text:
New Equipping Strategies for Combat Support Hospitals
Combat and Doctrine Development and COL Timothy Lamb , supported by MAJ Gary Cooper, included members of our team in visits to Sierra Army Depot and...aspect of improving materiel stew - ardship is improving the quality of data related to the procurement, maintenance, and upgrading of equipment
Risks Associated with Fresh Whole Blood and Red Blood Cell Transfusions in a Combat Support Hospital
National Research Council Canada - National Science Library
Spinella, Philip C; Perkins, Jeremy G; Grathwohl, Kurt W; Repine, Thomas; Beekley, Alec C; Sebesta, James; Jenkins, Donald; Azarow, Kenneth; Holcomb, John B
.... Between April 2004 and December 2004, FWB was prescreened only at one combat support hospital for human immunodeficiency virus, hepatitis C virus, and hepatitis B surface antigen before transfusion...
The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital
National Research Council Canada - National Science Library
Borgman, Matthew A; Spinella, Philip C; Perkins, Jeremy G; Grathwohl, Kurt W; Repine, Thomas; Beekley, Alec C; Sebesta, James; Jenkins, Donald; Wade, Charles E; Holcomb, John B
...:1 ratio of plasma to red blood cell (RBC) units. Methods: We performed a retrospective chart review of 246 patients at a US Army combat support hospital, each of who received a massive transfusion...
Fresh whole blood transfusions in coalition military, foreign national, and enemy combatant patients during Operation Iraqi Freedom at a U.S. combat support hospital.
Spinella, Philip C; Perkins, Jeremy G; Grathwohl, Kurt W; Repine, Thomas; Beekley, Alec C; Sebesta, James; Jenkins, Donald; Azarow, Kenneth; Holcomb, John B
United States military doctrine permits the use of fresh whole blood (FWB), donated by U.S. military personnel on site, for casualties with life-threatening injuries at combat support hospitals. U.S. Military Medical Department policy dictates that all patients treated at military facilities during combat (coalition military personnel, foreign nationals, and enemy combatants) are to be treated equally. The objectives of this study were to describe admission vital signs and laboratory values and injury location for patients transfused with FWB, and to determine if FWB was employed equally among all patient personnel categories at a combat support hospital. This retrospective cohort study evaluated admission vital signs and laboratory values, injury location, and personnel category for all patients receiving FWB at a U.S. Army combat support hospital in Baghdad, Iraq, between January and December 2004. Eighty-seven patients received 545 units of FWB. Upon admission, the average (+/-S.D.) heart rate was 144 bpm (+/-25); systolic blood pressure, 106 mmHg (+/-33); base deficit, 9 (+/-6.5); hemoglobin, 9.0 g/dl (+/-2.6); platelet concentration, 81.9 x 10(3)/mm(3) (+/-81); international normalized ratio (INR), 2.0 (+/-1.1); and temperature 95.7 degrees F (+/-2.6). The percentages of intensive care patients who received FWB by personnel category were as follows: coalition soldiers, 51/592 (8.6%); foreign nationals, 25/347 (7.2%); and enemy combatants, 11/128 (8.5% (p = 0.38). The amount of FWB transfused by personnel category was as follows: coalition soldier, 4 units (1-35); foreign national, 4 units (1-36); and enemy combatant, 4 units (1-11) (p = 0.9). Fresh whole blood was used for anemic, acidemic, hypothermic, coagulopathic patients with life-threatening traumatic injuries in hemorrhagic shock, and it was transfused in equal percentages and amounts for coalition soldiers, foreign nationals, and enemy combatants.
War-related extremity injuries in children: 89 cases managed in a combat support hospital in Afghanistan.
Bertani, A; Mathieu, L; Dahan, J-L; Launay, F; Rongiéras, F; Rigal, S
Meeting paediatric needs is among the priorities of western healthcare providers working in Afghanistan. Insufficient information is available on paediatric wartime injuries to the extremities. Our objective here was to describe these injuries and their management on the field. We retrospectively reviewed consecutive cases of injuries to the extremities in children (< 16 years of age) due to weapons and managed at the Kabul International Airport (KaIA) Combat Support Hospital between June 2009 and April 2013. We identified 89 patients with a mean age of 10.2 ± 3.5 years and a total of 137 elemental lesions. Explosive devices accounted for most injuries (78.6%) and carried a significantly higher risk of multiple lesions. There were 54 bone lesions (traumatic amputations and fractures) and 83 soft-tissue lesions. The amputation rate was 18%. Presence of bone lesions was associated with a higher risk of injury to blood vessels and nerves. Of the 89 patients, four (4.5%) died and eight (9%) were transferred elsewhere. Of the 77 remaining patients, at last follow-up (median, one month; range, 0.1-16 months), 73 (95%) had achieved a full recovery (healed wound and/or fracture) or were recovering with no expectation that further surgery would be needed. Despite the absence of paediatric surgeons, the combat support hospital provided appropriate care at the limb salvage and reconstruction phases. The highly specialised treatments needed to manage sequelae were very rarely provided. These treatments probably deserve to be developed in combat support hospitals. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
High-velocity penetrating thoracic trauma with suspected cardiac involvement in a combat support hospital
International Nuclear Information System (INIS)
Dominguez, F.; Gentlesk, P.J.; Eckart, R.E.; Beekley, A.C.; Huffer, L.L.
The most common cardiac injuries in the United States are blunt trauma from motor vehicle accidents or low-velocity trauma from stabbings. During military conflict, high-velocity injuries, including gunshot wounds (GSW) and fragment injury from improvised explosive devices (IED), are relatively more common. This is a retrospective review of cases with high-velocity penetrating injury and suspected myocardial involvement during a 6-month period in Baghdad, Iraq, at a United States Army hospital during Operation Iraqi Freedom. Eleven cases survived to admission (GSW in 5, IED in 6). The mean age of the all-male cohort was 27 years (range, 3-54 years). Eight of the 11 patients (73%) were victims of polytrauma. The entrance involved the right ventricle (n=3), right atrium (n=2), left ventricle (n=1), or mediastinum and pericardial reflections (n=5). Echocardiography was performed in all 11 patients. In 7 patients, no foreign body was identifiable, and in 2 patients the foreign body was identified within the pericardial fat pad. Three patients were identified as having a suspected ventricular septal defect, ranging in size from 2 to 8 mm. The most common electrocardiographic abnormality was atrioventricular block and right bundle branch block. In 4 patients, the management of the chest injury was nonsurgical, and in 1 patient the treatment was a chest tube only. Four of the patients underwent median sternotomy, 1 underwent emergent lateral thoracotomy, and 1 underwent an infradiaphragmatic approach. This case series is too small to draw definitive conclusions; however, a multidisciplinary approach to high-velocity injuries with potential for cardiac involvement augments preoperative assessment for myocardial injury and may allow selective nonoperative management. (author)
Nutrition support in hospitals
DEFF Research Database (Denmark)
Kondrup, Jens
Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance.......Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance....
The Nation's Combat Logistics Support Agency
Services Doing Business With DLA Customer Support Business Operations Small Business Federal Contracting CENTCOM & SOCOM DLA Europe & Africa DLA Pacific History News Careers A graphic shows rows of cross -shaped gravestones in a cemetery with the words Heritage, History, Heroes over a partial American Flag
The role of the American Hospital Association in combating AIDS.
McCarthy, C
The American Hospital Association (AHA) has taken a leadership role in assisting health care providers in dealing effectively with the challenges of AIDS. Early work focused on preventing infection in the health care setting with the use of the Centers for Disease Control's recommended precautions concerning blood and body fluids. Supporting this effort were a number of live teleconferences, videotapes, and publications that addressed the use of precautions with AIDS patients, community issues associated with the disease, and the development of employee policies. In July 1987, a Special Committee on AIDS/HIV Infection Policy was formed by the AHA Board of Trustees and charged with developing recommendations on the issues that needed to be addressed if hospitals were to continue to meet the challenge of AIDS effectively. The committee's first set of recommendations, approved in November 1987, reaffirmed the use of universal precautions, provided guidance on the appropriate uses and application of HIV testing, and stated that the delivery of care should not be conditioned on the willingness of a patient to undergo testing. The second set of recommendations, which were approved in January 1988, focused on the need to distribute the responsibility for AIDS care among a wide variety of health care providers, to seek creative financing approaches that involve both the private and public sectors, and called on hospitals to provide leadership in ensuring that a continuum of services is available to AIDS patients. Continuing efforts to assist hospitals in the care delivery issues associated with AIDS are described.
Combat Internist: The Internal Medicine Experience in a Combat Hospital in Afghanistan
massive trans- fusion protocol.6 As such, critical care included frequent monitoring of hemoglobin and coagulation parameters with administration of...ongoing resuscitation. With the rise in nutritional supplement use, it was no sur- prise that they were frequently used in the combat zone. Numerous...recommendations on standard precautions and further care of his vaccine site. Education and Administration There were many opportunities to train and
Candid Voices - Agile Combat Support From the OC-ALC Engine Shop Viewpoint. Volume XXII, Number 4
National Research Council Canada - National Science Library
Larvick, Jon
.... This article will take the Agile Combat Support initiative -the focus of combat support shifts from maintaining massive inventories to establishing a response capability-as the goal and will focus...
Plan for Combat Operations (Battlefield Function 18) as Accomplished by a Direct Support Field Artillery Battalion. Volume 2: Assessment Package
National Research Council Canada - National Science Library
Mullen, William
The purpose of the overall research program was to document the synchronization required by command and control tasks performed within the armored brigade to include combat support and combat service support units...
Plan for Combat Operations (Battlefield Function 18) as Accomplished by a Forward Support Battalion. Volume 1: Function Analysis
National Research Council Canada - National Science Library
Whitley, Sam
The purpose of the overall research program was to document the synchronization required by command and control tasks performed within the armored brigade, to include combat support and combat service support units...
Tradeoff Analysis for Combat Service Support Wireless Communications Alternatives
Energy Technology Data Exchange (ETDEWEB)
Burnette, John R.; Thibodeau, Christopher C.; Greitzer, Frank L.
As the Army moves toward more mobile and agile forces and continued sustainment of numerous high-cost legacy logistics management systems, the requirement for wireless connectivity and a wireless network to supporting organizations has become ever more critical. There are currently several Army communications initiatives underway to resolve this wireless connectivity issue. However, to fully appreciate and understand the value of these initiatives, a Tradeoff Analysis is needed. The present study seeks to identify and assess solutions. The analysis identified issues that impede Interim Brigade Combat Team (IBCT) communication system integration and outlined core requirements for sharing of logistics data between the field and Army battle command systems. Then, the analysis examined wireless communication alternatives as possible solutions for IBCT logistics communications problems. The current baseline system was compared with possible alternatives involving tactical radio systems, wireless/near term digital radio, cellular satellite, and third-generation (3G) wireless technologies. Cellular satellite and 3G wireless technologies offer clear advantages and should be considered for later IBCTs.
The American Organization of Nurse Executives and American Hospital Association Initiatives Work to Combat Violence.
Wray, Karen
Violence affecting healthcare workers and healthcare organizations continues to be a serious safety issue. In this Leadership Perspectives column, Karen Wray, an American Organization of Nurse Executives (AONE) member who has experienced a mass causality incident 1st hand, outlines AONE's continuing work to promote safety and combat violence. She discusses recent work on violence issues by the American Hospital Association, AONE's parent organization.
Evaluation of Combat Service Support Logistics Concepts for Supplying a USMC Regimental Task Force
National Research Council Canada - National Science Library
Lenhardt, Thomas
.... This thesis evaluates existing and proposed concepts on how to best use the CSSE resources of a Force Service Support Group to transport supplies to Regimental Combat Teams over constrained networks...
Global Combat Support System - Army Increment 2 (GCSS-A Inc 2)
2016 Major Automated Information System Annual Report Global Combat Support System - Army Increment 2 (GCSS-A Inc 2) Defense Acquisition...Secretary of Defense PB - President's Budget RDT&E - Research, Development, Test, and Evaluation SAE - Service Acquisition Executive TBD - To Be...Date Assigned: Program Information Program Name Global Combat Support System - Army Increment 2 (GCSS-A Inc 2) DoD Component Army Responsible
Combat Health Support of the Transformation Force in 2015
National Research Council Canada - National Science Library
Gouge, Steven
.... Minimizing death and morbidity requires appropriate and timely evacuation and treatment. Joint medical doctrine has been changed to emphasize evacuation of less-stable patients out of theater and decrease the theater hospital footprint...
Combat Service Support Model Development: BRASS - TRANSLOG - Army 21
throughout'the system. Transitional problems may address specific hardware and related software , such as the Standard Army Ammunition System ( SAAS ...FILE. 00 Cabat Service Support Model Development .,PASS TRANSLOG -- ARMY 21 0 Contract Number DAAK11-84-D-0004 Task Order #1 DRAFT REPOkT July 1984 D...Armament Systems, Inc. 211 West Bel Air Avenue P.O. Box 158 Aberdeen, MD 21001 8 8 8 2 1 S CORMIT SERVICE SUPPORT MODEL DEVELOPMENT BRASS -- TRANSLOG
Workplace breastfeeding support for hospital employees.
Dodgson, Joan E; Chee, Yuet-Oi; Yap, Tian Sew
Breastfeeding initiation rates have been steadily rising in Hong Kong, but most employed women wean prior to returning to work. While health care providers promote breastfeeding, women receive little support from employers. A few health care facilities offer some workplace breastfeeding support, but little is known about the specific types and amount of support that are offered. This paper reports a study whose aim was to describe workplace supports available to breastfeeding women employed by hospitals that provide maternity services in Hong Kong, and to determine if differences in workplace supports exist based on the hospitals' numbers of employees or funding source. In late 2001, a cross-sectional survey was completed by nurse managers or lactation consultants most knowledgeable about supports to breastfeeding employees in 19 hospitals. The number of workplace breastfeeding supports or Breastfeeding Support Score (M = 7.47; sd = 3.37) varied considerably. Mean Breastfeeding Support Score for government-funded hospitals was significantly higher (t = 2.31; P = 0.03) than for private hospitals. Of the 14 hospitals that had a designated space for using a breast pump, only five (26.3%) had a private room with a door that locked. Only two hospitals (11.1%) allowed employees to take breaks as needed to use a pump; employees in 10 (55.6%) had to use their meal and regular break times. Hospitals having a hospital-wide committee that addressed workplace breastfeeding issues had a more supportive environment for breastfeeding employees. Although all surveyed hospitals returned the questionnaire, the sample size was small. It was difficult to ensure accuracy and to differentiate subtle variations in the services provided using a self-report survey. Facilitating continued breastfeeding after employees' return to work requires that employers understand the needs of breastfeeding employees. Policy at the level of the employer and government is an essential component of
Plan for Combat Operations (Battlefield Function 18) as Accomplished by an Engineer Battalion Supporting a Heavy Brigade. Volume 1: Function Analysis
National Research Council Canada - National Science Library
Anderson, Martin
The purpose of the overall research program was to document the synchronization required by command and control tasks performed within the armored brigade, to include combat support and combat service support units...
Plan for Combat Operations (Battlefield Function 18) as Accomplished by an Engineer Battalion Supporting a Heavy Brigade. Volume 2: Assessment Package
National Research Council Canada - National Science Library
Mullen, William
The purpose of the overall research program was to document the synchronization required by command and control tasks performed within the armored brigade to include combat support and combat service support units...
Race/ethnicity, psychological resilience, and social support among OEF/OIF combat veterans.
Herbert, Matthew S; Leung, Desmond W; Pittman, James O E; Floto, Elizabeth; Afari, Niloofar
This study examined the relationship between race/ethnicity and psychological resilience, and the moderating role of social support in this relationship among non-Hispanic White (n = 605), Hispanic (n = 107), African American (n = 141), and Asian American (n = 97) Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans. Veterans were primarily male (88%) with a mean age of 31.4 years (SD = 8.35). An analysis of covariance showed that Asian American veterans reported significantly lower psychological resilience than non-Hispanic White veterans. The interaction of race/ethnicity and social support with psychological resilience was examined via linear regression. We found that the relationship between psychological resilience and social support significantly differed by race/ethnicity such that social support was positively associated with psychological resilience among non-Hispanic White veterans, but not among other racial/ethnic groups. Our findings are consistent with previous studies that show Asian American veterans report lower psychological resilience than non-Hispanic White veterans. Cultural differences in how and why individuals use social support may underlie racial/ethnic differences in the relationship between social support and psychological resilience. Future qualitative and quantitative research is encouraged to better understand how social support relates to psychological resilience among minority OEF/OIF combat veterans. Copyright © 2018. Published by Elsevier B.V.
Supported Conversation for hospital staff
DEFF Research Database (Denmark)
Forchhammer, Hysse B; Løvholt, Annelise P.; Mathiesen, Lone Lundbak
in communication and interaction, Supported Conversation for Adults with Aphasia (SCA) was adapted and implemented in a large neurological department at Rigshospitalet-Glostrup in Copenhagen. Method 152 staff members representing different health professionals were assigned to one of eleven courses during a six...... month period. Each course had 10-12 participants and lasted 6 hours, including instruction in the SCA principles, video analysis, interdisciplinary group work, and practice sessions with PWAs. Self-assessed learning outcomes were evaluated with a brief questionnaire filled out by staff members...... in communication, also showed significant improvements across all staff groups. After the course, more time to spend with patients was perceived as the most important factor to further increase communication success with PWA. Conclusion The results show that interdisciplinary SCA-courses successfully increase...
Hospital Costs Of Extracorporeal Life Support Therapy
Oude Lansink-Hartgring, Annemieke; van den Hengel, Berber; van der Bij, Wim; Erasmus, Michiel E.; Mariani, Massimo A.; Rienstra, Michiel; Cernak, Vladimir; Vermeulen, Karin M.; van den Bergh, Walter M.
Objectives: To conduct an exploration of the hospital costs of extracorporeal life support therapy. Extracorporeal life support seems an efficient therapy for acute, potentially reversible cardiac or respiratory failure, when conventional therapy has been inadequate, or as bridge to transplant, but
Effects of social support and battle intensity on loneliness and breakdown during combat.
Solomon, Z; Mikulincer, M; Hobfoll, S E
A sample of 382 Israeli soldiers who developed combat stress reactions (CSR) during the 1982 Israel-Lebanon War were compared with groups of carefully matched controls who did not develop CSR. Lack of social support from officers was found to be related to greater feelings of loneliness and greater likelihood of CSR in soldiers. Lack of social support from buddies was found to be related to greater loneliness. Intensity of battle was also found to be related to greater feelings of loneliness and increased likelihood of CSR. A path model was tested and supported. The model suggests that battle intensity and officer support lead to CSR directly and indirectly by causing increased feelings of loneliness. Possible cognitive and psychodynamic explanations for the findings are offered. The limitations of making causal statements from retrospective perceptions is discussed.
Global Combat Support System-Marine Corps Logistics Chain Management Increment 1 (GCSS-MC LCM Inc 1)
Global Combat Support System – Marine Corps (GCSS-MC) is a portfolio of systems that supports logistics elements of command and control, joint...future Marine Corps logistics systems modernization . GCSS-MC/LCM Increment 1 Capability Release 1 (hereinafter Release 1.1) is the baseline
Supporting Air and Space Expeditionary Forces: Expanded Operational Architecture for Combat Support Execution Planning and Control
National Research Council Canada - National Science Library
Mills, Patrick; Evers, Ken; Kinlin, Donna; Tripp, Robert S
During the past decade, the U.S. military has supported continuous deployments of forces around the world, often on very short notice and for prolonged duration, to meet the needs of a wide range of peacekeeping and humanitarian...
S.A.C.I.: Incident Combat Support System; S.A.C.I.: Sistema de Apoio ao Combate de Incidentes
Energy Technology Data Exchange (ETDEWEB)
Macedo, Antonio R.L. [ARMTEC Tecnologia em Robotica, Fotrtaleza, CE (Brazil); Macedo, Antonio R.M. [Universidade de Fortaleza, CE (Brazil)
The incidents that occur in the petrochemical industry are extremely dangerous, because of the range of temperature that it reaches and the radius of the explosion. For this reason the S.A.C.I. that is an Incident's Combat Support System was developed. The purpose of this paper is to present the complete operational capability of this machine, and also some of the construction design calculations. It is a controlled-by-distance robot that carries one water cannon that generates fog, stream or foam with a limit pressure of 125 psi. It works within 90 m from the operator, has 3 degrees of freedom and a minimum autonomy of 3 hours. Before this prototype was made, only the United Kingdom by Qinetiq and the Japan by the Tokyo Fire Department had this technology. This prototype is around 70% of the investment of the ones in the market. The tests shown in the paper were made in the training bunker of Ceara's Military Fire Corp. Headquarters and in an arena in the Gloria Marine in Rio de Janeiro. The results of this project is a national product that improves the incident's combat response time, saving the most important resource, that is the human been. (author)
S.A.C.I.: Incident Combat Support System; S.A.C.I.: Sistema de Apoio ao Combate de Incidentes
Energy Technology Data Exchange (ETDEWEB)
Macedo, Antonio R.L. [ARMTEC Tecnologia em Robotica, Fotrtaleza, CE (Brazil); Macedo, Antonio R.M. [Universidade de Fortaleza, CE (Brazil)
The incidents that occur in the petrochemical industry are extremely dangerous, because of the range of temperature that it reaches and the radius of the explosion. For this reason the S.A.C.I. that is an Incident's Combat Support System was developed. The purpose of this paper is to present the complete operational capability of this machine, and also some of the construction design calculations. It is a controlled-by-distance robot that carries one water cannon that generates fog, stream or foam with a limit pressure of 125 psi. It works within 90 m from the operator, has 3 degrees of freedom and a minimum autonomy of 3 hours. Before this prototype was made, only the United Kingdom by Qinetiq and the Japan by the Tokyo Fire Department had this technology. This prototype is around 70% of the investment of the ones in the market. The tests shown in the paper were made in the training bunker of Ceara's Military Fire Corp. Headquarters and in an arena in the Gloria Marine in Rio de Janeiro. The results of this project is a national product that improves the incident's combat response time, saving the most important resource, that is the human been. (author)
Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support.
Park, Crystal L; Wachen, Jennifer Schuster; Kaiser, Anica Pless; Mager Stellman, Jeanne
Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.
Hospital outreach to support faith community nursing.
Messerly, Sally; King, Michalene A; Hughes, Suzanne
A Faith Community Nurse (FCN) Program was initiated by a Magnet hospital and developed through collaboration between hospital departments and a university nurse educator. This article describes the program's development and activities that offer FCNs networking, free continuing education, and are an extension of the hospital's mission and values.
[The medico-psychological rehabilitation of participants in combat actions in a general hospital].
Belinskiĭ, A V; Liamin, M V
There were investigated 453 servicemen--participants of fighting actions in Chechnya [correction of Chechenskaya] Republic in whom the incidence of psychologic stress reactions nearly twice exceeded disorders of other types of psychic dysfunction. 5 groups of combatants were selected and severity of psychic disorders depending on duration of participation in fighting actions was determined. Posttraumatic stress disorders were revealed in 14.5% of servicemen, no signs of psychologic desadaptation were detected in 16.6%, 16.9% had pathologic psychogenic reactions, 18.6% showed pathologic level of psychic disorders, and psychologic stress reactions were noted in 33.4%. The developed individual programs of medico-psychologic rehabilitation depending on type and severity of psychic disorders will allow to reduce the period of restorative treatment and significantly decrease servicemen discharge from the Armed Forces because of psychic disorders.
Supporting PECO countries in combating illicit trafficking of nuclear materials - Status of ongoing projects
International Nuclear Information System (INIS)
Janssens, W.; Daures, P.; Cromboom, O.; Mayer, K.; Koch, L.
Full text: In order to support the development of an efficient and validated response to counteract illicit trafficking of nuclear materials in the EU, the candidate countries and some CIS countries, ITU is currently executing a series of dedicated projects with the Candidate Countries to the European Union, based upon the experience gained in previous Phare and Tacis projects. Following the recommendations of the International Technical Working Group (ITWG), the objectives of the projects are: assessment of the national situation during a fact-finding mission in the country; technical upgrade and/or training related to the categorisation of nuclear material on the spot and assistance for the identification of seized nuclear material, through joint analysis at ITU; implementation of the recommended Model Action Plan in the form of a national handbook called RITNUM (Response to Illicit Trafficking of NUclear Material); validation of the national Model Action Plan by the organisation of a demonstration exercise in the country involving all the identified services in the field. After a kick-off meeting held in Karlsruhe in November 2000 and attended by two participants of each country, 5 fact-finding missions have been already performed (Romania, Slovenia and the three Baltic States). A general meeting with all the involved parties (Customs, Police, Intelligence services. Health Physics, Nuclear reference laboratory...) was organised to describe the procedure of the integrated response and the national needs were assessed. The corresponding training sessions are planed in January 2002 at ITU for three participants for each country (Customs and Police officer and high level scientist dealing with nuclear measurements). This training session will be organised and supported by IAEA which have a common interest through its Regional Program on Combating Illicit Trafficking (RER60). This joint action will be extended to other eastern countries (ex. Belarus) on IAEA request
Simulation as a hospital management support tool
Directory of Open Access Journals (Sweden)
Nemesio Rodrigues Capocci
Full Text Available This study aims to demonstrate the use of the discrete event simulation technique as a hospital management support tool, as well as all complex processes existing in a health unit. There must be an analysis of the system as a whole from the perspective of service level provided to patients regarding waiting times. The role of this technique is to show the behavior of a given system. Data were collected from employees of a public Polyclinic, located in a city of the greater São Paulo, by means of interviews which questions were prepared to determine the time spent in the processes of the service system. Such data were inserted in the software Arena in flowchart format for analysis and identification of the problem. Since the person responsible for the screening process was overloaded, thus causing longer waiting times for patients submitted for screening, some changes were made in the model in order to propose an improvement, to balance the occupancy levels of the health unit's staff and, at the same time, reach a shorter withdrawal period of patients throughout the system. Results showed a significant improvement in the performance of the Polyclinic's system, as well as a subsequent improvement in the level of service provided to patients. Based on this study, one can note that simulation allows for evaluating scenarios and projecting changes that will impact the behavior of a certain system with no physical changes, thus preventing the lack of scientific basis when making management decisions and allowing for improvements.
Automated Battle Planning for Combat Models with Maneuver and Fire Support
risk. Black squares block line of sight. Red squares are targetable by both red threats, and tan squares are targetable by only one. The damage... Nicolas Barriga, and Michael Buro. 2015. "Using Lanchester Attrition Laws for Combat Prediction in StarCraft." In Proceedings of the Eleventh AAAI
An Analysis Plan for the ARCOMS II (Armor Combat Operations Model Support II) Experiment.
In order to facilitate Armor Combat Modeling, the data analysis shculd focus upon the methods which transform the data intc descriptive or predictive ...discussed in Chapter III tc predict the Farameter for probability of detection in time ŕt. This should be compared with the results of the N.4gh -t Vision...J 6A 46.) I-I 0 f U-CL 0~ z o -Z 06 09 03 v 0 0 SJldnYS 10 ON Ipgr Cp o LSTm n at emn itgas 4AA rI z ;A (AZ - 090.0 UlA0 -O ON 404 Fiur CAd &P CC
Nurse as a support of long - term hospitalized senior
TUŠLOVÁ, Michaela
This thesis "Nurse as a support of long-term hospitalized senior" is divided into a theoretical and an empirical part. It deals with the issue of long-term hospitalization of seniors at the aftercare department, especially with the nurses' support to seniors and their interrelationships. Three main goals were appointed. It was examined how the seniors perceive nurses who takes care of them. Then in which areas nurses are supportive and which techniques they try to use to be a support for seni...
Peer Support, Self-efficacy, and Combat-related Trauma Symptoms among Returning OIF/OEF Veterans
Directory of Open Access Journals (Sweden)
Ann MacEachron
Full Text Available The incidence of PTSD and other combat-related trauma symptoms among more than 2 million veterans returning from Operation Iraqi Freedom (OIF and Operation Enduring Freedom (OEF in Afghanistan suggests that many will experience psychological challenges in adjusting to civilian life. However, the literature is sparse about this new group of veterans. This study examined the relationships between peer support, self-efficacy, and PTSD symptoms among 216 OIF/OEF veterans who had attended 1 of 17 Vets4Vets peer support weekend retreats. Vets4Vets is a national grassroots program whose mission is to improve the psychological well-being of returning OIF/OEF veterans. Analysis of posttest changes indicate the generalizability of previous research findings, based on other groups of trauma-affected groups, to OIF/OEF veterans. As predicted, increased perceived peer support and self-efficacy reduced PTSD symptoms. From a theoretical perspective, we found that both models of self-efficacy, situation-specific (Bandura, 1997; Benight & Bandura, 2004 and general self-efficacy (Schwarzer & Fuchs, 1996, mediated or explained the relationship between peer support and PTSD symptoms. Implications for social work are discussed.
Rehabilitation of Combat-Related Injuries in the Veterans Administration: A Web of Support.
Howell, Paul; Capehart, Bruce P; Hoenig, Helen
The Department of Veterans Affairs provides acute, subacute, and continuing rehabilitation for veterans using a hub-and-spoke system of hospitals and outpatient facilities. Using traumatic brain injury as an example, this commentary illustrates how this system provides interdisciplinary rehabilitative care to veterans throughout North Carolina.
A conceptual evolutionary aseismic decision support framework for hospitals
Hu, Yufeng; Dargush, Gary F.; Shao, Xiaoyun
In this paper, aconceptual evolutionary framework for aseismic decision support for hospitalsthat attempts to integrate a range of engineering and sociotechnical models is presented. Genetic algorithms are applied to find the optimal decision sets. A case study is completed to demonstrate how the frameworkmay applytoa specific hospital.The simulations show that the proposed evolutionary decision support framework is able to discover robust policy sets in either uncertain or fixed environments. The framework also qualitatively identifies some of the characteristicbehavior of the critical care organization. Thus, by utilizing the proposedframework, the decision makers are able to make more informed decisions, especially toenhance the seismic safety of the hospitals.
Extracorporeal Organ Support following Trauma: The Dawn of a New Era in Combat Casualty Critical Care
liver support has undergone significant technological advances. The Food and Drug Administration approved (December 2012) the Molecular Adsorbent Re...Williams & Wilkins Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. encephalopathy caused by...chronic liver disease decompen- sation. The Extracorporeal Liver Assist Device (ELAD) pro- vides continuous extracorporeal liver support with
Preceptor Support in Hospital Transition to Practice Programs.
Blegen, Mary A; Spector, Nancy; Ulrich, Beth T; Lynn, Mary R; Barnsteiner, Jane; Silvestre, Josephine
The aim of this study was to describe newly licensed RN (NLRN) preceptorships and the effects on competency and retention. Preceptors are widely used, but little is known about the benefit from the perspective of the NLRN or about the models of the relationships. The National Council of State Boards of Nursing added questions about the preceptor experience in a study of transition-to-practice programs. Hospitals were coded as having high or low preceptor support in regard to scheduling NLRN on the same shifts as their preceptors, assignment sharing, and preceptor release time and a low number of preceptors per preceptee. Half of the 82 hospitals were classified as high, and half as low preceptor support. NLRNs and their preceptors in high-support hospitals evaluated the preceptor experience and NLRN competence higher. In addition, NLRN retention was higher in the high-support hospitals. To improve NLRN competence and retention, preceptors should have adequate time with each NLRN, share shift and patient assignments, and have few preceptees assigned to each preceptor concurrently.
Combination of Extracorporeal Life Support and Mesenchymal Stem Cell Therapy for Treatment of ARDS in Combat Casualties and Evacuation of Service Members with ARDS
AWARD NUMBER: W81XWH-15-2-0072 TITLE: Combination of Extracorporeal Life Support and Mesenchymal Stem Cell Therapy for Treatment of ARDS in...Mesenchymal Stem Cell Therapy for Treatment of ARDS in Combat Casualties and Evacuation of Service Members with ARDS 5b. GRANT NUMBER W81XWH-15...Figure 4. Mitochondrial activity is mostly preserved on the animals that were supported with ventilator devices and mesenchymal stem cells . Using a
Hospital to home paediatric enteral nutrition--parents need support.
LENUS (Irish Health Repository)
Shortall, C
This study assessed the provision of education and support to parents of children on home enteral nutrition (HEN), current dietetic support available and perceived challenges facing parents and carers. From the 39 responses (13%), 29 (83%, n = 35) parents suggested services for HEN need improvement. 29 (74%, n = 39) parents wanted more structured follow up and 22 (56%) would like one person to co-ordinate HEN, education and discharge. 7 parents (18%) reported a need for further education of health care professionals (HCP). Hospital dietitians were the most common HCPs reported to provide support to patients following discharge. Specialist paediatric HEN dietetic services working in a dedicated HEN team, who would provide accurate training and education and liaise with both parents and community care services post discharge should be in place. This would facilitate transfer to community care, reduce hospital re-admissions, outpatient department attendances and costs.
Miniature Munitions: Is The US Military Prepared to Support Major Combat Operations
offensive as the only weapon. The number of weapons, cost, and production rate are compared to the Operation Iraqi Freedom (OIF) air campaign. The SDB...two major conflicts in Afghanistan and Iraq. In 2003, US and coalition forces began Operation Iraqi Freedom (OIF) with an aerial bombardment campaign...were able to advance into the Iraqi capital city of Baghdad with relative ease thanks in part to the support from the air campaign. Nearly 30,000
Using Heuristics for Supportability Analysis of Adaptive Weapon Systems in Combat
a n/a Customer Requirements Im p o rt an ce w ei g ht f ac to r F o rc e to o p en E xt er na l d im en si o ns C D p o si ti o ni ng f ea tu...usually include Contractor Logistics Support (CLS), and the contract structure normally incentivizes CLS to exceed the KPP Operational Readiness...adaptive baseline, a viable plan for maximizing availability and reducing costs would involve an early design effort for replacing contractor maintenance
Information Architecture for Quality Management Support in Hospitals.
Rocha, Álvaro; Freixo, Jorge
Quality Management occupies a strategic role in organizations, and the adoption of computer tools within an aligned information architecture facilitates the challenge of making more with less, promoting the development of a competitive edge and sustainability. A formal Information Architecture (IA) lends organizations an enhanced knowledge but, above all, favours management. This simplifies the reinvention of processes, the reformulation of procedures, bridging and the cooperation amongst the multiple actors of an organization. In the present investigation work we planned the IA for the Quality Management System (QMS) of a Hospital, which allowed us to develop and implement the QUALITUS (QUALITUS, name of the computer application developed to support Quality Management in a Hospital Unit) computer application. This solution translated itself in significant gains for the Hospital Unit under study, accelerating the quality management process and reducing the tasks, the number of documents, the information to be filled in and information errors, amongst others.
Layered autonomous overwatch: the necessity and feasability of multiple unmanned systems in combat support
Monckton, Simon; Digney, Bruce; Broten, Greg; Penzes, Steve
Unmanned systems simultaneously reduce risk and magnify the impact of soldier-operators. For example, in Afghanistan UAVs routinely provide overwatch to manned units while UGVs support IED identification and disposal roles. Expanding these roles requires greater autonomy with a coherent unmanned "system of systems" approach that leverages one platform's strengths against the weakness of another. Specific collaborative unmanned systems such as shared sensing, communication relay, and distributed computing to achieve greater autonomy are often presented as possible solutions. By surveying currently deployed systems, this paper shows that the spectrum of air and ground systems provide an important mixture of range, speed, payload, and endurance with significant implications on mission structure. Rather than proposing UxV teams collaborating towards specific autonomous capabilities, this paper proposes that basic physical and environmental constraints will drive tactics towards a layered, unmanned battlespace that provides force protection and reconnaissance in depth to a manned core.
Instant messaging at the hospital: supporting articulation work?
Iversen, Tobias Buschmann; Melby, Line; Toussaint, Pieter
Clinical work is increasingly fragmented and requires extensive articulation and coordination. Computer systems may support such work. In this study, we investigate how instant messaging functions as a tool for supporting articulation work at the hospital. This paper aims to describe the characteristics of instant messaging communication in terms of number and length of messages, distribution over time, and the number of participants included in conversations. We also aim to determine what kind of articulation work is supported by analysing message content. Analysis of one month's worth of instant messages sent through the perioperative coordination and communication system at a Danish hospital. Instant messaging was found to be used extensively for articulation work, mostly through short, simple conversational exchanges. It is used particularly often for communication concerning the patient, specifically, the coordination and logistics of patient care. Instant messaging is used by all actors involved in the perioperative domain. Articulation work and clinical work are hard to separate in a real clinical setting. Predefined messages and strict workflow design do not suffice when supporting communication in the context of collaborative clinical work. Flexibility is of vital importance, and this needs to be reflected in the design of supportive communication systems. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Hospitals of the Future - Ubiquitous Computing support for Medical Work in Hospitals
DEFF Research Database (Denmark)
Bardram, Jakob Eyvind
This paper describes the visions and on-going research within creating ubiquitous computing support for medical work in the hospitals of the future. Today, clinical computer systems seldom play any role in the execution of clinical work as such. Electronic Patient Records (EPR) are more often...... located in offices at a hospital rather than at patients' bedside, or in operating theaters. There are a number of challenges to the hardware and software design of contemporary computer systems that make them unsuitable for clinical work. It is, for example, difficult to operate a keyboard and a mouse...... while operating a patient. Research within UbiComp provides a range of new conceptual and technological possibilities, which enable us to move clinical computer support closer to the clinical work setting. An important barnce of the research at the Danish Center for Pervasive Healthcare is to design...
Monitoring and Assessment Science to Support Decision-Making by the United Nations Convention to Combat Desertification (UNCCD)
Winslow, M.; Akhtar-Schuster, M.; Cherlet, M.; Martius, C.; Sommer, S.; Thomas, R.; Vogt, J.
The United Nations Convention to Combat Desertification (UNCCD) is a global treaty that emerged from the Rio Earth Summit and formally took force in 1996. It has now been ratified by 193 countries (known as Parties to the Convention). Yet the UNCCD has gained only modest support from donors, largely due to questions about the science base underlying its target issue (desertification) resulting in ambiguous definitions and quantification of the problem. The UNCCD recognizes the need to reform itself and commissioned a scientific conference in Buenos Aires, Argentina in September 2009 to discuss ways to improve the scientific underpinning of monitoring and assessment (M&A) of desertification, land degradation and drought (DLDD). Previous attempts by the UNCCD on M&A focused largely on a search for a common, simple, universal set of indicators that could be reported by country Parties to the Convention Secretariat, which would collate them into a global report. However experience found that no single set of indicators is satisfactory to all countries, because DLDD depends strongly on the local environmental and human/social context. Three preparatory Working Groups analyzed the issue of DLDD M&A and recommended the following. Parties should recognize that M&A methods must integrate human-environment parameters to capture the complexity of DLDD phenomena as defined in the Convention's text. Traditional tendencies had been to isolate biophysical from social and economic parameters, leading to unrealistic conclusions. Parties should take advantage of a much wider range of analytical techniques than just the coarse-scale indicators that had been their main focus to date. Powerful but underutilized techniques include integrated assessment models, remote sensing, geographic information systems and mapping, participatory stakeholder assessment, hierarchical aggregation of related data, knowledge management and many others. Multiple methods could provide validation checks
Pervasive Computing Support for Hospitals: An Overview of the Activity-Based Computing Project
DEFF Research Database (Denmark)
Christensen, Henrik Bærbak; Bardram, Jakob E
The activity-based computing project researched pervasive computing support for clinical hospital work. Such technologies have potential for supporting the mobile, collaborative, and disruptive use of heterogeneous embedded devices in a hospital......The activity-based computing project researched pervasive computing support for clinical hospital work. Such technologies have potential for supporting the mobile, collaborative, and disruptive use of heterogeneous embedded devices in a hospital...
Family support, family stress, and suicidal ideation in a combat-exposed sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans.
Gradus, Jaimie L; Smith, Brian N; Vogt, Dawne
Deployment-related risk factors for suicidal ideation among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have received a great deal of attention. Studies show that mental health symptoms mediate the association between most deployment stressors and suicidal ideation; however, family-related factors during deployment are largely unexplored. We examined posttraumatic stress disorder (PTSD) and depression symptoms as mediators of the associations between deployment family support and stress and post-deployment suicidal ideation in combat-exposed OEF/OIF veterans. National cross-sectional mail survey. 1046 veterans responded to the survey. The sample for this study was 978 veterans who experienced combat. Regression-based path analyses were conducted. Family support and stress had direct associations with suicidal ideation. When PTSD and depression symptoms were examined as mediators of these associations, results revealed significant indirect paths through these symptoms. This study contributes to the literature on suicidal ideation risk factors among OEF/OIF veterans. Deployment family support and family stress are associated with suicidal ideation; however these associations occur primarily through mental health symptomatology, consistent with findings observed for other deployment factors. This research supports ongoing efforts to treat mental health symptomatology as a means of suicide prevention.
Large Hospital 50% Energy Savings: Technical Support Document
Energy Technology Data Exchange (ETDEWEB)
Bonnema, E.; Studer, D.; Parker, A.; Pless, S.; Torcellini, P.
This Technical Support Document documents the technical analysis and design guidance for large hospitals to achieve whole-building energy savings of at least 50% over ANSI/ASHRAE/IESNA Standard 90.1-2004 and represents a step toward determining how to provide design guidance for aggressive energy savings targets. This report documents the modeling methods used to demonstrate that the design recommendations meet or exceed the 50% goal. EnergyPlus was used to model the predicted energy performance of the baseline and low-energy buildings to verify that 50% energy savings are achievable. Percent energy savings are based on a nominal minimally code-compliant building and whole-building, net site energy use intensity. The report defines architectural-program characteristics for typical large hospitals, thereby defining a prototype model; creates baseline energy models for each climate zone that are elaborations of the prototype models and are minimally compliant with Standard 90.1-2004; creates a list of energy design measures that can be applied to the prototype model to create low-energy models; uses industry feedback to strengthen inputs for baseline energy models and energy design measures; and simulates low-energy models for each climate zone to show that when the energy design measures are applied to the prototype model, 50% energy savings (or more) are achieved.
2006 Combat Vehicles Conference
stressed or worn out beyond economic repair due to combat operations by repairing, rebuilding, or procuring replacement equipment. These...lives Vehicle Hardening Logistics Solutions for the Warfighter • Unique and economical surge capability • Support in coordination with op tempo...Speed, • Diagnostics Indicators – DECU Health Check Indicator, Utility Bus Comm Failure, 1553 Bus Comm Failure; MPU Critical Failure, Cautions and
Evaluation of nutritional support in a regional hospital.
Morán López, Jesús Manuel; Hernández González, Miriam; Peñalver Talavera, David; Peralta Watt, María; Temprano Ferreras, José Luis; Redondo Llorente, Cristina; Rubio Blanco, María Yolanda
Disease-related malnutrition (DRM) is highly prevalent in Spanish hospitals (occurring in 1 out of every 4 patients). The 'Más Nutridos' Alliance has developed an action plan to detect and treat DRM. In Extremadura (Spain), the public health system has included nutritional screening as the only mechanism to fight malnutrition. The results of this strategy are evaluated here. An agreement study was conducted in standard clinical practice. Variables collected included the following rates: nutritional screening at entry, coded nutritional diagnoses, nutritional status assessment, nutritional requirements, successful nutritional therapy, weight and height at entry and discharge, referral to a nutritional support unit (NSU). Standards to comparison based on the results of the Netherland Program to Fight Malnutrition. Nutritional screening rate at entry was 20.5% (95% CI: 18.00-21.00). Coding and nutritional status assessment rate at entry was 13%. Weight and height were both measured in 16.5% of patients at entry and 20% at discharge. Nutritional requirements were estimated in 30% and were poorly monitored (13.3%). Only 15% of patients were referred to a NSU. Significantly lower values were found for all indicators as compared to standards, with kappa values lower than 0.2 in all cases. Data analysis showed poorer results when patients referred to the NSU were excluded. A strategy to fight malnutrition based on nutritional screening alone is highly inefficient in hospitals such as HVP. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.
Why Does Military Combat Experience Adversely Affect Marital Relations?
Gimbel, Cynthia; Booth, Alan
Describes investigation of ways in which combat decreases marital quality and stability. Results support three models: (1) factors propelling men into combat also make them poor marriage material; (2) combat causes problems that increase marital adversity; and (3) combat intensifies premilitary stress and antisocial behavior which then negatively…
Support to the Air Force Installation and Mission Support Center: Enabling AFIMSC's Role in Agile Combat Support Planning, Execution, Monitoring, and Control
development, test, and evaluation; and supply chain management —and also quality-of-life support to military members, their families, retirees, and so on...AFIMSC and Air Education and Training Command Director of Logistics (AETC/A4) at a time when AFIMSC was being established to focus on managing the...operations of new ACS global management organizations.3 1 Program Action Directive (PAD) 14-04, Implementation of the Air Force Installation and
support area • Location of unit TOC or HQ • Location of actual combat operations • No basis to answer this question 4. Given the U.S. Army's current...welfare issue. I recall that part of General Order #1 was no sexual relations when deployed. Obviously, soldiers discovering pregnancy in the middle of...and had discussion about sexual relations and the 60 effect on unit cohesion, pregnancy testing, and affairs of the heart; whether appropriate or
[Support to spiritual needs in hospital care. Integration perspective in modern hospitals].
Proserpio, Tullio; Piccinelli, Claudia; Arice, Carmine; Petrini, Massimo; Mozzanica, Mario; Veneroni, Laura; Clerici, Carlo Alfredo
Within the course of medical care in the most advanced health care settings, an increasing attention is being paid to the so-called care humanization. According to this perspective, we try to integrate the usual care pathways with aspects related to the spiritual and religious dimension of all people and their families, as well as the employees themselves. It is clearly important to establish this kind of practices on the basis of scientific evidences. That is the reason why it's a necessity to improve the knowledge about the importance that spiritual assistance can offer within the current health service. The aim of this work is to show the relevance of the integration of spiritual perspectives in the hospital setting according to a multidisciplinary point of view. In this work many data that emerge from the international scientific literature, as well as the definition that is given to the concept of "spirituality" are analyzed; about this definition in fact there is not unanimous consent even today. It is also analyzed the legal situation in force within the European territory according to the different laws and social realities. Finally, the possible organizational practices related to spiritual support are described and the opportunity to specific accreditation pathways and careful training of chaplains able to integrate traditional religious practices with modern spiritual perspectives is discussed.
Directory of Open Access Journals (Sweden)
Yu Yi
Full Text Available The article considers the state support fordevelopment of personnel potential in hospitality business in China. Hospitality frameshave quantitative and qualitative characteristics. The gap between the needs of business organizations of hospitality for highlyqualified personnel at all levels and theirpresence in such a gigantic scale of countriessuch as China, can only be overcome withthe assistance of the state targeted programplanning. Support for human resourcesdevelopment in the hospitality businessincludes directions - the integration of stateformation, educational institutions and businesses. Further step towards improving thecompetitiveness of Chinese tourism shouldbe to develop a national target program fortraining of hospitality
Legal and regulatory aspects of optimization comprehensive support service and combat activity of the Security service of Ukraine and the National guard of Ukraine emergency social situation
Directory of Open Access Journals (Sweden)
В. В. Мацюк
Full Text Available Problem setting. The status of comprehensive support of military units in the world's leading powers is considered to be one of the key factors which defines the success of the social emergency settling operations. The experience of service and military application of the National Guard of Ukraine in the anti-terrorist operation zone on the South-East of Ukraine shows that emergency response tasks are generally carried out in cooperation with other Ukrainian security sector authorities, mostly with the Security Service of Ukraine. However, the forces joint managing authority chiefs usually do not cover the matter of such activities' comprehensive support, which forces the commanders of the military units to rely on themselves in this question. Recent research and publications analysis. The analysis of research of status and development prospects of the comprehensive support of the Armed Forces of Ukraine, other security authorities, armies of the world's leading powers, peculiarities of creation and functioning of such systems, application of their means and powers, scientific thought on the problems of service and military application of the National Guard units has shown the problematic tasks of the joint unit comprehensive support system optimization. Therefore, the question of regulatory and legal support of this process is of current importance. Paper objective. The objective of this paper is to define regulatory and legal aspects of comprehensive support optimization of the Security Service of Ukraine and the National Guard of Ukraine service and combat activities during social emergencies. Paper main body. According to the current legislation, comprehensive support comprises of the following types of support: operative (also called military, moral and psychological, materiel (logistical. All other types of support are parts of these three basic ones. Their examination is necessary due to the fact, that there is confusion in the
Philanthropic Donor Perspectives on Supporting Nursing Excellence in a Community Hospital.
Fickley, Sharon K; Mishler, Ray R; Black, Amelia S; DeGuzman, Pam B
The purpose of this research is to explore donors' perspectives on support of nursing excellence in a community hospital. Philanthropic support is rapidly becoming critical to support nursing excellence in hospitals, including continuing education, nursing research, and professional development. However, no research has examined the experience of private donors who support nursing programs in community hospitals. Structured interviews were conducted with individuals with a history of providing significant financial support (gifts >$50 000) targeted specifically for nursing in a 176- bed community hospital in the southeastern United States. Analysis was performed using descriptive content analysis. Four themes emerged that centered around making a difference, helping nurses meet new challenges, an existing foundation of service, and valuing excellent nursing care received. This research provides specific information that nursing administrators can use when seeking philanthropic gifts to support nursing excellence programs in US community hospitals.
Evaluating Michigan's community hospital access: spatial methods for decision support
Directory of Open Access Journals (Sweden)
Varnakovida Pariwate
Full Text Available Abstract Background Community hospital placement is dictated by a diverse set of geographical factors and historical contingency. In the summer of 2004, a multi-organizational committee headed by the State of Michigan's Department of Community Health approached the authors of this paper with questions about how spatial analyses might be employed to develop a revised community hospital approval procedure. Three objectives were set. First, the committee needed visualizations of both the spatial pattern of Michigan's population and its 139 community hospitals. Second, the committee required a clear, defensible assessment methodology to quantify access to existing hospitals statewide, taking into account factors such as distance to nearest hospital and road network density to estimate travel time. Third, the committee wanted to contrast the spatial distribution of existing community hospitals with a theoretical configuration that best met statewide demand. This paper presents our efforts to first describe the distribution of Michigan's current community hospital pattern and its people, and second, develop two models, access-based and demand-based, to identify areas with inadequate access to existing hospitals. Results Using the product from the access-based model and contiguity and population criteria, two areas were identified as being "under-served." The lower area, located north/northeast of Detroit, contained the greater total land area and population of the two areas. The upper area was centered north of Grand Rapids. A demand-based model was applied to evaluate the existing facility arrangement by allocating daily bed demand in each ZIP code to the closest facility. We found 1,887 beds per day were demanded by ZIP centroids more than 16.1 kilometers from the nearest existing hospital. This represented 12.7% of the average statewide daily bed demand. If a 32.3 kilometer radius was employed, unmet demand dropped to 160 beds per day (1
Opportunities and Design Considerations for Peer Support in a Hospital Setting.
Haldar, Shefali; Mishra, Sonali R; Khelifi, Maher; Pollack, Ari H; Pratt, Wanda
Although research has demonstrated improved outcomes for outpatients who receive peer support-such as through online health communities, support groups, and mentoring systems-hospitalized patients have few mechanisms to receive such valuable support. To explore the opportunities for a hospital-based peer support system, we administered a survey to 146 pediatric patients and caregivers, and conducted semi-structured interviews with twelve patients and three caregivers in a children's hospital. Our analysis revealed that hospitalized individuals need peer support for five key purposes: (1) to ask about medical details-such as procedures, treatments, and medications; (2) to learn about healthcare providers; (3) to report and prevent medical errors; (4) to exchange emotional support; and (5) to manage their time in the hospital. In this paper, we examine these themes and describe potential barriers to using a hospital-based peer support system. We then discuss the unique opportunities and challenges that the hospital environment presents when designing for peer support in this setting.
Supporting statistics in the workplace: experiences with two hospitals
Directory of Open Access Journals (Sweden)
M. Y. Mortlock
Full Text Available This paper provides some reflections on the promotion of lifelong learning in statistics in the workplace. The initiative from which the reflections are drawn is a collaboration between a university and two public hospitals, of which one of the stated aims is to develop statistical skills among the hospitals' researchers. This is realized in the provision of 'biostatistical clinics' in which workplace teaching and learning of statistics takes place in one-on-one or small group situations. The central issue that is identified is the need to accommodate diversity: in backgrounds, motivations and learning needs of workplace learners (in this case medical researchers, in the workplace environments themselves and in the projects encountered. Operational issues for the statistician in providing such training are addressed. These considerations may reflect the experiences of the wider community of statisticians involved in service provision within a larger organization.
[Desirable medical technologists in a community support hospital].
Takeda, Kyoko
Recently, there have been marked advances in the technological strategies employed in medical examinations. The educational concept to nurture highly capable medical technologists is considered to be a priority issue by not only educators but also employers, even though the medical educational levels have markedly improved in every college and university. It is commonly acknowledged that the results of any examination in the clinical laboratory should be accurate and fed back to medical doctors as soon as possible. The business outline of medical technologists in our hospital is becoming more extensive because we act as a core hospital in the area, and so knowledge regarding many kinds of chemical and transfusion examinations is required in operations performed around the clock. Furthermore, medical doctors, clerical workers, nurses, and volunteers comprise a team of sophisticated workers in our hospital. To accomplish our daily work, character traits such as accuracy, honesty, perseverance, and ability to follow instruction manuals, are the most fundamental and valuable. To nurture a highly career-oriented medical technologist, we propose that the following should be focused on: self-responsibility, reduction of malpractices, economic profitability, brainstorming, education of subsequent generations, and the spirit of cooperativeness and reconciliation. Additionally, it is another basic requirement of competent medical technologists to learn to adapt to laboratory-based changes in their work throughout their career. In conclusion, how to adapt to any social demand and learn strategies in any era should be taught in college or university as well as after graduation because each hospital and institute has a different philosophy and requirements of newcomers. It is important for medical technologists and doctors to develop flexible ways of thinking, although we sometimes might accede to traditional ways.
Bacterial flora of combat wounds from eastern Ukraine and time-specified changes of bacterial recovery during treatment in Ukrainian military hospital.
Valentine, Kovalchuk P; Viacheslav, Kondratiuk M
Microbiology of modern war wounds is unique for each military conflict. Climatic and geographical features of the theater of war, contemporary warfare as well as wound management affect the microbial flora of wounds. This study was designed to determine time-specific microbial flora of combat wounds of upper and lower extremities obtained during the war in eastern Ukraine. The patients enrolled in study had combat wounds of upper or lower extremities which were treated in the Military Medical Clinical Center of Central Region. The wounds were swab-cultured and measured at each surgical debridement. The recovered microorganisms were identified and their antimicrobial resistance profiles were evaluated by disc diffusion method. Forty-nine patients with battle-field wounds were enrolled in the study from July to November 2014; all patients were male with a mean Injury Severity Score and arrival APACHE II scores of 16.2 ± 10.7 and 7.4 ± 4.2 respectively. Among 128 swab cultures, 100 swab cultures were positive. Swab cultures were obtained from 57 wounds of 49 patients. The results of the test showed that 87.7% of all positive swab cultures contained a single-organism while the rest of the swab-culture results showed polymicrobial growth. Among the isolated microorganisms 65% (76 strains) were Gram-negative rods, 22.2% (26 strains) of Gram-positive cocci, followed by Gram-positive rods (12.8%, 15 strains). We found that epidemiology of wound infection changes with the time after injury. The most common bacterial isolates cultured during the first week were Gram-positive microbes with low pathogenicity. The number of Gram-negative rods increased during the wound healing process. The incidence of Gram-positive microorganisms' growth fell after the first week and increased after third week. During wound healing, bacterial microflora of wounds changes with increasing number of Gram-negative rods with predominance of Acinetobacter species. Predominant microorganisms in
Hospital Adoption of Health Information Technology to Support Public Health Infrastructure.
