Sponsored by the U.S. Department of Homeland Security Science & Technology (DHS S&T) Chemical Security Analysis Center (CSAC), the U.S. Department of Defense (DoD) Defense Threat Reduction Agency ...(DTRA), Transport Canada, and Defence Research and Development Canada (DRDC), the Jack Rabbit II tests were designed to release liquid chlorine at ambient temperature in quantities of 5–20 T for the purpose of quantifying the behavior and hazards of catastrophic chlorine releases at scales represented by rail and truck transport vessels. In 2015, five successful field trials were conducted in which chlorine was released in quantities of 5–10 tons through a 6-inch circular breach in the tank and directed vertically downward at 1 m elevation over a concrete pad. In 2016, three additional trials were conducted with releases of 10 tons also through 6-inch circular breaches at different release orientations. A final 20 ton test was conducted in 2016. Data from the test program is available. This paper summarizes an analysis of the available data from the concrete pad including analysis of the temperature measurements above and below grade in the concrete pad. Assessment of the chlorine rainout is estimated based on temperature measurements and available video data analysis.
•The Jack Rabbit II tests were designed to release liquid chlorine at ambient temperature in quantities of 5–20 T for the purpose of quantifying the behavior and hazards of catastrophic chlorine releases at scales represented by rail and truck transport vessels.•This paper summarizes an analysis of the available data from the underlying concrete pad including analysis of the temperature measurements above and below grade in the concrete pad.•Assessment of the chlorine rainout is estimated based on temperature measurements and available video data analysis.
From a list of the top prescribed drugs in Canada, 11 pharmaceuticals and two metabolites were selected for study in municipal sewage treatment plant effluents and receiving waters. Wastewater ...samples were collected from 16 wastewater treatment plants across Southwest Nova Scotia including the Annapolis Valley, South Shore, and Metropolitan Halifax. Samples were also collected between 100 and 200 m downstream of effluent outflows. Seven pharmaceuticals were found above μg/L levels with their highest concentrations as follows: metformin (10.6 μg/L), acetaminophen (28.9 μg/L), paraxanthine (18.2 μg/L), cotinine (3.10 μg/L), caffeine (115 μg/L), naproxen (29.1 μg/L), and venlafaxine (2.65 μg/L). Metformin, paraxanthine, caffeine, naproxen, ramipril, and venlafaxine were detected in every wastewater effluent sample. Statistical analysis revealed significant differences in pharmaceutical occurrence by treatment methods, weak dependence of pharmaceutical concentrations on populations, and the co-occurrence of some pharmaceuticals. Experimental results might indicate the limitation of primary only treatment methods in breaking down pharmaceuticals.
Failure to recognise deterioration early which results in patient death, is considered failure to rescue and it is identified as one of the leading causes of harm to patients. It is recognised that ...patients and their families can often recognise changes within the child’s condition before healthcare professionals. To mitigate the risk of failure to rescue and promote early intervention, family-activated rapid response systems are becoming widely acknowledged and accepted as part of family integrated care.
To identify current family-activated rapid response interventions in hospitalised paediatric patients and understand mechanisms by which family activation works.
A narrative systematic review of published studies was conducted. Seven online databases; AMED, CINHAL, EMBASE, EMCARE, HMIC, JBI, and Medline were searched for potentially relevant papers. The critical appraisal skills programme tool was used to assess methodological rigor and validity of included studies.
Six studies met the predefined inclusion criteria. Five telephone family activation interventions were identified; Call for Help, medical emergency-teams, Condition HELP, rapid response teams, and family initiated rapid response. Principles underpinning all interventions were founded on a principal of granting families access to a process to escalate concerns to hospital emergency teams. Identified interventions outcomes and mechanisms include; patient safety, empowerment of families, partnership working/ family centred care, effective communication and better patient outcomes. Interventions lacked multi-lingual options.
Family activation rapid response system are fundamental to family integrated care and enhancing patient safety. Underlying principles and concepts in delivering interventions are transferable across global healthcare system.
