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Hospitals are required to maintain emergency preparedness 24/7. In order to maintain readiness, Israeli hospitals operate Emergency Committees comprised of medical, nursing, and administrative professionals who are responsible for capacity building including the development of plans, infrastructure, equipment, training, crisis management, and learning lessons. The Ministry of Health (MOH) and Home Front Command (HFC) conduct a comprehensive, structured evaluation of emergency preparedness in every hospital every two to three years.
To assess the impact of a periodical evaluation on levels of emergency preparedness over time in a level one trauma center.
Evaluation of emergency preparedness is conducted by approximately 12 evaluators from the MOH and HFC, encompassing mass casualty incidents (MCIs), mass toxicological/chemical incidents (MTEs), radiological and biological events, earthquakes and conflicts. Evaluations are based on objective parameters, relayed to hospitals prior to the evaluation. The hospital’s level of emergency preparedness is graded and improvements that must be implemented are delineated. The grades of four evaluations conducted from 2011 to 2018 were compared to identify trends in preparedness.
Mean levels of emergency preparedness in the 2018 versus 2011 evaluations presented an increase concerning all threats, including MCIs (92 vs. 90), MTEs (99 vs. 77, respectively), biological events (96 vs. 73, respectively), radiological events (91 vs. 79), earthquakes (87 vs. 60, respectively), and conflicts (95 vs. 74). The relative change in levels of preparedness was more noted concerning biological events and earthquakes.
A periodical evaluation by governing authorities seems to motivate the hospital’s administrations to invest efforts in building and maintain a high level of emergency preparedness. Systematic evaluations conducted bi-annually contributed to improved readiness for diverse emergency scenarios, including for threats that less frequently materialize.
Cardiac surgery has seen substantial scientific progress over recent decades. Health economic evaluations have become important tools for decision makers to prioritize scarce health resources. The present study aimed to identify and critically appraise the reporting quality of health economic evaluations conducted in the field of cardiac surgery.
A literature search was performed to identify health economic evaluations in cardiac surgery. The consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of studies.
A total 4,705 articles published between 1981 and 2016 were identified; sixty-nine studies fulfilled the inclusion criteria. There was a trend toward a greater number of publications and reporting quality over time. Six (8.7 percent) studies were conducted between 1981 and 1990, nine (13 percent) between 1991 and 2000, twenty-four (34.8 percent) between 2001 and 2010, and thirty (43.5 percent) after 2011. The mean CHEERS score of all articles was 16.7/24; for those published between 1980 and 1990 the mean (SD) score was 10.2 (±1.4), for those published between 1991 and 2000 it was 11.2 (±2.4), between 2001 and 2010 it was 15.3 (±4.8), and after 2011 it was 19.9 (±2.9). The quality of reporting was still insufficient for several studies after 2000, especially concerning items “characterizing heterogeneity,” “assumptions,” and “choice of model.”
The present study suggests that, even if the quantity and the quality of health economics evaluation in cardiac surgery has increased, there remains a need for improvement in several reporting criteria to ensure greater transparency.
This paper considers an invariant of modules over a finite-dimensional Hopf algebra, called the critical group. This generalises the critical groups of complex finite group representations studied in [1, 11]. A formula is given for the cardinality of the critical group generally, and the critical group for the regular representation is described completely. A key role in the formulas is played by the greatest common divisor of the dimensions of the indecomposable projective representations.
The dual immaculate functions are a basis of the ring QSym of quasisymmetric functions and form one of the most natural analogues of the Schur functions. The dual immaculate function corresponding to a composition is a weighted generating function for immaculate tableaux in the same way as a Schur function is for semistandard Young tableaux; an immaculate tableau is defined similarly to a semistandard Young tableau, but the shape is a composition rather than a partition, and only the first column is required to strictly increase (whereas the other columns can be arbitrary, but each row has to weakly increase). Dual immaculate functions were introduced by Berg, Bergeron, Saliola, Serrano, and Zabrocki in arXiv:1208.5191, and have since been found to possess numerous nontrivial properties.