Walker, Daniel M; Diana, Mark L
Health information technology (IT) has the potential to improve the nation's public health infrastructure. In support of this belief, meaningful use incentives include criteria for hospitals to electronically report to immunization registries, as well as to public health agencies for reportable laboratory results and syndromic surveillance. Electronic reporting can facilitate faster and more appropriate public health response. However, it remains unclear the extent that hospitals have adopted IT for public health efforts. To examine hospital adoption of IT for public health and to compare hospitals capable of using and not using public health IT. Cross-sectional design with data from the 2012 American Hospital Association annual survey matched with data from the 2013 American Hospital Association Information Technology Supplement. Multivariate logistic regression was used to compare hospital characteristics. Inverse probability weights were applied to adjust for selection bias because of survey nonresponse. All acute care general hospitals in the United States that matched across the surveys and had complete data available were included in the analytic sample. Three separate outcome measures were used: whether the hospital could electronically report to immunization registries, whether the hospital could send electronic laboratory results, and whether the hospital can participate in syndromic surveillance. A total of 2841 hospitals met the inclusion criteria. Weighted results show that of these hospitals, 62.7% can electronically submit to immunization registries, 56.6% can electronically report laboratory results, and 54.4% can electronically report syndromic surveillance. Adjusted and weighted results from the multivariate analyses show that small, rural hospitals and hospitals without electronic health record systems lag in the adoption of public health IT capabilities. While a majority of hospitals are using public health IT, the infrastructure still has
Major Differences in Advanced Life Support Training Strategies Among Danish Hospitals - A Nationwide Study
DEFF Research Database (Denmark)
Glerup Lauridsen, Kasper; Mygind-Klausen, Troels; Stærk, Mathilde
Introduction: Advanced life support (ALS) training may increase survival from in-hospital cardiac arrest. Efficient ALS training includes practice of both technical and non-technical skills in a realistic setting with frequent retraining to avoid decay in ALS skills. ALS training strategies among...... hospitals are currently unknown. This study aimed to investigate ALS training strategies in Danish hospitals.Methods: We included all public, somatic hospitals in Denmark with a cardiac arrest team (n=46). Online questionnaires were distributed to resuscitation officers in each hospital. Questionnaires...... inquired information on: A) Course duration and retraining interval, B) Training methods and setting, C) Scenario training and practicing non-technical skills.Results: In total, 44 hospitals replied (response rate: 96%). ALS training was conducted in 43 hospitals (98%). Median (range) ALS course duration...
Radiation oncology: An Irish hospitals approach to supporting patients
Energy Technology Data Exchange (ETDEWEB)
Miller, Caragh [Cork University Hospital (Ireland)], E-mail: email@example.com
Despite advances in medical technology, cancer is still one of the leading causes of death globally, leaving many patients to deal with the emotional and psychological aspects associated with cancer and its treatment [Department of Health and Children. A strategy for cancer control in Ireland. National Cancer Forum. Dublin; 2006]. The recognition and management of psychological conditions are an integral part of comprehensive cancer care. As a result, the Health Services Executive as part of the continuing expansion of Cork Radiation Oncology Department created the role of Information and Support Radiation Therapist. This post was specially created during June 2005 to facilitate the smooth entry into the treatment for patients and family members experiencing radiotherapy for the first time. Working alongside the oncology nurses and other health professionals the Information and Support Radiation Therapist aims to provide vital education/information and support to patients and their families. The provision of this new service for patients enables departments to adopt a holistic approach to treatment. This research identifies the cancer services and psychological support services in Ireland. Up-to-date audits of the new patient services established in the Cork Radiation Oncology Department and their psychological contribution towards cancer development and treatment are also discussed.
Radiation oncology: An Irish hospitals approach to supporting patients
International Nuclear Information System (INIS)
Miller, Caragh
Despite advances in medical technology, cancer is still one of the leading causes of death globally, leaving many patients to deal with the emotional and psychological aspects associated with cancer and its treatment [Department of Health and Children. A strategy for cancer control in Ireland. National Cancer Forum. Dublin; 2006]. The recognition and management of psychological conditions are an integral part of comprehensive cancer care. As a result, the Health Services Executive as part of the continuing expansion of Cork Radiation Oncology Department created the role of Information and Support Radiation Therapist. This post was specially created during June 2005 to facilitate the smooth entry into the treatment for patients and family members experiencing radiotherapy for the first time. Working alongside the oncology nurses and other health professionals the Information and Support Radiation Therapist aims to provide vital education/information and support to patients and their families. The provision of this new service for patients enables departments to adopt a holistic approach to treatment. This research identifies the cancer services and psychological support services in Ireland. Up-to-date audits of the new patient services established in the Cork Radiation Oncology Department and their psychological contribution towards cancer development and treatment are also discussed
[Risk management of hospital infections as a supporting tool for the improvement of hospital quality - some European examples].
Sitek, Mateusz; Witczak, Izabela; Kiedik, Dorota
Prevention and control of nosocomial infections is one of the main pillars of security in each medical facility. This affects the quality of services and helps to minimize the economic losses incurred as a result of such infections. (Prolonged hospitalization, expensive antibiotic therapies, court costs of damages). Nosocomial infections occur in every medical facility in the hospitals in terms of risk of infection compared to other medicinal entities are at greater risk of environmental (number of hospitalizations for one bed, the amount of disinfectants, etc.). The number and diverse category of employment of medical and auxiliary, which should meet certain standards for the prevention of hospital infections, has an impact on the incidence of infection. It is impossible to eliminate hospital-acquired infections, but can be limited by appropriate measures, ranging from monitoring through the use of risk management methods, which are one of the elements supporting the improvement of the quality of medical entities. Hospital infection is a threat not only for patients but also for workers exposed to the risk of so-called occupational exposure. A comprehensive approach including elements of active surveillance and effective monitoring can help to minimize the risk of nosocomial infections.
Supported Discharge Teams for older people in hospital acute care: a randomised controlled trial.
Parsons, Matthew; Parsons, John; Rouse, Paul; Pillai, Avinesh; Mathieson, Sean; Parsons, Rochelle; Smith, Christine; Kenealy, Tim
Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs. Randomised controlled trial with follow-up to 6 months; 103 older women and 80 men (n = 183) (mean age 79), in hospital, were randomised to receive either Supported Discharge Team or usual care. Home-based rehabilitation was delivered by trained Health Care Assistants up to four times a day, 7 days a week, under the guidance of registered nurses, allied health and geriatricians for up to 6 weeks. Participants randomised to the Supported Discharge Team spent less time in hospital during the index admission (mean 15.7 days) in comparison to usual care (mean 21.6 days) (mean difference 5.9: 95% CI 0.6, 11.3 days: P = 0.03) and spent less time in hospital in the 6 months following discharge home. Supported discharge group costs were calculated at mean NZ$10,836 (SD NZ$12,087) compared to NZ$16,943 (SD NZ$22,303) in usual care. A Supported Discharge Team can provide an effective means of discharging older people home early from hospital and can make a cost-effective contribution to managing increasing demand for hospital beds. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: firstname.lastname@example.com
The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital
therapy resuscitation, and exacer- bated by hemorrhagic shock, metabolic acidosis, hypother- mia, hyperfibrinolysis, hypocalcemia , and anemia.11,14–19...outcome studies examining the effect of blood product transfusion ratios for trauma patients requiring massive transfusion. Most deaths (80% to 85%) that...calculation of apheresis platelet units transfused, though FWB has previously been shown to be as effective as 10 units of platelet concentrate.33 The
An Analysis of the Patient Appointing System of the 121st Combat Support Hospital to Determine an Optimal Appointing System
Orthopedics/ Podiatry 18 Physical Medicine/Physical Therapy 18 EENT Clinic 19 TRICARE 20 Primary Care Walk-ins to the Emergency Room 20 Statement of...specialty clinics are reviewed below. 17 Orthopedics/ Podiatry Patients needing to be seen by Orthopedics/ Podiatry are referred by primary care
International Atomic Energy Agency. Supporting member states to combat Zika virus outbreaks through its human health programme
Energy Technology Data Exchange (ETDEWEB)
Becic, Taric; Paez, Diana; Abdel-Wahab, May [International Atomic Energy Agency, Vienna (Austria). Div. of Human Health
Zika virus, discovered in late 1940s in Uganda, has rapidly spread into other parts of Africa and Asia. Since 2007, outbreaks have been documented in a great number of countries and territories, with Latin America and Caribbean region carrying the highest burden. The IAEA has therefore undertaken immediate actions to support members states as part of the global effort led by WHO. Due to its well-established know-how in the use of molecular diagnostic techniques, the IAEA organised a training course for detection of Zika virus in coordination with WHO-PAHO and provided equipment and reagents to some member states in Central America and the Caribbean as well as Pacific islands. In addition, the IAEA's support also comprises SIT as part of integrated vector management control.
International Atomic Energy Agency. Supporting member states to combat Zika virus outbreaks through its human health programme
International Nuclear Information System (INIS)
Becic, Taric; Paez, Diana; Abdel-Wahab, May
Zika virus, discovered in late 1940s in Uganda, has rapidly spread into other parts of Africa and Asia. Since 2007, outbreaks have been documented in a great number of countries and territories, with Latin America and Caribbean region carrying the highest burden. The IAEA has therefore undertaken immediate actions to support members states as part of the global effort led by WHO. Due to its well-established know-how in the use of molecular diagnostic techniques, the IAEA organised a training course for detection of Zika virus in coordination with WHO-PAHO and provided equipment and reagents to some member states in Central America and the Caribbean as well as Pacific islands. In addition, the IAEA's support also comprises SIT as part of integrated vector management control.
Do Hospitals Support Second Victims? Collective Insights From Patient Safety Leaders in Maryland.
Edrees, Hanan H; Morlock, Laura; Wu, Albert W
Second victims-defined as health care providers who are emotionally traumatized after a patient adverse event-may not receive needed emotional support. Although most health care organizations have an employee assistance program (EAP), second victims may be reluctant to access this service because of worries about confidentiality. A study was conducted to describe the extent to which organizational support for second victims is perceived as desirable by patient safety officers in acute care hospitals in Maryland and to identify existing support programs. Semistructured interviews (using existing and newly developed questions) were conducted with 43 patient safety representatives from 38 of the 46 acute care hospitals in Maryland (83% response rate). All but one of the responding hospitals offered EAP services to their employees, but there were gaps in the services provided related to timeliness, EAP staff's ability to relate to clinical providers, and physical accessibility. There were no valid measures in place to assess the effectiveness of EAP services. Participants identified a need for peer support, both for the second victim and potentially for individuals who provide that support. Six (16%) of the 38 hospitals had second victim support programs, which varied in structure, accessibility, and outcomes, while an additional 5 hospitals (13%) were developing such a program. Patient safety officers thought their organizations should reevaluate the support currently provided by their EAPs, and consider additional peer support mechanisms. Future research is needed to evaluate the effectiveness of these programs. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.
The impact of the hospital work environment on social support from physicians in breast cancer care.
Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole
Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
[The implementation of strategy of medicinal support in multi-type hospital].
Ludupova, E Yu
The article presents brief review of implementation of strategy of medicinal support of population of the Russian Federation and experience of application of at the level of regional hospital. The necessity and importance of implementation into practice of hospitals of methodology of pharmaco-economical management of medicinal care using modern technologies of XYZ-, ABC and VEN-analysis is demonstrated. The stages of development and implementation of process of medicinal support of multifield hospital applying principles of system of quality management (processing and systemic approaches, risk management) on the basis of standards ISO 9001 are described. The significance of monitoring of results ofprocess of medicinal support of the basis of implementation of priority target programs (prevention of venous thrombo-embolic complications, system od control of anti-bacterial therapy) are demonstrated in relation to multi-field hospital using technique of ATC/DDD-analysis for evaluating indices of effectiveness and efficiency.
Enhancing Brigade Combat Team Adaptability
Developing Learning Infrastructures (Training, Education , Practice, Research, Doctrine) -Create a shared vision -Build the business case (assess/Buy...To effectively respond to the characteristics of the operational environment, Brigade Combat Teams must be able to learn constantly from experience...behavior. Organizational adaptive behavior consists of three supporting emergent behaviors which are: self-organization, learning , and organizational
Effect of hospital nutrition support on growth velocity and nutritional status of low birth weight infants.
Azzeh, Firas S; Alazzeh, Awfa Y; Dabbour, Ibrahim R; Jazar, Abdelelah S; Obeidat, Ahmed A
Infants with low birth weights are provided with hospital nutrition support to enhance their survivability and body weights. However, different hospitals have different nutrition support formulas. Therefore, the effectiveness of these nutrition support formulas should be investigated. To assess the effect of hospital nutrition support on growth velocity and nutritional status of low birth weight infants at Al-Noor hospital, Saudi Arabia. A cross-sectional study was conducted between October, 2010 and December, 2012. Three hundred newborns were recruited from Al-Noor Hospital in Makkah city, Saudi Arabia. Infants were selected according to their birth weights and were divided equally into three groups; (i) Low Birth Weight (LBW) infants (1501- 2500 g birth weight), (ii) Very Low Birth Weight (VLBW) infants (1001-1500 g birth weight) and (iii) Extremely Low Birth Weight (ELBW) infants ( 0.05) were observed among groups. Serum calcium, phosphorus and potassium levels at discharge were higher (p < 0.05) than that at birth for ELBW and VLBW groups; while sodium level decreased in ELBW group to be within normal ranges. Albumin level was improved (p < 0.05) in ELBW group. Health care management for low birth weight infants in Al-Noor Hospital was not sufficient to achieve normal growth rate for low birth weight infants, while biochemical indicators were remarkably improved in all groups. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Linking Hospital and Tax data to support research on the economic impacts of hospitalization
Directory of Open Access Journals (Sweden)
Claudia Sanmartin
This project has created a unique linked database that will support research on the economic consequences of 'health shocks' for individuals and their families, and the implications for income, labour and health policies. This database represents a new and unique resource that will fill an important national data gap, and enable a wide range of relevant research.
The Agile Rapid Global Combat Support (ARGCS) System: A Cost and Benefit Analysis of Including the ARGCS Technologies in the Acquisition of the Enhanced Consolidated Support System (ECASS)
National Research Council Canada - National Science Library
Lund, John N
...). The ultimate goal of this project is to assist in the analysis of the ARGCS technologies and what benefit they would provide if included in the proposed next generation of Naval Aviation test equipment, currently called the Enhanced Consolidated Automated Support System (ECASS).
Technical Support Document: Development of the Advanced Energy Design Guide for Large Hospitals - 50% Energy Savings
Energy Technology Data Exchange (ETDEWEB)
Bonnema, E.; Leach, M.; Pless, S.
This Technical Support Document describes the process and methodology for the development of the Advanced Energy Design Guide for Large Hospitals: Achieving 50% Energy Savings Toward a Net Zero Energy Building (AEDG-LH) ASHRAE et al. (2011b). The AEDG-LH is intended to provide recommendations for achieving 50% whole-building energy savings in large hospitals over levels achieved by following Standard 90.1-2004. The AEDG-LH was created for a 'standard' mid- to large-size hospital, typically at least 100,000 ft2, but the strategies apply to all sizes and classifications of new construction hospital buildings. Its primary focus is new construction, but recommendations may be applicable to facilities undergoing total renovation, and in part to many other hospital renovation, addition, remodeling, and modernization projects (including changes to one or more systems in existing buildings).
Nutritional support management in premature infant in a Mexican (Guanajuato) hospital.
Monroy-Torres, R.; Mendoza Hernández, A. N.; Ruiz González, S. R.
Introduction: Premature infant has special nutritional and physiological recommendations. Nutritional support promotes an appropriate weight gain. While this support is monitored according to international guidelines, the metabolic and infectious complicationscan be reduced and prevented.Objective: To describe the management of nutritional support in premature infant in a Mexican (Guana juato) hospital.Methods: A descriptive cross-sectional study, where a survey of 22 questions was applied by...
Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support.
Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P; Zaslavsky, Alan M
Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited. To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest. Observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from nonrural counties who experienced out-of-hospital cardiac arrest between January 1, 2009, and October 2, 2011, and for whom ALS or BLS ambulance services were billed to Medicare (31,292 ALS cases and 1643 BLS cases). Propensity score methods were used to compare the effects of ALS and BLS on patient survival, neurological performance, and medical spending after cardiac arrest. Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year. Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3-5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2-4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6-27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154,333. Patients with out-of-hospital cardiac arrest who received BLS had higher survival at hospital discharge and at 90 days compared with those who received ALS and were less likely to experience poor neurological functioning.
Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals
Directory of Open Access Journals (Sweden)
Lydeka Zigmas
Full Text Available Abstract Background The regulations of the Quality Management System (QMS implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. Methods A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence. Results Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it. The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale. The most critical issues related to the QMS implementation include procedure development (5.5, lack of financial resources (5.4 and information (5.1, and development of work guidelines (4.6, while improved responsibility and power sharing (5.2, better service quality (5.1 and higher patient satisfaction (5.1 were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6. However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. Conclusion
What supports hospital pharmacist prescribing in Scotland? - A mixed methods, exploratory sequential study.
Fisher, J; Kinnear, M; Reid, F; Souter, C; Stewart, D
While approximately half of all qualified hospital pharmacist independent prescribers (PIPs) in Scotland are active prescribers, there are major differences in prescribing activity across geographical areas. This study aimed to explore, through focus groups, interviews and a questionnaire, hospital PIPs' perceptions of factors associated with prescribing activity and to investigate the infrastructure required to better support active prescribing by PIPs. Findings reinforced the perceived positive impact of supportive pharmacy leadership within the organisation, recognition that prescribing is integral to the clinical pharmacist role and a work environment conducive to prescribing. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
Nutrition support team management of enterally fed patients in a community hospital is cost-beneficial.
Hassell, J T; Games, A D; Shaffer, B; Harkins, L E
To determine whether nutrition support team (NST) management of enterally fed patients is cost-beneficial and to compare primary outcomes of care between team and nonteam management. A quasi-experimental study was conducted over a 7-month period. A 400-bed community hospital. A convenience sample of 136 subjects who had received enteral nutrition support for at least 24 hours. Forty-two patients died; only their mortality data were used. Ninety-six patients completed the study. Outcomes, including cost, for enterally fed patients in two treatment groups--those managed by the nutrition support team and those managed by nonteam staff--were compared. Severity of illness level was determined for patients managed by the nutrition support team and those managed by nonteam staff. For each group, the following measures were adjusted to reflect a significant difference in average severity of illness and then compared: length of hospital stay, readmission rates, and mortality rates. Complication rates between the groups were also compared. The cost benefit was determined based on savings from the reduction in adjusted length of hospital stay. Parametric and nonparametric statistics were used to evaluate outcomes between the two groups. Differences were statistically significant for both severity of illness, which was at a higher level in the nutrition support team group (P group (P team-managed group, there was a 23% reduction in adjusted mortality rate, an 11.6% reduction in the adjusted length of hospital stay, and a 43% reduction in adjusted readmission rate. Cost-benefit analysis revealed that for every $1 invested in nutrition support team management, a benefit of $4.20 was realized. Financial and humanitarian benefits are associated with nutrition support team management of enterally fed hospitalized patients.
Combat Power Analysis is Combat Power Density
Lanchester equations, Weapon Effectiveness Index (WEI), Weighted Unit Value (WUV), Armored Division Equivalents (ADE), and Unit Frontages. The research...6 Lanchester Equations... Lanchester Equations ............................................................................................... 53 Appendix C: Relative Combat Power
The Impact of Combat Status on Veterans' Attitudes Toward Help Seeking: The Hierarchy of Combat Elitism.
Ashley, Wendy; Brown, Jodi Constantine
Many veterans do not seek assistance for mental health concerns despite the staggering prevalence of trauma-related symptomatology. Barriers to service provision include personal and professional stigma and inter-veteran attitudes that dictate who is more or less deserving of services. Veteran attitudes are shaped by military culture, which promotes a hyper-masculine paradigm upholding combat experience as the defining feature of the "ideal soldier." The stratification of soldiers into combat or non-combat status creates a hierarchy of combat elitism that extends far beyond active duty. This pilot study surveyed veterans (n = 24) to explore how combat experience may affect attitudes toward help seeking. Findings indicate combat and non-combat veterans are less accepting of non-combat veterans' help-seeking behavior, supporting the notion that veterans' attitudes toward help seeking are influenced by combat status. Despite limitations, the results of this study reflect a need for increased attention to the attitudes veterans have about each other and themselves.
A national study of nurse leadership and supports for quality improvement in rural hospitals.
Paez, Kathryn; Schur, Claudia; Zhao, Lan; Lucado, Jennifer
This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.
Application of smart phone and supporting set for fundus imaging in primary hospital of rural area
Directory of Open Access Journals (Sweden)
Yong-Feng Jing
Full Text Available AIM: To describe the application of smart phone and supporting set for acquiring fundus images with slitlamp examination and non-contact lens in primary hospital of the rural area. METHODS: The supporting set for smart phone was purchased from taobao and securely connected to the ocular lens of slitlamp microscopy. The fundus photos were imaged with assistance of non-contact slitlamp lens from Volk. RESULTS: High quality images of various retinal diseases could be successfully taken with smart phone and supporting set by slitlamp examination. The fundus images were send to patients with Wechat as medical records or used for telconsultant. CONCLUSION: High resolution smart phones are wildly used nowadays and supporting sets are very accessible; thus high quality of images could be obtained with minimal cost in rural hospitals. The digital fundus images will be beneficial for medical record and rapid diagnosis with telconsultant.
Use of Tourniquets and their Effects on Limb Function in the Modern Combat Environment
pressure by tightening a tourniquet, the pressure can soon damage nerves (>500 mm Hg) while remaining ineffective. Many tourniquet manufacturers are unaware...testing, and clinical use.2,57 TOURNIQUET USE, TISSUE ISCHEMIA, AND LIMB FUNCTION Skin , bone, tendon, fat, fascia, joints, and vessels tolerate ischemia...injury in a combat support hospital: results of a case control study. J Trauma 2008;64(Suppl 2):S99–106 [discussion: S106–7]. 21. Bellamy RF . The
Friendliness, functionality and freedom: Design characteristics that support midwifery practice in the hospital setting.
Hammond, Athena; Homer, Caroline S E; Foureur, Maralyn
to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. this study used a qualitative exploratory descriptive methodology underpinned by the theoretical approach of critical realism. Data was collected through 21 in-depth, face-to-face photo-elicitation interviews and a thematic analysis guided by study objectives and the aims of exploratory research was undertaken. the study was set at a recently renovated tertiary hospital in a large Australian city. participants were 16 registered midwives working in a tertiary hospital; seven in delivery suite and nine in birth centre settings. Experience as a midwife ranged from three to 39 years and the sample included midwives in diverse roles such as educator, student support and unit manager. three design characteristics were identified that supported midwifery practice. They were friendliness, functionality and freedom. Friendly rooms reduced stress and increased midwives' feelings of safety. Functional rooms enabled choice and provided options to better meet the needs of labouring women. And freedom allowed for flexible, spontaneous and responsive midwifery practice. hospital birth rooms that possess the characteristics of friendliness, functionality and freedom offer enhanced support for midwives and may therefore increase effective care provision. new and existing birth rooms can be designed or adapted to better support the wellbeing and effectiveness of midwives and may thereby enhance the quality of midwifery care delivered in the hospital. Quality midwifery care is associated with positive outcomes and experiences for labouring women. Further research is required to investigate the benefit that may be transmitted to women by implementing design intended to support and enhance midwifery practice. Copyright © 2017 Elsevier Ltd. All rights reserved.
Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals
Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S.
Background: Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. Methods: A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. Results: The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%), pharmacopoeia availability (92%), equipment calibration (87%) and identifying responsibilities (86%). Least reported was external auditing of the DCSS (57%). The clinical chemistry and microbiology laboratories (84%), pharmacies, blood bank services (83%) reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%). There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO) and private-for-profit hospitals than in governmental hospitals. Conclusion: There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits) can be improved. Both the effectiveness of QA
Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals.
Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S
Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%), pharmacopoeia availability (92%), equipment calibration (87%) and identifying responsibilities (86%). Least reported was external auditing of the DCSS (57%). The clinical chemistry and microbiology laboratories (84%), pharmacies, blood bank services (83%) reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%). There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO) and private-for-profit hospitals than in governmental hospitals. There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits) can be improved. Both the effectiveness of QA strategies in practice, and the application of
Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals
Directory of Open Access Journals (Sweden)
Asgar Aghaei Hashjin
Full Text Available Background Iran has a widespread diagnostics and clinical support services (DCSS network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. Methods A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. Results The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%, pharmacopoeia availability (92%, equipment calibration (87% and identifying responsibilities (86%. Least reported was external auditing of the DCSS (57%. The clinical chemistry and microbiology laboratories (84%, pharmacies, blood bank services (83% reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%. There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO and private-for-profit hospitals than in governmental hospitals. Conclusion There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits can be improved. Both the effectiveness of QA
Accidents with potentially hazardous biological material among workers in hospital supporting services.
Canini, Silvia Rita Marin da Silva; Gir, Elucir; Machado, Alcyone Artiolli
Descriptive study was carried out to characterize the occupational accidents involving potentially contaminated material among workers of hospital supporting services. The study reviewed records of workers involved in these accidents and attended at a specialized outpatient clinic of a large tertiary care hospital between January 1997 and October 2001. A total of 2814 workers from different professional categories were attended during this period. Of these, 147 (5.2%) belonged to the hospital supporting services and were the victims of 156 accidents, auxiliary cleaning personnel (80.2%), and over a third of the workers had not received any dose of hepatitis B vaccine (35.4%). Most accidents were due to sharp injuries (96.8%) caused by inadequately discarded hollow needles. Chemoprophylaxis for HIV was not indicated in only 23.1% of cases. We conclude that these workers are also exposed to the possibility of acquiring blood-borne pathogens and that periodical education programs are needed.
Psychosocially Supportive Design: The Case for Greater Attention to Social Space Within the Pediatric Hospital.
McLaughlan, Rebecca
Models of patient and family-centered care advocate catering to psychosocial needs when designing healthcare facilities yet there is little evidence available to determine how the built environment can cater to psychosocial needs. This article highlights the obstacles to overcoming this knowledge deficit in the pursuit of evidence-based guidelines to inform social provisions within the pediatric hospital setting. It will propose a working definition for psychosocial space and identify new research directions to enhance understandings of the relationship between social space and well-being. While traditional multibed ward configurations afforded opportunities for peer support relationships to develop, both for patients and caregivers, the contemporary preference for single-occupancy rooms intensifies the need to critically examine social spaces within the pediatric hospital. Research suggests a correlation between social support and well-being. This article reviews the research underpinning contemporary understandings of this relationship; it positions literature from sociology, environmental psychology, and evidence-based design to highlight the limitations of this knowledge and identify where additional research is required to inform evidence-based design guidelines for psychosocially supportive spaces within pediatric healthcare settings. Evidence regarding the therapeutic value of social support within the pediatric hospital is not sufficiently sophisticated or conclusive to inform guidelines for the provision of social space with pediatric hospitals. There is an urgent need for targeted research to inform evidence-based design guidelines; this will demand a broad disciplinary approach.
Oral nutritional support of older (65 years+) medical and surgical patients after discharge from hospital
DEFF Research Database (Denmark)
Beck, Anne Marie; Holst, Mette; Rasmussen, Henrik Højgaard
To estimate the effectiveness of oral nutritional support compared to placebo or usual care in improving clinical outcome in older (65 years+) medical and surgical patients after discharge from hospital. Outcome goals were: re-admissions, survival, nutritional and functional status, quality of life...
A Customized Workflow-Driven Instant Messaging System Support Team Communication in the Hospital.
Lee, Ying-Li; Chien, Tsai-Feng; Chen, Hsiu-Chin
Effective communication among the healthcare team is a very important skill to support team resource management (TRM). However, we take too much effort to connect with other team members by using traditional telephone communication. In this study, we developed an instant messaging system embedded in the original hospital information system and evaluated the preliminary outcome and the usage of the system.
Evidence of combat in triceratops.
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Andrew A Farke
Full Text Available The horns and frill of Triceratops and other ceratopsids (horned dinosaurs are interpreted variously as display structures or as weapons against conspecifics and predators. Lesions (in the form of periosteal reactive bone, healing fractures, and alleged punctures on Triceratops skulls have been used as anecdotal support of intraspecific combat similar to that in modern horned and antlered animals. If ceratopsids with different cranial morphologies used their horns in such combat, this should be reflected in the rates of lesion occurrence across the skull.We used a G-test of independence to compare incidence rates of lesions in Triceratops (which possesses two large brow horns and a smaller nasal horn and the related ceratopsid Centrosaurus (with a large nasal horn and small brow horns, for the nasal, jugal, squamosal, and parietal bones of the skull. The two taxa differ significantly in the occurrence of lesions on the squamosal bone of the frill (P = 0.002, but not in other cranial bones (P > 0.20.This pattern is consistent with Triceratops using its horns in combat and the frill being adapted as a protective structure for this taxon. Lower pathology rates in Centrosaurus may indicate visual rather than physical use of cranial ornamentation in this genus, or a form of combat focused on the body rather than the head.
Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.
Bergersen, Tone Kristin; Storheim, Elisabeth; Gundersen, Stina; Kleven, Linn; Johnson, Maria; Sandvik, Leiv; Kvaerner, Kari Jorunn; Ørjasæter, Nils-Otto
The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. The number of control appointments (t = 3.80, P home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.
The ESTHER hospital partnership initiative: a powerful levy for building capacities to combat the HIV pandemic in low-resource countries
Raguin, Gilles
Partnerships between hospitals in high income countries and low resource countries are uniquely capable of fulfilling the tripartite needs of care, training, and research required to address health care crises in low resource countries. Of particular interest, at a time when the EBOLA crisis highlights the weaknesses of health systems in resource-poor settings, the institutional resources and expertise of hospitals can also contribute to strengthening health systems with long-term sustainabil...
Highly Efficient F, Cu doped TiO2 anti-bacterial visible light active photocatalytic coatings to combat hospital-acquired infections
Nigel S. Leyland; Joanna Podporska-Carroll; John Browne; Steven J. Hinder; Brid Quilty; Suresh C. Pillai
Bacterial infections are a major threat to the health of patients in healthcare facilities including hospitals. One of the major causes of patient morbidity is infection with Staphylococcus aureus. One of the the most dominant nosocomial bacteria, Methicillin Resistant Staphylococcus aureus (MRSA) have been reported to survive on hospital surfaces (e.g. privacy window glasses) for up to 5 months. None of the current anti-bacterial technology is efficient in eliminating Staphylococcus aureus. ...
Support for smoke-free policies in the Cyprus hospitality industry.
Lazuras, Lambros; Savva, Christos S; Talias, Michael A; Soteriades, Elpidoforos S
The present study used attitudinal and behavioural indicators to measure support for smoke-free policies among employers and employees in the hospitality industry in Cyprus. A representative sample of 600 participants (95 % response rate) completed anonymous structured questionnaires on demographic variables, smoking status, exposure to second-hand smoke at work and related health beliefs, social norms, and smoke-free policy support. Participants were predominantly males (68.3 %), with a mean age of 40 years (SD = 12.69), and 39.7 % were employers/owners of the hospitality venue. Analysis of variance showed that employers and smokers were less supportive of smoke-free policies, as compared to employees and non-smokers. Linear regression models showed that attitudes towards smoke-free policy were predicted by smoking status, SHS exposure and related health beliefs, and social norm variables. Logistic regression analysis showed that willingness to confront a policy violator was predicted by SHS exposure, perceived prevalence of smoker clients, and smoke-free policy attitudes. SHS exposure and related health beliefs, and normative factors should be targeted by interventions aiming to promote policy support in the hospitality industry in Cyprus.
Optimization-based decision support to assist in logistics planning for hospital evacuations.
Glick, Roger; Bish, Douglas R; Agca, Esra
The evacuation of the hospital is a very complex process and evacuation planning is an important part of a hospital's emergency management plan. There are numerous factors that affect the evacuation plan including the nature of threat, availability of resources and staff the characteristics of the evacuee population, and risk to patients and staff. The safety and health of patients is of fundamental importance, but safely moving patients to alternative care facilities while under threat is a very challenging task. This article describes the logistical issues and complexities involved in planning and execution of hospital evacuations. Furthermore, this article provides examples of how optimization-based decision support tools can help evacuation planners to better plan for complex evacuations by providing real-world solutions to various evacuation scenarios.
Senior management leadership, social support, job design and stressor-to-strain relationships in hospital practice.
Buttigieg, Sandra C; West, Michael A
The purpose of this paper is to examine the effect of the quality of senior management leadership on social support and job design, whose main effects on strains, and moderating effects on work stressors-to-strains relationships were assessed. A survey involving distribution of questionnaires was carried out on a random sample of health care employees in acute hospital practice in the UK. The sample comprised 65,142 respondents. The work stressors tested were quantitative overload and hostile environment, whereas strains were measured through job satisfaction and turnover intentions. Structural equation modelling and moderated regression analyses were used in the analysis. Quality of senior management leadership explained 75 per cent and 94 per cent of the variance of social support and job design respectively, whereas work stressors explained 51 per cent of the variance of strains. Social support and job design predicted job satisfaction and turnover intentions, as well as moderated significantly the relationships between quantitative workload/hostility and job satisfaction/turnover intentions. The findings are useful to management and to health employees working in acute/specialist hospitals. Further research could be done in other counties to take into account cultural differences and variations in health systems. The limitations included self-reported data and percept-percept bias due to same source data collection. The quality of senior management leaders in hospitals has an impact on the social environment, the support given to health employees, their job design, as well as work stressors and strains perceived. The study argues in favour of effective senior management leadership of hospitals, as well as ensuring adequate support structures and job design. The findings may be useful to health policy makers and human resources managers.
Reviewing information support during the Great East Japan Earthquake disaster : From the perspective of a hospital library that received support
Terasawa, Motoko
The Great East Japan Earthquake of March 11, 2011 caused extensive damage over a widespread area. Our hospital library, which is located in the affected area, was no exception. A large collection of books was lost, and some web content was inaccessible due to damage to the network environment. This greatly hindered our efforts to continue providing post-disaster medical information services. Information support, such as free access to databases, journals, and other online content related to the disaster areas, helped us immensely during this time. We were fortunate to have the cooperation of various medical employees and library members via social networks, such as twitter, during the process of attaining this information support.
Supportive care for older people with frailty in hospital: An integrative review.
Nicholson, Caroline; Morrow, Elizabeth M; Hicks, Allan; Fitzpatrick, Joanne
Growing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care. To identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation. An integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term 'supportive care'. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken. Literature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n=52) were integrated using synthesis of themes. Relevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings. The findings and model developed here will inform
Early discharge care with ongoing follow-up support may reduce hospital readmissions in COPD
Directory of Open Access Journals (Sweden)
Maria Lawlor
Full Text Available Maria Lawlor1, Sinead Kealy1, Michelle Agnew1, Bettina Korn1, Jennifer Quinn1, Ciara Cassidy1, Bernard Silke2, Finbarr O'Connell1, Rory O'Donnell11Department of Respiratory Medicine, CResT Directorate, St. James' Hospital, Dublin 8, Ireland; 2Department of General Internal Medicine, Gems Directorate, St. James' Hospital, Dublin 8, IrelandBackground: Early discharge care and self-management education, although effective in the management of chronic obstructive pulmonary disease (COPD, do not typically reduce hospital re-admission rates for exacerbations of the disease. We hypothesized that a respiratory outreach programme that comprises early discharge care followed by continued rapid-access out-patient support would reduce the need for hospital readmission in these patients.Methods: Two hundred and forty-six patients, acutely admitted with exacerbations of COPD, were recruited to the respiratory outreach programme that included early discharge care, followup education, telephone support and rapid future access to respiratory out-patient clinics. Sixty of these patients received self-management education also. Emergency department presentations and admission rates were compared at six and 12 months after, compared to prior to, participation in the programme for the same patient cohort.Results: The frequency of both emergency department presentations and hospital admissions was significantly reduced after participation in the programme.Conclusions: Provision of a respiratory outreach service that includes early discharge care, followed by education, telephone support and ongoing rapid access to out-patient clinics is associated with reduced readmission rates in COPD patients.Keywords: COPD management outreach, follow-up, out-patient clinics
[The development of a portable life support device for transporting pre-hospital critically ill patients].
Song, Zhen-xing; Wu, Tai-hu; Meng, Xing-ju; Lu, Heng-zhi; Zheng, Jie-wen; Wang, Hai-tao
To describe a portable life support device for transportation of pre-hospital patients with critical illness. The characteristics and requirements for urgent management during transportation of critically ill patients to a hospital were analyzed. With adoption of the original equipment, with the aid of staple of the art soft ware, the overall structure, its installation, fixation, freedom from interference, operational function were studied, and the whole system of life support and resuscitation was designed. The system was composed by different modules, including mechanical ventilation, transfusion, aspiration, critical care, oxygen supply and power supply parts. The system could be fastened quickly to a stretcher to form portable intensive care unit (ICU), and it could be carried by different size vehicles to provide nonstop treatment by using power supply of the vehicle, thus raising the efficiency of urgent care. With characteristics of its small size, lightweight and portable, the device is particularly suitable for narrow space and extreme environment.
Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...
Hospital-based education support for students with chronic health conditions.
Hopkins, Liza J
Objective To examine the evidence for best practice in educational support to hospitalised students and describe the existing supports available across each Australian state and territory. Methods A descriptive approach to the diversity of current practice and a review of the published evidence for best practice. Results We have constructed a model of best-practice in education support to hospitalised students. We found that education support services in each state met some of the criteria for best practice, but no one state service met all of the criteria. Conclusions All Australian states and territories make provision for hospitalised students to continue with their education, however the services in some states are closer to the best-practice model than others. What is known about the topic? It is well known that children and young people living with health conditions are at higher risk of educational underachievement and premature disengagement from school than their healthy peers. Although each state and territory across Australia offers some form of educational support to students during periods of hospitalisation, this support differs widely in each jurisdiction in fundamentals such as which students are eligible for support, where the support is delivered, how it is delivered and who coordinates the support. Published evidence in the literature suggests that the elements of good practice in education support have been well identified but, in practice, lack of policy direction can hinder the implementation of coordinated support. What does this paper add? This paper draws together the different models in place to support students in hospital in each state and territory and identifies the common issues that are faced by hospital education support services, as well as identifying areas where practice differs across settings. It also identifies the elements of good practice from the literature and links the elements of theory and practice to present a model of
Tools in a clinical information system supporting clinical trials at a Swiss University Hospital.
Weisskopf, Michael; Bucklar, Guido; Blaser, Jürg
Issues concerning inadequate source data of clinical trials rank second in the most common findings by regulatory authorities. The increasing use of electronic clinical information systems by healthcare providers offers an opportunity to facilitate and improve the conduct of clinical trials and the source documentation. We report on a number of tools implemented into the clinical information system of a university hospital to support clinical research. In 2011/2012, a set of tools was developed in the clinical information system of the University Hospital Zurich to support clinical research, including (1) a trial registry for documenting metadata on the clinical trials conducted at the hospital, (2) a patient-trial-assignment-tool to tag patients in the electronic medical charts as participants of specific trials, (3) medical record templates for the documentation of study visits and trial-related procedures, (4) online queries on trials and trial participants, (5) access to the electronic medical records for clinical monitors, (6) an alerting tool to notify of hospital admissions of trial participants, (7) queries to identify potentially eligible patients in the planning phase as trial feasibility checks and during the trial as recruitment support, and (8) order sets to facilitate the complete and accurate performance of study visit procedures. The number of approximately 100 new registrations per year in the voluntary trial registry in the clinical information system now matches the numbers of the existing mandatory trial registry of the hospital. Likewise, the yearly numbers of patients tagged as trial participants as well as the use of the standardized trial record templates increased to 2408 documented trial enrolments and 190 reports generated/month in the year 2013. Accounts for 32 clinical monitors have been established in the first 2 years monitoring a total of 49 trials in 16 clinical departments. A total of 15 months after adding the optional feature of
Challenges of implementing routine health behavior change support in a children's hospital setting.
Elwell, Laura; Powell, Jane; Wordsworth, Sharon; Cummins, Carole
Evidence indicates that health behavior change initiatives are often not implemented successfully. This qualitative study aims to understand the barriers and facilitators to implementation of health behavior change brief advice into routine practice in an acute children's hospital setting. Semi-structured interviews were conducted with health professionals working at a UK children's hospital (n=33). Participants were purposively sampled to incorporate a range of specialties, job roles and training. An inductive thematic framework analysis identified two emergent themes. These capture the challenges of implementing routine health behavior change support in a children's hospital setting: (1) 'health professional knowledge, beliefs and behaviors' and (2) 'patient and family related challenges'. This study enhances findings from previous research by outlining the challenges pediatric health professionals face in relation to supporting health behavior change. Challenges include failure to assume responsibility, low confidence, prioritization of the health provider relationship with patients and families, health provider and patient knowledge, and low patient and family motivation. Skills-based behavior change training is needed for pediatric health professionals to effectively support health behavior change. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Early discharge care with ongoing follow-up support may reduce hospital readmissions in COPD.
LENUS (Irish Health Repository)
Lawlor, Maria
BACKGROUND: Early discharge care and self-management education, although effective in the management of chronic obstructive pulmonary disease (COPD), do not typically reduce hospital re-admission rates for exacerbations of the disease. We hypothesized that a respiratory outreach programme that comprises early discharge care followed by continued rapid-access out-patient support would reduce the need for hospital readmission in these patients. METHODS: Two hundred and forty-six patients, acutely admitted with exacerbations of COPD, were recruited to the respiratory outreach programme that included early discharge care, follow-up education, telephone support and rapid future access to respiratory out-patient clinics. Sixty of these patients received self-management education also. Emergency department presentations and admission rates were compared at six and 12 months after, compared to prior to, participation in the programme for the same patient cohort. RESULTS: The frequency of both emergency department presentations and hospital admissions was significantly reduced after participation in the programme. CONCLUSIONS: Provision of a respiratory outreach service that includes early discharge care, followed by education, telephone support and ongoing rapid access to out-patient clinics is associated with reduced readmission rates in COPD patients.
Directory of Open Access Journals (Sweden)
Svetlana A. Mukhortova
Full Text Available Improving the quality of medical care is a priority in countries with developed and developing health care system. There are various approaches to improve the quality and safety of patient's care, as well as various strategies to encourage hospitals to achieve this goal. The purpose of the presented literature review was to analyze existing experience of the implementation of technology of supportive supervision in health care facilities to improve the quality of hospital care delivery. The data sources for publication were obtained from the following medical databases: PubMed, Cochrane Library, Medscape, e-library, and books on the topic of the review written by experts. The article discusses the results of the research studies demonstrating the successes and failures of supportive supervision technology application. Implementation of supportive supervision in medical facilities based on generalized experience of different countries is a promising direction in improving the quality of medical care delivery. This technology opens up opportunities to improve skills and work quality of the staff at pediatric hospitals in the Russian Federation.
Supporting Information Access in a Hospital Ward by a Context-Aware Mobile Electronic Patient Record
DEFF Research Database (Denmark)
Skov, Mikael B.; Høegh, Rune Thaarup
Context-awareness holds promise for improving the utility of software products. Context-aware mobile systems encompass the ability to automatically discover and react to changes in an environment. Most contemporary context-aware mobile systems aim to support users in private situations, for example......Ward is to support nurses in conducting morning procedures in a hospital ward. MobileWard is context-aware as it is able to discover and react autonomously according to changes in the environment and since it integrates the ability to provide information and services to the user where the relevancy depends....... Implications and limitations of the proposed solution are further discussed....
Executive Support of Information Technology and Information Systems in Australian Hospitals: an empirical study
Directory of Open Access Journals (Sweden)
Graeme Rose
Full Text Available Little is known regarding the form executive support should take for the progressive use of information technology and information systems [FT] within organisations. This study applies the theory developed by Jarvenpaa and Ives (1991 who examined two forms of support provided by chief executive officers. These were executive participation, a set of IT-related activities, and executive involvement, a psychological state reflecting the importance of IT for the organisation's success. Our research, using data obtained from a questionnaire mailed to a sample of Australian hospitals, measures the relationships between these two forms of support and the progressive use of IT. Our statistical analysis supports the findings of Jarvenpaa and Ives (1991, who found a stronger relationship between executive involvement and the progressive use of IT. Using Australian hospitals allowed Jarvenpaa and Ives' (1991 theory to be applied in a different environment, increasing its external validity. Firm size was also found to have a positive relationship with the progressive use of IT independent of the two forms of executive support.
A management system integrating radiation protection and safety supporting safety culture in the hospital
International Nuclear Information System (INIS)
Almen, A.; Lundh, C.
Quality assurance has been identified as an important part of radiation protection and safety for a considerable time period. A rational expansion and improvement of quality assurance is to integrate radiation protection and safety in a management system. The aim of this study was to explore factors influencing the implementing strategy when introducing a management system including radiation protection and safety in hospitals and to outline benefits of such a system. The main experience from developing a management system is that it is possible to create a vast number of common policies and routines for the whole hospital, resulting in a cost-efficient system. One of the key benefits is the involvement of management at all levels, including the hospital director. Furthermore, a transparent system will involve staff throughout the organisation as well. A management system supports a common view on what should be done, who should do it and how the activities are reviewed. An integrated management system for radiation protection and safety includes key elements supporting a safety culture. (authors)
The role of social support on occupational stress among hospital nurses.
Yu, Jiegen; Ren, Xiaohua; Wang, Quanhai; He, Lianping; Wang, Jinquan; Jin, Yuelong; Chen, Yan; Wang, Linghong; Nie, Zhonghua; Guo, Daoxia; Yao, Yingshui
Stress is a nonspecific reaction to everything the body needs. Although occupational stress exists in every occupation, it is seen with more frequency and intensity amongst those occupations related to human health. In this study, we aimed to investigate the relationship between occupational stress and social support (SS) among hospital nurses. A cross-sectional survey was conducted among 1144 hospital nurse in China. They were investigated with a self-administered questionnaire about socio-demographic characteristics, occupational stress and social support. A validated version of the revised Occupational Stress Inventory (OSI-R) was applied to evaluate occupational stress; SS was measured by nine questions. Logistic regression analysis was used to study the association between occupational stress and SS and adjusted for income, gender, marital status, working years, educational level, and profession. Of 1144 nurses, the majority age group was less than 30 years, and the mean age across participants was 31.8 years. Further correlation analysis indicated that score of ORQ and PSQ had a significant negative correlation with score of SS (Poccupational stress in hospitals nurse. We also should pay more attention to occupational stress of married and long working years nurse.
Directory of Open Access Journals (Sweden)
Ighoyota B. AJENAGHUGHRURE
Full Text Available Military infantry recruits, although trained, lacks experience in real-time combat operations, despite the combat simulations training. Therefore, the choice of including them in military operations is a thorough and careful process. This has left top military commanders with the tough task of deciding, the best blend of inexperienced and experienced infantry soldiers, for any military operation, based on available information on enemy strength and capability. This research project delves into the design of a mission combat efficiency estimator (MCEE. It is a decision support system that aids top military commanders in estimating the best combination of soldiers suitable for different military operations, based on available information on enemy's combat experience. Hence, its advantages consist of reducing casualties and other risks that compromises the entire operation overall success, and also boosting the morals of soldiers in an operation, with such information as an estimation of combat efficiency of their enemies. The system was developed using Microsoft Asp.Net and Sql server backend. A case study test conducted with the MECEE system, reveals clearly that the MECEE system is an efficient tool for military mission planning in terms of team selection. Hence, when the MECEE system is fully deployed it will aid military commanders in the task of decision making on team members' combination for any given operation based on enemy personnel information that is well known beforehand. Further work on the MECEE will be undertaken to explore fire power types and impact in mission combat efficiency estimation.
Hospital support services and the impacts of outsourcing on occupational health and safety.
Siganporia, Pearl; Astrakianakis, George; Alamgir, Hasanat; Ostry, Aleck; Nicol, Anne-Marie; Koehoorn, Mieke
Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors. This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach. Worker's compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups. Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries. This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers.
Hospital support services and the impacts of outsourcing on occupational health and safety
Alamgir, Hasanat; Ostry, Aleck; Nicol, Anne-Marie; Koehoorn, Mieke
Background Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors. Objectives This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach. Methods Worker's compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups. Results Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries. Conclusions This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers. PMID:27696988
Combat desertification, arret deforestation
International Nuclear Information System (INIS)
Tin-Latt; Soe-Win-Hlaing
This article presents the major progress on the actions of the Forest Department and Dry Zone Greening Department to arrest forestation and to combat desertification in the dry zone of central Myanmar
Highly Efficient F, Cu doped TiO2 anti-bacterial visible light active photocatalytic coatings to combat hospital-acquired infections
Leyland, Nigel S.; Podporska-Carroll, Joanna; Browne, John; Hinder, Steven J.; Quilty, Brid; Pillai, Suresh C.
Bacterial infections are a major threat to the health of patients in healthcare facilities including hospitals. One of the major causes of patient morbidity is infection with Staphylococcus aureus. One of the the most dominant nosocomial bacteria, Methicillin Resistant Staphylococcus aureus (MRSA) have been reported to survive on hospital surfaces (e.g. privacy window glasses) for up to 5 months. None of the current anti-bacterial technology is efficient in eliminating Staphylococcus aureus. A novel transparent, immobilised and superhydrophilic coating of titanium dioxide, co-doped with fluorine and copper has been prepared on float glass substrates. Antibacterial activity has demonstrated (by using Staphylococcus aureus), resulting from a combination of visible light activated (VLA) photocatalysis and copper ion toxicity. Co-doping with copper and fluorine has been shown to improve the performance of the coating, relative to a purely fluorine-doped VLA photocatalyst. Reductions in bacterial population of log10 = 4.2 under visible light irradiation and log10 = 1.8 in darkness have been achieved, compared with log10 = 1.8 under visible light irradiation and no activity, for a purely fluorine-doped titania. Generation of reactive oxygen species from the photocatalytic coatings is the major factor that significantly reduces the bacterial growth on the glass surfaces.
Combat Rescue Helicopter (CRH)
Selected Acquisition Report (SAR) RCS: DD-A&T(Q&A)823-479 Combat Rescue Helicopter (CRH) As of FY 2017 President's Budget Defense Acquisition...Name Combat Rescue Helicopter (CRH) DoD Component Air Force Responsible Office References SAR Baseline (Development Estimate) Defense Acquisition... Helicopter (CRH) system will provide Personnel Recovery (PR) forces with a vertical takeoff and landing aircraft that is quickly deployable and
Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients.
Nikolic, D; Richter, S S; Asamoto, K; Wyllie, R; Tuttle, R; Procop, G W
There is substantial evidence that stool culture and parasitological examinations are of minimal to no value after 3 days of hospitalization. We implemented and studied the impact of a clinical decision support tool (CDST) to decrease the number of unnecessary stool cultures (STCUL), ova/parasite (O&P) examinations, and Giardia / Cryptosporidium enzyme immunoassay screens (GC-EIA) performed for patients hospitalized >3 days. We studied the frequency of stool studies ordered before or on day 3 and after day 3 of hospitalization (i.e., categorical orders/total number of orders) before and after this intervention and denoted the numbers and types of microorganisms detected within those time frames. This intervention, which corresponded to a custom-programmed hard-stop alert tool in the Epic hospital information system, allowed providers to override the intervention by calling the laboratory, if testing was deemed medically necessary. Comparative statistics were employed to determine significance, and cost savings were estimated based on our internal costs. Before the intervention, 129/670 (19.25%) O&P examinations, 47/204 (23.04%) GC-EIA, and 249/1,229 (20.26%) STCUL were ordered after 3 days of hospitalization. After the intervention, 46/521 (8.83%) O&P examinations, 27/157 (17.20%) GC-EIA, and 106/1,028 (10.31%) STCUL were ordered after 3 days of hospitalization. The proportions of reductions in the number of tests performed after 3 days and the associated P values were 54.1% for O&P examinations ( P < 0.0001), 22.58% for GC-EIA ( P = 0.2807), and 49.1% for STCUL ( P < 0.0001). This was estimated to have resulted in $8,108.84 of cost savings. The electronic CDST resulted in a substantial reduction in the number of evaluations of stool cultures and the number of parasitological examinations for patients hospitalized for more than 3 days and in a cost savings while retaining the ability of the clinician to obtain these tests if clinically indicated. Copyright © 2017
Plan for Combat Operations (Battlefield Function 18) as Accomplished by a Heavy Brigade. Volume 2: Assessment Package
National Research Council Canada - National Science Library
Mullen, William
The purpose of the overall research program was to document the synchronization required by command and control tasks performed within the armored brigade, to include combat support and combat service support units...
Outcomes and hospital admissions during long-term support with a HeartMate II
DEFF Research Database (Denmark)
Rossing, Kasper; Jung, Mette Holme; Sander, Kaare
OBJECTIVES: Continuous-flow left ventricular assist devices like the HeartMate II (HMII) improves survival in severe heart failure but little is known about the incidence and causes of hospitalizations during long-term support which was evaluated in this study. DESIGN: Observational follow-up study...... comprising all patients who received a HMII at our institution either as bridge-to-transplantation (BTT) or destination therapy (DT). All patients were followed from HMII implantation to transplantation, device explantation, death, or May 2015. RESULTS: The HMII was implanted in 66(44 BTT, 22 DT) patients...
Support, sensitivity, satisfaction: Filipino, Turkish and Vietnamese women's experiences of postnatal hospital stay.
Yelland, J; Small, R; Lumley, J; Rice, P L; Cotronei, V; Warren, R
To assess Filipino, Turkish and Vietnamese women's views about their care during the postnatal hospital stay. Interviews were conducted with recent mothers in the language of the women's choice, 6-9 months after birth, by three bilingual interviewers. Three hundred and eighteen women born in the Philippines (107), Turkey (107) and Vietnam (104) who had migrated to Australia. Women were recruited from the postnatal wards of three maternity teaching hospitals in Melbourne, Australia, and interviewed at home. Overall satisfaction with care was low, and one in three women left hospital feeling that they required more support and assistance with both baby care and their own personal needs. The method of baby feeding varied between the groups, with women giving some insight into the reason for their choice. A significant minority wanted more help with feeding, irrespective of the method. The need for rest was a recurrent theme, with women stating that staff's attitudes to individual preferences, coupled with lack of assistance, made this difficult. The majority of comments women made regarding their postnatal stay focused on the attitude and behaviour of staff and about routine aspects of care. Issues related to culture and cultural practices were not of primary concern to women. Maternity services need to consider ways in which care can focus on the individual needs and preferences of women.
[Mechanical circulatory support in pediatrics. Experience at the Dr. Juan P. Garrahan Pediatric Hospital. Argentina].
