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Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update
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- Michael Klompas, Richard Branson, Kelly Cawcutt, Matthew Crist, Eric C. Eichenwald, Linda R. Greene, Grace Lee, Lisa L. Maragakis, Krista Powell, Gregory P. Priebe, Kathleen Speck, Deborah S. Yokoe, Sean M. Berenholtz
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 43 / Issue 6 / June 2022
- Published online by Cambridge University Press:
- 20 May 2022, pp. 687-713
- Print publication:
- June 2022
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The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
Administrative and Educational Characteristics of Paramedic Programs in the United States
- Matthew T. Ball, Jonathan R. Powell, Lisa Collard, Doug K. York, Ashish R. Panchal
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- Journal:
- Prehospital and Disaster Medicine / Volume 37 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 02 February 2022, pp. 152-156
- Print publication:
- April 2022
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Introduction:
Paramedics are a vital component of the Emergency Medical Services (EMS) workforce and the United States health care system. The continued provision of high-quality care demands constantly improving education at accredited institutions. To date, only limited characteristics of paramedic education in the United States have been documented and studied in the literature. The objective of this study was to describe the educational infrastructure of accredited paramedic programs in the United States in 2018.
Methods:This is a retrospective, cross-sectional evaluation of the 2018 paramedic program annual report from The Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP; Rowlett, Texas USA). The dataset includes detailed program metrics. Additionally, questions concerning program characteristics, demographics, and resources were asked as part of the evaluation. Resource availability was assessed via the Resource Assessment Matrix (RAM) with a benchmark of 80%. Included in the analysis are all paramedic programs with students enrolled. Descriptive statistics were calculated (median, [interquartile range/IQR]).
Results:A total of 677 programs submitted data (100% response rate). Of these, 626 met inclusion criteria, totaling 17,422 students. Program annual enrollment varied greatly from one to 362 with most programs having small sizes (18 students [IQR 12-30]). Program duration was 12 months [IQR 12-16] with total hours of instruction being approximately 1,174 [IQR 1069-1304], 19% of which were dedicated to clinical experience. Full-time faculty sizes were small (two faculty members [IQR 1-3]) with most programs (80%) having annual operating budgets below USD$500,000. For programs with an annual budget below USD$100,000 (34% of programs), annual enrollment was approximately 14 students [IQR 9-21]. Degrees conferred by programs included certificates (90%), associate degrees (55%), and bachelor’s degree (2%). Simulation access was assessed with nearly all (100%) programs reporting simple task trainers and 84% of programs investing in advanced simulation manikins. Seventy-eight percent of programs met the RAM benchmark.
Conclusion:Most paramedic educational programs in the United States have small annual enrollments with low numbers of dedicated faculty and confer certificates and associate degrees. Nearly one-quarter of paramedic educational programs are not adequately resourced. This study is limited by self-reported data to the national accreditation agency. Future work is needed to identify program characteristics that are associated with high performance.
Proliferation of Faulty Materials Data Analysis in the Literature
- Matthew R. Linford, Vincent S. Smentkowski, John T. Grant, C. Richard Brundle, Peter M.A. Sherwood, Mark C. Biesinger, Jeff Terry, Kateryna Artyushkova, Alberto Herrera-Gómez, Sven Tougaard, William Skinner, Jean-Jacques Pireaux, Christopher F. McConville, Christopher D. Easton, Thomas R. Gengenbach, George H. Major, Paul Dietrich, Andreas Thissen, Mark Engelhard, Cedric J. Powell, Karen J. Gaskell, Donald R. Baer
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- Journal:
- Microscopy and Microanalysis / Volume 26 / Issue 1 / February 2020
- Published online by Cambridge University Press:
- 17 January 2020, pp. 1-2
- Print publication:
- February 2020
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Associations between childhood maltreatment and inflammatory markers
- Alish B. Palmos, Stuart Watson, Tom Hughes, Andreas Finkelmeyer, R. Hamish McAllister-Williams, Nicol Ferrier, Ian M. Anderson, Rajesh Nair, Allan H. Young, Rebecca Strawbridge, Anthony J. Cleare, Raymond Chung, Souci Frissa, Laura Goodwin, Matthew Hotopf, Stephani L. Hatch, Hong Wang, David A. Collier, Sandrine Thuret, Gerome Breen, Timothy R. Powell
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- Journal:
- BJPsych Open / Volume 5 / Issue 1 / January 2019
- Published online by Cambridge University Press:
- 04 January 2019, e3
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Background
Childhood maltreatment is one of the strongest predictors of adulthood depression and alterations to circulating levels of inflammatory markers is one putative mechanism mediating risk or resilience.
