages of the trial were characterised by inertia and organisational confusion. Implementing ICS improved organisation, coordination, and communication between multiple agencies and service groups, and greatly streamlined regulatory compliance administration. However, unfamiliarity of clinicians with ICS culture, conflicting resource allocation priorities, and communication bottlenecks were significant barriers. ICS is a flexible and powerful organisational tool for managing large complex clinical trials. However, for successful implementation the cultural, psychological, and social environment of trial participants must be

  10. 77 FR 19681 - National Park Service Concessions Management Advisory Board Reestablishment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-02

    ... DEPARTMENT OF THE INTERIOR [NPS-WASO-2410-0113-9304; 2410-OYC] National Park Service Concessions Management Advisory Board Reestablishment AGENCY: National Park Service, Interior. ACTION: Notice of Renewal. SUMMARY: The Secretary of the Interior is giving notice of renewal of the National Park Service...

  11. Incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United kingdom and Republic of Ireland: prospective, enhanced, national population-based surveillance.

    PubMed

    Okike, Ifeanyichukwu O; Johnson, Alan P; Henderson, Katherine L; Blackburn, Ruth M; Muller-Pebody, Berit; Ladhani, Shamez N; Anthony, Mark; Ninis, Nelly; Heath, Paul T

    2014-11-15

    Bacterial meningitis remains a major cause of morbidity and mortality in young infants. Understanding the epidemiology and burden of disease is important. Prospective, enhanced, national population-based active surveillance was undertaken to determine the incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United Kingdom and Ireland. During July 2010-July 2011, 364 cases were identified (annual incidence, 0.38/1000 live births; 95% confidence interval [CI], .35-.42). In England and Wales, the incidence of confirmed neonatal bacterial meningitis was 0.21 (n = 167; 95% CI, .18-.25). A total of 302 bacteria were isolated in 298 (82%) of the cases. The pathogens responsible varied by route of admission, gestation at birth, and age at infection. Group B Streptococcus (GBS) (150/302 [50%]; incidence, 0.16/1000 live births; 95% CI, .13-.18) and Escherichia coli (41/302 [14%]; incidence, 0.04/1000; 95% CI, .03-.06) were responsible for approximately two-thirds of identified bacteria. Pneumococcal (28/302 [9%]) and meningococcal (23/302 [8%]) meningitis were rare in the first month, whereas Listeria meningitis was seen only in the first month of life (11/302 [4%]). In hospitalized preterm infants, the etiology of both early- and late-onset meningitis was more varied. Overall case fatality was 8% (25/329) and was higher for pneumococcal meningitis (5/26 [19%]) than GBS meningitis (7/135 [5%]; P = .04) and for preterm (15/90 [17%]) compared with term (10/235 [4%]; P = .0002) infants. The incidence of bacterial meningitis in young infants remains unchanged since the 1980s and is associated with significant case fatality. Prevention strategies and guidelines to improve the early management of cases should be prioritized. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  12. Emergency response to mass casualty incidents in Lebanon.

    PubMed

    El Sayed, Mazen J

    2013-08-01

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

  13. 28 CFR 115.386 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Sexual abuse incident reviews. 115.386... NATIONAL STANDARDS Standards for Juvenile Facilities Data Collection and Review § 115.386 Sexual abuse incident reviews. (a) The facility shall conduct a sexual abuse incident review at the conclusion of every...

  14. 28 CFR 115.386 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Sexual abuse incident reviews. 115.386... NATIONAL STANDARDS Standards for Juvenile Facilities Data Collection and Review § 115.386 Sexual abuse incident reviews. (a) The facility shall conduct a sexual abuse incident review at the conclusion of every...

  15. 28 CFR 115.386 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Sexual abuse incident reviews. 115.386... NATIONAL STANDARDS Standards for Juvenile Facilities Data Collection and Review § 115.386 Sexual abuse incident reviews. (a) The facility shall conduct a sexual abuse incident review at the conclusion of every...

  16. Kalaupapa National Historic Park Air Tour Management Plan planning and NEPA scoping study

    DOT National Transportation Integrated Search

    2005-03-03

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of an Air Tour Management Plan (ATMP) for Kalaupapa Historic Park pursuant to the National Parks Air Tour Management Act of ...

  17. Incidence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Nationwide Population-Based Study Using National Health Insurance Database in Korea.

    PubMed

    Yang, Min-Suk; Lee, Jin Yong; Kim, Jayeun; Kim, Gun-Woo; Kim, Byung-Keun; Kim, Ju-Young; Park, Heung-Woo; Cho, Sang-Heon; Min, Kyung-Up; Kang, Hye-Ryun

    2016-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases; however, it is hard to estimate their incidence due to the rarity of these diseases. We evaluated the incidence of SJS and TEN using a nationwide administrative database. We used a national medical insurance review system (Health Insurance Review and Assessment) database which contained the claim data of the entire nation from 2009 to 2013 to estimate the accurate incidence of SJS and TEN in Korea. The diagnostic codes of L511 (SJS) or L512 (TEN) from the International Classification of Diseases-10th revision were used to define the target study population. We also retrospectively followed up a 2011 SJS and TEN cohort for 24 months in order to assess the in-hospital mortality, related complications and total claims cost due to SJS and TEN. A total of 1,167 (938 SJS and 229 TEN) cases were newly diagnosed from 2010 to 2013. The age- and sex-standardized annual incidences estimated in this study were 3.96 to 5.03 in SJS and 0.94 to 1.45 in TEN per million. There was no significant change in annual incidence throughout the study periods. When analyzed by 10-year age groups, the annual incidence was the lowest in group 20-29 years and the highest in group 70 for both SJS and TEN. Based on the 2011 cohort analysis, the in-hospital mortality were 5.7 and 15.1% for SJS and TEN, respectively. The mortality increased with age, particularly, after 40 years of age. Among the complications related with SJS or TEN, ocular sequelae was the most common (43.1 and 43.4% of SJS and TEN patients, respectively) followed by urethral sequelae (5.7 and 9.4% of SJS and TEN patients, respectively). Overall, our data suggest that SJS, and TEN are infrequent but constantly arise throughout the years.

  18. Perceived Marital Support and Incident Mental Illness: Evidence from the National Comorbidity Survey.

    PubMed

    Feder, Kenneth A; Heatherington, Laurie; Mojtabai, Ramin; Eaton, William W

    2018-06-26

    Social support in marriage may be associated with reduced risk for mental illness. Past studies are limited by short follow up and a focus on depression. A two-wave nationally representative survey in the United States (n = 2,503) is used to examine whether social support in marriage is associated with the onset of each of four clusters of disorders-internalizing, externalizing, phobic, and bipolar-10 years later. Results indicate that higher levels of perceived marital support were protective against internalizing, fear, and bipolar disorders, and against incident externalizing disorders for women. Protective effects of social support in marriage against mental illness are long-lasting, and sometimes differ by gender. Findings suggest the importance of mental health assessment in clinical practice. © 2018 American Association for Marriage and Family Therapy.

  19. 78 FR 55093 - Dog Management Plan, Supplemental Environmental Impact Statement, Golden Gate National Recreation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-09

    ....YP0000] Dog Management Plan, Supplemental Environmental Impact Statement, Golden Gate National Recreation... the Dog Management Plan (Plan/SEIS), Golden Gate National Recreation Area (GGNRA), California. Current dog management in the park is based on a number of factors. Areas included in the GGNRA Citizens...

  20. Trends and variations in breast and colorectal cancer incidence from 1995 to 2011: a comparative study between Texas Cancer Registry and National Cancer Institute's Surveillance, Epidemiology and End Results data.

    PubMed

    Liu, Zheyu; Zhang, Yefei; Franzin, Luisa; Cormier, Janice N; Chan, Wenyaw; Xu, Hua; Du, Xianglin L

    2015-04-01

    Few studies have examined the cancer incidence trends in the state of Texas, and no study has ever been conducted to compare the temporal trends of breast and colorectal cancer incidence in Texas with those of the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) in the United States. This study aimed to conduct a parallel comparison between the Texas Cancer Registry and the National Cancer Institute's SEER on cancer incidence from 1995 to 2011. A total of 951,899 breast and colorectal cancer patients were included. Age-adjusted breast cancer incidence was 134.74 per 100,000 in Texas and 131.78 per 100,000 in SEER in 1995-2011, whereas age-adjusted colorectal cancer incidence was 50.52 per 100,000 in Texas and 49.44 per 100,000 in SEER. Breast cancer incidence increased from 1995 to 2001, decreased from 2002 to 2006, and then remained relatively stable from 2007 to 2011. For colorectal cancer, the incidence increased in 1995-1997, and then decreased continuously from 1998 to 2011 in Texas and SEER areas. Incidence rates and relative risks by age, gender and ethnicity were identical between Texas and SEER.

  1. Pregnancy incidence and outcomes in women with perinatal HIV infection.

    PubMed

    Byrne, Laura; Sconza, Rebecca; Foster, Caroline; Tookey, Pat A; Cortina-Borja, Mario; Thorne, Claire

    2017-07-31

    To estimate the incidence of first pregnancy in women living with perinatally acquired HIV (PHIV) in the United Kingdom and to compare pregnancy management and outcomes with age-matched women with behaviourally acquired HIV (BHIV). The National Study of HIV in Pregnancy and Childhood is a comprehensive, population-based surveillance study that collects demographic and clinical data on all pregnant women living with HIV, their children, and all HIV-infected children in the United Kingdom and Ireland. The incident rate ratio of first pregnancy was calculated for all women of reproductive age who had been reported to the National Study of HIV in Pregnancy and Childhood as vertically infected children. These women and their pregnancies were compared to age-matched pregnant women with BHIV. Of the 630 women with PHIV reported in the United Kingdom as children, 7% (45) went on to have at least one pregnancy, with 70 pregnancies reported. The incident rate ratio of first pregnancy was 13/1000 woman-years. The BHIV comparison group comprised 118 women (184 pregnancies). Women with PHIV were more likely to be on combined antiretroviral therapy at conception and have a lower baseline CD4 cell count (P < 0.01 for both). In adjusted analysis, PHIV and a low baseline CD4 cell count were risk factors for detectable viral load near delivery; older age at conception and being on combined antiretroviral therapy at conception reduced this risk. Women with PHIV in the United Kingdom have a low pregnancy incidence, but those who become pregnant are at risk of detectable viral load near delivery, reflecting their often complex clinical history, adherence, and drug resistance issues.

  2. 28 CFR 115.86 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Sexual abuse incident reviews. 115.86... NATIONAL STANDARDS Standards for Adult Prisons and Jails Data Collection and Review § 115.86 Sexual abuse incident reviews. (a) The facility shall conduct a sexual abuse incident review at the conclusion of every...

  3. 28 CFR 115.86 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Sexual abuse incident reviews. 115.86... NATIONAL STANDARDS Standards for Adult Prisons and Jails Data Collection and Review § 115.86 Sexual abuse incident reviews. (a) The facility shall conduct a sexual abuse incident review at the conclusion of every...

  4. 28 CFR 115.86 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Sexual abuse incident reviews. 115.86... NATIONAL STANDARDS Standards for Adult Prisons and Jails Data Collection and Review § 115.86 Sexual abuse incident reviews. (a) The facility shall conduct a sexual abuse incident review at the conclusion of every...

  5. 28 CFR 115.186 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Sexual abuse incident reviews. 115.186... NATIONAL STANDARDS Standards for Lockups Data Collection and Review § 115.186 Sexual abuse incident reviews. (a) The lockup shall conduct a sexual abuse incident review at the conclusion of every sexual abuse...

  6. 28 CFR 115.186 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Sexual abuse incident reviews. 115.186... NATIONAL STANDARDS Standards for Lockups Data Collection and Review § 115.186 Sexual abuse incident reviews. (a) The lockup shall conduct a sexual abuse incident review at the conclusion of every sexual abuse...

  7. 28 CFR 115.186 - Sexual abuse incident reviews.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Sexual abuse incident reviews. 115.186... NATIONAL STANDARDS Standards for Lockups Data Collection and Review § 115.186 Sexual abuse incident reviews. (a) The lockup shall conduct a sexual abuse incident review at the conclusion of every sexual abuse...

  8. Hazardous chemical incidents in schools--United States, 2002-2007.

    PubMed

    2008-11-07

    Chemicals that can cause adverse health effects are used in many elementary and secondary schools (e.g., in chemistry laboratories, art classrooms, automotive repair areas, printing and other vocational shops, and facility maintenance areas). Every year, unintentional and intentional releases of these chemicals, or related fires or explosions, occur in schools, causing injuries, costly cleanups, and lost school days. The federal Agency for Toxic Substances and Disease Registry (ATSDR) conducts national public health surveillance of chemical incidents through its Hazardous Substances Emergency Events Surveillance (HSEES) system. To identify school-related incidents and elucidate their causes and consequences to highlight the need for intervention, ATSDR conducted an analysis of HSEES data for 2002-2007. During that period, 423 chemical incidents in elementary and secondary schools were reported by 15 participating states. Mercury was the most common chemical released. The analysis found that 62% of reported chemical incidents at elementary and secondary schools resulted from human error (i.e., mistakes in the use or handling of a substance), and 30% of incidents resulted in at least one acute injury. Proper chemical use and management (e.g., keeping an inventory and properly storing, labeling, and disposing of chemicals) is essential to protect school building occupants. Additional education directed at raising awareness of the problem and providing resources to reduce the risk is needed to ensure that schools are safe from unnecessary dangers posed by hazardous chemicals.

  9. Indicator-based systems of performance management in the National Health Service: a comparison of the perceptions of local- and national-level managers.

    PubMed

    Jones, G T

    2000-02-01

    Historically, the UK Government has policed the use of National Health Service (NHS) resources through the centralization of control. With the majority of resource-draining decisions being taken by clinicians, however, professional financial accountability is becoming more important within the NHS management structure. Variations in clinical performance can be monitored through the use of performance indicators, although these are not without their problems. The use of league tables of such indicators in the national press is now infamous and there is much anecdotal evidence about the intraorganizational conflict arising from the use of such tables. A questionnaire survey and interview study of clinical directors, clinical service directors and business managers in several Scottish NHS Trusts was undertaken to ascertain the perceptions of local-level managers on the issue of performance indicators. Interviews were also carried out with a number of personnel in the Scottish Office Department of Economics and Information, the Division of Health Gain and the Finance Directorate. This paper explores the differences between the perceptions of the managers at these two levels of the NHS with regards to issues of performance measurement, intraorganizational conflict and corporate vision.

  10. The Influence of Proximity to a National Forest on Emotions and Fire-Management Decisions

    NASA Astrophysics Data System (ADS)

    Vining, Joanne; Merrick, Melinda S.

    2008-02-01

    Because American national forests are managed for all citizens, it is important that researchers explore the differences and similarities between citizens living both near and far from publicly managed land. We surveyed residents living at various distances from nationally managed land to collect resident perceptions of different forest fire-management techniques, to determine public preferences for these techniques, and to examine the motivations behind these preferences. Participants both close to and far away from national forests tended to favor a multipronged approach to fire management by preferring the use of a combination of two or more fire-management techniques. There were no significant differences by proximity in participants’ self-rated emotions, types of fire-management techniques preferred, or the reasons and rationales for their preferred fire-management technique(s), indicating that the proximity variable may not be as significant as previously thought.

  11. The influence of proximity to a national forest on emotions and fire-management decisions.

    PubMed

    Vining, Joanne; Merrick, Melinda S

    2008-02-01

    Because American national forests are managed for all citizens, it is important that researchers explore the differences and similarities between citizens living both near and far from publicly managed land. We surveyed residents living at various distances from nationally managed land to collect resident perceptions of different forest fire-management techniques, to determine public preferences for these techniques, and to examine the motivations behind these preferences. Participants both close to and far away from national forests tended to favor a multipronged approach to fire management by preferring the use of a combination of two or more fire-management techniques. There were no significant differences by proximity in participants' self-rated emotions, types of fire-management techniques preferred, or the reasons and rationales for their preferred fire-management technique(s), indicating that the proximity variable may not be as significant as previously thought.

  12. Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines.