Moreno, Guillermo E; Magliola, Ricardo; Pilán, María Luisa; Althabe, María; Balestrini, María; Lenz, Ana Miriam; Krysnki, Mariela; Rodríguez, Ricardo; Salgado, Gladys; Martin, Analía; Cardoso, Hugo; Ruffa, Pablo; Cornelis, Carlos Javier; Barreta, Jorge; García Delucis, Pablo
Mechanical circulatory support provides oxygen to the tissues in patients with cardiac and/or respiratory reversible disease refractory to conventional treatments. The aim of this study is to show our initial results of mechanical circulatory support in children with heart disease. Retrospective cohort between March 2006 and March 2012. Demographic data (age, sex, weight, cardiac diagnosis), surgery (technique, pump, aortic cross clamping time) and mechanical circulatory support (type of assistance, indication, duration, complications and outcome) were collected. Thirty-three patients were supported (1.3% of all surgeries), extracorporeal membrane oxygenation 32 cases and one ventricular assist device. The median age 7.4 months (one day-18 years) and weight 6kg (2.3-75). The most frequent cardiac malformations supported were the transpositions of the great arteries associated with other anomalies and the corrected transpositions (ventricular inversion or double discordance). The most common reason for admission was post-cardiotomy biventricular dysfunction. Twenty-eight patients were supported in the postoperative period, 4 in the preoperative period and in one with myocarditis. Median days of support were 3 days (1-10). The most common complications were infection (21%), bleeding (21%). Elective decannulation was achieved in 94% of cases. Hospital discharge survival: 52%. The mechanical circulatory support in our institution is a safe and standard procedure. We have been using it in a small number of cases with a similar survival to that reported internationally. This complex procedure is widely justified because it allows for the recovery of more than half of the patients who otherwise would have died. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.
The relationships between psychological strain, organizational support, affective commitment and turnover intentions of highly educated hospitality employees
Tromp, D.M.; Rheede, van A.; Blomme, R.J.
Turnover of highly educated employees in the hospitality industry is growing rapidly. A predictor of turnover in the hospitality industry recently put forward, but not yet fully researched, is psychological strain. This chapter investigates the role of psychological strain and organizational support
Feasibility of integrated home/hospital physiotherapeutic support for children with cancer.
Savio, Christian; Garaventa, Alberto; Gremmo, Marina; Camoriano, Riccardo; Manfredini, Luca; Fieramosca, Sara; Dini, Giorgio; Miano, Maurizio
Children suffering from cancer often have to undergo physiotherapy that either extends the duration of in-patient hospitalisation or requires more frequent visits to the outpatient clinic. To improve care and to decrease the length of hospitalisation of children being treated at the Dept. of Haematoloy/Oncology of the Gaslini Children's Hospital, a programme of Home Care was set up in April 2000. In June 2003, rehabilitation was added to the procedures that were feasible at home and included i.v. therapy administration, blood examinations, transfusion and/or psychological support, as well as palliative care for terminally ill children. The physiotherapy sessions were done in the ward, in the Rehabilitation Unit Gym, or at home, depending on the clinical conditions and the needs of the child and the family. Between June 2003 and May 2005, 46 children, whose median age was 7 years (range 6 months-21 years) suffering from CNS tumours (13), leukaemia (13), neuroblastoma (7), bone tumours (6), sarcoma (4) and lymphoma (3), underwent 1,398 physiotherapy sessions for neuro-motor re-education (534), motor rehabilitation (485), strain re-education and training (250), respiratory care (79), or to improve comfort during the terminal phase of the disease (50). To maintain continuity of care, the treatments were performed at home (931), in the hospital ward (282), or in the gymnasium of our Physiotherapy Service (185). The physiotherapist was able to start or to continue assistance at home or in the hospital, and to keep up the programme based on the child's needs. Integrated home/hospital physiotherapy for children suffering from cancer is feasible and is useful for maintaining continuity of treatment without lengthening hospitalisation.
Multiple physical signs detection and decision support system for hospitalized older adults
International Nuclear Information System (INIS)
Baig, Mirza Mansoor; GholamHosseini, Hamid; Connolly, Martin J
Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way healthcare is currently delivered. Smart monitoring systems automate patient monitoring tasks and thereby improve patient workflow management. Moreover, expert systems have the potential to assist clinicians and improve their performance by accurately executing repetitive tasks, to which humans are ill-suited. Clinicians working in hospital wards are responsible for conducting a multitude of tasks which require constant vigilance, and thus the need for a smart decision support system has arisen. In particular, wireless patient monitoring systems are emerging as a low cost, reliable and accurate means of healthcare delivery.Vital signs monitoring systems are rapidly becoming part of today's healthcare delivery. The paradigm has shifted from traditional and manual recording to computer-based electronic records and, further, to handheld devices as versatile and innovative healthcare monitoring systems. The current study focuses on interpreting multiple physical signs and early warning for hospitalized older adults so that severe consequences can be minimized. Data from a total of 30 patients have been collated in New Zealand hospitals under local and national ethics approvals. The system records blood pressure, heart rate (pulse), oxygen saturation (SpO2), ear temperature and blood glucose levels from hospitalized patients and transfers this information to a web-based software application for remote monitoring and further interpretation. Ultimately, this system is aimed to achieve a high level of agreement with clinicians' interpretation when assessing specific physical signs such as bradycardia, tachycardia, hypertension, hypotension, hypoxaemia, fever and hypothermia to generate early warnings. The performance of the vital signs interpretation system was validated through off-line as well as real-time tests with a high level of agreement between
[Document management systems to support quality management systems at university hospitals - an interview-based study].
Holderried, Martin; Bökel, Ann-Catrin; Ochsmann, Elke
In order to save and control the processes and quality of medical services, a suitable steering system of all relevant documents is essential from the point of view of clinical quality management. Systems supporting an automated steering system of documents are called document management systems (DMS), and they also enter the healthcare sector. The use of DMS in the German healthcare sector has hardly been investigated so far. To close this knowledge gap, interviews were carried out with German university hospitals over a six-month period and subjected to a qualitative content analysis according to Mayring. In total, 25 university hospitals agreed to participate in this study, 19 of which have been working with a digital DMS for about six years on average. There was a great variety among the IT systems used. Document management and usability of the DMS as well as its integration into existing IT structures were key decision-making criteria for the selection of a digital DMS. In general, the long-term usability of the DMS is supported by regular evaluation of one's own requirements for the system, administration and training programs. In addition, DMS have a positive effect on patient safety and the quality of medical care. Copyright © 2018. Published by Elsevier GmbH.
The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review
Background Inappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR. Objectives To evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings. Methods A systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale. Results Eighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted. Conclusions CDS has the potential to improve the adequacy of antibiotic
The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review.
Directory of Open Access Journals (Sweden)
Christopher E Curtis
Full Text Available Inappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR. Health information technology (HIT in the form of Computerised Decision Support (CDS represents an option for improving antimicrobial prescribing and containing AMR.To evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings.A systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing OR (clinical decision support AND (antibiotic or antibacterial or antimicrobial AND (hospital or secondary care or inpatient. Studies were evaluated for quality using a 10-point rating scale.Eighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]. Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]. CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted.CDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in
The Effect of Job Demand-Control-Social Support Model on Nurses' Job Satisfaction in Specialized Teaching Hospitals, Ethiopia
Negussie, Nebiat; Kaur, Geetinder
Background The job demand-control-social support model has been widely studied in western countries but has not been theoretically addressed on health workers of sub-Saharan African countries. Therefore, this study investigates the relationship between Job Demand-Control-Support Model and job satisfaction in specialized teaching hospitals in Ethiopia. Method A cross-sectional survey was conducted from September 2014 to May 2015 in three public specialized teaching hospitals in Ethiopia. Among...
Supporting in grief and burnout of the nursing team from pediatric units in Chilean hospitals.
Vega, Paula Vega; Rodriguez, Rina González; Galdamez, Natalie Santibáñez; Molina, Camila Ferrada; Orellana, Javiera Spicto; Villanueva, Antonia Sateler; Melo, Jose Bustos
Objective To know the levels of Burnout Syndrome and perception of grief support in nursing teams of oncology and pediatric intensive care in public hospitals in Chile. Method A study of descriptive cross-sectional design. The Maslach Burnout Inventory and the Grief Support Health Care Scale were applied to university-level and technical nursing professionals between March and November 2015. An analysis to compare the means was performed with use of the Student's t-test, and the level of significance was set at 5%. Results The study included 153 professionals. Results show 4% of professionals have Burnout Syndrome (BS) and 89% are at risk of having it. Oncology professionals are at higher risk as they present higher levels of emotional exhaustion and lower levels of personal fulfillment. Half of professionals have a high level of perception of grief support, which is greater in the oncology team. Conclusion Professionals working in pediatric oncology units are at increased risk of Burnout Syndrome and grief support may be a mediating factor in this process.
Engineer Company Force Structure Force Modularization in Support of Decisive Action. Does the Corps of Engineers Need to Re-Structure Engineer Construction Companies Again in order to Support Decisive Actions?
Regional Command RCP Route Clearance Platoon RSOI Reception, Staging, Onward Movement, Integration SBCT Stryker Brigade Combat Team TOE Table of...Point (ASPs), and field hospital platforms; prepare river crossing sites; and support port repair due to Hydraulic Excavator (HYEX), provides force...platforms, FARPS, supply routes, roads, control points, fire bases, tank ditches, ASPs, and field hospital platforms; prepare river crossing sites; and
Supporting 'medicine at a distance' for delivery of hospital services in war-torn Somalia: how well are we doing?
Maalim, Abdisalan M; Zachariah, Rony; Khogali, Mohamed; Van Griensven, Johan; Van den Bergh, Rafael; Tayler-Smith, Katherine; Kizito, Walter; Baruani, Bienvenu; Osoble, Abdirahman; Abdirahman, Faiza; Ayada, Latifa; Mohamed, Abdinoor H
We describe an innovative strategy implemented to support national staff at Istarlin Hospital in the conflict setting of Somalia; and report on inpatient morbidities, mortality and adverse hospital exit outcomes. This was a retrospective analysis of hospital data for 2011. Of 8584 admitted patients, the largest numbers were for lower respiratory tract infections (LRTI) (2114; 25%), normal deliveries (1355; 16%) and diarrhoeal diseases (715; 8%). The highest contributors to mortality were gunshot wounds in surgery (18/30; 60%), LRTIs in internal medicine (6/32; 19%) and malnutrition in paediatrics (30/81; 37%). Adverse hospital exit outcomes (deaths and absconded) were well within thresholds set by Médecins Sans Frontières. With a support package, satisfactory standards of care were met for hospital care in Somalia.
Family nursing hospital training and the outcome on job demands, control and support.
Sigurdardottir, Anna Olafia; Svavarsdottir, Erla Kolbrun; Juliusdottir, Sigrun
The purpose of this study was to evaluate the impact of a family systems nursing hospital training educational program (ETI program) on nurses' and midwives' perception of job demands, control, and/or support. Of the nurses and midwives who were working in the Women's and Children's Services Division at The National University Hospital in Iceland, 479 participated in the study on three time periods from 2009 to 2011. Scores for the characteristics of job demands and job control were created to categorize participants into four job types (Karasek and Theorell, 1990). These four job types are high strain (high demand, low control), passive (low demand, low control), low strain (low demand, high control), and active (high demand, high control). However, when the data were evaluated based on the proportion of job characteristics as reported by the nurses and the midwives, no significant difference was found over time (2009 to 2011) (χ(2)=5.203, p=.518). However, based on the results from the independent t-tests at time 1, a significant difference was found amongst the high strain job group regarding perceived support from administrators and colleagues among the nurses and midwives who had taken the ETI program compared to those who had not taken the program (χ(2)=2.218, p=.034). This indicates that the health care professionals who characterized their job to be of high demand but with low control evaluated the support from their administrators and colleagues to be significantly higher if they had taken the ETI program than did the nurses and midwives who did not take the ETI program. These findings are promising because they might, in the long run, increase the nurses' and midwives' autonomy and control over their own work. Copyright © 2015 Elsevier Ltd. All rights reserved.
Enteral nutritional support management in a university teaching hospital: team vs nonteam.
Brown, R O; Carlson, S D; Cowan, G S; Powers, D A; Luther, R W
Current hospital cost containment pressures have prompted a critical evaluation of whether nutritional support teams render more clinically effective and efficient patient care than nonteam management. To address this question with regard to enteral feeding, 102 consecutive hospitalized patients who required enteral nutritional support (ENS) by tube feeding during a 3 1/2-month period were prospectively studied. Fifty patients were managed by a nutritional support team; the other 52 were managed by their primary physicians. Choice of enteral formula, formula modifications, frequency of laboratory tests, and amounts of energy and protein received were recorded daily. In addition, each patient was monitored for pulmonary, mechanical, gastrointestinal, and metabolic abnormalities. Team-managed (T) and nonteam-managed (NT) patients received ENS for 632 and 398 days, respectively. The average time period for ENS was significantly longer in the team-managed patients (12.6 +/- 12.1 days vs 7.7 +/- 6.2 days, p less than 0.01). Significantly more of the team patients attained 1.2 X basal energy expenditure (BEE) (37 vs 26, p less than 0.05). Total number of abnormalities in each group was similar (T = 398, NT = 390); however, the abnormalities per day were significantly lower in the team group (T = 0.63 vs NT = 0.98, p less than 0.01). Mechanical (T = 0.05 vs NT = 0.11, p less than 0.01), gastrointestinal (T = 0.99 vs NT = 0.14, p less than 0.05), and metabolic (T = 0.49 vs NT = 0.72, p less than 0.01) abnormalities per day all were significantly lower in the team-managed patients.(ABSTRACT TRUNCATED AT 250 WORDS)
In-Hospital Basic Life Support: Major Differences in Duration, Retraining Intervals, and Training Methods - A Danish Nationwide Study
DEFF Research Database (Denmark)
Rasmussen, Ditte K; Glerup Lauridsen, Kasper; Staerk, Mathilde
Introduction: High-quality chest compressions and early defibrillation is essential to improve survival following in-hospital cardiac arrest. Efficient training in basic life support (BLS) for clinical staff is therefore important. This study aimed to investigate duration, training methods...... and retraining intervals for BLS training of clinical staff in Danish hospitals.Methods: We included all public, somatic hospitals in Denmark with a cardiac arrest team. Online questionnaires were distributed to resuscitation officers in each hospital. Questionnaires inquired information on: A) Course duration...... and retraining interval, and B) Training methods and setting.Results: In total, 44 hospitals replied (response rate: 96%). BLS training for clinical staff was conducted in 41 hospitals (93%). Median (Q1;Q3) course duration was 1.5 (1;2.5) hours. Retraining was conducted every year (17%), every second year (56...
DEFF Research Database (Denmark)
Mullins, Michael
The challenge could be briefly seen in these terms: hospitals as places for treatment where there's a technology focus and hospitals for healing where there's a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It's time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...
Hotspots of human-induced biomass productivity decline and their social-ecological types toward supporting national policy and local studies on combating land degradation
Vu, Quyet Manh; Le, Quang Bao; Vlek, Paul L. G.
Identification and social-ecological characterization of areas that experience high levels of persistent productivity decline are essential for planning appropriate management measures. Although land degradation is mainly induced by human actions, the phenomenon is concurrently influenced by global climate changes that need to be taken into account in land degradation assessments. This study aims to delineate the geographic hotspots of human-induced land degradation in the country and classify the social-ecological characterizations of each specific degradation hotspot type. The research entailed a long-term time-series (1982-2006) of Normalized Difference Vegetation Index to specify the extents of areas with significant biomass decline or increase in Vietnam. Annual rainfall and temperature time-series were then used to separate areas of human-induced biomass productivity decline from those driven by climate dynamics. Next, spatial cluster analyses identified social-ecological types of degradation for guiding further investigations at regional and local scales. The results show that about 19% of the national land mass experienced persistent declines in biomass productivity over the last 25 years. Most of the degraded areas are found in the Southeast and Mekong River Delta (17,984 km2), Northwest Mountains (14,336 km2), and Central Highlands (13,504 km2). We identified six and five social-ecological types of degradation hotspots in agricultural and forested zones, respectively. Constraints in soil nutrient availability and nutrient retention capability are widely spreading in all degradation hotspot types. These hotspot types are different from each other in social and ecological conditions, suggesting that region-specific strategies are needed for the formulation of land degradation combating policy.
Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals.
Banks, M D; Graves, N; Bauer, J D; Ash, S
This study estimates the economic outcomes of a nutrition intervention to at-risk patients compared with standard care in the prevention of pressure ulcer. Statistical models were developed to predict 'cases of pressure ulcer avoided', 'number of bed days gained' and 'change to economic costs' in public hospitals in 2002-2003 in Queensland, Australia. Input parameters were specified and appropriate probability distributions fitted for: number of discharges per annum; incidence rate for pressure ulcer; independent effect of pressure ulcer on length of stay; cost of a bed day; change in risk in developing a pressure ulcer associated with nutrition support; annual cost of the provision of a nutrition support intervention for at-risk patients. A total of 1000 random re-samples were made and the results expressed as output probability distributions. The model predicts a mean 2896 (s.d. 632) cases of pressure ulcer avoided; 12, 397 (s.d. 4491) bed days released and corresponding mean economic cost saving of euros 2 869 526 (s.d. 2 078 715) with a nutrition support intervention, compared with standard care. Nutrition intervention is predicted to be a cost-effective approach in the prevention of pressure ulcer in at-risk patients.
Clinical decision support systems in hospital care using ubiquitous devices: Current issues and challenges.
Baig, Mirza Mansoor; GholamHosseini, Hamid; Moqeem, Aasia A; Mirza, Farhaan; Lindén, Maria
Supporting clinicians in decision making using advanced technologies has been an active research area in biomedical engineering during the past years. Among a wide range of ubiquitous systems, smartphone applications have been increasingly developed in healthcare settings to help clinicians as well as patients. Today, many smartphone applications, from basic data analysis to advanced patient monitoring, are available to clinicians and patients. Such applications are now increasingly integrating into healthcare for clinical decision support, and therefore, concerns around accuracy, stability, and dependency of these applications are rising. In addition, lack of attention to the clinicians' acceptability, as well as the low impact on the medical professionals' decision making, are posing more serious issues on the acceptability of smartphone applications. This article reviews smartphone-based decision support applications, focusing on hospital care settings and their overall impact of these applications on the wider clinical workflow. Additionally, key challenges and barriers of the current ubiquitous device-based healthcare applications are identified. Finally, this article addresses current challenges, future directions, and the adoption of mobile healthcare applications.
A telemedicine network to support paediatric care in small hospitals in rural Tanzania.
Krüger, Carsten; Niemi, Mauri
We reviewed our experience with the Tanzanian Telemedicine Network in supporting paediatric care at 40 small, rural hospitals in the country. The network began operating in 2008. Store and forward telemedicine was provided via the open source software iPath. The 33 volunteer consultants were based in several countries, although most of them had practical experience in Tanzania. During the first three years of network operation there were 533 referrals. There were 159 paediatric cases (median age five years). Three paediatric specialists provided most consultations (64%), but other specialists provided recommendations when required. The response time was usually less than two days (median 6 h; inter-quartile range 2-24 h). A precise recommendation was not always provided, but since all consultants had an intimate knowledge of the state of health services in Tanzania, their advice was usually well adapted to the local circumstances of the hospitals. Referral to a higher level of care was recommended in 26 cases (16%). A simple web-based telemedicine system combined with email alerts is feasible in remote locations in Tanzania, even where fast Internet connections are not available. Copyright © 2012 by the Royal Society of Medicine Press Ltd
Social support for patients undergoing liver transplantation in a Public University Hospital.
Garcia, Clerison Stelvio; Lima, Agnaldo Soares; La-Rotta, Ehideé Isabel Gómez; Boin, Ilka de Fátima Santana Ferreira
Several diseases may lead to the need for liver transplantation due to progressive organ damage until the onset of cirrhosis, resulting in changes in interpersonal relationships. Social Support for transplant candidates is an important variable, providing them with psychological and social well-being. This study aims to assess social support in chronic hepatic patients, waiting for liver transplantation. A cross-sectional study was conducted with 119 patients, for convenience sampling, from the liver transplant waiting list at a Brazilian University Hospital Outpatients. The information was collected through semistructured questionnaires, in four stages: 1) socioeconomic and demographic information 2) clinical aspects 3) feelings 4) Social Support Network Inventory (SSNI), to Brazilian Portuguese. The statistical analysis was conducted using ANOVA and multivariate linear regression analysis to evaluate the relationship between the scales of social support and the collected co-variables. Average age was 50.2 ± 11.6, and 87 (73.1%) were men. Patients with alcohol and virus liver disease etiology had the same frequency of 28%. The MELD, without extrapoints, was 16.7 ± 4.9. Global social support family score was 3.72 ± 0.39, and Cronbach's alpha = 0.79. The multivariate analysis presented the following associations, age = [- 0.010 (95% CI = - 0.010 - -0.010); P = 0.001], etiology of hepatic disease = [- 0.212 (95% CI = - 0.37 - -0.05); P = 0.009], happiness = [- 0.214(95% CI = - 0.33 - -0.09) P = 0.001) and aggressiveness = [0.172 (95% CI = 0.040-0.030); P = 0.010). The social support was greater when the patients were younger (18 to 30 years). Patients with alcoholic cirrhosis, regardless of whether or not they were associated with virus, had less social support. As for feelings, the absence of happiness and the presence of aggressiveness showed a negative effect on social support.
Decreased hospital length of stay associated with presentation of cases at morning report with librarian support
Banks, Daniel E.; Shi, Runhua; Timm, Donna F.; Christopher, Kerri Ann; Duggar, David Charles; Comegys, Marianne; McLarty, Jerry
Objective: The research sought to determine whether case discussion at residents' morning report (MR), accompanied by a computerized literature search and librarian support, affects hospital charges, length of stay (LOS), and thirty-day readmission rate. Methods: This case-control study, conducted from August 2004 to March 2005, compared outcomes for 105 cases presented at MR within 24 hours of admission to 19,210 potential matches, including cases presented at MR and cases not presented at MR. With matching criteria of patient age (± 5 years), identical primary diagnosis, and secondary diagnoses (within 3 additional diagnoses) using International Classification of Diseases (ICD-9) codes, 55 cases were matched to 136 controls. Statistical analyses included Student's t tests, chi-squared tests, and nonparametric methods. Results: LOS differed significantly between matched MR cases and controls (3 days vs. 5 days, P librarians, was an effective means for introducing evidence-based medicine into patient care practices. PMID:17971885
Participatory design of probability-based decision support tools for in-hospital nurses.
Jeffery, Alvin D; Novak, Laurie L; Kennedy, Betsy; Dietrich, Mary S; Mion, Lorraine C
To describe nurses' preferences for the design of a probability-based clinical decision support (PB-CDS) tool for in-hospital clinical deterioration. A convenience sample of bedside nurses, charge nurses, and rapid response nurses (n = 20) from adult and pediatric hospitals completed participatory design sessions with researchers in a simulation laboratory to elicit preferred design considerations for a PB-CDS tool. Following theme-based content analysis, we shared findings with user interface designers and created a low-fidelity prototype. Three major themes and several considerations for design elements of a PB-CDS tool surfaced from end users. Themes focused on "painting a picture" of the patient condition over time, promoting empowerment, and aligning probability information with what a nurse already believes about the patient. The most notable design element consideration included visualizing a temporal trend of the predicted probability of the outcome along with user-selected overlapping depictions of vital signs, laboratory values, and outcome-related treatments and interventions. Participants expressed that the prototype adequately operationalized requests from the design sessions. Participatory design served as a valuable method in taking the first step toward developing PB-CDS tools for nurses. This information about preferred design elements of tools that support, rather than interrupt, nurses' cognitive workflows can benefit future studies in this field as well as nurses' practice. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.
Mobile emergency, an emergency support system for hospitals in mobile devices: pilot study.
Bellini, Pierfrancesco; Boncinelli, Sergio; Grossi, Francesco; Mangini, Marco; Nesi, Paolo; Sequi, Leonardo
Hospitals are vulnerable to natural disasters, man-made disasters, and mass causalities events. Within a short time, hospitals must provide care to large numbers of casualties in any damaged infrastructure, despite great personnel risk, inadequate communications, and limited resources. Communications are one of the most common challenges and drawbacks during in-hospital emergencies. Emergency difficulties in communicating with personnel and other agencies are mentioned in literature. At the moment of emergency inception and in the earliest emergency phases, the data regarding the true nature of the incidents are often inaccurate. The real needs and conditions are not yet clear, hospital personnel are neither efficiently coordinated nor informed on the real available resources. Information and communication technology solutions in health care turned out to have a great positive impact both on daily working practice and situations. The objective of this paper was to find a solution that addresses the aspects of communicating among medical personnel, formalizing the modalities and protocols and the information to guide the medical personnel during emergency conditions with a support of a Central Station (command center) to cope with emergency management and best practice network to produce and distribute intelligent content made available in the mobile devices of the medical personnel. The aim was to reduce the time needed to react and to cope with emergency organization, while facilitating communications. The solution has been realized by formalizing the scenarios, extracting, and identifying the requirements by using formal methods based on unified modeling language (UML). The system and was developed using mobile programming under iOS Apple and PHP: Hypertext Preprocessor My Structured Query Language (PHP MySQL). Formal questionnaires and time sheets were used for testing and validation, and a control group was used in order to estimate the reduction of time needed
Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies.
Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P; Zaslavsky, Alan M
Most Medicare patients seeking emergency medical transport are treated by ambulance providers trained in advanced life support (ALS). Evidence supporting the superiority of ALS over basic life support (BLS) is limited, but some studies suggest ALS may harm patients. To compare outcomes after ALS and BLS in out-of-hospital medical emergencies. Observational study with adjustment for propensity score weights and instrumental variable analyses based on county-level variations in ALS use. Traditional Medicare. 20% random sample of Medicare beneficiaries from nonrural counties between 2006 and 2011 with major trauma, stroke, acute myocardial infarction (AMI), or respiratory failure. Neurologic functioning and survival to 30 days, 90 days, 1 year, and 2 years. Except in cases of AMI, patients showed superior unadjusted outcomes with BLS despite being older and having more comorbidities. In propensity score analyses, survival to 90 days among patients with trauma, stroke, and respiratory failure was higher with BLS than ALS (6.1 percentage points [95% CI, 5.4 to 6.8 percentage points] for trauma; 7.0 percentage points [CI, 6.2 to 7.7 percentage points] for stroke; and 3.7 percentage points [CI, 2.5 to 4.8 percentage points] for respiratory failure). Patients with AMI did not exhibit differences in survival at 30 days but had better survival at 90 days with ALS (1.0 percentage point [CI, 0.1 to 1.9 percentage points]). Neurologic functioning favored BLS for all diagnoses. Results from instrumental variable analyses were broadly consistent with propensity score analyses for trauma and stroke, showed no survival differences between BLS and ALS for respiratory failure, and showed better survival at all time points with BLS than ALS for patients with AMI. Only Medicare beneficiaries from nonrural counties were studied. Advanced life support is associated with substantially higher mortality for several acute medical emergencies than BLS. National Science Foundation, Agency for
International Nuclear Information System (INIS)
In this document the starting points are described which underlie the new framework for the nuclear-accident combat in the Netherlands. All the elaboration of this is indicated in main lines. The juridical consequences of the proposed structure are enlightened and the sequel activities are indicated. (H.W.). 6 figs.; 8 tabs
Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study.
Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L
To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.
Intelligently interactive combat simulation
Fogel, Lawrence J.; Porto, Vincent W.; Alexander, Steven M.
To be fully effective, combat simulation must include an intelligently interactive enemy... one that can be calibrated. But human operated combat simulations are uncalibratable, for we learn during the engagement, there's no average enemy, and we cannot replicate their culture/personality. Rule-based combat simulations (expert systems) are not interactive. They do not take advantage of unexpected mistakes, learn, innovate, and reflect the changing mission/situation. And it is presumed that the enemy does not have a copy of the rules, that the available experts are good enough, that they know why they did what they did, that their combat experience provides a sufficient sample and that we know how to combine the rules offered by differing experts. Indeed, expert systems become increasingly complex, costly to develop, and brittle. They have face validity but may be misleading. In contrast, intelligently interactive combat simulation is purpose- driven. Each player is given a well-defined mission, reference to the available weapons/platforms, their dynamics, and the sensed environment. Optimal tactics are discovered online and in real-time by simulating phenotypic evolution in fast time. The initial behaviors are generated randomly or include hints. The process then learns without instruction. The Valuated State Space Approach provides a convenient way to represent any purpose/mission. Evolutionary programming searches the domain of possible tactics in a highly efficient manner. Coupled together, these provide a basis for cruise missile mission planning, and for driving tank warfare simulation. This approach is now being explored to benefit Air Force simulations by a shell that can enhance the original simulation.
Are there atheists in foxholes? Combat intensity and religious behavior.
Wansink, Brian; Wansink, Craig S
After battle, the moral and mortality stresses influence different soldiers in different ways. Using two large-scale surveys of World War II veterans, this research investigates the impact of combat on religiosity. Study 1 shows that as combat became more frightening, the percentage of soldiers who reported praying rose from 42 to 72%. Study 2 shows that 50 years later, many soldiers still exhibited religious behavior, but it varied by their war experience. Soldiers who faced heavy combat (vs. no combat) attended church 21% more often if they claimed their war experience was negative, but those who claimed their experience was positive attended 26% less often. The more a combat veteran disliked the war, the more religious they were 50 years later. While implications for counselors, clergy, support groups, and health practitioners are outlined, saying there are no atheists in foxholes may be less of an argument against atheism than it is against foxholes.
Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies.
Dawson, Angela J; Stasa, Helen; Roche, Michael A; Homer, Caroline S E; Duffield, Christine
This study aimed to reveal nurses' experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction. Nursing turnover is a serious issue that can compromise patient safety, increase health care costs and impact on staff morale. A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories. A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories. Key factors affecting nursing turnover were limited career opportunities; poor support; a lack of recognition; and negative staff attitudes. The nursing working environment is characterised by inappropriate skill-mix and inadequate patient-staff ratios; a lack of overseas qualified nurses with appropriate skills; low involvement in decision-making processes; and increased patient demands. These issues impacted upon heavy workloads and stress levels with nurses feeling undervalued and disempowered. Nurses described supportive strategies: improving performance appraisals, responsive preceptorship and flexible employment options. Nursing turnover is influenced by the experiences of nurses. Positive steps can be made towards improving workplace conditions and ensuring nurse retention. Improving performance management and work design are strategies that nurse managers could harness to reduce turnover.
Cost-effectiveness Analysis of Nutritional Support for the Prevention of Pressure Ulcers in High-Risk Hospitalized Patients.
Tuffaha, Haitham W; Roberts, Shelley; Chaboyer, Wendy; Gordon, Louisa G; Scuffham, Paul A
To evaluate the cost-effectiveness of nutritional support compared with standard care in preventing pressure ulcers (PrUs) in high-risk hospitalized patients. An economic model using data from a systematic literature review. A meta-analysis of randomized controlled trials on the efficacy of nutritional support in reducing the incidence of PrUs was conducted. Modeled cohort of hospitalized patients at high risk of developing PrUs and malnutrition simulated during their hospital stay and up to 1 year. Standard care included PrU prevention strategies, such as redistribution surfaces, repositioning, and skin protection strategies, along with standard hospital diet. In addition to the standard care, the intervention group received nutritional support comprising patient education, nutrition goal setting, and the consumption of high-protein supplements. The analysis was from a healthcare payer perspective. Key outcomes of the model included the average costs and quality-adjusted life years. Model results were tested in univariate sensitivity analyses, and decision uncertainty was characterized using a probabilistic sensitivity analysis. Compared with standard care, nutritional support was cost saving at AU $425 per patient and marginally more effective with an average 0.005 quality-adjusted life years gained. The probability of nutritional support being cost-effective was 87%. Nutritional support to prevent PrUs in high-risk hospitalized patients is cost-effective with substantial cost savings predicted. Hospitals should implement the recommendations from the current PrU practice guidelines and offer nutritional support to high-risk patients.
Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.
Zimlichman, Eyal; Keohane, Carol; Franz, Calvin; Everett, Wendy L; Seger, Diane L; Yoon, Catherine; Leung, Alexander A; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan E; Bates, David W
In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts. Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE. Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%. Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.
Worldwide actions to combat abuse.
This paper reports several developments on the global efforts to combat abuse and violence against women and children. It is noted that in South Africa, Belem, Brazil, and Lesotho, protest actions were conducted against women and child abuse. Although the protests were made separately, the protests generally called for implementation of initiatives from the government to address the issue of child and women abuse. In the context of preventing abusive behaviors, a study by the University of Cape Town in South Africa on the appropriateness and feasibility of short-term community-based group therapy concluded that such an approach might be effective in treating delinquent behavior. In Indonesia, the Rifka Annisa Women's Crisis Centre is working to combat violence against women by providing services to victims; while in Israel, a media campaign is aiming to increase awareness and support for women's help centers. In addition, the government of Bangladesh has established a Cell Against Violence Against Women that provides legal counseling and assistance for civil and criminal cases related to violence against women. Furthermore, the WHO and the International Federation of Obstetricians and Gynecologists have collaborated to conduct a joint workshop to explore how violence against women can be eliminated.
The views of domestic staff and porters when supporting patients with dementia in the acute hospital: An exploratory qualitative study.
Ashton, Caroline; Manthorpe, Jill
There is increasing recognition that very many hospital patients have dementia but there are many concerns about the quality of care and support they receive. Consequently there have been numerous calls for hospital staff to have dementia training. While cleaning or domestic staff and porters form considerable parts of the hospital workforce they are infrequently considered in discussions of dementia care training and practice. This exploratory study aimed to investigate the experiences of domestic staff and porters working in an acute hospital setting who are in contact regularly with patients with dementia. Semi-structured interviews were undertaken in 2016 with seven domestic staff and five porters in one English acute hospital to investigate their views and experiences. Data were analysed thematically by constant comparison technique and theoretical sampling. Themes were identified and realistic concepts developed. Participants observed that caring attitudes and behaviour in their encounters with patients with dementia are important but challenging to put into practice. Several would have valued more information about dementia. Some noted situations in the hospital stay that seemed particularly difficult for patients with dementia such as travelling to different parts of the hospital for treatments. The study suggests the need for improving the dementia-related knowledge and skills of all non-clinical staff especially those new to the NHS. The impact of witnessing dementia symptoms and distress on emotional well-being requires further research so that ancillary staff can improve the hospital stay of patients with dementia.
Combat sports for persons with disabilities
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Kasum Goran
Full Text Available In literature, the term adapted sport indicates sports activities, modified and adapted to persons with disabilities. In spite of their highly prominent values, combat sports are underrepresented among persons with disabilities in Serbia. The benefits of combat sports practicing are numerous, and at some international hospitals, martial sports and arts already have an important role in the treatment of traumatized and disabled persons. Currently, the programme of Paralympic Games includes only two sports, these are fencing and judo, in male and female competition. Almost certainly, karate will also be included in the programme of Paralympic Games, and there are similar ambitions in the case of taekwondo as well. In addition to these sports, some martial arts, especially aikido, thai-chi-chuan and qigong, have obtained significant representation and interest among persons with disabilities. The reasons for weaker interest in other martial sports and arts, should be sought in the fact that they are underrepresented among this population, and that these persons are not offered the possibility of organized practice of such sports. Orientation towards a combat sport brings great refreshment and powerful emotional experience to each practitioner, and this fact has special significance to persons with disabilities. In Serbia, combat sports are not widely represented among persons with disabilities, and only the wrestlers with impaired hearing have achieved significant success on the international stage. On the other hand, the popularity of combat sports among persons with disabilities in the world is significantly growing. It is necessary to take concrete steps to make it so in Serbia as well.
The challenges of training, support and assessment of healthcare support workers: A qualitative study of experiences in three English acute hospitals.
Sarre, Sophie; Maben, Jill; Aldus, Clare; Schneider, Justine; Wharrad, Heather; Nicholson, Caroline; Arthur, Antony
Ever-growing demands on care systems have increased reliance on healthcare support workers. In the UK, their training has been variable, but organisation-wide failures in care have prompted questions about how this crucial section of the workforce should be developed. Their training, support and assessment has become a policy priority. This paper examines: healthcare support workers' access to training, support and assessment; perceived gaps in training provision; and barriers and facilitators to implementation of relevant policies in acute care. We undertook a qualitative study of staff caring for older inpatients at ward, divisional or organisational-level in three acute National Health Service hospitals in England in 2014. 58 staff working with older people (30 healthcare support workers and 24 staff managing or working alongside them) and 4 healthcare support worker training leads. One-to-one semi-structured interviews included: views and experiences of training and support; translation of training into practice; training, support and assessment policies and difficulties of implementing them. Transcripts were analysed to identify themes. Induction training was valued, but did not fully prepare healthcare support workers for the realities of the ward. Implementation of hospital policies concerning supervision and formal assessment of competencies varied between and within hospitals, and was subject to availability of appropriate staff and competing demands on staff time. Gaps identified in training provision included: caring for people with cognitive impairment; managing the emotions of patients, families and themselves; and having difficult conversations. Access to ongoing training was affected by: lack of time; infrequent provision; attitudes of ward managers to additional support workforce training, and their need to balance this against patients' and other staff members' needs; and the use of e-learning as a default mode of training delivery. With the
Anaesthesia perspective of combat injuries at south waziristan agency-a field experience of war on terrorism
International Nuclear Information System (INIS)
Ahmad, M.; Ahmad, M.
To determine the presentation form of combat injuries, different aspects of anaesthesia management and methods of effective pain control inside the field hospital. Study Design: A descriptive study. Place and Duration of Study: South Waziristan Scouts Hospital, South Waziristan Agency, Wana, Khyber Pakhtun Khawa province from March 2007 to August 2009. Patients and Methods: A descriptive review of the type of injuries sustained by the troops including local civil population reporting to South Waziristan Scouts (SWS) Hospital from March 2007 to Aug 2009. All patients of combat related injuries reporting to SWS Hospital were included in this study excluding elective surgical cases, gynaecological cases and routine medical patients. Initial anaesthesia management, pain control in anaesthetized patients or analgesia provided without anaesthesia in injured patients and evacuation process of emergencies to tertiary care hospital are discussed. The data was collected from hospital records including operation theatre and was analyzed in the SPSS version 14 for windows in the form of frequency of patients. Results: A total of 149 male (age 30 ± 15) patients were managed at SWS hospital after sustaining combat related injuries. General anaesthesia was given to 61% patients whereas 26% were operated under spinal anaesthesia. Deaths reported were 12.75% comprising 1.3% brought in dead during combat, 2.68% after cardiopulmonary resuscitation inside the hospital, 2.68% homicides by miscreants, 0.67% suicide, 0.67% of bomb disposal squad during mines search operation and 4.69% due to helicopter crash due to snow fall. Firearm and splinter injuries were the commonest in active encounter followed by IED linked injuries. Stray bullets injured a soldier in the chest causing pneumothorax and minor injuries to other 2%. Suicide 0.67% of permanent residing troop and homicides of 2.68% soldiers by the miscreants were documented. The time for casualty arrival in the hospital was 15 min
Comprehensive cardiopulmonary life support (CCLS for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital
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Rakesh Garg
Full Text Available The cardiopulmonary resuscitation (CPR guideline of comprehensive cardiopulmonary life support (CCLS for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India. The CCLS guideline emphasise the need to recognise patients at risk for cardiac arrest and their timely management before a cardiac arrest occurs. The basic components of CPR include chest compressions for blood circulation; airway maintenance to ensure airway patency; lung ventilation to enable oxygenation and defibrillation to convert a pathologic 'shockable' cardiac rhythm to one capable to maintaining effective blood circulation. CCLS emphasises incorporation of airway management, drugs, and identification of the cause of arrest and its correction, while chest compression and ventilation are ongoing. It also emphasises the value of organised team approach and optimal post-resuscitation care.
Basic cardiopulmonary life support (BCLS for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital
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Rakesh Garg
Full Text Available The cardiopulmonary resuscitation guideline of Basic Cardiopulmonary Life Support (BCLS for management of adult victims with cardiopulmonary arrest outside the hospital provides an algorithmic stepwise approach for optimal outcome of the victims by trained medics and paramedics. This guideline has been developed considering the need to have a universally acceptable practice guideline for India and keeping in mind the infrastructural limitations of some areas of the country. This guideline is based on evidence elicited in the international and national literature. In the absence of data from Indian population, the excerpts have been taken from international data, discussed with Indian experts and thereafter modified to make them practically applicable across India. The optimal outcome for a victim with cardiopulmonary arrest would depend on core links of early recognition and activation; early high-quality cardiopulmonary resuscitation, early defibrillation and early transfer to medical facility. These links are elaborated in a stepwise manner in the BCLS algorithm. The BCLS also emphasise on quality check for various steps of resuscitation.
Combat Wound Initiative program.
Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M
The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.
Evaluation of a pilot 'peer support' training programme for volunteers in a hospital-based cancer information and support centre.
Kinnane, Nicole Anne; Waters, Trish; Aranda, Sanchia
Volunteers from Peter MacCallum Cancer Centre (Peter Mac) Patient Information and Support Centre (PISC) assist the Cancer Support Nurse by helping patients and families/carers find information and provide face-to-face peer support. Benefits of shared personal experiences between volunteer and patient are clearly different from professional support. Volunteers require specific skill sets and detailed preparation for this role. Volunteers completed a 3-day training programme adapted from the Cancer Council Victoria's 'Cancer Connect Telephone Peer Support Volunteer' training programme. The focus was role expectations and boundaries for peer support volunteers, debriefing, communication skills training, support services, complementary and alternative therapies and internet information. Assessment included a quiz and observation for a range of competencies. Role-play with simulated patients developed appropriate support skills. Eight volunteers participated. Pre-training questionnaires revealed all volunteers highly self-rated existing skills supporting people affected by cancer. During training, volunteers recognised these skills were inadequate. All agreed that role-play using an actor as a 'simulated patient' helped develop communication skills; however, the experience proved challenging. Post-training all reported increased knowledge of role definition and boundaries, supportive communication skills, supports available for patients and families/carers and importance of self-care. Facilitators recommended seven of the eight participants be accredited PISC Peer Support Volunteers. One volunteer was assessed unsuitable for consistently overstepping the boundaries of the peer support role and withdrew from training. Success of the programme resulted in a trained 'face-to-face peer support volunteer' group better equipped for their role. Sixteen months following training, all who completed the programme remain active volunteers in the PISC. Planned educational updates
Assessing the ability of health information systems in hospitals to support evidence-informed decisions in Kenya
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Elesban Kihuba
Full Text Available Background: Hospital management information systems (HMIS is a key component of national health information systems (HIS, and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. We conducted an evaluation of core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making. Design: The survey was a cross-sectional, cluster sample study conducted in 22 hospitals in Kenya. The statistical analysis was descriptive with adjustment for clustering. Results: Most of the HMIS departments complied with formal guidance to develop departmental plans. However, only a few (3/22 had carried out a data quality audit in the 12 months prior to the survey. On average 3% (range 1–8% of the total hospital income was allocated to the HMIS departments. About half of the records officer positions were filled and about half (13/22 of hospitals had implemented some form of electronic health record largely focused on improving patient billing and not linked to the district HIS. Completeness of manual patient registers varied, being 90% (95% CI 80.1–99.3%, 75.8% (95% CI 68.7–82.8%, and 58% (95% CI 50.4–65.1% in maternal child health clinic, maternity, and pediatric wards, respectively. Vital events notification rates were low with 25.7, 42.6, and 71.3% of neonatal deaths, infant deaths, and live births recorded, respectively. Routine hospital reports suggested slight over-reporting of live births and under-reporting of fresh stillbirths and neonatal deaths. Conclusions: Study findings indicate that the HMIS does not deliver quality data. Significant constraints exist in data quality assurance, supervisory support, data infrastructure in respect to information and communications technology application, human resources, financial
Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest
Waalewijn, Reinier A.; Nijpels, Marië A.; Tijssen, Jan G.; Koster, Rudolph W.
Survival of cardiac arrest is improved by basic life support (BLS). This study investigated the relationship between ventricular fibrillation (VF) characteristics and survival. In a 2-year prospective study out-of-hospital witnessed non-traumatic cardiac arrests were observed. The probabilities of
Nurse Middle Managers' Dispositions of Habitus : A Bourdieusian Analysis of Supporting Role Behaviors in Dutch and American Hospitals
Pieterbas Lalleman; Jeroen Dikken
A Magnet-related program has been recently adopted in the Netherlands. Support for staff nurses from nurse middle managers (NMMs) is a key component of such a program. A Bourdieusian ethnographic organizational case study in 4 hospitals in the Netherlands and the United States (Magnet,
The Effectiveness of a Damage Control Resuscitation Strategy for Vascular Injury in a Combat Support Hospital: Results of a Case Control Study
National Research Council Canada - National Science Library
Fox, Charles J; Gillespie, David L; Cox, E. D; Mehta, Sumeru G; Kragh, Jr., John J; Salinas, Jose; Holcomb, John B
...). Standard damage control principles are routinely applied to achieve rapid hemorrhage control, and to initiate a hemostatic resuscitation plan that will correct metabolic imbalances and prevent...
Combating trafficking: the Swiss approach
Sebastian Rauber
Switzerland is committed to combating and preventingtrafficking in human beings. Effective policy implementationin a federal structure depends on networking,effective information exchange and development ofrobust cooperation mechanisms.
Structure, organisation and clinical outcomes in cancer patients of hospital support teams in Spain.
Tuca-Rodriguez, Albert; Gómez-Batiste, Xavier; Espinosa-Rojas, Jose; Martínez-Muñoz, Marisa; Codorniu, Nuria; Porta-Sales, Josep
To describe the structure, characteristics of patients and basic clinical outcomes in cancer patients receiving care from palliative care hospital support teams (HSTs) in Spain. A multi-centre observational two phase study. Phase I: A descriptive survey of all HSTs in Spain. Phase II: A quasi-experimental prospective cohort study to describe the clinical outcomes, symptom severity and survival. 60 HSTs in Spain met the inclusion criteria. All HSTs were multidisciplinary with wide experience (mean 6.8 years). HSTs coverage was 21.5% of all cancer deaths in Spain. A total number of 364 advanced cancer patients were included in the cohort study; 76% were classified as moderate or high complexity. Overall, 64% were male subjects and the most frequent primary cancer site was lung (26%). Half of the patients had no detailed information about cancer staging and only 19% knew their short-term prognosis. The mean length of intervention was 6.5 days (mean three visits per patient). Outcomes were: 34% deaths during the admission process; 38% were discharged home; and 28% were transferred to another medium-term-stay specialist unit. The main symptoms were pain (68%), dyspnoea (43%), vomiting (24%), anorexia (72%), asthenia (78%), insomnia (50%), anxiety (45%) and depression (35%). After the HSTs intervention, the symptom severity was significantly reduced (p<0.001) for all symptoms, except for weakness and anorexia. The mean survival from inclusion was 111 days. Palliative intervention of HSTs is characterised by being adjusted to patient needs and short duration. Their care was focused on the preterminal phase of cancer patients of moderate-high complexity.
Smartphone apps to support hospital prescribing and pharmacology education: a review of current provision.
Haffey, Faye; Brady, Richard R W; Maxwell, Simon
Junior doctors write the majority of hospital prescriptions but many indicate they feel underprepared to assume this responsibility and around 10% of prescriptions contain errors. Medical smartphone apps are now widely used in clinical practice and present an opportunity to provide support to inexperienced prescribers. This study assesses the contemporary range of smartphone apps with prescribing or related content. Six smartphone app stores were searched for apps aimed at the healthcare professional with drug, pharmacology or prescribing content. Three hundred and six apps were identified. 34% appeared to be for use within the clinical environment in order to aid prescribing, 14% out with the clinical setting and 51% of apps were deemed appropriate for both clinical and non-clinical use. Apps with drug reference material, such as textbooks, manuals or medical apps with drug information were the commonest apps found (51%), followed by apps offering drug or infusion rate dose calculation (26%). 68% of apps charged for download, with a mean price of £14.25 per app and a range of £0.62-101.90. A diverse range of pharmacology-themed apps are available and there is further potential for the development of contemporary apps to improve prescribing performance. Personalized app stores may help universities/healthcare organizations offer high quality apps to students to aid in pharmacology education. Users of prescribing apps must be aware of the lack of information regarding the medical expertise of app developers. This will enable them to make informed choices about the use of such apps in their clinical practice. © 2013 The British Pharmacological Society.
How Does Supervisor Support Influence Turnover Intent Among Frontline Hospital Workers? The Mediating Role of Affective Commitment.
Nichols, Helen M; Swanberg, Jennifer E; Bright, Charlotte Lyn
Turnover among frontline hospital service workers can disrupt organizational effectiveness, reduce profitability, and limit the ability to provide high-quality, patient-centered care. This concern is compounded by the increasing reliance on frontline supervisors to manage this workforce, often without necessary training and support. However, research addressing the relationship between frontline supervisor support and intent to turnover among service workers and the process by which these variables are related is limited. By surveying 270 housekeeping and dietary service workers employed at 2 US hospitals, this study examined the relationship between supervisor support and turnover intent and assessed the mediating role of affective commitment between supervisor support and intent to turnover. Turnover intentions were lower for workers who reported greater levels of supervisor support and affective commitment; both supervisor support and affective commitment were significant predictors of turnover intent when tested individually. However, when controlling for affective commitment, supervisor support no longer predicted turnover intent, indicating that affective commitment fully mediated the relationship between supervisor support and intent to turnover. Implications for further research and organizational practice are discussed.
Combat Trains Command Post (CTCP) Operations
development through the execution of several validation exercises leading up to the NTC rotation. The squadron utilized home station training opportunities at...evolving problem as the troop 1SG had the responsibility to tie in all disabled vehicles awaiting parts into the security plan. The crews of those...Additionally, depth of knowledge in critical equipment would have assisted the CTCP [i.e. only one operator for the Combat-Service- Support Automated
A model management system for combat simulation
Dolk, Daniel R.
The design and implementation of a model management system to support combat modeling is discussed. Structured modeling is introduced as a formalism for representing mathematical models. A relational information resource dictionary system is developed which can accommodate structured models. An implementation is described. Structured modeling is then compared to Jackson System Development (JSD) as a methodology for facilitating discrete event simulation. JSD is currently better at representin...
From words to action: visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital.
Buttigieg, Sandra C; Cassar, Vincent; Scully, Judy W
The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. The authors draw on solid theoretical frameworks--the complexity theory, team effectiveness model and the social identity theory--to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level.
An Investigation of Perspectives of Respite Admission Among People Living With Amyotrophic Lateral Sclerosis and the Hospitals That Support Them.
Nakai, Michiko; Narita, Yugo; Tomimoto, Hidekazu
Amyotrophic lateral sclerosis is a progressive disease with rapid degeneration. Respite care is an essential service for improving the well-being of both patients with this disease and their family caregivers, but accessibility of respite services is limited. This study investigates perspectives on respite admission among people living with amyotrophic lateral sclerosis and the hospitals supporting them. We conducted semistructured interviews among 3 patients with amyotrophic lateral sclerosis and 12 family members, exploring demographic information and their awareness and experience of respite admission. We also interviewed 16 representatives from hospitals about awareness of and preparation for respite admission for patients with this disease, the role of regional networks for intractable diseases, and knowledge about communication support schemes. We found significant differences in the revised Amyotrophic Lateral Sclerosis Functional Rating Scale between patients who had and had not received respite admission. Qualitative analysis of the data indicated that respite admission was a contributory factor in continuing and stabilizing home care. Limited provision of social services and hospital care quality were barriers to respite admission. Respite admission was essential to continued home care for patients with amyotrophic lateral sclerosis. Severe-stage patients were eligible for respite admission. Its accessibility, however, was limited, especially for patients living in rural areas. Supporting hospitals had limited capacity to respond to patients' needs. Individualized care and communication were internal barriers to respite admission.
Sgarbozza, M.; Depitre, A.
A discussion of the characteristics and the noise levels of combat aircraft and of a transport aircraft in taking off and landing are presented. Some methods of noise reduction are discussed, including the following: operational anti-noise procedures; and concepts of future engines (silent post-combustion and variable cycle). Some measurement results concerning the noise generated in flight at great speeds and low altitude will also be examined. Finally, the protection of the environment of French air bases against noise will be described and the possibilities of regulation examined.
Cross-sectional survey of patients' need for information and support with medicines after discharge from hospital.
Mackridge, Adam J; Rodgers, Ruth; Lee, Dan; Morecroft, Charles W; Krska, Janet
Most patients experience changes to prescribed medicines during a hospital stay. Ensuring they understand such changes is important for preventing adverse events post-discharge and optimising patient understanding. However, little work has explored the information that patients receive about medicines or their perceived needs for information and support after discharge. To determine information that hospital inpatients who experience medicine changes receive about their medicines during admission and their needs and preferences for, and use of, post-discharge support. Cross-sectional survey with adult medical inpatients experiencing medicine changes in six English hospitals, with telephone follow-up 2-3 weeks post-discharge. A total of 444 inpatients completed surveys, and 99 of these were followed up post-discharge. Of the 444, 44 (10%) were unaware of changes to medicines and 65 (16%) did not recall discussing them with a health professional, but 305 (77%) reported understanding the changes. Type of information provided and patients' perceived need for post-discharge support differed between hospitals. Information about changes was most frequently provided by consultant medical staff (157; 39%) with pharmacists providing information least often (71; 17%). One third of patients surveyed considered community pharmacists as potential sources of information about medicines and associated support post-discharge. Post-discharge, just 5% had spoken to a pharmacist, although 35% reported medicine-related problems. In north-west England, patient inclusion in treatment decisions could be improved, but provision of information prior to discharge is reasonable. There is scope to develop hospital and community pharmacists' role in medicine optimisation to maximise safety and effectiveness of care. © 2017 Royal Pharmaceutical Society.
Can there be mutual support between hospital marketing and continuous quality improvement?
Weiland, D E
Marketing the results of continuous quality improvement in hospitals builds a growing bank of loyal customers in an increasingly competitive and quality-oriented environment: If healthcare institutions want to survive and flourish, they must develop a lasting relationship with their customers. The long-term goal of CQI is to provide quality products and services. If marketing managers can sell these improved services, hospitals will build a solid client foundation.
Access to and value of information to support good practice for staff in Kenyan hospitals
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Naomi Muinga
Full Text Available Background: Studies have sought to define information needs of health workers within very specific settings or projects. Lacking in the literature is how hospitals in low-income settings are able to meet the information needs of their staff and the use of information communication technologies (ICT in day-to-day information searching. Objective: The study aimed to explore where professionals in Kenyan hospitals turn to for work-related information in their day-to-day work. Additionally, it examined what existing solutions are provided by hospitals with regard to provision of best practice care. Lastly, the study explored the use of ICT in information searching. Design: Data for this study were collected in July 2012. Self-administered questionnaires (SAQs were distributed across 22 study hospitals with an aim to get a response from 34 health workers per hospital. Results: SAQs were collected from 657 health workers. The most popular sources of information to guide work were fellow health workers and printed guidelines while the least popular were scientific journals. Of value to health workers were: national treatment policies, new research findings, regular reports from surveillance data, information on costs of services and information on their performance of routine clinical tasks; however, hospitals only partially met these needs. Barriers to accessing information sources included: 'not available/difficult to get' and 'difficult to understand'. ICT use for information seeking was reported and with demographic specific differences noted from the multivariate logistic regression model; nurses compared to medical doctors and older workers were less likely to use ICT for health information searching. Barriers to accessing Internet were identified as: high costs and the lack of the service at home or at work. Conclusions: Hospitals need to provide appropriate information by improving information dissemination efforts and providing an
[Impact of family support over food intake and depressive status in cervical cancer patients during hospitalization].