AimsTo determine the effects of childhood maltreatment on circulating levels of 41 inflammatory markers in healthy individuals and those with a major depressive disorder (MDD) diagnosis.
MethodWe investigated the association of childhood maltreatment with levels of 41 inflammatory markers in two groups, 164 patients with MDD and 301 controls, using multiplex electrochemiluminescence methods applied to blood serum.
ResultsChildhood maltreatment was not associated with altered inflammatory markers in either group after multiple testing correction. Body mass index (BMI) exerted strong effects on interleukin-6 and C-reactive protein levels in those with MDD.
ConclusionsChildhood maltreatment did not exert effects on inflammatory marker levels in either the participants with MDD or the control group in our study. Our results instead highlight the more pertinent influence of BMI.
Declaration of interestD.A.C. and H.W. work for Eli Lilly Inc. R.N. has received speaker fees from Sunovion, Jansen and Lundbeck. G.B. has received consultancy fees and funding from Eli Lilly. R.H.M.-W. has received consultancy fees or has a financial relationship with AstraZeneca, Bristol-Myers Squibb, Cyberonics, Eli Lilly, Ferrer, Janssen-Cilag, Lundbeck, MyTomorrows, Otsuka, Pfizer, Pulse, Roche, Servier, SPIMACO and Sunovian. I.M.A. has received consultancy fees or has a financial relationship with Alkermes, Lundbeck, Lundbeck/Otsuka, and Servier. S.W. has sat on an advisory board for Sunovion, Allergan and has received speaker fees from Astra Zeneca. A.H.Y. has received honoraria for speaking from Astra Zeneca, Lundbeck, Eli Lilly, Sunovion; honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion, Janssen; and research grant support from Janssen. A.J.C. has received honoraria for speaking from Astra Zeneca, honoraria for consulting with Allergan, Livanova and Lundbeck and research grant support from Lundbeck.
WISSARD at Subglacial Lake Whillans, West Antarctica: scientific operations and initial observations
- Slawek Tulaczyk, Jill A. Mikucki, Matthew R. Siegfried, John C. Priscu, C. Grace Barcheck, Lucas H. Beem, Alberto Behar, Justin Burnett, Brent C. Christner, Andrew T. Fisher, Helen A. Fricker, Kenneth D. Mankoff, Ross D. Powell, Frank Rack, Daniel Sampson, Reed P. Scherer, Susan Y. Schwartz, The Wissard Science Team
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- Journal:
- Annals of Glaciology / Volume 55 / Issue 65 / 2014
- Published online by Cambridge University Press:
- 26 July 2017, pp. 51-58
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A clean hot-water drill was used to gain access to Subglacial Lake Whillans (SLW) in late January 2013 as part of the Whillans Ice Stream Subglacial Access Research Drilling (WISSARD) project. Over 3 days, we deployed an array of scientific tools through the SLW borehole: a downhole camera, a conductivity–temperature–depth (CTD) probe, a Niskin water sampler, an in situ filtration unit, three different sediment corers, a geothermal probe and a geophysical sensor string. Our observations confirm the existence of a subglacial water reservoir whose presence was previously inferred from satellite altimetry and surface geophysics. Subglacial water is about two orders of magnitude less saline than sea water (0.37–0.41 psu vs 35 psu) and two orders of magnitude more saline than pure drill meltwater (<0.002 psu). It reaches a minimum temperature of –0.55~C, consistent with depression of the freezing point by 7.019 MPa of water pressure. Subglacial water was turbid and remained turbid following filtration through 0.45 µm filters. The recovered sediment cores, which sampled down to 0.8 m below the lake bottom, contained a macroscopically structureless diamicton with shear strength between 2 and 6 kPa. Our main operational recommendation for future subglacial access through water-filled boreholes is to supply enough heat to the top of the borehole to keep it from freezing.