    PubMed

    Herzon, F S

    1995-08-01

    Currently there is no agreement on the treatment of patients who develop a peritonsillar abscess (PTA). This lack of consensus results in highly variable and possibly expensive therapeutic regimens that may not provide optimum quality patient care at reasonable cost. The present study evaluates surgical, medical, diagnostic, and cost factors that affect the management of PTA based on the following: 1. a cohort study of 123 patients with PTA treated using needle aspiration as the initial surgical drainage; 2. a national survey of the PTA management practices of otolaryngologists; and 3. meta-analyses of various components of the treatment regimen for PTA. In the cohort study, patients diagnosed with PTA were treated by both otolaryngologists and emergency medicine specialists with needle aspiration as the primary surgical modality resulting in a 96% acute resolution rate for PTA. In the national survey, questionnaires were sent to 2000 randomly selected members of the American Academy of Otolaryngology-Head and Neck Surgery regarding their management of PTA. The return rate was 73%. Ninety-six percent of the physicians who returned survey forms treated an average of seven PTAs per year using either needle aspiration, incision and drainage, or abscess tonsillectomy to drain the abscess initially. The incidence of PTA in the United States and Puerto Rico among patients 5 to 59 years of age treated by survey practitioners is 30.1 per 100,000 person years, accounting for approximately 45,000 cases per year. Four meta-analyses were completed to quantify the success rate of needle aspiration in the treatment of PTA (94%), the recurrence rate of PTA (10% to 15%), the rate at which penicillin-resistant microorganisms are found in patients with PTA (0% to 56%), and the rate of prior oropharyngeal infections associated with PTA (11% to 56%). The recurrence rate for PTA in the United States is 10%, which is significantly different from the recurrence rate of 15% reported from

  13. Recent advances in applying decision science to managing national forests

    USGS Publications Warehouse

    Marcot, Bruce G.; Thompson, Matthew P.; Runge, Michael C.; Thompson, Frank R.; McNulty, Steven; Cleaves, David; Tomosy, Monica; Fisher, Larry A.; Andrew, Bliss

    2012-01-01

    Management of federal public forests to meet sustainability goals and multiple use regulations is an immense challenge. To succeed, we suggest use of formal decision science procedures and tools in the context of structured decision making (SDM). SDM entails four stages: problem structuring (framing the problem and defining objectives and evaluation criteria), problem analysis (defining alternatives, evaluating likely consequences, identifying key uncertainties, and analyzing tradeoffs), decision point (identifying the preferred alternative), and implementation and monitoring the preferred alternative with adaptive management feedbacks. We list a wide array of models, techniques, and tools available for each stage, and provide three case studies of their selected use in National Forest land management and project plans. Successful use of SDM involves participation by decision-makers, analysts, scientists, and stakeholders. We suggest specific areas for training and instituting SDM to foster transparency, rigor, clarity, and inclusiveness in formal decision processes regarding management of national forests.

  14. National Economic Burden Associated with Management of Periodontitis in Malaysia

    PubMed Central

    Ayob, Rasidah; Abd Muttalib, Khairiyah

    2016-01-01

    Objectives. The aim of this study is to estimate the economic burden associated with the management of periodontitis in Malaysia from the societal perspective. Methods. We estimated the economic burden of periodontitis by combining the disease prevalence with its treatment costs. We estimated treatment costs (with 2012 value of Malaysian Ringgit) using the cost-of-illness approach and included both direct and indirect costs. We used the National Oral Health Survey for Adults (2010) data to estimate the prevalence of periodontitis and 2010 national census data to estimate the adult population at risk for periodontitis. Results. The economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately MYR 32.5 billion, accounting for 3.83% of the 2012 Gross Domestic Product of the country. It would cost the nation MYR 18.3 billion to treat patients with moderate periodontitis and MYR 13.7 billion to treat patients with severe periodontitis. Conclusion. The economic burden of periodontitis in Malaysia is substantial and comparable with that of other chronic diseases in the country. This is attributable to its high prevalence and high cost of treatment. Judicious application of promotive, preventive, and curative approaches to periodontitis management is decidedly warranted. PMID:27092180

  15. National Economic Burden Associated with Management of Periodontitis in Malaysia.

    PubMed

    Mohd Dom, Tuti Ningseh; Ayob, Rasidah; Abd Muttalib, Khairiyah; Aljunid, Syed Mohamed

    2016-01-01

    Objectives. The aim of this study is to estimate the economic burden associated with the management of periodontitis in Malaysia from the societal perspective. Methods. We estimated the economic burden of periodontitis by combining the disease prevalence with its treatment costs. We estimated treatment costs (with 2012 value of Malaysian Ringgit) using the cost-of-illness approach and included both direct and indirect costs. We used the National Oral Health Survey for Adults (2010) data to estimate the prevalence of periodontitis and 2010 national census data to estimate the adult population at risk for periodontitis. Results. The economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately MYR 32.5 billion, accounting for 3.83% of the 2012 Gross Domestic Product of the country. It would cost the nation MYR 18.3 billion to treat patients with moderate periodontitis and MYR 13.7 billion to treat patients with severe periodontitis. Conclusion. The economic burden of periodontitis in Malaysia is substantial and comparable with that of other chronic diseases in the country. This is attributable to its high prevalence and high cost of treatment. Judicious application of promotive, preventive, and curative approaches to periodontitis management is decidedly warranted.

  16. The Federal Emergency Management Agency's National Incident Management System

    EPA Pesticide Factsheets

    The NIMS provides an integrated framework defining the roles and responsibilities of federal, state and local first responders, developed with responders from different jurisdictions and disciplines, to better work together during emergency events.

  17. Meteorological factors affecting dengue incidence in Davao, Philippines.

    PubMed

    Iguchi, Jesavel A; Seposo, Xerxes T; Honda, Yasushi

    2018-05-15

    Dengue fever is a major public health concern in the Philippines, and has been a significant cause of hospitalizations and deaths among young children. Previous literature links climate change to dengue, and with increasingly unpredictable changing climate patterns, there is a need to understand how these meteorological variables affect dengue incidence in a highly endemic area. Weekly dengue incidences (2011-2015) in Davao Region, Philippines were obtained from the Department of Health. Same period of weekly local meteorological variables were obtained from the National Climatic Data Center (NCDC) and the National Oceanic and Atmospheric Administration (NOAA). Wavelet coherence analysis was used to determine the presence of non-stationary relationships, while a quasi-Poisson regression combined with distributed lag nonlinear model (DLNM) was used to analyze the association between meteorological variables and dengue incidences. Significant periodicity was detected in the 7 to 14-week band between the year 2011-2012 and a 26-week periodicity from the year 2013-2014. Overall cumulative risks were particularly high for rainfall at 32 mm (RR: 1.67, 95% CI: 1.07-2.62), while risks were observed to increase with increasing dew point. On the other hand, lower average temperature of 26 °C has resulted to an increased RR of dengue (RR: 1.96, 95% CI: 0.47-8.15) while higher temperature from 27 °C to 31 °C has lower RR. The observed possible threshold levels of these meteorological variables can be integrated into an early warning system to enhance dengue prediction for better vector control and management in the future.

  18. Governance and management of national telehealth programs in Asia.

    PubMed

    Marcelo, Alvin; Ganesh, Jai; Mohan, Jai; Kadam, D B; Ratta, B S; Kulatunga, Gumindu; John, Sheila; Chandra, Andry; Primadi, Oscar; Mohamed, Athika Abdul Sattar; Khan, Muhammad Abdul Hannan; Azad, Abul Alam; Marcelo, Portia

    2015-01-01

    Telehealth and telemedicine are increasingly becoming accepted practices in Asia, but challenges remain in deploying these services to the farthest areas of many developing countries. With the increasing popularity of universal health coverage, there is a resurgence in promoting telehealth services. But while telehealth that reaches the remotest part of a nation is the ideal endpoint, such goals are burdened by various constraints ranging from governance to funding to infrastructure and operational efficiency. enumerate the public funded national telehealth programs in Asia and determine the state of their governance and management. Review of literature, review of official program websites and request for information from key informants. While there are national telehealth programs already in operation in Asia, most experience challenges with governance and subsequently, with management and sustainability of operations. It is important to learn from successful programs that have built and maintained their services over time. An IT governance framework may assist countries to achieve success in offering telehealth and telemedicine to their citizens.

  19. Community Participation Of Coastal Area On Management Of National Park, Karimunjawa Island

    NASA Astrophysics Data System (ADS)

    Wibowo, Bambang A.; Aditomo, Aryo B.; Prihantoko, Kukuh E.

    2018-02-01

    Karimunjawa island located in Jepara Regacy, Central Java has potential marine and fishing resources. Since 1998, this area has been selected as conservation for its natural resources. National park of Karimunjawa is managed by Balai Taman Nasional Karimunjawa (Karimunjawa National Park Beuroue). Some activities involved community have been done in order to get effective management. Community participation is an important component for success in coastal area management. The level of community/people awareness anual on natural resource conservation can increate sustainable resource. However, it is necesssary to provide tools in resource utilization for the community, so that their economic life can be secured. This study observe the level of community participation in the effort of Karimunjawa National Park management. Descriptive method and purposive random sampling were used to carry out the study parameters observed in this study include community participation related to level of knowladge and obedience on the rule of area zonation, an its impact to community. The result show that community knowledge was quite high (40%) with obedience (56%) on the rule of area zonation. Impact area zonation rule was less significant to community. The level of community participation to Karimunjawa National Park management was performed will low to medium level.

  20. Spatial strategies for managing visitor impacts in National Parks

    USGS Publications Warehouse

    Leung, Y.-F.; Marion, J.L.

    1999-01-01

    Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or

  1. Essentials of disaster management: the role of the orthopaedic surgeon.

    PubMed

    Born, Christopher T; Monchik, Keith O; Hayda, Roman A; Bosse, Michael J; Pollak, Andrew N

    2011-01-01

    Disaster preparedness and management education is essential for allowing orthopaedic surgeons to play a valuable, constructive role in responding to disasters. The National Incident Management System, as part of the National Response Framework, provides coordination between all levels of government and uses the Incident Command System as its unified command structure. An "all-hazards" approach to disasters, whether natural, man-made, intentional, or unintentional, is fundamental to disaster planning. To respond to any disaster, command and control must be established, and emergency management must be integrated with public health and medical care. In the face of increasing acts of terrorism, an understanding of blast injury pathophysiology allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents and their attendant clinical symptoms is also prerequisite. Credentialing and coordination between designated organizations and the federal government are essential to allow civilian orthopaedic surgeons to access systems capable of disaster response.

  2. The ecological sustainability of tropical forest management: evaluation of the national forest management standards of Costa Rica and Nicaragua, with emphasis on the need for adaptive. management

    Treesearch

    Kathleen McGinleya; Bryan Fineganb

    2003-01-01

    From a conceptual point of view, national forest management standards in Latin American countries have progressed significantly in recent years.Examples include the Costa Rican Standards and Procedures for Sustainable Forest Management and Certification, developed by the National Commission for Forest Certification and in Nicaragua, the National Institute of Forestry...

  3. National briefing summaries: Nuclear fuel cycle and waste management

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

    Schneider, K.J.; Lakey, L.T.; Silviera, D.J.

    The National Briefing Summaries is a compilation of publicly available information concerning the nuclear fuel cycle and radioactive waste management strategies and programs of 21 nations, including the United States and three international agencies that have publicized their activities in this field. It presents available highlight information with references that may be used by the reader for additional information. The information in this document is compiled primarily for use by the US Department of Energy and other US federal agencies and their contractors to provide summary information on radioactive waste management activities in other countries. This document provides an awarenessmore » to managers and technical staff of what is occurring in other countries with regard to strategies, activities, and facilities. The information may be useful in program planning to improve and benefit United States' programs through foreign information exchange. Benefits to foreign exchange may be derived through a number of exchange activities.« less

  4. Red-cockaded woodpecker population trends and management on Texas national forests

    Treesearch

    Richard N. Conner; D. Craig Rudolph

    1994-01-01

    Red-cockaded Woodpecker (Picoides borealis) population trends and concurrent management on four national forests in eastern Texas were evaluated from 1983 through 1993. Following years of decline, populations stabilized and began to increase after intensive management efforts were initiated. Management activities included control of hardwood midstory and understory,...

  5. The National Study of Charter Management Organization (CMO) Effectiveness. Report on Interim Findings

    ERIC Educational Resources Information Center

    Lake, Robin; Dusseault, Brianna; Bowen, Melissa; Demeritt, Allison; Hill, Paul

    2010-01-01

    The National Study of CMO (charter management organizations) Effectiveness is a national, longitudinal research effort designed to measure how nonprofit charter school management organizations (CMOs) affect student achievement, and to examine the internal structures, practices, and policy contexts that may influence these outcomes. The study began…

  6. Hawaii Volcanoes National Park Air Tour Management Plan: Planning and NEPA Scoping Document

    DOT National Transportation Integrated Search

    2004-03-03

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of Air Tour Management Plans (ATMPs) for Haleakala National Park, Hawaii Volcanoes National Park, Puukohola Heiau National H...

  7. Care Staff Perceptions of Choking Incidents: What Details Are Reported?

    ERIC Educational Resources Information Center

    Guthrie, Susan; Lecko, Caroline; Roddam, Hazel

    2015-01-01

    Background: Following a series of fatal choking incidents in one UK specialist service, this study evaluated the detail included in incident reporting. This study compared the enhanced reporting system in the specialist service with the national reporting and learning system. Methods: Eligible reports were selected from a national organization and…

  8. Forest invasive adaptive management on national wildlife refuge lands in the central hardwood region

    Treesearch

    Damon B. Lesmeister; Sean M. Blomquist; Eric V. Lonsdorf; Daniel Wood; Perry J. Williams; Brad Pendley; Karen E. Mangan; Benjamin A. Walker

    2014-01-01

    Approximately 2.4 million acres of National Wildlife Refuge System lands are impacted by invasive plants and are the primary challenge for habitat management in the Central Hardwood region. In 2011, biologists, managers, and contracted support staff from six national wildlife refuges in southern Indiana, Illinois, and Missouri developed an adaptive management project...

  9. A Study of Student Publications Adviser Management Style (Theory X, Theory Y).

    ERIC Educational Resources Information Center

    Ames, Steve

    Members of the National Council of College Publications Advisers were surveyed to determine the predominant management style within which the advisers worked. The choices of management style were restrictive-Theory X and permissive-Theory Y. Respondents were encouraged to give general examples, cite specific incidents, and include clippings from…

  10. Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey

    PubMed Central

    Butler, Chris C; Hawking, Meredith KD; Quigley, Anna; McNulty, Cliodna AM

    2015-01-01

    Background Limited knowledge of the population incidence and management of uncomplicated urinary tract infection (UTI) limits information provision and interventions to enhance care in the community. Aim To describe incidence and severity, help seeking, and management of UTI from a population perspective. Design and setting Household survey in England in 2014. Method In total, a random sample of 2424 females aged ≥16 years were interviewed in their own homes using computer-assisted interviewing about their UTI symptoms, help seeking, and management. Data were weighted by sex, age, ethnicity, working status, social grade, and housing tenure, and Government Office Region to be broadly representative of the general population. Results Of the females interviewed, 892 (37%) reported having had at least one UTI in their lifetime (29% had more than one episode). In the past year, 11% of all females reported a UTI and 3% recurrent UTI (≥3 or more). Of those who had ever had a UTI, 48% rated their last UTI as fairly or very severe. In total, 95% consulted a health professional; 65% at their local GP practice during routine consulting hours. Out-of-hours consulting was uncommon but more prevalent in younger females. Of those contacting a health professional, 76% had a urine test, 74% were prescribed an antibiotic, but only 63% of these reported taking the antibiotic. Delayed antibiotic prescribing was rare. Conclusion UTI symptoms are common; most females consult in general practice, and are prescribed antibiotics, but one-third report not taking the antibiotics as prescribed. Benefit and harms in those taking, and not taking, antibiotics need to be better understood in order to improve help seeking, management, and adherence. Urine tests and antibiotics could be reduced by basing empirical antibiotics on symptoms, and increasing use of back-up prescriptions. PMID:26412847

  11. 36 CFR 221.3 - Disposal of national forest timber according to management plans.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Disposal of national forest timber according to management plans. 221.3 Section 221.3 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE TIMBER MANAGEMENT PLANNING § 221.3 Disposal of national forest timber...

