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Global health disasters are on the rise and can occur at any time with little advance warning, necessitating preparation. The authors created a comprehensive evidence-based Emergency Preparedness Training Program focused on long-term retention and sustained learner engagement.
A prospective observational study was conducted of a simulation-based mass casualty event training program designed using an outcomes-based logic model. A total of 25 frontline healthcare workers from multiple hospital sites in the New York metropolitan area participated in an 8-hour immersive workshop. Data was collected from assessments, and surveys provided to participants 3 weeks prior to the workshop, immediately following the workshop, and 3 months after completion of the workshop.
The mean percentage of total knowledge scores improved across pre-workshop, post-workshop and retention (3 months post-workshop) assessments (53.2% vs. 64.8% vs. 67.6%, P < 0.05). Average comfort scores in the core MCI competencies increased across pre-workshop, post-workshop and retention self-assessments (P < 0.01). Of the participants assessed at 3 months retention (n = 14, 56%), 50.0% (n = 7) assisted in updating their hospital’s emergency operations plan and 50.0% (n = 7) pursued further self-directed learning in disaster preparedness medicine.
The use of the logic model provided a transparent framework for the design, implementation, and evaluation of a competency-based EPT program at a single academic center.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Emergency physicians who work in academic settings enjoy an expanding number of roles beyond that of the skilled clinician. Faculty development (FD) encompasses the broad range of activities that institutions use to renew skill-sets and assist faculty members in these multiple roles. This study seeks to define the current FD needs and interests of Canadian academic emergency physicians (AEPs).
An online survey was administered to 943 AEPs in eight centers across Canada to determine their current FD activities, provide a detailed understanding of their FD needs and interests, elucidate the perceived barriers to and motivation for engaging in FD, and identify preferred methods of delivery for FD activities.
This national, cross-sectional survey was completed by 336 respondents. It shows that need for FD is universally high, particularly in traditional domains of scholarship, leadership and education (79%, 80%, 87% overall interest, respectively). However, the study also suggests that there is increasing need for FD in areas where current participation is lowest, namely research and social accountability (12% and 13% more interest, respectively). Senior and junior faculty evince equivalent overall FD interest (p>0.05), whereas female AEPs expressed greater overall FD needs in leadership (1.82 vs 1.44 activities, p=0.003) than males. Continued participation in FD activities is best promoted by offering relevant topics, at convenient times and locations.
This study reports the first comprehensive national FD needs assessment of Canadian academic emergency physicians.
We carried out a population-based study of dystrophin mutations in patients followed by members of the Canadian Paediatric Neuromuscular Group (CPNG) over a ten-year period.
We aimed to describe the changes in diagnostic testing for dystrophinopathy and to determine the frequency of dystrophin mutations from 2000 to 2009.
De-identified data containing the clinical phenotypes, diagnostic methods, and mutational reports from dystrophinopathy patients followed by CPNG centres from January 2000 to December 2009 were analyzed using descriptive statistics.
773 patients had a confirmed diagnosis of dystrophinopathy based on genetic testing (97%), muscle biopsy (2%), or family history (1%). 573 (74%) had complete deletion/duplication analysis of all 79 exons or whole gene sequencing, resulting in 366 (64%) deletions, 64 (11%) duplications, and 143 (25%) point mutations. The percentage of patients who were diagnosed using currently accepted genetic testing methods varied across Canada, with a mean of 63% (SD 23). 246 (43%) mutations involved exons 45 to 53. The top ten deletions (n=147, 26%) were exons 45-47, 45-48, 45, 45-50, 45-55, 51, 45-49, 45-52, 49-50, and 46-47. 169 (29%) mutations involved exons 2 to 20. The most common duplications (n=29, 5.1%) were exons 2, 2-7, 2-17, 3-7, 8-11, 10, 10-11, and 12.
This is the most comprehensive report of dystrophin mutations in Canada. Consensus guidelines regarding the diagnostic approach to dystrophinopathy will hopefully reduce the geographical variation in mutation detection rates in the coming decade.
Objectives: An influenza pandemic, as with any disaster involving contagion or contamination, has the potential to influence the number of health care employees who will report for duty. Our project assessed the uptake of proposed interventions to mitigate absenteeism in hospital workers during a pandemic.
Methods: Focus groups were followed by an Internet-based survey of a convenience sample frame of 17,000 hospital workers across 5 large urban facilities. Employees were asked to select their top barrier to reporting for duty and to score their willingness to work before and after a series of interventions were offered to mitigate it.
Results: Overall, 2864 responses were analyzed. Safety concerns were the most frequently cited top barrier to reporting for work, followed by issues of dependent care and transportation. Significant increases in employee willingness to work scores were observed from mitigation strategies that included preferential access to antiviral medication or personal protective equipment for the employee as well as their immediate family.
