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To provide standardized recommendations for the emergency department (ED) response to chemical, biological, radiological, and nuclear (CBRN) events by combining the human factors/ergonomics method of hierarchical task analysis with the theoretical framework for Work as Imagined versus Work as Done.
Methods:
Document analyses were used to represent CBRN response operational procedures. Semi-structured interviews using scenario cards were carried out with 57 first receivers (ED staff) to represent CBRN practice at 2 acute hospitals in England.
Results:
Variability existed in general organizational responsibilities associated with the CBRN response. Variability was further evident in top level CBRN tasks and CBRN phases at both EDs. Operational procedures focused on tasks such as documentation, checking, and timing. CBRN practice focused on patient needs through assessment, treatment, and diagnosis.
Conclusion:
The findings provide top-down and bottom-up insights to enhance the ED CBRN response through standardization. The standardized CBRN action card template embeds the choice approach to standardization. The standardized CBRN framework implements the streamlined categorization of CBRN phases. Work as Imagined versus Work as Done is a useful theoretical framework to unpack a complex sociotechnical system, and hierarchical task analysis is an effective system mapping tool in health care.
Especially with the Asian financial crisis of 1997–98, Asian countries have advocated a profound reform of the international financial architecture. Their proposals focused on two main axes: a reform of the global financial system, and stronger regional monetary integration in Asia. There are here significant parallels with the ideas of Robert Triffin (1911–1993). Triffin became famous with trenchant analyses of the vulnerabilities of the international monetary system. The Triffin dilemma is still present among international monetary policy-makers, also in Asia. Triffin put forward several proposals for reforming the global monetary system, but he also developed proposals for regional monetary integration. These were very much based on his experience with the European Payments Union, and focused on the creation of a (European) reserve fund and a (European) currency unit. In this paper we focus on Triffin’s proposals for an Asian payments union in the late 1960s, giving special attention to Japan (in Triffin’s time, the biggest Asian economy; moreover, Triffin had an important Japanese network).
During the height of its power over everyday life, between 1968 and 1993, the Cuban Communist Party outlawed virtually all non-state labour and exchange. Since then, however, its continuity in power has increasingly depended on devolution: shifting responsibility for the provision of basic goods and services from failing state enterprises back to the self-employed. The latter now produce the majority of food and basic products; receive most of the national income from tourism, remittances and foreign investment; and generate most new jobs. Nevertheless, they subsist under a subaltern regime of fragile and conditional freedoms. The article adapts James Scott's consideration for the subaltern's ‘hidden transcripts’ and agencies to contemporary Cuba. It analyses the unavoidability of informal and illegal practices for daily subsistence; their naturalisation in society in contrast with their delegitimisation as opportunistic self-enrichment in party-controlled media; and how the self-employed resist such judgements in favour of more conciliatory civic visions.
Among food groups with putative benefits for brain structures, dairy products (DP) have been poorly studied. The sample included participants without dementia from the ancillary brain imaging study of the Three-City cohort who were aged 65+ years, had their DP intake assessed with a FFQ at baseline and underwent an anatomical scan 3 years (n 343) or 9 years (n 195) after completing the dietary survey. The frequencies of consumption of total DP, milk and cheese were not associated with brain structure. Compared with the lowest frequency, the highest frequency of fresh DP (F-DP) consumption (< 0·5 v. > 1·5 times/d) was significantly associated with a lower medial temporal lobe volume (MTLV) (β = −1·09 cm3, 95 % CI − 1·83, −0·36) 9 years later. In this population-based study of older adults, the consumption of F-DP more than 1·5 times/d was associated with a lower MTLV, which is considered an early biomarker of Alzheimer’s disease, 9 years later. This original study should be replicated in different settings before conclusions are drawn.
Even before the onset of the COVID-19 pandemic, and especially since, I-O psychology has demonstrated its ability to adapt and to make meaningful contributions to how work is accomplished in tumultuous environments. Such contributions reflect the ongoing evolution of the field and an increased awareness of the potential for I-O psychologists to effect meaningful societal change. We believe that I-O psychology must embrace this evolution and, using the United Nations Sustainable Development Goals to help us target our efforts, become a resource and a voice for workers and organizations around the world, and a force for the greater good.
In infants and young children, good image quality in MRI and CT requires sedation or general anesthesia to prevent motion artefacts. This study aims to determine the safety of ambulatory sedation for children with CHD in an outpatient setting as a feasible alternative to in-hospital management.
Methods:
We recorded 91 consecutive MRI and CT examinations of patients with CHD younger than 6 years with ambulatory sedation. CHD diagnoses, vital signs, applied sedatives, and adverse events during or after ambulatory sedation were investigated.
Results:
We analysed 91 patients under 72 months (6 years) of age (median 26.0, range 1–70 months; 36% female). Sixty-eight per cent were classified as ASA IV, 25% as ASA III, and 7% as ASA II (American Society of Anesthesiologists Physical Status Classification). Ambulatory sedation was performed by using midazolam, propofol, and/or S-ketamine. The median sedation time for MRI was 90 minutes (range 35–235 minutes) and 65 minutes for CT (range 40–280 minutes). Two male patients (age 1.5 months, ASA II, and age 17 months, ASA IV) were admitted for in-hospital observation due to unexpected severe airway obstruction. The patients were discharged without sequelae after 1 and 3 days, respectively. All other patients were sent home on the day of examination.