  12. Documentation and tagging of casualties in multiple casualty incidents.

    PubMed

    Garner, Alan

    2003-01-01

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

  13. Actualizing Concepts in Home Management: Proceedings of a National Conference.

    ERIC Educational Resources Information Center

    American Home Economics Association, Washington, DC.

    The booklet prints the following papers delivered at a national conference: Actualizing Concepts in Home Management: Decision Making, Dorothy Z. Price; Innovations in Teaching: Ergonomics, Fern E. Hunt; Relevant Concepts of Home Management: Innovations in Teaching, Kay P. Edwards; Standards in a Managerial Context, Florence S. Walker; Organizing:…

  14. Cyber Incidents Involving Control Systems

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

    Robert J. Turk

    2005-10-01

    The Analysis Function of the US-CERT Control Systems Security Center (CSSC) at the Idaho National Laboratory (INL) has prepared this report to document cyber security incidents for use by the CSSC. The description and analysis of incidents reported herein support three CSSC tasks: establishing a business case; increasing security awareness and private and corporate participation related to enhanced cyber security of control systems; and providing informational material to support model development and prioritize activities for CSSC. The stated mission of CSSC is to reduce vulnerability of critical infrastructure to cyber attack on control systems. As stated in the Incident Managementmore » Tool Requirements (August 2005) ''Vulnerability reduction is promoted by risk analysis that tracks actual risk, emphasizes high risk, determines risk reduction as a function of countermeasures, tracks increase of risk due to external influence, and measures success of the vulnerability reduction program''. Process control and Supervisory Control and Data Acquisition (SCADA) systems, with their reliance on proprietary networks and hardware, have long been considered immune to the network attacks that have wreaked so much havoc on corporate information systems. New research indicates this confidence is misplaced--the move to open standards such as Ethernet, Transmission Control Protocol/Internet Protocol, and Web technologies is allowing hackers to take advantage of the control industry's unawareness. Much of the available information about cyber incidents represents a characterization as opposed to an analysis of events. The lack of good analyses reflects an overall weakness in reporting requirements as well as the fact that to date there have been very few serious cyber attacks on control systems. Most companies prefer not to share cyber attack incident data because of potential financial repercussions. Uniform reporting requirements will do much to make this information

  15. Incidence and management of colonoscopic perforations: 8 years’ experience

    PubMed Central

    Tulchinsky, Hagit; Madhala-Givon, Osnat; Wasserberg, Nir; Lelcuk, Shlomo; Niv, Yaron

    2006-01-01

    AIM: To review the experience of a major medical teaching center with diagnostic and therapeutic colonoscopies and to assess the incidence and management of related colonic perforations. METHODS: All colonoscopies performed between January 1994 and December 2001 were studied. Data on patients, colonoscopic reports and procedure-related complications were collected from the departmental computerized database. The medical records of the patients with post procedural colonic perforation were reviewed. RESULTS: A total of 12 067 colonoscopies were performed during the 8 years of the study. Seven colonoscopic perforations (4 females, 3 males) were diagnosed (0.058%). Five occurred during diagnostic and two during therapeutic colonoscopy. Six were suspected during or immediately after colonoscopy. All except one had signs of diffuse tenderness and underwent immediate operation with primary repair done in 4 patients. No deaths were reported. CONCLUSION: Perforation rate during colonoscopy is low. Nevertheless, it is a serious complication and its early recognition and treatment are essential to optimize outcome. In patients with diffuse peritonitis early operative intervention makes primary repair a safe option. PMID:16830377

  16. 77 FR 30320 - General Management Plan/Environmental Impact Statement, Ross Lake National Recreation Area, North...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-22

    ... Management Plan/Environmental Impact Statement, Ross Lake National Recreation Area, North Cascades National... Impact Statement for the new General Management Plan (GMP) for Ross Lake National Recreation Area, part... Wilderness Act of 1988. The full range of foreseeable environmental consequences from implementing the...

  17. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

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

    Shah, Chirag; Vicini, Frank A., E-mail: fvicini@beaumont.edu

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially withmore » a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.« less

  18. Can incident reporting improve safety? Healthcare practitioners' views of the effectiveness of incident reporting.

    PubMed

    Anderson, Janet E; Kodate, Naonori; Walters, Rhiannon; Dodds, Anneliese

    2013-04-01

    Recent critiques of incident reporting suggest that its role in managing safety has been over emphasized. The objective of this study was to examine the perceived effectiveness of incident reporting in improving safety in mental health and acute hospital settings by asking staff about their perceptions and experiences. Qualitative research design using documentary analysis and semi-structured interviews. Two large teaching hospitals in London; one providing acute and the other mental healthcare. Sixty-two healthcare practitioners with experience of reporting and analysing incidents. Incident reporting was perceived as having a positive effect on safety, not only by leading to changes in care processes but also by changing staff attitudes and knowledge. Staff discussed examples of both instrumental and conceptual uses of the knowledge generated by incident reports. There are difficulties in using incident reports to improve safety in healthcare at all stages of the incident reporting process. Differences in the risks encountered and the organizational systems developed in the two hospitals to review reported incidents could be linked to the differences we found in attitudes to incident reporting between the two hospitals. Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.

  19. 78 FR 26067 - General Management Plan, Draft Environmental Impact Statement, Big Thicket National Preserve, Texas

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-03

    .... Alternative 2, the NPS preferred alternative, would support a broad ecosystem approach for preserve management... management of cross-boundary resource issues and the importance of encouraging partnerships to address and... Management Plan, Draft Environmental Impact Statement, Big Thicket National Preserve, Texas AGENCY: National...

  20. Kaloko-Honokohau National Historical Park Air Tour Management Plan planning and NEPA scoping document

    DOT National Transportation Integrated Search

    2004-03-03

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of an Air Tour Management Plan (ATMP) for Kaloko-Honokohau Historic Park pursuant to the National Parks Air Tour Management ...

  1. Longitudinal relationship between traumatic brain injury and the risk of incident optic neuropathy: A 10-year follow-up nationally representative Taiwan survey.

    PubMed

    Chen, Ying-Jen; Liang, Chang-Min; Tai, Ming-Cheng; Chang, Yun-Hsiang; Lin, Tzu-Yu; Chung, Chi-Hsiang; Lin, Fu-Huang; Tsao, Chang-Huei; Chien, Wu-Chien

    2017-10-17

    Accumulating evidences had shown that traumatic brain injury was associated with visual impairment or vision loss. However, there were a limited number of empirical studies regarding the longitudinal relationship between traumatic brain injury and incident optic neuropathy. We studied a cohort from the Taiwanese National Health Insurance data comprising 553918 participants with traumatic brain injury and optic neuropathy-free in the case group and 1107836 individuals without traumatic brain injury in the control group from 1st January 2000. After the index date until the end of 2010, Cox proportional hazards analysis was used to compare the risk of incident optic neuropathy. During the follow-up period, case group was more likely to develop incident optic neuropathy (0.24%) than the control group (0.11%). Multivariate Cox regression analysis demonstrated that the case group had a 3-fold increased risk of optic neuropathy (HR = 3.017, 95% CI = 2.767-3.289, p < 0.001). After stratification by demographic information, traumatic brain injury remained a significant factor for incident optic neuropathy. Our study provided evidence of the increased risk of incident optic neuropathy after traumatic brain injury during a 10-year follow-up period. Patients with traumatic brain injury required periodic and thorough eye examinations for incident optic neuropathy to prevent potentially irreversible vision loss.

  2. Decreased incidence of gout in diabetic patients using pioglitazone.

    PubMed

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

    2018-01-01

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

  3. Increased incidence of gonorrhoea and chlamydia in Greenland 1990-2012.

    PubMed

    Johansen, Mila Broby; Koch, Anders; Wohlfahrt, Jan; Kamper-Jørgensen, Mads; Hoffmann, Steen; Soborg, Bolette

    2017-01-01

    Since the 1970s, Greenland has presented the highest reported incidence rates of the sexually transmitted infections (STIs) gonorrhoea and chlamydia in the Arctic regions. This study aims to describe sex- and age-specific incidence rates of gonorrhoea and chlamydia from 1990 to 2012 in Greenland, and to evaluate if changes in case definitions, diagnostic procedures and implementation of STI interventions during the period coincide with rate changes. Gonorrhoea and chlamydia cases were identified from the national STI surveillance. For 1990-2008, STI cases were identified from weekly notified aggregated data. For 2009-2012, cases were identified in person-identifiable national registers. We used log-linear Poisson regression to calculate incidence rates (IRs) and incidence rate ratios (IRRs) with 95% confidence intervals (95% CI). Analyses were stratified according to sex, age and calendar period. Gonorrhoea and chlamydia incidence rates have increased since 1995 to reach 2,555 per 100,000 person-years (PY) for gonorrhoea and 6,403 per 100,000 PY for chlamydia in 2012. From 2006 to 2012, the incidence rates among young adults aged 15-19 years were 8,187 and 22,515 per 100,000 PY for gonorrhoea and chlamydia, respectively. Changes in surveillance reporting did not seem to influence the incidence rates for either disease, whereas a change in diagnostic test coincided with an increased incidence of chlamydia. Overall, the incidence of chlamydia in Greenland increased during the study period, whereas the incidence of gonorrhoea decreased until 1995 but increased thereafter. Young adults aged 15-24 years were at highest risk of infection. The increase in incidence rates was independent of changes in case definitions, whereas an observed increase in chlamydia incidence in 2005 coincided with a change in diagnostic test. None of the STI interventions launched after 1995 seemed to coincide with decreasing national incidence rates.

  4. Communicating old-growth forest management on the Allegheny National Forest

    Treesearch

    Brad Nelson; Chris Nowak; Dave deCalesta; Steve Wingate

    1997-01-01

    Successful communication of old-growth management, including the role of silviculture, is achieved by integrating as a working whole the topics addressed in this workshop. We have used research, technology transfer and adaptive management to achieve this integration on the Allegheny National Forest. Program success depends on scientists and practitioners working...

  5. Critical incident reporting and learning.

    PubMed

    Mahajan, R P

    2010-07-01

    The success of incident reporting in improving safety, although obvious in aviation and other high-risk industries, is yet to be seen in health-care systems. An incident reporting system which would improve patient safety would allow front-end clinicians to have easy access for reporting an incident with an understanding that their report will be handled in a non-punitive manner, and that it will lead to enhanced learning regarding the causation of the incident and systemic changes which will prevent it from recurring. At present, significant problems remain with local and national incident reporting systems. These include fear of punitive action, poor safety culture in an organization, lack of understanding among clinicians about what should be reported, lack of awareness of how the reported incidents will be analysed, and how will the reports ultimately lead to changes which will improve patient safety. In particular, lack of systematic analysis of the reports and feedback directly to the clinicians are seen as major barriers to clinical engagement. In this review, robust systematic methodology of analysing incidents is discussed. This methodology is based on human factors model, and the learning paradigm which emphasizes significant shift from traditional judicial approach to understanding how 'latent errors' may play a role in a chain of events which can set up an 'active error' to occur. Feedback directly to the clinicians is extremely important for keeping them 'in the loop' for their continued engagement, and it should target different levels of analyses. In addition to high-level information on the types of incidents, the feedback should incorporate results of the analyses of active and latent factors. Finally, it should inform what actions, and at what level/stage, have been taken in response to the reported incidents. For this, local and national systems will be required to work in close cooperation, so that the lessons can be learnt and actions taken

  6. 76 FR 35467 - Deer and Vegetation Management Plan/Environmental Impact Statement, Fire Island National Seashore...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-17

    ... Plan/Environmental Impact Statement, Fire Island National Seashore, New York AGENCY: National Park... for a Deer and Vegetation Management Plan, Fire Island National Seashore, New York. SUMMARY: Pursuant... preparing an Environmental Impact Statement (EIS) for a Deer and Vegetation Management Plan at Fire Island...

  7. The Incidence and Management of Conflicts in Secular and Non-Secular Tertiary Institutions in South West Nigeria

    ERIC Educational Resources Information Center

    Ayodele, Joseph Babatola; Adewumi, Joseph Olukayode

    2007-01-01

    This paper compared the incidence and management of conflicts in secular and non-secular tertiary institutions in Nigeria. The sample of this study was made of sixty staff, and two hundred and forty students randomly selected each from two secular and two non-secular tertiary institutions in south western Nigeria. A validated questionnaire was…

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

    PubMed

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

    2017-03-01

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

  9. Camping impact management on the Appalachian National Scenic Trail

    USGS Publications Warehouse

    Marion, J.L.

    2003-01-01

    This report addresses the management of overnight use and associated impacts along the Appalachian National Scenic Trail (A.T.). This effort was initiated in response to agency and Appalachian Trail Conference (ATC) management concerns regarding the resource and social impacts of increasing overnight visitation, particularly in high use areas. Report findings and recommendations are primarily based on series of on-site investigations at 17 problem areas selected by A.T. clubs and ATC staff. However, the report?s recommendations also draw on an examination of relevant A.T. legislative, agency, and organization guidance and visitor impact management knowledge derived from research and management experience.

  10. Lithium in drinking water and the incidence of bipolar disorder: A nation-wide population-based study.

    PubMed

    Kessing, Lars V; Gerds, Thomas A; Knudsen, Nikoline N; Jørgensen, Lisbeth F; Kristiansen, Søren M; Voutchkova, Denitza; Ernstsen, Vibeke; Schullehner, Jörg; Hansen, Birgitte; Andersen, Per K; Ersbøll, Annette K

    2017-11-01

    Animal data suggest that subtherapeutic doses, including micro doses, of lithium may influence mood, and lithium levels in drinking water have been found to correlate with the rate of suicide. It has never been investigated whether consumption of lithium may prevent the development of bipolar disorder (primary prophylaxis). In a nation-wide population-based study, we investigated whether long-term exposure to micro levels of lithium in drinking water correlates with the incidence of bipolar disorder in the general population, hypothesizing an inverse association in which higher long-term lithium exposure is associated with lower incidences of bipolar disorder. We included longitudinal individual geographical data on municipality of residence, data from drinking water lithium measurements and time-specific data from all cases with a hospital contact with a diagnosis of mania/bipolar disorder from 1995 to 2013 (N=14 820) and 10 age- and gender-matched controls from the Danish population (N= 140 311). Average drinking water lithium exposure was estimated for all study individuals. The median of the average lithium exposure did not differ between cases with a diagnosis of mania/bipolar disorder (12.7 μg/L; interquartile range [IQR]: 7.9-15.5 μg/L) and controls (12.5 μg/L; IQR: 7.6-15.7 μg/L; P=.2). Further, the incidence rate ratio of mania/bipolar disorder did not decrease with higher long-term lithium exposure, overall, or within age categories (0-40, 41-60 and 61-100 years of age). Higher long-term lithium exposure from drinking water was not associated with a lower incidence of bipolar disorder. The association should be investigated in areas with higher lithium levels than in Denmark. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Effects of national forest-management regimes on unprotected forests of the Himalaya.