Conclusions: The knowledge base on workforce absenteeism during disasters is growing, although in general this issue is underrepresented in emergency planning efforts. Our data suggest that a mitigation strategy that includes options for preferential access to either antiviral therapy, protective equipment, or both for the employee as well as his or her immediate family will have the greatest impact. These findings likely have import for other disasters involving contamination or contagion, and in critical infrastructure sectors beyond health care. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S141–S147)
Few studies have prospectively examined psychosocial and psychiatric
predictors of adolescent substance use disorders simultaneously.
To identify psychosocial and psychiatric predictors of substance use
disorders in adolescence.
School children aged 12 years (s. d. =0. 3) free from any substance use
disorder at grade7(n=428) were assessed in three
consecutive years, using a standardised psychiatric interview. Their
baseline psychosocial information was also collected. The outcome was the
onset age of a substance use disorder. The Cox regression model was used
for data analysis.
The most significant predictive factors for adolescent substance use
disorder included male gender, attention-deficit hyperactivity disorder,
conduct disorder and sibling use of tobacco. Three protective factors
against such morbidity included living in a household with two parents, a
good academic grade at grade 7 and objection to the use of
Early intervention for disruptive behaviour disorders and specific
psychosocial risk factors might prevent substance use disorders in early
Objective: To test the validity and reliability of the Chinese Geriatric Mental State Schedule (CGMS) in Taiwanese elders. Methods: The CGMS has gone through a standardized two-way translation, a pretest phase, and consensus focus group meetings in order to modify relevant culture-related terms of the original English version. The interrater reliability of the CGMS among eight psychiatrists was conducted after a training course was given to them. Diagnoses generated by the CGMS-AGECAT (Automated Geriatric Examination for Computer Assisted Taxonomy) were compared with psychiatric diagnoses according to the DSM-III-R criteria. The sample subjects were aged 65 and over and recruited from a community (n = 36) and an “old age home” (n = 56). Results: Four of the eight diagnostic categories generated by the CGMS-AGECAT had a generalized kappa value of 1.0, and the figures for the remaining four categories were acceptable: .8 for depressive neurosis, .6 for anxiety disorder, .5 for schizophrenia, and .5 for depressive psychosis (generalized kappa = .5). The overall agreement between the CGMS-AGECAT and independent psychiatric diagnosis (based on the DSM-III-R criteria) was satisfactory. Conclusion: The CGMS has been found to be a crossculturally valid and reliable instrument for use in Taiwan.
A variety of polymer materials including polyimide (PI), polyarylate (PAR), polynorbonene (PNB) and polyethersulphone (PES) have been studied for use as substrates in the formation of active matrix displays based upon polycrystalline silicon (poly-Si) thin film transistors (TFTs). A process used to fabricate transflective mobile phone displays at 250°C on such substrates is described in detail. The NMOS TFTs show a mobility of 100cm2/Vs, and a threshold voltage of 3.9V; the PMOS devices have a mobility of 52cm2/Vs, and a threshold voltage of -6V. Issues relating to performance of these devices, yield of the arrays, and manufacturability are discussed.
Hearing loss has long been associated with diabetes mellitus. Microangiopathy, associated with thickening of the basement membranes of small vessels, has been implicated as a major source of multiple system organ disease.
Objective This study was designed to evaluate changes in basement membrane thickness in the inner ear of laboratory animals suffering from non-insulin-dependent diabetes mellitus (NIDDM) with, and without, exposure to moderate intensity noise exposure in an attempt to extrapolate the same disease process in humans.
Design Spontaneously hypertensive-corpulent non-insulin-dependent rats (SHR/N-cp) were selected as a genetic model for the above study. Both lean and obese rats were used in this study. A genetically similar control group of animals (LA/N-cp) were used as controls. These animals express both the lean and obese phenotypes, but they lack the NIDDM gene. Forty-eight animals in each group were sacrificed at the end of the study. The cochleas were dissected and fixed. The basement membrane of the stria vascularis was examined using transmission electron microscopy.
Setting This study was a laboratory-based, standard animal study.
Main outcome This study was designed to show microangiography of the inner ear as related to NIDDM with, and without, obesity and noise exposure.
Results/Conclusions NIDDM alone does not cause statistically significant basement membrane thickening; however, NIDDM in combination with obesity and/or noise exposure did show significant thickening and the combination of all three showed the greatest thickening. NIDDM appeared to be the greatest contributing factor.
This paper considers series estimators of additive interactive regression (AIR) models. AIR models are nonparametric regression models that generalize additive regression models by allowing interactions between different regressor variables. They place more restrictions on the regression function, however, than do fully nonparametric regression models. By doing so, they attempt to circumvent the curse of dimensionality that afflicts the estimation of fully non-parametric regression models.
In this paper, we present a finite sample bound and asymptotic rate of convergence results for the mean average squared error of series estimators that show that AIR models do circumvent the curse of dimensionality. A lower bound on the rate of convergence of these estimators is shown to depend on the order of the AIR model and the smoothness of the regression function, but not on the dimension of the regressor vector. Series estimators with fixed and data-dependent truncation parameters are considered.
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