Conclusion:
In infants and young children with CHD, MRI or CT imaging can be performed under sedation in an outpatient setting by a well-experienced team. In-hospital backup should be available for unexpected events.
In the setting of finite groups, suppose $J$ acts on $N$ via automorphisms so that the induced semidirect product $N\rtimes J$ acts on some non-empty set $\Omega$, with $N$ acting transitively. Glauberman proved that if the orders of $J$ and $N$ are coprime, then $J$ fixes a point in $\Omega$. We consider the non-coprime case and show that if $N$ is abelian and a Sylow $p$-subgroup of $J$ fixes a point in $\Omega$ for each prime $p$, then $J$ fixes a point in $\Omega$. We also show that if $N$ is nilpotent, $N\rtimes J$ is supersoluble, and a Sylow $p$-subgroup of $J$ fixes a point in $\Omega$ for each prime $p$, then $J$ fixes a point in $\Omega$.
This paper discusses a rare Late Ming blue and white porcelain bowl with five cartouches depicting scenes of sexual intercourse, which was found during archaeological excavations in the Santana convent, a former Franciscan nunnery located in Lisbon founded in 1562. The paper begins with a description of the bowl, the context of its recovery and its significance, highlighting its extreme rarity among Chinese export porcelains. The second section discusses Chinese sexuality and the production of erotica during the Late Ming period, namely porcelains with erotic and sexual imagery, a subject that has been overlooked by mainstream scholarship. The last section proposes an explanation for the presence of this bowl in the Santana nunnery, emphasising the gap between the ideals of Iberian Catholic monastic life and the worldly practices conducted by the members of these religious orders in the Baroque era.
Paediatric early warning score systems are used for early detection of clinical deterioration of patients in paediatric wards. Several paediatric early warning scores have been developed, but most of them are not suitable for children with cyanotic CHD who are adapted to lower arterial oxygen saturation.
Aim:
The present study compared the original paediatric early warning system of the Royal College of Physicians of Ireland with a modification for children with cyanotic CHD.
Design:
Retrospective single-centre study in a paediatric cardiology intermediate care unit at a German university hospital.
Results:
The distribution of recorded values showed a significant shift towards higher score values in patients with cyanotic CHD (p < 0.001) using the original score, but not with the modification. An analysis of sensitivity and specificity for the factor “requirement of action” showed an area under the receiver operating characteristic for non-cyanotic patients of 0.908 (95% CI 0.862–0.954). For patients with cyanotic CHD, using the original score, the area under the receiver operating characteristic was reduced to 0.731 (95% CI 0.637–0.824, p = 0.001) compared to 0.862 (95% CI 0.809–0.915, p = 0.207), when the modified score was used. Using the critical threshold of scores ≥ 4 in patients with cyanotic CHD, sensitivity and specificity for the modified score was higher than for the original (sensitivity 78.8 versus 72.7%, specificity 78.2 versus 58.4%).
Conclusion:
The modified score is a uniform scoring system for identifying clinical deterioration, which can be used in children with and without cyanotic CHD.
The Expression of the Emotions in Man and Animals has been considered Charles Darwin's forgotten masterpiece and is his only book on psychology. It is also the first ever systematic application of Darwinian theory to the expression of emotions and has been considered by some to be the foundational text of evolutionary psychology. This article explores some key concepts in the book and gives reasons why both psychiatry and psychology can benefit greatly from becoming better acquainted with this work.
A taxonomic review was performed on cestodes of the genus Neoskrjabinolepis Spassky, 1947 that parasitize different species of Sorex shrews in different regions of the northern Palearctic and in the Nearctic (Alaska, USA). Information on Palearctic Neoskrjabinolepis cestodes published in various articles is summarized. An overview of the geographical distribution of the Neoskrjabinolepis species is also presented. Currently, the genus includes 17 species. In the European part of the Palearctic, four species of the genus are registered; in the Asian part, 13 species; and on the American continent (Seward Peninsula, Alaska, USA), two species. Descriptions, illustrations, and differential diagnoses are given for a new species of Neoskrjabinolepis, i.e. N. paradoxa n. sp., which was found in shrews Sorex unguiculatus Dobson and S. caecutiens Laxmann on Sakhalin Island. A unique feature of the new species is irregularly alternating genital pores in the uterus series in the strobila. Amended new differential features (positioning of the uterus relative to osmoregulatory canals and alternation of genital pores) of genus diagnosis and an identification key for Neoskrjabinolepis spp. are presented.
Jordan Peterson is a darling among conservatives and religious people alike. In defending religious belief as the only bulwark against a return to the dark ages, it becomes obvious that Peterson himself doesn't believe in what he preaches. People, he insists, should believe in the archetypal symbolism that is only revealed through a close reading of the Bible. If atheists would only read scripture with more sophistication they wouldn't so embarrassingly reject religion, and simultaneously threaten the very foundations of Western Civilization. It turns out that it's Peterson who comprehensively ignores symbolism. A simple Sunday school lesson shows this.