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Little is known about risk management in homecare for people with dementia. We aimed to gain an understanding of the ways in which homecare workers assess and manage risk whilst caring for people with dementia in their own homes. We conducted a qualitative interview study with 17 homecare workers assisting people with dementia with their personal care. Interviews were face-to-face, semi-structured, recorded and transcribed verbatim. Analysis was inductive and thematic. A key theme of risk was identified, with three main sources: the client as a source of risk to the homecare worker, the clients' home and behaviours as a risk to the client, and the wider health and social care system as a risk to both clients and homecare workers. Three interrelated aspects of risk were found to influence homecare workers' decision making and actions: homecare workers' perception of the level of risk, their perceived ability to control the risk and their tolerability of risk. The higher the perceived risk, the stronger the action taken by the worker or agency to mitigate it and the greater the impact on the client. To support effective development of this workforce there is a need to devise training that incorporates the use of tacit knowledge and experiential learning. Risk management policies for homecare should acknowledge and utilise the expertise, experiences and values of homecare workers.
Cryogenic power electronics enable the highly efficient ultra-dense power conversion systems that are critical for electrified aircraft propulsion (EAP) and have the potential to transform aircraft powertrain design. Much like superconducting electric machines, cryogenic power electronics offer benefits achieved through improved power device performance, reduced conductor electrical resistivity, and increased heat transfer temperature differential. In this chapter, key steps in the development of cryogenic power electronics are presented, from the component to the converter level. First, the characterization of critical components – including power devices and magnetics – at cryogenic temperature is introduced to establish the basic knowledge necessary for cryogenic design and optimization. Second, special considerations specific to cryogenic design, and trade and design studies for the cryogenic power stage and filter electronics are detailed. Finally, an example of a high-power cryogenically-cooled inverter system for an EAP application is illustrated, with safety considerations and the protection scheme highlighted.
At Corn Products Refining (CPR), stockholders so disagreed with one another that they threatened to undermine the merger itself. Its predecessor, Corn Products (1902–1906), nearly failed, and so might have CPR. For several years, from its organization in 1906 to perhaps 1915, CPR’s owners weighed paying dividends against funding factories. Because paying dividends chanced syphoning off sums needed for plants, this might cause facilities to deteriorate and workers to face threats like factory fires that often set off explosions. CPR President E. T. Bedford managed this test and strove to upgrade facilities, which, by design or not, helped improve safety. His efforts almost came to naught given CPR’s anticompetitive tactics, yet the court’s antitrust decision—although highly critical—inadvertently gave the merger the chance to enhance profits and safety.
The debate around the international framework for HRtWS is permeated by challenges and endorsements from United Nations member states and civil society. Such a debate has implications both as to what precisely the content of the rights are and what the nature of countries’ obligations related to such rights is, as well as how these should be concretely realized in practical terms.
The primary objective was to evaluate the trend of blood sirolimus concentrations in neonates following ductal stenting. The long-term outcomes and incidence of infections were also evaluated.
Methods:
Prospective open-label observational study in a tertiary referral centre over a 1-year period. Serum sirolimus levels were estimated at 1 hour and 24hrs post-stent insertion followed by 7 days in neonates who underwent ductal stenting. The trend in sirolimus levels, incidence of infections, complications and outcomes following ductal stenting were studied.
Results:
Seven neonates with duct-dependent pulmonary circulation underwent ductal stenting at median age of 8.5 days and weight of 2.83kg. The average stent size was 3.5±0.4 mm, and average stent length was 16.3±5.1 mm. The mean sirolimus concentrations at 1 hour, 24 hours and 7 days were 41.3±6.9ng/ml, 15.4±7.1ng/ml and 3.1±0.85ng/ml respectively. Levels fell below therapeutic range for all patients by 7 days. Three patients had sepsis or necrotising enterocolitis, but responded well to antibiotics; 1 patient had aspiration related sudden death. There were no further events at a mean follow-up of 207 days, and 4 patients underwent elective surgery at 238 ± 81 days after ductal stenting.
Conclusions:
This study demonstrates applicability of drug-eluting stents for ductal stenting in newborns. Drug-eluting stents with abluminal drug delivery are associated with high sirolimus levels in initial hours but rapidly taper to negligible levels within a week of implantation. Neonates with high pre-procedure likelihood of infection developed sepsis but responded well to conservative management. The patency of drug-eluting ductal stents is preserved over long-term follow-up.
This chapter looks at transport innovation in the mining sector between 1990 and 2016. Shipping the mining output is an expensive and in most cases an unavoidable component of the mining process. The importance of transport, in the logistics chain of getting raw materials to final users/consumers, increases over time. This triggers the need to innovate in the transport sector, which leads to making mining locations that were more remote, accessible. This chapter uses patent data to explore transport innovations in mining, both within the mining area and outside, in the form of haulage to destination. It explores all relevant modes of transport for mining sector, namely road, rail, conveyers and maritime. Through patent citation analysis, the chapter shows that most innovation originates from the transport sector and is then adopted into the mining sector.