In this note, we prove a conjecture of M. Zabrocki that provides an alternative construction for the dual immaculate functions in terms of certain “vertex operators”. The proof uses a dendriform structure on the ring QSym; we discuss the relation of this structure to known dendriform structures on the combinatorial Hopf algebras FQSym and WQSym.
The La Plata River Basin, bordering Uruguay and Brazil, was the site of constant disputes between the Spanish and Portuguese crowns into the eighteenth century. The conflicts dated back to the seventeenth century with the founding of the Colônia do Santíssimo Sacramento on the left bank of the river. Although both sides engaged in diplomatic efforts over the years, these were not enough to prevent war, and there were ongoing battles interspersed with short periods of calm until the end of the 1860s and the so-called Paraguayan War (1865–70).
Numerous scholars have emphasized the “centrality” of Inner Asia to furthering our understanding of global, or cross-cultural phenomena, and the role of such phenomena in the preservation, modification, and transmission of historical experience. Yet the research has almost exclusively been carried out by specialists in Chinese civilization, and as one moves further away from the Chinese sphere of influence the notion of Eurasia as an integrated socio-political unit of historical analysis becomes more problematic. Here I attempt to bridge the western and eastern edges of the great steppe by focusing on a specific aspect of Inner Asian political culture—the phenomenon of shared sovereignty between military-based ruling dynasties and their urban constituencies—in the principalities of Rus' and the oases of Transoxiana, between the ninth and twelfth centuries. I propose that the dual administrative structure that developed in the two regions was an autochthonic, Eurasian state-formation, distinct from the city-state and imperial models, which emerged as a result of what Joseph Fletcher identified as “horizontal continuities.”
In this note we prove that the local martingale part of a convex function
f of a d-dimensional semimartingale
X = M + A can be written in terms of
an Itô stochastic integral
H(x) is some particular measurable choice of
f at x, and M is the martingale part
of X. This result was first proved by Bouleau in [N. Bouleau, C.
R. Acad. Sci. Paris Sér. I Math. 292 (1981) 87–90]. Here we
present a new treatment of the problem. We first prove the result for
ϵ > 0, where B is a standard
Brownian motion, and then pass to the limit as ϵ → 0, using results in
[M.T. Barlow and P. Protter, On convergence of semimartingales. In Séminaire de
Probabilités, XXIV, 1988/89, Lect. Notes Math., vol. 1426.
Springer, Berlin (1990) 188–193; E. Carlen and P. Protter, Illinois J. Math.
36 (1992) 420–427]. The former paper concerns convergence of
semimartingale decompositions of semimartingales, while the latter studies a special case
of converging convex functions of semimartingales.
‘How did it happen that the whole of RAPM was left standing alone, while everyone else turned to Comrade Stalin for protection?’ This was the question thrown at members of RAPM, who had been called to attend a special closed session of the Narkompros Collegium on 26 February 1932. What brought RAPM to this point was the so-called ‘Gnesin affair’, when a fight with Vseroskomdram peaked in an open and bitter confrontation with one man who would not retreat – the composer and Conservatoire professor Mikhail Gnesin. A man of strong views, Gnesin retained his independence and refrained from aligning himself with any group during the 1920s. In 1928, for example, we find him opposing Goldenweiser and taking the side of Pedfak (he became its Dean). But later he fought against Rabfak, which had caused a lowering of standards that dismayed him. During the previous year, he had been involved in several highly publicised events. The first was a discussion of his own music at a Conservatoire ‘production meeting’, where he made an unguarded comment:
[I] once had the opportunity to play my part in the life of a particular peasant who is now a well-known writer, Chapygin. I could hold him in great affection, I could assist him in his work, learn from him and also teach him some things, but I have always felt that next to him I am a complex man, that my thoughts and feelings were more complex, and his were simpler.