Bejarano, M; Fuchs, V; Fernández, N; Amancio, O
Uterine cervical cancer represents a public health problem in Mexico; the patients suffer physical and psychological stress leading to depression and weight loss. Eating with a relative has positive effects in food ingestion and depressive status in hospitalized patients. In our society, food is the closest way that family members have to bring care and to show affection to the patient that has less appetite as disease goes on. To establish the relationship between presence of the family during the meals and depresion, food intake, and weight variation during hospitalization. 106 women admitted to the Oncology Department at the General Hospital of Mexico with a diagnosis of CUCA clinical stage II and III were studied in order to improve their condition. Weight and height, diet by means of 24 hour recalls were assessed both at hospital admission and discharge, and Beck's depression inventory was applied; the frequency with which the relatives escorted the patient was recorded. Patients were classified in two groups according to the frequency of family escorting; it was found that 43 patients (40.6%) were accompanied, and 63 patients (59.4%) were not. We did not find significant differences in age and days of hospital stay between the groups (p > 0.05). The escorted patients had more foods available during hospitalization (p < 0.05). Energy consumption (kcal) in escorted patients was higher by 12.7% as compared to non-escorted patients. 76.7% of the escorted patients were depressed, as compared to 55% in the non-escorted group. Significant differences were found with regards to clinical status and presence of depression (p < 0.05) between the study groups. Family escorting does not have an influence on the amount of foods consumed during hospitalization or body weight variation; however, it does have an influence on the presence of depression.
Regenerative medicine applications in combat casualty care.
Fleming, Mark E; Bharmal, Husain; Valerio, Ian
The purpose of this report is to describe regenerative medicine applications in the management of complex injuries sustained by service members injured in support of the wars in Afghanistan and Iraq. Improvements in body armor, resuscitative techniques and faster transport have translated into increased patient survivability and more complex wounds. Combat-related blast injuries have resulted in multiple extremity injuries, significant tissue loss and amputations. Due to the limited availability and morbidity associated with autologous tissue donor sites, the introduction of regenerative medicine has been critical in managing war extremity injuries with composite massive tissue loss. Through case reports and clinical images, this report reviews the application of regenerative medicine modalities employed to manage combat-related injuries. It illustrates that the novel use of hybrid reconstructions combining traditional and regenerative medicine approaches are an effective tool in managing wounds. Lessons learned can be adapted to civilian care.
International Nuclear Information System (INIS)
Biro, L.L.; Grama, E.V.
Full text: National Commission for Nuclear Activities Control (CNCAN) is the national authority, which is contact point for illicit trafficking and coordinates all measures and activities to combat and prevent illicit trafficking with nuclear material and radioactive sources. Legal framework regarding illicit trafficking has been improved due to new Physical Protection Regulations, Regulations on using the DBT, Regulations on requirements for qualification of guards and physical protection personnel, Design Basis Threat for each nuclear facility to avoid the unauthorized removal or theft of nuclear material or radioactive sources. New amendments of the Law for the safe deployment of nuclear activities, Law no. 111/1996, republished, in respect of illicit trafficking with nuclear material and radioactive sources are in the process to be approved by the Parliament. CNCAN is member of the Romanian Non-proliferation Group that is an interdepartmental mechanism of cooperation entered into force in August 1999. During the sessions of this group there are discussions focused on the preventing and combating illicit trafficking with nuclear material and radioactive sources. CNCAN is member of the Interministerial Council that controls import and export with strategic products including nuclear material, non nuclear material and equipment pertinent for proliferation of nuclear weapons. An Emergency Mobile Unit has been created in 2001 that contains instruments (gamma dose rate instruments portable and personal, contaminometers, mini MCA with CdZnTe detector, a CANBERRA Inspector with Nal, CdZnTe and HPGe detectors and 2 FiedSPEC, a mobile laboratory, 2 cars and individual equipment). CNCAN is cooperating with the Police through a National Plan to verify the authorization holders in order to prevent and combat illicit trafficking, and to find the orphan sources. CNCAN is the beneficiary of the PECO Project initiated by the European Commission in cooperation with the IAEA and
Health technology management: a database analysis as support of technology managers in hospitals.
Miniati, Roberto; Dori, Fabrizio; Iadanza, Ernesto; Fregonara, Mario M; Gentili, Guido Biffi
Technology management in healthcare must continually respond and adapt itself to new improvements in medical equipment. Multidisciplinary approaches which consider the interaction of different technologies, their use and user skills, are necessary in order to improve safety and quality. An easy and sustainable methodology is vital to Clinical Engineering (CE) services in healthcare organizations in order to define criteria regarding technology acquisition and replacement. This article underlines the critical aspects of technology management in hospitals by providing appropriate indicators for benchmarking CE services exclusively referring to the maintenance database from the CE department at the Careggi Hospital in Florence, Italy.
Violence in Al-Zahra Hospital from the Viewpoint of Administrative Support Staff: A Qualitative Study
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Mahmoud Keyvanara
Conclusion: Considering the high prevalence of violence in hospitals and its adverse effects on the societies, organizations and individuals, necessary measures must be taken to diminish the occurrence of this problem, some of which include: increasing insurance coverage, changing physical structure of hospitals to increase security, limiting the entrance of individuals, making administrative processes more transparent, culture-making about terms of visiting and patient companionship, holding workshops on violence and proper relationship with patients and families and using experienced staff to interact with clients.
Mothers' access to supportive hospital services after the loss of a baby through stillbirth or neonatal death
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J Conry
Full Text Available Every year, 3-5% of pregnant mothers in South Africa lose their babies to a stillbirth or neonatal death. These mothers need adequate services to prevent complications in their grieving process. Most of these babies are lost in hospital settings, so the treatment medical staff provide is vital. This study examined mothers' experiences of accessing hospital, religious, formal and social services after a stillbirth or neonatal death. An exploratory research design was used to conduct applied research. A semi-structured interview schedule was used with a sample of 15 mothers who had lost a baby in the last 5 years. The findings were analysed quantitatively and qualitatively. The primary focus of this article is the quantitative findings relating to hospital services. The sample was small and these results cannot be generalised, but some conclusions are reached and recommendations are made to service providers in hospitals working with mothers who have lost babies. Mothers generally experienced the support services from hospitals as inadequate, compared to what hospitals could offer. Mothers that receive support after the loss of a baby generally cope better. This support thus assists them in the grieving process. Hospital staff can be trained to provide these services. Opsomming In Suid-Afrika verloor 3-5% swanger moeders hulle babas deur stilgeboorte of neonatale dood. Hierdie moeders benodig voldoende dienste om komplikasies in die rouproses te verhoed. Die behandeling deur mediese personeel is uiters belangrik omdat die meeste van dié babas in 'n hospitaalopset sterf. Hierdie studie het moeders se ervarings van die toeganklikheid van hospitaal-, godsdienstige, formele en sosiale dienste na die dood van hulle babas deur stilgeboorte of neonatale dood ondersoek. Toegepaste navorsing is met behulp van 'n verkennende navorsingsontwerp gedoen. 'n Semi-gestruktureerde onderhoudskedule is gebruik met 'n steekproef van 15 moeders wat hulle
Interspecialty communication supported by health information technology associated with lower hospitalization rates for ambulatory care-sensitive conditions.
O'Malley, Ann S; Reschovsky, James D; Saiontz-Martinez, Cynthia
Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of 4 ambulatory care-sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the usual provider. Key independent variables of interest were physicians' practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care-sensitive hospitalizations for one or more of these 4 conditions. Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the
Perceived organisational support, organisational commitment and self-competence among nurses: a study in two Italian hospitals.
Battistelli, Adalgisa; Galletta, Maura; Vandenberghe, Christian; Odoardi, Carlo
This study examined the contributions of perceived organisational support (POS) and organisational commitment (i.e. affective, continuance and normative) to self-competence among nurses. In high-POS environments, workers benefit from socio-emotional resources to improve their skills, while positive forms of commitment (e.g. affective commitment) create a fertile context for developing one's competencies. A cross-sectional study was conducted among the nursing staff of two Italian urban hospitals (hospital A, n = 160; hospital B, n = 192). A structured questionnaire was administered individually to the nurses. Data analysis was conducted through multi-group analysis and supplemented by a bootstrapping approach. The results showed that POS was positively related to self-competence through affective commitment. In contrast, continuance and normative commitment did not mediate this relationship. This study shows that supporting employees through caring about their well-being as well as fostering positive forms of organisational commitment increases nurses' self-competence. Nurse managers may increase support perceptions and commitment among their staff by rewarding their contributions and caring about their well-being, as well as concentrating on training strategies that improve work-related skills. © 2015 John Wiley & Sons Ltd.
Supporting Hospital Inter-departmental Coordination of work with Electronic Whiteboards
DEFF Research Database (Denmark)
Lassen, Jens Vejrup; Simonsen, Jesper
We present an ethnographic study of the organizational aspects of the use of an electronic whiteboard (EW) system implemented in a Danish hospital located in Nykøbing Falster (NFH) . The EW system had originally been developed for the emergency department (ED), but had later been extended to the ...
Experiencing Work: Supporting the Undergraduate Hospitality, Tourism and Cruise Management Student on an Overseas Work Placement
Gibson, Philip; Busby, Graham
This paper reports on a funded research project into the experiences of tourism, hospitality and cruise management students on internship outside the UK as part of their British university degree between 2007 and 2009. The research reflected on the perceptions of students, course managers, placement officers and members of university placement…
Expeditionary Combat Support System: Root Cause Analysis
Process Alea Bluepri'lting Ends SEP 06 Protest of SJ Contract Award SEP06 Syttem Integrator (SIJ Contnllel AWiltd (CSC ---18 months lost to t'.t...Afghan mountains (recall that the "E" in ECSS stands for "Expeditionary").19 Lastly, ERPs are so large and affect so many different people and
Combating Terrorism Technology Support Office 2006 Review
of Veterinary Medicine , Auburn Myers and Associates, Auburn Sparta, Inc., Huntsville U.S. Army Aeromedical Research Laboratory, Fort Rucker arizoNa...disguised handwritings, and writing in different languages and character sets. Develop software to identify counterfeit documents and match...of Medicine and Surgery – Naval Air Warfare Center – Naval Criminal Investigative Service – Naval Explosive Ordnance Disposal Fleet Liaison
Combating Terrorism Technical Support Office. 2008 Review
and coordination of necessary law enforcement agencies. The EPT provides real-time visualization of pedestrian movements around and within major...Applied Research Associates, Inc., North Florida Division, Panama City Coda Octopus Inc, St Petersburg Florida Film and Video, St. Petersburg Florida
Nutritional support team vs nonteam management of enteral nutritional support in a Veterans Administration Medical Center teaching hospital.
Powers, D A; Brown, R O; Cowan, G S; Luther, R W; Sutherland, D A; Drexler, P G
One hundred one patients receiving enteral nutritional support (ENS) by tube feeding during a 5-month period were prospectively studied. Fifty patients were managed by a nutritional support team (T) and 51 patients were managed by the nonteam approach (NT). Demographics, primary diagnosis, chronic diseases, medical service, calculated basal energy expenditure (BEE), duration of ENS, and final patient disposition were recorded. Enteral formula, formula modifications, results of laboratory tests and calories delivered were obtained daily. Results of nitrogen balance studies were obtained when available and each patient was monitored for pulmonary, mechanical, gastrointestinal, and metabolic abnormalities. No significant difference was found between the team and nonteam managed groups in regard to total feeding days, mean feeding days per patient, total laboratory tests, laboratory tests per patient or laboratory tests per day. Significantly more team patients attained 1.2 times BEE (T = 47, NT = 38, p less than 0.05) for a significantly greater period of time (T = 398 days, NT = 281 days, p less than 0.05). Significantly more team patients achieved a measured positive nitrogen balance than nonteam patients (T = 42, NT = 1, p less than 0.05). Formula modifications to correct nutritional or metabolic aberrations were made in 15 (30%) team patients and five (9.8%) nonteam patients (p less than 0.05). The number of individual abnormalities (pulmonary, mechanical, gastrointestinal, and metabolic), as well as total abnormalities occurring in the team-managed group, was significantly lower than in the nonteam managed group (160 vs 695, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
The role of participatory music making in supporting people with dementia in hospital environments.
Daykin, Norma; Parry, Barbara; Ball, Kerry; Walters, David; Henry, Ann; Platten, Bronwyn; Hayden, Rachel
Background Improving the quality of care for people with dementia in general hospitals is a key priority. Creative activities including music have been examined for their potential role in enhancing quality of life for people with dementia, although relatively few studies have evaluated their use in acute hospital settings. Methods A mixed methods study examined the effects of a ten week period of weekly music sessions on the wellbeing of patients with dementia and on the ward environment in an acute elderly care service in a UK hospital. Potential effects of the music project on the ward environment were examined by comparing descriptive quantitative ward level data for two equivalent time periods, one with music and one with no music. The impact of the activity on participants' wellbeing was assessed using observational data as well as semi-structured interviews and focus groups with patients, visitors, the musician and staff. Results Ward level data were available for 85 patients with a dementia diagnosis who had stayed on the wards during the study periods. Comparison between the two periods showed a number of differences between the music and the non-music time periods, including a reduction in prescription of antipsychotic drugs. However, many factors could have contributed to the differences in the ward environment. Observational data revealed nuanced responses to music and suggested that participants generally enjoyed the activity. The impacts of music making were mediated strongly by staff responses and hospital organisation. Conclusion Data from this limited pilot study suggest that music is a useful intervention for enhancing patient and staff experiences and improving care in acute dementia care environments. The suggestion that use of anti-psychotic drugs may be reduced when music is present warrants further research.
Supporting Faculty Development in Hospital Medicine: Design and Implementation of a Personalized Structured Mentoring Program.
Nagarur, Amulya; O'Neill, Regina M; Lawton, Donna; Greenwald, Jeffrey L
The guidance of a mentor can have a tremendous influence on the careers of academic physicians. The lack of mentorship in the relatively young field of hospital medicine has been documented, but the efficacy of formalized mentorship programs has not been well studied. We implemented and evaluated a structured mentorship program for junior faculty at a large academic medical center. Of the 16 mentees who participated in the mentorship program, 14 (88%) completed preintervention surveys and 10 (63%) completed postintervention surveys. After completing the program, there was a statistically significant improvement in overall satisfaction within 5 specific domains: career planning, professional connectedness, self-reflection, research skills, and mentoring skills. All mentees reported that they would recommend that all hospital medicine faculty participate in similar mentorship programs. In this small, single-center pilot study, we found that the addition of a structured mentorship program based on training sessions that focus on best practices in mentoring was feasible and led to increased satisfaction in certain career domains among early-career hospitalists. Larger prospective studies with a longer follow-up are needed to assess the generalizability and durability of our findings. © 2017 Society of Hospital Medicine.
Managing complex therapies outside hospitals. An analysis of GPs practices of how to support medication at home.
Piras, Enrico Maria; Miele, Francesco; Bruni, Attila; Coletta, Claudio; Zanutto, Alberto
Support systems for the management of prescriptions are commonplace in hospitals, whilst they are rarely found in general practice. This exploratory study draws on a qualitative survey conducted with focus groups to investigate the information needs of General Practitioners (GPs) in regard to the therapeutic management of complex patients, the purpose being to identify possible areas of application. The question addressed is whether the systems existing in hospitals can be usefully adapted and used by GPs or if a different approach needs to be adopted to design other tools. The analysis shows that the information needs of GPs relative to medication management are significantly different from those of their hospital colleagues because the former are not directly responsible for the administration but instead operate within a care network on which they cannot exercise direct control. This study suggests that support systems for therapy management should be designed on the assumption that it derives from cooperative work by a heterogeneous network of actors, and therefore with functionalities intended to satisfy the coordination needs of all the actors involved in the process.
Mobile Display of Information about Aggregated Antibiotic Resistance in the Hospital Setting Supported by Near Field Communication.
Meng, Philipp; Fehre, Karsten; Rappelsberger, Andrea; Adlassnig, Klaus-Peter
Antibiotic resistance is a heterogeneous phenomenon. It does not only differ between countries or states, but also between wards of hospitals, where different resistance patterns have been found. To support clinicians in administering empiric antibiotic therapy, we developed software to present information about antibiotic resistance using a mobile concept. A pre-existing infrastructure was deployed as the server component. The systems analyze and aggregate data from laboratory information systems, generating statistical data on antibiotic resistance. The information is presented to the Android client using a Representational State Transfer (REST) interface. Geographical localization is performed using near field communication (NFC) tags. The prototype provides tabulated data concerning antibiotic resistance patterns in the wards of a hospital. Using Android, NFC, and data caching, the usability of the system is estimated to be high. We hypothesize that antibiotic stewardship in hospitals can be supported by this software, thus improving medical monitoring of antibiotic resistance. Future studies in a productive environment are needed to measure the impact of the system on the outcome of patient care.
HTA decision support system for sustainable business continuity management in hospitals. The case of surgical activity at the University Hospital in Florence.
Miniati, Roberto; Dori, Fabrizio; Cecconi, Giulio; Gusinu, Roberto; Niccolini, Fabrizio; Gentili, Guido Biffi
A fundamental element of the social and safety function of a health structure is the need to guarantee continuity of clinical activity through the continuity of technology. This paper aims to design a Decision Support System (DSS) for medical technology evaluations based on the use of Key Performance Indicators (KPI) in order to provide a multi-disciplinary valuation of a technology in a health structure. The methodology used in planning the DSS followed the following key steps: the definition of relevant KPIs, the development of a database to calculate the KPIs, the calculation of the defined KPIs and the resulting study report. Finally, the clinical and economic validation of the system was conducted though a case study of Business Continuity applied in the operating department of the Florence University Hospital AOU Careggi in Italy. A web-based support system was designed for HTA in health structures. The case study enabled Business Continuity Management (BCM) to be implemented in a hospital department in relation to aspects of a single technology and the specific clinical process. Finally, an economic analysis of the procedure was carried out. The system is useful for decision makers in that it precisely defines which equipment to include in the BCM procedure, using a scale analysis of the specific clinical process in which the equipment is used. In addition, the economic analysis shows how the cost of the procedure is completely covered by the indirect costs which would result from the expenses incurred from a broken device, hence showing the complete auto-sustainability of the methodology.
Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals
Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S.
Background: Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in
Combatant Commanders Informational Series, USEUCOM
National Research Council Canada - National Science Library
Burton, Steven
...) and the diverse challenges it faces require it to maintain one of the highest operational and personnel tempos of the combatant command, are limited in the opportunity of personnel new to the command...
Combating trafficking: the Swiss approach
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Sebastian Rauber
Full Text Available Switzerland is committed to combating and preventingtrafficking in human beings. Effective policy implementationin a federal structure depends on networking,effective information exchange and development ofrobust cooperation mechanisms.
The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study.
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Sara Garfield
Full Text Available Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients' involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing.We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses' medication administration rounds, pharmacists' ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically.Paper or electronic medication records were shown to patients in only 4 (2% of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture.Patients appear to have more access to paper-based records than
Polymers for Combating Biocorrosion
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Jing Guo
Full Text Available Biocorrosion has been considered as big trouble in many industries and marine environments due to causing of great economic loss. The main disadvantages of present approaches to prevent corrosion include being limited by environmental factors, being expensive, inapplicable to field, and sometimes inefficient. Studies show that polymer coatings with anticorrosion and antimicrobial properties have been widely accepted as a novel and effective approach to prevent biocorrosion. The main purpose of this review is to summarize up the progressive status of polymer coatings used for combating microbial corrosion. Polymers used to synthesize protective coatings are generally divided into three categories: (i traditional polymers incorporated with biocides, (ii antibacterial polymers containing quaternary ammonium compounds, and (iii conductive polymers. The strategies to synthesize polymer coatings resort mainly to grafting antibacterial polymers from the metal substrate surface using novel surface-functionalization approaches, such as free radical polymerization, chemically oxidative polymerization, and surface-initiated atom transfer radical polymerization, as opposed to the traditional approaches of dip coating or spin coating.
Cogitation on Occupational Stress and Social Support among Hospital Nurses: a Case Study of Zanjan Province, Iran
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Samira Jafari
Full Text Available Despite extensive research on stress among hospital nurses, the important effects of support and stress on care quality are not yet well established. Similar to other jobs, nurses face stress in their routine working day. The relationship between occupational stress, social support and factors relating to each of them, among Iranian nurses are attempted to correlate. This cross-sectional analytical-descriptive study was carried out in 2013 in Zanjan province where 248 nurses filled the given questionnaires including Demographic data, Work Factors, Nursing Stress Scale, and Social Integration Scale. Data were analyzed using SPSS 16.00. In our study, we found that the stress and social support were significantly correlated. Our findings revealed a significant relation between social supports and occupational stress in nurses. Conclusively, support from supervisors and coworkers can help control nurses' stress. In addition, both social support and occupational stress are related to three major components: job satisfaction, job security and others' attitude towards nursing. Therefore, creating a positive attitude towards nursing in society, and a suitable working environment for them is a way to increase their efficiency.
Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization.
Rudoler, David; de Oliveira, Claire; Jacob, Binu; Hopkins, Melonie; Kurdyak, Paul
The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.
Psychological workshops for children and adolescents suffering from malignant disease: The model of psychosocial support during hospitalization and treatment
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Klikovac Tamara
Full Text Available Pediatric psycho-oncology within psycho-oncology is a highly developed scientific discipline in the world, both at the level of basic research and the development of theoretical concepts and at the practical level, which refers to the creation and implementation of various models of psychosocial support to children and young people who are suffering from various malignant diseases and their families during all stages of the demanding oncology treatment. One of the models of psychosocial support for children are workshops, as a form of group psychological treatment in which children and young people who are in distress, crisis, shock and even trauma, acquire a new positive experience and which provides new insights and knowledge to empower and boost the quality of life for overcoming severe malignant disease and treatment through meaningful games, all of which leads to overcoming the 'downtime' and regression and encouraging further psychological development. The outcome of workshop activities are various products (drawings, photographs, videos, posters, written material, but also positive feelings and behaviours in children and adolescents. The main objectives of introducing psychological workshops at the department of pediatric hematology-oncology in our community are, on the one hand, to provide professional counselling and support to children and young people during hospitalization and, on the other, to introduce a standard psychological procedure and quality psychological practice of group psychological counselling for sick children and young people in the hospital environment.
Exploring example models of cross-sector, sessional employment of pharmacists to improve medication management and pharmacy support in rural hospitals.
Tan, Amy Cw; Emmerton, Lynne M; Hattingh, Laetitia; La Caze, Adam
Many rural hospitals in Australia are not large enough to sustain employment of a full-time pharmacist, or are unable to recruit or retain a full-time pharmacist. The absence of a pharmacist may result in hospital nurses undertaking medication-related roles outside their scope of practice. A potential solution to address rural hospitals' medication management needs is contracted part-time ('sessional') employment of a local pharmacist external to the hospital ('cross-sector'). The aim of this study was to explore the roles and experiences of pharmacists in their provision of sessional services to rural hospitals with no on-site pharmacist and explore how these roles could potentially address shortfalls in medication management in rural hospitals. A qualitative study was conducted to explore models with pharmacists who had provided sessional services to a rural hospital. A semi-structured interview guide was informed by a literature review, preliminary research and stakeholder consultation. Participants were recruited via advertisement and personal contacts. Consenting pharmacists were interviewed between August 2012 and January 2013 via telephone or Skype for 40-55 minutes. Thirteen pharmacists with previous or ongoing hospital sessional contracts in rural communities across Australia and New Zealand participated. Most commonly, the pharmacists provided weekly services to rural hospitals. All believed the sessional model was a practical solution to increase hospital access to pharmacist-mediated support and to address medication management gaps. Roles perceived to promote quality use of medicines were inpatient consultation services, medicines information/education to hospital staff, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities. This study is the first to explore the concept of sessional rural hospital employment undertaken by pharmacists in Australia and New Zealand. Insights from participants
Supporting newly qualified nurse transition: A case study in a UK hospital.
Whitehead, Bill; Owen, Patricia; Henshaw, Lorraine; Beddingham, Elaine; Simmons, Maxine
Nurse education in the United Kingdom (UK) has been university based since the mid-1990s but despite careful preparation and assessment of student nurses it has been considered necessary to provide a period of additional support for newly qualified nurses (NQNs) to help them settle into their new role and responsibilities. Preceptorship is the process of supporting NQNs over the transition from student to registered nurse (RN) and it is recognised that this can be a difficult time for NQNs. A systematic review was conducted as part of this project and has been published in an earlier edition of Nurse Education Today (Whitehead et al, 2013). This suggests that preceptorship is a positive and essential experience for NQNs. Lincoln and Guba's Naturalistic Inquiry (1985) was used. A qualitative case study method was developed and consisted of a multi-stage approach including semi-structured interviews with key personnel; documentary analysis of preceptorship material; and focus groups with key actors. Ethical approval was attained for the project. The aim was to interpret the social phenomena and to produce an evidence based tool to improve preceptorship. Findings are grouped under the headings indicated by the research design. In addition a further 11 themes emerged, including: the need for specific time for preceptors and preceptees; formal recognition of the role and a culture of support; selection and preparation of preceptors and the management structure to support preceptorship. The findings indicate that there are a range of factors which are reported to affect the successful transition from student to NQN. Based on these factors recommendations are made for practice and for further research. Practice recommendations: to provide supported preceptorship following the recommendations of the research findings. to concentrate on enhancing preceptorship as preceptorship in any form is better than none. Copyright © 2015 Elsevier Ltd. All rights reserved.
Supporting management of medical equipment for inpatient service in public hospitals: a case study.
Figueroa, Rosa L; Vallejos, Guido E
This work presents a study of medical equipment availability in the short and long term. The work is divided in two parts. The first part is an analysis of the medical equipment inventory for the institution of study. We consider the replacement, maintenance, and reinforcement of the available medical equipment by considering local guidelines and surveying clinical personnel appreciation. The resulting recommendation is to upgrade the current equipment inventory if necessary. The second part considered a demand analysis in the short and medium term. We predicted the future demand with a 5-year horizon using Holt-Winters models. Inventory analysis showed that 27% of the medical equipment in stock was not functional. Due to this poor performance result we suggested that the hospital gradually addresses this situation by replacing 29 non-functional equipment items, reinforcing stock with 40 new items, and adding 11 items not available in the inventory but suggested by the national guidelines. The results suggest that general medicine inpatient demand has a tendency to increase within the time e.g. for general medicine inpatient service the highest increment is obtained by respiratory (12%, RMSE=8%) and genitourinary diseases (20%, RMSE=9%). This increment did not involve any further upgrading of the proposed inventory.
A self-supporting library service in a rural region: a new look at hospital consortia.
Gillikin, P; Price, L; Lee, S; Sprinkle, M D; Leist, J C
To meet the informational needs of health care practitioners and trainees in a four-county rural area of northwestern North Carolina, the eleven-member UNIFOUR Consortium was founded as a two-year experimental project from 1978 to 1980. The consortium has several unique features: (1) it is an organization of institutions, not libraries; (2) it employs its own professional librarian who manages a central library, coordinates consortium programs, and makes regular circuit visits to all affiliated institutions; (3) the central library, where the circuit is based, is a developing community hospital library, not an established academic medical center library; and (4) it is ultimately tied to the Northwest Area Health Education Center and that organization's emerging learning resources network, which includes the Bowman Gray School of Medicine, Library, two other subregional libraries, and the libraries of all member institutions. At the end of the experimental period in 1980, member institutions voted unanimously to continue the program and assume their share of the costs.
Surgical support of Operation Sea Signal: adaptability of the 59th Air Transportable Hospital in Cuba.
Pelton, Jeffrey J; Buehrer, Jeffrey L; Cull, David L
The attempted migration of approximately 50,000 Cubans in the summer of 1994 created a large patient population detained at Guantanamo Bay, Cuba. This study examined the roles and results of the 59th Air Transportable Hospital (ATH) in treating surgical problems within that population during Operation Sea Signal. The surgical case log of the 59th ATH was used to identify all patients operated on at the 59th ATH during the interval of August 1994 to April 1995. These case records and the individual records of the three 59th ATH surgeons were used to determine the types of cases performed, complications, and outcomes. A total of 333 operations were performed at the 59th ATH in three types of surgery: (1) elective (267); (2) emergency for nonself-inflicted conditions (46); and (3) emergency for self-inflicted conditions (20). The total perioperative complication rate was 2.4% (8/333), and the wound infection rate for clean surgical cases was 0.87% (2/229). Elective surgery may be performed in a field environment with acceptable complication and wound infection rates. Humanitarian missions will be faced with considerable pathology from pre-existing conditions within the population cared for. The humanitarian mission may be complicated by political situations that may encourage malingering and self-injurious behavior within the population cared for. The latter events have not been previously encountered in humanitarian missions involving the U.S. military and must be considered by policy makers and mission planners in planning future humanitarian missions.
Enhancing the quality of oral nutrition support for hospitalized patients: a mixed methods knowledge translation study (The EQONS study).
Gerrish, Kate; Laker, Sara; Taylor, Carolyn; Kennedy, Fiona; McDonnell, Ann
The aim of this study was to report a multifaceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. Malnutrition among hospitalized patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. A mixed method integrated knowledge translation study. The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18 months between 2011-2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi-structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. Statistically significant relationships (Chi Square) were observed between self-reported confidence of nurses (a) to assess patients using the Malnutrition Universal Screening Tool, (b) to teach colleagues how to use the Malnutrition Universal Screening Tool and (c) to ensure that patients were assessed within 24 hours of admission. Ward-based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organization) and macro (healthcare system) levels acted as barriers and enablers for change. Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition. © 2016 John Wiley & Sons Ltd.
Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.
Kurz, Michael Christopher; Schmicker, Robert H; Leroux, Brian; Nichol, Graham; Aufderheide, Tom P; Cheskes, Sheldon; Grunau, Brian; Jasti, Jamie; Kudenchuk, Peter; Vilke, Gary M; Buick, Jason; Wittwer, Lynn; Sahni, Ritu; Straight, Ronald; Wang, Henry E
Prior observational studies suggest no additional benefit from advanced life support (ALS) when compared with providing basic life support (BLS) for patients with out-of-hospital cardiac arrest (OHCA). We compared the association of ALS care with OHCA outcomes using prospective clinical data from the Resuscitation Outcomes Consortium (ROC). Included were consecutive adults OHCA treated by participating emergency medical services (EMS) agencies between June 1, 2011, and June 30, 2015. We defined BLS as receipt of cardiopulmonary resuscitation (CPR) and/or automated defibrillation and ALS as receipt of an advanced airway, manual defibrillation, or intravenous drug therapy. We compared outcomes among patients receiving: 1) BLS-only; 2) BLS + late ALS; 3) BLS + early ALS; and 4) ALS-first care. Using multivariable logistic regression, we evaluated the associations between level of care and return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with good functional status, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, EMS response time, CPR quality, and ROC site. Among 35,065 patients with OHCA, characteristics were median age 68 years (IQR 56-80), male 63.9%, witnessed arrest 43.8%, bystander CPR 50.6%, and shockable initial rhythm 24.2%. Care delivered was: 4.0% BLS-only, 31.5% BLS + late ALS, 17.2% BLS + early ALS, and 47.3% ALS-first. ALS care with or without initial BLS care was independently associated with increased adjusted ROSC and survival to hospital discharge unless delivered greater than 6 min after BLS arrival (BLS + late ALS). Regardless of when it was delivered, ALS care was not associated with significantly greater functional outcome. ALS care was associated with survival to hospital discharge when provided initially or within six minutes of BLS arrival. ALS care, with or without initial BLS care, was associated with increased ROSC, however it was
Battlemind Training: Transitioning Home from Combat
National Research Council Canada - National Science Library
Castro, Carl A; Hoge, Charles W; Milliken, Charles W; McGurk, Dennis; Adler, Amy B; Cox, Anthony; Bliese, Paul D
.... Destruction, injury, and death were ever present in the combat zone. Transitioning from combat to home can be difficult, and many Soldiers encounter readjustment problems ranging from elevated post-traumatic stress disorder (PTSD...
Relational use of an electronic quality of life and practice support system in hospital palliative consult care: A pilot study.
Krawczyk, Marian; Sawatzky, Richard
This study is part of an overarching research initiative on the development and integration of an electronic Quality of Life and Practice Support System (QPSS) that uses patient-reported outcome and experience measures in clinical practice. The current study focused on palliative nurse consultants trialing the QPSS with older hospitalized adults receiving acute care. The primary aim of the study was to better understand consultants' and patients' experiences and perspectives of use. The project involved two nurse specialists within a larger palliative outreach consult team (POCT) and consenting older adult patients (age 55+) in a large tertiary acute care hospital in western Canada. User-centered design of the QPSS was informed by three focus groups with the entire POCT team, and implementation was evaluated by direct observation as well as interviews with the POCT nurses and three patients. Thematic analysis of interviews and field notes was informed by theoretical perspectives from social sciences. Result Over 9 weeks, the POCT nurses used the QPSS at least once with 20 patients, for a total of 47 administrations. The nurses most often assisted patients in using the QPSS. Participants referenced three primary benefits of relational use: enhanced communication, strengthened therapeutic relations, and cocreation of new insights about quality of life and care experiences. The nurses also reported increased visibility of quality of life concerns and positive development as relational care providers. Significance of results Participants expressed that QPSS use positively influenced relations of care and enhanced practices consistent with person-centered care. Results also indicate that electronic assessment systems may, in some instances, function as actor-objects enabling new knowledge and relations of care rather than merely as a neutral technological platform. This is the first study to examine hospital palliative consult clinicians' use of a tablet-based system
Determinants of hospitalization in Chinese patients with type 2 diabetes receiving a peer support intervention and JADE integrated care: the PEARL randomised controlled trial.
Yeung, Roseanne O; Cai, Jing-Heng; Zhang, Yuying; Luk, Andrea O; Pan, Jun-Hao; Yin, Junmei; Ozaki, Risa; Kong, Alice P S; Ma, Ronald; So, Wing-Yee; Tsang, Chiu Chi; Lau, K P; Fisher, Edwin; Goggins, Williams; Oldenburg, Brian; Chan, Julianna
In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores. We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization. Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer support reduced the frequency of hospitalizations by 48% with a relative risk of 0.52 (95% CI 0·35-0·79; p = 0·0018). Using SEM, improvement of negative emotions reduced treatment nonadherence (Est = 0.240, p = 0.034) and hospitalizations (Est=-0.218, p = 0.001). The latter was also reduced by an interactive term of peer support and chronic kidney disease (Est = 0.833, p = diabetes, improvement of negative emotions and peer support reduced hospitalizations, especially in those with comorbidities, in part mediated through improving treatment nonadherence. Integrating peer support is feasible and adds value to multidisciplinary care, augmented by information technology, especially in patients with comorbidities. NCT00950716 Registered July 31, 2009.
Empowering leadership, perceived organizational support, trust, and job burnout for nurses: a study in an Italian general hospital.
Bobbio, Andrea; Bellan, Maria; Manganelli, Anna Maria
A strong nursing leadership that instills trust in the leader and in the organization is an important component for an effective leadership, particularly for health care organizations, because trust defines the heart of health care workplaces by promoting patient safety, excellence in care, recruitment, and retention of the nursing staff. This study aimed to test the impact of perceived empowerment leadership style expressed by the nurse supervisor, nurses' perceived organizational support, trust in the leader, and trust in the organization on nurses' job burnout. A group of 273 nurses from an Italian public general hospital took part in a cross-sectional study on a voluntary basis by filling out an anonymous questionnaire. Empowering leadership was an important predictor of trust in the leader. Trust in the organization was influenced by perceived organizational support and by the Informing dimension of the empowering leadership style. Trust in the leader and trust in the organization showed a negative impact on job burnout and also mediated the effects of some empowering leadership dimensions and perceived organizational support on job burnout. The central role of trust in health care organizations was corroborated, as well as the beneficial effects of adopting specific features of empowerment leadership behaviors toward the nursing staff. Empowering leadership could be successfully proposed in training programs directed to nurses' supervisors and health care managers.
Supporting staff in employment: the emotional wellbeing of staff in an NHS psychiatric hospital.
Patterson, I D; Bell, J S
The objective of this study was to assess the emotional wellbeing of a broad sample of NHS employees in a psychiatric setting; to seek their views on sources of distress; and to identify preferred ways of dealing with it. A cross-sectional postal survey, employing two questionnaires: GHQ-28, and a semi-structured questionnaire. These were sent to a nominal 50% sample (n = 599). The population was the staff of a large Scottish psychiatric service. A 47.9% response rate was achieved; 32.9% of respondents exceeded a cut-off score of four on the GHQ-28. Neither occupational, group nor gender effects were significant on this measure. The reporting of emotionally-distressing problems affecting their performance was found to be more common amongst doctors; males, overall, showed a non-significant trend towards having been affected more than females by such problems; and older staff (above 45) were affected significantly more often than younger staff. Almost a third of staff were unaware of the availability of an internal organisational resource (the Occupational Health service). NHS Trusts should ensure the culture at work is appropriate from a preventative point of view and be aware that factors outwith the workplace can affect employees emotional wellbeing and performance. Preventative and supportive measures to minimise psychological distress in the workforce should be considered; the Scottish Needs Assessment Programme: Mental Health in the Workplace offers useful guidance.
Combatting the Terrorist Threat.
have supplied many terrorist groups with plastique and other explosives to build bombs. 3 Using these explosives they have produced vehicle bombs which...deceptive, if not dangerously naive.1 5 State Supported Terrorism State supported terrorism is not a new concept , however, it has only recently been...terrorist incidents. The product of that study was the tri-level US anti- terrorism program concept . 3 The program structure is shown in Figure 11. President
Advanced life support therapy and on out-of-hospital cardiac arrest patients: Applying signal processing and pattern recognition methods
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Trygve Eftestøl
Full Text Available In the US alone, several hundred thousands die of sudden cardiac arrests each year. Basic life support defined as chest compressions and ventilations and early defibrillation are the only factors proven to increase the survival of patients with out-of-hospital cardiac arrest, and are key elements in the chain of survival defined by the American Heart Association. The current cardiopulmonary resuscitation guidelines treat all patients the same, but studies show need for more individualiza- tion of treatment. This review will focus on ideas on how to strengthen the weak parts of the chain of survival including the ability to measure the effects of therapy, improve time efficiency, and optimize the sequence and quality of the various components of cardiopulmonary resuscitation.
A study conducted on the demographic factors of victims of violence in support and administrative departments of hospital in 2013.
Keyvanara, Mahmoud; Maracy, Mohammad Reza; Ziari, Najmeh Bahman
Violence is now regarded as a serious problem and its complication causes heavy costs on the healthcare systems. The present study aimed to investigate the correlation between some demographic characteristics and confrontation with violence. Since there is no study on the prevalence of violence among the support and administration staff of hospitals in Iran, this study was conducted to investigate violence in these departments. This descriptive-analytical and correlation survey was carried out by census among the support and administrative staff interacting with patients and their companions in Al-Zahra University Hospital of Isfahan in 2013. Research tool was a researcher-made questionnaire including five domains: Personal information, workplace information, verbal violence, physical violence, and other violent acts. Its validity was evaluated by experts reviewing it and its reliability by test-retest (r =0.9). Finally, data were analyzed using descriptive statistical indicators and statistical tests such as Chi-square for sex, marital status, and work department and Mann-Whitney U test for age, level of education, work experience, and violence types by the statistical software SPSS version 20. According to the results obtained, 81% of subjects had been abused at least once and the most reported violence was related to verbal violence (78.4%). There was significant correlation between sex and violence and men were the main victims of violence, but there was no relation between marital status, age, and violence. Work experience was correlated to physical violence and other violent acts conversely. There was also an inverse correlation between physical violence and education; also, security staff faced more violence than others. As high prevalence of violence was found especially among the security staff and personnel with less education and work experience, it is suggested to take actions such as educating about patient accompaniment and visiting condition, holding
What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation.
Liberati, Elisa G; Ruggiero, Francesca; Galuppo, Laura; Gorli, Mara; González-Lorenzo, Marien; Maraldi, Marco; Ruggieri, Pietro; Polo Friz, Hernan; Scaratti, Giuseppe; Kwag, Koren H; Vespignani, Roberto; Moja, Lorenzo
Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation. We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as "positions." The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians' perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians' reasoning and fostering organizational learning. Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation
Regulating and Combating Underground Banking
Borgers, M.J.
In combating and regulating underground banking, a choice can be made of roughly two models, the risk model and the assimilation model. The risk model comes down to a complete prohibition of underground banking combined with an active investigation and prosecution policy. In the assimilation model,
Combating corruption in global health.
Mackey, Tim K; Kohler, Jillian; Lewis, Maureen; Vian, Taryn
Corruption is a critical challenge to global health efforts, and combating it requires international action, advocacy, and research. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.
Effective Protection or Effective Combat
DEFF Research Database (Denmark)
Lemberg-Pedersen, Martin
alternative routes. On the other hand, European border control and its 'combat against smugglers' has emerged as a massively lucrative market for the European arms industry, both in terms of contracts to guard the EU's external borders and in terms of the export of weapons and control systems to North African...
Combating Training-Stress Syndromes.
Voight, Mike
Addresses the nature and ramifications of various training stress syndromes (overtraining, under-recovery, distress, staleness, and burnout) that can accompany inappropriate training practices, examining the interventions that players and coaches can use to combat these syndromes (including physical, psychological, and performance interventions),…
New Russian Combat Small Boats
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Aleksandr F. Mitrofanov
Full Text Available The article presents an overview of small combat boats. The author provides a description and gives an analysis of the characteristics of the boat "Raptor", boat "BK-16", boat "Strizh-4-1 DSh", and assault boat "BK-10".
Teaching Combative Sports through Tactics
Kozub, Francis M.; Kozub, Mary L.
Martial arts have become popular in the United States and have transitioned from being spectator sports to avenues for active participation by people of all ages. The purpose of this article is to highlight tactical similarities in selected combative sport activities and to provide martial arts and wrestling instructors with an alternative…
Simulating barrier penetration during combat. Technical report
International Nuclear Information System (INIS)
De Laquil, P. III.
A computer program, BARS, simulates combat between an adversary group attempting to hijack special nuclear material and escort personnel attempting to protect it. BARS is designed to investigate how various combat strategies and levels of performance affect the time required to penetrate barriers (armor, deterrent systems, etc.) against forcible entry. A Monte Carlo code, BARS uses a game theoretic approach to allocate the attacking and defending forces. Combat suppression is simulated using a stochastic state-transition model for the behavior of individuals under combat stress. The BARS program was developed as part of the overall combat modelling effort of the transportation safeguards program
Abductive networks applied to electronic combat
Montgomery, Gerard J.; Hess, Paul; Hwang, Jong S.
A practical approach to dealing with combinatorial decision problems and uncertainties associated with electronic combat through the use of networks of high-level functional elements called abductive networks is presented. It describes the application of the Abductory Induction Mechanism (AIMTM) a supervised inductive learning tool for synthesizing polynomial abductive networks to the electronic combat problem domain. From databases of historical expert-generated or simulated combat engagements AIM can often induce compact and robust network models for making effective real-time electronic combat decisions despite significant uncertainties or a combinatorial explosion of possible situations. The feasibility of applying abductive networks to realize advanced combat decision aiding capabilities was demonstrated by applying AIM to a set of electronic combat simulations. The networks synthesized by AIM generated accurate assessments of the intent lethality and overall risk associated with a variety of simulated threats and produced reasonable estimates of the expected effectiveness of a group of electronic countermeasures for a large number of simulated combat scenarios. This paper presents the application of abductive networks to electronic combat summarizes the results of experiments performed using AIM discusses the benefits and limitations of applying abductive networks to electronic combat and indicates why abductive networks can often result in capabilities not attainable using alternative approaches. 1. ELECTRONIC COMBAT. UNCERTAINTY. AND MACHINE LEARNING Electronic combat has become an essential part of the ability to make war and has become increasingly complex since
Home Discharge and Out-of-Hospital Follow-Up of Total Artificial Heart Patients Supported by a Portable Driver System
To enhance ambulation and facilitate hospital discharge of total artificial heart (TAH)–supported patients, we adapted a mobile ventricular assistance device (VAD) driver (Excor) for TAH use and report on the performance of Excor-driven TAH patients discharged home. Ten patients stabilized on a TAH, driven by the CSS ("Circulatory Support System"), were progressively switched over to the Excor in hospital over 14 days as a pilot, with daily hemodynamics and laboratory parameters measured. Twenty-two stable TAH patients were subsequently placed on the Excor, trained, and discharged home. Clinical and hemodynamic parameters were followed. All pilot study patients were clinically stable on the Excor, with no decrease in TAH output noted (6.3 + 0.3 L/min [day 1] vs. 5.8 + 0.2 L/min [day 14], p = 0.174), with a trend suggesting improvement of both hepatic and renal function. Twenty-two TAH patients were subsequently successfully discharged home on the portable driver and were supported out of hospital for up to 598 days (range, 2–598; mean = 179 ± 140 days), remaining ambulatory, New York Heart Association (NYHA) class I or II, and free of readmission for 88.5% of the time of support. TAH patients may be effectively and safely supported by a mobile drive system. As such, the utility of the TAH may be extended to support patients beyond the hospital, at home, with overall ambulatory freedom. PMID:24577369
Combat Wound Initiative Program
Government as part of that person's official duties. Deliver~~ by Publishing Technology to: Waiter Reed Army Institute of R~l!il>~~vTP:11~1~:S6;!4!B1...develop a predictive model, which could serve as a clinical decision support tool in the management of complex war wounds. Bayesian belief networks...decisions regarding the surgical management of wounds and estimate overall out- come of patients on the basis of casualty-specific factors in wounded
Integration of Hospital Information and Clinical Decision Support Systems to Enable the Reuse of Electronic Health Record Data.
Kopanitsa, Georgy
The efficiency and acceptance of clinical decision support systems (CDSS) can increase if they reuse medical data captured during health care delivery. High heterogeneity of the existing legacy data formats has become the main barrier for the reuse of data. Thus, we need to apply data modeling mechanisms that provide standardization, transformation, accumulation and querying medical data to allow its reuse. In this paper, we focus on the interoperability issues of the hospital information systems (HIS) and CDSS data integration. Our study is based on the approach proposed by Marcos et al. where archetypes are used as a standardized mechanism for the interaction of a CDSS with an electronic health record (EHR). We build an integration tool to enable CDSSs collect data from various institutions without a need for modifications in the implementation. The approach implies development of a conceptual level as a set of archetypes representing concepts required by a CDSS. Treatment case data from Regional Clinical Hospital in Tomsk, Russia was extracted, transformed and loaded to the archetype database of a clinical decision support system. Test records' normalization has been performed by defining transformation and aggregation rules between the EHR data and the archetypes. These mapping rules were used to automatically generate openEHR compliant data. After the transformation, archetype data instances were loaded into the CDSS archetype based data storage. The performance times showed acceptable performance for the extraction stage with a mean of 17.428 s per year (3436 case records). The transformation times were also acceptable with 136.954 s per year (0.039 s per one instance). The accuracy evaluation showed the correctness and applicability of the method for the wide range of HISes. These operations were performed without interrupting the HIS workflow to prevent the HISes from disturbing the service provision to the users. The project results have proven that
Detecting and combating malicious email
Ryan, Julie JCH
Malicious email is, simply put, email with a malicious purpose. The malicious purpose could be fraud, theft, espionage, or malware injection. The processes by which email execute the malicious activity vary widely, from fully manual (e.g. human-directed) to fully automated. One example of a malicious email is one that contains an attachment which the recipient is directed to open. When the attachment is opened, malicious software is installed on the recipient's computer. Because malicious email can vary so broadly in form and function, automated detection is only marginally helpful. The education of all users to detect potential malicious email is important to containing the threat and limiting the damage. It is increasingly necessary for all email users to understand how to recognize and combat malicious email. Detecting and Combating Malicious Email describes the different types of malicious email, shows how to differentiate malicious email from benign email, and suggest protective strategies for both perso...
A Simple Probabilistic Combat Model
Government may violate any copyrights that exist in this work. This page intentionally left blank. ABSTRACT The Lanchester ...page intentionally left blank. TABLE OF CONTENTS Page No.Abstract iii List of Illustrations vii 1. INTRODUCTION 1 2. DETERMINISTIC LANCHESTER MODEL...This page intentionally left blank. 1. INTRODUCTION The Lanchester combat model1 is a simple way to assess the effects of quantity and quality
A Theory of Combative Advertising
Yuxin Chen; Yogesh V. Joshi; Jagmohan S. Raju; Z. John Zhang
In mature markets with competing firms, a common role for advertising is to shift consumer preferences towards the advertiser in a tug-of-war, with no effect on category demand. In this paper, we analyze the effect of such "combative" advertising on market power. We show that, depending on the nature of consumer response, combative advertising can reduce price competition to benefit competing firms. However, it can also lead to a procompetitive outcome where individual firms advertise to incr...
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Pawel Rouba Billowicz
Full Text Available "Combats Escènics" és un treball que tracta sobre la interpretació artística de la violència d'artistes de l'espectacle per tal de divertir el públic i emetre un missatge humanista mitjançant una coreografia ritual. En aquest estudi es presenta una classificació del combat escènic des del doble vessant agonista/antagonista, es realitza un passeig històric de la representació artística del combat a través de les diferents etapes i de les diverses cultures, s'aborda la preparació escènica de l'actor i del coreògraf, i s'entreveuen les perspectives de futur d'aquesta modalitat artística. Estudi realitzat per Pawel Rouba Billewicz (Inowroclaw, Polònia, 1939 - Barcelona, 2007, director, coreògraf, actor, mestre d'armes, mestre del gest i de la pantomima i professor de l'INEF de Catalunya. Aquest article, editorialment inèdit, es publica postmortem per Apunts. Educació Física i Esports com a homenatge i reconeixement de l'autor per la seva extraordinària i polivalent aportació al camp de l'art i l'Activitat Física i l'Esport.
Combating transnational environmental crime
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Pisarić Milana
Full Text Available Environmental crime is a serious and growing international problem, and one which takes many different forms. It is not limited to criminals polluting the air, water and land and pushing commercially valuable wildlife species closer to extinction; it can also include crimes which speed up climate change, destroy fish stocks, annihilate forests and exhaust essential natural resources. These crimes can have a harmful impact on the economies and security of multiple nations, in some cases they may even threaten the very existence of a country or people. Furthermore, a significant proportion of both wildlife crime and pollution crime cases point to the involvement of organized crime networks. This is evidenced by the detailed planning of operations, substantial financial support, the careful management of international shipments and massive profits. Still, to date, transnational environmental crime has been poorly attended to by the transnational organised crime and transnational policing discourse. National and international institutions have prioritised other forms of organised crime, giving little thought to the nuances of environmental crime and how they should be reflected in policing. Intention of this paper is to point out the importance of international cooperation and to point out the its good examples.
Comparing the effects of adaptive support ventilation and synchronized intermittent mandatory ventilation on intubation duration and hospital stay after coronary artery bypass graft surgery
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Ahmadreza Yazdannik
Full Text Available Background: Different modes of mechanical ventilation are used for respiratory support after coronary artery bypass graft (CABG. This study aimed to compare the effect(s of using adaptive support ventilation (ASV and synchronized intermittent mandatory ventilation (SIMV on the length of mechanical ventilation (intubation duration and hospital stay after coronary artery bypass graft surgery. Materials and Methods: In a randomized control trial, 64 patients were ventilated with ASV as the experiment group or with SIMV as the control group after CABG surgery in Chamran Hospital of Isfahan University of Medical Sciences. The time of tracheal intubation and the length of hospital stay were compared between the two groups. Data were analyzed and described using statistical analysis (independent t-test. Results: The mean time of intubation duration was significantly lower in ASV group compared with SIMV group. (4.83 h vs 6.71 h, P < 0.001. The lengths of hospital stay in the ASV and the SIMV groups were 140.6 h and 145.1 h, respectively. This difference was significant between the two groups (P = 0.006. Conclusions: According to the results of this study, using ASV mode for mechanical ventilation after CABG led to a decrease in intubation duration and also hospital stay in comparison with the SIMV group. It is recommended to use ASV mode on ventilators for respiratory support of patients undergoing coronary artery bypass graft surgery.
Assured communications and combat resiliency: the relationship between effective national communications and combat efficiency
Allgood, Glenn O.; Kuruganti, Phani Teja; Nutaro, James; Saffold, Jay
Combat resiliency is the ability of a commander to prosecute, control, and consolidate his/her's sphere of influence in adverse and changing conditions. To support this, an infrastructure must exist that allows the commander to view the world in varying degrees of granularity with sufficient levels of detail to permit confidence estimates to be levied against decisions and course of actions. An infrastructure such as this will include the ability to effectively communicate context and relevance within and across the battle space. To achieve this will require careful thought, planning, and understanding of a network and its capacity limitations in post-event command and control. Relevance and impact on any existing infrastructure must be fully understood prior to deployment to exploit the system's full capacity and capabilities. In this view, the combat communication network is considered an integral part of or National communication network and infrastructure. This paper will describe an analytical tool set developed at ORNL and RNI incorporating complexity theory, advanced communications modeling, simulation, and visualization technologies that could be used as a pre-planning tool or post event reasoning application to support response and containment.
Tailored support for type 2 diabetes patients with an acute coronary event after discharge from hospital: design and development of a randomised controlled trial.
Kasteleyn, M.J.; Gorter, K.J.; Stellato, R.K.; Rijken, M.; Nijpels, G.; Rutten, G.E.H.M.
Background: Type 2 diabetes mellitus patients with an acute coronary event (ACE) experience decreased quality of life and increased distress. According to the American Diabetes Association, discharge from the hospital is a time of increased distress for all patients. Tailored support specific to
Tailored support for type 2 diabetes patients with an acute coronary event after discharge from hospital - design and development of a randomised controlled trial
Kasteleyn, M.J.; Gorter, K.J.; Stellato, R.K.; Rijken, M.; Nijpels, G.; Rutten, G.E.H.M.
Background: Type 2 diabetes mellitus patients with an acute coronary event (ACE) experience decreased quality of life and increased distress. According to the American Diabetes Association, discharge from the hospital is a time of increased distress for all patients. Tailored support specific to
The Affect of Mobile Performance Support Devices on Anxiety and Self-Efficacy of Hospital Float Staff
Riley McKee, Megan
Floating describes the act of staff moving from one unit to another based on the needs of the patients in a hospital. Many staff who float to different units express negative feelings, including anxiety and lack in self-efficacy. However, floating is both an economical and efficient method to use staff across the hospital, especially with current…
Combating plagiarism: the role of the health librarian.
Spring, Hannah; Adams, Rachel
This feature looks at the issue of plagiarism in health care students and the role of the health librarian in combating the problem. In particular, consideration is given to how plagiarism can occur and provides some examples from two UK universities of approaches health librarians can take in supporting students to avoid these common pitfalls. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.
Comparison of two different running models for the shock wave lithotripsy machine in Taipei City Hospital: self-support versus outsourcing cooperation.