Preparedness in different sections of a society can improve the reactions of individuals at the time of disasters and strengthen the cooperation and coordination between people and organizations. The present study aimed to investigate the preparedness of households in Ardabil Province of Iran in the face of disasters in 2020.
Methods:
This descriptive, cross-sectional study was conducted in Ardabil Province in Iran in 2020. The target population included the households living in Ardabil Province. The study was conducted on 10 502 participants. The data were collected using a questionnaire completed by trained questioners by referring to the participants’ houses. It should be noted that the questionnaires were completed by one of the household parents. The questionnaire contained 15 questions related to taking and not taking disaster preparedness measures at specific times. EXCEL 2016 (Microsoft, Redmond, WA) and SPSS 23 software (IBM Corp, Armonk, NY) were used for data analysis.
Results:
Considering the score of 1 for each action, the mean score of households’ disaster preparedness in Ardabil Province was 31.09%. The preparedness level of 51.4%, 42.31%, and 6.29% of the households in the province against disasters was at low, moderate, and good levels, respectively. Among the items of preparedness in the face of disasters, the highest value was related to the familiarity of family members with the initial warnings of significant hazards (5162 households, 49.15%) followed by planning for coping with disasters (43.12%) and assessing the non-structural vulnerability (38.93%). Furthermore, the results showed that the level of household preparedness was higher in the center of the province compared to other cities.
Conclusion:
Evaluating the level of preparedness of different societies in the face of disasters can be very useful in identifying the challenges to improve preparedness and, consequently, achieving sustainable development. This assessment can be considered a resource for provincial policy-making and planning to achieve the priorities set out in the Sendai framework. However, such assessments should be performed periodically, for example, annually, to reflect the effectiveness of the interventional measures in improving preparedness. Considering the low level of households’ preparedness in the present study, there is a gap between what people know and what they do, and comprehensive studies are needed on various factors that encourage people to take preparedness measures.
The FDA’s strategic vision for monitoring high-risk medical devices emphasizes the role of postmarket registries. Registries are cost-effective relative to traditional clinical trials and can enroll large numbers of patients to provide generalizable observations and identification of safety events. Although they differ in their structure, study goals, and stewardship, registries facilitate advancements in device use, manufacture, and design. Registries are particularly useful for cardiovascular devices. The FDA and CMS can mandate postmarket registries as a condition of approval or reimbursement, respectively. However, some registries involve compulsory enrollment with no opt-out mechanism. Although regulators provide some guidance and oversight on study design, there has been little evaluation of the legal and ethical implications of compulsory medical device registries. In particular, it is unclear whether compulsory registries accord with health privacy laws and ethical standards for human subjects research. We discuss the emerging and integral role of registries in FDA’s medical device postmarket repertoire and evaluate the applicability of HIPAA, state health privacy laws, and the Common Rule to compulsory registries. We assess whether compulsory registries satisfy fundamental ethical principles, and propose guidelines for registry development, including rules for enrollment, consent, data use, and access to data.
Phase 1 clinical trials are the entrance to the further clinical development of new compounds. The chapter describes the regulatory background and highlights most important issues about selection of the maximum recommended starting dose, dose escalation steps, and definition of maximum tolerated dose, or maximum applied dose in a study considering actual guidelines. There is an overview about selection of subject populations and frequently used trial designs. The principles of single-ascending-dose and multiple-ascending-dose tolerance studies are described with a few examples of studies in Alzheimer’s disease (AD). The safety assessment is important in clinical practice, as AD drugs will be used over many years, so excellent tolerability is a must! In Phase 1, a careful assessment of pharmacokinetic (PK) properties of a new compound forms the basis for dose selection in Phase 2 and 3 studies and supports the decision on the treatment regimen. The importance of inclusion of different biomarkers in these studies to allow assessment of pharmacodynamic and PK relationship and to potentially identify first signals in human studies indicating therapeutic usefulness in the indication.
This chapter provides an overview of 20 primary recommendations for safe working in the andrology laboratory, along with sections on accident prevention, appropriate clothing and the proper use of personal protective equipment (PPE), fire safety, dealing with spills, use and disposal of biological materials, chemical hazards, compressed gases, and cryogenics.