To examine the current state of satisfaction with the academic medicine workplace among U.S. medical school faculty and the workplace factors that have the greatest influence on global satisfaction.
...The authors used data from the 2009 administration of a medical school faculty job satisfaction survey and used descriptive statistics and χ analyses to assess levels of overall satisfaction within faculty subgroups. Multiple regressions used the mean scores of the 18 survey dimensions and demographic variables to predict three global satisfaction measures.
The survey was completed by 9,638 full-time faculty from 23 U.S. medical schools. Respondents were mostly satisfied on global satisfaction measures including satisfaction with their department (6,506/9,128; 71.3%) and medical school (5,796/9,124; 63.5%) and whether they would again choose to work at their medical school (5,968/8,506; 70.2%). The survey dimensions predicted global satisfaction well, with the final models explaining 51% to 67% of the variance in the dependent measures. Predictors across models include organization, governance, and transparency; focus of mission; recruitment and retention effectiveness; department relationships; workplace culture; and nature of work.
Despite the relatively unpredictable environmental challenges facing medical schools today, leaders have opportunities to influence and improve the workplace satisfaction of their faculty. Examples of opportunities include fostering a culture characterized by open communication and occasions for faculty input, and remaining vigilant regarding factors contributing to faculty burnout. Understanding what drives faculty satisfaction is crucial for medical schools as they continue to seek excellence in all missions and recruit and retain high-quality faculty.
At least 85% of unplanned admissions to critical care wards for children and young people (CYP) are associated with clinical deterioration. CYP and their families play an integral role in the ...recognition of deterioration. The Paediatric Critical Care Outreach Team (PCCOT) supports the reduction of avoidable harm through earlier recognition and treatment of the deteriorating child, acting as a welcome conduit between the multiprofessional teams, helping ensure that CYP gets the right care, at the right time and in the right place. This positions PCCOT well to respond to families who call for help as part of family activation.
This protocol details the methods and process of developing a family activation rapid response online application.
This is a single-centre, sequential, multiple methods study design. Firstly, a systematic review of the international literature on rapid response interventions in paediatric family activation was conducted. Findings from the review aimed to inform the content for next stages; interviews/ focus groups and experience-based co-design (EBCD) workshops.
parents / caregivers whose children have been discharged or admitted to an acute care hospital and healthcare professionals who care for paediatric patients (CYP). During interviews and workshops participants' opinion, views and input will be sort on designing a family activation rapid response online-app, detailing content, aesthetics, broad functionality and multi-lingual aspects. Further areas of discussions include; who will use the app, access, appropriate language and terminology for use. A suitable app development company will be identified and will be part of the stakeholders present at workshops. Data obtained will be used to develop a multi-lingual paediatric family activation rapid response web based application prototype.
Full ethical approval was received from the Wales Research Ethics Committee 2. Cardiff; REC reference: 22/WA/0174. The findings will be made available to all stakeholders.
Cattle have been identified as leading sources of injuries to agricultural workers. The present study focused on worker injuries that involved the interaction of cattle, cattle handlers, and farm ...structures or equipment. The goal of the study was to identify opportunities for injury prevention. We examined 221 reports of injury to cattle handlers from the Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS). Expected interactions led to many of the cattle-handling injuries reported in the NEISS database. In almost 30% of cases, cattle pushed workers into structures such as fences, gates, posts, and walls. In another 16% to 19% of injuries, cattle struck gates and other objects, propelling them at the victims. The present research makes several important contributions to the study of cattle-handling injuries. First, the research supports an increased emphasis on the development of safer gate designs (e.g., gates that are remotely operated or that absorb energy to limit the speed at which they may be propelled by animals). Second, the research suggests a need for additional study of energy-absorbing fence and wall structures. We view these two points to be of significance because gates and associated structures (e.g., posts, fences, and walls) accounted for 45% of the injuries in the dataset, based on the associated injury narrative. Finally, the research identifies a previously unexplored source of agricultural injury data, namely the NEISS database.