The Impact of a Concussion-U Educational Program on Knowledge of and Attitudes about Concussion
- Matthew E. Eagles, David J. Bradbury-Squires, Maria F. Powell, Justin R. Murphy, Graeme D. Campbell, Falah B. Maroun
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 43 / Issue 5 / September 2016
- Published online by Cambridge University Press:
- 28 July 2016, pp. 659-664
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Background: The diagnosis of a sports-related concussion is often dependent on the athlete self-reporting their symptoms. It has been suggested that improving youth athlete knowledge and attitudes toward concussion may increase self-reporting behaviour. The objective of this study was to determine if a novel Concussion-U educational program improves knowledge of and attitudes about concussion among a cohort of elite male Bantam and Midget AAA hockey players. Methods: Fifty-seven male Bantam and Midget AAA-level hockey players (mean age=14.52±1.13 years) were recruited from the local community. Each participant completed a modified version of the Rosenbaum Concussion Knowledge and Attitudes Survey–Student Version immediately before and after a Concussion-U educational presentation. Follow-up sessions were arranged 4 to 6 months after the presentation, and assessed retention of knowledge and attitude changes. Results: Forty-three players completed all three surveys. Concussion knowledge and attitude scores significantly (p<0.01) increased from pre- to post-presentation by 12.79 and 8.41%, respectively. At long-term follow-up, knowledge levels remained significantly (p<0.01) higher than baseline by 8.49%. Mean attitude scores were also increased at follow-up; however, this increase was not statistically significant. Conclusions: A Concussion-U educational program led to an immediate improvement in concussion knowledge and attitudes among elite male Bantam and Midget AAA hockey players. Increased knowledge was maintained at long-term follow-up, but improved attitude was not. Future studies should investigate whether similar educational programs influence symptom reporting and concussion incidence. In addition, they should focus on how to maintain improved concussion attitudes.
Contributors
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- By Hamid M. Abdolmaleky, Cory Adamson, Paola Allavena, Dimitrios Anastasiou, Johanna Apfel, Surinder K. Batra, Mark E. Burkard, Amancio Carnero, Michael J. Clemens, Jeanette Gowen Cook, Isabel Dominguez, Jeremy S. Edwards, Wafik S. El-Deiry, Androulla Elia, Mohammad R. Eskandari, Aurora Esquela-Kerscher, Manel Esteller, Rob M. Ewing, Douglas V. Faller, Kristopher Frese, Xijin Ge, Giovanni Germano, Daniel A. Haber, William C. Hahn, Antoine Ho, Christine Iacobuzio-Donahue, Sergii Ivakhno, Prasad V. Jallepalli, Rosanne Jones, Sharyn Katz, Arnaud Krebs, Karl Krueger, Arthur W. Lambert, Adam Lerner, Holly Lewis, Jason W. Locasale, Giselle Y. López, Shyamala Maheswaran, Alberto Mantovani, José Ignacio Martín-Subero, Simon J. Morley, Oliver Müller, Kathleen R. Nevis, Sait Ozturk, Panagiotis Papageorgis, Jignesh R. Parikh, Steven M. Powell, Kimberly L. Raiford, Andrew M. Rankin, Patricia Reischmann, Simon Rosenfeld, Marc Samsky, Anthony Scott, Shantibhusan Senapati, Yashaswi Shrestha, Anurag Singh, Rakesh K. Singh, Gromoslaw A. Smolen, Sudhir Srivastava, Simon Tavaré, Sam Thiagalingam, László Tora, David Tuveson, Asad Umar, Matthew G. Vander Heiden, Cyrus Vaziri, Zhenghe John Wang, Kevin Webster, Chen Khuan Wong, Yu Xia, Hai Yan, Jian Yu, Lihua Yu, Min Yu, Lin Zhang, Jin-Rong Zhou
- Edited by Sam Thiagalingam
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- Book:
- Systems Biology of Cancer
- Published online:
- 05 April 2015
- Print publication:
- 09 April 2015, pp ix-xiv
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Origination, extinction, invasion, and extirpation components of the brachiopod latitudinal biodiversity gradient through the Phanerozoic Eon
- Matthew G. Powell, Brandi R. Moore, Travis J. Smith
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- Paleobiology / Volume 41 / Issue 2 / March 2015
- Published online by Cambridge University Press:
- 05 March 2015, pp. 330-341