    PubMed

    Brandt, Jodi S; Allendorf, Teri; Radeloff, Volker; Brooks, Jeremy

    2017-12-01

    Globally, deforestation continues, and although protected areas effectively protect forests, the majority of forests are not in protected areas. Thus, how effective are different management regimes to avoid deforestation in non-protected forests? We sought to assess the effectiveness of different national forest-management regimes to safeguard forests outside protected areas. We compared 2000-2014 deforestation rates across the temperate forests of 5 countries in the Himalaya (Bhutan, Nepal, China, India, and Myanmar) of which 13% are protected. We reviewed the literature to characterize forest management regimes in each country and conducted a quasi-experimental analysis to measure differences in deforestation of unprotected forests among countries and states in India. Countries varied in both overarching forest-management goals and specific tenure arrangements and policies for unprotected forests, from policies emphasizing economic development to those focused on forest conservation. Deforestation rates differed up to 1.4% between countries, even after accounting for local determinants of deforestation, such as human population density, market access, and topography. The highest deforestation rates were associated with forest policies aimed at maximizing profits and unstable tenure regimes. Deforestation in national forest-management regimes that emphasized conservation and community management were relatively low. In India results were consistent with the national-level results. We interpreted our results in the context of the broader literature on decentralized, community-based natural resource management, and our findings emphasize that the type and quality of community-based forestry programs and the degree to which they are oriented toward sustainable use rather than economic development are important for forest protection. Our cross-national results are consistent with results from site- and regional-scale studies that show forest-management regimes that

  12. Epidemiology Characteristics and Trends of Lung Cancer Incidence in Iran.

    PubMed

    Almasi, Zeinab; Salehiniya, Hamid; Amoori, Neda; Enayatrad, Mostafa

    2016-01-01

    Lung cancer is one of the most common cancers in the world and a major cause of death from cancer. One of the important indicators to compare the prevalence and incidence of the disease is a change in the trend. The aim of this study was to investigate the changes in the incidence of lung cancer in Iran. This study was conducted based on existing data obtained from a national registry of cancer cases and the Disease Management Center of Ministry of Health in Iran. All cases registered in the country were included during 2003-2008. Incidence rates were reported based on the direct method and standard population of World Health Organization. The study also examined the morphology of common lung cancers. Trends in incidence underwent joinpoint regression analysis. Based on the results of this study, 14,403 cases of lung cancer have been recorded of which 10,582 cases were in men and 3,821 in women. Highest incidence rates were observed in the 80-84 age group. Considerable variation across provinces was evident. In females squamous cell carcinoma (SCC) demonstrated a reduction from 24% to 16% of lesions over the period of study, while adenocarcinoma rose from 21% to 29%. In males a similar reduction in SCC was apparent (42% to 29%, again with increase in AC (13 % to 18%). The results show that the increase in the incidence of lung cancer the trend is that more men than women and in men and may be caused by changes in smoking pattern. The incidence of lung cancer in the North West and West provinces was higher than in other regions.

  13. [Analysis of liver cancer incidence and trend in China].

    PubMed

    Zuo, Tingting; Zheng, Rongshou; Zeng, Hongmei; Zhang, Siwei; Chen, Wanqing

    2015-09-01

    The national population-based cancer registration data were used to analyze the liver cancer incidence and trend in China, in order to provide advise for making further strategy on liver cancer prevention and control. Liver cancer data of 2011 were retrieved from the database of the National Cancer Registry. The incident cases of liver cancer were estimated using age-specific rate by urban or rural areas and gender according to the national population in 2011. Liver cancer incidence data from 22 cancer registries were used to analyze the incidence trend during 2000-2011. The estimates of new cases of liver cancer were about 356 thousand in China in 2011. The incidence rate was 26.39/10(5,) and the age-standardized incidence rates by Chinese standard population and by world population were 19.48/10(5) and 19.10/10(5,) respectively.There was an increasing trend of incidence rate of liver cancer in China during 2000-2011 with an average annual percentage change(AAPC) of 1.0% (95%CI: 0.5%-1.4%), 1.2% (95%CI: 0.7%-1.8%)in urban areas and 1.1% (95%CI: 0.5%-1.8%) in rural areas. After age standardization, the incidence rate was significantly decreased, with an AAPC of -1.8% (95%CI: -2.4% to -1.2%), -1.6% (95%CI: -2.2% to -0.9%) in urban and -1.4% (95%CI: -2.5% to -0.3%) in rural areas. Liver cancer is a common cancer in China. As changing in people's dietary habits and implementing neonatal HBV vaccination for years, the exposure to risk factors is reducing, and age-standardized incidence rate is decreasing. While cardinal number of population is big and aging population is growing rapidly in the country, trend of incidence rate is increasing, and the burden of liver cancer is still high in China.

  14. TU-CD-BRD-00: Incident Learning / RO-ILS

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

    NONE

    2015-06-15

    It has long been standard practice in radiation oncology to report internally when a patient’s treatment has not gone as planned and to report events to regulatory agencies when legally required. Most potential errors are caught early and never affect the patient. Quality assurance steps routinely prevent errors from reaching the patient, and these “near misses” are much more frequent than treatment errors. A growing number of radiation oncology facilities have implemented incident learning systems to report and analyze both errors and near misses. Using the term “incident learning” instead of “event reporting” emphasizes the need to use these experiencesmore » to change the practice and make future errors less likely and promote an educational, non-punitive environment. There are challenges in making such a system practical and effective. Speakers from institutions of different sizes and practice environments will share their experiences on how to make such a system work and what benefits their clinics have accrued. Questions that will be addressed include: How to create a system that is easy for front line staff to access How to motivate staff to report How to promote the system as positive and educational and not punitive or demeaning How to organize the team for reviewing and responding to reports How to prioritize which reports to discuss in depth How not to dismiss the rest How to identify underlying causes How to design corrective actions and implement change How to develop useful statistics and analysis tools How to coordinate a departmental system with a larger risk management system How to do this without a dedicated quality manager Some speakers’ experience is with in-house systems and some will share experience with the AAPM/ASTRO national Radiation Oncology Incident Learning System (RO-ILS). Reports intended to be of value nationally need to be comprehensible to outsiders; examples of useful reports will be shown. There will be ample

  15. Progress toward national estimates of police use of force

    PubMed Central

    Garner, Joel H.; Malega, Ronald W.; Maxwell, Christopher D.

    2018-01-01

    This research builds on three decades of effort to produce national estimates of the amount and rate of force used by law enforcement officers in the United States. Prior efforts to produce national estimates have suffered from poor and inconsistent measurements of force, small and unrepresentative samples, low survey and/or item response rates, and disparate reporting of rates of force. The present study employs data from a nationally representative survey of state and local law enforcement agencies that has a high survey response rate as well as a relatively high rate of reporting uses of force. Using data on arrests for violent offenses and the number of sworn officers to impute missing data on uses of force, we estimate a total of 337,590 use of physical force incidents among State and local law enforcement agencies during 2012 with a 95 percent confidence interval of +/- 10,470 incidents or +/- 3.1 percent. This article reports the extent to which the number and rate of force incidents vary by the type and size of law enforcement agencies. Our findings demonstrate the willingness of a large proportion of law enforcement agencies to voluntarily report the amount of force used by their officers and the relative strengths and weaknesses of the Law Enforcement Management and Administrative Statistics (LEMAS) program to produce nationally representative information about police behavior. PMID:29447295

  16. 75 FR 27812 - Final Environmental Impact Statement for the General Management Plan; Harpers Ferry National...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... guidance to park management for administration, development, and interpretation of park resources over the... General Management Plan for Harpers Ferry National Historical Park. SUMMARY: Pursuant to the National... availability of a Final Environmental Impact Statement for the General Management Plan for Harpers Ferry [[Page...

  17. Incidence and Characteristics of Injuries during the 2010 FELDA/FAM National Futsal League in Malaysia

    PubMed Central

    A. Hamid, Mohamad Shariff; Jaafar, Zulkarnain; Mohd Ali, Azril Syazwan

    2014-01-01

    Objective In Malaysia, futsal is a popular sport played by individuals across all ages and genders. Despite its popularity, information on futsal related injury in Malaysia is not available. The purpose of this study is to examine the injury incidence and injury patterns among amateur men and women futsal players in Malaysia. Methods Players reported injury to the tournament medical team during the FELDA/FAM National Futsal League 2010 were interviewed and assessed by a Sports Medicine registrar. Player's socio-demographic profiles and information about the injury were documented in the injury report form adapted from medical report form used by FIFA: Medical Assessment and Research Centre (F-Marc). Results A total of 86 injuries were reported from 141 matches, equivalent to an incidence of 91.5 injuries per 1000 player hours (95% CI 72.2 to 110.8), or 61.0 injuries per 1000 player matches (95% CI 48.1 to 73.9). Most were minor injuries resulted from contact with another player. Injuries often involved the lower extremity (44%) followed by the trunk (14%) and the upper limb (13%). Ankle (n = 7; 39%) and knee (n = 6; 33%) sprains were the most prevalent diagnoses of time-loss injuries. A significant association between time-loss and type of injury was found χ 2 (1,N = 86) = 3.99, p = 0.04. In addition, time-loss injury was significantly associated with playing surface χ 2 (1,N = 86) = 10.11, p = 0.018. Conclusion The injury rate during the FELDA/FAM National Amateur Futsal Men's League in Malaysia was lower compared with previous Futsal World Cups competition. Most injuries resulted from contact with another player were minor and did not lead to time-loss from participation. Time-loss injury was significantly associated with type of injury and playing surface. PMID:24733140

  18. Incidence and characteristics of injuries during the 2010 FELDA/FAM National Futsal League in Malaysia.

    PubMed

    Hamid, Mohamad Shariff A; Jaafar, Zulkarnain; Mohd Ali, Azril Syazwan

    2014-01-01

    In Malaysia, futsal is a popular sport played by individuals across all ages and genders. Despite its popularity, information on futsal related injury in Malaysia is not available. The purpose of this study is to examine the injury incidence and injury patterns among amateur men and women futsal players in Malaysia. Players reported injury to the tournament medical team during the FELDA/FAM National Futsal League 2010 were interviewed and assessed by a Sports Medicine registrar. Player's socio-demographic profiles and information about the injury were documented in the injury report form adapted from medical report form used by FIFA: Medical Assessment and Research Centre (F-Marc). A total of 86 injuries were reported from 141 matches, equivalent to an incidence of 91.5 injuries per 1000 player hours (95% CI 72.2 to 110.8), or 61.0 injuries per 1000 player matches (95% CI 48.1 to 73.9). Most were minor injuries resulted from contact with another player. Injuries often involved the lower extremity (44%) followed by the trunk (14%) and the upper limb (13%). Ankle (n = 7; 39%) and knee (n = 6; 33%) sprains were the most prevalent diagnoses of time-loss injuries. A significant association between time-loss and type of injury was found χ2 (1,N = 86) = 3.99, p = 0.04. In addition, time-loss injury was significantly associated with playing surface χ2 (1,N = 86) = 10.11, p = 0.018. The injury rate during the FELDA/FAM National Amateur Futsal Men's League in Malaysia was lower compared with previous Futsal World Cups competition. Most injuries resulted from contact with another player were minor and did not lead to time-loss from participation. Time-loss injury was significantly associated with type of injury and playing surface.

  19. ECOSYSTEM RESTORATION RESEARCH THROUGH THE NATIONAL RISK MANAGEMENT RESEARCH LABORATORY (NRMRL)

    EPA Science Inventory

    The Ecosystem Restoration Research Program underway through ORD's National Risk Management Research Laboratory (NRMRL) has the long-term goal of providing watershed managers with "..state-of-the-science field-evaluated tools, technical guidance, and decision-support systems for s...

  20. Effect of management practices and animal age on incidence of mastitis in Nili Ravi buffaloes.

    PubMed

    Ali, Tariq; Rahman, Abdur; Qureshi, Muhammand Subhan; Hussain, Muhammad Tariq; Khan, Muhammad Shauib; Uddin, Siraj; Iqbal, Muhammad; Han, Bo

    2014-10-01

    Buffalo is an economically important dairy animal in South Asia but mostly ignored in research priorities. In this retrospective study, the effect of management practices and age of animal on the incidence of mastitis in Nili Ravi buffaloes was investigated. A total of 1,560 quarters of buffaloes (n = 390) were screened by visual examination of the udder and milk (clinical mastitis) and California mastitis test (subclinical mastitis). Household data was collected on a predesigned questionnaire and analyzed. The prevalence of subclinical mastitis, clinical mastitis, and blind quarters was 41.8, 13.6, and 9.7 %, respectively. The highest prevalence was noted in the hind quarters and left side as compared to that in the forequarters and right side. This data significantly (p < 0.05) supported the idea that larger herd size has more chances of mastitis, with the highest prevalence (40, 32, and 27 %) in the large, medium, and small herds, respectively. Stage of lactation was significantly (p < 0.01) involved in mastitis, and the highest incidence (43.3 %) was noted in early lactation. Milk production of lactating buffaloes that ranged 6-10 l/day showed a higher rate of mastitis occurrence (p < 0.05). The cleanliness condition of a farm also contributed significantly. Animal age significantly affected the incidence of mastitis. Results revealed that age of the animal has a positive correlation (R (2) = 0.772) with mastitis. This study concluded that some factors alone or in combination with other factors influence significantly the occurrence of mastitis, and to minimize the infection, these factors should be considered. The outcome of the study will be valuable for policy-making for positive management practices and implementation of preventive measures.

  1. Working relationships between obstetric care staff and their managers: a critical incident analysis.

    PubMed

    Chipeta, Effie; Bradley, Susan; Chimwaza-Manda, Wanangwa; McAuliffe, Eilish

    2016-08-26

    Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi's disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers. A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres' providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software. Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers' lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post. Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers' job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi.

  2. 76 FR 3652 - Dog Management Plan/Environmental Impact Statement, Golden Gate National Recreation Area, California

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-20

    ... DEPARTMENT OF THE INTERIOR National Park Service [8145-8B90-SZM] Dog Management Plan/Environmental...: Notice of Availability of a Draft Environmental Impact Statement for the Dog Management Plan, Golden Gate... the Dog Management Plan (Draft Plan/EIS), Golden Gate National Recreation Area (GGNRA), California...

  3. Medical management of acute radiation syndrome and associated infections in a high-casualty incident.

    PubMed

    Dainiak, Nicholas

    2018-04-01

    A high-casualty incident may result in a significant human toll due to the inability of a community to meet the health care demands of the population. A successful medical response requires health care facilities to not only communicate and integrate medical services, meet surge capacity, protect health care workers and implement triage and treatment protocols, but also to provide the venue for clinical management of acute radiation injuries and their associated infections. Today, clinical management is primarily guided by the recommendations of a Consultancy that were made at the World Health Organization (WHO). This international consensus was reached on evidence-based, clinical management of each of the four sub-syndromes that compose acute radiation syndrome (ARS), including the hematopoietic subsyndrome (HS), gastrointestinal subsyndrome (GIS), neurovascular subsyndrome (NVS) and cutaneous subsyndrome (CS). Major findings in studies meeting inclusion criteria for management strategies for HS were that (i) no randomized controlled studies of medical countermeasures have been (or will likely ever be) performed for ARS cases, (ii) the data for management of HS are restricted by the lack of comparator groups, and (iii) reports of countermeasures for management of injury to non-hematopoietic organs are often incompletely described. Here, (i) recommendations made in Geneva are summarized; (ii) the analysis of countermeasures for HS is updated by review of two additional cases and extended to published reports not meeting inclusion criteria; and (iii) guidelines are provided for management of microbial infections based upon patient risk for prolonged immunosuppression.

  4. Research to guide trail management at Acadia National Park, Maine

    Treesearch

    Kelly Goonan; Robert Manning; William Valliere

    2009-01-01

    Acadia National Park, Maine, is the tenth most-visited national park in the United States. Managers face the challenge of protecting the park's trail system from damage while maintaining a high quality recreation experience. For this study, an initial phase of research was conducted to identify potential indicators of quality for trail resources and the visitor...

  5. 76 FR 22917 - Dog Management Plan/Draft Environmental Impact Statement, Golden Gate National Recreation Area...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-25

    ... DEPARTMENT OF THE INTERIOR National Park Service [NPS-PWR-PWRO--0315-696; 8145-8B90-SZM] Dog... Impact Statement/Dog Management Plan, Golden Gate National Recreation Area. SUMMARY: The National Park Service has prepared a Draft Dog Management Plan and Environmental Impact Statement (Plan/DEIS). The Plan...

  6. Spectrum Management Guidelines for National and Service Test and Training Ranges

    DTIC Science & Technology

    2017-07-12

    GPS Global Positioning System ISM Installation Spectrum Manager JTIDS Joint Tactical Information Distribution System KMR Kwajalein Missile Range... information UAV unmanned aerial vehicle US&P United States and Possessions Spectrum Management Guidelines for National and Service Test and Training...frequency deconfliction processes. The AFC will inform the range or center commander and the Installation Spectrum Manager (ISM) at the

  7. Epidemiologic Measures for Quantifying the Incidence of Concussion in National Collegiate Athletic Association Sports.