Huang, Chi-Yi; Chen, Shiou-Sheng; Chen, Li-Kuei
To compare two different running models including self-support and outsourcing cooperation for the extracorporeal shock wave lithotripsy (SWL) machine in Taipei City Hospital, we made a retrospective study. Self-support means that the hospital has to buy an SWL machine and get all the payment from SWL. In outsourcing cooperation, the cooperative company provides an SWL machine and shares the payment with the hospital. Between January 2002 and December 2006, we used self-support for the SWL machine, and from January 2007 to December 2008, we used outsourcing cooperation. We used the method of full costing to calculate the cost of SWL, and the break-even point was the lowest number of treatment sessions of SWL to make balance of payments every month. Quality parameters including stone-free rate, retreatment rate, additional procedures and complication rate were evaluated. When outsourcing cooperation was used, there were significantly more treatment sessions of SWL every month than when utilizing self-support (36.3 +/- 5.1 vs. 48.1 +/- 8.4, P = 0.03). The cost of SWL for every treatment session was significantly higher using self-support than with outsourcing cooperation (25027.5 +/- 1789.8 NT$ vs. 21367.4 +/- 201.0 NT$). The break-even point was 28.3 (treatment sessions) for self-support, and 28.4 for outsourcing cooperation, when the hospital got 40% of the payment, which would decrease if the percentage increased. No significant differences were noticed for stone-free rate, retreatment rate, additional procedures and complication rate of SWL between the two running models. Besides, outsourcing cooperation had lower cost (every treatment session), but a greater number of treatment sessions of SWL every month than self-support.
Weight Loss Strategies in Combat Sports and Concerning Habits in Mixed Martial Arts.
Barley, Oliver R; Chapman, Dale W; Abbiss, Chris R
Combat sports are typically divided into weight classes and body mass manipulation to reach a weight class is commonplace. Previous research suggests that mixed martial arts (MMA) weight loss practices may be more extreme than other combat sports. We sought to investigate the magnitude of weight lost and prevalence of weight loss strategies in different combat sports. Competitors (n=637) from Brazilian jiu jitsu (BJJ), boxing, judo, MMA, muay Thai/kickboxing (MT/K), taekwondo (TKD) and wrestling completed an online questionnaire seeking information regarding their weight loss practices. Body mass manipulation was commonly undertaken by all combat sports athletes, with a particularly high incidence of gradual dieting, increased exercise and fluid restriction. Skipping meals was higher in TKD and wrestling (84%) compared with the other combat sports (~58%), whilst training in heated rooms and forced oral fluid loss (spitting) was higher in wrestling (83% and 47%, respectively) compared with other combat sports (~45% and ~19%, respectively). MMA athletes reported the highest usage of sauna (76%) and water loading (67%) whilst also reporting the second highest use of training in rubber/plastic suits (63%). Body mass manipulation was present in all combat sports with the prevalence and magnitude of acute weight loss greater in MMA. The incidence of and practices reported will assist support staff to be fully aware of the variety of methods these athletes and coaches may use to achieve weight loss. Additionally, the results could aid regulatory bodies in the further development of policies on weight cutting.
The Influence of Quality Assurance and Supportive Supervision on the Quality of Medical Care in Children's Hospitals of the Municipal Level of the Rostov Region
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Tatiana V. Kulichenko
Full Text Available Background. Improving the quality of medical care is the absolute priority of the World Health Organization and all socially-oriented ministries and departments around the world.Objective. Our aim was to evaluate the effectiveness of quality assurance and supportive supervision in municipal hospitals to improve the quality of medical care for children (by the example of the Rostov region.Methods. The open observational study included 10 second-level hospitals in the Rostov Region. At the start of the project, the quality of inpatient care for children in the region was audited based on recommendations and tools of the World Health Organization, and training of medical personnel was organized. Monitoring visits to hospitals were carried out by experts every 3 months (supportive supervision. Reaudit of the quality of care was conducted a year later.Results. As a result of regular quality assurance and supportive supervision of hospitals during the first year of operation, such indicators of the quality of medical care as the availability of medical equipment for emergency care for children, the infrastructure of children's departments, the triage and provision of emergency care in children's departments, managing patients with various acute conditions (fever, diarrhea, respiratory diseases, supporting care, internal quality assurance, accessibility to standards of care and clinical guidelines for the diagnosis and treatment of various diseases, respect for children's rights were significantly (p < 0.05 improved.Conclusion. Supportive supervision and regular external quality assurances of hospitals contribute to a rapid increase in the quality of medical care for children.
Decision-Oriented Health Technology Assessment: One Step Forward in Supporting the Decision-Making Process in Hospitals.
Ritrovato, Matteo; Faggiano, Francesco C; Tedesco, Giorgia; Derrico, Pietro
This article outlines the Decision-Oriented Health Technology Assessment: a new implementation of the European network for Health Technology Assessment Core Model, integrating the multicriteria decision-making analysis by using the analytic hierarchy process to introduce a standardized methodological approach as a valued and shared tool to support health care decision making within a hospital. Following the Core Model as guidance (European network for Health Technology Assessment. HTA core model for medical and surgical interventions. Available from: http://www.eunethta.eu/outputs/hta-core-model-medical-and-surgical-interventions-10r. [Accessed May 27, 2014]), it is possible to apply the analytic hierarchy process to break down a problem into its constituent parts and identify priorities (i.e., assigning a weight to each part) in a hierarchical structure. Thus, it quantitatively compares the importance of multiple criteria in assessing health technologies and how the alternative technologies perform in satisfying these criteria. The verbal ratings are translated into a quantitative form by using the Saaty scale (Saaty TL. Decision making with the analytic hierarchy process. Int J Serv Sci 2008;1:83-98). An eigenvectors analysis is used for deriving the weights' systems (i.e., local and global weights' system) that reflect the importance assigned to the criteria and the priorities related to the performance of the alternative technologies. Compared with the Core Model, this methodological approach supplies a more timely as well as contextualized evidence for a specific technology, making it possible to obtain data that are more relevant and easier to interpret, and therefore more useful for decision makers to make investment choices with greater awareness. We reached the conclusion that although there may be scope for improvement, this implementation is a step forward toward the goal of building a "solid bridge" between the scientific evidence and the final decision
An Interdisciplinary Nutrition Support Team Improves Clinical and Hospitalized Outcomes of Esophageal Cancer Patients with Concurrent Chemoradiotherapy
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Ming-Hua Cong
Full Text Available Background: The prevalence of malnutrition is very high in patients with cancer. The purpose of this study was to investigate whether or not a nutrition support team (NST could benefit esophageal cancer patients undergoing chemoradiotherapy (CRT. Methods: Between June 2012 and April 2014, 50 esophageal cancer patients undergoing concurrent CRT were randomly assigned into two groups: The NST group and the control group. The nutritional statuses of 25 patients in the NST group were managed by the NST. The other 25 patients in the control group underwent the supervision of radiotherapy practitioners. At the end of the CRT, nutritional status, the incidence of complications, and completion rate of radiotherapy were evaluated. Besides, the length of hospital stay (LOS and the in-patient cost were also compared between these two groups. Results: At the completion of CRF, the nutritional status in the NST group were much better than those in the control group, as evidenced by prealbumin (ALB, transferrin, and ALB parameters (P = 0.001, 0.000, and 0.000, respectively. The complication incidences, including bone marrow suppression (20% vs. 48%, P = 0.037 and complications related infections (12% vs. 44%, P = 0.012, in the NST group were lower and significantly different from the control group. In addition, only one patient in the NST group did not complete the planned radiotherapy while 6 patients in the control group had interrupted or delayed radiotherapy (96% vs. 76%, P = 0.103. Furthermore, the average LOS was decreased by 4.5 days (P = 0.001 and in-patient cost was reduced to 1.26 ± 0.75 thousand US dollars person-times (P > 0.05 in the NST group. Conclusions: A NST could provide positive effects in esophageal cancer patients during concurrent CRT on maintaining their nutrition status and improving the compliance of CRF. Moreover, the NST could be helpful on reducing LOS and in-patient costs.
Combating cyberspace fraud in Africa
CSIR Research Space (South Africa)
Grobler, M
Full Text Available in Africa Marthie Grobler, Joey Jansen van Vuuren Council for Scientific and Industrial Research Defence, Peace, Safety & Security © CSIR 2007 www.csir.co.za Combating cyber crime in Africa is a reality • Computer crime... www.csir.co.za Reduction of Cyber Crime was given as one of the major objectives during the State of the Nation address by President Zuma on 3 June 2009. "Amongst other key initiatives, we will start the process of setting up a Border Management...
Littoral Combat Vessels: Analysis and Comparison of Designs
National Research Council Canada - National Science Library
Christiansen, Bryan J
.... The candidates are a Littoral Combat Ship with a surface warfare module, a National Security Cutter augmented with offensive and defensive weaponry, a "Sea Lance" inshore combat vessel, and a Combat...
Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation.
Genbrugge, Cornelia; Meex, Ingrid; Boer, Willem; Jans, Frank; Heylen, René; Ferdinande, Bert; Dens, Jo; De Deyne, Cathy
By maintaining sufficient cerebral blood flow and oxygenation, the goal of cardiopulmonary resuscitation (CPR) is to preserve the pre-arrest neurological state. To date, cerebral monitoring abilities during CPR have been limited. Therefore, we investigated the time-course of cerebral oxygen saturation values (rSO₂) during advanced life support in out-of-hospital cardiac arrest. Our primary aim was to compare rSO₂ values during advanced life support from patients with return of spontaneous circulation (ROSC) to patients who did not achieve ROSC. We performed an observational study to measure rSO₂ using Equanox (Nonin, Plymouth, MI) from the start of advanced life support in the pre-hospital setting. rSO₂ of 49 consecutive out-of-hospital cardiac arrest patients were analyzed. The total increase from initial rSO₂ value until two minutes before ROSC or end of advanced life support efforts was significantly larger in the group with ROSC 16% (9 to 36) compared to the patients without ROSC 10% (4 to 15) (P = 0.02). Mean rSO₂ from the start of measurement until two minutes before ROSC or until termination of advanced life support was higher in patients with ROSC than in those without, namely 39% ± 7 and 31% ± 4 (P = 0.05) respectively. During pre-hospital advanced life support, higher increases in rSO₂ are observed in patients attaining ROSC, even before ROSC was clinically determined. Our findings suggest that rSO₂ could be used in the future to guide patient tailored treatment during cardiac arrest and could therefore be a surrogate marker of the systemic oxygenation state of the patient.
Strategic Analysis and Associated Management Products Supporting the Reengineering of Bayne-Jones Army Community Hospital: Consultative Products and Findings
National Research Council Canada - National Science Library
Fulton, Larry
.... ̂Product 2 - "Bayne-Jones Army Community Hospital Web Site," a strategic Internet web site for marketing health and wellness, the TRICARE medical network, the Joint Readiness Training Center Surgeon's...
Combat Leadership Styles: Empowerment versus Authoritarianism
Combat Leadership Styles : Empowerment versus Authoritarianism FARIS R. KIRKLAND Recent research in Israel and the United States suggests that...Combat Leadership Styles : Empowerment versus Authoritarianism 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d
A pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support
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Schmaltz Heidi N
Full Text Available Abstract Delirium occurs in up to 65% of older hip fracture patients. Developing delirium in hospital has been associated with a variety of adverse outcomes. Trials have shown that multi-component preventive interventions can lower delirium rates. The objective of this study was to implement and evaluate the effectiveness of an evidence-based electronic care pathway, which incorporates multi-component delirium strategies, among older hip fracture patients. We conducted a pragmatic study using an interrupted time series design in order to evaluate the use and impact of the intervention. The target population was all consenting patients aged 65 years or older admitted with an acute hip fracture to the orthopedic units at two Calgary, Alberta hospitals. The primary outcome was delirium rates. Secondary outcomes included length of hospital stay, in-hospital falls, in-hospital mortality, new discharges to long-term care, and readmissions. A Durbin Watson test was conducted to test for serial correlation and, because no correlation was found, Chi-square statistics, Wilcoxon test and logistic regression analyses were conducted as appropriate. At study completion, focus groups were conducted at each hospital to explore issues around the use of the order set. During the 40-week study period, 134 patients were enrolled. The intervention had no effect on the overall delirium rate (33% pre versus 31% post; p = 0.84. However, there was a significant interaction between study phase and hospital (p = 0.03. Although one hospital did not experience a decline in delirium rate, the delirium rate at the other hospital declined from 42% to 19% (p = 0.08. This difference by hospital was mirrored in focus group feedback. The hospital that experienced a decline in delirium rates was more supportive of the intervention. Overall, post-intervention there were no significant differences in mean length of stay (12 days post versus 14 days pre; p = 0.74, falls (6% post
Organisation, regulations, preparation and logistics of parenteral nutrition in hospitals and homes; the role of the nutrition support team – Guidelines on Parenteral Nutrition, Chapter 8
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Kester, L.
Full Text Available PN (parenteral nutrition should be standardised to ensure quality and to reduce complications, and it should be carried out in consultation with a specialised nutrition support team whenever possible. Interdisciplinary nutrition support teams should be established in all hospitals because effectiveness and efficiency in the implementation of PN are increased. The tasks of the team include improvements of quality of care as well as enhancing the benefit to cost ratio. Therapeutic decisions must be taken by attending physicians, who should collaborate with the nutrition support team. "All-in-One" bags are generally preferred for PN in hospitals and may be industrially manufactured, industrially manufactured with the necessity to add micronutrients, or be prepared "on-demand" within or outside the hospital according to a standardised or individual composition and under consideration of sterile and aseptic conditions. A standardised procedure should be established for introduction and advancement of enteral or oral nutrition. Home PN may be indicated if the expected duration of when PN exceeds 4 weeks. Home PN is a well established method for providing long-term PN, which should be indicated by the attending physician and be reviewed by the nutrition support team. The care of home PN patients should be standardised whenever possible. The indication for home PN should be regularly reviewed during the course of PN.
Clinically Prepared Veterinary Students: Enhancing Veterinary Student Hands-on Experiences and Supporting Hospital Caseload Using Shelter Medicine Program
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Jacob M. Shivley
Full Text Available Referral-level medicine is important in the veterinary curriculum, however veterinary students also need a solid base knowledge of clinically relevant, routine surgical and diagnostic skills to be clinically prepared after graduation. Exposure to a referral-only, or primarily referral caseload, does not always provide veterinary students with the routine hands-on experiences and competencies expected by the American Veterinary Medical Association Council on Education, the Royal College of Veterinary Surgeons, the Australian Veterinary Boards Council, or prospective employers. The aim of this descriptive study was to assess how a shelter medicine program can fill the companion animal caseload gap and create the necessary hands-on experiences considered essential in the veterinary curriculum. Pedagogical frameworks, course curriculum and design, student experiences, and student assessments were described for three core curricular areas (surgery, medical days, population medicine of the Shelter Medicine Program at Mississippi State University. The shelter surgery experience provided a high-quality, high-volume spay/neuter environment where fourth-year students averaged 65 sterilization surgeries in two weeks and demonstrated a quantifiable decrease in surgical time. The shelter surgery experience added on average 9,000 small animal cases per year to the overall hospital caseload. Shelter medical days, where students provide veterinary care during on-site shelter visits, created opportunities for third-year students to directly interact with shelter animals by performing physical examinations and diagnostic testing, and to gain experience in developing treatment protocols and recommendations for commonly encountered problems. The shelter medical days experience averaged over 700 small animal cases per year and over 1,500 diagnostic procedures. Finally, students participated in 15 onsite shelter consultations where they obtained a working knowledge
Clinically Prepared Veterinary Students: Enhancing Veterinary Student Hands-on Experiences and Supporting Hospital Caseload Using Shelter Medicine Program.
Shivley, Jacob M; Brookshire, Wilson C; Bushby, Philip A; Woodruff, Kimberly A
Referral-level medicine is important in the veterinary curriculum, however veterinary students also need a solid base knowledge of clinically relevant, routine surgical and diagnostic skills to be clinically prepared after graduation. Exposure to a referral-only, or primarily referral caseload, does not always provide veterinary students with the routine hands-on experiences and competencies expected by the American Veterinary Medical Association Council on Education, the Royal College of Veterinary Surgeons, the Australian Veterinary Boards Council, or prospective employers. The aim of this descriptive study was to assess how a shelter medicine program can fill the companion animal caseload gap and create the necessary hands-on experiences considered essential in the veterinary curriculum. Pedagogical frameworks, course curriculum and design, student experiences, and student assessments were described for three core curricular areas (surgery, medical days, population medicine) of the Shelter Medicine Program at Mississippi State University. The shelter surgery experience provided a high-quality, high-volume spay/neuter environment where fourth-year students averaged 65 sterilization surgeries in two weeks and demonstrated a quantifiable decrease in surgical time. The shelter surgery experience added on average 9,000 small animal cases per year to the overall hospital caseload. Shelter medical days, where students provide veterinary care during on-site shelter visits, created opportunities for third-year students to directly interact with shelter animals by performing physical examinations and diagnostic testing, and to gain experience in developing treatment protocols and recommendations for commonly encountered problems. The shelter medical days experience averaged over 700 small animal cases per year and over 1,500 diagnostic procedures. Finally, students participated in 15 onsite shelter consultations where they obtained a working knowledge of biosecurity at a
Towards a theory of ex-combatant reintegration
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Stina Torjesen
Full Text Available This paper encourages the development of a theoretical framework for the study of the reintegration of ex-combatants after war. It takes the first steps towards this by proposing a new definition of reintegration, where the processes ex-combatants experience, rather than the programmatic support offered by international and national agencies, take centre stage. The article links the study of reintegration to two broader disciplines; political economy and sociology, and in particular to the two disciplines' account of power and group belonging. It argues that a political economy approach is particularly useful for making sense of the context in which reintegration processes unfold. The article also suggests some relevant research questions and highlights methodological concerns related to research on reintegration.
The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties.
Kotwal, Russ S; Howard, Jeffrey T; Orman, Jean A; Tarpey, Bruce W; Bailey, Jeffrey A; Champion, Howard R; Mabry, Robert L; Holcomb, John B; Gross, Kirby R
support hospitals (9.1% [48 of 530] vs 15.7% [86 of 547]; P < .01). Acute morbidity was higher among those critically injured who were transported in 60 minutes or less (36.9% [295 of 799] vs 27.3% [76 of 278]; P < .01), those severely and critically injured initially treated at combat support hospitals (severely injured, 51.1% [161 of 315] vs 33.1% [104 of 314]; P < .001; and critically injured, 39.8% [211 of 530] vs 29.3% [160 of 547]; P < .001), and casualties who received a blood transfusion (50.2% [618 of 1231] vs 3.7% [121 of 3311]; P < .001), emphasizing the need for timely advanced treatment. A mandate made in 2009 by Secretary of Defense Gates reduced the time between combat injury and receiving definitive care. Prehospital transport time and treatment capability are important factors for casualty survival on the battlefield.
Treating Dehydration at Home Avoids Healthcare Costs Associated With Emergency Department Visits and Hospital Readmissions for Adult Patients Receiving Home Parenteral Support.
Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F
Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.
Combining multi-criteria decision analysis and mini-health technology assessment: A funding decision-support tool for medical devices in a university hospital setting.
Martelli, Nicolas; Hansen, Paul; van den Brink, Hélène; Boudard, Aurélie; Cordonnier, Anne-Laure; Devaux, Capucine; Pineau, Judith; Prognon, Patrice; Borget, Isabelle
At the hospital level, decisions about purchasing new and oftentimes expensive medical devices must take into account multiple criteria simultaneously. Multi-criteria decision analysis (MCDA) is increasingly used for health technology assessment (HTA). One of the most successful hospital-based HTA approaches is mini-HTA, of which a notable example is the Matrix4value model. To develop a funding decision-support tool combining MCDA and mini-HTA, based on Matrix4value, suitable for medical devices for individual patient use in French university hospitals - known as the IDA tool, short for 'innovative device assessment'. Criteria for assessing medical devices were identified from a literature review and a survey of 18 French university hospitals. Weights for the criteria, representing their relative importance, were derived from a survey of 25 members of a medical devices committee using an elicitation technique involving pairwise comparisons. As a test of its usefulness, the IDA tool was applied to two new drug-eluting beads (DEBs) for transcatheter arterial chemoembolization. The IDA tool comprises five criteria and weights for each of two over-arching categories: risk and value. The tool revealed that the two new DEBs conferred no additional value relative to DEBs currently available. Feedback from participating decision-makers about the IDA tool was very positive. The tool could help to promote a more structured and transparent approach to HTA decision-making in French university hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.
The limitations of using the existing TAM in adoption of clinical decision support system in hospitals: An emprical study in Malaysia
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Pouyan Emaeilzadeh
Physician adoption of clinical information technology is important for its successful implementation. Therefore, the purpose of this study is to gain a better insight about factors affecting physicians' acceptance of clinical decision support systems (CDSS in a hospital setting. The results reflect the importance of perceived threat to professional autonomy, perceived interactivity with clinical IT, perceived usefulness and perceived ease of use in determining physicians' intention to use CDSS.
Blended Training for Combat Medics
Fowlkes, Jennifer; Dickinson, Sandra; Lazarus, Todd
Bleeding from extremity wounds is the number one cause of preventable death on the battlefield and current research stresses the importance of training in preparing every Soldier to use tourniquets. HapMed is designed to provide tourniquet application training to combat medics and Soldiers using a blended training solution encompassing information, demonstration, practice, and feedback. The system combines an instrumented manikin arm, PDA, and computer. The manikin arm provides several training options including stand-alone, hands-on skills training in which soldiers can experience the actual torque required to staunch bleeding from an extremity wound and be timed on tourniquet application. This is more realistic than using a block of wood to act as a limb, which is often how training is conducted today. Combining the manikin arm with the PDA allows instructors to provide scenario based training. In a classroom or field setting, an instructor can specify wound variables such as location, casualty size, and whether the wound is a tough bleed. The PDA also allows more detailed feedback to be provided. Finally, combining the manikin arm with game-based technologies, the third component, provides opportunities to build knowledge and to practice battlefield decision making. Not only do soldiers learn how to apply a tourniquet, but when to apply a tourniquet in combat. The purpose of the paper is to describe the learning science underlying the design of HapMed, illustrate the training system and ways it is being expanded to encompass other critical life-saving tasks, and report on feedback received from instructors and trainees at military training and simulation centers.
Family bedside orientations: An innovative peer support model to enhance a culture of family-centred care at the Stollery Children's Hospital.
Wodinski, Lindsay M; Mattson McCrady, Heather M; Oswald, Christie M; Lyste, Nicole J M; Forbes, Karen L L
This paper presents family bedside orientations, an innovative bedside peer support model for families of paediatric patients piloted in one unit at the Stollery Children's Hospital in Edmonton, Alberta. The model invites family members of former patients back to the hospital as volunteer peer mentors responsible for meeting one-on-one with current inpatient families to provide a listening presence, discuss patient safety practices and encourage families to participate in their child's care. Using qualitative and quantitative data collection methods, the model was evaluated over 1 year (December 2014 to December 2015). Data sources included peer mentor field notes (from 163 visits) detailing the number of family bedside orientations completed by peer mentors and how they interacted with families, as well as post-visit family (n=35) surveys, Hospital-Child Inpatient Experience Survey data, peer mentor (n=6) questionnaires, focus groups with unit staff (n=10) and interviews with members of the project leadership team (n=5). Our findings indicated that family bedside orientations became an established practice in the pilot unit and positively impacted family care experiences. We attribute these successes to championing and support from unit staff and our multidisciplinary project leadership team. We discuss how our team addressed family privacy and confidentiality while introducing peer mentors in the unit. We also highlight strategies used to integrate peer mentors as part of the staff team and enhance peer support culture in the pilot unit. Practical considerations for implementing this model in other paediatric environments are provided.
[The influence of counseling for patients with cancer on their discharge from the palliative care support department of the community health care service of Minoh City Hospital].
Suita, Tomoko; Kato, Rika; Fujita, Misao; Hidaka, Kumi; Iijima, Shohei
Counseling for patients with cancer by a certified nurse in palliative care began in April 2011 in Minoh City Hospital. Counseling was provided immediately after a patient was informed by the treating physician of a primary diagnosis of cancer, a metastatic recurrence, or a decision to terminate cancer therapy. We examined the patient's support system after the counseling ended. The number of patients receiving end-of-life support with home or hospital care rapidly increased from 118 prior to the program's beginning to 186. The number of patients counseled was comparable to the rapid increase in their number(n=68). New cases in the outpatient department comprised 59% of all patients, of which, 45% began supportive counseling, with 43%of them ultimately returning home. Of the new cases receiving counseling in the hospital, 34%eventually returned home after discharge, and the highest percentage of discharges were to a palliative care unit or hospice program (48%). The initiation of counseling in the outpatient department allowed us to provide sufficient time to make decisions about appropriate places for end-of-life care. Cooperation with the patients' physicians was necessary to provide counseling from the outpatient department. Our findings suggest the importance of sharing the patients' medical and social information among the staff when necessary.
Overturning refusal of a hospital to terminate life support for a brain-dead mother until the fetus was born: What is the law in South Africa?
McQuoid-Mason, David Jan
In a Texas case the court granted a husband an order for the removal of life support from his brain-dead pregnant wife after a hospital tried to keep her on it until the fetus was born. In South Africa the court would have issued a similar order, but for different reasons. Here, unlawfully and intentionally subjecting a pregnant corpse to life-support measures to keep a fetus alive against the wishes of the family would amount to the crime of violating a corpse.
Effects of Emergency Preparedness and Disaster Response on Hospital Focusing on Ancillary and Support Services: Policy Analysis
trauma centers are required to have immediate availability of trauma surgeons, anesthesiologists, physician specialists, nurses , and resuscitation...has emphasized alternative delivery settings, such as outpatient treatments, home health care, and the use of nursing homes. Managed care...hospitals should do to prepare for an influenza pandemic. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 4(4), 397-402
Directory of Open Access Journals (Sweden)
Andrew M. Lane
the center of mass for three different judo-throwing techniques. McGuigan et al. (2006 explore the utility of isometric strength training among a sample of wrestlers. Body fat and weight management play an important role in combat sports. Kazemi et al., 2006 identify the profile of the Olympic champions and Pieter et al., 2006 assess the relative total body fat and skinfold patterning of Filipino national karate and pencak silat athletes. Bledsoe et al., 2006 examine the prevalence and incidence of injury in Professional Mixed Martial Arts Competitions. Nunan (2006 sought to develop a sport-specific fitness test for competitive Karate practitioners with results suggesting that the new test accurately simulates the actions of competitive Karate sparring. Blais and Trilles, 2006 propose a specific piece of apparatus designed to enhance judo performance In terms of skill analysis, Hristovski et al., 2006 examine the factors that boxers use when deciding to punch a target. Myers et al., 2006 investigated judging practices and processes in Muay Thai. The subjective nature of combat sport scoring means that this is an universal issue. Devonport, 2006 uses qualitative techniques to explore psychological issues relate to success in kickboxing. Stevens et al., 2006 used a transactional design to investigate changes in mood states and emotions in a judo player during Olympic trials. Wong et al., 2006 explored mood-performance relationships among Malaysian athletes with results lending some support to the conceptual framework for mood-performance relationships offered by Lane and Terry, 2000. Jones et al., 2006 investigated motivational profiles of martial artists. The range of articles and suggestions for future research should inspire researchers and practitioners alike to investigate the efficacy of their interventions, test the validity of the measures, develop new measures and develop specific theories. This special edition has raised more questions than answers but in
Using Videoconferencing Technology to Provide Breastfeeding Support to Low-Income Women: Connecting Hospital-Based Lactation Consultants with Clients Receiving Care at a Community Health Center.
Friesen, Carol A; Hormuth, Laura J; Petersen, Devan; Babbitt, Tina
The Tele-Lactation Pilot Project (TLPP), 1 of 13 community-based breastfeeding projects implemented in Indiana in 2013 using Centers for Disease Control and Prevention grant funds, explored the feasibility of using videoconferencing technology to provide breastfeeding education and support to low-income women by a centrally located International Board Certified Lactation Consultant (IBCLC). The IBCLC was housed at the Breastfeeding Center at the hospital where the women would deliver; the women receiving the education and support were located at an inner-city community health center (CHC) where they received their primary care. The videoconferencing sessions were juxtaposed with the women's regularly scheduled prenatal and postnatal visits at the CHC. After delivery, the lactation consultant visited the mother and infant in person at the hospital to offer additional support. Overall, 35 mothers were served by the TLPP during the 9-month project period. A total of 134 visits (30-45 minutes each) were conducted (3.8 sessions per woman). At the conclusion of the project, interviews with key participants indicated that the tele-lactation videoconferencing sessions were easy to implement, allowed the IBCLC to reach a wider client base, and allowed the women to receive expert support that they might not have otherwise received. Comments indicated that, in addition to providing education and increasing the women's confidence, the tele-lactation sessions appeared to have decreased the mothers' anxiety about the birthing process and the hospital experience. The TLPP demonstrated that incorporating videoconferencing technology into routine care can help foster collaboration among health care providers and provide mothers with continuous, easily accessible breastfeeding education and support. © The Author(s) 2015.
Implementing an evidence-based computerized decision support system to improve patient care in a general hospital: the CODES study protocol for a randomized controlled trial.
Moja, Lorenzo; Polo Friz, Hernan; Capobussi, Matteo; Kwag, Koren; Banzi, Rita; Ruggiero, Francesca; González-Lorenzo, Marien; Liberati, Elisa Giulia; Mangia, Massimo; Nyberg, Peter; Kunnamo, Ilkka; Cimminiello, Claudio; Vighi, Giuseppe; Grimshaw, Jeremy; Bonovas, Stefanos
Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. We designed a pragmatic randomized controlled trial to evaluate the effectiveness of patient-specific, evidence-based reminders generated at the point-of-care by a multi-specialty decision support system on clinical practice and the quality of care. We will include all the patients admitted to the internal medicine department of one large general hospital. The primary outcome is the rate at which medical problems, which are detected by the decision support software and reported through the reminders, are resolved (i.e., resolution rates). Secondary outcomes are resolution rates for reminders specific to venous thromboembolism (VTE) prevention, in-hospital all causes and VTE-related mortality, and the length of hospital stay during the study period. The adoption of CDSSs is likely to increase across healthcare systems due to growing concerns about the quality of medical care and discrepancy between real and ideal practice, continuous demands for a meaningful use of health information technology, and the increasing use of and familiarity with advanced technology among new generations of physicians. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in primary care and hospital settings, thereby informing future research and healthcare policy questions related to the feasibility and value of CDSS use in healthcare systems. This trial is seconded by a specialty trial randomizing patients in an oncology setting (ONCO-CODES). ClinicalTrials.gov, https://clinicaltrials.gov/ct2
Who cares for the carers at hospital discharge at the end of life? A qualitative study of current practice in discharge planning and the potential value of using The Carer Support Needs Assessment Tool (CSNAT) Approach.
Ewing, Gail; Austin, Lynn; Jones, Debra; Grande, Gunn
Carer factors prevent patients achieving timely and appropriate hospital discharge. There is a lack of research into interventions to support carers at hospital discharge. To explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers. Qualitative. Three National Health Service Trusts in England: focus groups with 40 hospital and community-based practitioners and 22 carer interviews about experiences of carer support during hospital discharge and views of The CSNAT Approach. Two workshops brought together 14 practitioners and five carers to discuss implementation issues. Framework analysis was conducted. Current barriers to supporting carers at hospital discharge were an organisational focus on patients' needs, what practitioners perceived as carers' often 'unrealistic expectations' of end-of-life caregiving at home and lack of awareness of patients' end-of-life situation. The CSNAT Approach was viewed as enabling carer support and addressing difficulties of discussing the realities of supporting someone at home towards end of life. Implementation in hospital required organisational considerations of practitioner workload and training. To enhance carer support, a two-stage process of assessment and support (hospital with community follow-up) was suggested using the CSNAT as a carer-held record to manage the transition. This study identifies a novel intervention, which expands the focus of discharge planning to include assessment of carers' support needs at transition, potentially preventing breakdown of care at home and patient readmissions to hospital.
Status and tendencies in combating computer crime at European level
Directory of Open Access Journals (Sweden)
Pisarić Milana
Full Text Available Without certain adjustments to specifics of computer crime, as to a phenomenon of global proportions, detection, investigation and prosecution of this type of crime is almost impossible. Therefore, the need for setting up a legal framework for combating cyber crime has been identified, in order to define which activities related to information systems are considered computer crime; to determine the specific procedural rules, which would enable the access to data, computer and networks during investigating and prosecuting computer crime and to provide continuous training of members of the institutions responsible for countering this form of crime. This legal framework should consist of substantive and procedural rules adapted to this type of crime due its aim is the improvement of international cooperation in the framework of global and regional approach to combating cyber crime. In this this paper the current situation of strategic and legal framework of countering cyber crime is presented (at the level of the Council of Europe and of the European Union as well as trends in the development of systematic approach towards countering the mentioned abuses within these regional organizations. At the European level, the legal framework to combat cyber crime is set in the Council of Europe Convention on cyber crime and the Council of EU Framework Decision on attacks against information systems. In a series of documents organs of EU confirmed the strategic support of COE Convention and the encouragement of Member States to ratify the Convention. In addition, the Convention represent the base of the said Framework Decision. These two legal instruments have the same goal - removing the differences between national legislation, the introduction of new powers in the discovery and evidence of computer crime and improvement of the international cooperation in combating cyber crime. Although their legal nature and scope vary, its objectives will be achieved
Let's have a meeting: How hospitals use scheduled meetings to support cross-boundary collaboration
DEFF Research Database (Denmark)
Prætorius, Thim; Hasle, Peter; Nielsen, Anders Paarup
of meetings, we add to previous research studying when meetings are used (e.g., task and input uncertainty). In particular, we focus on meetings' role for achieving collaboration across occupational and departmental boundaries and for developing the collaboration skills component of organizational social...... and help those involved to solve concrete care tasks. Meetings are often inter-disciplinary, thereby having the potential to develop relations, common goals and trust (organizational social capital components) across occupational and departmental boundaries. For hospital managers, our findings...... are important because they can use meetings to respond to the pressing need for more and better intra-organizational health care collaboration. Using meetings sensibly also allows hospitals to benefit from the positive outcomes of collaboration and social capital (e.g., knowledge sharing, performance...
Transfusion-Associated Microchimerism in Combat Casualties
National Research Council Canada - National Science Library
Dunne, James R; Lee, Tzong-Hae; Burns, Christopher; Cardo, Lisa J; Curry, Kathleen; Busch, Michael P
...) in civilian trauma patients receiving allogenic red blood cell (RBC) transfusions. We explored the incidence of TA-MC in combat casualties receiving FrWB compared with patients receiving standard stored RBC transfusions. Methods...
Logistical Analysis of the Littoral Combat Ship
National Research Council Canada - National Science Library
Rudko, David
The purpose of the Littoral Combat Ship (LCS) is to provide the Navy with an affordable, small, multi-mission ship capable of independent, interdependent, and integrated operations inside the littorals...
Innovative contracting strategies for combating climate change.
The state of Maryland has made a strong commitment to combating climate change and reducing : greenhouse gas emissions. This research investigated the state of practice of innovative contracting : solutions to reduce emissions from highway constructi...
2001 Industry Studies: Land Combat Systems
National Research Council Canada - National Science Library
Alyaqout, Faisal
.... The days when production lines and factories hummed at peak capacity are gone. Orders for land combat systems have been reduced by nearly two-thirds since 1990, and competition for what few procurement dollars remain is stiff...
Combat Neurosis in the Battered Teacher.
Science News, 1978
Investigates the effect of school violence on classroom teachers. The study of 253 Los Angeles inner city classroom teachers reveals that many of them have developed conditions similar to the combat neurosis found in soldiers at war. (HM)
Medical capability team: the clinical microsystem for combat healthcare delivery in counterinsurgency operations.
Clark, Susz; Van Steenvort, Jon K
Today's operational environment in the support of counterinsurgency operations requires greater tactical and operational flexibility and diverse medical capabilities. The skills and organizations required for full spectrum medical operations are different from those of the past. Combat healthcare demands agility and the capacity for rapid change in clinical systems and processes to better support the counterinsurgency environment. This article proposes the Army Medical Department (AMEDD) develop and implement the medical capability team (MCT) for combat healthcare delivery. It discusses using the concept of the brigade combat team to develop medical capability teams as the unit of effectiveness to transform frontline care; provides a theoretical overview of the MCT as a "clinical microsystem"; discusses MCT leadership, training, and organizational support, and the deployment and employment of the MCT in a counterinsurgency environment. Additionally, this article proposes that the AMEDD initiate the development of an AMEDD Combat Training Center of Excellence to train and validate the MCTs. The complexity of combat healthcare demands an agile and campaign quality AMEDD with joint expeditionary capability in order to promote the best patient outcomes in a counterinsurgency environment.
University Research Initiative Program for Combat Readiness
microscope image of one of the lenses. This array was selected for testing because it is fabricated in a relatively inexpensive polyacrylic material, the...potent analogues of the potassium -sparing diuretic, amiloride. However, our results 179 University Reasearch Initiative for Combat Readiness Annual Report...for Combat Readiness Annual Report for the period June 1, 1998 - June 30, 1999 Roger H. Sawyer University of South Carolina Columbia, SC 29208 May
Crowd Behavior Algorithm Development for COMBAT XXI
non-combatants to military operations in an urban area. We show how to link this model with COMBATXXI at the application programming interface (API...level so that the model can be run in tight conjunction with COMBATXXI. TRAC and other anaytic organizations can use this type of crowd model to... organizations , and materiel. crowd, agent-based modeling , combat models , COMBATXXI, NetLogo, mega-cities, civilians on the battlefield Unclassified U U U U 39
Selecting Candidates for Key Leadership Positions in Program Executive Offices Ground Combat Systems and Combat Service and Combat Service Support
start or continue a profitable growth pattern and boost morale and motivation, a poor decision may bring the company to the brink of financial...HON Frank Kendall issued a memorandum titled "Key Leadership Positions and Qualification Criteria" (Kendall, 2013). This memorandum provides a...Chief Developmental Tester • Program Lead, Business Financial Manager SELECTING CANDIDATES FOR KEY LEADERSHIP POSITIONS 4
Secondary use of data from hospital electronic prescribing and pharmacy systems to support the quality and safety of antimicrobial use: a systematic review.
Micallef, Christianne; Chaudhry, Navila T; Holmes, Alison H; Hopkins, Susan; Benn, Jonathan; Franklin, Bryony Dean
Electronic prescribing (EP) and electronic hospital pharmacy (EHP) systems are increasingly common. A potential benefit is the extensive data in these systems that could be used to support antimicrobial stewardship, but there is little information on how such data are currently used to support the quality and safety of antimicrobial use. To summarize the literature on secondary use of data (SuD) from EP and EHP systems to support quality and safety of antimicrobial use, to describe any barriers to secondary use and to make recommendations for future work in this field. We conducted a systematic search within four databases; we included original research studies that were (1) based on SuD from hospital EP or EHP systems and (2) reported outcomes relating to quality and/or safety of antimicrobial use and/or qualitative findings relating to SuD in this context. Ninety-four full-text articles were obtained; 14 met our inclusion criteria. Only two described interventions based on SuD; seven described SuD to evaluate other antimicrobial stewardship interventions and five described descriptive or exploratory studies of potential applications of SuD. Types of data used were quantitative antibiotic usage data ( n = 9 studies), dose administration data ( n = 4) and user log data from an electronic dashboard ( n = 1). Barriers included data access, data accuracy and completeness, and complexity when using data from multiple systems or hospital sites. The literature suggests that SuD from EP and EHP systems is potentially useful to support or evaluate antimicrobial stewardship activities; greater system functionality would help to realize these benefits. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: firstname.lastname@example.com.
Born to fight? Genetics and combat sports
Directory of Open Access Journals (Sweden)
Emerson Franchini
Full Text Available Recently, the influence of genetics on sports performance has received increased attention from many researchers. In combat sports, some investigations have also been conducted. This article's main objective was to review the representation of specific gene polymorphisms in combat sports athletes compared to controls. The following databases were searched: PubMed, Web of Science and SportDiscus. The terms used in this search involved combat sports (boxing, karate, judo, mixed martial arts, taekwondo and wrestling, genes, genetics and candidate genes. Articles published until November 2013 were included if combat sports athletes were considered as a single group (i.e., not mixed with athletes of other sports. Seven studies were found, with two presenting no difference between combat sports athletes and controls, two presenting higher frequencies of candidate genes related to a more endurance-related profile compared to controls, and three where a more power-related gene overrepresentation was found in comparison to controls. Taken together, the initial studies about the genetic characteristics of combat sports athletes are controversial, which is probably due to the mixed (aerobic and anaerobic characteristic and to the multifactorial performance determinants of these sports.
Polymeric Coatings for Combating Biocorrosion
Guo, Jing; Yuan, Shaojun; Jiang, Wei; Lv, Li; Liang, Bin; Pehkonen, Simo O.
Biocorrosion has been considered as big trouble in many industries and marine environments due to causing great economic loss. The main disadvantages of present approaches to prevent corrosion include being limited by environmental factors, being expensive, inapplicable to field, and sometimes inefficient. Studies show that polymer coatings with anti-corrosion and anti-microbial properties have been widely accepted as a novel and effective approach to preventbiocorrosion. The main purpose of this review is to summarize up the progressive status of polymer coatings used for combating microbially-induced corrosion. Polymers used to synthesize protective coatings are generally divided into three categories: i) traditional polymers incorporated with biocides, ii) antibacterial polymers containing quaternary ammonium compounds, and iii) conductive polymers. The strategies to synthesize polymer coatings resort mainly to grafting anti-bacterial polymers from the metal substrate surface using novel surface-functionalization approaches, such as free radical polymerization, chemically oxidative polymerization and surface-initiated atom transfer radical polymerization, as opposed to the traditional approaches of dip coating or spin coating.
Energy Technology Data Exchange (ETDEWEB)
The application of foam in dealing with underground fire is well known due to its smothering action by cutting off air feed to burning fuel as well as acting as coolant. Besides plugging air feed to fire, water could be virtually reached to the fire affected areas much beyond the jet range as underground galleries with low roof restrict jet range of water. This method also enables a closer approach of a fire fighting team by isolating the toxic gases and smoke with a foam plug. The paper describes the development of high expansion foam composition and its application technology in order that foam plug method can be suitably utilized for combating mine fires in India. Three compositions were recommended for generation of high expansion foam: (a) 0.5% sodium/ammonium lauryl sulphate, 0.15 to 0.2% sodium carboxy methyl cellulose, 0.1% booster; (b) 0.5% sodium/ammonium lauryl sulfate, 0.12 to 0.15% alkaline solution of gum arabic, 0.1 to 0.2% ferrous gluconate; and (c) 0.35% sodium/ammonium lauryl sulfate, 0.20% booster, 0.2% xylene sulfonate.
Support to the DoD Comprehensive Review Working Group Analyzing the Impact of Repealing 'Don't Ask, Don't Tell'. Volume 1: Findings From the Surveys
describes your current military occupational specialty? Army N Percent MOE Combat Arms (CA/ MFE ) 7,411 25.8% 0.62 Combat Support (CS/OS) 8,783 31.4...Army N Overall Army Navy Marine Corps Air Force Coast Guard MOE Combat Arms (CA/ MFE ) 7,411 25.8% -- -- -- -- -- 0.62 Combat Support (CS...Reserve Guard Max MOE Combat Arms (CA/ MFE ) 7,411 25.8% 29.1% 9.7% 30.0% 0.98 Combat Support (CS/OS) 8,783 31.4% 31.0% 35.0% 30.1% 1.29 Combat
An exploratory study of communication, gender-role conflict, and social support of parents of children treated at children's hospital.
Hall, Jeffrey A
This article explores the relationships between communication and social support of parents of children with cancer (N = 44), and the importance of gender-role conflict in fathers. Structural equation modeling and the Actor-Partner Interdependence Model were used to test the expected relationships between communication, social support, gender-role conflict, and anxiety, and to control for sample nonindependence. Results suggest communication increases perceived emotional and instrumental social support between parents, and instrumental support from fathers results in less anxiety for mothers. When fathers experienced more conflict about their role as financial supporter for the family (i.e., career achievement gender-role conflict), fathers perceived less instrumental and emotional support from their wives. However, fathers who experienced more conflict about career achievement were also less anxious. A second measure of fathers' gender-role conflict (i.e., emotional expression) was unrelated to either mothers' or fathers' outcomes. The role of gender, communication, and social support in the context of pediatric oncology is discussed.
Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: an observational study.
Müller, Michael P; Richter, Torsten; Papkalla, Norbert; Poenicke, Cynthia; Herkner, Carsten; Osmers, Anne; Brenner, Sigrid; Koch, Thea; Schwanebeck, Uta; Heller, Axel R
Many hospitals have basic life support (BLS) training programmes, but the effects on the quality of chest compressions are unclear. This study aimed to evaluate the no-flow fraction (NFF) during BLS provided by standard care nursing teams over a five-year observation period during which annual participation in the BLS training was mandatory. All healthcare professionals working at Dresden University Hospital were instructed in BLS and automated external defibrillator (AED) use according to the current European Resuscitation Council guidelines on an annual basis. After each cardiac arrest occurring on a standard care ward, AED data were analyzed. The time without chest compressions during the period without spontaneous circulation (i.e., the no-flow fraction) was calculated using thoracic impedance data. For each year of the study period (2008-2012), a total of 1454, 1466, 1487, 1432, and 1388 health care professionals, respectively, participated in the training. The median no-flow fraction decreased significantly from 0.55 [0.42; 0.57] (median [25‰; 75‰]) in 2008 to 0.3 [0.28; 0.35] in 2012. Following revision of the BLS curriculum after publication of the 2010 guidelines, cardiac arrest was associated with a higher proportion of patients achieving ROSC (72% vs. 48%, P=0.025) but not a higher survival rate to hospital discharge (35% vs. 19%, P=0.073). The NFF during in-hospital cardiac resuscitation decreased after establishment of a mandatory annual BLS training for healthcare professionals. Following publication of the 2010 guidelines, more patients achieved ROSC after in-hospital cardiac arrest. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Direct and Lead Units During Preparation for the Battle (Battlefield Function 19) as Accomplished by a Direct Support Field Artillery Battalion. Volume 2: Assessment Package
National Research Council Canada - National Science Library
Mullen, William
The purpose of the overall research program was to document the synchronization required by command and control tasks performed within the armored brigade, to include combat support and combat service support units...
Direct and Lead Units During Preparation for the Battle (Battlefield Function 19) as Accomplished by an Engineer Battalion Supporting a Heavy Brigade. Volume 1: Function Analysis
National Research Council Canada - National Science Library
Clagg, Robert
The purpose of the overall research program was to document the synchronization required by command and control tasks performed within the armored brigade, to include combat support and combat service support units...
Direct and Lead Units in Execution of Battle (Battlefield Function 20) as Accomplished by an Engineer Battalion Supporting a Heavy Brigade. Volume 2: Assessment Package
National Research Council Canada - National Science Library
Mullen, William
The purpose of the overall research program was to document the synchronization required by command and control tasks performed within the armored brigade to include combat support and combat service support units...
Perceived organizational support and job involvement in the Iranian health care system: A case study of emergency room nurses in general hospitals.
Gorji, Hassan Abolghasem; Etemadi, Manal; Hoseini, Fatemeh
Researchers believe that there are social exchanges between the employers and employees, because the employees would be interested in their organization and trust it based on how the organization values them and their welfare, comfort, and security. This belief is known as perceived organizational support that makes employees consider themselves as a part of their organization and have a commitment to it. The literature review is very limited in both variables in Iran and thus few studies also report the perceived organizational support and job involvement at the lower levels in our country. This research aimed at studying the levels of perceived organizational support and job involvement, relationship between this two, and the demographic factors relationship with both of them. This research was a descriptive analytical study conducted in 2012. The population included 123 emergency nurses in General Hospitals of Qom. Data were collected through Perceived Organizational Support and Job Involvement Questionnaires and analyzed using SPSS software, descriptive statistics and Spearman correlation and Chi-square test. Both mean scores for perceived organizational support and job involvement were in average level, 146/12 and 35/38, respectively. There was a significant relationship between perceived organizational support and age, education, tenure, organizational position, and job shift. There was also a significant relationship between job involvement and age and education and finally between perceived organizational support and job involvement (P = 0/029). The high correlation between perceived organizational support and job involvement indicates that the improvement of perceived organizational support are necessary through motivating the employees, showing interest in them, paying attention to them, respecting them, and providing development opportunity in the organization. These should be always considered by managers to improve job involvement.
Basic Combat Unit of the Slovenian Armed Forces
public sector .6 There are three main reasons why: 1. After Slovenia joined NATO, political support for the armed forces began to decline. Image...can put three $20 bills together, but if we have an $18 or $20 fight, we have a unit that's capable of a better integration (with other forces) and... three different $20 bills . It has to be noted, that the U.S. Army did significantly reduce the number of types of combat brigades from seventeen to
Conceptual basis of preventing and combating human trafficking in Ukraine
Directory of Open Access Journals (Sweden)
N. M. Lukach
The basic mechanisms and instruments of international community against human trafficking are explored by the author and also the ways of solving problems is proposed. In the article based on the international experience of combating human trafficking and the latest national legislation conceptual basics of preventing and counteracting human trafficking in Ukraine are examined. Including: improvement of laws against human trafficking and improvement of law enforcement; changing the the status of persons and support for persons from risk groups; increasing the level of public awareness, especially persons from risk groups; the qualified help to victims of trafficking.
Spousal caregivers and persons with dementia: Increasing participation in shared leisure activities among hospital-based dementia support program participants.
DiLauro, Michelle; Pereira, Amanda; Carr, Jennifer; Chiu, Mary; Wesson, Virginia
Spousal caregivers of persons with dementia often have difficulty engaging persons with dementia in leisure activities. This qualitative descriptive study identifies how caregivers perceive their spouses' participation in leisure activities since dementia onset and the professional guidance caregivers require to increase persons with dementia participation in shared leisure activities. Nine spousal caregivers from a hospital-based caregiver intervention attended one of three focus groups. Using symbolic interactionism and selective optimization with compensation theory as guiding frameworks, thematic content analysis was performed. Three major themes were identified: Recognizing and acknowledging changes, Making sense of changes and conflicts, and Embracing changes and forging ahead. Findings can be used by healthcare providers to better understand caregivers' needs for engaging persons with dementia in shared leisure activities, and inform development of feedback protocols to enhance caregiver interventions. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Cooperation between In-Hospital Psychological Support and Pastoral Care Providers: Obstacles and Opportunities for a Modern Approach.
Proserpio, Tullio; Ferrari, Andrea; Veneroni, Laura; Arice, Carmine; Massimino, Maura; Clerici, Carlo Alfredo
The meaning that patients with cancer attribute to life influences their expectations and their attitudes to the disease and its treatment. Over the centuries, religion has commonly been the answer encoded by the social setting when it came to matters of life and death. The present article analyzes the historical grounds for forms of cooperation between the scientific disciplines that focus on mental health and the approach of religion, centered on the Italian situation. Such cooperation was hard to imagine in the past, but the situation has changed considerably and cooperation is not only possible but extremely desirable. Acknowledgment of their spiritual needs helps patients to battle with their disease. The care of patients should include catering for their spiritual needs by ensuring the constant presence of a chaplain on hospital wards.
Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated.
Hagihara, Akihito; Onozuka, Daisuke; Nagata, Takashi; Hasegawa, Manabu
The effects and relative benefits of advanced airway management and epinephrine on patients with out-of-hospital cardiac arrest (OHCA) who were defibrillated are not well understood. This was a prospective observational study. Using data of all out-of-hospital cardiac arrest cases occurring between 2005 and 2013 in Japan, hierarchical logistic regression and conditional logistic regression along with time-dependent propensity matching were performed. Outcome measures were survival and minimal neurological impairment [cerebral performance category (CPC) 1 or 2] at 1month after the event. We analyzed 37,873 cases that met the inclusion criteria. Among propensity-matched patients, advanced airway management and/or prehospital epinephrine use was related to decreased rates of 1-month survival (adjusted odds ratio 0.88, 95% confidence interval 0.80 to 0.97) and CPC (1, 2) (adjusted odds ratio 0.56, 95% confidence interval 0.48 to 0.66). Advanced airway management was related to decreased rates of 1-month survival (adjusted odds ratio 0.89, 95% confidence interval 0.81to 0.98) and CPC (1, 2) (adjusted odds ratio 0.54, 95% confidence interval 0.46 to 0.64) in patients who did not receive epinephrine, whereas epinephrine use was not related to the outcome measures. In defibrillated patients with OHCA, advanced airway management and/or epinephrine are related to reduced long-term survival, and advanced airway management is less beneficial than epinephrine. However, the proportion of patients with OHCA who responded to an initial shock was very low in the study subjects, and the external validity of our findings might be limited. Copyright © 2017 Elsevier Inc. All rights reserved.
The Influence of Supportive and Ethical Work Environments on Work-Related Accidents, Injuries, and Serious Psychological Distress among Hospital Nurses.
Tei-Tominaga, Maki; Nakanishi, Miharu
The healthcare industry in Japan has experienced many cases of work-related injuries, accidents, and workers' compensation claims because of mental illness. This study examined the influence of supportive and ethical work environments on work-related accidents, injuries, and serious psychological distress among hospital nurses. Self-reported questionnaires were distributed to nurses ( n = 1114) from 11 hospitals. Valid responses ( n = 822, 93% women, mean age = 38.49 ± 10.09 years) were used for analyses. The questionnaire included items addressing basic attributes, work and organizational characteristics, social capital and ethical climate at the workplace, psychological distress, and experience of work-related accidents or injuries in the last half year. The final model of a multivariate logistic regression analysis revealed that those who work less than 4 h of overtime per week (OR = 0.313), those who work on days off more than once per month (OR = 0.424), and an exclusive workplace climate (OR = 1.314) were significantly associated with work-related accidents or injuries. Additionally, an exclusive workplace climate (OR = 1.696) elevated the risk of serious psychological distress. To prevent work-related compensation cases, which are caused by these variables, strengthening hospitals' occupational health and safety is necessary.
Combat ocular trauma and systemic injury.
Weichel, Eric D; Colyer, Marcus H
To review the recent literature regarding combat ocular trauma during hostilities in Operations Iraqi Freedom and Enduring Freedom, describe the classification of combat ocular trauma, and offer strategies that may assist in the management of eye injuries. Several recent publications have highlighted features of combat ocular trauma from Operation Iraqi Freedom. The most common cause of today's combat ocular injuries is unconventional fragmentary munitions causing significant blast injuries. These explosive munitions cause high rates of concomitant nonocular injuries such as traumatic brain injury, amputation, and other organ injuries. The most frequent ocular injuries include open-globe and adnexal lacerations. The extreme severity of combat-related open-globe injuries leads to high rates of primary enucleation and retained intraocular foreign bodies. Visual outcomes of intraocular foreign body injuries are similar to other series despite delayed removal, and no cases of endophthalmitis have occurred. Despite these advances, however, significant vision loss persists in cases of perforating globe injuries as well as open and closed-globe trauma involving the posterior segment. This review summarizes the recent literature describing ocular and systemic injuries sustained during Operations Iraqi and Enduring Freedom. An emphasis on classification of ocular injuries as well as a discussion of main outcome measures and complications is discussed.
Hospital Library Administration.
