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The Society for Healthcare Epidemiology of America, the Association of Professionals in Infection Control and Epidemiology, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society represent the core expertise regarding healthcare infection prevention and infectious diseases and have written multisociety statement for healthcare facility leaders, regulatory agencies, payors, and patients to strengthen requirements and expectations around facility infection prevention and control (IPC) programs. Based on a systematic literature search and formal consensus process, the authors advocate raising the expectations for facility IPC programs, moving to effective programs that are:
• Foundational and influential parts of the facility’s operational structure
• Resourced with the correct expertise and leadership
• Prioritized to address all potential infectious harms
This document discusses the IPC program’s leadership—a dyad model that includes both physician and infection preventionist leaders—its reporting structure, expertise, and competencies of its members, and the roles and accountability of partnering groups within the healthcare facility. The document outlines a process for identifying minimum IPC program medical director support. It applies to all types of healthcare settings except post-acute long-term care and focuses on resources for the IPC program. Long-term acute care hospital (LTACH) staffing and antimicrobial stewardship programs will be discussed in subsequent documents.
To minimize loss of life, mass casualty response requires swift identification, efficient triage categorization, and rapid hemorrhage control. Current training methods remain suboptimal. Our objective was to train first responders to triage a mass casualty incident using Virtual Reality (VR) simulation and obtain their impressions of the training’s quality and effectiveness.
Methods
We trained subjects in SALT Triage then had them respond to a terrorist bombing of a subway station using a fully immersive VR simulation. We gathered learner reactions to their VR experience and post-encounter debriefing with a custom electronic survey.
Results
Nearly 400 subjects experienced the VR encounter and completed evaluation surveys. Most participants (95%) recommended the experience for other first responders and rated the simulation (95%) and virtual patients (91%) as realistic. Ninety-four percent of participants rated the VR simulator as “excellent” or “good.” We observed no differences between those who owned a personal VR system and those who did not.
Conclusions
Our VR simulator (go.osu.edu/firstresponder) is an automated, customizable, fully immersive virtual reality system for training and assessing personnel in the proper response to a mass casualty incident. Participants perceived the encounter as effective for training, regardless of their prior experience with virtual reality.
Hemorrhage control, triage efficiency, and triage accuracy are essential skills for optimal outcomes in mass casualty incidents. This study evaluated user application of skills through a Virtual Reality (VR) simulation of a subway bombing.
Methods
EMS clinicians and healthcare professionals engaged in a VR simulation of a bomb/blast scenario utilizing VRFirstResponder, a high-fidelity, fully immersive, automated, customizable, and programmable VR simulation platform. Metrics including time to control life-threatening hemorrhage and triage efficacy were analyzed using median and interquartile ranges (IQR).
Results
389 EMS responders engaged in this high-fidelity VR simulation encountering 11 virtual patients with varying injury severity. The median time to triage the scene was 7:38 minutes (SD = 2:27, IQR = 6:13, 8:59). A robust 93% of participants successfully implemented all required hemorrhage control, with a median time of 3:51 minutes for life-threatening hemorrhage control (SD = 1:44, IQR = 2:41, 4:52). Hemorrhage control per patient took a median of 11 seconds (SD = 0:47, IQR = 0:06, 0:20). Participants accurately tagged 73% of patients and 17% effectively utilized the SALT sort commands for optimal patient evaluation.
Conclusion
The VRFirstResponder simulation, currently under validation, aims to enhance realism by incorporating distractors and refining assessment tools.
In order to study the structure and temperature distribution within high-mass star-forming clumps, we employed the Australia Telescope Compact Array to image the $\mathrm{NH}_3$ (J,K) = (1,1) through (6,6) and the (2,1) inversion transitions, the $\mathrm{H}_2\mathrm{O}$$6_{16}$-$5_{23}$ maser line at 22.23508 GHz, several $\mathrm{CH}_3\mathrm{OH}$ lines and hydrogen and helium recombination lines. In addition, 22- and 24-GHz radio continuum emission was also imaged.
The $\mathrm{NH}_3$ lines probe the optical depth and gas temperature of compact structures within the clumps. The $\mathrm{H}_2\mathrm{O}$ maser pinpoints the location of shocked gas associated with star formation. The recombination lines and the continuum emission trace the ionised gas associated with hot OB stars. The paper describes the data and presents sample images and spectra towards select clumps. The technique for estimating gas temperature from $\mathrm{NH}_3$ line ratios is described. The data show widespread hyperfine intensity anomalies in the $\mathrm{NH}_3$ (1,1) images, an indicator of non-LTE $\mathrm{NH}_3$ excitation. We also identify several new $\mathrm{NH}_3$ (3,3) masers associated with shocked gas. Towards AGAL328.809+00.632, the $\mathrm{H}_2\mathrm{O}$$6_{16}$-$5_{23}$ line, normally seen as a maser, is instead seen as a thermally excited absorption feature against a strong background continuum. The data products are described in detail.