    PubMed

    Kerr, Zachary Y; Roos, Karen G; Djoko, Aristarque; Dalton, Sara L; Broglio, Steven P; Marshall, Stephen W; Dompier, Thomas P

    2017-03-01

    Injury rates compare the relative frequency of sport-related concussions across groups. However, they may not be intuitive to policy makers, parents, or coaches in understanding the likelihood of concussion. To describe 4 measures of incidence (athlete-based rate, athlete-based risk, team-based rate, and team-based risk) during the 2011-2012 through 2014-2015 academic years.  Descriptive epidemiology study. Aggregate injury and exposure data collected from the National Collegiate Athletic Association Injury Surveillance Program in 13 sports (men's baseball, basketball, football, ice hockey, lacrosse, soccer, and wrestling and women's basketball, ice hockey, lacrosse, soccer, softball, and volleyball). Collegiate student-athletes. Sport-related concussion data from the National Collegiate Athletic Association Injury Surveillance Program during the 2011-2012 through 2014-2015 academic years were analyzed. We calculated concussion rates per 1000 athlete-exposures (AEs), concussion risk, average number of concussions per team, and percentage of teams with at least 1 concussion. During the 2011-2012 through 2014-2015 academic years, 1485 concussions were sustained by 1410 student-athletes across 13 sports. Concussion rates ranged from 0.09/1000 AEs in men's baseball to 0.89/1000 AEs in men's wrestling. Concussion risk ranged from 0.74% in men's baseball to 7.92% in men's wrestling. The average ± SD number of concussions per team ranged from 0.25 ± 0.43 in men's baseball to 5.63 ± 5.36 in men's football. The percentage of teams with a concussion ranged from 24.5% in men's baseball to 80.6% in men's football.   Although men's wrestling had a higher concussion rate and risk, men's football had the largest average number of concussions per team and the largest percentage of teams with at least 1 concussion. The risk of concussion, average number of concussions per team, and percentage of teams with concussions may be more intuitive measures of incidence for decision

  8. Cancer incidence following infectious mononucleosis.

    PubMed

    Carter, C D; Brown, T M; Herbert, J T; Heath, C W

    1977-01-01

    By means of a mailed questionnaire, the investigators examined the incidence of cancer among 2282 former college students in whom heterophile-positive infectious mononucleosis (IM) was diagnosed between 1949 and 1969 at five U.S. universities. Cancer incidence among these IM cases was compared both with national incidence rates and with an age and sex-matched group of 2779 non-IM students. No significant increase in cancer incidence was found. Three cases of Hodgkin's disease (HD) had occurred in the IM group (1.3 cases expected) and one case in the control group. All three post-IM cases of HD were in males. Intervals between diagnoses of IM and HD were three, four, and seven years, respectively. Only two other cases of lymphoma or leukemia were observed, and both were in the control group.

  9. Exploring the perception of aid organizations' staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study.

    PubMed

    Bazeli, Javad; Aryankhesal, Aidin; Khorasani-Zavareh, Davoud

    2017-07-01

    Traffic incidents are of main health issues all around the world and cause countless deaths, heavy casualties, and considerable tangible and intangible damage. In this regard, mass casualty traffic incidents are worthy of special attention as, in addition to all losses and damage, they create challenges in the way of providing health services to the victims. The present study is an attempt to explore the challenges and facilitators in management of mass casualty traffic incidents in Iran. This qualitative grounded theory study was carried out with participation of 14 purposively selected experienced managers, paramedics and staff of aid organizations in different provinces of Iran in 2016. Semi-structured interviews were conducted in order to develop the theory. The transcribed interviews were analyzed through open, axial and selective coding. Despite the recent and relatively good improvements in facilities and management procedure of mass casualty traffic incidents in Iran, several problems such as lack of coordination, lack of centralized and integrated command system, large number of organizations participating in operations, duplicate attempts and parallel operations carried out by different organizations, intervention of lay people, and cultural factors halt provision of effective health services to the victims. It is necessary to improve the theoretical and practical knowledge of the relief personnel and paramedics, provide public with education about first aid and improve driving culture, prohibit laypeople from intervening in aid operations, and increase quality and quantity of aid facilities.

  10. Sandia National Laboratories California Waste Management Program Annual Report February 2008.

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

    Brynildson, Mark E.

    The annual program report provides detailed information about all aspects of the Sandia National Laboratories, California (SNL/CA) Waste Management Program. It functions as supporting documentation to the SNL/CA Environmental Management System Program Manual. This annual program report describes the activities undertaken during the past year, and activities planned in future years to implement the Waste Management (WM) Program, one of six programs that supports environmental management at SNL/CA.

  11. NRMRL SCIENCE PUBLICATIONS (NATIONAL RISK MANAGEMENT RESEARCH LABORATORY, EPA, CINCINNATI, OH)

    EPA Science Inventory

    The National Risk Management Research Laboratory (NRMRL)is the U.S.EPA's center for investigating technological and management approaches for preventing and reducing risks from pollution that threaten human health and the environment. The focus of the Laboratory's research progra...

  12. QUALITY MANAGEMENT PLAN FOR THE NATIONAL CHILDREN'S STUDY

    EPA Science Inventory

    EPA has taken the lead, in consort with NIH, in developing the Quality Management Plan (QMP) for the National Children's Study (NCS); the QMP will delineate a systematic planning process for the implementation of the NCS. The QMP will state the goals and objectives of the NCS, th...

  13. Incidence and risk factors of homicide-suicide in Swiss households: National Cohort study.

    PubMed

    Panczak, Radoslaw; Zwahlen, Marcel; Spoerri, Adrian; Tal, Kali; Killias, Martin; Egger, Matthias

    2013-01-01

    Homicide-suicides are rare but catastrophic events. This study examined the epidemiology of homicide-suicide in Switzerland. The study identified homicide-suicide events 1991-2008 in persons from the same household in the Swiss National Cohort, which links census and mortality records. The analysis examined the association of the risk of dying in a homicide-suicide event with socio-demographic variables, measured at the individual-level, household composition variables and area-level variables. Proportional hazards regression models were calculated for male perpetrators and female victims. Results are presented as age-adjusted hazard ratios (HR) with 95% confidence intervals (95%CI). The study identified 158 deaths from homicide-suicide events, including 85 murder victims (62 women, 4 men, 19 children and adolescents) and 68 male and 5 female perpetrators. The incidence was 3 events per million households and year. Firearms were the most prominent method for both homicides and suicides. The risk of perpetrating homicide-suicide was higher in divorced than in married men (HR 3.64; 95%CI 1.56-8.49), in foreigners without permanent residency compared to Swiss citizens (HR 3.95; 1.52-10.2), higher in men without religious affiliations than in Catholics (HR 2.23; 1.14-4.36) and higher in crowded households (HR 4.85; 1.72-13.6 comparing ≥2 with <1 persons/room). There was no association with education, occupation or nationality, the number of children, the language region or degree of urbanicity. Associations were similar for female victims. This national longitudinal study shows that living conditions associated with psychological stress and lower levels of social support are associated with homicide-suicide events in Switzerland.

  14. 76 FR 10338 - Evaluation of State Coastal Management Programs and National Estuarine Research Reserves

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-24

    ... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration Evaluation of State Coastal... Administration (NOAA), Office of Ocean and Coastal Resource Management, National Ocean Service, Commerce. ACTION... to its Reserve final management plan approved by the Secretary of Commerce, and adhered to the terms...

  15. Targeting safety improvements through identification of incident origination and detection in a near-miss incident learning system.

    PubMed

    Novak, Avrey; Nyflot, Matthew J; Ermoian, Ralph P; Jordan, Loucille E; Sponseller, Patricia A; Kane, Gabrielle M; Ford, Eric C; Zeng, Jing

    2016-05-01

    Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflecting potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically during the documentation of

  16. Trends and variations in breast and colorectal cancer incidence from 1995 to 2011: A comparative study between Texas Cancer Registry and National Cancer Institute’s Surveillance, Epidemiology and End Results data

    PubMed Central

    LIU, ZHEYU; ZHANG, YEFEI; FRANZIN, LUISA; CORMIER, JANICE N.; CHAN, WENYAW; XU, HUA; DU, XIANGLIN L.

    2015-01-01

    Few studies have examined the cancer incidence trends in the state of Texas, and no study has ever been conducted to compare the temporal trends of breast and colorectal cancer incidence in Texas with those of the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) in the United States. This study aimed to conduct a parallel comparison between the Texas Cancer Registry and the National Cancer Institute’s SEER on cancer incidence from 1995 to 2011. A total of 951,899 breast and colorectal cancer patients were included. Age-adjusted breast cancer incidence was 134.74 per 100,000 in Texas and 131.78 per 100,000 in SEER in 1995–2011, whereas age-adjusted colorectal cancer incidence was 50.52 per 100,000 in Texas and 49.44 per 100,000 in SEER. Breast cancer incidence increased from 1995 to 2001, decreased from 2002 to 2006, and then remained relatively stable from 2007 to 2011. For colorectal cancer, the incidence increased in 1995–1997, and then decreased continuously from 1998 to 2011 in Texas and SEER areas. Incidence rates and relative risks by age, gender and ethnicity were identical between Texas and SEER. PMID:25672365

  17. Idaho National Laboratory Cultural Resource Management Annual Report FY 2007

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

    Julie Braun; Hollie Gilbert; Dino Lowrey

    2008-03-01

    The Idaho National Laboratory (INL) Site is home to vast numbers and a wide variety of important cultural resources representing at least a 13,500-year span of human land use in the region. As a federal agency, the Department of Energy Idaho Operations Office has legal responsibility for the management and protection of those resources and has delegated these responsibilities to its primary contractor, Battelle Energy Alliance (BEA). The BEA professional staff is committed to maintaining a cultural resource management program that accepts these challenges in a manner reflecting the resources’ importance in local, regional, and national history. This annual reportmore » summarizes activities performed by the INL Cultural Resource Management Office (CRMO) staff during fiscal year 2007. This work is diverse, far-reaching and though generally confined to INL cultural resource compliance, also includes a myriad of professional and voluntary community activities. This document is intended to be both informative to internal and external stakeholders, and to serve as a planning tool for future cultural resource management work to be conducted on the INL.« less

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

    DTIC Science & Technology

    2010-07-01

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

  19. A remotely piloted aircraft system in major incident management: concept and pilot, feasibility study.

    PubMed

    Abrahamsen, Håkon B

    2015-06-10

    Major incidents are complex, dynamic and bewildering task environments characterised by simultaneous, rapidly changing events, uncertainty and ill-structured problems. Efficient management, communication, decision-making and allocation of scarce medical resources at the chaotic scene of a major incident is challenging and often relies on sparse information and data. Communication and information sharing is primarily voice-to-voice through phone or radio on specified radio frequencies. Visual cues are abundant and difficult to communicate between teams and team members that are not co-located. The aim was to assess the concept and feasibility of using a remotely piloted aircraft (RPA) system to support remote sensing in simulated major incident exercises. We carried out an experimental, pilot feasibility study. A custom-made, remotely controlled, multirotor unmanned aerial vehicle with vertical take-off and landing was equipped with digital colour- and thermal imaging cameras, a laser beam, a mechanical gripper arm and an avalanche transceiver. We collected data in five simulated exercises: 1) mass casualty traffic accident, 2) mountain rescue, 3) avalanche with buried victims, 4) fisherman through thin ice and 5) search for casualties in the dark. The unmanned aerial vehicle was remotely controlled, with high precision, in close proximity to air space obstacles at very low levels without compromising work on the ground. Payload capacity and tolerance to wind and turbulence were limited. Aerial video, shot from different altitudes, and remote aerial avalanche beacon search were streamed wirelessly in real time to a monitor at a ground base. Electromagnetic interference disturbed signal reception in the ground monitor. A small remotely piloted aircraft can be used as an effective tool carrier, although limited by its payload capacity, wind speed and flight endurance. Remote sensing using already existing remotely piloted aircraft technology in pre

  20. The effect of case management and vector-control interventions on space-time patterns of malaria incidence in Uganda.

    PubMed

    Ssempiira, Julius; Kissa, John; Nambuusi, Betty; Kyozira, Carol; Rutazaana, Damian; Mukooyo, Eddie; Opigo, Jimmy; Makumbi, Fredrick; Kasasa, Simon; Vounatsou, Penelope

    2018-04-12

    Electronic reporting of routine health facility data in Uganda began with the adoption of the District Health Information Software System version 2 (DHIS2) in 2011. This has improved health facility reporting and overall data quality. In this study, the effects of case management with artemisinin-based combination therapy (ACT) and vector control interventions on space-time patterns of disease incidence were determined using DHIS2 data reported during 2013-2016. Bayesian spatio-temporal negative binomial models were fitted on district-aggregated monthly malaria cases, reported by two age groups, defined by a cut-off age of 5 years. The effects of interventions were adjusted for socio-economic and climatic factors. Spatial and temporal correlations were taken into account by assuming a conditional autoregressive and a first-order autoregressive AR(1) process on district and monthly specific random effects, respectively. Fourier trigonometric functions were incorporated in the models to take into account seasonal fluctuations in malaria transmission. The temporal variation in incidence was similar in both age groups and depicted a steady decline up to February 2014, followed by an increase from March 2015 onwards. The trends were characterized by a strong bi-annual seasonal pattern with two peaks during May-July and September-December. Average monthly incidence in children < 5 years declined from 74.7 cases (95% CI 72.4-77.1) in 2013 to 49.4 (95% CI 42.9-55.8) per 1000 in 2015 and followed by an increase in 2016 of up to 51.3 (95% CI 42.9-55.8). In individuals ≥ 5 years, a decline in incidence from 2013 to 2015 was followed by an increase in 2016. A 100% increase in insecticide-treated nets (ITN) coverage was associated with a decline in incidence by 44% (95% BCI 28-59%). Similarly, a 100% increase in ACT coverage reduces incidence by 28% (95% BCI 11-45%) and 25% (95% BCI 20-28%) in children < 5 years and individuals ≥ 5 years, respectively

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

    PubMed Central

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

    2014-01-01

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

  2. UK national survey of management of breast lobular carcinoma in situ.

    PubMed

    Chester, R; Bokinni, O; Ahmed, I; Kasem, A

    2015-11-01

    There is no national standard treatment for patients with breast lobular carcinoma in situ (LCIS). Association of Breast Surgery guidelines for the management of breast cancer suggest that lesions containing LCIS should be excised for definitive diagnosis and recommend close surveillance after excision biopsy. The aim of this study was to form a picture of the current management of LCIS by UK breast surgeons. A questionnaire about the management of LCIS was sent to 490 UK breast surgeons. Of 490 questionnaires sent out, 173 (35%) were returned. When LCIS is present in a core biopsy, 61% of breast surgeons perform surgical excision, 22% would not excise but would continue follow-up and the remainder perform neither or set no clear management plan. Over half (54%) follow patients up with five years of annual mammography. If classic LCIS were found at the margins of wide local excision, 92% would not re-excise. Conversely, if pleomorphic LCIS were found, 71% would achieve clear margins. Respondents were split evenly regarding management of classic LCIS with a family history as 54% would not alter management whereas 43% would treat the disease more aggressively. Our survey has shown that in cases where LCIS is found at core biopsy, most surgeons follow Association of Breast Surgery guidance, obtaining further histological samples to exclude pleomorphic LCIS, ductal carcinoma in situ or invasive cancer, whereas others opt for annual surveillance and some discharge the patient. This study highlighted the huge variability in LCIS management, and the need for randomised controlled trials and input into national audits such as the Sloane Project to establish evidence-based national standard guidelines.

  3. Public attitudes toward forest management: a Shawnee National Forest example

    Treesearch

    Joanne Vining

    2003-01-01

    One of the fundamental problems of modern public lands management is the accurate and representative assessment of public opinion. The purpose of this study was to examine differences in perceptions and attitudes of Shawnee National Forest management activities and plans among members of local and regional publics. A survey was administered to members of the public in...

  4. 75 FR 52710 - Notice of Request for Extension of Approval of an Information Collection; National Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-27

    ...] Notice of Request for Extension of Approval of an Information Collection; National Management Information... approval of an information collection associated with cooperative wildlife damage management programs...: For information on the national management information system for cooperative wildlife damage...