Many toxic industrial chemicals (TICs) such as chlorine and ammonia are very reactive with commonly encountered materials in the environment. The amount of TIC material reacted in the environment is ...an important factor in determining the impact of a release. Typically characterized with a dry deposition rate in atmospheric dispersion models, the reaction rate has predominately been studied in field scale experiments at concentration levels typical for air pollution (ppm levels). When considering the removal of chlorine by (dry) deposition in an episodic release, gas phase concentrations will be much higher than those associated with air pollution, and near-field reaction of chlorine with local vegetation will be strongly influenced by the response of leaves and other elements of the surface “canopy” to those high concentrations. In this work, standard engineering methods characterizing the rate of mass transfer from a fluid to a surface in conjunction with reaction at that surface are applied. Previous experimental programs that studied the removal of chlorine under conditions relevant to this study show that deposition of chlorine to plant material can reach a limiting maximum so that the plant material can no longer react with gaseous chlorine despite continued exposure. In the analysis presented here, it is shown that the effect of the maximum deposition can be treated using the same approach as has been used to model catalyst poisoning. This study developed a model to account for boundary layer resistance and the impact of maximum deposition in a framework that could be incorporated in atmospheric dispersion models. To test the efficacy of this model, the Controlled Environment Reactivity Test (CERT) apparatus was designed to expose selected environmental materials (substrates including soil, rye grass, white clover, maple leaves, and spruce branches) to chlorine with initial concentration of (nominally) 1000 ppm where the gas phase chlorine concentration can be measured as a function of time to determine relevant modeling parameters. The apparatus was built to control the flow velocity of the chlorine/air mixture over the experimental substrates with turbulence levels that are comparable to the atmosphere. Model parameters were found for the environmental materials tested.
•Chlorine dry deposition is limited by a maximum and depends on the material.•Model developed for chlorine dry deposition with surface kinetics and deposition.•Experimental results for sample surfaces presented.
This paper serves as an introduction to the special Atmospheric Environment issue on comparisons of 17 widely-used dense-gas dispersion models using observations from the Jack Rabbit II (JR II) ...chlorine release experiments, which were led by the U.S. Department of Homeland Security Science & Technology (DHS S&T) Chemical Security Analysis Center (CSAC) and a collaborative team of interagency partners, and conducted at the U.S. Army Dugway Proving Ground in 2015 and 2016. Nine of the 17 models that were compared were from outside the U.S. Other papers in the Special Issue describe specific aspects (e.g., observations of emissions, meteorology, and concentrations) of the JR II field experiments, results of individual dispersion model simulations for the models and comparisons of model predictions with JR II observations and other models. This paper provides a general overview of the field experiments and a brief summary of the model comparison goals and methods.
•Overview of Jack Rabbit II, the largest ever experimental releases of chlorine.•Field test data supports emergency response, industrial safety, risk mitigation.•Chlorine concentration data measured at distance intervals up to 11 km downwind.•Hundreds of sensors measured meteorological, release rates, and other parameters.•Jack Rabbit II data used as basis to compare 17 dense gas dispersion models.
Abstract We assessed syphilis screening data from overseas medical examinations among U.S.-bound refugees to characterize seropositive syphilis cases and treatment from January 1, 2015, to December ...31, 2018. During this time period, all refugees 15 years and older were required to undergo syphilis screening prior to resettlement to the United States. Of the 160,381 refugee arrivals who had a syphilis screening performed, 697 (434 per 100,000) were diagnosed with any stage (infectious or non-infectious) of syphilis. Among the 697 persons with seropositive syphilis, a majority (63%) were from the Africa region and were male (58%), and 53 (7.6%) were diagnosed with an infectious stage of syphilis. All infectious cases were treated prior to resettlement. This information suggests a comparable risk of infection among U.S.-bound refugees compared to a report of syphilis among U.S.-bound refugees from 2009 to 2013, indicating low rates in this population for at least a decade.
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