Cramer, Anne
The objectives of a hospital are to improve patient care, while the objectives of a hospital library are to improve services to the staff which will support their efforts. This handbook dealing with hospital administration is designed to aid the librarian in either implementing a hospital library, or improving services in an existing medical…
Report of the psychological support given to victims of the Goiania radiological accident in Brazil; Relatorio das atividades desenvolvidas pela Psicologia no Hospital Geral de Goiania (HGC) e CRF (FEBEM) com as vitimas diretas do Cesio-137
Energy Technology Data Exchange (ETDEWEB)
Nunes, Lenice Cruvinel; Pereira, Maria Emilia Pontes
The psychological support given to the victims of the Goiania accident are described. The assistance lasted two months on the average and was given while the victims were in the hospital and later on in the recuperation center 1 tab.
[The assessment of the impact of education and support to nursing research on nurses' scientific production in an Emilia Romagna Hospital].
Forni, Cristiana; Chiari, Paolo; Guarino, Lorenza; Tremosini, Morena; Trofa, Carmela; D'Alessandro, Fabio; Sabattini, Tania; Mini, Sandra; Zanotti, Enrichetta
In Italy research conducted by non medical professions is scarce also for the lack of knowledge on methods. At Rizzoli hospital in Bologna in 2006 a Centre for research to educate and support health professionals was implemented. To assess the impact of the research centre on number of research articles and protocols produced by nurses. Interrupted time series. In the five years before and after the implementation of the centre data on the number of protocols approved by Ethical Committee with a nurse as principal investigator and on the number of articles published on impacted journals with a nurse as first author were collected. The number of nurses authors of the publications was also collected. For all the variables an increasing trend, starting from 2006 was observed, with statistically significant differences from 2008 for the number of research protocols presented (p=0.037), the number of nurses authors of scientific articles (p=0.027). Although the number of publications on impacted journals increased from 2006, differences were not statistically significant after 2008. An hospital based Centre for education and support to research for health professionals may facilitate the scientific and research production.
Automated cardiopulmonary resuscitation using a load-distributing band external cardiac support device for in-hospital cardiac arrest: a single centre experience of AutoPulse-CPR.
Spiro, J R; White, S; Quinn, N; Gubran, C J; Ludman, P F; Townend, J N; Doshi, S N
Poor quality cardiopulmonary resuscitation (CPR) predicts adverse outcome. During invasive cardiac procedures automated-CPR (A-CPR) may help maintain effective resuscitation. The use of A-CPR following in-hospital cardiac arrest (IHCA) remains poorly described. Firstly, we aimed to assess the efficiency of healthcare staff using A-CPR in a cardiac arrest scenario at baseline, following re-training and over time (Scenario-based training). Secondly, we studied our clinical experience of A-CPR at our institution over a 2-year period, with particular emphasis on the details of invasive cardiac procedures performed, problems encountered, resuscitation rates and in-hospital outcome (AutoPulse-CPR Registry). Scenario-based training: Forty healthcare professionals were assessed. At baseline, time-to-position device was slow (mean 59 (±24) s (range 15-96s)), with the majority (57%) unable to mode-switch. Following re-training time-to-position reduced (28 (±9) s, pCPR Registry: 285 patients suffered IHCA, 25 received A-CPR. Survival to hospital discharge following conventional CPR was 28/260 (11%) and 7/25 (28%) following A-CPR. A-CPR supported invasive procedures in 9 patients, 2 of whom had A-CPR dependant circulation during transfer to the catheter lab. A-CPR may provide excellent haemodynamic support and facilitate simultaneous invasive cardiac procedures. A significant learning curve exists when integrating A-CPR into clinical practice. Further studies are required to better define the role and effectiveness of A-CPR following IHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals.
Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S
Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care. © 2012 John Wiley & Sons Ltd.
Expeditionary Logistics: How the Marine Corps Supports Its Expeditionary Operations
Asset Planning at the Lowest Level .................60 5. Improve Field Testing of All New Data Systems .............................60 C...Figure 7. The Levels of Logistic Support. (from MCDP 4, 1997) ..................................21 Figure 8. Case Study Methodology (Yin, 2009, p. 1...Combat Support System–Marine Corps GCE Ground Combat Element JOPES Joint Operational Planning and Execution System LCE Logistics Combat Element MAGTF
Combating student plagiarism an academic librarian's guide
Lampert, Lynn D
This practical book introduces readers to the current issues facing todays academic reference and instruction librarians grappling with the growing problem of student plagiarism. The book provides up-to-date overviews of student plagiarism, examples of ways in which librarians can educate students through proven instructional techniques, collaboration approaches and outreach methods, and discusses common problems and questions librarians may encounter when incorporating current anti-plagiarism instruction into their instructional services. Topics include: role of the academic librarian in combating student plagiarism, discipline-based approaches to combating student plagiarism, information literacy techniques and faculty/librarian collaboration. Investigates the issues surrounding the growth of instances of student plagiarism Discusses the academic librarian's role in combating student plagiarism Recommends effective outreach techniques and instructional methods for preventing plagiarism.
Ignoring the Innocent: Non-combatants in Urban Operations and in Military Models and Simulations
SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research organization providing objective...Defence Weekly, May 19, 2004. Lauren, M.K. Characterising the Difference Between Complex Adaptive and Conventional Combat Models. Auckland , New...Survivability in a Generic Peacekeeping Setting Using ISAAC. Auckland , New Zealand: Defence Operational Technology Support Establishment, 2000
The interactive role of job stress and organizational perceived support on psychological capital and job deviation behavior of hospital's nurses and staffs
Directory of Open Access Journals (Sweden)
Abolfazl Ghasemzadeh
Full Text Available The phenomenon of job stress is an inevitable part of professional life and in the activities and efficiency is reflected in the organization. This study aimed to identify and predict the relationship between psychological capital and job deviation behavior through job stress regarding the moderating role of perceived organizational support. This study is correlation by using descriptive methods for applied goals. Standard questionnaire was used to collect data. 180 participants was estimated and stratified random sampling. The results showed the significance of the relationship between the variables except the relationship between deviant behaviors with psychological capital. Also, the interactive role of job stress and perceived organizational support on psychological capital and job deviation behavior was confirmed. This means that for the hospital's nurses and staffs with job stress, increasing perceived organizational support associated with enhancing psychological capital and decreasing job deviation behavior. These results emphasize necessity of recognizing interactive role of job stress and perceived organizational support in psychological capital and job deviation behavior
Evaluation of a Computerized Problem-Oriented Medical Record in a Hospital Department: Does it Support Daily Clinical Practice?
DEFF Research Database (Denmark)
Bossen, Claus
led to more time spent documenting clinical work, fragmentation of patient situation into separate problems, and lack of overview.Conclusion: The problem-oriented method for structuring a computerized medical record may provide a description of how physicians think or ought to think, but does...... not adequately support complex clinical work. While the CPOMR can be used for patients with few, simple problems who are admitted for only a short time, the CPOMR is not useful for patients with a complex set of problems or for patients admitted for longer periods of time. This is in accordance with criticism...
Directory of Open Access Journals (Sweden)
Yuniarti Yuniarti
Full Text Available Following the terrorist attacks in the USA on September 11th, 2001, it was discovered that money laundering was a significant source of finance for terrorists. Although, the amount of money that involve is not as involve as in drug and gun trafficking, terrorist financing had been the most important substance to be monitor. Further, various legal measures have been taken internationally in order to combat terrorist financing. This research analyses the legal measures that have been taken internationally and at EU level to combat terrorist financing. Key words: Money Laundering, Terrorist Financing, International Legal measures, EU.
Directory of Open Access Journals (Sweden)
Daniela P. POPA
- A faulty legislation that allows them to circumvent the failure to pay taxes. Measures to combat tax evasion must act in the areas of legislative, administrative and educational. The legislative drafting tax legislation seeks appropriate, clear, concise, stable and consistent. It is also necessary to eliminate or withdrawal of exemptions, reductions and deductions that give rise to multiple interpretations. In terms of administrative measures aimed at creating a comprehensive and operational information system, ensuring adequate administrative structures and instruments effectively combating tax evasion and training specialists with morality and professionalism required of shapes and sizes evasion.
Building Software Tools for Combat Modeling and Analysis
National Research Council Canada - National Science Library
Yuanxin, Chen
... (Meta-Language for Combat Simulations) and its associated parser and C++ code generator were designed to reduce the amount of time and developmental efforts needed to build sophisticated real world combat simulations. A C++...
Personality Factors Affecting Pilot Combat Performance: A Preliminary Investigation
National Research Council Canada - National Science Library
Siem, Frederick M; Murray, Michael W
.... The present research was designed to examine the relationship between personality and combat performance using the "Big Five" model of personality and a multicomponent model of pilot combat performance...
Employee designation and health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital.
Feemster, Kristen A; Prasad, Priya; Smith, Michael J; Feudtner, Chris; Caplan, Arthur; Offit, Paul; Coffin, Susan E
Determine predictors of support of a mandatory seasonal influenza vaccine program among health care workers (HCWs). Cross-sectional anonymous survey of 2443 (out of 8093) randomly selected clinical and non-clinical HCWs at a large pediatric network after implementation of a mandatory vaccination program in 2009-10. 1388 HCWs (58.2%) completed the survey and 75.2% of respondents reported agreeing with the new mandatory policy. Most respondents (72%) believed that the policy was coercive but >90% agreed that the policy was important for protecting patients and staff and was part of professional ethical responsibility. When we adjusted for attitudes and beliefs regarding influenza and the mandate, there was no significant difference between clinical and nonclinical staff in their support of the mandate (OR 1.08, 95% C.I. 0.94, 1.26). Attitudes and beliefs regarding influenza and the mandate may transcend professional role. Targeted outreach activities can capitalize on beliefs regarding patient protection and ethical responsibility. Copyright © 2011 Elsevier Ltd. All rights reserved.
Evaluation of the decision support system for antimicrobial treatment, TREAT, in an acute medical ward of a university hospital
DEFF Research Database (Denmark)
Arboe, Bente; Laub, Rasmus Rude; Kronborg, Gitte
OBJECTIVES: TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward. METHODS: Patients admitted on suspicion of infection were included in the study. The evaluation of TREAT was done both retrospectively and prospectively. Coverage of empirical...... antimicrobial treatments was compared to recommendations from TREAT and the optimal use of local guidelines. RESULTS: Five hundred and eleven patients were included, of whom 162 had a microbiologically documented infection. In the retrospective part of the study, TREAT, physician, and guideline antimicrobial.......247). The coverage of TREAT advice for the bacteraemia patients was non-inferior to the physicians (p=1.00). CONCLUSIONS: TREAT can potentially improve the ecological costs of empirical antimicrobial therapy for patients in acute medical wards, but provided lower coverage than local guidelines....
Management of colonic injuries in the combat theater.
Cho, S David; Kiraly, Laszlo N; Flaherty, Stephen F; Herzig, Daniel O; Lu, Kim C; Schreiber, Martin A
Combat injuries are more often associated with blast, penetrating, and high-energy mechanisms than civilian trauma, generating controversy about the management of combat colonic injury. Despite implementation of mandatory colostomy in World War II, recent civilian data suggest that primary repair without diversion is safe and feasible. This study describes the modern management of battle-related colonic injuries and seeks to determine whether management strategy affects early complications. Records from the combat theater (downrange) and tertiary referral center in Germany were retrospectively reviewed from 2005 to 2006. Patient characteristics, management strategy, treatment course, and early complications were recorded. Comparison groups by management strategy were as follows: primary repair, diversion, and damage control. A total of 133 (97% male) patients sustained colonic injuries from penetrating (71%), blunt (5%), and blast (23%) mechanisms. Average injury severity score was 21 and length of stay in the referral center was 7.1 days. Injury distribution was 21% ascending, 21% descending, 15% transverse, 27% sigmoid, and 25% rectum. Downrange complications for primary repair, initial ostomy, and damage control groups were 14%, 15%, and 30%, respectively. On discharge from the center, 62% of patients had undergone a diversion. The complication rate was 18% overall and was unrelated to management strategy (P = .16). Multivariate analysis did not identify independent predictors of complications. Early complications were similar by mechanism, anatomic location, severity of injury, and management strategy. More diversions were performed for rectosigmoid injury. Good surgical judgment allows for low morbidity and supports primary repair in selected cases. Damage control surgery is effective in a multinational theater of operations.
Male combat veterans' narratives of PTSD, masculinity, and health.
Caddick, Nick; Smith, Brett; Phoenix, Cassandra
This article uniquely examines the ways a group of male combat veterans talk about masculinity and how, following post-traumatic stress disorder (PTSD), they performed masculinities in the context of a surfing group, and what effects this had upon their health and wellbeing. Participant observations and life history interviews were conducted with a group of combat veterans who belonged to a surfing charity for veterans experiencing PTSD. Data were rigorously explored via narrative analysis. Our findings revealed the ways in which veterans enacted masculinities in accordance with the values that were cultivated during military service. These masculine performances in the surfing group had important effects both on and for the veterans' wellbeing. Significantly, the study highlights how masculine performances can be seen alternately as a danger and as a resource for health and wellbeing in relation to PTSD. The article advances knowledge on combat veterans and mental health with critical implications for the promotion of male veterans' mental health. These include the original suggestion that health-promoting masculine performances might be recognised and supported in PTSD treatment settings. Rather than automatically viewing masculinity as problematic, this article moves the field forward by highlighting how hegemonic masculinities can be reconstructed in positive ways which might improve veterans' health and wellbeing. A video abstract of this article can be found at: https://www.youtube.com/watch?v=BaYzaOP1kAY. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Barriers to Implementing a Single Joint Combat Camouflage Uniform
opportunities, threats (SWOT), and political, economic, social, and technological (PEST) analyses; examines the requirements and role of each of the...SUBJECT TERMS ground combat uniform, combat camouflage uniform history , combat camouflage uniform pattern, camouflage pattern testing 15. NUMBER...methodology applies strengths, weaknesses, opportunities, threats (SWOT), and political, economic, social, and technological (PEST) analyses
Unit Reconstitutions: Combat Stress as an Indicator of Unit Effectiveness
doctrinally "Combat and Operational Stress Reactions:" A. Shell shock B. War neurosis C. Battle fatigue D. Combat exhaustion E. Combat stress F...... neurosis . The approach that evolved–proximity, immediacy, and expectancy–was a formula that incorporated some of the best practices to increase the
Evaluation of supportive care management outcomes in cancer chemotherapy: A prospective observational study in a tertiary care teaching hospital in South India
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Reshma Susan Reji
Full Text Available Aims: Evaluation of supportive care management of cancer patients experiencing drug-related problems (DRPs is a challenge because it might increase the cost due to additional therapy. The main objectives of this study were to estimate chemotherapy-associated drug-related hospital admissions in the department of medical oncology and to estimate the cost of managing chemotherapy-associated DRPs.Settings and Design: This study is a prospective observational study.Subjects and Methods: Patients with chemotherapy-related DRPs were prospectively identified from the patient's medical records. The contribution of DRPs and cost incurred due to each hospitalization was assessed.Statistical Analysis Used: Data were analyzed using SPSS® 20.0 version.Results: Out of 55 patients analyzed for DRPs, 25 (45.5% patients in the age group of 51–60 years experienced DRPs most frequently. Most commonly occurring DRP was adverse drug reactions 42 (76.4%, which were more frequent in females. DRPs were maximum with alkylating agents 15 (27.3% and the least with hormonal agents 1 (1.8%. The mean length of hospitalization was 9.6 ± 6.5 days. The total direct medical cost was Rs. 31,540 ± 42,476, of which medicine cost accounted for Rs. 16,550 ± 25,404, constituting a major share of the total medical costs.Conclusions: Pharmacists can provide better patient care by identifying and preventing DRPs and reducing drug-related morbidity and mortality.
Significant reduction in red blood cell transfusions in a general hospital after successful implementation of a restrictive transfusion policy supported by prospective computerized order auditing.
Yerrabothala, Swaroopa; Desrosiers, Kevin P; Szczepiorkowski, Zbigniew M; Dunbar, Nancy M
Our hospital transfusion policy was recently revised to recommend single-unit red blood cell transfusion (RBC TXN) for nonbleeding inpatients when the hemoglobin (Hb) level is not more than 7 g/dL. Our computerized provider order entry system was reconfigured to provide real-time decision support using prospective computerized order auditing based on the most recent Hb level and to remove the single-click ordering option for 2-unit RBC TXNs to enhance compliance. This study was undertaken to assess the impact of these changes on hospital transfusion practice. This study analyzed the total number of transfusion events, proportion of single and 2-unit transfusions and the Hb transfusion trigger in the preimplementation period (October 2011-March 2012) compared to the postimplementation period (October 2012-March 2013). In the postimplementation period the total number of RBC units transfused/1000 patient-days decreased from 60.8 to 44.2 (p auditing has resulted in significantly decreased RBC utilization at our institution. © 2014 AABB.
The Influence of Supportive and Ethical Work Environments on Work-Related Accidents, Injuries, and Serious Psychological Distress among Hospital Nurses
Tei-Tominaga, Maki; Nakanishi, Miharu
The healthcare industry in Japan has experienced many cases of work-related injuries, accidents, and workers' compensation claims because of mental illness. This study examined the influence of supportive and ethical work environments on work-related accidents, injuries, and serious psychological distress among hospital nurses. Self-reported questionnaires were distributed to nurses (n = 1114) from 11 hospitals. Valid responses (n = 822, 93% women, mean age = 38.49 ± 10.09 years) were used for analyses. The questionnaire included items addressing basic attributes, work and organizational characteristics, social capital and ethical climate at the workplace, psychological distress, and experience of work-related accidents or injuries in the last half year. The final model of a multivariate logistic regression analysis revealed that those who work less than 4 h of overtime per week (OR = 0.313), those who work on days off more than once per month (OR = 0.424), and an exclusive workplace climate (OR = 1.314) were significantly associated with work-related accidents or injuries. Additionally, an exclusive workplace climate (OR = 1.696) elevated the risk of serious psychological distress. To prevent work-related compensation cases, which are caused by these variables, strengthening hospitals' occupational health and safety is necessary. PMID:29385044
The limitations of using the existing TAM in adoption of clinical decision support system in hospitals: An empirical study in Malaysia
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Pouyan Esmaeilzadeh
Full Text Available The technology acceptance model (TAM has been widely used to study user acceptance of new computer technologies. Previous studies claimed that future technology acceptance research should explore other additional explanatory variables, which may affect the originally proposed constructs of the TAM. The use of information technology in the health care sector and especially in hospitals offers great potential for improving the performance of physicians, increasing the quality of services and also reducing the organizational expenses. However, the main challenge that arises according to the literature is whether healthcare professionals are willing to adopt and use clinical information technology while performing their tasks. Although adoption of various information technologies has been studied using the technology acceptance model (TAM, the study of technology acceptance for professional groups (such as physicians has been limited. Physician adoption of clinical information technology is important for its successful implementation. Therefore, the purpose of this study is to gain a better insight about factors affecting physicians' acceptance of clinical decision support systems (CDSS in a hospital setting. The results reflect the importance of perceived threat to professional autonomy, perceived interactivity with clinical IT, perceived usefulness and perceived ease of use in determining physicians' intention to use CDSS.
The role of performing life support courses in rural areas in improving pre-hospital physiologic condition of patients with penetrating injuries
International Nuclear Information System (INIS)
Naffisi, N.; Mohebbi, H.A.; Moharamzadeh, Y.
To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group (226 patients) consisted of those who received this cares by the trained group and second group (245 patients) were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score (PSS) was calculated to determine the physiologic condition of patients in both groups. Results: The most prevalent cause of trauma in both groups was car accidents (61.6%). Controlling of hemorrhage was the most frequent provided initial medical care (40.6%). A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group (7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9). The mortality rates of the first and second group of patients were 3% and 7.3%, respectively (p=0.051). Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries. (author)
The Influence of Supportive and Ethical Work Environments on Work-Related Accidents, Injuries, and Serious Psychological Distress among Hospital Nurses
Directory of Open Access Journals (Sweden)
Maki Tei-Tominaga
Full Text Available The healthcare industry in Japan has experienced many cases of work-related injuries, accidents, and workers' compensation claims because of mental illness. This study examined the influence of supportive and ethical work environments on work-related accidents, injuries, and serious psychological distress among hospital nurses. Self-reported questionnaires were distributed to nurses (n = 1114 from 11 hospitals. Valid responses (n = 822, 93% women, mean age = 38.49 ± 10.09 years were used for analyses. The questionnaire included items addressing basic attributes, work and organizational characteristics, social capital and ethical climate at the workplace, psychological distress, and experience of work-related accidents or injuries in the last half year. The final model of a multivariate logistic regression analysis revealed that those who work less than 4 h of overtime per week (OR = 0.313, those who work on days off more than once per month (OR = 0.424, and an exclusive workplace climate (OR = 1.314 were significantly associated with work-related accidents or injuries. Additionally, an exclusive workplace climate (OR = 1.696 elevated the risk of serious psychological distress. To prevent work-related compensation cases, which are caused by these variables, strengthening hospitals' occupational health and safety is necessary.
Awareness, Attitude, and Knowledge of Basic Life Support among Medical, Dental, and Nursing Faculties and Students in the University Hospital.
Sangamesh, N C; Vidya, K C; Pathi, Jugajyoti; Singh, Arpita
To assess the awareness, attitude, and knowledge about basic life support (BLS) among medical, dental, and nursing students and faculties and the proposal of BLS skills in the academic curriculum of undergraduate (UG) course. Recognition, prevention, and effective management of life-threatening emergencies are the responsibility of health-care professionals. These situations can be successfully managed by proper knowledge and training of the BLS skills. These life-saving maneuvers can be given through the structured resuscitation programs, which are lacking in the academic curriculum. A questionnaire study consisting of 20 questions was conducted among 659 participants in the Kalinga Institute of Dental Sciences, Kalinga Institute of Medical Sciences, KIIT University. Medical junior residents, BDS faculties, interns, nursing faculties, and 3 rd -year and final-year UG students from both medical and dental colleges were chosen. The statistical analysis was carried out using SPSS software version 20.0 (Armonk, NY:IBM Corp). After collecting the data, the values were statistically analyzed and tabulated. Statistical analysis was performed using Mann-Whitney U-test. The results with P life-threatening emergencies.
Combating Forest Corruption: the Forest Integrity Network
Gupta, A.; Siebert, U.
This article describes the strategies and activities of the Forest Integrity Network. One of the most important underlying causes of forest degradation is corruption and related illegal logging. The Forest Integrity Network is a timely new initiative to combat forest corruption. Its approach is to
Africanity: A Combative Ontology | Mafeje | CODESRIA Bulletin
African Journals Online (AJOL)
Africanity: A Combative Ontology. Archie Mafeje. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact AJOL · News. OTHER RESOURCES... for Researchers · for Journals · for Authors · for Policy ...
On shelterbelt design for combating sand invasion.
Mohammed, A.E.; Stigter, C.J.; Adam, H.S.
After a review of the scarce literature on using trees against sand encroachment, a quantitative experiment with a wide shelterbelt to combat sand invasion is reported on. Experimental work was carried out at the northwestern border of the Gezira Scheme (Sudan), an area of severe land degradation
Combatives for Alienated Youth: Problems and Prospects.
Hellison, Don
Combative activities (boxing, wrestling, kung fu, etc.) are seen as having a positive influence on alienated inner city youth. Potential contributions of such activities in a school curriculum or recreation program include involvement, security, self-concept, and self-realization. Participants may be able to free themselves from such stereotype…
Hemodynamics and vasopressor support during targeted temperature management at 33°C Versus 36°C after out-of-hospital cardiac arrest
DEFF Research Database (Denmark)
Bro-Jeppesen, John; Annborn, Martin; Hassager, Christian
OBJECTIVE: To investigate the hemodynamic profile associated with different target temperatures and to assess the prognostic implication of inotropic/vasopressor support and mean arterial pressure after out-of-hospital cardiac arrest. There is a lack of information how different target temperatures...... may affect hemodynamics. DESIGN: Post hoc analysis of a prospective randomized study. SETTING: Thirty-six ICUs in 10 countries. PATIENTS: Nine hundred twenty patients (97%) with available vasopressor data out of 950 patients from the Target Temperature Management trial randomly assigned patients...... to a targeted temperature management at 33 °C or 36 °C. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure, heart rate, and lactate were registered at prespecified time points. The population was stratified according to cardiovascular Sequential Organ Failure Assessment = 4 defining...
U.S. Cyber Command Support to Geographic Combatant Commands
State Association of Colleges and Schools, 3624 Market Street, Philadelphia, PA 19104, (215) 662-5606. The Commission on Higher Education is an...the Middle States Association of Colleges and Schools, 3624 Market Street, Philadelphia, PA 19104, (215) 662-5606. The Commission on Higher...Defense Regarding Cybersecurity. 33 The NCCIC is augmented by the Cyber Unified Coordination Group ( UCG ) made up of public and private sector officials
Integrating Agile Combat Support within Title 10 Wargames
5 II. Literature Review...progressed, the warfare has changed from tribal to medieval to trench to guerilla and now to modern warfare. As these types of warfare have evolved, the...connection between logistics and wargames. 6 II. Literature Review The purpose of this chapter is to review literature on wargames, the issues
Customer Service Analysis of Air Combat Command Vehicle Maintenance Support
the survey, the researchers categorized the services or variables into marketing mix components: product, price, promotion, and customer service...comparing and analyzing the variables identified in the previous three phases to determine a strategic marketing mix (46:9). After analyzing the data...service/physical distribution. Additionally, they found that customer service/physical distribution was an integral component of the marketing mix , and
Designing Assessments of Microworld Training for Combat Service Support Staff
National Research Council Canada - National Science Library
Straus, Susan
...) microworld training. RAND developed and piloted microworld training for distribution management skills as a part of a larger project that entailed making changes to the current structure, content, and methods of CSS training...
Awareness about basic life support and emergency medical services and its associated factors among students in a tertiary care hospital in South India
Directory of Open Access Journals (Sweden)
Akshatha Rao Aroor
Full Text Available Background: The knowledge and skills about the basic life support (BLS and the advanced life support are the most important determining factors of the cardiopulmonary resuscitation (CPR success rates. Objectives: To determine the level of awareness on BLS and skills among undergraduate and postgraduate students of medical and dental profession, as well as nursing students and interns in a tertiary care hospital. Materials and Methods: This descriptive cross-sectional study was conducted in a tertiary care hospital in South India. The awareness level on BLS and factors associated which include age, sex, level of training (undergraduate, internship, and postgraduate groups, course of study (nursing, dental, and medical groups, and previous exposure to BLS were assessed by using a structured questionnaire. The association of these variables with awareness level was assessed by independent t test, analysis of variance, and linear regression analysis. Results: Among 520 study subjects, 229 were students, 171 were interns, and 120 were postgraduate students. The overall mean score of awareness was 4.16 ± 1.40 (score range: 0-10. Age, sex, level of training, course of study, and previous exposure to BLS were significantly associated with awareness level in univariate analysis (P < 0.05. Linear regression model also showed that all the above variables were significantly associated with awareness level (P < 0.05. About 322 (61.9% subjects attributed lack of awareness about BLS to lack of available professional training. About 479 (92.1% responded that BLS training should be a part of medical curriculum. Conclusion: Awareness level on BLS is below average indicating the importance of professional training at all levels in a tertiary care health institution.
A cross-sectional descriptive study of the family functioning, health and social support of hospital patients with family violence backgrounds.
Kivelä, Salla; Leppäkoski, Tuija; Helminen, Mika; Paavilainen, Eija
Family violence (FV) has serious effects on the health and well-being of the family. The health sector plays a vital role in FV prevention by helping to identify abuse early, providing victims with the necessary treatment and referring patients to appropriate care. The aim of the present cross-sectional study was to describe the prevalence of FV among hospital patients, as well as to assess the association between family functioning, health and social support, considering patients as the perpetrators or victims of violence. The data were collected using a Family Functioning, Health and Social Support (FAFHES) questionnaire that was given to patients who visited a Finnish central hospital between October 2012 and April 2013. As a result, the data (N = 188) were contributed by the patients who returned the questionnaire and gave permission for a follow-up survey. The participation rate was 47%, of which 73% were women and 27% were men. Their ages ranged from 18 to 89 years. The data were analysed with quantitative methods using the unadjusted analyses and linear regression model. In total, 24% of both the male and female participants had experienced or used violence at home or in the family. Of these, 22 had been the perpetrators, and 23 had been the victims. Participants in relationships and who were living together had less violence than singles and those who were not living together. The family functioning and health of the participants who had experienced or used FV were worse than those of the participants who had not. Various patients can have an FV background, and nursing professionals are on the front line to identify and intervene in FV situations. The results of this study can be utilised in the treatment of FV victims and perpetrators by training healthcare workers to identify and intervene in violence. © 2017 Nordic College of Caring Science.
Awareness about basic life support and emergency medical services and its associated factors among students in a tertiary care hospital in South India.
Aroor, Akshatha Rao; Saya, Rama Prakash; Attar, Nazir Rahim; Saya, Ganesh Kumar; Ravinanthanan, Manikandan
The knowledge and skills about the basic life support (BLS) and the advanced life support are the most important determining factors of the cardiopulmonary resuscitation (CPR) success rates. To determine the level of awareness on BLS and skills among undergraduate and postgraduate students of medical and dental profession, as well as nursing students and interns in a tertiary care hospital. This descriptive cross-sectional study was conducted in a tertiary care hospital in South India. The awareness level on BLS and factors associated which include age, sex, level of training (undergraduate, internship, and postgraduate groups), course of study (nursing, dental, and medical groups), and previous exposure to BLS were assessed by using a structured questionnaire. The association of these variables with awareness level was assessed by independent t test, analysis of variance, and linear regression analysis. Among 520 study subjects, 229 were students, 171 were interns, and 120 were postgraduate students. The overall mean score of awareness was 4.16 ± 1.40 (score range: 0-10). Age, sex, level of training, course of study, and previous exposure to BLS were significantly associated with awareness level in univariate analysis (P < 0.05). Linear regression model also showed that all the above variables were significantly associated with awareness level (P < 0.05). About 322 (61.9%) subjects attributed lack of awareness about BLS to lack of available professional training. About 479 (92.1%) responded that BLS training should be a part of medical curriculum. Awareness level on BLS is below average indicating the importance of professional training at all levels in a tertiary care health institution.
Dutch National Plan combat nuclear accidents
International Nuclear Information System (INIS)
This document presents the Dutch National Plan combat nuclear accidents (NPK). Ch. 2 discusses some important starting points which are determining for the framework and the performance of the NPK, in particular the accident typology which underlies the plan. Also the new accident-classification system for the Dutch nuclear power plants, the standardization for the measures to be taken and the staging around nuclear power plants are pursued. In ch. 3 the legal framework of the combat nuclear accidents is described. In particular the Nuclear-power law, the Accident law and the Municipality law are pursued. Also the role of province and municipality are described. Ch. 4 deals with the role of the owner/licensee of the object where the accident occurs, in the combat of accident. In ch. 5 the structure of the nuclear-accident combat at national level is outlined, subdivided in alarm phase, combat phase and the winding-up phase. In ch.'s 6-12 these phases are elaborated more in detail. In ch.'s 10-13 the measures to be taken in nuclear accidents, are described. These measures are distinguished with regard to: protection of the population and medical aspects, water economy, drinking-water supply, agriculture and food supply. Ch. 14 describes the responsibility of the burgomaster. Ch.'s 15 and 16 present an overview of the personnel, material, procedural and juridical modifications and supplements of existing structures which are necessary with regard to the new and modified parts of the structure. Ch. 17 indicates how by means of the appropriate education and exercise it can be achieved that all personnel, services and institutes concerned possess the knowledge and experience necessary for the activities from the NKP to be executed as has been described. Ch. 18 contains a survey of activities to be performed and a proposal how these can be realized. (H.W.). figs.; tabs
Knowledge, skills and attitudes of hospital pharmacists in the use of information technology and electronic tools to support clinical practice: A Brazilian survey.
Néri, Eugenie Desirèe Rabelo; Meira, Assuero Silva; Vasconcelos, Hemerson Bruno da Silva; Woods, David John; Fonteles, Marta Maria de França
This study aimed to identify the knowledge, skills and attitudes of Brazilian hospital pharmacists in the use of information technology and electronic tools to support clinical practice. A questionnaire was sent by email to clinical pharmacists working public and private hospitals in Brazil. The instrument was validated using the method of Polit and Beck to determine the content validity index. Data (n = 348) were analyzed using descriptive statistics, Pearson's Chi-square test and Gamma correlation tests. Pharmacists had 1-4 electronic devices for personal use, mainly smartphones (84.8%; n = 295) and laptops (81.6%; n = 284). At work, pharmacists had access to a computer (89.4%; n = 311), mostly connected to the internet (83.9%; n = 292). They felt competent (very capable/capable) searching for a web page/web site on a specific subject (100%; n = 348), downloading files (99.7%; n = 347), using spreadsheets (90.2%; n = 314), searching using MeSH terms in PubMed (97.4%; n = 339) and general searching for articles in bibliographic databases (such as Medline/PubMed: 93.4%; n = 325). Pharmacists did not feel competent in using statistical analysis software (somewhat capable/incapable: 78.4%; n = 273). Most pharmacists reported that they had not received formal education to perform most of these actions except searching using MeSH terms. Access to bibliographic databases was available in Brazilian hospitals, however, most pharmacists (78.7%; n = 274) reported daily use of a non-specific search engine such as Google. This result may reflect the lack of formal knowledge and training in the use of bibliographic databases and difficulty with the English language. The need to expand knowledge about information search tools was recognized by most pharmacists in clinical practice in Brazil, especially those with less time dedicated exclusively to clinical activity (Chi-square, p = 0.006). These results will assist in defining minimal competencies for the training of
Knowledge, skills and attitudes of hospital pharmacists in the use of information technology and electronic tools to support clinical practice: A Brazilian survey.
Directory of Open Access Journals (Sweden)
Eugenie Desirèe Rabelo Néri
Full Text Available This study aimed to identify the knowledge, skills and attitudes of Brazilian hospital pharmacists in the use of information technology and electronic tools to support clinical practice.A questionnaire was sent by email to clinical pharmacists working public and private hospitals in Brazil. The instrument was validated using the method of Polit and Beck to determine the content validity index. Data (n = 348 were analyzed using descriptive statistics, Pearson's Chi-square test and Gamma correlation tests.Pharmacists had 1-4 electronic devices for personal use, mainly smartphones (84.8%; n = 295 and laptops (81.6%; n = 284. At work, pharmacists had access to a computer (89.4%; n = 311, mostly connected to the internet (83.9%; n = 292. They felt competent (very capable/capable searching for a web page/web site on a specific subject (100%; n = 348, downloading files (99.7%; n = 347, using spreadsheets (90.2%; n = 314, searching using MeSH terms in PubMed (97.4%; n = 339 and general searching for articles in bibliographic databases (such as Medline/PubMed: 93.4%; n = 325. Pharmacists did not feel competent in using statistical analysis software (somewhat capable/incapable: 78.4%; n = 273. Most pharmacists reported that they had not received formal education to perform most of these actions except searching using MeSH terms. Access to bibliographic databases was available in Brazilian hospitals, however, most pharmacists (78.7%; n = 274 reported daily use of a non-specific search engine such as Google. This result may reflect the lack of formal knowledge and training in the use of bibliographic databases and difficulty with the English language. The need to expand knowledge about information search tools was recognized by most pharmacists in clinical practice in Brazil, especially those with less time dedicated exclusively to clinical activity (Chi-square, p = 0.006.These results will assist in defining minimal competencies for the training of
Oil combatting in a cold environment using bioremediation techniques
International Nuclear Information System (INIS)
Rytkoenen, J.; Liukkonen, S.; Levchenko, A.; Worthington, T.; Matishov, G.; Petrov, V.
The clean-up of oil spills in the Arctic environment is often limited by severe and cold environmental conditions. Mechanical methods are usually considered to be most favorable for oil spill combatting. However, remote spill sites, long distances, severe environmental conditions and sensitive ecosystems mean that more advanced combatting techniques are also needed to back up conventional recovery and clean-up measures. This paper describes the results of macro-scale tests conducted by VTT Manufacturing Technology to study the effectiveness of biosorbent technology against marine oil spills. The use of biosorbents was studied as a joint research project involving VTT (Finland) and the Murmansk Marine Biological Institute (Russia). Selected biosorbent products of Marine Systems, U.S.A., and the Bios Group, Russia, were used in macro-scale tests conducted in a basin measuring 15.0 x 3.0 m in length and width, respectively. This paper outlines the macro-scale test project, including microbiological and chemical studies, supported by toxicity tests and various analyses to understand better the fate of oil, especially the degree of biodegradation during the test
The role of performing life support courses in rural areas in improving pre-hospital physiologic conditions of patients with penetrating injuries.
Nia, Masoud Saghafi; Naffisi, Nahid; Mohebbi, Hassan Ali; Moharamzadeh, Yashar
To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Experimental study. This study was carried out in Mehran city and its neighbouring rural districts in western part of Iran from 2002 to 2004. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group (226 patients) consisted of those who received this cares by the trained group and second group (245 patients) were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score (PSS) was calculated to determine the physiologic condition of patients in both groups. The most prevalent cause of trauma in both groups was car accidents (61.6%). Controlling of hemorrhage was the most frequent provided initial medical care (40.6%). A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group (7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9). The mortality rates of the first and second group of patients were 3% and 7.3%, respectively (p=0.051). Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries.
Scrutinized with inadequate control and support: Interns' experiences communicating with and writing referrals to hospital radiology departments – A qualitative study
International Nuclear Information System (INIS)
Kruse, J.; Lehto, N.; Riklund, K.; Tegner, Y.; Engström, Å.
Introduction: Interns' experiences communicating with and writing referrals to hospital radiology departments are important for patient safety, image quality, and decision-making in the diagnostic process. Understanding roles within the department and in the diagnostic process is important for communication. This study aimed to describe interns' experiences communicating with and writing referrals to their hospital's radiology department. Method: A qualitative study design was used. Data was collected from focus discussions with ten interns in three focus groups in Northern Sweden during 2012. The data were subjected to qualitative content analysis. Results: One theme, "a feeling of being scrutinized and lacking control", was identified in the final categories. The interns experienced that the radiology department placed high demands on them and desired more diagnostic skills training, resources and feedback. The interns suggested the following improvements: enhanced dialogue and feedback, improved education, handy guidelines, and practice writing referrals. Conclusion: Interns need more feedback from, and dialogue with, members of the Department of Radiology. They also need more knowledge of referral guidelines, appropriateness criteria and more practice to develop their knowledge and skill for writing referrals. They describe feelings of inadequate support and feel scrutinized in demanding work conditions and need more collaboration. They also need more time and more control of radiology outcomes, and they are eager to learn. - Highlights: • Interns' experiences of writing referrals are important in the diagnostic process. • Communication between referents and radiology staff influences patient safety. • Medical interns experience insufficient diagnostic skills. • Interns need more feedback from, and dialogue with radiology staff. • The learning process could benefit from knowledge of the referrers perspective.
Advanced protection technology for ground combat vehicles.
Bosse, Timothy G
Just as highway drivers use radar detectors to attempt to stay ahead of police armed with the latest radar technology, the Armed Forces are locked in a spiral to protect combat vehicles and their crews against the latest threats in both the contemporary operating environment and the anticipated operating environment (ie, beyond 2020). In response to bigger, heavier, or better-protected vehicles, adversaries build and deploy larger explosive devices or bombs. However, making improvements to combat vehicles is much more expensive than deploying larger explosives. In addition, demand is increasing for lighter-weight vehicles capable of rapid deployment. Together, these two facts give the threat a clear advantage in the future. To protect vehicles and crews, technologies focusing on detection and hit avoidance, denial of penetration, and crew survivability must be combined synergistically to provide the best chance of survival on the modern battlefield.
New approaches to combat Porphyromonas gingivalis biofilms
Gerits, Evelien; Verstraeten, Natalie; Michiels, Jan
ABSTRACT In nature, bacteria predominantly reside in structured, surface-attached communities embedded in a self-produced, extracellular matrix. These so-called biofilms play an important role in the development and pathogenesis of many infections, as they are difficult to eradicate due to their resistance to antimicrobials and host defense mechanisms. This review focusses on the biofilm-forming periodontal bacterium Porphyromonas gingivalis. Current knowledge on the virulence mechanisms underlying P. gingivalis biofilm formation is presented. In addition, oral infectious diseases in which P. gingivalis plays a key role are described, and an overview of conventional and new therapies for combating P. gingivalis biofilms is given. More insight into this intriguing pathogen might direct the development of better strategies to combat oral infections. PMID:28473880
Using agility to combat cyber attacks.
Anderson, Kerry
Some incident response practitioners feel that they have been locked in a battle with cyber criminals since the popular adoption of the internet. Initially, organisations made great inroads in preventing and containing cyber attacks. In the last few years, however, cyber criminals have become adept at eluding defence security technologies and rapidly modifying their exploit strategies for financial or political gains. Similar to changes in military combat tactics, cyber criminals utilise distributed attack cells, real-time communications, and rapidly mutating exploits to minimise the potential for detection. Cyber criminals have changed their attack paradigm. This paper describes a new incident response paradigm aimed at combating the new model of cyber attacks with an emphasis on agility to increase the organisation's ability to respond rapidly to these new challenges.
Combat Stress and Substance Use Intervention
Additionally, excessive alcohol use in the military has been linked to serious consequences and loss of productivity , both of which are detrimental...and absenteeism among Iraq war veterans. The American Journal of Psychiatry, 164(1), 150– 153. Jakupcak, M., Tull, M. T., McDermott, M. J., Kaysen, D...2015, 2016) 106 1 Product Line Review (PLR) Meeting Technology- Facilitated Monitoring and Treatment in Mental Health 21 August 2012 Combat
Combat Conditioning: The Need for Stronger Marines
pounds. This leads to overuse injuries that can reduce a unit's combat effectiveness. Typically the injuries are isolated to the lower...extremities in the form of femoral and hip stress fractures. The way to avoid these types of injuries is to strengthen the muscles around these areas as...shows how the average weight carried by warriors has increased over time. 3 " CrossFit is a core strength and conditioning program
Exploiting Inhibitory Siglecs to Combat Food Allergies
AWARD NUMBER: W81XWH-16-1-0302 TITLE: Exploiting Inhibitory Siglecs to Combat Food Allergies PRINCIPAL INVESTIGATOR: Michael Kulis, Ph.D...CONTRACTING ORGANIZATION: University of North Carolina at Chapel Hill Chapel Hill, NC 27599 REPORT DATES: October 2017 TYPE OF REPORT: Annual PREPARED FOR...Department of Defense, Washington Headquarters Services , Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite
Violation of human rights to combat terrorism.
LL.B. No one definition of terrorism has gained universal acceptance. The lack of agreement on a definition of terrorism has been a major obstacle to meaningful international countermeasures to combat terrorism. There are 12 International Conventions related to terrorism and an explicit definition is still missing. Many states have tried to define terrorism and none of these definitions has been implemented, either by the United Nations or these states. There are many International Convent...
Barriers to combating human trafficking in Colombia
Wilcox, Daniel Joseph
Approved for public release; distribution is unlimited Despite international and domestic policies and programs intended to combat human trafficking, Colombia remains one of the countries with the highest instances of human trafficking in the Western Hemisphere. Factors contributing to human trafficking in Colombia, such as internal violence and displacement, drug trafficking, a weak central government, and widespread corruption, have overpowered what energies the government marshaled agai...
Lessons Worth Remembering: Combat In Urban Areas
vi Acronyms AQI Al Qaeda of Iraq ARVN Army of Vietnam CF Coalition Forces COP Combat Outpost IED Improvised...Finally, there was an unorganized criminal element that was interested in profiting from the general violence and lawlessness.181 The prime objective of...Ramadi. In June, the 1BCT ordered one of its battalion's, TF 1/37 Armor, to establish COP Falcon in the southwest section of the city.201 The operation
Combating Corruption in International Business Transactions
Celentani, Marco; Ganuza, Juan-José; Peydró, José-Luis
International business transactions pose the problem of deterring bribing of public officials by foreign firms. We first analyse a convention styled after the OECD's 'Convention on Combating Bribery of Foreign Public Officials in International Business Transactions', which requires signatory countries to proceed against firms that have bribed public officials of any foreign country. We then study the case in which the convention requires signatory countries to proceed against firms that have ...
Groundwork for a Theory of the Combatant
moral status of an individual combatant might have to be relativized to particular roles, or particular missions, rather than the justice of his or her...contemporary scholars understand killing in war. However, such arguments can be very complex, which makes them of little practical value in actual moral ...is the collectivist, because it better captures the nature of the various morally relevant relationships involved. Those relationships are between
Legislations combating counterfeit drugs in Hong Kong.
Lai, C W; Chan, W K
To understand legislation combating counterfeit drugs in Hong Kong. This study consisted of two parts. In part I, counterfeit drugs–related ordinances and court cases were reviewed. In part II, indepth interviews of the stakeholders were described. Hong Kong. All Hong Kong ordinances were screened manually to identify those combating counterfeit drugs. Court cases were searched for each of the identified cases. Then, the relevant judgement justifications were analysed to identify sentencing issues. Indepth interviews with the stakeholders were conducted to understand their perceptions about such legislation. Trade Marks Ordinance, Patents Ordinance, Trade Descriptions Ordinance, and Pharmacy and Poisons Ordinance were current legislative items combating counterfeit drugs. Sentencing criteria depended on: intention to deceive, quantity of seized drugs, presence of expected therapeutic effect or toxic ingredients, previous criminal records, cooperativeness with Customs officers, honest confessions, pleas of guilty, types of drugs, and precautionary measures to prevent sale of counterfeit drugs. Stakeholders' perceptions were explored with respect to legislation regarding the scale and significance of the counterfeit drug problem, penalties and deterrents, drug-specific legislation and authority, and inspections and enforcement. To plug the loopholes, a specific law with heavy penalties should be adopted. This could be supplemented by non-legal measures like education of judges, lawyers, and the public; publishing the names of offending pharmacies; and emphasising the role of pharmacists to the public.
[Designing and Operating a Comprehensive Mental Health Management System to Support Faculty at a University That Contains a Medical School and University Hospital].
Kawanishi, Chiaki
In Japan, healthcare professionals and healthcare workers typically practice a culture of self-assessment when it comes to managing their own health. Even where this background leads to instances of mental health disorders or other serious problems within a given organization, such cases are customarily addressed by the psychiatrists or psychiatric departments of the facilities affected. Organized occupational mental health initiatives for professionals and workers within the healthcare system are extremely rare across Japan, and there is little recognition of the need for such initiatives even among those most directly affected. The author has some experience designing and operating a comprehensive health management system to support students and faculty at a university in the Tokyo Metropolitan Area that contains a medical school and university hospital. At this university, various mental health-related problems were routinely being allowed to develop into serious cases, while the fundamental reforms required by the health management center and the mental health management scheme organized through the center had come to represent a challenge for the entire university. From this initial situation, we undertook several successive initiatives, including raising the number of staff in the health management center and its affiliated organizations, revising and drafting new health management rules and regulations, launching an employment support and management system, implementing screenings to identify people with mental ill-health, revamping and expanding a counselling response system, instituting regular collaboration meetings with academic affairs staff, and launching educational and awareness-raising activities. This resulted in the possibility of intervention in all cases of mental health crisis, such as suicidal ideation. We counted more than 2,400 consultations (cumulative total number; more than half of consultations was from the medical school, postgraduate
Effectiveness of a Hospital-Based Work Support Intervention for Female Cancer Patients – A Multi-Centre Randomised Controlled Trial
Tamminga, Sietske J.; Verbeek, Jos H. A. M.; Bos, Monique M. E. M.; Fons, Guus; Kitzen, Jos J. E. M.; Plaisier, Peter W.; Frings-Dresen, Monique H. W.; de Boer, Angela G. E. M.
Objective One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer survivors face problems upon their return-to-work. For that reason, we developed a hospital-based work support intervention aimed at enhancing return-to-work. We studied effectiveness of the intervention compared to usual care for female cancer patients in a multi-centre randomised controlled trial. Methods Breast and gynaecological cancer patients who were treated with curative intent and had paid work were randomised to the intervention group (n = 65) or control group (n = 68). The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians. In addition, we asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Outcomes at 12 months of follow-up included rate and time until return-to-work (full or partial), quality of life, work ability, work functioning, and lost productivity costs. Time until return-to-work was analyzed with Kaplan-Meier survival analysis. Results Return-to-work rates were 86% and 83% (p = 0.6) for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up. Median time from initial sick leave to partial return-to-work was 194 days (range 14–435) versus 192 days (range 82–465) (p = 0.90) with a hazard ratio of 1.03 (95% CI 0.64–1.6). Quality of life and work ability improved statistically over time but did not differ statistically between groups. Work functioning and costs did not differ statistically between groups. Conclusion The intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates. We failed to show any differences between groups on return-to-work outcomes and quality of life scores. Further research is needed to study which aspects of
Intelligent Terrain Analysis and Tactical Support System (ITATSS) for Unmanned Ground Vehicles
National Research Council Canada - National Science Library
Jones, Randolph M; Arkin, Ron; Sidki, Nahid
...). The system enable unmanned combat and support vehicles to achieve significant new levels of autonomy, mobility, rapid response, coordination and effectiveness, while simultaneously enriching human...
Human performance modeling for system of systems analytics: combat performance-shaping factors.
Energy Technology Data Exchange (ETDEWEB)
Lawton, Craig R.; Miller, Dwight Peter
The US military has identified Human Performance Modeling (HPM) as a significant requirement and challenge of future systems modeling and analysis initiatives. To support this goal, Sandia National Laboratories (SNL) has undertaken a program of HPM as an integral augmentation to its system-of-system (SoS) analytics capabilities. The previous effort, reported in SAND2005-6569, evaluated the effects of soldier cognitive fatigue on SoS performance. The current effort began with a very broad survey of any performance-shaping factors (PSFs) that also might affect soldiers performance in combat situations. The work included consideration of three different approaches to cognition modeling and how appropriate they would be for application to SoS analytics. This bulk of this report categorizes 47 PSFs into three groups (internal, external, and task-related) and provides brief descriptions of how each affects combat performance, according to the literature. The PSFs were then assembled into a matrix with 22 representative military tasks and assigned one of four levels of estimated negative impact on task performance, based on the literature. Blank versions of the matrix were then sent to two ex-military subject-matter experts to be filled out based on their personal experiences. Data analysis was performed to identify the consensus most influential PSFs. Results indicate that combat-related injury, cognitive fatigue, inadequate training, physical fatigue, thirst, stress, poor perceptual processing, and presence of chemical agents are among the PSFs with the most negative impact on combat performance.
Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK.
Simpson, Alan; Flood, Chris; Rowe, Julie; Quigley, Jody; Henry, Susan; Hall, Cerdic; Evans, Richard; Sherman, Paul; Bowers, Len
Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged. This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge. A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support. The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to
Prevalence of supporting limb laminitis in a UK equine practice and referral hospital setting between 2005 and 2013: implications for future epidemiological studies.
Wylie, C E; Newton, J R; Bathe, A P; Payne, R J
The electronic patient records of all equine patients of Rossdales Equine Practice between January 1, 2005 and November 1, 2013 were reviewed to determine the number of cases of supporting limb laminitis (SLL) in a large equine practice and referral hospital setting in the UK and to discuss the implications for future epidemiological studies. The clinical notes were searched electronically for a combination of 'laminitis AND (contralateral OR supporting OR overload OR weight bearing)'. The prevalence of SLL within each identified denominator population and the corresponding 95% CI were calculated. SLL developed in nine horses, one donkey and one pony. Thoroughbreds were the most commonly affected breed (72.7 per cent, CI 46.4 to 99.1 per cent), aged 2-14 years (median six years), and only mares (n=9) and stallions (n=2) were represented. SLL was not restricted to horses that were non-weightbearing lame, it developed within 4-100 days after injury (median 14.5 days) and occurred most commonly in a forelimb (54.6 per cent, CI 25.1 to 84.0 per cent). During the same time frame, a total of 65,327 horses were registered with Rossdales Equine Practice, resulting in an overall practice prevalence of SLL of 0.02 per cent (CI 0.01 to 0.03 per cent). Future epidemiological studies to investigate risk factors for SLL prevention will, therefore, be a logistical challenge. British Veterinary Association.
Using voice to create hospital progress notes: Description of a mobile application and supporting system integrated with a commercial electronic health record.
Payne, Thomas H; Alonso, W David; Markiel, J Andrew; Lybarger, Kevin; White, Andrew A
We describe the development and design of a smartphone app-based system to create inpatient progress notes using voice, commercial automatic speech recognition software, with text processing to recognize spoken voice commands and format the note, and integration with a commercial EHR. This new system fits hospital rounding workflow and was used to support a randomized clinical trial testing whether use of voice to create notes improves timeliness of note availability, note quality, and physician satisfaction with the note creation process. The system was used to create 709 notes which were placed in the corresponding patient's EHR record. The median time from pressing the Send button to appearance of the formatted note in the Inbox was 8.8 min. It was generally very reliable, accepted by physician users, and secure. This approach provides an alternative to use of keyboard and templates to create progress notes and may appeal to physicians who prefer voice to typing. Copyright © 2017 Elsevier Inc. All rights reserved.
Social Network Analysis as a Methodological Approach to Explore Health Systems: A Case Study Exploring Support among Senior Managers/Executives in a Hospital Network.
De Brún, Aoife; McAuliffe, Eilish
Health systems research recognizes the complexity of healthcare, and the interacting and interdependent nature of components of a health system. To better understand such systems, innovative methods are required to depict and analyze their structures. This paper describes social network analysis as a methodology to depict, diagnose, and evaluate health systems and networks therein. Social network analysis is a set of techniques to map, measure, and analyze social relationships between people, teams, and organizations. Through use of a case study exploring support relationships among senior managers in a newly established hospital group, this paper illustrates some of the commonly used network- and node-level metrics in social network analysis, and demonstrates the value of these maps and metrics to understand systems. Network analysis offers a valuable approach to health systems and services researchers as it offers a means to depict activity relevant to network questions of interest, to identify opinion leaders, influencers, clusters in the network, and those individuals serving as bridgers across clusters. The strengths and limitations inherent in the method are discussed, and the applications of social network analysis in health services research are explored.
Social Network Analysis as a Methodological Approach to Explore Health Systems: A Case Study Exploring Support among Senior Managers/Executives in a Hospital Network
Directory of Open Access Journals (Sweden)
Aoife De Brún
Full Text Available Health systems research recognizes the complexity of healthcare, and the interacting and interdependent nature of components of a health system. To better understand such systems, innovative methods are required to depict and analyze their structures. This paper describes social network analysis as a methodology to depict, diagnose, and evaluate health systems and networks therein. Social network analysis is a set of techniques to map, measure, and analyze social relationships between people, teams, and organizations. Through use of a case study exploring support relationships among senior managers in a newly established hospital group, this paper illustrates some of the commonly used network- and node-level metrics in social network analysis, and demonstrates the value of these maps and metrics to understand systems. Network analysis offers a valuable approach to health systems and services researchers as it offers a means to depict activity relevant to network questions of interest, to identify opinion leaders, influencers, clusters in the network, and those individuals serving as bridgers across clusters. The strengths and limitations inherent in the method are discussed, and the applications of social network analysis in health services research are explored.