  5. The incidence of Kawasaki disease after vaccination within the UK pre-school National Immunisation Programme: an observational THIN database study.

    PubMed

    Hall, Gillian C; Tulloh, Robert Mr; Tulloh, Louise E

    2016-11-01

    To provide expected incidence rates of Kawasaki disease after vaccination in routine clinical practice and as recommended within a pre-school National Immunisation Programme (NIP). A post-immunisation risk period when Kawasaki disease onset might be associated with vaccination was defined as 28 days. Immunisation records for children under 6 years were identified from The Health Improvement Network (THIN) database of electronic UK primary health care records (2008-2012) and linked to previously validated cases of Kawasaki disease with an assigned date of onset. Kawasaki disease incidence in the risk period after a complete NIP recommended set of vaccinations was estimated for five vaccination stages individually and in total. A total of 642 170 complete pre-school immunisation stages from 275 986 children were included. Six cases of Kawasaki disease had onset in the risk period after any NIP stage providing an incidence of 12.8 per 100 000 person years (95%CI 5.7, 28.4). The incidence after any single immunisation stage ranged from 0 to 27.4 (95%CI 8.8, 84.8) per 100 000 person years. There were few cases of Kawasaki disease in the risk period after any NIP vaccination combination. The incidence rates will aid in the interpretation of clinical trials and post-marketing surveillance of new vaccines. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  6. [Multicentre study of infection incidence in knee prosthesis].

    PubMed

    Jaén, F; Sanz-Gallardo, M I; Arrazola, M P; García de Codes, A; de Juanes, A; Resines, C

    2012-01-01

    To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures. Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.

  7. Longitudinal relationship between traumatic brain injury and the risk of incident optic neuropathy: A 10-year follow-up nationally representative Taiwan survey

    PubMed Central

    Chen, Ying-Jen; Liang, Chang-Min; Tai, Ming-Cheng; Chang, Yun-Hsiang; Lin, Tzu-Yu; Chung, Chi-Hsiang; Lin, Fu-Huang; Tsao, Chang-Huei; Chien, Wu-Chien

    2017-01-01

    Accumulating evidences had shown that traumatic brain injury was associated with visual impairment or vision loss. However, there were a limited number of empirical studies regarding the longitudinal relationship between traumatic brain injury and incident optic neuropathy. We studied a cohort from the Taiwanese National Health Insurance data comprising 553918 participants with traumatic brain injury and optic neuropathy-free in the case group and 1107836 individuals without traumatic brain injury in the control group from 1st January 2000. After the index date until the end of 2010, Cox proportional hazards analysis was used to compare the risk of incident optic neuropathy. During the follow-up period, case group was more likely to develop incident optic neuropathy (0.24%) than the control group (0.11%). Multivariate Cox regression analysis demonstrated that the case group had a 3-fold increased risk of optic neuropathy (HR = 3.017, 95% CI = 2.767–3.289, p < 0.001). After stratification by demographic information, traumatic brain injury remained a significant factor for incident optic neuropathy. Our study provided evidence of the increased risk of incident optic neuropathy after traumatic brain injury during a 10-year follow-up period. Patients with traumatic brain injury required periodic and thorough eye examinations for incident optic neuropathy to prevent potentially irreversible vision loss. PMID:29156847

  8. Cape Cod National Seashore parking management system pilot synthesis

    DOT National Transportation Integrated Search

    2013-12-27

    The Cape Cod National Seashore (CACO) has undertaken a program to improve parking management at its beach parking lots, and to provide information about parking availability to CACO visitors. This project will build upon work already accomplished, to...

  9. 77 FR 71774 - Notice of Request for Extension of Approval of an Information Collection; National Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-04

    ...] Notice of Request for Extension of Approval of an Information Collection; National Management Information... approval of an information collection associated with cooperative wildlife damage management programs... FURTHER INFORMATION CONTACT: For information on the national management information system for cooperative...

  10. Metabolic syndrome and incidence of breast cancer in middle-aged Korean women: a nationwide cohort study.

    PubMed

    Lee, Jung Ah; Yoo, Jung Eun; Park, Hye Soon

    2017-04-01

    To evaluate the risk of breast cancer in middle-aged women with metabolic syndrome using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We analyzed 23,820 women aged 50-64 years who participated in the NHIS-NCS in 2008 and 2009. We excluded subjects with any previous history of cancer or with inadequate information regarding metabolic syndrome. Participated subjects underwent anthropometric measurements and provided fasting blood samples for the assessment of glucose and lipid profiles, and answered a lifestyle questionnaire. Cox regression analysis was performed to evaluate relative risks (RRs) and 95% confidence intervals (CIs) for the association between metabolic syndrome and breast cancer. During the 5-year follow-up, 131 subjects were newly diagnosed with breast cancer (incidence, 10.86 per 10,000 person years). After adjusting for age and body mass index, the RR for incident breast cancer in participants with metabolic syndrome versus those without it was 1.47 (95% CI 1.01-2.13). For those individuals of metabolic syndrome, hyperglycemia was most primarily related with the incidence of breast cancer (RR 1.44, 95% CI 1.02-2.04). Among the study individuals who were middle-aged Korean women, metabolic syndrome is highly related with the risk of breast cancer. Therefore, it needs to be managed or prevented to reduce the incidence of breast cancer.

  11. Regional variation in thyroid cancer incidence in Belgium is associated with variation in thyroid imaging and thyroid disease management.

    PubMed

    Van den Bruel, Annick; Francart, Julie; Dubois, Cecile; Adam, Marielle; Vlayen, Joan; De Schutter, Harlinde; Stordeur, Sabine; Decallonne, Brigitte

    2013-10-01

    Increased thyroid cancer incidence is at least partially attributed to increased detection and shows considerable regional variation. We investigated whether regional variation in cancer incidence was associated with variations in thyroid disease management. We conducted a retrospective population-based cohort study that involved linking data from the Belgian Health Insurance database and the Belgian Cancer Registry to compare thyroid-related procedures between regions with high and low cancer incidence. Primary outcome measures were rates of TSH testing, imaging, fine-needle aspiration cytology (FNAC), and thyroid surgery. Secondary study outcomes were proportions of subjects with thyrotoxicosis and nodular disease treated with surgery, of subjects treated with surgery preceded by FNAC or with synchronous lymph node dissection, and of thyroid cancer diagnosis after surgery. The rate of TSH testing was similar, but the rate of imaging was lower in the low incidence region. The rate of FNAC was similar, whereas the rate of surgery was lower in the low incidence region (34 [95% CI 33; 35 ] vs 80 [95% CI 79; 81 ] per 100,000 person years in the high incidence region; P < .05). In the low incidence region compared to the high incidence region, surgery represented a less chosen therapy for euthyroid nodular disease patients (47% [95% CI 46; 48] vs 69% [95% CI 68; 70]; P < .05), proportionally more surgery was preceded by FNAC, more cancer was diagnosed after total thyroidectomy, and thyroid cancer patients had more preoperative FNAC and synchronous lymph node dissection. Regional variation in thyroid cancer incidence, most marked for low-risk disease, is associated with different usage of thyroid imaging and surgery, supporting variable detection as a key determinant in geographic variation.

  12. Proceedings: national workshop on recreation research and management.

    Treesearch

    Linda E. Kruger; Rhonda Mazza; Kelly Lawrence

    2007-01-01

    Given increasing need and decreasing capacity, the Forest Service outdoor recreation research program must strategize how best to address current and future priorities. The papers compiled here were presented at the National Workshop on Recreation Research and Management held in Portland, Oregon, February 8-10, 2005. Papers are organized around four themes:...

  13. Incidence and characteristics of chemical burns.

    PubMed

    Koh, Dong-Hee; Lee, Sang-Gil; Kim, Hwan-Cheol

    2017-05-01

    Chemical burns can lead to serious health outcomes. Previous studies about chemical burns have been performed based on burn center data so these studies have provided limited information about the incidence of chemical burns at the national level. The aim of this study was to evaluate the incidence and characteristics of chemical burns using nationwide databases. A cohort representing the Korean population, which was established using a national health insurance database, and a nationwide workers' compensation database were used to evaluate the incidence and characteristics of chemical burns. Characteristics of the affected body region, depth of burns, industry, task, and causative agents were analyzed from two databases. The incidence of chemical burns was calculated according to employment status. The most common regions involving chemical burns with hospital visits were the skin followed by the eyes. For skin lesions, the hands and wrists were the most commonly affected regions. Second degree burns were the most common in terms of depth of skin lesions. The hospital visit incidence was 1.96 per 10,000 person-year in the general population. The compensated chemical burns incidence was 0.17 per 10,000 person-year. Employees and the self-employed showed a significantly increased risk of chemical burns undergoing hospital visits compared to their dependents. Chemical burns on the skin and eyes are almost equally prevalent. The working environment was associated with increased risk of chemical burns. Our results may aid in estimating the size of the problem and prioritizing prevention of chemical burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  14. Regional economic impacts of current and proposed management alternatives for Don Edwards National Wildlife Refuge

    USGS Publications Warehouse

    Richardson, Leslie; Huber, Chris; Koontz, Lynne

    2012-01-01

    The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a Refuge and provide long-range guidance and management direction to achieve refuge purposes. The Don Edwards San Francisco Bay National Wildlife Refuge, located at the south end of California's San Francisco Bay and one of seven refuges in the San Francisco Bay National Wildlife Refuge Complex, is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan must contain an analysis of expected effects associated with current and proposed Refuge management strategies. For Refuge Comprehensive Conservation Plan planning, a regional economic analysis provides a means of estimating how current management (No Action Alternative) and proposed management activities (alternatives) affect the local economy. This type of analysis provides two critical pieces of information: (1) it illustrates the Don Edwards San Francisco Bay National Wildlife Refuge's contribution to the local community, and (2) it can help in determining whether economic effects are or are not a real concern in choosing among management alternatives. This report first presents a description of the local community and economy near the Don Edwards San Francisco Bay National Wildlife Refuge. Next, the methods used to conduct a regional economic impact analysis are described. An analysis of the final Comprehensive Conservation Plan management strategies that could affect stakeholders, residents, and the local economy is then presented. The management activities of economic concern in this analysis are: * Spending in the local community by Refuge visitors; * Refuge personnel salary spending; and * Refuge purchases of goods and services within the local

  15. Decision modeling for fire incident analysis

    Treesearch

    Donald G. MacGregor; Armando González-Cabán

    2009-01-01

    This paper reports on methods for representing and modeling fire incidents based on concepts and models from the decision and risk sciences. A set of modeling techniques are used to characterize key fire management decision processes and provide a basis for incident analysis. The results of these methods can be used to provide insights into the structure of fire...

  16. Leading and Managing: Effects of Context, Culture, and Gender.

    ERIC Educational Resources Information Center

    Bolman, Lee G.; Deal, Terrence E.

    1992-01-01

    Examines the relationship between management and leadership for school administrators in the United States and in Singapore. In both places, administrators were asked to write accounts of challenging leadership incidents. Analyses of cognitive patterns indicate that national boundaries make a difference, and the patterns for managerial and…

  17. Herpetology of the Coronado National Forest: managing our natural heritage

    Treesearch

    Lawrence L. C. Jones; Charles W. Painter

    2005-01-01

    The Coronado National Forest (CNF) is the primary public land management agency for the United States’ portion of the Madrean Archipelago. The region has a large diversity of amphibians and reptiles, with approximately 110 native species occurring on the CNF. Management of the CNF’s herpetofauna is regulated primarily by environmental laws and policies. Sixteen taxa...

  18. 76 FR 23623 - Backcountry Management Plan, Environmental Impact Statement, Grand Canyon National Park, Arizona

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-27

    ... DEPARTMENT OF THE INTERIOR National Park Service Backcountry Management Plan, Environmental Impact Statement, Grand Canyon National Park, Arizona AGENCY: National Park Service, Department of the Interior..., Grand Canyon National Park. SUMMARY: Pursuant to the National Environmental Policy Act of 1969 (42 U.S.C...

  19. Results of an online questionnaire to survey calf management practices on dairy cattle breeding farms in Austria and to estimate differences in disease incidences depending on farm structure and management practices.

    PubMed

    Klein-Jöbstl, Daniela; Arnholdt, Tim; Sturmlechner, Franz; Iwersen, Michael; Drillich, Marc

    2015-08-19

    Calf disease may result in great economic losses. To implement prevention strategies it is important to gain information on management and to point out risk factors. The objective of this internet based survey was to describe calf management practices on registered dairy breeding farms in Austria and to estimate differences in calf disease incidences depending on farm structure and management practices. A total of 1287 questionnaires were finally analysed (response rate 12.2 %). Herd characteristics and regional distribution of farms indicated that this survey gives a good overview on calf management practices on registered dairy farms in Austria. The median number of cows per farm was 20 (interquartile range 13-30). Significant differences regarding farm characteristics and calf management between small and large farms (≤20 vs >20 cows) were present. Only 2.8 % of farmers tested first colostrum quality by use of a hydrometer. Storing frozen colostrum was more prevalent on large farms (80.8 vs 64.2 %). On 85.1 % of the farms, whole milk, including waste milk, was fed to the calves. Milk replacer and waste milk were more often used on large farms. In accordance with similar studies from other countries, calf diarrhoea was indicated as the most prevalent disease. Multivariable logistic regression analysis revealed that herd size was associated with calf diarrhoea and calf respiratory tract disease, with higher risk of disease on large farms. Furthermore, feeding waste milk to the calves was associated with increasing calf diarrhoea incidence on farm. In the final model with calf respiratory tract disease as outcome, respondents from organic farms reported less often a respiratory tract disease incidence of over 10 % compared with conventional farms [odds ratio (OR) 0.40, 95 % confidence interval (CI) 0.21-0.75] and farmers that housed calves individually or in groups after birth significantly reported more often to have an incidence of respiratory tract

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

    Treesearch

    Matthew P. Thompson

    2014-01-01

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

  1. A national survey (NAP5-Ireland baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in Ireland.

    PubMed

    Jonker, W R; Hanumanthiah, D; O'Sullivan, E P; Cook, T M; Pandit, J J

    2014-09-01

    As part of the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland concerning accidental awareness during general anaesthesia, we issued a questionnaire to every consultant anaesthetist in each of 46 public hospitals in Ireland, represented by 41 local co-ordinators. The survey ascertained the number of new cases of accidental awareness becoming known to them for patients under their care or supervision for a calendar year, as well as their career experience. Consultants from all hospitals responded, with an individual response rate of 87% (299 anaesthetists). There were eight new cases of accidental awareness that became known to consultants in 2011; an estimated incidence of 1:23 366. Two out of the eight cases (25%) occurred at or after induction of anaesthesia, but before surgery; four cases (50%) occurred during surgery; and two cases (25%) occurred after surgery was complete, but before full emergence. Four cases were associated with pain or distress (50%), one after an experience at induction and three after experiences during surgery. There were no formal complaints or legal actions that arose in 2011 related to awareness. Depth of anaesthesia monitoring was reported to be available in 33 (80%) departments, and was used by 184 consultants (62%), 18 (6%) routinely. None of the 46 hospitals had a policy to prevent or manage awareness. Similar to the results of a larger survey in the UK, the disparity between the incidence of awareness as known to anaesthetists and that reported in trials warrants explanation. Compared with UK practice, there appears to be greater use of depth of anaesthesia monitoring in Ireland, although this is still infrequent. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  2. Annual incidence of snake bite in rural bangladesh.