We investigate the effectiveness of two extrapolation-based methods aiming to approximate the initial state required by an iterative solver in simulations of unsteady flow problems. The methods lead to about a ten-fold reduction in the iteration count while requiring only negligible computational overhead. They are particularly suitable for parallel computing since they are based almost exclusively on data stored locally on each processor. Performance has been evaluated in simulations of turbulent flow in a stenosed carotid artery and also in laminar flow in a very large domain containing the human intracranial arterial tree.
The occurrence of a gastrointestinal illness among a class of 96 undergraduate veterinary students in New Zealand prompted laboratory and questionnaire-based investigations. Cryptosporidium parvum was the only enteropathogen identified in 4/7 faecal specimens analysed. The C. parvum isolates carried a rare IIa GP60 allele, indicating a point-source outbreak. The infection source could not be microbiologically traced, but the investigation suggested contact with calves during a practical class as the most likely exposure. A total of 25/80 respondents to a questionnaire were defined as cases using a clinical case definition (31% attack rate). The inferred median incubation period was 5 days (range 0–11 days), and the median illness duration was 5–6 days (range 2–23 days), corroborating previous observations in experimental cryptosporidiosis. Disease was self-limiting, characterized by abdominal discomfort, diarrhoea, and in some cases, vomiting. Originating from a rural area and having had previously handled ruminants were associated with a significant risk reduction in males. All the three students who reported chronic use of steroid inhalers for treatment of asthma were cases. This case highlighted, once again, the potential hazard for explosive outbreaks of cryptosporidiosis.
Lev Grinberg, political sociologist at Ben Gurion University, and public intellectual of Israel discusses the issue of Palestinian refugees and their ‘right of return’ in an interview with Aditi Bhaduri.
You are both a Zionist and a supporter of the Palestinians, who has branded Israel's military action in the occupied territories as ‘state terrorism’. How do you explain this dichotomy?
There is no contradiction in being a Zionist and recognizing the national rights of the Palestinians. In common perception, Zionism is synonymous with Palestinian dispossession and colonization. For me, Zionism is completely different – meaning living in a Jewish community, speaking in Hebrew, celebrating Jewish culture and holidays without fear that I shall be persecuted for my Jewishness. But it also does not mean the repression of the Palestinian people. On the contrary, since my arrival in Israel I started to struggle against discrimination of the Palestinians Arabs in Israel and against the occupation of the West Bank and Gaza strip – the Palestinian territories. Two years after my arrival in Israel I founded a students' movement called ‘Campus’, which had both Jewish and Arab students. Some of the Arabs of that movement are today members of Knesset and gained their political experience in that movement. As a Zionist, for me it was clear that if I was against the discrimination of Jews in the Diaspora I must be against the discrimination of the Arabs.
Cattle are among the major reservoirs of Cryptosporidium parvum in nature. However, the relative contribution of C. parvum oocysts originating from cattle to human disease burden is difficult to assess, as various transmission pathways – including the human to human route – can co-occur. In this study, multilocus genotype richness of representative samples of human and bovine C. parvum are compared statistically using analytical rarefaction and non-parametric taxonomic richness estimators. Results suggest that in the time and space frames underlying the analysed data, humans were infected with significantly wider spectra of C. parvum genotypes than cattle, and consequently, a significant fraction of human infections may not have originated from the regional bovine reservoirs. This study provides statistical support to the emerging idea of the existence of distinct anthroponotic C. parvum cycles that do not involve cattle.
An epidemiological and molecular investigation of a cutaneous suppurative infection with Staphylococcus aureus in a dairy farmer, occurring concurrently with an outbreak of clinical mastitis in his herd, was carried out. A common aetiology for the diseases in the farmer and his cows was established by combining clinical evidence with a molecular genomic analysis of the bacterial isolates using pulsed field gel electrophoresis of DNA macro-restriction fragments. This case indicates the possibility of the emergence and circulation of anthropozoonotic clones of S. aureus in dairy herds. It also provides further evidence of the severe impact of infection with highly virulent clones on dairy lactating cattle.