Appetitive aggression and adverse childhood experiences shape violent behavior in females formerly associated with combat
Directory of Open Access Journals (Sweden)
Mareike eAugsburger
Full Text Available This study investigated the impact of violent experiences during childhood, posttraumatic stress disorder (PTSD and appetitive aggression on everyday violent behavior in Burundian females with varying participation in war. Moreover, group differences in trauma-related and aggression variables were expected. Appetitive aggression describes the perception of violence perpetration as fascinating and appealing and is a common phenomenon in former combatants. Semi-structured interviews were conducted with 157 females, either former combatants, supporters of armed forces or civilians during the civil war in Burundi. The PTSD Symptom Scale Interview was used to assess PTSD symptom severity, the Appetitive Aggression Scale to measure appetitive aggression and the Domestic and Community Violence Checklist to assess both childhood maltreatment and recent aggressive behavior. Former combatants had experienced more traumatic events, perpetrated more violence and reported higher levels of appetitive aggression than supporters and civilians. They also suffered more severely from PTSD symptoms than civilians but not than supporters. The groups did not differ regarding childhood maltreatment. Both appetitive aggression and childhood violence predicted ongoing aggressive behavior, whereas the latter outperformed PTSD symptom severity. These findings support current research showing that adverse childhood experiences and a positive attitude towards aggression serve as the basis for aggressive behavior and promote an ongoing cycle of violence in post-conflict regions. Female members of armed groups are in need of demobilization procedures including trauma-related care and interventions addressing appetitive aggression.
Analysis of Error Propagation Within Hierarchical Air Combat Models
values alone are propagated through layers of combat models, the final results will likely be biased, and risk underestimated. An air-to-air...values alone are propagated through layers of combat models, the final results will likely be biased, and risk underestimated. An air-to-air engagement... PROPAGATION WITHIN HIERARCHICAL AIR COMBAT MODELS by Salih Ilaslan June 2016 Thesis Advisor: Thomas W. Lucas Second Reader: Jeffrey
597 Days: A Division's Morale During Sustained Combat
The army broke combat exhaustion into two groups: new replacements and veterans. For new replacements the symptoms of combat exhaustion appeared...through the initial effects of combat to fall into the veteran group. The manifestation of symptoms for veterans generally occurred around the 120th...concentrated strength" that the German Army was simply overrun. The battle turned into a " gigantic mopping- up operation," one that saw the Red Bulls solidify
Medical rescue of naval combat: challenges and future
Jin, Hai; Hou, Li-Jun; Fu, Xiao-Bing
There has been no large-scale naval combat in the last 30?years. With the rapid development of battleships, weapons manufacturing and electronic technology, naval combat will present some new characteristics. Additionally, naval combat is facing unprecedented challenges. In this paper, we discuss the topic of medical rescue at sea: what challenges we face and what we could do. The contents discussed in this paper contain battlefield self-aid buddy care, clinical skills, organized health servi...
Termination of Resuscitation Rules to Predict Neurological Outcomes in Out-of-Hospital Cardiac Arrest for an Intermediate Life Support Prehospital System.
Cheong, Randy Wang Long; Li, Huihua; Doctor, Nausheen Edwin; Ng, Yih Yng; Goh, E Shaun; Leong, Benjamin Sieu-Hon; Gan, Han Nee; Foo, David; Tham, Lai Peng; Charles, Rabind; Ong, Marcus Eng Hock
Futile resuscitation can lead to unnecessary transports for out-of-hospital cardiac arrest (OHCA). The Basic Life Support (BLS) and Advanced Life Support (ALS) termination of resuscitation (TOR) guidelines have been validated with good results in North America. This study aims to evaluate the performance of these two rules in predicting neurological outcomes of OHCA patients in Singapore, which has an intermediate life support Emergency Medical Services (EMS) system. A retrospective cohort study was carried out on Singapore OHCA data collected from April 2010 to May 2012 for the Pan-Asian Resuscitation Outcomes Study (PAROS). The outcomes of each rule were compared to the actual neurological outcomes of the patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and predicted transport rates of each test were evaluated. A total of 2,193 patients had cardiac arrest of presumed cardiac etiology. TOR was recommended for 1,411 patients with the BLS-TOR rule, with a specificity of 100% (91.9, 100.0) for predicting poor neurological outcomes, PPV 100% (99.7, 100.0), sensitivity 65.7% (63.6, 67.7), NPV 5.6% (4.1, 7.5), and transportation rate 35.6%. Using the ALS-TOR rule, TOR was recommended for 587 patients, specificity 100% (91.9, 100.0) for predicting poor neurological outcomes, PPV 100% (99.4, 100.0), sensitivity 27.3% (25.4, 29.3), NPV 2.7% (2.0, 3.7), and transportation rate 73.2%. BLS-TOR predicted survival (any neurological outcome) with specificity 93.4% (95% CI 85.3, 97.8) versus ALS-TOR 98.7% (95% CI 92.9, 99.8). Both the BLS and ALS-TOR rules had high specificities and PPV values in predicting neurological outcomes, the BLS-TOR rule had a lower predicted transport rate while the ALS-TOR rule was more accurate in predicting futility of resuscitation. Further research into unique local cultural issues would be useful to evaluate the feasibility of any system-wide implementation of TOR.
Using education and support strategies to improve the way nurses assess regular and transient pain - A quality improvement study of three hospitals.
Peterson, Anna; Carlfjord, Siw; Schaller, Anne; Gerdle, Björn; Larsson, Britt
Systematic and regular pain assessment has been shown to improve pain management. Well-functioning pain assessments require using strategies informed by well-established theory. This study evaluates documented pain assessments reported in medical records and by patients, including reassessment using a Numeric Rating Scale (NRS) after patients receive rescue medication. Documentation surveys (DS) and patient surveys (PS) were performed at baseline (BL), after six months, and after 12 months in 44 in-patient wards at the three hospitals in Östergötland County, Sweden. Nurses and nurse assistants received training on pain assessment and support. The Knowledge to Action Framework guided the implementation of new routines. According to DS pain assessment using NRS, pain assessment increased significantly: from 7% at baseline to 36% at 12 months (peducation and support strategies, systematic pain assessment increased, an encouraging finding considering the complex contexts of in-patient facilities. However, the achieved assessment levels and especially reassessments related to rescue medication were clinically unsatisfactory. Future studies should include nursing staff and physicians and increase interactivity such as providing online education support. A discrepancy between documented and reported reassessment in association with given rescue medication might indicate that nurses need better ways to provide pain relief. The fairly low level of patient-reported pain via NRS and documented use of NRS before and 12 months after the educational programme stresses the need for education on pain management in nursing education. Implementations differing from traditional educational attempts such as interactive implementations might complement educational programmes given at the work place. Standardized routines for pain management that include the possibility for nurses to deliver pain medication within well-defined margins might improve pain management and increase the use
Medical rescue of naval combat: challenges and future.
Jin, Hai; Hou, Li-Jun; Fu, Xiao-Bing
There has been no large-scale naval combat in the last 30 years. With the rapid development of battleships, weapons manufacturing and electronic technology, naval combat will present some new characteristics. Additionally, naval combat is facing unprecedented challenges. In this paper, we discuss the topic of medical rescue at sea: what challenges we face and what we could do. The contents discussed in this paper contain battlefield self-aid buddy care, clinical skills, organized health services, medical training and future medical research programs. We also discuss the characteristics of modern naval combat, medical rescue challenges, medical treatment highlights and future developments of medical rescue at sea.
The combat film : the death and rebirth of an American film tradition
Greve, Henrik Havdal
Abstract This thesis analyzes how four popular combat films produced by Hollywood portray and interprets important events in American history. The films exemplify how American cinema has varied in its portrayal of the American army in relation to both the perspectives of the film makers and widely held attitudes toward war and American foreign policy. In regard to social attitudes, militarism has been an instrument to create support for war. The term describes a process where a societ...
Diabetes in Combat: Effect of Military Deployment on Diabetes Mellitus in Air Force Personnel
FROM: 59 MDW/SGVU SUBJECT: Professional Presentation Approval 16 MAR 201 7 1. Your paper, entitled Diabetes in Combat: Effect of Military Deployment...your presentation was given. At that time, we will need the date (month, day and year) along with the location of your presentation. It is...important to update this information so that we can provide quality support for you, your department, and the Medical Center commander. This information is
A model of antibiotic-resistant bacterial epidemics in hospitals
Webb, Glenn F.; D'Agata, Erika M. C.; Magal, Pierre; Ruan, Shigui
The emergence of drug-resistant strains of bacteria is an increasing threat to society, especially in hospital settings. Many antibiotics that were formerly effective in combating bacterial infections in hospital patients are no longer effective because of the evolution of resistant strains, which compromises medical care worldwide. In this article, we formulate a two-level population model to quantify key elements in nosocomial (hospital-acquired) infections. At the bacteria level, patients ...
Psicoterapia de grupo de apoio multifamiliar (PGA em hospital-dia (HD psiquiátrico Multifamily support group psychotherapy for relatives (SGR in a psychiatric day hospital program (DH
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José Onildo B. Contel
Full Text Available INTRODUÇÃO: O familiar é a ponte, entre o ambiente da casa do paciente e o ambiente terapêutico do hospital-dia (HD, onde o paciente permanece das 7h30 às 15h30, de segunda a sexta-feira. A complexidade para a integração do exercício dessa tarefa e suas conseqüências para o tratamento em HD, levou-nos a criar a Psicoterapia de Grupo de Apoio multifamiliar (PGA para facilitar o exame das vissicitudes desta via de duas mãos entre a residência e o HD. OBJETIVOS: As características, liderança e fatores terapêuticos de Yalom nessa PGA serão objetos do presente trabalho MÉTODO: A PGA é um grupo aberto com 1 h e 15 minutos de duração, de freqüência semanal e com coordenação, em coterapia, de um psicoterapeuta de grupo e de uma enfermeira psiquiátrica. RESULTADOS E DISCUSSÃO: Os resultados foram obtidos pelo exame de 20 grupos sucessivos, tanto após cada sessão, pelos coterapeutas e observador mudo, durante 20-30 min, como pela análise de conteúdo de 20 sessões transcritas. A presença sempre foi maior que 80% dos familiares esperados, com predomínio de mulheres, especialmente mães de pacientes. A estrutura oferecida pela liderança apressou a obtenção de resultados no curto prazo, entre 4 a 6 sessões. A Coesão Grupal de Yalom apareceu em situações comuns e criou um senso de união entre todos. CONCLUSÃO: A adesão de familiares à PGA facilita e abrevia a terapia em HD. Questiona-se quanto, no futuro, a família orientada assumirá na condução do tratamento dos seus pacientes.INTRODUCTION: The relative is the bridge between the patient's home environment and the therapeutic environment of the day-hospital (DH. The difficulties for the relative to play this task gave birth to the multi-family support group therapy (SGR. To describe the features, leadership and Yalom's therapeutic factors in the SGR is the aim of this paper. METHOD: The SGR is an open group that last for one hour and 15 minutes, meets once weekly
Networked sensors for the combat forces
Klager, Gene
Real-time and detailed information is critical to the success of ground combat forces. Current manned reconnaissance, surveillance, and target acquisition (RSTA) capabilities are not sufficient to cover battlefield intelligence gaps, provide Beyond-Line-of-Sight (BLOS) targeting, and the ambush avoidance information necessary for combat forces operating in hostile situations, complex terrain, and conducting military operations in urban terrain. This paper describes a current US Army program developing advanced networked unmanned/unattended sensor systems to survey these gaps and provide the Commander with real-time, pertinent information. Networked Sensors for the Combat Forces plans to develop and demonstrate a new generation of low cost distributed unmanned sensor systems organic to the RSTA Element. Networked unmanned sensors will provide remote monitoring of gaps, will increase a unit"s area of coverage, and will provide the commander organic assets to complete his Battlefield Situational Awareness (BSA) picture for direct and indirect fire weapons, early warning, and threat avoidance. Current efforts include developing sensor packages for unmanned ground vehicles, small unmanned aerial vehicles, and unattended ground sensors using advanced sensor technologies. These sensors will be integrated with robust networked communications and Battle Command tools for mission planning, intelligence "reachback", and sensor data management. The network architecture design is based on a model that identifies a three-part modular design: 1) standardized sensor message protocols, 2) Sensor Data Management, and 3) Service Oriented Architecture. This simple model provides maximum flexibility for data exchange, information management and distribution. Products include: Sensor suites optimized for unmanned platforms, stationary and mobile versions of the Sensor Data Management Center, Battle Command planning tools, networked communications, and sensor management software. Details
Casualties of War: Combat Trauma and the Return of the Combat Veteran
Kiely, Denis O.; Swift, Lisa
The experience of the combat soldier and the road back to civilian life are recurrent themes in American literature and cinema. Whether the treatment is tragic (Stephen Crane's "Red Badge of Courage", Tim O'Brien's "The Things They Carried", or Tony Scott's "Blackhawk Down"), satirical (Joseph Heller's "Catch Twenty-Two" and Robert Altman's…
Women in Combat: The Medical and Behavioral Health Effects on Women Who Have Served in Combat
urinary tract infections or bacterial vaginosis while deployed, and with limited medical care available, could lead to long-term reproductive issues......experience (Gaylord 2006). Several studies have been conducted on pregnancy outcomes in female Soldiers who have deployed to combat, such as fertility
Online fathering: the experience of first-time fatherhood in combat-deployed troops.
Schachman, Kathleen A
More than 90% of fathers in the United States attend the births of their children. Each year, thousands of fathers are absent during this important life transition because of military deployment in combat regions; however, it is unknown how this population experiences new fatherhood. The purpose of this study was to explore the lived experience of first-time fatherhood from the unique perspective of military men deployed to combat regions during birth. A phenomenological approach was used. Seventeen men who were stationed in Okinawa, Japan, and had returned recently from a combat deployment participated. Unstructured, in-depth interviews were conducted 2 to 6 months after the births. Interviews were audiotaped, transcribed, and analyzed using Colaizzi's method. Disruption of the protector and provider role was a main theme that encompassed four theme clusters: (a) worry-a traumatic and lonely childbirth; (b) lost opportunity; (c) guilt-an absent father; and (d) fear of death and dismemberment-who will be the father? Although their absence interfered with their ability to fulfill the fatherhood role as they perceived it, this was offset by the theme cluster Communication: The ties that bind, highlighting the role of online communication with their partner (e.g., e-mail, instant messaging, Facebook, blogs, and chat rooms) in restoring balance to the protector and provider role. Insight is provided into the needs of first-time fathers who are combat-deployed during the births of their babies. Understanding these experiences assists nurses in identifying better ways to prepare and to support men in an involved fatherhood role, despite the limitations of a stressful combat environment and geographic separation. This information can set the stage for a healthy reunion, which may take place at military bases and within communities across the globe, and thus is of benefit to all nurses working with military families.
Sleep quality affects cognitive functioning in returning combat veterans beyond combat exposure, PTSD, and mild TBI history.
Martindale, Sarah L; Morissette, Sandra B; Rowland, Jared A; Dolan, Sara L
The purpose of this study was to determine how sleep quality affects cognitive functioning in returning combat veterans after accounting for effects of combat exposure, posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI) history. This was a cross-sectional assessment study evaluating combat exposure, PTSD, mTBI history, sleep quality, and neuropsychological functioning. One hundred and nine eligible male Iraq/Afghanistan combat veterans completed an assessment consisting of a structured clinical interview, neuropsychological battery, and self-report measures. Using partial least squares structural equation modeling, combat experiences and mTBI history were not directly associated with sleep quality. PTSD was directly associated with sleep quality, which contributed to deficits in neuropsychological functioning independently of and in addition to combat experiences, PTSD, and mTBI history. Combat experiences and PTSD were differentially associated with motor speed. Sleep affected cognitive function independently of combat experiences, PTSD, and mTBI history. Sleep quality also contributed to cognitive deficits beyond effects of PTSD. An evaluation of sleep quality may be a useful point of clinical intervention in combat veterans with cognitive complaints. Improving sleep quality could alleviate cognitive complaints, improving veterans' ability to engage in treatment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Reduction of the nosocomial meticillin-resistant Staphylococcus aureus incidence density by a region-wide search and follow-strategy in forty German hospitals of the EUREGIO, 2009 to 2011
Jurke, A; Kock, R; Becker, K; Thole, S; Hendrix, R; Rossen, J; Daniels-Haardt, I; Friedrich, AW
Meticillin-resistant Staphylococcus aureus (MRSA) disseminates between hospitals serving one patient catchment area. Successful prevention and control requires concerted efforts and regional surveillance. Forty hospitals located in the German EUREGIO have established a network for combating MRSA. In
Mitigation approaches to combat the flu pandemic
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Raman Chawla
The National Disaster Management Authority (NDMA, Government of India, with the active cooperation of UN agencies and other stakeholders/experts has formulated a concept paper on role of nonhealth service providers during pandemics in April 2008 and released national guidelines - management of biological disasters in July 2008. These guidelines enumerate that the success of medical management endeavors like pharmaceutical (anti-viral Oseltamivir and Zanamivir therapies, nonpharmaceutical interventions and vaccination development etc., largely depends on level of resistance offered by mutagenic viral strain and rationale use of pharmaco therapeutic interventions. This article describes the mitigation approach to combat flu pandemic with its effective implementation at national, state and local levels.
Combating infection in developing countries. The IAEA contribution
International Nuclear Information System (INIS)
Groth, Stefan; Khan, Baldip; Padhy, Ajit; Soo Ling Ch'ng; Soricelli, Andreas; Yanfen Xie; Ford, JoAnne
Control of infection and infectious diseases is an international priority. Worldwide infectious diseases are responsible for an estimated 13 million deaths each year, exacting a large and disproportionately high toll in developing countries. Forty-three percent of all deaths in developing countries are due to infectious diseases, whereas the corresponding figure for developed countries is only 1%. A large proportion of these deaths could be prevented if timely diagnosis and effective treatment were available locally. Loss of life or productivity due to infectious disease is not just a health matter, it also has an important social and economic impact on individuals, families, regions, and countries. According to the World Health Organization, infectious diseases are now the world's largest killer of young adults and children. Hundreds of millions of people are disabled by infectious disease. The economic impact of repeated episodes of illness and long term disability is a major cause of underdevelopment in many countries today. For example, according to the WHO 1999 Infectious Disease Report, malaria alone has cost Africa billions of dollars in the past decade. More recently, a WHO study estimates that malaria slows economic growth in Africa by up to 1.3% each year and that malaria-free countries average three times higher gross domestic product per person than do malarious countries. This brochure highlights the role of the International Atomic Energy Agency (IAEA) in disseminating nuclear techniques to combat infection and infectious disease. Some of the techniques are used to diagnose and manage infectious diseases of serious concern to developing countries - malaria, tuberculosis, hepatitis, and Chagas disease. Other techniques are used to detect infection sites in the body, in bones, and organs. The challenges posed by infection and infectious disease and the nuclear techniques that the Agency offers for support illustrate how nuclear techniques can be used to
The incidence of and risk factors for emergence delirium in U.S. military combat veterans.
McGuire, Jason M
The purpose of this research was to identify the incidence and potential risk factors for emergence delirium (ED) in a U.S. military combat veteran surgical population at Naval Hospital Camp Pendleton. ED is a postanesthetic phenomenon that occurs immediately after emergence from general anesthesia and is characterized by agitation, confusion, and violent behavior. Clinical evidence suggests that ED is increasingly seen among military personnel returning from the wars in Iraq and Afghanistan, and that the incidence of anxiety, depression, and post-traumatic stress disorder (PTSD) are higher in this population than in noncombat troops or nonmilitary populations. The incidence of ED in this sample of 130 postoperative military personnel with combat exposure was 20% (n=26). Those previously diagnosed with a psychological disorder had a higher rate of ED (50%) than those who did not (17.5%), χ(2)=5.53, PPTSD symptoms, and depression [state anxiety: r(128)=0.40, PPTSD: r(128)=0.35, PPTSD, and depression as risk factors. Regression modeling suggested that state-anxiety served as the best predictor. These findings increase clinicians' understanding of ED among combat veterans and give direction to future studies that should focus on preventive treatment. Published by Elsevier Inc.
University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....
The Potential Utility of Urinary Biomarkers for Risk Prediction in Combat Casualties: A Prospective Observational Cohort Study
Methods The study took place at Craig Joint Theater Hospital (CJTH) in Bagram Airfield, Afghanistan from October 2012 to December 2013. We included US...explain why we failed to observe an association be- tween KIM-1 and the combined outcome. There is evidence that elevated UBs even in the ab- sence of...several limitations. We had initially sought to enroll 226 subjects; however, the study took place during a drawdown of combat forces in Afghanistan
Survival curves to support quality improvement in hospitals with excess 30-day mortality after acute myocardial infarction, cerebral stroke and hip fracture: a before-after study.
Kristoffersen, Doris Tove; Helgeland, Jon; Waage, Halfrid Persdatter; Thalamus, Jacob; Clemens, Dirk; Lindman, Anja Schou; Rygh, Liv Helen; Tjomsland, Ole
To evaluate survival curves (Kaplan-Meier) as a means of identifying areas in the clinical pathway amenable to quality improvement. Observational before-after study. In Norway, annual public reporting of nationwide 30-day in-and-out-of-hospital mortality (30D) for three medical conditions started in 2011: first time acute myocardial infarction (AMI), stroke and hip fracture; reported for 2009. 12 of 61 hospitals had statistically significant lower/higher mortality compared with the hospital mean. Three hospitals with significantly higher mortality requested detailed analyses for quality improvement purposes: Telemark Hospital Trust Skien (AMI and stroke), Østfold Hospital Trust Fredrikstad (stroke), Innlandet Hospital Trust Gjøvik (hip fracture). Survival curves, crude and risk-adjusted 30D before (2008-2009) and after (2012-2013). Unadjusted survival curves for the outlier hospitals were compared to curves based on pooled data from the other hospitals for the 30-day period 2008-2009. For patients admitted with AMI (Skien), stroke (Fredrikstad) and hip fracture (Gjøvik), the curves suggested increased mortality from the initial part of the clinical pathway. For stroke (Skien), increased mortality appeared after about 8 days. The curve profiles were thought to reflect suboptimal care in various phases in the clinical pathway. This informed improvement efforts. For 2008-2009, hospital-specific curves differed from other hospitals: borderline significant for AMI (p=0.064), highly significant (p≤0.005) for the remainder. After intervention, no difference was found (p>0.188). Before-after comparison of the curves within each hospital revealed a significant change for Fredrikstad (p=0.006). For the three hospitals, crude 30D declined and they were non-outliers for risk-adjusted 30D for 2013. Survival curves as a supplement to 30D may be useful for identifying suboptimal care in the clinical pathway, and thus informing design of quality improvement projects
The role of science education for combating and preventing diseases
International Nuclear Information System (INIS)
Ghaffar, A.
In most developing countries, the role of science education for combating and preventing diseases is both minimal and impracticable. There are two main reasons to this: i) lack of medical knowledge; and ii) lack of practical knowledge. These consequences may be a result of exclusion of medically trained people in the education system, e.g. in our education systems, there is no established trend of medical doctors to teach at school, college or even at university levels. There is a provision of medical education at teaching hospitals, but they still lack the right educationists and latest trainings at par with global standards. In order to consolidate the concept and promotion of science education in the field of health and medicine, this paper discusses four diseases commonly found in developing countries like Pakistan. These diseases are Poliomyelitis, Malaria, Rabies and Typhoid. The disability/mortality due to Poliomyelitis; the morbidity and mortality as a result of Malaria and Typhoid fever, and a very high death rate (up to 5000/year) as a result of dog bites (Rabies) are reported in Pakistan. The study takes into account myths and mysteries related to these diseases and their consequences/complications leading to mortality. This study is focused on the prophylactic measures (prophylaxis), as an ounce of prevention is worth a pound of cure. Prophytactic measures can only be taken by creating awareness about these diseases and re-evaluation of the role of science education in all sectors. (author)
The role of science education for combating and preventing diseases
Energy Technology Data Exchange (ETDEWEB)
Ghaffar, A. [COMSATS Inst. of Information Technology, Islamabad (Pakistan). Dept. of Meteorology; Tariq, S. [Department of Meteorology, Islamabad (Pakistan)
In most developing countries, the role of science education for combating and preventing diseases is both minimal and impracticable. There are two main reasons to this: i) lack of medical knowledge; and ii) lack of practical knowledge. These consequences may be a result of exclusion of medically trained people in the education system, e.g. in our education systems, there is no established trend of medical doctors to teach at school, college or even at university levels. There is a provision of medical education at teaching hospitals, but they still lack the right educationists and latest trainings at par with global standards. In order to consolidate the concept and promotion of science education in the field of health and medicine, this paper discusses four diseases commonly found in developing countries like Pakistan. These diseases are Poliomyelitis, Malaria, Rabies and Typhoid. The disability/mortality due to Poliomyelitis; the morbidity and mortality as a result of Malaria and Typhoid fever, and a very high death rate (up to 5000/year) as a result of dog bites (Rabies) are reported in Pakistan. The study takes into account myths and mysteries related to these diseases and their consequences/complications leading to mortality. This study is focused on the prophylactic measures (prophylaxis), as an ounce of prevention is worth a pound of cure. Prophytactic measures can only be taken by creating awareness about these diseases and re-evaluation of the role of science education in all sectors. (author)
Energy Harvesting Combat Boot for Satellite Positioning
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Haluk Akay
Full Text Available Most portable electronic devices are power-limited by battery capacity, and recharging these batteries often interrupts the user's experience with the device. The product presented in this paper provides an alternative to powering portables by converting regular human walking motion to electricity. The device harvests electric power using air bulbs, distributed in the sole of a shoe to drive a series of micro-turbines connected to small DC motors. The number and position of air bulbs is optimized to harvest the maximum airflow from each foot-strike. The system is designed to continuously drive the micro-turbines by utilizing both outflow and inflow from the air bulbs. A prototype combat boot was fitted on the right foot of a 75 kg test subject, and produced an average continuous power on the order of 10 s of mW over a 22 Ω load during walking at 3.0 mph. This combat boot provides enough electric power to a passive GPS tracker that periodically relays geographical coordinates to a smartphone via satellite without battery replacement.
Promotion of good governance and combating corruption and ...
African Journals Online (AJOL)
Melvin Mbao and G.G Komboni criticise the legal regime and institutional arrangements designed to promote good government and to combat corruption and maladministration in Botswana, a country widely acclaimed as Africa's success story. Using internationally accepted benchmarks on good governance and combating ...
Appetitive Aggression in Women: Comparing Male and Female War Combatants
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Danie eMeyer-Parlapanis
Full Text Available Appetitive aggression refers to positive feelings being associated with the perpetration of violent behavior and has been shown to provide resilience against the development of PTSD in combatants returning from the battlefield. Until this point, appetitive aggression has been primarily researched in males. This study investigates appetitive aggression in females. Female and male combatants and civilians from Burundi were assessed for levels of appetitive aggression. In contrast to non-combatants, no sex difference in appetitive aggression could be detected for combatants. Furthermore, each of the female and male combatant groups displayed substantially higher levels of appetitive aggression than each of the male and female civilian control groups. This study demonstrates that in violent contexts, such as armed conflict, in which individuals perpetrate numerous aggressive acts against others, the likelihood for an experience of appetitive aggression increases- regardless of whether the individuals are male or female.
Development of data analysis tool for combat system integration
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Seung-Chun Shin
Full Text Available System integration is an important element for the construction of naval combat ships. In particular, because impeccable combat system integration together with the sensors and weapons can ensure the combat capability and survivability of the ship, the integrated performance of the combat system should be verified and validated whether or not it fulfills the requirements of the end user. In order to conduct systematic verification and validation, a data analysis tool is requisite. This paper suggests the Data Extraction, Recording and Analysis Tool (DERAT for the data analysis of the integrated performance of the combat system, including the functional definition, architecture and effectiveness of the DERAT by presenting the test results.
A naturalistic decision making model for simulated human combatants
International Nuclear Information System (INIS)
The authors describe a naturalistic behavioral model for the simulation of small unit combat. This model, Klein's recognition-primed decision making (RPD) model, is driven by situational awareness rather than a rational process of selecting from a set of action options. They argue that simulated combatants modeled with RPD will have more flexible and realistic responses to a broad range of small-scale combat scenarios. Furthermore, they note that the predictability of a simulation using an RPD framework can be easily controlled to provide multiple evaluations of a given combat scenario. Finally, they discuss computational issues for building an RPD-based behavior engine for fully automated combatants in small conflict scenarios, which are being investigated within Sandia's Next Generation Site Security project
Psycho-physiological response of soldiers in urban combat
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Vicente J. Clemente-Suárez
Full Text Available Current armed conflicts are asymmetrical and are developed m urban areas. These new requirements have not been studied for current literature. The aim of this study was to analyse changes in cortical arousal, blood lactate, muscle strength, autonomic modulation and rate of perceived exertion in a simulated urban combat. We analyzed 20 soldiers before and after an urban combat simulation. The results showed how urban combat produced high sympathetic nervous system activation, increasing the muscle strength, heart rate and blood lactate concentration of the soldiers. Despite this effort, rate of perceived exertion were not consistent with the physiological response that soldiers presented, the rate of perceived exertion was lower than the physiological response evaluated. Furthermore, the information processing and cortical arousal decreased after the urban combat simulation. These results have showed the psycho-physiological response of soldiers in combat, helping to better understanding and enabling an improvement of current training methods of soldiers.
Physiological Implications, Performance Assessment and Risk Mitigation Strategies of Women in Combat-Centric Occupations.
Greeves, Julie P
Women have historically featured in military conflicts, but were not formally integrated into the military until the 20th century; occupations were mainly restricted to clerical or support roles. An increasing number of occupations have been opened to women and the higher physical demands of combat roles present new challenges. Inherent biological differences between sexes require women to work harder when undertaking the same tasks as men. This is reflected, in part, by the greater risk of musculoskeletal injuries of women observed notably during integrated military training. Gender "neutral" occupational standards, based on the physical requirements of the role, will ensure that women are suitably selected to cope with the demands of military tasks with a minimal risk of injury and to operational effectiveness. Initiatives such as reduced running mileage and single-sex training have contributed to a reduction in lower-limb musculoskeletal injuries, but the risk of injury remains higher in women. Nevertheless, women experience substantial gains in aerobic power and strength with appropriate and targeted training, narrowing the gap in physical performance between the sexes. Evidence-based occupational standards and optimal training programs provide short-term solutions for integrating women in support combat, and indeed direct combat roles.
Nuclear or conventional power for surface combatant ships: Department of the Navy. Report to the Congress
International Nuclear Information System (INIS)
GAO reviewed the controversy over whether the Navy's major surface combatant ships should be all nuclear powered, all conventionally powered, or a mix of both. Nuclear ships are more capable but cost more and their relative cost-effectiveness cannot be measured because Navy analysts cannot quantify many benefits of nuclear power. The Congress, in reviewing Navy shipbuilding plans for surface combatant ships, should be cognizant that buying only conventional ships will maximize naval firepower; buying only nuclear ships will provide mobility and greater freedom from logistics support; and buying a mix is a third option providing, to varying degrees, the advantages and disadvantages of the all-nuclear and all-conventional options
Anger, impulsivity, and anger control in combat-related posttraumatic stress disorder.
Chemtob, C M; Hamada, R S; Roitblat, H L; Muraoka, M Y
Empirical evidence of a relationship between combat-related PTSD and increased anger is lacking. In this study, 24 veterans of the Vietnam War with posttraumatic stress disorder (PTSD) scored significantly higher on an Anger factor comprising multiple measures of anger than did comparison groups of 23 well-adjusted Vietnam combat veterans and 12 noncombat Vietnam-era veterans with psychiatric diagnoses. In contrast, the 3 groups did not differ significantly on orthogonal factors, one of which comprised cognitive impulsivity measures and the other of which reflected motor impulsivity. Changes in heart rate in response to provocation loaded positively on the Anger factor and negatively on the 2 Impulsivity factors. Concurrent depression and trait anxiety did not have an effect on level of anger in individuals with PTSD. These empirical findings support and extend the clinical evidence regarding PTSD and anger.
Combating cancer one step at a time
Directory of Open Access Journals (Sweden)
R.N Sugitha Nadarajah
widespread consequences, not only in a medical sense but also socially and economically," says Dr. Abdel-Rahman. "We need to put in every effort to combat this fatal disease," he adds.Tackling the spread of cancer and the increase in the number of cases reported every year is not without its challenges, he asserts. "I see the key challenges as the unequal availability of cancer treatments worldwide, the increasing cost of cancer treatment, and the increased median age of the population in many parts of the world, which carries with it a consequent increase in the risk of certain cancers," he says. "We need to reassess the current pace and orientation of cancer research because, with time, cancer research is becoming industry-oriented rather than academia-oriented — which, in my view, could be very dangerous to the future of cancer research," adds Dr. Abdel-Rahman. "Governments need to provide more research funding to improve the outcome of cancer patients," he explains.His efforts and hard work have led to him receiving a number of distinguished awards, namely the UICC International Cancer Technology Transfer (ICRETT fellowship in 2014 at the Investigational New Drugs Unit in the European Institute of Oncology, Milan, Italy; EACR travel fellowship in 2015 at The Christie NHS Foundation Trust, Manchester, UK; and also several travel grants to Ireland, Switzerland, Belgium, Spain, and many other countries where he attended medical conferences. Dr. Abdel-Rahman is currently engaged in a project to establish a clinical/translational cancer research center at his institute, which seeks to incorporate various cancer-related disciplines in order to produce a real bench-to-bedside practice, hoping that it would "change research that may help shape the future of cancer therapy".Dr. Abdel-Rahman is also an active founding member of the clinical research unit at his institute and is a representative to the prestigious European Organization for Research and
Control coordination abilities in shock combat sports
Directory of Open Access Journals (Sweden)
Natalya Boychenko
Full Text Available Purpose: optimize the process control level of coordination abilities in martial arts. Material and Methods: analysis and compilation of scientific and methodological literature, interviews with coaches of drum martial arts, video analysis techniques, teacher observations. Results: identified specific types of coordination abilities in shock combat sports. Pod branny and offered specific and nonspecific tests to monitor the level of species athletes coordination abilities. Conclusion: it is determined that in order to achieve victory in the fight martial artists to navigate the space to be able to assess and manage dynamic and spatio-temporal parameters of movements, maintain balance, have a high coordination of movements. The proposed tests to monitor species coordination abilities athletes allow an objective assessment of not only the overall level of coordination, and the level of specific types of manifestations of this ability.
Combating Memory Corruption Attacks On Scada Devices
Bellettini, Carlo; Rrushi, Julian
Memory corruption attacks on SCADA devices can cause significant disruptions to control systems and the industrial processes they operate. However, despite the presence of numerous memory corruption vulnerabilities, few, if any, techniques have been proposed for addressing the vulnerabilities or for combating memory corruption attacks. This paper describes a technique for defending against memory corruption attacks by enforcing logical boundaries between potentially hostile data and safe data in protected processes. The technique encrypts all input data using random keys; the encrypted data is stored in main memory and is decrypted according to the principle of least privilege just before it is processed by the CPU. The defensive technique affects the precision with which attackers can corrupt control data and pure data, protecting against code injection and arc injection attacks, and alleviating problems posed by the incomparability of mitigation techniques. An experimental evaluation involving the popular Modbus protocol demonstrates the feasibility and efficiency of the defensive technique.
Mitigation approaches to combat the flu pandemic.
Chawla, Raman; Sharma, Rakesh Kumar; Madaan, Deepali; Dubey, Neha; Arora, Rajesh; Goel, Rajeev; Singh, Shefali; Kaushik, Vinod; Singh, Pankaj Kumar; Chabbra, Vivek; Bhardwaj, Janak Raj
Management of flu pandemic is a perpetual challenge for the medical fraternity since time immemorial. Animal to human transmission has been observed thrice in the last century within an average range of 11-39 years of antigenic recycling. The recent outbreak of influenza A (H1N1, also termed as swine flu), first reported in Mexico on April 26, 2009, occurred in the forty first year since last reported flu pandemic (July 1968). Within less than 50 days, it has assumed pandemic proportions (phase VI) affecting over 76 countries with 163 deaths/35,928 cases (as on 15(th) June 2009). It indicated the re-emergence of genetically reassorted virus having strains endemic to humans, swine and avian (H5N1). The World Health Organisation (WHO) member states have already pulled up their socks and geared up to combat such criticalities. Earlier outbreaks of avian flu (H5N1) in different countries led WHO to develop pandemic preparedness strategies with national/regional plans on pandemic preparedness. Numerous factors related to climatic conditions, socio-economic strata, governance and sharing of information/logistics at all levels have been considered critical indicators in monitoring the dynamics of escalation towards a pandemic situation.The National Disaster Management Authority (NDMA), Government of India, with the active cooperation of UN agencies and other stakeholders/experts has formulated a concept paper on role of nonhealth service providers during pandemics in April 2008 and released national guidelines - management of biological disasters in July 2008. These guidelines enumerate that the success of medical management endeavors like pharmaceutical (anti-viral Oseltamivir and Zanamivir therapies), nonpharmaceutical interventions and vaccination development etc., largely depends on level of resistance offered by mutagenic viral strain and rationale use of pharmaco therapeutic interventions. This article describes the mitigation approach to combat flu pandemic with
Mitigation Approaches to Combat the Flu Pandemic
Chawla, Raman; Sharma, Rakesh Kumar; Madaan, Deepali; Dubey, Neha; Arora, Rajesh; Goel, Rajeev; Singh, Shefali; Kaushik, Vinod; Singh, Pankaj Kumar; Chabbra, Vivek; Bhardwaj, Janak Raj
Management of flu pandemic is a perpetual challenge for the medical fraternity since time immemorial. Animal to human transmission has been observed thrice in the last century within an average range of 11-39 years of antigenic recycling. The recent outbreak of influenza A (H1N1, also termed as swine flu), first reported in Mexico on April 26, 2009, occurred in the forty first year since last reported flu pandemic (July 1968). Within less than 50 days, it has assumed pandemic proportions (phase VI) affecting over 76 countries with 163 deaths/35,928 cases (as on 15th June 2009). It indicated the re-emergence of genetically reassorted virus having strains endemic to humans, swine and avian (H5N1). The World Health Organisation (WHO) member states have already pulled up their socks and geared up to combat such criticalities. Earlier outbreaks of avian flu (H5N1) in different countries led WHO to develop pandemic preparedness strategies with national/regional plans on pandemic preparedness. Numerous factors related to climatic conditions, socio-economic strata, governance and sharing of information/logistics at all levels have been considered critical indicators in monitoring the dynamics of escalation towards a pandemic situation. The National Disaster Management Authority (NDMA), Government of India, with the active cooperation of UN agencies and other stakeholders/experts has formulated a concept paper on role of nonhealth service providers during pandemics in April 2008 and released national guidelines - management of biological disasters in July 2008. These guidelines enumerate that the success of medical management endeavors like pharmaceutical (anti-viral Oseltamivir and Zanamivir therapies), nonpharmaceutical interventions and vaccination development etc., largely depends on level of resistance offered by mutagenic viral strain and rationale use of pharmaco therapeutic interventions. This article describes the mitigation approach to combat flu pandemic with its
Combating (Child Human Trafficking: Building Capacity
Directory of Open Access Journals (Sweden)
John Winterdyk
Full Text Available The presentation/paper focuses on the challenges and necessity of building capacity at local, national, and international levels with a focus of how to more effectively combat trafficking in human beings (THB. Insight from several of initiatives are shared with the aim of illustrating how to capitalize on the vast number of opportunities that already exist at these levels and how they might be coordinated to enable collaborative work in an informed and dynamic manner to combat human trafficking. Information from several recent research projects that focus on some of these same issues is also incorporated into this paper. El artículo se centra en los desafíos de la lucha contra el tráfico de personas y en la necesidad de aumentar la capacidad para ser más eficaces en ese sentido, local, nacional e internacionalmente. Nos hacemos eco de la visión de varias iniciativas, con el fin de ilustrar cómo capitalizar el gran número de oportunidades que ya existen en los ámbitos citados, y la forma en que se podrían coordinar para posibilitar la colaboración de una manera informada y dinámica para combatir la trata de personas. También se incluye en el artículo información emanada de diversos proyectos recientes de investigación sobre el tema que nos ocupa. DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=3086067
A survey on the measure of combat readiness
Wen, Kwong Fook; Nor, Norazman Mohamad; Soon, Lee Lai
Measuring the combat readiness in military forces involves the measures of tangible and intangible elements of combat power. Though these measures are applicable, the mathematical models and formulae used focus mainly on either the tangible or the intangible elements. In this paper, a review is done to highlight the research gap in the formulation of a mathematical model that incorporates tangible elements with intangible elements to measure the combat readiness of a military force. It highlights the missing link between the tangible and intangible elements of combat power. To bridge the gap and missing link, a mathematical model could be formulated that measures both the tangible and intangible aspects of combat readiness by establishing the relationship between the causal (tangible and intangible) elements and its effects on the measure of combat readiness. The model uses multiple regression analysis as well as mathematical modeling and simulation which digest the capability component reflecting its assets and resources, the morale component reflecting human needs, and the quality of life component reflecting soldiers' state of satisfaction in life. The results of the review provide a mean to bridge the research gap through the formulation of a mathematical model that shows the total measure of a military force's combat readiness. The results also significantly identify parameters for each of the variables and factors in the model.
[Gastrointestinal diseases and abdominal pain in combat veterans].
Pal'tsev, A I; Torgashov, M N; Popova, O S
To analyze the role of consequences of combat stress in the development of gastrointestinal tract (GIT) diseases. One hundred and sixty-one combat veterans aged 24 to 69 years were examined. All underwent a clinical and neurological examination using the McGill pain questionnaire (MPQ), Beck depression inventory, Kotenev trauma stress questionnaire, and visual analogue scale to determine pain intensity. Anxiety, impairments in memory and sleep, and depression were identified. The SF-36 questionnaire was used to estimate quality of life in the patients. Gastric secretory function was investigated; esophagogastroduodenoscopy, X-ray and ultrasound studies, clinical and biochemical blood tests, coprological examinations, fecal tests for dysbiosis, if indicated, occult blood were made. Combat stress and its consequences as posttraumatic stress disorder have been shown to play an important role in the pathogenesis of GIT diseases and in the development of chronic abdominal pain. GIT diseases in combat veterans are in larger measure a sequel of impaired processes of adjustment to combat stress. Chronic abdominal pains were heterogeneous. On the one hand, chronic GIT disease serves as a source of pain syndrome; on the other hand, the central nervous system is of importance in the development of chronic abdominal pain. In addition to therapy for GIT and hepatobiliary diseases, the treatment of GIT diseases in this category of patients involves psychotherapy and neuroprotection, aimed at reducing the consequences of combat stress in combat veterans.
U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...
U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...
IAEA Nobel Peace fund schools for nutrition. Combating child malnutrition
International Nuclear Information System (INIS)
Full text: Dhaka, Bangladesh - Malnutrition remains the world's most serious health problem and the single biggest contributor to child deaths in the developing world, according to the World Bank. Now, the International Atomic Energy Agency (IAEA) is using its Nobel Peace Prize earnings to promote the use of nuclear techniques to combat malnutrition during the earliest years of life. 'One out of every ten children born in developing countries will die before his or her fifth birthday,' explains IAEA nutrition expert Lena Davidsson. 'That's more than 10 million dead children each year. And the vast majority of these child deaths in developing countries are preventable with a combination of good care, adequate nutrition and appropriate medical treatment,' explains Dr. Davidsson. 'This brings us hope that unacceptably high childhood mortality can be substantially reduced with effective and well-targeted nutritional interventions.' Undernutrition is an important factor in more than half of all child deaths worldwide. The high prevalence of infants born with low birth weight and undernutrition among Asian children, especially in South Asia, emphasizes the urgent need to develop effective nutrition interventions within 'the window of opportunity', i.e., to target young women before pregnancy as well as infants and young children during the first 2 years of life. The IAEA Nobel Peace Prize Fund School for Nutrition for Asia will be held in Dhaka, Bangladesh, April 22-26, 2007. It will focus on Interventions to combat undernutrition during early life and seeks to disseminate information about the usefulness of stable isotope techniques in intervention programs that reduce malnutrition, in particular in infants and children. The event is hosted by the Government of Bangladesh through the International Centre for Health and Population Research (ICDDR, B) and the Bangladesh Atomic Energy Commission (BAEC). The IAEA is assisting some of the world's poorest countries in their
Combating Desertification and Mitigating the Effects of Drought
International Nuclear Information System (INIS)
Awuondo, C.O
The paper discusses the effects of desertification and drought on the well-being of humankind and therefore it important for them to be combated and mitigated. Desertification is the process that turns fertile lands into desert; drought is defined as lack of sufficient precipitation to sustain plant and human life. In an effort to discuss how to combat desertification, the author has subdivided the paper into five sections namely; introduction, ecological crisis, strategies for combating desertification and mitigating the effects of drought and finally the conclusion
Combating gender stereotypes in the education system: success stories
Alvarez, Teresa
GEC 2015. Conferência realizada em Helsínquia, de 9-10 october 2014. Conferência de Abertura do Painel 2 – Combating gender stereotypes in the education system: success stories, da Conferência promovida pelo Conselho da Europa sobre "Combating gender stereotypes in and through education". Apresentam-se alguns desafios decorrentes do combate ao sexismo na escola e propõem-se algumas linhas de ação, ao nível individual, coletivo, organizacional e institucional. info:eu-repo/semantics/pub...
Effects of combat training on visuomotor performance in children aged 9 to 12 years - an eye-tracking study.
Ju, Yan-Ying; Liu, Yen-Hsiu; Cheng, Chih-Hsiu; Lee, Yu-Lung; Chang, Shih-Tsung; Sun, Chi-Chin; Cheng, Hsin-Yi Kathy
Data on visuomotor performance in combat training and the effects of combat training on visuomotor performance are limited. This study aimed to investigate the effects of a specially designed combat sports (CS) training program on the visuomotor performance levels of children. A pre-post comparative design was implemented. A total of 26 students aged 9-12 years underwent 40-min CS training sessions twice a week for 8 weeks during their physical education classes. The CS training program was designed by a karate coach and a motor control specialist. The other 30 students continued their regular activities and were considered as a control group. Each student's eye movement was monitored using an eye tracker, whereas the motor performance was measured using a target hitting system with a program-controlled microprocessor. The measurements were taken 8 weeks before (baseline), 1 day before (pretest), and 1 week after (posttest) the designated training program. The task used for evaluating these students was hitting or tracking random illuminated targets as rapidly as possible. A two-way analysis of variance [group(2) × time(3)] with repeated measures of time was performed for statistical analysis. For the children who received combat training, although the eye response improvement was not significant, both the primary and secondary saccade onset latencies were significantly earlier compared to the children without combat training. Both groups of students exhibited improvement in their hit response times during the target hitting tasks. The current finding supported the notion that sports training efforts essentially enhance visuomotor function in children aged 9-12 years, and combat training facilitates an earlier secondary saccade onset.
Dissemination and genetic support of broad-spectrum beta-lactam-resistant Escherichia coli strain isolated from two Tunisian hospitals during 2004-2012.
Ayari, Khaoula; Bourouis, Amel; Chihi, Hela; Mahrouki, Sihem; Naas, Thierry; Belhadj, Omrane
The dissemination of extended-spectrum β-lactamase (ESBL)-producing bacteria presented a great concern worldwide. Gram-negative organisms such as Escherichia coli and Klebsiella pneumoniae are the most frequently isolated pathogens responsible for nosocomial infections. The aim of this study was to investigate and to follow the emergence of resistance and the characterization of Extended-Spectrum Beta-Lactamases (ESBL) among broad-spectrum beta-lactam- Escherichia coli clinical isolates recovered from the military hospital and Habib Thameur hospital in Tunisia. A total of 113 E.coli isolates obtained during the period 2004 through 2012 showed a significant degree of multi-resistance. Among these strains, the double-disk synergy test confirmed the ESBL phenotype in 46 isolates. These included 32(70%) strains from Hospital A and 14(30%) from Hospital B. The ESBL was identified as CTX-M-15. The ESBL resistance was transferred by a 60 kb plasmid CTXM-15-producing isolates were unrelated according to the PFGE analysis and characterization of the regions surrounding the blaCTX-M-15 showed the ISEcp1 elements located in the upstream region of the bla gene and 20 of them truncated by IS26. ESBL producing E. coli strains are a serious threat in the community in Tunisia and we should take into consideration any possible spread of such epidemiological resistance.
Spreadsheet Decision Support Model for Training Exercise Material Requirements Planning
National Research Council Canada - National Science Library
Tringali, Arthur
This thesis focuses on developing a spreadsheet decision support model that can be used by combat engineer platoon and company commanders in determining the material requirements and estimated costs...
Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities.
Good, V S; Saldaña, M; Gilder, R; Nicewander, D; Kennerly, D A
The Institute for Healthcare Improvement encourages use of the Global Trigger Tool to objectively determine and monitor adverse events (AEs). Baylor Health Care System (BHCS) is an integrated healthcare delivery system in North Texas. The Global Trigger Tool was applied to BHCS's eight general acute care hospitals, two inpatient cardiovascular hospitals and two rehabilitation/long-term acute care hospitals. Data were collected from a monthly random sample of charts for each facility for patients discharged between 1 July 2006 and 30 June 2007 by external professional nurse auditors using an MS Access Tool developed for this initiative. In addition to the data elements recommended by Institute for Healthcare Improvement, BHCS developed fields to permit further characterisation of AEs to identify learning opportunities. A structured narrative description of each identified AE facilitated text mining to further characterise AEs. INITIAL FINDINGS: Based on this sample, AE rates were found to be 68.1 per 1000 patient days, or 50.8 per 100 encounters, and 39.8% of admissions were found to have ≥1 AE. Of all AEs identified, 61.2% were hospital-acquired, 10.1% of which were associated with a National Coordinating Council - Medical Error Reporting and Prevention harm score of "H or I" (near death or death). To enhance learning opportunities and guide quality improvement, BHCS collected data-such as preventability and AE source-to characterise the nature of AEs. Data are provided regularly to hospital teams to direct quality initiatives, moving from a general focus on reducing AEs to more specific programmes based on patterns of harm and preventability.
Bi-Directional Tuning of Amygdala Sensitivity in Combat Veterans Investigated with fMRI
Brashers-Krug, Tom; Jorge, Ricardo
Objectives Combat stress can be followed by persistent emotional consequences. It is thought that these emotional consequences are caused in part by increased amygdala reactivity. It is also thought that amygdala hyper-reactivity results from decreased inhibition from portions of the anterior cingulate cortex (ACC) in which activity is negatively correlated with activity in the amygdala. However, experimental support for these proposals has been inconsistent. Methods We showed movies of combat and civilian scenes during a functional magnetic resonance imaging (fMRI) session to 50 veterans of recent combat. We collected skin conductance responses (SCRs) as measures of emotional arousal. We examined the relation of blood oxygenation-level dependent (BOLD) signal in the amygdala and ACC to symptom measures and to SCRs. Results Emotional arousal, as measured with SCR, was greater during the combat movie than during the civilian movie and did not depend on symptom severity. As expected, amygdala signal during the less-arousing movie increased with increasing symptom severity. Surprisingly, during the more-arousing movie amygdala signal decreased with increasing symptom severity. These differences led to the unexpected result that amygdala signal in highly symptomatic subjects was lower during the more-arousing movie than during the less-arousing movie. Also unexpectedly, we found no significant inverse correlation between any portions of the amygdala and ACC. Rather, signal throughout more than 80% of the ACC showed a strong positive correlation with signal throughout more than 90% of the amygdala. Conclusions Amygdala reactivity can be tuned bi-directionally, either up or down, in the same person depending on the stimulus and the degree of post-traumatic symptoms. The exclusively positive correlations in BOLD activity between the amygdala and ACC contrast with findings that have been cited as evidence for inhibitory control of the amygdala by the ACC. The
Report on combating of illicit trafficking. The Illicit Trafficking Combat Project Group. January 2000
International Nuclear Information System (INIS)
of spot-checks, the authority can then convince itself that the operator is fulfilling the requirements. The legislation should also impose heavy sanctions and penalties for all criminal activities related to illicit trafficking. As a direct measure to combat illicit trafficking on the national level, the State supervisory and law enforcement authorities should establish co-operation between themselves and with authorities in other countries and international organisations. Special national committees for combating illicit trafficking should be set up and should use intelligence and open sources information. Regions of States should investigate and implement joint task forces for combating illicit trafficking. Improvements on the International level by the IAEA: The IAEA should assist States in the practical implementation of measures and means for combating illicit trafficking and for the evaluation of threat scenarios. To improve that process in an efficient way, the IAEA should apply the principle of public access to information on its operations to a greater extent. Among other measures for promoting the development of more efficient tools and systems for combating illicit trafficking, the IAEA should: in assisting States, establish rules about duties and responsibilities for operators, authorities and individuals in the NPT area, through appropriate documentation; promote assistance programmes to States in consultation with NPT States, as need may be, of technical equipment and competent staff for the combating of illicit trafficking; provide experts and establish standards and procedures, across borders, for the investigation of serious cases of illicit trafficking, in consultation with national and international nuclear and law enforcement authorities and organisations; incorporate a more modern safeguards inspection technique of the national systems for accountancy and control, in accordance with standards and procedures that were intended to be established
Combating the corporate paper war: Electronic mail abuse
Directory of Open Access Journals (Sweden)
M. M. Botha
Full Text Available The primary objective of the research was to investigate the mailing practices and filing methods in a computer support or administrative environment involving the resulting abuse of paper. In applied research, an exploratory investigation focused on selected higher education institutions in Gauteng with a structured questionnaire as measuring instrument. In the analysis and interpretations of the findings, correlation and cross-tabulation on all sets of variables determined whether any meaningful associations could be found. The investigation indicated that the war against paper abuse is not over by any means. Perceptions regarding a paperless office and assumptions that technology could assist organisations to combat paper abuse were unfounded, mainly because of a lack of guidance, training interventions and control measures. Consequently, follow-up research is presently conducted whereby models will be designed and implemented concomitant with specified computer software features in order to counteract the abuse of paper and facilitate the effective use of information and communication technology interfaced work processes and procedures. This article focuses only on the electronic mail and filing components of the investigation.
Establishing capabilities for combating illicit trafficking: the Syrian experience
International Nuclear Information System (INIS)
Othman, I.; Suman, H.
Since the late 80 's, Syria has been taking steps towards combating illicit trafficking or inadvertent movement involving radioactive or nuclear material within the country or across its border. By applying the proper combination of technical and procedural measures, an acceptable level of performance has been achieved. The measures undertaken by AECS include anticipative measures, which aim at identifying potential loss of control over radioactive sources and potential illicit trafficking within the country, as well as defensive measures which aim at detection of and response to events of illicit trafficking. In addition, a tight follow up of radiation source along their entire lifetime in the Syrian territory, supported by proper data analysis is one of the most efficient tools for identifying potential loss of control over sources. AECS has established Border Monitoring Centers (BMC) in almost all border crossings. They work in close cooperation with the customs and other relevant authorities at the Syrian borders. AECS has been also providing the necessary training for the front-line officers. (author)
Establishing capabilities for combating illicit trafficking: the Syrian experience
International Nuclear Information System (INIS)
Othman, I.; Suman, H.