    PubMed

    Rahman, Ridwanur; Faiz, M Abul; Selim, Shahjada; Rahman, Bayzidur; Basher, Ariful; Jones, Alison; d'Este, Catherine; Hossain, Moazzem; Islam, Ziaul; Ahmed, Habib; Milton, Abul Hasnat

    2010-10-26

    Snake bite is a neglected public health problem in the world and one of the major causes of mortality and morbidity in many areas, particularly in the rural tropics. It also poses substantial economic burdens on the snake bite victims due to treatment related expenditure and loss of productivity. An accurate estimate of the risk of snake bite is largely unknown for most countries in the developing world, especially South-East Asia. We undertook a national epidemiological survey to determine the annual incidence density of snake bite among the rural Bangladeshi population. Information on frequency of snake bite and individuals' length of stay in selected households over the preceding twelve months was rigorously collected from the respondents through an interviewer administered questionnaire. Point estimates and confidence intervals of the incidence density of snake bite, weighted and adjusted for the multi-stage cluster sampling design, were obtained. Out of 18,857 study participants, over one year a total of 98 snake bites, including one death were reported in rural Bangladesh. The estimated incidence density of snake bite is 623.4/100,000 person years (95% C I 513.4-789.2/100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) receive snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of the victims went directly to either a medical doctor or a hospital. Incidence density of snake bite in rural Bangladesh is substantially higher than previously estimated. This is likely due to better ascertainment of the incidence through a population based survey. Poor access to health services increases snake bite related morbidity and mortality; therefore, effective public health actions are warranted.

  3. Annual Incidence of Snake Bite in Rural Bangladesh

    PubMed Central

    Rahman, Ridwanur; Faiz, M. Abul; Selim, Shahjada; Rahman, Bayzidur; Basher, Ariful; Jones, Alison; d'Este, Catherine; Hossain, Moazzem; Islam, Ziaul; Ahmed, Habib; Milton, Abul Hasnat

    2010-01-01

    Background Snake bite is a neglected public health problem in the world and one of the major causes of mortality and morbidity in many areas, particularly in the rural tropics. It also poses substantial economic burdens on the snake bite victims due to treatment related expenditure and loss of productivity. An accurate estimate of the risk of snake bite is largely unknown for most countries in the developing world, especially South-East Asia. Methodology/Principal Findings We undertook a national epidemiological survey to determine the annual incidence density of snake bite among the rural Bangladeshi population. Information on frequency of snake bite and individuals' length of stay in selected households over the preceding twelve months was rigorously collected from the respondents through an interviewer administered questionnaire. Point estimates and confidence intervals of the incidence density of snake bite, weighted and adjusted for the multi-stage cluster sampling design, were obtained. Out of 18,857 study participants, over one year a total of 98 snake bites, including one death were reported in rural Bangladesh. The estimated incidence density of snake bite is 623.4 / 100,000 person years (95% C I 513.4–789.2 /100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) receive snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of the victims went directly to either a medical doctor or a hospital. Conclusions/Significance Incidence density of snake bite in rural Bangladesh is substantially higher than previously estimated. This is likely due to better ascertainment of the incidence through a population based survey. Poor access to health services increases snake bite related morbidity and mortality; therefore, effective public health actions are warranted. PMID:21049056

  4. Cancer incidence among boat-building workers exposed to styrene.

    PubMed

    Ruder, Avima M; Bertke, Stephen J

    2017-07-01

    A cancer incidence analysis was conducted on The National Institute for Occupational Safety and Health boat-builders cohort exposed to styrene, a possible carcinogen. Standardized incidence ratios (SIR) and standardized rate ratios (SRR) were calculated using national and Washington State rates and a person-years analysis program. Among 3704 workers living in Washington State after 1991, when cancer registry case accrual began, 516 first primary diagnoses occurred through 2007. While overall cancer incidence was significantly reduced [SIR: 0.83 (0.76, 0.90)], internal comparisons suggest an association with exposure comparing high to low exposed person-time [SRR: 1.28 (1.05, 1.55)]. There is evidence of styrene exposure being linked to cancer incidence, which is notable since the cohort has not yet reached the median age of cancer diagnosis (65) in the United States. © 2017 Wiley Periodicals, Inc.

  5. Incidence and Risk Factors of Homicide–Suicide in Swiss Households: National Cohort Study

    PubMed Central

    Panczak, Radoslaw; Zwahlen, Marcel; Spoerri, Adrian; Tal, Kali; Killias, Martin; Egger, Matthias

    2013-01-01

    Background Homicide–suicides are rare but catastrophic events. This study examined the epidemiology of homicide-suicide in Switzerland. Methods The study identified homicide–suicide events 1991–2008 in persons from the same household in the Swiss National Cohort, which links census and mortality records. The analysis examined the association of the risk of dying in a homicide–suicide event with socio-demographic variables, measured at the individual-level, household composition variables and area-level variables. Proportional hazards regression models were calculated for male perpetrators and female victims. Results are presented as age-adjusted hazard ratios (HR) with 95% confidence intervals (95%CI). Results The study identified 158 deaths from homicide–suicide events, including 85 murder victims (62 women, 4 men, 19 children and adolescents) and 68 male and 5 female perpetrators. The incidence was 3 events per million households and year. Firearms were the most prominent method for both homicides and suicides. The risk of perpetrating homicide-suicide was higher in divorced than in married men (HR 3.64; 95%CI 1.56–8.49), in foreigners without permanent residency compared to Swiss citizens (HR 3.95; 1.52–10.2), higher in men without religious affiliations than in Catholics (HR 2.23; 1.14–4.36) and higher in crowded households (HR 4.85; 1.72–13.6 comparing ≥2 with <1 persons/room). There was no association with education, occupation or nationality, the number of children, the language region or degree of urbanicity. Associations were similar for female victims. Conclusions This national longitudinal study shows that living conditions associated with psychological stress and lower levels of social support are associated with homicide-suicide events in Switzerland. PMID:23326491

  6. 14 CFR 91.1021 - Internal safety reporting and incident/accident response.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    .../accident response. 91.1021 Section 91.1021 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION... incident/accident response. (a) Each program manager must establish an internal anonymous safety reporting.... (b) Each program manager must establish procedures to respond to an aviation incident/accident. ...

  7. Sociodemographic and Psychopathologic Predictors of First Incidence of DSM-IV Substance Use, Mood, and Anxiety Disorders: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

    PubMed Central

    Grant, Bridget F.; Goldstein, Rise B.; Chou, S. Patricia; Huang, Boji; Stinson, Frederick S.; Dawson, Deborah A.; Saha, Tulshi D.; Smith, Sharon M.; Pulay, Attila J.; Pickering, Roger P.; Ruan, W. June; Compton, Wilson M.

    2009-01-01

    The objective of this study was to present nationally representative findings on sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance, mood and anxiety disorders using the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. One-year incidence rates of DSM-IV substance, mood and anxiety disorders were highest for alcohol abuse (1.02) alcohol dependence (1.70), major depressive disorder (MDD: 1.51) and generalized anxiety disorder (GAD: 1.12). Incidence rates were significantly greater (p < 0.01) among men for substance use disorders and greater among women for mood and anxiety disorders except bipolar disorder and social phobia. Age was inversely related to all disorders. Black individuals were at decreased risk of incident alcohol abuse and Hispanic individuals were at decreased risk of GAD. Anxiety disorders at baseline more often predicted incidence of other anxiety disorders than mood disorders. Reciprocal temporal relationships were found between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. Borderline and schizotypal personality disorders predicted most incident disorders. Incidence rates of substance, mood and anxiety disorders were comparable to or greater than rates of lung cancer, stroke, and cardiovascular disease. The greater incidence of all disorders in the youngest cohort underscores the need for increased vigilance in identifying and treating these disorders among young adults. Strong common factors and unique factors appear to underlie associations between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. The major results of this study are discussed with regard to prevention and treatment implications. PMID:18427559

  8. 48 CFR 801.602-80 - Legal and technical review-Office of Construction and Facilities Management and National Cemetery...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-Office of Construction and Facilities Management and National Cemetery Administration. 801.602-80 Section... Responsibilities 801.602-80 Legal and technical review-Office of Construction and Facilities Management and National Cemetery Administration. An Office of Construction and Facilities Management or National Cemetery...

  9. 48 CFR 801.602-80 - Legal and technical review-Office of Construction and Facilities Management and National Cemetery...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...-Office of Construction and Facilities Management and National Cemetery Administration. 801.602-80 Section... Responsibilities 801.602-80 Legal and technical review-Office of Construction and Facilities Management and National Cemetery Administration. An Office of Construction and Facilities Management or National Cemetery...

  10. 48 CFR 801.602-80 - Legal and technical review-Office of Construction and Facilities Management and National Cemetery...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-Office of Construction and Facilities Management and National Cemetery Administration. 801.602-80 Section... Responsibilities 801.602-80 Legal and technical review-Office of Construction and Facilities Management and National Cemetery Administration. An Office of Construction and Facilities Management or National Cemetery...

  11. 48 CFR 801.602-80 - Legal and technical review-Office of Construction and Facilities Management and National Cemetery...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-Office of Construction and Facilities Management and National Cemetery Administration. 801.602-80 Section... Responsibilities 801.602-80 Legal and technical review-Office of Construction and Facilities Management and National Cemetery Administration. An Office of Construction and Facilities Management or National Cemetery...

  12. Contingency Management Requirements Document: Preliminary Version. Revision F

    NASA Technical Reports Server (NTRS)

    2005-01-01

    This is the High Altitude, Long Endurance (HALE) Remotely Operated Aircraft (ROA) Contingency Management (CM) Functional Requirements document. This document applies to HALE ROA operating within the National Airspace System (NAS) limited at this time to enroute operations above 43,000 feet (defined as Step 1 of the Access 5 project, sponsored by the National Aeronautics and Space Administration). A contingency is an unforeseen event requiring a response. The unforeseen event may be an emergency, an incident, a deviation, or an observation. Contingency Management (CM) is the process of evaluating the event, deciding on the proper course of action (a plan), and successfully executing the plan.

  13. Identifying determinants of nations' wetland management programs using structural equation modeling: An exploratory analysis

    USGS Publications Warehouse

    La Peyre, M.K.; Mendelssohn, I.A.; Reams, M.A.; Templet, P.H.; Grace, J.B.

    2001-01-01

    Integrated management and policy models suggest that solutions to environmental issues may be linked to the socioeconomic and political Characteristics of a nation. In this study, we empirically explore these suggestions by applying them to the wetland management activities of nations. Structural equation modeling was used to evaluate a model of national wetland management effort and one of national wetland protection. Using five predictor variables of social capital, economic capital, environmental and political characteristics, and land-use pressure, the multivariate models were able to explain 60% of the variation in nations' wetland protection efforts based on data from 90 nations, as defined by level of participation, in the international wetland convention. Social capital had the largest direct effect on wetland protection efforts, suggesting that increased social development may eventually lead to better wetland protection. In contrast, increasing economic development had a negative linear relationship with wetland protection efforts, suggesting the need for explicit wetland protection programs as nations continue to focus on economic development. Government, environmental characteristics, and land-use pressure also had a positive direct effect on wetland protection, and mediated the effect of social capital on wetland protection. Explicit wetland protection policies, combined with a focus on social development, would lead to better wetland protection at the national level.

  14. Wilderness management planning in an Alaskan national park: last chance to do it right?

    Treesearch

    Michael J. Tranel

    2000-01-01

    Like many wilderness areas, Denali National Park and Preserve faces a variety of challenges in its wilderness management planning. As an Alaska conservation unit that has been significantly expanded by the Alaska National Interest Lands Conservation Act of 1980 (ANILCA), Denali faces the additional responsibility of acknowledging that its management of controversial...

  15. The science of decisionmaking: applications for sustainable forest and grassland management in the National Forest System

    Treesearch

    Matthew P. Thompson; Bruce G. Marcot; Frank R. Thompson; Steven McNulty; Larry A. Fisher; Michael C. Runge; David Cleaves; Monica Tomosy

    2013-01-01

    Sustainable management of national forests and grasslands within the National Forest System (NFS) often requires managers to make tough decisions under considerable uncertainty, complexity, and potential conflict. Resource decisionmakers must weigh a variety of risks, stressors, and challenges to sustainable management, including climate change, wildland fire, invasive...

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

    DOT National Transportation Integrated Search

    2015-09-30

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

  17. The influence of a local, media covered hospital incident on public trust in health care.

    PubMed

    van der Schee, Evelien; de Jong, Judith D; Groenewegen, Peter P

    2012-08-01

    Incidents in health care happen every now and then. Incidents are often extensively covered by the news media. In this study, we investigated the impact of an incident in a Dutch hospital on public trust in health care in the population living in the vicinity of where the incident took place and in the national population. News media coverage of the incident started in Fall 2008. We collected data in three samples, using a postal questionnaire on public trust in health care. Two samples were a cross-section of the Dutch population; one was questioned in October 2006 and the other in October 2008. The third sample, also questioned in October 2008, consisted of 1000 people living in the surrounding area of the hospital where the incident occurred. The cross-sectional sample of October 2006 was a reference group, and at that time no incidents in health care were covered in the media. In the local population, the incident had a strong impact on public trust in the hospital and among the specialists working there. Also, in the local population, the impact of the incident was generalized to trust in hospitals and specialists in general. In the national population, no impact of the incident on the public's trust was found, despite national news media coverage. Local incidents have an impact on public trust in health care in the local population. However, these incidents do not influence public trust in health care in the national population.

  18. Simulation of Automatic Incidents Detection Algorithm on the Transport Network

    ERIC Educational Resources Information Center

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

    2016-01-01

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

  19. 76 FR 11193 - Sequoia National Forest; California; Piute Mountains Travel Management Plan; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-01

    ... National Forest; California; Piute Mountains Travel Management Plan; Correction AGENCY: Forest Service... intent to prepare an environmental impact statement for the Piute Mountains Travel Management Plan. FOR...

  20. Prostate cancer incidence and newly diagnosed patient profile in Spain in 2010.

    PubMed

    Cózar, José M; Miñana, Bernardino; Gómez-Veiga, Francisco; Rodríguez-Antolín, Alfredo; Villavicencio, Humberto; Cantalapiedra, Arancha; Pedrosa, Emilio

    2012-12-01

    What's known on the subject? and What does the study add? Prostate cancer (PCa) accounts for 12% of newly diagnosed cases of cancer in Europe. It is one of the most frequently diagnosed tumours in the developed world. Since the introduction of prostate specific antigen as a test for early detection of PCa, the rate of diagnosis has increased significantly and specific mortality has reduced in most western countries. Most of the data on the incidence of PCa are obtained from population-based cancer registries which frequently do not cover the whole population. This first national hospital-based PCa registry aims not only to estimate the incidence of the disease but to ascertain the clinical profile of newly diagnosed PCa patients, a useful tool for evaluating the impact of the disease and its socio-health management. • To estimate the 2010 incidence of prostate cancer (PCa) in Spain. • To describe the clinical profile of newly diagnosed cases using a nationwide hospital-based registry. • This was a national epidemiological observational study in 25 public hospitals with a specific reference population according to the National Health System. • Sociodemographic and clinical variables of all newly diagnosed, histopathologically confirmed PCa cases were collected in 2010, in the area of influence of each centre. Cases diagnosed in private practice were not collected (estimated nearly 10% in Spain). • Data monitoring was external to guarantee quality and homogeneity. • The age-standardized PCa incidence was determined based on the age distribution of the European standard population. • In all, 4087 new cases of PCa were diagnosed for a reference population of 4933940 men (21.8% of the Spanish male population). • The estimated age-standardized PCa incidence was 70.75 cases per 100000 men. • Mean age at diagnosis was 69 years; 11.6% of patients presented with tumour-related symptoms and 39.5% with LUTS. Median PSA was 8 ng/mL. Gleason score was ≤ 6 in

  1. Incidence and management of leukopenia/neutropenia in 233 kidney transplant patients following single dose alemtuzumab induction.