Islamic Jihadism has deep ties to National Socialism, both in its history and in its vision of a world that is “purified of the Jews.” Chapter 8 demonstrates the influences of Nazi exterminationist Jew hatred on modern Islamic Jihadism. It should be noted that I use the term Islamic Jihadism to distinguish Jihadists from other Muslims who are not part of this movement. Tracing the path from Hitler to Hamas, the chapter brings out the connections between the antisemitism of the Muslim Brotherhood and National Socialist Jew hatred, with particular attention to the Nazi war criminal Haj Amin al-Husseini. I incorporate primary texts of Jihadist ideologues such as Hasan al-Banna, Sayyid Qutb, Abdullah Azzam, Ruhullah Khomeini, and others. Like the Nazis, but with theological differences, the Jihadists maintain not that all Jews are evil but that all evil is Jewish, to which and that to resolve it there can be only a Final Solution.
This chapter shows how the modern thought that has shaped the current intellectual landscape played a role in the extermination of the Jews. Very often the millennial history of Christian antisemitism is blamed for the Holocaust. It is not so often, however, that the speculative philosophical tradition, particularly in the modern period, is taken to task. This chapter examines the ways in which the modern philosophical period is characterized by a process of thinking God out of the picture. From here Martin Heidegger emerges as the culmination of modern philosophical thought. Levinas has observed, “Heideggerian philosophy precisely marks the apogee of a thought in which the finite does not refer to the infinite … in which every deficiency is but weakness and every fault committed against oneself - the outcome of a long tradition of pride, heroism, domination, and cruelty. Heideggerian ontology subordinates the relation with the other to the relation with the neuter, Being, and it thus continues to exalt the will to power, whose legitimacy the other alone can unsettle, troubling good conscience.” This chapter demonstrates the truth of Levinas’s statement.
If the Jews were the target of the Nazis’ extermination project, we must ask: Why the Jews? Who are the Jews? What makes them Jews? One premise for this investigation, as already stated, is that Judaism is the key to the connections between antisemitism and the Holocaust that it spawned. Therefore these reflections on the connections among Judaism, antisemitism, and the Holocaust begin with the Judaism that makes Jews Jewish, which is the focus of the first chapter. The key to the matter of who is a Jew is Judaism. Whether a particular Jew is reform, orthodox, or atheist, his or her identity as a Jew ultimately stems from Judaism, from the Covenant of Torah: Without the Torah, there would be no Jews. The Covenant of Torah comes with certain categories of thought, beginning with the categories of creation, revelation, and redemption. It comes with a certain teaching and testimony concerning God, world, and humanity. The Jewish people signify that teaching and testimony by their very presence in the world.
Central to a number of manifestations of antisemitism is anti-Zionism, which in our time has become not only intellectually fashionable but morally required: One cannot be deemed morally good without supporting those who are bent on the annihilation of the Jewish state. This is the topic of Chapter 7. Like most manifestations of antisemitism, but although it is one that has the explicit endorsement both of the left-wing elite and of Islamic Jihadists, anti-Zionism is cloaked in the self-righteous garb of moral indignation. Here anti-Zionism is understood as an opposition not to the policies of the Jewish state but to the existence of the Jewish state. The chapter explains how notions of Holy Land and sacred history are tied to anti-Zionism, how anti-Zionism is tied to a contempt for Judaism, and what this has to do with the demonization and delegitimization of the Jewish state. Once again, we find that demonization introduces a metaphysical dimension that will not tolerate any compromise or half-measures. Like most manifestations of antisemitism, but one that has yet distinct from them in that it has become intellectually fashionable, anti-Zionism is cloaked in the self-righteous garb of moral indignation.