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The geographic distribution of brachiopod genus occurrences over the Phanerozoic shows that secular declines in origination and extinction rates were paralleled by increases in invasion and extirpation rates. Origination and extinction rates declined in two phases, the first from the Cambrian to latest Permian Periods and the second from the latest Permian Period to the present, which were accompanied by concomitant increases in invasion and extirpation rates. In addition to the temporal correlation, an inverse correlation was also weakly evident among time-averaged latitudinal gradients of rates. Compared with faunas at higher latitudes, low-latitude faunas experienced higher origination and extinction rates, and lower invasion and extirpation rates. We suggest that progressive increases in migration ability lowered origination and extinction rates because species that were better equipped to track a preferred habitat, for example, by the ability to disperse larvae over large distances, were less likely to evolve or become extinct in response to local environmental changes. The two phases were separated by the end-Permian mass extinction, which reset to high levels the origination and extinction rates of a taxonomically and ecologically altered global brachiopod fauna. Our data also allow us to quantify the relative contributions of origination, extinction, invasion, and extirpation to regional diversity (quantified as 10° latitudinal zones) more generally. Overall, invasion and extirpation explained slightly more variation in diversity than in situ origination and extinction. The four variables usually occurred in combinations that maintained rather than altered the shape of the latitudinal diversity gradient. For most of the Phanerozoic Eon, the gradient was not the product of continuous renewal, but rather existed as a holdover from a previous interval.
Contributors
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- By Krista Adamek, Ana Luisa K. Albernaz, J. Marcio Ayres†, Andrew J. Baker, Karen L. Bales, Adrian A. Barnett, Christopher Barton, John M. Bates, Jennie Becker, Bruna M. Bezerra, Júlio César Bicca-Marques, Richard Bodmer, Jean P. Boubli, Mark Bowler, Sarah A. Boyle, Christini Barbosa Caselli, Janice Chism, Elena P. Cunningham, José Maria C. da Silva, Lesa C. Davies, Nayara de Alcântara Cardoso, Manuella A. de Souza, Stella de la Torre, Ana Gabriela de Luna, Thomas R. Defler, Anthony Di Fiore, Eduardo Fernandez-Duque, Stephen F. Ferrari, Wilsea M.B. Figueiredo-Ready, Tracy Frampton, Paul A. Garber, Brian W. Grafton, L. Tremaine Gregory, Maria L. Harada, Amy Harrison-Levine, Walter C. Hartwig, Stefanie Heiduck, Eckhard W. Heymann, André Hirsch, Leandro Jerusalinsky, Gareth Jones, Richard F. Kay, Martin M. Kowalewski, Shawn M. Lehman, Laura Marsh, Jesús Martinez, William A. Mason, Hope Matthews, Wynlyn McBride, Shona McCann-Wood, W. Scott McGraw, D. Jeffrey Meldrum, Sally P. Mendoza, Nohelia Mercado, Russell A. Mittermeier, Mirjam N. Nadjafzadeh, Marilyn A. Norconk, Robert Gary Norman, Marcela Oliveira, Marcelo M. Oliveira, Maria Juliana Ospina Rodríguez, Erwin Palacios, Suzanne Palminteri, Liliam P. Pinto, Marcio Port-Carvalho, Leila Porter, Carlos Portillo-Quintero, George Powell, Ghillean T. Prance, Rodrigo C. Printes, Pablo Puertas, P. Kirsten Pullen, Helder L. Queiroz, Luis Reginaldo R. Rodrigues, Adriana Rodríguez, Alfred L. Rosenberger, Anthony B. Rylands, Ricardo R. Santos, Horacio Schneider, Eleonore Z.F. Setz, Suleima S.B. Silva, José S. Silva Júnior, Andrew T. Smith, Marcelo C. Sousa, Antonio S. Souto, Wilson R. Spironello, Masanaru Takai, Marcelo F. Tejedor, Cynthia L. Thompson, Diego G. Tirira, Raul Tupayachi, Bernardo Urbani, Liza M. Veiga, Marianela Velilla, João Valsecchi, Jean-Christophe Vié, Tatiana M. Vieira, Suzanne E. Walker-Pacheco, Rob Wallace, Patricia C. Wright, Charles E. Zartman
- Edited by Liza M. Veiga, Universidade Federal do Pará, Brazil, Adrian A. Barnett, Roehampton University, London, Stephen F. Ferrari, Universidade Federal de Sergipe, Brazil, Marilyn A. Norconk, Kent State University, Ohio
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- Book:
- Evolutionary Biology and Conservation of Titis, Sakis and Uacaris
- Published online:
- 05 April 2013