Recent epistemology has witnessed a substantial opposition between two competing approaches to capturing the notion of non-accidentality in the analysis of knowledge: the explanationist and the modalist. According to the latest advocates of the former (e.g., Bogardus and Perrin 2020), S knows that p if and only if S believes that p because p is true. According to champions of the latter (e.g., safety and sensitivity theorists), S knows that p if and only if S's belief that p is true in a relevant set of possible worlds. Because Bogardus and Perrin's explanationism promises to deliver a plausible analysis of knowledge without any need for modal notions, it is an elegant proposal with prima facie appeal. However, such version of explanationism ultimately does not live up to its promises: in this paper, I raise some objections to their explanationist analysis of knowledge while showing that modalism is in much better shape than they think. In particular, I argue that their explanationist condition generates the wrong results in Gettier cases and fake-barn cases. I also offer and defend a novel version of modalism: I introduce a refined safety condition which is shown to successfully handle the same Gettier cases that beset Bogardus and Perrin's version of explanationism. The paper concludes with a reassessment of the explanationist's initial ambition to provide an analysis of knowledge without modal notions. The upshot will be that even if the prospects for such analysis remain dim, our money should be on the modalist, not the explanationist.
The chapter offers visceral examples of the limits of human attention and how technology can be used to counteract those limitations. It opens with a story about world-famous rock climber Lynn Hill and an instance where she forgot to tie herself correctly to the rope - resulting in a fall of over 40 feet. This rock climbing accident provides a basis for exploring what attention is, the different types of attention, and why attention explains the creativity inherent in ADHD. There is also a short test readers can take to experience the limits of their own attention. Next, we explore some controversial stories of people who forgot their children in hot cars. Attention research explains why we can’t expect parents to stop forgetting and why we need safeguards other than admonishing people to “be more careful.” A last grim example documents the kinds of injuries people get from table saws, totaling about 4,000 missing fingers per year. The title of the last section is “Safety Doesn’t Sell,” because people are unwilling to pay extra for safety features since they think these accidents won’t happen to them. Table saw manufacturers have fought requirements for providing safety systems but the conclusion restates that since we cannot improve or extend human attention, technological solutions are our only hope.
Obsessive–compulsive disorder (OCD) is a chronic psychiatric disorder that results in significant disability and substantial compromise in the quality of life. Until now, the role of repetitive transcranial magnetic stimulation (rTMS) has been primarily explored in individuals with treatment-resistant OCD. In this study, we investigated the safety and efficacy of rTMS as an early augmentation strategy in drug-free patients with OCD.
Methods
This is a randomized double-blind, placebo-controlled study that involved the administration of a total of 20 sessions of rTMS (active/sham) to drug-naïve OCD patients using a standard protocol (1-Hz; 20 trains [80 pulses/train]; 1600 pulses per session at 100% resting motor threshold) at supplementary motor area. All patients (active and sham) were started on escitalopram 10 mg/d, which was subsequently increased to 20 mg/d after 10 days.
Results
Out of the 24 patients, 13 received active and 11 received sham rTMS. At the end of rTMS therapy, there was a substantial reduction (P = .001) in total Yale-Brown Obsessive–Compulsive Scale, obsessions (P = .030) and compulsions (P = .001) between the groups. Only few patients (N = 8) reported mild side effect with rTMS, local pain, and headache being the commonest. The study revealed large effect size (Cohen’s d = 1.6) of rTMS as an early augmentation strategy in drug-free patients of OCD.
Conclusions
rTMS is a safe and effective early augmentation strategy in the management of OCD. Larger randomized controlled trials are required to establish the therapeutic role of rTMS as early augmentation in OCD.
Applying non-accident critical events (NACEs) as an alternative measuring method to assess ship collision risk has become popular in recent years. NACEs has shown temporal features in different waters. This study uses the quaternion ship domain method to identify NACEs around the Yangtze Estuary and adjacent coastal waters from the Automatic Identification System (AIS) data in October 2019. The results indicate that NACEs show different temporal features in estuaries and coastal waters. The relationship between tides, channel types and ships is discussed. In addition, we established a statistical method for the occurrence time of NACEs and the state of tides according to the half-tide level and the nearest time. The outcomes of this study provide a direction for exploring the relationship between NACEs and environmental conditions, which is also instructive for the study of the causes of ship accidents.
Analysts have warned on multiple occasions that hospitals are potential soft targets for terrorist attacks. Such attacks will have far-reaching consequences, including decreased accessibility, possible casualties, and fear among people. The extent, incidence, and characteristics of terrorist attacks against hospitals are unknown. Therefore, the objective of this study was to identify and to characterize terrorist attacks against hospitals reported to the Global Terrorism Database (GTD) over a 50-year period.
Methods:
The GTD was used to search for all terrorist attacks against hospitals from 1970-2019. Analyses were performed on temporal factors, location, attack and weapon type, and number of casualties or hostages. Chi-square tests were performed to evaluate trends over time and differences in attack types per world region.