Chapter 12 explores the question of how the Jewish people might understand the “after” in “after the Holocaust.” These concluding reflections entail an examination of several questions: What should be the Jewish response to the radical assault on the Judaism that makes the Jewish soul Jewish? How do Jews recover a name in the aftermath of the ubiquitous, systematic assault on their names, their souls, and the Name of the Holy One? The chapter takes up these questions through an examination of a tale from the Torah that fundamentally defines the Jews and Judaism: the account of Jacob at Peniel, when Jacob wrestled the name of Israel from the Angel of Death, from God Himself. After the Holocaust, the most stark and extreme manifestation of antisemitism, the Jews confront just such an angel - and God Himself - in an effort to recover a remembrance and a name, a yad vashem. The name that the Jews must once again wrestle from God is Yisrael, Israel, which means “one who struggles with God and humanity.”
Here I argue that, inasmuch as antisemitism has a theological or ideological dimension, it manifests itself in three fundamental ways: the appropriation of the Word, the accusation and spilling of blood, and the determination of redemption. Always originating with highly sophisticated thinkers, antisemitism requires the appropriation or removal of the Holy Word in order to have the final word on the value of the human being and the higher relation that defines our humanity. In religious traditions this shows up as an appropriation of sacred texts; in the secular world we see it in texts like The Protocols of the Elders of Zion. Similarly, the antisemite demands purity, a demand manifest in blood libel, blood purification, and bloodletting: For the antisemite, sanctity means purity, and purity requires the elimination of the contagion, which is the Jew and the Judaism, and the contagion is in his or her blood. Finally, the antisemite must be the guardian of the gate to redemption, whether it lies in the salvation of the soul or in a utopian totalitarianism.
Chapter 10 shows how what began with philosophy’s rendering God superfluous ended in a war against the God of Abraham. Here we have the singularity of the Holocaust, which lies in a singular assault on the Jewish people as the perennial witnesses to that God the God of Abraham. Drawing on the testimony of the Holocaust diaries, written within the whirlwind of the assault on God, this chapter demonstrates that this defining feature of the Holocaust can be seen, for example, in the Nazis’ use of the holy calendar in the execution of their actions, in the prohibitions against prayer and Sabbath observance, in the destruction of synagogues and Hebrew Bibles, and in the targeting of children, elders, and mothers. What the diaries reveal about the essence of Holocaust that the historians cannot, it is argued, is this: The Holocaust was the systematic annihilation of not just of the bodies but of the souls of the Jews as a means of annihilating the God of the Jews. It is unprecedented and unparalleled.
This chapter examines (1) the connection between the movement of return and a messianic redemption, (2) the distinctively Jewish teachings on the Messiah, and (3) the relation between Jewish messianism and a Jewish understanding of history as sacred history. The key to these connections lies in the principle that our humanity is rooted in a responsibility to and for the other human being, which is ultimately a messianic responsibility: If the Messiah tarries it is because we tarry, because we are forever late for the appointment, late in answering, “Here I am for you,” to the anguished outcry of our fellow human being, beginning with the stranger, the other, the child of Adam. This blindness to what Emmanuel Levinas calls “the exigency of the holy,” in the face of the other, which is fundamental to Judaism, lies at the heart of antisemitism.
The fundamental problem defining the human condition, both ontological and metaphysical, is the problem of the movement from a wilderness to a dwelling place. This teaching is couched in the first letter of the Torah, which is itself the foundation of creation. The beit with which the Torah begins designates a “house,” the shelter that we are summoned to transform into a dwelling place. What is a dwelling place? It is a space into which we invite another, the stranger - the space opened up by the Torah that commands the Jews to attend to the care of the stranger. Drawing upon the Hebrew language, this chapter examines Jewish thinking about exile and return. Arguing that exile is not a punishment but is itself part of the Jewish journey to redemption, this chapter addresses (1) the relation between exile and revelation, (2) the condition of the soul in exile, and (3) the traumatic isolation of exile. The chapter shows that (1) Jewish thinking about any spiritual journey is different from the thinking that characterizes Western speculative thought, and that (2) for Jewish thought, exile is a metaphysical condition
This chapter examines the metaphysical origins of antisemitism, what drives the phenomenon, and what exactly antisemitism is anti-. Antisemitism, it is argued, cannot be reduced to a form of racism or bigotry. The Nazis, for example, were not antisemites because they were racists; rather, they were racists because they were antisemites: They had to establish an antisemitic premise in order to arrive at a racist outlook. Antisemitism is not a form of racism; rather, racism is a form of antisemitism. The Why of antisemitism is to be found in a fundamental opposition to a fundamental teaching from Judaism concerning the sanctity of the other human being, particularly the stranger. It lies in an ascent to the divine Throne of Judgment on the part of the antisemite, who now determines truth and lie, good and evil, salvation and damnation. Thus the Why of antisemitism lies in succumbing to the most ancient of temptations, the temptation to be like God.