Healthcare worker competencies for disaster training

BACKGROUND: Although training and education have long been accepted as integral to disaster preparedness, many currently taught practices are neither evidence-based nor standardized. The need for effective evidence-based disaster training of healthcare staff at all levels, including the development of standards and guidelines for training in the multi-disciplinary health response to major events, has been designated by the disaster response community as a high priority. We describe the application of systematic evidence-based consensus building methods to derive educational competencies and objectives in criteria-based preparedness and response relevant to all hospital healthcare workers. METHODS: The conceptual development of cross-cutting competencies incorporated current evidence through a systematic consensus building process with the following steps: (1) review of peer-reviewed literature on relevant content areas and educational theory; (2) structured review of existing competencies, national level courses and published training objectives; (3) synthesis of new cross-cutting competencies; (4) expert panel review; (5) refinement of new competencies and; (6) development of testable terminal objectives for each competency using similar processes covering requisite knowledge, attitudes, and skills. RESULTS: Seven cross-cutting competencies were developed: (1) Recognize a potential critical event and implement initial actions; (2) Apply the principles of critical event management; (3) Demonstrate critical event safety principles; (4) Understand the institutional emergency operations plan; (5) Demonstrate effective critical event communications; (6) Understand the incident command system and your role in it; (7) Demonstrate the knowledge and skills needed to fulfill your role during a critical event. For each of the cross-cutting competencies, comprehensive terminal objectives are described. CONCLUSION: Cross-cutting competencies and objectives developed through a systematic evidence-based consensus building approach may serve as a foundation for future hospital healthcare worker training and education in disaster preparedness and response

PERLINDUNGAN HUKUM TERHADAP HAK PENGELOLAAN DAN PEMANFAATAN ATAS TANAH OLEH MASYARAKAT HUKUM ADAT YANG BERADA DALAM KAWASAN TAMAN NASIONAL KELIMUTU

The establishment of the zoning of the Kelimutu National Park by the relevant agencies resulted in the management of the forest area being closed to the access of the Customary Law community as the owner of agricultural/plantation land in Niowula Village, Detusoko District, Ende Regency and this is detrimental to the community. In this regard, this study aims to examine how customary forests are regulated in the versions of regulations before and after the Constitutional Court Decision No. 35/PUU-X/2012. This research is a normative research using a statutory approach. The existing primary and secondary legal materials were then subjected to a qualitative juridical analysis. The results of the study show that the constitution requires conflict resolution to be carried out using a functional approach and a human rights approach, but in fact the use of a human rights approach creates a conflict between the rules under the constitution and the constitution. This requires the government to harmonize regulations because there are still many regulations which are very dominant with a functional approach, and very little use of a human rights approach

Simulação da Dispersão de Poluentes Usando o Método de Decomposição

A idéia principal deste trabalho é resolver a equação de Langevinanaliticamente pelo método de decomposição assumindo condições de turbulênciaGaussiana e não-Gaussiana

Automatic Routing System for Intelligent Warehouses

Automation of logistic processes is essential to improve productivity and reduce costs. In this context, intelligent warehouses are becoming a key to logistic systems thanks to their ability of optimizing transportation tasks and, consequently, reducing costs. This paper initially presents briefly routing systems applied on intelligent warehouses. Then, we present the approach used to develop our router system. This router system is able to solve traffic jams and collisions, generate conflict-free and optimized paths before sending the final paths to the robotic forklifts. It also verifies the progress of all tasks. When a problem occurs, the router system can change the task priorities, routes, etc. in order to avoid new conflicts. In the routing simulations, each vehicle executes its tasks starting from a predefined initial pose, moving to the desired position. Our algorithm is based on Dijkstra's shortest path and the time window approaches and it was implemented in C language. Computer simulation tests were used to validate the algorithm efficiency under different working conditions. Several simulations were carried out using the Player/Stage Simulator to test the algorithms. Thanks to the simulations, we could solve many faults and refine the algorithms before embedding them in real robots.Comment: 2010 IEEE International Conference on Robotics and Automation, International workshop on Robotics and Intelligent Transportation System, Full Day Workshop, May 7th 2010, Anchorage, Alaska. Organizers,Christian Laugier (INRIA, France), Ming Lin (University of North Carolina, USA), Philippe Martinet IFMA and LASMEA, France),Urbano Nunes (ISR, Portugal