Results:
In total, 454 terrorist attacks against hospitals were identified in 61 different countries. Of these, 78 attacks targeted a specific person within the hospital, about one-half (52.6%) involved medical personnel. There was an increasing trend in yearly number of attacks from 2008 onwards, with a peak in 2014 (n = 41) and 2015 (n = 41). With 179 incidents, the “Middle East & North Africa” was the most heavily hit region of the world, followed by “South Asia” with 125 attacks. Bombings and explosions were the most common attack type (n = 270), followed by 77 armed assaults. Overall, there were 2,746 people injured and 1,631 fatalities. In three incidents, hospitals were identified as secondary targets (deliberate follow-up attack on a hospital after a primary incident elsewhere).
Conclusion:
This analysis of the GTD identified 454 terrorist attacks against hospitals over a 50-year period. It demonstrates that the threat is real, especially in recent years and in world regions where terrorism is prevalent. The findings of this study may help to create or further improve contingency plans for a scenario wherein the hospital becomes a target of terrorism.
Chapter 1 describes the main objectives of the book. It argues that uncertainties are omnipresent in all aspects of the design, analysis, construction, operation, and maintenance of structures and infrastructure systems. It sets three goals for engineering of constructed facilities under conditions of uncertainty: safety, serviceability, and optimal use of resources. It then argues that probability theory and Bayesian statistics provide the proper mathematical framework for assessing safety and serviceability and for formulating optimal design under uncertainty. The chapter provides a brief review of the history and key developments of the field during the past 100 years. Also described are commercial and free software that can be used to carry out the kind of analyses that are described in the book. The chapter ends with a description of the organization of the book and outlines of the subsequent chapters.
From exoskeletons to lightweight robotic suits, wearable robots are changing dynamically and rapidly, challenging the timeliness of laws and regulatory standards that were not prepared for robots that would help wheelchair users walk again. In this context, equipping regulators with technical knowledge on technologies could solve information asymmetries among developers and policymakers and avoid the problem of regulatory disconnection. This article introduces pushing robot development for lawmaking (PROPELLING), an financial support to third parties from the Horizon 2020 EUROBENCH project that explores how robot testing facilities could generate policy-relevant knowledge and support optimized regulations for robot technologies. With ISO 13482:2014 as a case study, PROPELLING investigates how robot testbeds could be used as data generators to improve the regulation for lower-limb exoskeletons. Specifically, the article discusses how robot testbeds could help regulators tackle hazards like fear of falling, instability in collisions, or define the safe scenarios for avoiding any adverse consequences generated by abrupt protective stops. The article’s central point is that testbeds offer a promising setting to bring policymakers closer to research and development to make policies more attuned to societal needs. In this way, these approximations can be harnessed to unravel an optimal regulatory framework for emerging technologies, such as robots and artificial intelligence, based on science and evidence.
Lithium is viewed as the first-line long-term treatment for prevention of relapse in people with bipolar disorder.
Aims
This study examined factors associated with the likelihood of maintaining serum lithium levels within the recommended range and explored whether the monitoring interval could be extended in some cases.
Method
We included 46 555 lithium rest requests in 3371 individuals over 7 years from three UK centres. Using lithium results in four categories (<0.4 mmol/L; 0.40–0.79 mmol/L; 0.80–0.99 mmol/L; ≥1.0 mmol/L), we determined the proportion of instances where lithium results remained stable or switched category on subsequent testing, considering the effects of age, duration of lithium therapy and testing history.
Results
For tests within the recommended range (0.40–0.99 mmol/L categories), 84.5% of subsequent tests remained within this range. Overall, 3 monthly testing was associated with 90% of lithium results remaining within range, compared with 85% at 6 monthly intervals. In cases where the lithium level in the previous 12 months was on target (0.40–0.79 mmol/L; British National Formulary/National Institute for Health and Care Excellence criteria), 90% remained within the target range at 6 months. Neither age nor duration of lithium therapy had any significant effect on lithium level stability. Levels within the 0.80–0.99 mmol/L category were linked to a higher probability of moving to the ≥1.0 mmol/L category (10%) compared with those in the 0.4–0.79 mmol/L group (2%), irrespective of testing frequency.
Conclusion
We propose that for those who achieve 12 months of lithium tests within the 0.40–0.79 mmol/L range, the interval between tests could increase to 6 months, irrespective of age. Where lithium levels are 0.80–0.99 mmol/L, the test interval should remain at 3 months. This could reduce lithium test numbers by 15% and costs by ~$0.4 m p.a.
This chapter considers the themes advanced by those who promote the Nordic Model. These include human rights (especially women’s rights, safety and concern for the environment, and a spirit of creativity and innovation). Private companies like Volvo, Lego, and IKEA promote these values together with Nordic governments.