    PubMed

    Smith, A; Couvillion, R; Zhang, R; Killackey, M; Buell, J; Lee, B; Saggi, B H; Paramesh, A S

    2014-12-01

    The purpose of this study was to determine the incidence and management strategies for post-transplant leukopenia/neutropenia in kidney recipients receiving alemtuzumab induction during the first year following transplantation. We prospectively identified 233 adult patients who underwent kidney transplantation with alemtuzumab induction at a single institution. The incidence and severity of leukopenia (white blood cell count [WBC] ≤2500/mm(3)) and neutropenia (absolute neutrophil count [ANC] ≤500/mm(3)) were evaluated at 1, 3, 6, and 12 months post-transplantation. We determined any association with cytomegalovirus (CMV) infection, graft rejection, and infections requiring hospitalization. We also reviewed interventions performed, including medication adjustments, treatment with granulocyte stimulating factor, and hospitalization. The combined incidence of either leukopenia or neutropenia was 47.5% (n = 114/233) with an average WBC nadir of 1700 ± 50/mm(3) at 131.0 ± 8.5 days and an average ANC nadir of 1500 ± 100/mm(3) at 130.4 ± 9.6 days. No significant difference in graft rejection, CMV infection, or infections requiring hospitalization was found in the leukopenia/neutropenia group vs the normal WBC group (P = .3). The most common intervention performed for leukopenia/neutropenia group was prophylactic medication adjustment. Six patients (5.2%) required a change in >1 medication. The majority of these patients also required granulocyte stimulating factor (61.5%; 32/52), with an average of 2.5 doses given. A total of 25 patients (21.9%) required hospitalization due to leukopenia/neutropenia with an average length of stay of 6 days. Kidney transplant patients receiving alemtuzumab induction required significant interventions due to leukopenia/neutropenia in the first year post-transplantation. These results suggest the need for additional studies aimed at defining the optimum management strategies of leukopenia/neutropenia in this population

  2. Integrating Data From the UK National Reporting and Learning System With Work Domain Analysis to Understand Patient Safety Incidents in Community Pharmacy.

    PubMed

    Phipps, Denham L; Tam, W Vanessa; Ashcroft, Darren M

    2017-03-01

    To explore the combined use of a critical incident database and work domain analysis to understand patient safety issues in a health-care setting. A retrospective review was conducted of incidents reported to the UK National Reporting and Learning System (NRLS) that involved community pharmacy between April 2005 and August 2010. A work domain analysis of community pharmacy was constructed using observational data from 5 community pharmacies, technical documentation, and a focus group with 6 pharmacists. Reports from the NRLS were mapped onto the model generated by the work domain analysis. Approximately 14,709 incident reports meeting the selection criteria were retrieved from the NRLS. Descriptive statistical analysis of these reports found that almost all of the incidents involved medication and that the most frequently occurring error types were dose/strength errors, incorrect medication, and incorrect formulation. The work domain analysis identified 4 overall purposes for community pharmacy: business viability, health promotion and clinical services, provision of medication, and use of medication. These purposes were served by lower-order characteristics of the work system (such as the functions, processes and objects). The tasks most frequently implicated in the incident reports were those involving medication storage, assembly, or patient medication records. Combining the insights from different analytical methods improves understanding of patient safety problems. Incident reporting data can be used to identify general patterns, whereas the work domain analysis can generate information about the contextual factors that surround a critical task.

  3. 78 FR 43226 - Going-to-the-Sun Road Corridor Management Plan, Environmental Impact Statement, Glacier National...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-19

    ...] Going-to-the-Sun Road Corridor Management Plan, Environmental Impact Statement, Glacier National Park... Statement for the Going-to-the-Sun Road Corridor Management Plan for Glacier National Park, Montana. This effort will result in an integrated visitor and transportation management plan for the Going-to-the Sun...

  4. Investigation of a “Sharps” Incident

    DOE PAGES

    Cournoyer, Michael Edward; Trujillo, Stanley; Schreiber, Stephen Bruce

    2016-08-03

    Special nuclear material research, process development, technology demonstration, and manufacturing capabilities are provided at the Los Alamos National Laboratory Plutonium Facility. Engineered barriers provide the most effective protection from radioactive and hazardous materials. The Worker Safety Security Team augments these passive safety feature by investigating incidents to identify appropriate prevention and mitigation measures. “Learning Teams” facilitate employee feedback loop and integration toward process improvement. Here, this article reports an investigation of a “Sharps” incident and reviews a case study of a technician that cuts his left thumb while making a gasket. Causal analysis of the sharps incident uncovered contributing factorsmore » that created the environment in which the incident occurred. Finally, latent organizational conditions that created error-likely situations or weakened defenses were identified and controlled. Effective improvements that reduce the probability or consequence of similar sharps incidents were implemented.« less

  5. NATIONAL HEALTH & ENVIRONMENTAL EFFECTS RESEARCH LABORATORY BEGINS IMPLEMENTATION OF AN ELECTRONIC SCIENTIFIC DATA MANAGEMENT SYSTEM

    EPA Science Inventory

    Data and records management have changed greatly as a result of progress in computer technology, but many organizations, including the US EPA's National Records Management Program (NRMP) and the U.S. National Archives and Records Administration (NARA), still struggle to escape th...

  6. 77 FR 10485 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-22

    ... Status EM/National Nuclear Security Administration Integration Ecological Surveys Ground Water Waste Area... and site management in the areas of environmental restoration, waste management, and related... Idaho Cleanup Project (ICP) Workforce Reductions Advanced Mixed Waste Cleanup Project (AMWTP) Workforce...

  7. A Decade of Child-Initiated Family Violence: Comparative Analysis of Child-Parent Violence and Parricide Examining Offender, Victim, and Event Characteristics in a National Sample of Reported Incidents, 1995-2005

    ERIC Educational Resources Information Center

    Walsh, Jeffrey A.; Krienert, Jessie L.

    2009-01-01

    This article examines 11 years (1995-2005) of National Incident Based Reporting System data comparing victim, offender, and incident characteristics for two types of child-initiated family violence: child-parent violence (CPV) and parricide. The objective is to better understand the victim-offender relationship for CPV and parricide and to…

  8. Breast Cancer Incidence and Risk Reduction in the Hispanic Population.

    PubMed

    Power, Eric J; Chin, Megan L; Haq, Mohamed M

    2018-02-26

    Breast cancer is the most common non-skin cancer amongst women worldwide and is the fifth leading cause of cancer-related mortality overall. It is also the foremost reason for cancer-related mortality in Hispanic females in the United States (US). Although the current incidence of breast cancer is significantly lower in Hispanics compared to that of non-Hispanic Whites (NHW) and Blacks, (91.9, 128.1, and 124.3 per 100,000, respectively, annually), this may increase if Hispanics develop similar lifestyle behaviors to other American women, in categories such as weight management, age at first birth, number of children, and breastfeeding habits. Stage-for-stage mortality for Hispanics is similar to NHWs, but the mortality rate is not declining as rapidly in this ethnic group. Hispanic women share many of the same risk factors for developing breast cancer as NHWs and Blacks. This suggests that many of the risk reduction strategies used in other racial populations may also benefit this group. Providing education about breast cancer and implementing risk reduction strategies in culturally-aware environments could help keep incidence low and reduce cancer-related mortality. Since Hispanics are the largest minority group in the US, this could have a significant impact on the incidence and mortality nationally.

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

    PubMed

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

    2010-08-11

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

  10. Management perceptions of off-highway vehicle use on national forest system lands in Appalachia

    Treesearch

    Katherine A. Thompson; Chad D. Pierskalla; Michael A. Schuett

    2008-01-01

    In 2005, the U.S. Forest Service (USFS) issued new standards for dealing with unmanaged recreation. All National Forest System units are to develop travel management plans by 2009. The purpose of this study was to determine differences in perceptions between USFS managers of national forests in Appalachia with low and high levels of offhighway vehicle (OHV) use...

  11. The medical decision model and decision maker tools for management of radiological and nuclear incidents.

    PubMed

    Koerner, John F; Coleman, C Norman; Murrain-Hill, Paula; FitzGerald, Denis J; Sullivan, Julie M

    2014-06-01

    Effective decision making during a rapidly evolving emergency such as a radiological or nuclear incident requires timely interim decisions and communications from onsite decision makers while further data processing, consultation, and review are ongoing by reachback experts. The authors have recently proposed a medical decision model for use during a radiological or nuclear disaster, which is similar in concept to that used in medical care, especially when delay in action can have disastrous effects. For decision makers to function most effectively during a complex response, they require access to onsite subject matter experts who can provide information, recommendations, and participate in public communication efforts. However, in the time before this expertise is available or during the planning phase, just-in-time tools are essential that provide critical overview of the subject matter written specifically for the decision makers. Recognizing the complexity of the science, risk assessment, and multitude of potential response assets that will be required after a nuclear incident, the Office of the Assistant Secretary for Preparedness and Response, in collaboration with other government and non-government experts, has prepared a practical guide for decision makers. This paper illustrates how the medical decision model process could facilitate onsite decision making that includes using the deliberative reachback process from science and policy experts and describes the tools now available to facilitate timely and effective incident management.

  12. The Research of the Crisis Pre-Warning Management System under the Particularity of Nationalities Universities and Colleges

    ERIC Educational Resources Information Center

    Wang, Hui

    2009-01-01

    The nationalities universities and colleges set up the crisis pre-warning management system, not only related to the management of our nationalities universities and colleges and their growth, but also related to the country's national unity plan in some way. However, because of minority students in the particularity of the national cultural…

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

    PubMed

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

    2016-07-01

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

  14. The Vacuous Rhetoric of Diversity: Exploring How Institutional Responses to National Racial Incidences Effect Faculty of Color Perceptions of University Commitment to Diversity

    ERIC Educational Resources Information Center

    Squire, Dian

    2017-01-01

    Recent news cycles have illuminated the disparate, racialized experiences of Black people in the United States but university leadership responses have been reactionary, or worse non-responsive. This study examines how university responses to national racial incidences such as the police brutality affect how faculty of color in one discipline…

  15. Incidence, patterns and severity of reported unintentional injuries in Pakistan for persons five years and older: results of the National Health Survey of Pakistan 1990-94.

    PubMed

    Fatmi, Zafar; Hadden, Wilbur C; Razzak, Junaid A; Qureshi, Huma I; Hyder, Adnan A; Pappas, Gregory

    2007-07-10

    National level estimates of injuries are not readily available for developing countries. This study estimated the annual incidence, patterns and severity of unintentional injuries among persons over five years of age in Pakistan. National Health Survey of Pakistan (NHSP 1990-94) is a nationally representative survey of the household. Through a two-stage stratified design, 18, 315 persons over 5 years of age were interviewed to estimate the overall annual incidence, patterns and severity of unintentional injuries for males and females in urban and rural areas over the preceding one year. Weighted estimates were computed adjusting for complex survey design using surveyfreq and surveylogistic option of SAS 9.1 software. The overall annual incidence of all unintentional injuries was 45.9 (CI: 39.3-52.5) per 1000 per year; 59.2 (CI: 49.2-69.2) and 33.2 (CI: 27.0-39.4) per 1000 per year among males and females over five years of age, respectively. An estimated 6.16 million unintentional injuries occur in Pakistan annually among persons over five years of age. Urban and rural injuries were 55.9 (95% CI: 48.1-63.7) and 41.2 (95% CI: 32.2-50.0) per 1000 per year, respectively. The annual incidence of injuries due to falls were 22.2 (95% CI: 18.0-26.4), poisoning 3.3 (95%CI: 0.5-6.1) and burn was 1.5 (95%CI: 0.9-2.1) per 1000 per year. The majority of injuries occurred at home 19.2 (95%CI: 16.0-22.4) or on the roads 17.0 (95%CI: 13.8-20.2). Road traffic/street, school and urban injuries were more likely to result in handicap. There is high burden of unintentional injuries among persons over five years of age in Pakistan. These results are useful to plan further studies and prioritizing prevention programs on injuries nationally and other developing countries with similar situation.

  16. Epidemiologic Measures for Quantifying the Incidence of Concussion in National Collegiate Athletic Association Sports

    PubMed Central

    Kerr, Zachary Y.; Roos, Karen G.; Djoko, Aristarque; Dalton, Sara L.; Broglio, Steven P.; Marshall, Stephen W.; Dompier, Thomas P.

    2017-01-01

    Context: Injury rates compare the relative frequency of sport-related concussions across groups. However, they may not be intuitive to policy makers, parents, or coaches in understanding the likelihood of concussion. Objective: To describe 4 measures of incidence (athlete-based rate, athlete-based risk, team-based rate, and team-based risk) during the 2011–2012 through 2014–2015 academic years. Design: Descriptive epidemiology study. Setting: Aggregate injury and exposure data collected from the National Collegiate Athletic Association Injury Surveillance Program in 13 sports (men's baseball, basketball, football, ice hockey, lacrosse, soccer, and wrestling and women's basketball, ice hockey, lacrosse, soccer, softball, and volleyball). Patients or Other Participants: Collegiate student-athletes. Main Outcome Measure(s): Sport-related concussion data from the National Collegiate Athletic Association Injury Surveillance Program during the 2011–2012 through 2014–2015 academic years were analyzed. We calculated concussion rates per 1000 athlete-exposures (AEs), concussion risk, average number of concussions per team, and percentage of teams with at least 1 concussion. Results: During the 2011–2012 through 2014–2015 academic years, 1485 concussions were sustained by 1410 student-athletes across 13 sports. Concussion rates ranged from 0.09/1000 AEs in men's baseball to 0.89/1000 AEs in men's wrestling. Concussion risk ranged from 0.74% in men's baseball to 7.92% in men's wrestling. The average ± SD number of concussions per team ranged from 0.25 ± 0.43 in men's baseball to 5.63 ± 5.36 in men's football. The percentage of teams with a concussion ranged from 24.5% in men's baseball to 80.6% in men's football. Conclusions: Although men's wrestling had a higher concussion rate and risk, men's football had the largest average number of concussions per team and the largest percentage of teams with at least 1 concussion. The risk of concussion, average number of

  17. [The progression of lung cancer incidence in France (1978-2000)].

    PubMed

    Molinié, F; Velten, M; Remontet, L; Bercelli, P; Réseau Francim

    2006-04-01

    Lung cancer is the most common cause of death from malignant disease in the world. Our objective was to describe the progression of this cancer's incidence, and the changing distribution of histological types in France between 1978 and 2000. National incidence rates were obtained by modelling lung cancer incidence data provided by the French cancer registries, taking into account national mortality data. These registries also provided information about histological type. In the year 2000, with 28,000 estimated new diagnoses, lung cancer represented 10.0% of all incident cancers and was responsible for 18.1% of deaths from cancer. From 1980 to 2000, the incidence rose from 47.4 to 52.2 per hundred thousand in men and from 3.7 to 8.6 per hundred thousand in women. The risk of developing lung cancer, which remained constant in men, has increased considerably (+451%) between the generation of women born in 1953 and those born in 1913. The proportion of epidermoid cancers has dropped whilst that of adenocarcinomas has risen sharply. The last few years have seen a large increase in the incidence of lung cancer in women and an increasing incidence of adenocarcinoma in both men and women.

  18. 2014 National Asset Management Conference and Training on Implementation Strategies.

    DOT National Transportation Integrated Search

    2014-07-01

    This report documents the major research activities conducted as part of the Federal Highway Administration (FHWA) : Transportation Pooled Fund (TPF) Program project, TPF-5(275) 2014 National Asset Management Conference and Training on : Implementati...

  19. 2014 National Asset Management Conference and training on implementation strategies.

    DOT National Transportation Integrated Search

    2014-07-01

    This report documents the major research activities conducted as part of the Federal Highway Administration (FHWA) : Transportation Pooled Fund (TPF) Program project, TPF-5(275) 2014 National Asset Management Conference and Training on : Implementati...

  20. College law enforcement and security department responses to alcohol-related incidents: a national study.

    PubMed

    Bernat, Debra H; Lenk, Kathleen M; Nelson, Toben F; Winters, Ken C; Toomey, Traci L

    2014-08-01

    Campus police and security personnel are often the first to respond to alcohol-related incidents on campus. The purpose of this study is to examine how campus law enforcement and security respond to alcohol-related incidents, and how consequences and communication differ based on characteristics of the incident. Directors of campus police/security from 343 colleges across the United States completed a survey regarding usual practice following serious, underage, and less serious alcohol incidents on and off campus. Campus law enforcement and security most commonly reported contacting campus officials. A minority reported issuing citations and referring students to the health center. Enforcement actions were more commonly reported for serious and underage incidents than for less serious incidents. Large (vs. small) colleges, public (vs. private) colleges, and those located in small (vs. large) towns more consistently reported taking actions against drinkers. Understanding how campus police and security respond to alcohol-related incidents is essential for reducing alcohol-related problems on college campuses. Copyright © 2014 by the Research Society on Alcoholism.