Perancangan Pendeteksi Arus Bolak-Balik Tanpa Sentuhan Rendah Biaya Berbasis Multivibrator Monostabil

Listrik merupakan elemen penting dalam kehidupan sehari-hari. Hampir semua peralatan, seperti lampu, televisi dan penanak nasi ditenagai oleh arus bolak-balik. Namun di sisi lain arus bolak-balik memiliki properti tidak terlihat dan dapat menyetrum, sehingga berpotensi menimbulkan bahaya. Untuk mencegah bahaya, diperlukan alat yang mampu mendeteksi (pendeteksi) keberadaan arus bolak-balik. Berdasarkan sifatnya ada dua jenis alat pendeteksi; dengan sentuhan dan tanpa sentuhan. Alat pendeteksi dengan sentuhan seperti tespen dan multimeter memiliki kelemahan dimana isolasi peralatan listrik harus dibuka terlebih dahulu. Alat pendeteksi tanpa sentuhan tidak mensyaratkan dibukanya isolasi peralatan listrik, namun memilki harga yang mahal. Pada penelitian ini dirancang pendeteksi arus bolak-balik tanpa sentuhan menggunakan komponen-komponen sederhana, sehingga rendah biaya. Prinsip pendeteksian menggunakan prinsip induksi elektromagnetik dan multivibrator monostabil

CD3e expression in HTLV-1-infected individuals is associated with proviral load and Tax expression

Financial support: FUNDHERP, CTC, INCTC, FAPESP, CNPq and CAPES

Creation of Surge Capacity by Early Discharge of Hospitalized Patients at Low Risk for Untoward Events

Objectives: US hospitals are expected to function without external aid for up to 96 hours during a disaster; however, concern exists that there is insufficient capacity in hospitals to absorb large numbers of acute casualties. The aim of the study was to determine the potential for creation of inpatient bed surge capacity from the early discharge (reverse triage) of hospital inpatients at low risk of untoward events for up to 96 hours. Methods: In a health system with 3 capacity-constrained hospitals that are representative of US facilities (academic, teaching affiliate, community), a variety (N = 50) of inpatient units were prospectively canvassed in rotation using a blocked randomized design for 19 weeks ending in February 2006. Intensive care units (ICUs), nurseries, and pediatric units were excluded. Assuming a disaster occurred on the day of enrollment, patients who did not require any (previously defined) critical intervention for 4 days were deemed suitable for early discharge. Results: Of 3491 patients, 44% did not require any critical intervention and were suitable for early discharge. Accounting for additional routine patient discharges, full use of staffed and unstaffed licensed beds, gross surge capacity was estimated at 77%, 95%, and 103% for the 3 hospitals. Factoring likely continuance of nonvictim emergency admissions, net surge capacity available for disaster victims was estimated at 66%, 71%, and 81%, respectively. Reverse triage made up the majority (50%, 55%, 59%) of surge beds. Most realized capacity was available within 24 to 48 hours. Conclusions: Hospital surge capacity for standard inpatient beds may be greater than previously believed. Reverse triage, if appropriately harnessed, can be a major contributor to surge capacity

Arabidopsis RCD1 coordinates chloroplast and mitochondrial functions through interaction with ANAC transcription factors

Reactive oxygen species (ROS)-dependent signaling pathways from chloroplasts and mitochondria merge at the nuclear protein RADICAL-INDUCED CELL DEATH1 (RCD1). RCD1 interacts in vivo and suppresses the activity of the transcription factors ANAC013 and ANAC017, which mediate a ROS-related retrograde signal originating from mitochondrial complex III. Inactivation of RCD1 leads to increased expression of mitochondrial dysfunction stimulon (MDS) genes regulated by ANAC013 and ANAC017. Accumulating MDS gene products, including alternative oxidases (AOXs), affect redox status of the chloroplasts, leading to changes in chloroplast ROS processing and increased protection of photosynthetic apparatus. ROS alter the abundance, thiol redox state and oligomerization of the RCD1 protein in vivo, providing feedback control on its function. RCD1-dependent regulation is linked to chloroplast signaling by 3'-phosphoadenosine 5'-phosphate (PAP). Thus, RCD1 integrates organellar signaling from chloroplasts and mitochondria to establish transcriptional control over the metabolic processes in both organelles.Peer reviewe

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand.

OBJECTIVE: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. DESIGN: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. METHODS: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. RESULTS: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. CONCLUSION: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age