Since the late 80's, Syria has been taking steps towards combating illicit trafficking or inadvertent movement involving radioactive or nuclear material within the country or across its border. By applying the proper combination of technical and procedural measures, an acceptable level of performance has been achieved. The measures undertaken by AECS include anticipative measures, which aim at identifying potential loss of control over radioactive sources and potential illicit trafficking within the country, as well as defensive measures which aim at detection of and response to events of illicit trafficking. In addition, a tight follow up of radiation source along their entire lifetime in the Syrian territory, supported by proper data analysis is one of the most efficient tools for identifying potential loss of control over sources. AECS has established Border Monitoring Centers (BMC) in almost all border crossings. They work in close cooperation with the customs and other relevant authorities at the Syrian borders. AECS has been also providing the necessary training for the frontline officers. (author)
Virtual Individual Combatant Trainer for Embedded Rehearsal (VICTER)
National Research Council Canada - National Science Library
Barham, Paul
Report developed under SBIR contract. Reality by Design, Inc. (RBD) presents its Phase 2 Plus results of developing a modular, man-in-the-loop, embedded simulation system for Individual Combatant (IC...
Reinforcement Sensitivity and Social Anxiety in Combat Veterans
Kimbrel, Nathan A.; Meyer, Eric C.; DeBeer, Bryann B.; Mitchell, John T.; Kimbrel, Azure D.; Nelson-Gray, Rosemery O.; Morissette, Sandra B.
Objective The present study tested the hypothesis that low behavioral approach system (BAS) sensitivity is associated with social anxiety in combat veterans. Method Self-report measures of reinforcement sensitivity, combat exposure, social interaction anxiety, and social observation anxiety were administered to 197 Iraq/Afghanistan combat veterans. Results As expected, combat exposure, behavioral inhibition system (BIS) sensitivity, and fight-flight-freeze system (FFFS) sensitivity were positively associated with both social interaction anxiety and social observation anxiety. In contrast, BAS sensitivity was negatively associated with social interaction anxiety only. An analysis of the BAS subscales revealed that the Reward Responsiveness subscale was the only BAS subscale associated with social interaction anxiety. BAS-Reward Responsiveness was also associated with social observation anxiety. Conclusion The findings from the present research provide further evidence that low BAS sensitivity may be associated with social anxiety over and above the effects of BIS and FFFS sensitivity. PMID:28966424
Russia's Chechen Wars 1994-2000: Lessons from Urban Combat
National Research Council Canada - National Science Library
Oliker, Olga
This report provides an analysis of Russian combat in Chechnya beginning with the first modern Chechen war of 1994-1996 and comparing and contrasting it with the ongoing conflict that began in 1999...
The Big Issue: Command and Combat in the Information Age
National Research Council Canada - National Science Library
Potts, David
This Occasional Paper considers command and combat in the information age. A small team in the British Army's conceptual "think tank," the Directorate General Development and Doctrine, worked together on this issue for 18 months...
NUCLEAR NONPROLIFERATION: U.S. Efforts to Combat Nuclear Smuggling
National Research Council Canada - National Science Library
...) information about efforts to combat nuclear smuggling at U.S. borders. My statement today is based on the results of our May 16, 2002, report on this subject1 and information we obtained from the U.S...
Future Combat Systems (FCS) Creates Cannon and Mortar Synergy
National Research Council Canada - National Science Library
Beard, Kirby; James, Jeff; Tolbert, Vincent J
.... The NLOS-C is one of the eight MGVs. Program Manager FCS (Brigade Combat Team (PM FCS(BCT)) is leveraging previous and current research and development efforts to create synergy between cannons and mortars, without duplication of effort...
Contributions of Women to U.S. Combat Operations
National Research Council Canada - National Science Library
Burnes, Thresa
.... combat operations from the Revolutionary War to present-day conflicts. The U.S. military continues to fight a transnational, dispersed enemy that employs irregular tactics and asymmetric warfare...
The Warfighting Capacity of Air Combat Command's Numbered Air Forces
National Research Council Canada - National Science Library
Hanser, Lawrence
...) of the Air Combat Command (ACC), General Richard E. Hawley, the ACC Commander, asked if RAND could offer an analysis of the number of NAFs that were needed by ACC to meet warfighting requirements...
Is Democratization a Sound Strategy for Combating Fundamentalist Islam
National Research Council Canada - National Science Library
Johnson, Anthony J
.... This paper examines the premise that "universal human rights", as the basis for democracy, is compatible with Islamic culture and is therefore a sound strategy for combating the spread of "Islamic...
Surface Combatant Planning Since the End of the Cold War
National Research Council Canada - National Science Library
Gillen, Daniel
.... This reduction was part of the U.S. military transformation in the post-Cold War period. This thesis examined the major factors that influenced the change in surface combatant planning since 1990, i.e...
Object-Oriented Modular Architecture for Ground Combat Simulation
National Research Council Canada - National Science Library
Luqi; Berzins, V; Shing, M; Saluto, M; Williams, J
.... It describes the effective use of computer-aided prototyping techniques for re-engineering the legacy software to develop an object-oriented modular architecture for the Janus combat simulation system. Janus...
Public Affairs Capacity Building: A Soft Tool for Combatant Commanders
National Research Council Canada - National Science Library
Salata, Jason P
Public affairs capacity building is a valuable soft component of the Combatant Commander's Theater Campaign Plan that builds habitual relationships, fosters transparency, and enhances the ability to shape the AOR...
Logistics Operations in Combat Operations Against an Insurgent Force
National Research Council Canada - National Science Library
Hatcher, Clay
.... The road networks are generally not secure and put soldiers at risk. How do we distribute supplies and reduce the risk or avoid the enemy's threat to our combat logistics patrols in an insurgent environment...
Project Guardian: Optimizing Electronic Warfare Systems for Ground Combat Vehicles
National Research Council Canada - National Science Library
Parks, Jack G; Jackson, William; Revello, James; Soltesz, James
.... The study, Project Guardian, represents a new process for determining the optimum set of sensors and countermeasures for a specific vehicle class under the constraints of threat projection, combat...
Combating infection in developing countries. The IAEA contribution
Energy Technology Data Exchange (ETDEWEB)
Groth, Stefan [International Atomic Energy Agency, Vienna (Austria). Division of Human Health; Khan, Baldip; Padhy, Ajit; Ch' ng, Soo Ling; Soricelli, Andreas; Xie, Yanfen [International Atomic Energy Agency, Vienna (Austria). Division of Human Health, Nuclear Medicine Section; Ford, JoAnne [International Atomic Energy Agency, Vienna (Austria). Division of Public Information
Control of infection and infectious diseases is an international priority. Worldwide infectious diseases are responsible for an estimated 13 million deaths each year, exacting a large and disproportionately high toll in developing countries. Forty-three percent of all deaths in developing countries are due to infectious diseases, whereas the corresponding figure for developed countries is only 1%. A large proportion of these deaths could be prevented if timely diagnosis and effective treatment were available locally. Loss of life or productivity due to infectious disease is not just a health matter, it also has an important social and economic impact on individuals, families, regions, and countries. According to the World Health Organization, infectious diseases are now the world's largest killer of young adults and children. Hundreds of millions of people are disabled by infectious disease. The economic impact of repeated episodes of illness and long term disability is a major cause of underdevelopment in many countries today. For example, according to the WHO 1999 Infectious Disease Report, malaria alone has cost Africa billions of dollars in the past decade. More recently, a WHO study estimates that malaria slows economic growth in Africa by up to 1.3% each year and that malaria-free countries average three times higher gross domestic product per person than do malarious countries. This brochure highlights the role of the International Atomic Energy Agency (IAEA) in disseminating nuclear techniques to combat infection and infectious disease. Some of the techniques are used to diagnose and manage infectious diseases of serious concern to developing countries - malaria, tuberculosis, hepatitis, and Chagas disease. Other techniques are used to detect infection sites in the body, in bones, and organs. The challenges posed by infection and infectious disease and the nuclear techniques that the Agency offers for support illustrate how nuclear techniques can be used to
Excellence in fleet combat replacement squadrons: predicting carrier qualification success
Smith, Martin P.
This thesis presents a two-part analysis of excellence criteria for fleet combat replacement squadrons. Part one focuses on the qualitative issues and management techniques identified in outstanding fleet combat replacement squadrons. Part two develops and presents a regression model for predicting a fleet replacement squadron pilot's carrier qualification grade. The model was derived using standard linear regression techniques and the SPSSx software package of the Naval Postgraduate School. ...
Prevalence and patterns of combat sport related maxillofacial injuries
Shirani, Gholamreza; Kalantar Motamedi, Mohammad Hosein; Ashuri, Alireza; Eshkevari, Pooyan Sadr
Aim: This study was designed to assess the prevalence, distribution, and patterns of injury among athletes engaged in combat sports and compare the prevalence, pattern, and types of oral and maxillofacial trauma in these athletes. Materials and Methods: A total of 120 male athletes engaged in four combat sports (boxing, taekwondo, kickboxing, and Muay Thai) who had sustained bodily trauma were studied; 95 subjects with at least one traumatic injury to the face requiring treatment were referre...
Technical-tactical and physiological demands of wrestling combats
Bianka Miarka
Technical-tactical and physiological demand analyses of wrestling combats are important because they reveal essential information for the development of contextual training and specific physical preparation of wrestlers. Therefore, the aim of this review is to describe the characteristics of wrestling combats in freestyle, female and Greco-roman styles. The time-motion analysis presented in this article is the main component to carry out inferences on intensity and effort: pause ratio of comb...
Combat Resource Management (11bm) Applied Research Project (ARP)
tactiques de combat embarquées, comme partie du processus C2 naval militaire, définit un domaine application qui implique à la fois des décideurs humains ...combat ships defending against incoming threats and where coordination of their respective resources is a complex problem of capital importance...the case of the several frigates defending against incoming threats, multi-agent coordi- nation is a complex problem of capital importance. Better
Improving Relative Combat Power Estimation: The Road to Victory
was unthinkable before. Napoleon Bonaparte achieved a superior warfighting system compared to his opponents, which resulted in SOF. Napoleon's...observations about combat power estimation and force empoloyment, remain valid. Napoleon also offered thoughts about combat power and superiority whe he...force. However, Napoleon did not think one- sidedly about the problem. He also said: "The moral is to the physical as three to one."11 This dual
Is Persuasive Advertising Always Combative in a Distribution Channel?
Chi-Cheng Wu; Ying-Ju Chen; Chih-Jen Wang
The existing marketing literature suggests that persuasive advertising elicits counteractions from competing manufacturers and consequently leads to wasteful cancellation of the advertising effects. Thus, persuasive advertising is widely perceived to be combative in nature. A series of previously published papers demonstrates that appropriate targeting may partially mitigate the combative nature of persuasive advertising in that either the rival manufacturer or the retailer may benefit. In th...
The nutritional intake of elderly patients with dysphagia admitted to the internal medical department of the emergency hospital was analyzed. The Fujishima dysphagia scale after care and treatment by the Nutrition Support Team was assessed.
Niwano, Mototaka
The Nutrition Support Team (NST) assessed the severity of dysphagia in elderly patients admitted to the internal medical department, and the appropriate nutritional treatment was determined. Patients were treated with either oral nutrition (enteral nutrition, EN) or artificial alimentation (parenteral nutrition, PN). The goal of this study was to analyze whether or not the route of nutrition affected the patient discharge rates. We divided 290 elderly inpatients with dysphagia into 2 groups, the pneumonia group (200 patients) and the non-pneumonia group (90 patients). The NST estimated the swallowing function using the Fujishima dysphagia scale. Monitoring was continued until the NST care and treatment had been finalized. We further divided the pneumonia patients into two subgroups: those with a Fujishima dysphagia scale score ≤3 or ≥4 at the beginning of NST intervention. The changes in the swallowing function were analyzed.The swallowing function in the patients with a score ≥4 was significantly improved compared with that in the patients with a score ≤3. This difference, however, was not observed in the non-pneumonia group. In both the pneumonia and non-pneumonia groups, the ratio of patients discharged on oral nutrition was one-third, and the ratio of death in hospital was one-quarter, the remaining patients required artificial alimentation. Among elderly patients admitted to the internal medical department of the emergency hospital with dysphagia, one-third left the hospital with oral nutritional intake, one-quarter died in hospital, and the remaining required artificial alimentation.
Impact of Combat Duty in Iraq and Afghanistan on Family Functioning: Findings from the Walter Reed Army Institute of Research Land Combat Study
National Research Council Canada - National Science Library
Huge, Charles W; Castro, Carl A; Eaton, Karen M
.... However, most studies of the impact of combat on military families have not been conducted proximal to the time of deployments, and there are many research gaps in understanding the full impact of combat deployment...
Inpatient Hospitalization in Addiction Treatment for Patients with a History of Suicide Attempt: A Case of Support for Treatment Performance Measures†
Glass, Joseph E.; Ilgen, Mark A.; Winters, Jamie J.; Murray, Regan L.; Perron, Brian E.; Chermack, Stephen T.
This study attempts to validate substance use disorder (SUD) treatment performance measures (PM) in a naturalistic treatment setting. Despite its significance in healthcare systems and in SUD populations, suicidality is one patient characteristic that remains unexplored in the context of SUD PMs. The current study focused on the extent to which the care processes encouraged by SUD PMs were associated with improved outcomes in patients with a prior suicide attempt as compared to those without. We abstracted Addiction Severity Index and health services data from the VA medical record for 381 veterans who initiated outpatient SUD treatment and completed baseline intake measures at a Midwestern VA hospital. Cox proportional hazard regressions examined how baseline characteristics, prior suicide attempts, and PM status predicted the time until hospitalization for psychiatric or substance use problems. Prior suicide attempts significantly interacted with treatment engagement, and hospitalization risk was significantly higher among individuals with a prior suicide attempt who did not meet PMs. This study provides initial observational evidence that past suicide attempts may be a factor that should be considered when defining performance standards that influence the processes of SUD treatment. Future research on PMs should take into account the differences on indicators of high risk and poor treatment outcomes. PMID:21053754
Combat Stress Decreases Memory of Warfighters in Action.
Delgado-Moreno, Rosa; Robles-Pérez, José Juan; Clemente-Suárez, Vicente Javier
The present research aimed to analyze the effect of combat stress in the psychophysiological response and attention and memory of warfighters in a simulated combat situation. Variables of blood oxygen saturation, heart rate, blood glucose, blood lactate, body temperature, lower body muscular strength manifestation, cortical arousal, autonomic modulation, state anxiety and memory and attention through a postmission questionnaire were analyzed before and after a combat simulation in 20 male professional Spanish Army warfighters. The combat simulation produces a significant increase (p body temperature post, HF post/correct sound, body temperature post/glucose post, CFFTpre/lactate post, CFFT post/wrong sound, glucose post/AC pre, AC post/wrong fusil, AS post/SC post and SC post/wrong olfactory; and negative correlations: LF post/correct sound, body temperature post/lactate post and glucose post/lactate post. This data suggest that combat stress actives fight-flight system of soldiers. As conclusion, Combat stress produces an increased psychophysiological response that cause a selective decrease of memory, depending on the nature, dangerous or harmless of the objects.
Technical-tactical and physiological demands of wrestling combats
Directory of Open Access Journals (Sweden)
Bianka Miarka
Full Text Available Technical-tactical and physiological demand analyses of wrestling combats are important because they reveal essential information for the development of contextual training and specific physical preparation of wrestlers. Therefore, the aim of this review is to describe the characteristics of wrestling combats in freestyle, female and Greco-roman styles. The time-motion analysis presented in this article is the main component to carry out inferences on intensity and effort: pause ratio of combat actions. After rules modification in 2013, wrestling combats showed quicker and more diversified actions, especially in the lighter categories. For Greco-roman wrestling, most studies showed takedowns as the most effective techniques in World competitions for the period 2009-2011. For the same period, foot/leg techniques were the most effective in female and freestyle wrestling, followed by takedown attacks. Recent analyses, developed after 2013 rules modification, showed that the decisive offensive actions were applied on foot and in par terre situations – especially gutwrenches techniques and derivatives of suplex movements. The knowledge on the determinant and predominant actions of wrestling combats can be applied in future research, as well as can be used practically for training, physical preparation and assessments of similar combat actions. It also allows interventions to prevent injuries resulting from technical and tactical wrestling actions.
Report on combating of illicit trafficking. The Illicit Trafficking Combat Project Group. January 2000
Energy Technology Data Exchange (ETDEWEB)
of spot-checks, the authority can then convince itself that the operator is fulfilling the requirements. The legislation should also impose heavy sanctions and penalties for all criminal activities related to illicit trafficking. As a direct measure to combat illicit trafficking on the national level, the State supervisory and law enforcement authorities should establish co-operation between themselves and with authorities in other countries and international organisations. Special national committees for combating illicit trafficking should be set up and should use intelligence and open sources information. Regions of States should investigate and implement joint task forces for combating illicit trafficking. Improvements on the International level by the IAEA: The IAEA should assist States in the practical implementation of measures and means for combating illicit trafficking and for the evaluation of threat scenarios. To improve that process in an efficient way, the IAEA should apply the principle of public access to information on its operations to a greater extent. Among other measures for promoting the development of more efficient tools and systems for combating illicit trafficking, the IAEA should: in assisting States, establish rules about duties and responsibilities for operators, authorities and individuals in the NPT area, through appropriate documentation; promote assistance programmes to States in consultation with NPT States, as need may be, of technical equipment and competent staff for the combating of illicit trafficking; provide experts and establish standards and procedures, across borders, for the investigation of serious cases of illicit trafficking, in consultation with national and international nuclear and law enforcement authorities and organisations; incorporate a more modern safeguards inspection technique of the national systems for accountancy and control, in accordance with standards and procedures that were intended to be established
Report on combating of illicit trafficking. The Illicit Trafficking Combat Project Group. January 2000
Energy Technology Data Exchange (ETDEWEB)
. By means of spot-checks, the authority can then convince itself that the operator is fulfilling the requirements. The legislation should also impose heavy sanctions and penalties for all criminal activities related to illicit trafficking. As a direct measure to combat illicit trafficking on the national level, the State supervisory and law enforcement authorities should establish co-operation between themselves and with authorities in other countries and international organisations. Special national committees for combating illicit trafficking should be set up and should use intelligence and open sources information. Regions of States should investigate and implement joint task forces for combating illicit trafficking. Improvements on the International level by the IAEA: The IAEA should assist States in the practical implementation of measures and means for combating illicit trafficking and for the evaluation of threat scenarios. To improve that process in an efficient way, the IAEA should apply the principle of public access to information on its operations to a greater extent. Among other measures for promoting the development of more efficient tools and systems for combating illicit trafficking, the IAEA should: in assisting States, establish rules about duties and responsibilities for operators, authorities and individuals in the NPT area, through appropriate documentation; promote assistance programmes to States in consultation with NPT States, as need may be, of technical equipment and competent staff for the combating of illicit trafficking; provide experts and establish standards and procedures, across borders, for the investigation of serious cases of illicit trafficking, in consultation with national and international nuclear and law enforcement authorities and organisations; incorporate a more modern safeguards inspection technique of the national systems for accountancy and control, in accordance with standards and procedures that were intended to be
Trained and Ready Combat Forces: The Role of Training Devices in Sustaining Combat Force Proficiency During Deployments
National Research Council Canada - National Science Library
Taylor, James
... (MOOTW). The Army's ground combat forces, even while engaged in MOOTW activities, must maintain proficiency to wage war in the event that peacetime engagement, deterrence and conflict prevention fail...
Cultural and Religious Awareness: The Key to Analyzing and Combating the Relative Combat Power for Islamic-Based Terrorism
National Research Council Canada - National Science Library
Khan, Muhammad M
... terrorists. Second, the United States must conduct cultural awareness/cultural intelligence training for all military personnel who are deploying to combat the GWOT, and for all staff in the regional standing...
Combating the counterfeits with web portal technology
Ting, S. L.; Ip, W. H.
Due to the globalisation of counterfeiting activities, the penetration of fake products in open market is growing. So far, the technologies to combat counterfeiting are mostly applied to high-value products (e.g. premium wine and branded handbags); however, in the medium- and low-value products' perspective, there is no secure way for consumers to identify whether the purchased items are genuine or not. To address the counterfeiting problems effectively, a platform for identifying authenticated products and promoting anti-counterfeit activities is very important. The aim of this paper is to design and develop an anti-counterfeit platform which includes two functions: providing customers a secure network to ascertain the genuineness of their purchased product and increasing public awareness of the current counterfeit problems and updated anti-counterfeit solutions. By combining these two functions, it enables public to fight against fake and beware of counterfeit. Results of adopting portal technology in anti-counterfeiting show high accuracy in product checking and improved creditability. This reveals that the applicability and advantage of the proposed methodology are satisfactory.
FATF in Combating the Financing of Terrorism
Directory of Open Access Journals (Sweden)
Kristina Slavikovna Melkumyan
Full Text Available The article examines the FATF specific approach to the problem of terrorism financing. The FATF essence, content of the activity and influence levers are also analyzed within the article. It is shown that the FATF has reviewed the problem of terrorism financing in the broadest perspective, having engaged simultaneously and consistently mechanisms for combating money laundering and terrorism financing. The Task Force has greatly contributed to building of the world counter-terrorism financing system through forming the legal and institutional basis as well as through interaction with all the possible participants and actors of world politics in this area. Moreover, the FATF has succeeded in geographical expansion of the FATF influence from the original 16 to187 jurisdictions by promotion of FATF-style regional bodies establishment. Particular attention is drawn to the unique features of the FATF Recommendations in comparison with the earlier issued sources of international law, which define the international counter-terrorism financing regime. The author believes that one of the advantages of the FATF as an institute within the counter-terrorism financing system among others is the informal status of the FATF, which provides its flexibility and high ability to respond quickly and in a timely manner to evolving nature of money laundering and terrorism financing as well as emerging threats.
Combating gender based violence in Rwanda
Directory of Open Access Journals (Sweden)
Liberata Gahongayire
Full Text Available Gender Based Violence (GBV exists in Rwanda as in many other African societies. Efforts are being made by Governments and NGOs to curb the menace and help its victims. This study examines these efforts with particular reference to the city of Kigali in Rwanda. The study reveals the prevalence and various strategies used by government and other organisations in combating the practice of GBV. According to the study effective response to the plight of GBV victims depends on the competence and expertise of various individuals and organisations involved in giving assistance to victims. The establishment of a one-stop assistance centre for GBV services in Kigali has successfully given much needed aid to victims. The study recommends that in order to eradicate GBV all the stakeholders should utilize available resources. Logistical, economic and socio-cultural constraints should be dealt with accordingly. Above all, the judiciary has a crucial role to play. An effective judicial system is needed to curb the practice.
Development of botanicals to combat antibiotic resistance
Directory of Open Access Journals (Sweden)
Pooja D. Gupta
Full Text Available The discovery of antibiotics in the previous century lead to reduction in mortality and morbidity due to infectious diseases but their inappropriate and irrational use has resulted in emergence of resistant microbial populations. Alteration of target sites, active efflux of drugs and enzymatic degradations are the strategies employed by the pathogenic bacteria to develop intrinsic resistance to antibiotics. This has led to an increased interest in medicinal plants since 25–50% of current pharmaceuticals are plant derived. Crude extracts of medicinal plants could serve as an alternate source of resistance modifying agents owing to the wide variety of secondary metabolites. These metabolites (alkaloids, tannins, polyphenols etc. could act as potentials for antimicrobials and resistance modifiers. Plant extracts have the ability to bind to protein domains leading to modification or inhibition protein–protein interactions. This enables the herbals to also present themselves as effective modulators of host related cellular processes viz immune response, mitosis, apoptosis and signal transduction. Thus they may exert their activity not only by killing the microorganism but by affecting key events in the pathogenic process, thereby, the bacteria, fungi and viruses may have a reduced ability to develop resistance to botanicals. The article is meant to stimulate research wherein the cidal activity of the extract is not the only parameter considered but other mechanism of action by which plants can combat drug resistant microbes are investigated. The present article emphasizes on mechanisms involved in countering multi drug resistance.
Combating oil spill problem using plastic waste
Energy Technology Data Exchange (ETDEWEB)
Saleem, Junaid, E-mail: email@example.com [Department of Chemical Engineering, University of Karachi (Pakistan); Ning, Chao; Barford, John [Department of Chemical and Biomolecular Engineering, Hong Kong University of Science and Technology, Clear Water Bay, Kowloon (Hong Kong); McKay, Gordon [Department of Chemical and Biomolecular Engineering, Hong Kong University of Science and Technology, Clear Water Bay, Kowloon (Hong Kong); Division of Sustainable Development, College of Science, Engineering and Technology, Hamad Bin Khalifa University, Qatar Foundation, Doha (Qatar)
Highlights: • Up-cycling one type of pollution i.e. plastic waste and successfully using it to combat the other type of pollution i.e. oil spill. • Synthesized oil sorbent that has extremely high oil uptake of 90 g/g after prolonged dripping of 1 h. • Synthesized porous oil sorbent film which not only facilitates in oil sorption but also increases the affinity between sorbent and oil by means of adhesion. - Abstract: Thermoplastic polymers (such as polypropylene, polyethylene, polyethylene terephthalate (PET) and high density polyethylene (HDPE)) constitute 5–15% of municipal solid waste produced across the world. A huge quantity of plastic waste is disposed of each year and is mostly either discarded in landfills or incinerated. On the other hand, the usage of synthetic polymers as oil sorbents, in particular, polyolefins, including polypropylene (PP), and polyethylene (PE) are the most commonly used oil sorbent materials mainly due to their low cost. However, they possess relatively low oil absorption capacities. In this work, we provide an innovative way to produce a value-added product such as oil-sorbent film with high practical oil uptake values in terms of g/g from waste HDPE bottles for rapid oil spill remedy.
Combating oil spill problem using plastic waste
International Nuclear Information System (INIS)
Saleem, Junaid; Ning, Chao; Barford, John; McKay, Gordon
Highlights: • Up-cycling one type of pollution i.e. plastic waste and successfully using it to combat the other type of pollution i.e. oil spill. • Synthesized oil sorbent that has extremely high oil uptake of 90 g/g after prolonged dripping of 1 h. • Synthesized porous oil sorbent film which not only facilitates in oil sorption but also increases the affinity between sorbent and oil by means of adhesion. - Abstract: Thermoplastic polymers (such as polypropylene, polyethylene, polyethylene terephthalate (PET) and high density polyethylene (HDPE)) constitute 5–15% of municipal solid waste produced across the world. A huge quantity of plastic waste is disposed of each year and is mostly either discarded in landfills or incinerated. On the other hand, the usage of synthetic polymers as oil sorbents, in particular, polyolefins, including polypropylene (PP), and polyethylene (PE) are the most commonly used oil sorbent materials mainly due to their low cost. However, they possess relatively low oil absorption capacities. In this work, we provide an innovative way to produce a value-added product such as oil-sorbent film with high practical oil uptake values in terms of g/g from waste HDPE bottles for rapid oil spill remedy
Combating illegal nuclear traffic - Poland's experience
International Nuclear Information System (INIS)
Smagala, G.
International non-proliferation efforts have been taken to reduce the risk related to nuclear materials and radioactive sources. The physical security of nuclear facilities to prevent acts of sabotage or terrorism and to protect nuclear materials against loss or seizure is an essential element of the nuclear non-proliferation regime. Iraq case and the end of the Cold War have influenced the development of co-operation and openness in many countries. Poland due to: - its geolocation, - a growing number of post Chernobyl contamination transports and - high risk to become a transit country in illicit trafficking of nuclear materials and radioactive sources, initiated deployment of the fixed installation instruments at the border check-points. Since the end of 1990 to now 103 such devices have been installed. Broader involvement in combating illicit nuclear trafficking of Border Guards, Customs Services, Police and Intelligence Security has been noticed. Paper presents Poland's experience in implementing national prevention measures to reduce nuclear proliferation risk and in detecting capabilities against illicit nuclear traffic. (author)
The application of hospitality elements in hospitals.
Wu, Ziqi; Robson, Stephani; Hollis, Brooke
In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.
Urban Combat Advanced Training Technology Architecture (Architecture de technologie avancee pour l'entrainement au combat urbain)
NORTH ATLANTIC TREATY ORGANIZATION SCIENCE AND TECHNOLOGY ORGANIZATION AC/323(MSG-098)TP/740 www.sto.nato.int STO TECHNICAL...REPORT TR-MSG-098 Urban Combat Advanced Training Technology Architecture (Architecture de technologie avancée pour l'entraînement au combat urbain...NORTH ATLANTIC TREATY ORGANIZATION SCIENCE AND TECHNOLOGY ORGANIZATION AC/323(MSG-098)TP/740 www.sto.nato.int STO TECHNICAL
Selected Foreign Counterparts of U.S. Army Ground Combat Systems and Implications for Combat Operations and Modernization
responsibility is to defeat other nations' combat formations on the battlefield. In order to accomplish this, nations indigenously develop, maintain, and improve...defeat other nations' combat formations on the battlefield. In order to accomplish this, nations indigenously develop, maintain, and improve a variety...catastrophic kill. A number of foreign tracked IFVs mount either hard kill 13 or soft kill 14 APS and the Army is presently examining both non
Combating hidden hunger: the role of international agencies.
Dalmiya, Nita; Schultink, Werner
The importance of micronutrient deficiencies or "hidden hunger" was clearly emphasized by the inclusion of specific goals on iron, vitamin A, and iodine deficiency at the 1990 World Summit for Children and other major international nutrition conferences. Significant progress has since been made toward eliminating vitamin A and iodine deficiencies, with less progress made toward reducing the burden of iron-deficiency anemia. The role of international agencies, such as the World Health Organization, United Nations Children's Fund, Food and Agricultural Organization, and World Bank in assisting countries to make progress toward the World Summit for Children goals has been very important. International agencies have played a critical role in advocating for and raising awareness of these issues at the international, regional, and national levels among policymakers and the general population. Using a rights-based approach, UNICEF and other agencies have been instrumental in elevating to the highest political level the discussion of every child's right to adequate nutrition. International agencies have also been very supportive at the national level in providing technical guidance for programs, including monitoring and evaluation. These agencies have played a critical role in engaging the cooperation of other partners, including bilateral donors, non-governmental organizations, and the private sector for micronutrient programs. Furthermore, international agencies provide financial and material support for micronutrient programs. In the future, such agencies must continue to be heavily involved in programs to achieve the newly confirmed goals for 2010. The present paper focuses on the role of international agencies in combating micronutrient deficiencies, drawing on the lessons learned over the last decade. The first section of the paper summarizes the progress achieved since 1990, and the second section describes the specific role of international agencies in contributing
Development of two artificial neural network models to support the diagnosis of pulmonary tuberculosis in hospitalized patients in Rio de Janeiro, Brazil.
Aguiar, Fábio S; Torres, Rodrigo C; Pinto, João V F; Kritski, Afrânio L; Seixas, José M; Mello, Fernanda C Q
Pulmonary tuberculosis (PTB) remains a worldwide public health problem. Diagnostic algorithms to identify the best combination of diagnostic tests for PTB in each setting are needed for resource optimization. We developed one artificial neural network model for classification (multilayer perceptron-MLP) and another risk group assignment (self-organizing map-SOM) for PTB in hospitalized patients in a high complexity hospital in Rio de Janeiro City, using clinical and radiologic data collected from 315 presumed PTB cases admitted to isolation rooms from March 2003 to December 2004 (TB prevalence = 21.5 %). The MLP model included 7 variables-radiologic classification, age, gender, cough, night sweats, weight loss and anorexia. The sensitivity of the MLP model was 96.0 % (95 % CI ±2.0), the specificity was 89.0 % (95 % CI ±2.0), the positive predictive value was 72.5 % (95 % CI ±3.5) and the negative predictive value was 98.5 % (95 % CI ±0.5). The variable with the highest discriminative power was the radiologic classification. The high negative predictive value found in the MLP model suggests that the use of this model at the moment of hospital admission is safe. SOM model was able to correctly assign high-, medium- and low-risk groups to patients. If prospective validation in other series is confirmed, these models can become a tool for decision-making in tertiary health facilities in countries with limited resources.
The roles of users personal characteristics and organisational support in the attitude towards using ERP systems in a Spanish public hospital.
Escobar-Rodriguez, Tomas; Bartual-Sopena, Lourdes
Enterprise resources planning (ERP) systems enable central and integrative control over all processes throughout an organisation by ensuring one data entry point and the use of a common database. T his paper analyses the attitude of healthcare personnel towards the use of an ERP system in a Spanish public hospital, identifying influencing factors. This research is based on a regression analysis of latent variables using the optimisation technique of partial least squares. We propose a research model including possible relationships among different constructs using the technology acceptance model. Our results show that the personal characteristics of potential users are key factors in explaining attitude towards using ERP systems.
How can information systems provide support to nurses' hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections.
Marques, Rita; Gregório, João; Pinheiro, Fernando; Póvoa, Pedro; da Silva, Miguel Mira; Lapão, Luís Velez
Hospital-acquired infections are still amongst the major problems health systems are facing. Their occurrence can lead to higher morbidity and mortality rates, increased length of hospital stay, and higher costs for both hospital and patients. Performing hand hygiene is a simple and inexpensive prevention measure, but healthcare workers' compliance with it is often far from ideal. To raise awareness regarding hand hygiene compliance, individual behaviour change and performance optimization, we aimed to develop a gamification solution that collects data and provides real-time feedback accurately in a fun and engaging way. A Design Science Research Methodology (DSRM) was used to conduct this work. DSRM is useful to study the link between research and professional practices by designing, implementing and evaluating artifacts that address a specific need. It follows a development cycle (or iteration) composed by six activities. Two work iterations were performed applying gamification components, each using a different indoor location technology. Preliminary experiments, simulations and field studies were performed in an Intensive Care Unit (ICU) of a Portuguese tertiary hospital. Nurses working on this ICU were in a focus group during the research, participating in several sessions across the implementation process. Nurses enjoyed the concept and considered that it allows for a unique opportunity to receive feedback regarding their performance. Tests performed on the indoor location technology applied in the first iteration regarding distances estimation presented an unacceptable lack of accuracy. Using a proximity-based technique, it was possible to identify the sequence of positions, but beacons presented an unstable behaviour. In the second work iteration, a different indoor location technology was explored but it did not work properly, so there was no chance of testing the solution as a whole (gamification application included). Combining automated monitoring
The food and weight combat. A problematic fight for the elite combat sports athlete.
Pettersson, Stefan; Pipping Ekström, Marianne; Berg, Christina M
Weight reduction in athletes is motivated by optimisation of performance, aesthetic reasons or to achieve a pre-designated weight. Previous research has shown that dietary restraint and short term weight regulation frequently takes place among combat sports athletes such as wrestlers and judokas. The aim of this study was to explore negative experiences related to dietary strategies and weight-making practises used by elite combat sports athletes. Using semi-structured interviews, 14 Swedish national team athletes in wrestling, judo and taekwondo were asked about their dietary intake and their engagement in both long- and short-term weight regulation practises. Content analysis of the transcribed interviews, display a constant struggle regarding nutritional standpoints. Sport demands such as achieving an optimal weight and nutritional intake were considered as central in order for excellent performance. Adhering to these demands was found to be problematic however, primarily because of; (1) negative physiological responses and (2) opposing ideals of a non-sport related nature, such as the importance of the athletes to be healthy and social in their everyday lives. Copyright © 2012 Elsevier Ltd. All rights reserved.
Navy Hospital ships in history
Directory of Open Access Journals (Sweden)
Sougat Ray
Full Text Available Hospital ships are operated by the Naval forces in or near war zones to provide medical assistance to the wounded personnel of all nationalities and not be used for any military purpose. Hospital ships possibly existed in ancient times and the Athenian Navy had a ship named Therapia. However, it was only during the 17th century that it became a common practice for the naval squadrons to be accompanied by large ships with the facilities of carrying the wounded after each engagement. In 1860, the steamships HMS Melbourne and HMS Mauritius were equipped with genuine medical facilities. They were manned by the Medical Staff Corps and provided services to the British expedition to China. During the World War I and World War II, passenger ships were converted for use as hospital ships and were started to be used on a massive scale. RMS Aquitania and HMHS Britannic were two famous examples of hospital ships used extensively. Modern US hospital ships USNS Mercy and USNS Comfort are operated by Military Sealift Command of the US Navy. Their primary mission is to provide emergency on-site care for US combatant forces deployed in war or other operations.
Combat to social exclusion, awareness, and action through nuclear energy applications
Energy Technology Data Exchange (ETDEWEB)
Komatsu, Cintia Nagako, E-mail: email@example.com [Centro Tecnologico da Marinha em Sao Paulo (CTMSP), Sao Paulo, SP (Brazil); Aquino, Afonso Rodrigues de, E-mail: email@example.com [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)
Gradually the world becomes more and more supportive and human. Small actions in our daily behavior contribute in a positive way to the social inclusion of people who has not the same opportunities due to physical appearance, social position or education level. The Companies, the basis of our Economy, can also demonstrate this social inclusion mission offering benefits that do not meet only one social layer, but everybody. This paper aims to make a research about the actions that have that awareness to combat social exclusion, emphasizing nuclear technology as a tool to disseminate of such solidarity actions. (author)
Impact of mobile apps to combat obesity in children and adolescents: A systematic literature review.
Quelly, Susan B; Norris, Anne E; DiPietro, Jessica L
This review examines the impact of mobile app technology on obesity-related anthropometric, psychosocial, and behavioral outcomes in children and adolescents. Nine research articles retrieved from a systematic review of the literature met criteria. Evidence is limited and mixed, but argues for an impact of mobile app use on motivation and goal-setting behavior, and supports further study of the impact on childhood obesity-related outcomes such as attitudes, perceptions, physical activity, and dietary habits. Nurses can use this evidence to discuss potential benefits of health promotion mobile apps with parents, children, and adolescents to combat childhood obesity. © 2015, Wiley Periodicals, Inc.
Combat to social exclusion, awareness, and action through nuclear energy applications
International Nuclear Information System (INIS)
Komatsu, Cintia Nagako; Aquino, Afonso Rodrigues de
Gradually the world becomes more and more supportive and human. Small actions in our daily behavior contribute in a positive way to the social inclusion of people who has not the same opportunities due to physical appearance, social position or education level. The Companies, the basis of our Economy, can also demonstrate this social inclusion mission offering benefits that do not meet only one social layer, but everybody. This paper aims to make a research about the actions that have that awareness to combat social exclusion, emphasizing nuclear technology as a tool to disseminate of such solidarity actions. (author)
China's Near Seas Combat Capabilities (China Maritime Study, Number 11)
include FY- 2G and -2H in 2014, FY-3D/PM1 and FY-4 M in 2015, FY-3E/AM1 in 2017, FY-3F/PM2 in 2019, china's near seas combat capabilities 97 FY- 3G ...on ASCMs. This is indicated by the display of land-based, mobile YJ-62 transporter-erector-launchers (TELs) during the 1 October 2009 National Day...air defenses and a supporting targeting system that can detect fleeting mobile targets and rapidly relay the data underwater, submarines would
'Getting to Know Me': The second phase roll-out of a staff training programme for supporting people with dementia in general hospitals.
Elvish, Ruth; Burrow, Simon; Cawley, Rosanne; Harney, Kathryn; Pilling, Mark; Gregory, Julie; Keady, John
Objectives The aims were to evaluate a second phase roll-out of a dementia care training programme for general hospital staff and to further develop two outcome scales: the Confidence in Dementia scale for measuring confidence in working with people with dementia and the Knowledge in Dementia scale for measuring knowledge in dementia. Method Following a 'training the trainers' phase, the study involved the delivery of the 'Getting to Know Me' training programme to a large number of staff (n = 517) across three National Health Service (NHS) Trusts situated in North-West England. The impact of the programme was evaluated using a pre-post design which explored: (i) changes in confidence in dementia, (ii) changes in knowledge in dementia, and (iii) changes in beliefs about behaviours that challenge. Results Statistically significant change was identified between pre-post training on all outcome measures (Confidence in Dementia: eight point increase, p Staff knowledge in dementia and confidence in working with people with dementia significantly increased following attendance at the training sessions. The findings are consistent with preliminary findings and strengthen current knowledge about the impact of dementia care training in general hospitals. The Confidence in Dementia and Knowledge in Dementia scales continue to demonstrate psychometrically sound properties and demonstrate utility in the field of dementia research.
A proper strategy for combating mould.
Cheong, Cedric
managing director of Mycologia & Mould Worx, MSc, B.(Env. Sci.), TAE40110, examines the topic of mould exposure in healthcare facilities, and the associated duty of care for hospital facility managers and engineers. The article, published here in slightly adapted form, also focuses on the need for additional training of key personnel on the risks associated with exposure to environmental microbial contamination.
Perceptions of gender equality, work environment, support and social issues for women doctors at a university hospital in Riyadh, Kingdom of Saudi Arabia.
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Shehla Baqi
Full Text Available The Kingdom of Saudi Arabia (KSA is an Islamic monarchy and was established in 1932. Saudi women first entered the medical field in 1975 and the country has since seen a steady increase in women pursuing medicine. However, there is limited data on gender related issues for women doctors practicing in Saudi Arabia. Therefore, our study objective was to assess the perception amongst peers regarding gender equality and social issues faced by women doctors in Saudi Arabia. An online anonymous cross-sectional survey was administered in English to doctors at King Khalid Hospital, affiliated to King Saud University, in Riyadh, between April and May of 2016. Of 1015 doctors, 304 (30% participated, of which 129 (42.4% were females and 231 (76% were Saudi nationals. The average age was 32.4 years (±SD: 8.7. The majority opined that there was no gender discrimination in salaries (73.7% p-value = 0.4, hospital benefits (62.2% p-value = 0.06 or entry into any field of Medicine/Pediatrics (68.4% p-value = 0.207. However, only a minority believed that there was no gender discrimination for entry into surgery (37.3% p-value = .091. A higher proportion of male doctors agreed that promotion opportunities are equal (66.3% vs 45.7%, p-value = 0.002. However, of 54 consultants, only 18 (33.3% were women. Over half of the women (52.3% reported that they never wear the face veil. Only a minority of male and female doctors (12.2% believed women doctors should wear the veil since they examine male patients. Fewer respondents believed that female doctors face harassment from male doctors (14.5% whereas 30.7% believed female doctors face harassment from male patients. More females, than males, agreed with the statement that female doctors are as committed to their careers as are males (92.2% vs 67.4%, p-value<0.0001. Of 304 participants, 210 (69.1% said that they would still choose to become a doctor with approximately equal proportions between males and females (68% vs
Perceptions of gender equality, work environment, support and social issues for women doctors at a university hospital in Riyadh, Kingdom of Saudi Arabia.
Baqi, Shehla; Albalbeesi, Amal; Iftikhar, Sundus; Baig-Ansari, Naila; Alanazi, Mohammad; Alanazi, Awadh
The Kingdom of Saudi Arabia (KSA) is an Islamic monarchy and was established in 1932. Saudi women first entered the medical field in 1975 and the country has since seen a steady increase in women pursuing medicine. However, there is limited data on gender related issues for women doctors practicing in Saudi Arabia. Therefore, our study objective was to assess the perception amongst peers regarding gender equality and social issues faced by women doctors in Saudi Arabia. An online anonymous cross-sectional survey was administered in English to doctors at King Khalid Hospital, affiliated to King Saud University, in Riyadh, between April and May of 2016. Of 1015 doctors, 304 (30%) participated, of which 129 (42.4%) were females and 231 (76%) were Saudi nationals. The average age was 32.4 years (±SD: 8.7). The majority opined that there was no gender discrimination in salaries (73.7% p-value = 0.4), hospital benefits (62.2% p-value = 0.06) or entry into any field of Medicine/Pediatrics (68.4% p-value = 0.207). However, only a minority believed that there was no gender discrimination for entry into surgery (37.3% p-value = .091). A higher proportion of male doctors agreed that promotion opportunities are equal (66.3% vs 45.7%, p-value = 0.002). However, of 54 consultants, only 18 (33.3%) were women. Over half of the women (52.3%) reported that they never wear the face veil. Only a minority of male and female doctors (12.2%) believed women doctors should wear the veil since they examine male patients. Fewer respondents believed that female doctors face harassment from male doctors (14.5%) whereas 30.7% believed female doctors face harassment from male patients. More females, than males, agreed with the statement that female doctors are as committed to their careers as are males (92.2% vs 67.4%, p-valueequal proportions between males and females (68% vs 70.5%, p-value = 0.79). In conclusion, our survey of male and female doctors at a government university hospital in
repeatedly deployed, potentially leading to burnout or difficulties with post-traumatic stress .36 Some of this burden could be relieved with the use of an...1 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY UTILIZATION OF ACUTE CARE NURSE PRACTITIONERS TO COMBAT PHYSICIAN SHORTAGES IN THE...providers such as nurse practitioners to aid in achieving patient care goals, there is little published to support their use in the military
Femme Fatale: An Examination of the Role of Women in Combat and the Policy Implications for Future American Military Operations
Amazons . The mention of the word evokes images of tall, strong combative women who abandoned femininity and the protection of male companions to...live as their own tribe . Most assume that these are merely mythical tales about female warriors yet greater writers such as Homer and Plato described a... tribe of these women living in the southern areas of the former Soviet Union.2 Archeological evidence supports the idea that women participated in
Restructuring within an academic health center to support quality and safety: the development of the Center for Quality and Safety at the Massachusetts General Hospital.
Bohmer, Richard M J; Bloom, Jonathan D; Mort, Elizabeth A; Demehin, Akinluwa A; Meyer, Gregg S
Recent focus on the need to improve the quality and safety of health care has created new challenges for academic health centers (AHCs). Whereas previously quality was largely assumed, today it is increasingly quantifiable and requires organized systems for improvement. Traditional structures and cultures within AHCs, although well suited to the tripartite missions of teaching, research, and clinical care, are not easily adaptable to the tasks of measuring, reporting, and improving quality. Here, the authors use a case study of Massachusetts General Hospital's efforts to restructure quality and safety to illustrate the value of beginning with a focus on organizational culture, using a systematic process of engaging clinical leadership, developing an organizational framework dependent on proven business principles, leveraging focus events, and maintaining executive dedication to execution of the initiative. The case provides a generalizable example for AHCs of how applying explicit management design can foster robust organizational change with relatively modest incremental financial resources.
HIV Case Management Support Service Is Associated with Improved CD4 Counts of Patients Receiving Care at the Antiretroviral Clinic of Pantang Hospital, Ghana
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Bismark Sarfo
Full Text Available Background. Factors associated with individual patient-level management of HIV have received minimal attention in sub-Saharan Africa. This study determined the association between support services and cluster of differentiation 4 (CD4 counts among HIV patients attending ART clinic in Ghana. Methodology. This was a cross-sectional study involving adults with HIV recruited between 1 August 2014 and 31 January 2015. Data on support services were obtained through a closed-ended personal interview while the CD4 counts data were collected from their medical records. Data were entered into EpiData and analyzed using Stata software. Results. Of the 201 patients who participated in the study, 67% (129/191 received case management support service. Counseling about how to prevent the spread of HIV (crude odds ratio (cOR (95% confidence interval (CI (2.79 (1.17–6.68, mental health services (0.2 (0.04–1.00, and case management support service (2.80 (1.34–5.82 was associated with improved CD4 counts of 350 cells/mm3 or more. After adjusting for counseling about how to prevent the spread of HIV and mental health services, case management support service was significantly associated with CD4 counts of 350 cells/mm3 or more (aOR = 2.36 (CI = 1.01–5.49. Conclusion. Case management support service for HIV patients receiving ART improves their CD4 counts above 350 cells/mm3. Incorporating HIV case management services in ART regimen should be a priority in sub-Saharan Africa.
Stigma associated with PTSD: perceptions of treatment seeking combat veterans.
Mittal, Dinesh; Drummond, Karen L; Blevins, Dean; Curran, Geoffrey; Corrigan, Patrick; Sullivan, Greer
Although stigma associated with serious mental illness, substance abuse disorders, and depression has been studied very little is known about stigma associated with Posttraumatic Stress Disorder (PTSD). This study explored stigma related to PTSD among treatment-seeking Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combat veterans. Sixteen treatment-seeking OEF/OIF veterans with combat-related PTSD participated in focus groups. We used qualitative methods to explore PTSD-related stigma. Common perceived stereotypes of treatment-seeking veterans with PTSD included labels such as "dangerous/violent," or "crazy," and a belief that combat veterans are responsible for having PTSD. Most participants reported avoiding treatment early on to circumvent a label of mental illness. Participants initially reported experiencing some degree of self-stigma; however, following engagement in treatment they predominantly resisted these stereotypes. Although most participants considered combat-related PTSD as less stigmatizing than other mental illnesses, they reported difficulties with reintegration. Such challenges likely stem from both PTSD symptoms and veterans' perceptions of how the public views them. Most reported that fellow combat veterans best understood them. Awareness of public stereotypes impacts help seeking at least early in the course of illness. Peer-based outreach and therapy groups may help veterans engage in treatment early and resist stigma. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Sustained User Engagement in Health Information Technology: The Long Road from Implementation to System Optimization of Computerized Physician Order Entry and Clinical Decision Support Systems for Prescribing in Hospitals in England.
Cresswell, Kathrin M; Lee, Lisa; Mozaffar, Hajar; Williams, Robin; Sheikh, Aziz
To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. Six hospitals in England, United Kingdom. Qualitative case study. We undertook qualitative semi-structured interviews, non-participant observations of meetings and system use, and collected organizational documents over three time periods from six hospitals. Thematic analysis was initially undertaken within individual cases, followed by cross-case comparisons. We conducted 173 interviews, conducted 24 observations, and collected 17 documents between 2011 and 2015. We found that perceived individual and safety benefits among different user groups tended to facilitate engagement in some, while other less engaged groups developed resistance and unsanctioned workarounds if systems were perceived to be inadequate. We identified both the opportunity and need for sustained engagement across user groups around system enhancement (e.g., through customizing software) and the development of user competencies and effective use. There is an urgent need to move away from an episodic view of engagement focused on the preimplementation phase, to more continuous holistic attempts to engage with and respond to end-users. © Health Research and Educational Trust.
A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans.
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Chen Xue
Full Text Available Post-traumatic stress disorder (PTSD, a complex and chronic disorder caused by exposure to a traumatic event, is a common psychological result of current military operations. It causes substantial distress and interferes with personal and social functioning. Consequently, identifying the risk factors that make military personnel and veterans more likely to experience PTSD is of academic, clinical, and social importance. Four electronic databases (PubMed, Embase, Web of Science, and PsycINFO were used to search for observational studies (cross-sectional, retrospective, and cohort studies about PTSD after deployment to combat areas. The literature search, study selection, and data extraction were conducted by two of the authors independently. Thirty-two articles were included in this study. Summary estimates were obtained using random-effects models. Subgroup analyses, sensitivity analyses, and publication bias tests were performed. The prevalence of combat-related PTSD ranged from 1.09% to 34.84%. A total of 18 significant predictors of PTSD among military personnel and veterans were found. Risk factors stemming from before the trauma include female gender, ethnic minority status, low education, non-officer ranks, army service, combat specialization, high numbers of deployments, longer cumulative length of deployments, more adverse life events, prior trauma exposure, and prior psychological problems. Various aspects of the trauma period also constituted risk factors. These include increased combat exposure, discharging a weapon, witnessing someone being wounded or killed, severe trauma, and deployment-related stressors. Lastly, lack of post-deployment support during the post-trauma period also increased the risk of PTSD. The current analysis provides evidence of risk factors for combat-related PTSD in military personnel and veterans. More research is needed to determine how these variables interact and how to best protect against susceptibility
A Meta-Analysis of Risk Factors for Combat-Related PTSD among Military Personnel and Veterans
Liu, Yuan; Kang, Peng; Wang, Meng; Zhang, Lulu
Post-traumatic stress disorder (PTSD), a complex and chronic disorder caused by exposure to a traumatic event, is a common psychological result of current military operations. It causes substantial distress and interferes with personal and social functioning. Consequently, identifying the risk factors that make military personnel and veterans more likely to experience PTSD is of academic, clinical, and social importance. Four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) were used to search for observational studies (cross-sectional, retrospective, and cohort studies) about PTSD after deployment to combat areas. The literature search, study selection, and data extraction were conducted by two of the authors independently. Thirty-two articles were included in this study. Summary estimates were obtained using random-effects models. Subgroup analyses, sensitivity analyses, and publication bias tests were performed. The prevalence of combat-related PTSD ranged from 1.09% to 34.84%. A total of 18 significant predictors of PTSD among military personnel and veterans were found. Risk factors stemming from before the trauma include female gender, ethnic minority status, low education, non-officer ranks, army service, combat specialization, high numbers of deployments, longer cumulative length of deployments, more adverse life events, prior trauma exposure, and prior psychological problems. Various aspects of the trauma period also constituted risk factors. These include increased combat exposure, discharging a weapon, witnessing someone being wounded or killed, severe trauma, and deployment-related stressors. Lastly, lack of post-deployment support during the post-trauma period also increased the risk of PTSD. The current analysis provides evidence of risk factors for combat-related PTSD in military personnel and veterans. More research is needed to determine how these variables interact and how to best protect against susceptibility to PTSD. PMID
Metabolic control in type 1 diabetes patients practicing combat sports: at least two-year follow-up study.
Benbenek-Klupa, Teresa; Matejko, Bartlomiej; Klupa, Tomasz
It is well recognized that physical activity should be an integral part of the management of diabetes. It remains controversial, however, whether combat sports, often preferred by young individuals type 1 diabetes mellitus (T1DM), may be performed without high risk of metabolic decompensation. The aim of this observational study was to summarize a two-year follow-up period of five young male patients with T1DM practicing combat sports under the care of a physical-activity oriented specialist diabetes outpatient clinic. Of the five patients, three mixed martial arts and two kick-boxing competitors were included in the study. To control glucose in each patient, an individual approach was used that took into consideration the type of training, the sequence of the exercises, and the relative proportion of different forms of exercise. During the follow-up, glycemic control was improved and maintained in all individuals. Neither an episode of hospitalization-requiring diabetic ketoacidosis nor severe hypoglycemia occurred in these patients during the follow-up. In conclusion, an individual approach for T1DM patients practicing combat sports may result in achieving and maintaining satisfactory glycemic control without increased risk of metabolic decompensation.
Sustainable Living in Finland: Combating Climate Change in Everyday Life
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Arto O. Salonen
Full Text Available Finland aims to be a carbon-neutral society by the year 2050. We are interested to know on a general level how sustainable living materializes among Finnish people, what is the structure of a sustainable lifestyle in Finland and how do people reason about their everyday behavior choices in the context of sustainability in order to combat climate change. The data (n = 2052 were collected by questionnaire in April 2017. They were corrected by sex, age and residential area to be representative of the population of Finland (18–79 years old. We applied mixed methods. A principal axis factoring was conducted on the 32 variables with orthogonal rotation (varimax. Six factors explained 65.2% of the variance. The respondents were also able to write why they considered the specific variable to be important for them. We classified 2811 reasonings. According to our results, Finns have become conscious of climate change, but carbon reduction has not become mainstream in their everyday life. Circulation and preventing loss of materials show a promising start to a Finn's sustainable way of living. Recycling has been automated so that it is part of a Finn's everyday routine and habits. Finns also favor domestic food and products. They are interested in the origin of materials. Essential reasons for that are supporting the local economy and ensuring a good employment rate for the state. Smart, carbon-free mobility is a challenge. Finns seem to estimate that their personal car use is already at the proper level. On the other hand, even one fifth reported consideration of environmental effects when planning holidays.