- Print publication:
- 11 April 2013, pp xii-xv
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Incidence, Clinical Course, and Predictors of Prolonged Recovery Time Following Sport-Related Concussion in High School and College Athletes
- Michael McCrea, Kevin Guskiewicz, Christopher Randolph, William B. Barr, Thomas A. Hammeke, Stephen W. Marshall, Matthew R. Powell, Kwang Woo Ahn, Yanzhi Wang, James P. Kelly
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- Journal:
- Journal of the International Neuropsychological Society / Volume 19 / Issue 1 / January 2013
- Published online by Cambridge University Press:
- 12 October 2012, pp. 22-33
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Sport-related concussion (SRC) is typically followed by clinical recovery within days, but reports of prolonged symptoms are common. We investigated the incidence of prolonged recovery in a large cohort (n = 18,531) of athlete seasons over a 10-year period. A total of 570 athletes with concussion (3.1%) and 166 controls who underwent pre-injury baseline assessments of symptoms, neurocognitive functioning and balance were re-assessed immediately, 3 hr, and 1, 2, 3, 5, 7, and 45 or 90 days after concussion. Concussed athletes were stratified into typical (within 7 days) or prolonged (> 7 days) recovery groups based on symptom recovery time. Ten percent of athletes (n = 57) had a prolonged symptom recovery, which was also associated with lengthier recovery on neurocognitive testing (p < .001). At 45–90 days post-injury, the prolonged recovery group reported elevated symptoms, without deficits on cognitive or balance testing. Prolonged recovery was associated with unconsciousness [odds ratio (OR), 4.15; 95% confidence interval (CI) 2.12–8.15], posttraumatic amnesia (OR, 1.81; 95% CI, 1.00–3.28), and more severe acute symptoms (p < .0001). These results suggest that a small percentage of athletes may experience symptoms and functional impairments beyond the typical window of recovery after SRC, and that prolonged recovery is associated with acute indicators of more severe injury. (JINS, 2012, 18, 1–12)
From awe to satisfaction: immediate affective responses to the Antarctic tourism experience
- Robert B. Powell, Matthew T.J. Brownlee, Stephen R. Kellert, Sam H. Ham
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- Journal:
- Polar Record / Volume 48 / Issue 2 / April 2012
- Published online by Cambridge University Press:
- 28 July 2011, pp. 145-156
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Antarctica is a rugged, austere, and yet stunningly beautiful continent with charismatic fauna including several species of penguins, whales, and seals. Mass media, writings from the early explorers, and modern film all describe firsthand experiences as delightful, beautiful, challenging, humbling, and even awe-inspiring. This dramatic allure of Antarctica now fuels one of the fastest growing tourism markets in the world with over 30,000 visitors annually traveling to the continent. Despite the fact that Antarctic tourism has occurred for over 30 years, little research has investigated the psychological and affective influence of these immersive tourism experiences in the Antarctic environment. This study explored visitors' affective judgments regarding their Antarctic tourism experience. An onsite post experience survey was administered to Antarctic tourists to investigate their satisfaction with a range of tour attributes. In addition, the researchers used the open-ended question, “How did this Antarctic experience affect you?” to explore tourists’ affective response to their interaction with the Antarctic tourism environment. These open ended responses were coded using a priori themes generated from Kellert's environmental values typology. Additionally, each response was analysed for the presence of an awe experience. Further analysis revealed that tourists described five sub-dimensions of an ‘awe’ experience (nature-human relationship, spiritual connection, transformative experience, goal clarification, and sense of feeling humbled), with many individuals experiencing multiple dimensions of awe. Consequently, this analysis reveals that the impact of an Antarctic tour experience is powerful, rich, and extremely complex.
A Change Agenda for Reserving. Report of the General Insurance Reserving Issues Taskforce (GRIT)
- A. R. Jones, P. J. Copeman, E. R. Gibson, N. J. S. Line, J. A. Lowe, P. Martin, P. N. Matthews, D. S. Powell
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- Journal:
- British Actuarial Journal / Volume 12 / Issue 3 / 01 September 2006
- Published online by Cambridge University Press:
- 10 June 2011, pp. 435-599
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Reserving is important to our profession as it is a core activity for actuaries. The members of the General Insurance Reserving Issues Taskforce (GRIT) have been considering how actuaries can improve the way in which we do reserving in general insurance. We gathered our thoughts and recommendations together in a Consultation Paper which has been discussed widely in the profession. We are very grateful to everyone who shared their views and comments with us, particularly those who gave us written feedback. We have considered carefully all the feedback which we received and adapted our final report in response to this.
Given the scope and importance of our remit, it is perhaps not surprising that this is not a short paper. We hope that Section 1 provides a reasonable summary.
Generally, our view is that there are many things on which our profession should focus. However, it is also important to remind ourselves of the positive items of feedback which we heard from our stakeholders. In addition to many suggestions for things to do better, we consistently heard the message that actuaries play an extremely valuable role in general insurance.
This is a major testimony to the progress which the actuarial profession has made in recent years in its ability to contribute to the general insurance industry. Perhaps it is because of this progress that now is an appropriate time for us, as a profession, to take a hard look at what we do in reserving, and ask ourselves whether there are any things which we could do differently. We hope that GRIT's report will facilitate this debate.
GRIT's recommendations fall under the following key themes:
— Providing more transparency to our reserving methods and helping our stakeholders have more insight into the key reserving assumptions and decisions.
— Providing more information on uncertainty in our reserve estimates. In particular, we recommend that actuaries provide a quantitative indication of the range of outcomes for future claim payments, and that our profession defines a common vocabulary for communicating uncertainty.
— Understanding better the business we are reserving. We suggest a range of analyses and activities for doing this.
— Applying our standard actuarial reserving methods more consistently. We identify a list of specific areas where we believe that there is scope for improvement. Also, we believe that the actuarial training syllabus should be extended, and this leads to consideration of whether a more specialised general insurance actuarial qualification is needed.
— Understanding the implications of the underwriting cycle, which, we believe, influences the behaviour of claims development in a way that our reserving models do not currently capture. We suggest what we believe may be the foundations of a potentially more cycle proof methodology, but this is an area which we believe will require much more research.
— Helping actuaries understand how behaviour can affect the reserve estimation process, particularly in the face of uncertainty. We make various suggestions in this area, including helping actuaries manage pressure from third parties.
We are convinced that, for our profession to implement these suggestions, it will require a concerted change management strategy and set of actions to embed changes into the way in which actuaries work. We believe that this will include:
— increasing the level of debate and research in the profession on claims reserving;
— a broader communication programme with the general insurance industry, covering, amongst other things, uncertainty and data quality;
— a sub-group of the GI Board with a specific focus on reserving, responsible for implementing GRIT's recommendations and dealing with new issues as they arise; and
— our profession resolving the conflicting pressures which will arise out of the extra work required for reserving by the GRIT recommendations.
There is one specific item where we have not made a recommendation. It has been suggested to us that many of the standard reserving methods in common use, such as the chain ladder, are not sophisticated, and that more sophisticated mathematical and statistical methods should be a priority. We do not agree with this. Whereas, in the longer term, this might be an important issue for our profession, we believe that the current focus for actuaries should be in the areas set out in this paper, such as understanding the business better.
GRIT believes that the issues which we have identified are important for the future of our profession and the contribution which we can make to the general insurance industry.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Characterisation of Interfaces in SiGe Superlatrlces by Combined Grazing Incidence X-Ray Fluorescence and Reflectivity
- Adrian R. Powell, Jaroslav Bradler, Charles R. Thomas, Richard A. Kubiak, D. Keith Bowen, Matthew Wormington, John M. Hudson
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- MRS Online Proceedings Library Archive / Volume 238 / 1991
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- 25 February 2011, 653
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- 1991
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X-Ray reflectivity enables the determination of interface and surface roughness along with the variations present in the electron density. Total reflection X-ray fluorescence allows surface analysis with high sensitivity and quantification. By use of grazing angle x-ray fluorescence taken simultaneously with the reflectivity measurements, over a range of angles near the critical angle, it is possible in principle to produce a depth profile of each element, with a composition sensitivity of 0.0002%. A silicon-germanium single layer was used to calibrate the instrument and a Si-Ge 5- period superlattice for a demonstration measurement.