Industrial construction safety policies and practices with cost impacts in a COVID-19 pandemic environment: A Louisiana DOW case study

There are always significant challenges in improving the safety culture by changing and adding additional safety protocols. The unknown impacts of COVID-19 and how it quickly spreads led the industry to institute essential safety protocols. This paper addresses two problem statements. The first problem statement is: what are the additional safety protocols for process safety, construction & maintenance, and personal protective equipment requirements? The second problem statement is: what are the cost and schedule impacts of industrial construction projects resulting from implementing safety protocols and process safety during construction with the added PPE? While complying with added safety protocols, the industrial construction industry cannot forget that it has a distinct reputation for high incident rates and less than desirable safety performance. In 2017, the construction industry suffered 971 fatalities. This alarming number is compared to 1123 total fatalities in 2017 for the Gulf Coast States. The objective is to share the rationale and practices of social distancing, required additional PPE, and personal hygiene practices to reduce spreading and outbreaks during a pandemic within an industrial construction environment. Before any construction work, the process safety teams must clear, isolate, and tag out process lines, equipment, and instruments to be repaired or replaced. The information presented demonstrates the significant cost and schedule impacts that industrial construction companies will encounter during a pandemic like COVID-19. This paper aims to improve safety processes, cost & schedule impacts, and prescribe additional personal protective equipment in industrial construction during a pandemic such as COVID-19. The COVID-19 pandemic spread globally in a very short period. The reactions in mitigating the spread were suggestive, with little to no data on safety protective equipment and practices. The contribution this paper addresses are how to employ efficient safety practices and policies during a pandemic in an industrial construction environment

Style in Malory's book of Balin

The purpose of this study is to reveal the beginning of Malory's selfconscious artistry as it is exhibited in his book of Balin. I attempt to reveal this through an examination of his prose style, primarily by viewing the changes lie makes in his French source. In the first chapter I define style as not only syntax and the arrangement of words out also narrative structural devices. The second chapter deals with these narrative structural devices. In the third, fourth and fifth chapters I examine the stylistic techniques Malory uses in his narration, description and dialogue. The final chapter looks at "Balin" and its relationship to "The Tale of King Arthur" and the entire Le Morte Darthur

Koinonia

Guiding Principles: Toward Development of An Ethic of National and Community Service with an Emphasis Upon Higher Education, Cliff Briggs President\u27s Corner Focus on the ACSD 1993 National Conference: Mirrors of the Past, Directions for the Future When Goals Hinder Vision CoCCA: Planning Activities for Adult Students; Hot Program and Promotional Tips Males\u27 Attributions and Expectancies about Potential Mates as a Function of Sex Roles Part IIhttps://pillars.taylor.edu/acsd_koinonia/1048/thumbnail.jp

Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study

Objective To explore pressure area related pain as a predictor of category ≥2 pressure ulcer (PU) development. Design Multicentre prospective cohort study. Setting UK hospital and community settings. Participants inclusion Consenting acutely ill patients aged ≥18 years, defined as high risk (Braden bedfast/chairfast AND completely immobile/very limited mobility; pressure area related pain or; category 1 PU). Exclusion Patients too unwell, unable to report pain, 2 or more category ≥2 PUs. Follow-up Twice weekly for 30 days. Primary and secondary outcome measures Development and time to development of one or more category ≥2 PUs. Results Of 3819 screened, 1266 were eligible, 634 patients were recruited, 32 lost to follow-up, providing a 602 analysis population. 152 (25.2%) developed one or more category ≥2 PUs. 464 (77.1%) patients reported pressure area related pain on a healthy, altered or category 1 skin site of whom 130 (28.0%) developed a category ≥2 PU compared with 22 (15.9%) of those without pain. Full stepwise variable selection was used throughout the analyses. (1) Multivariable logistic regression model to assess 9 a priori factors: presence of category 1 PU (OR=3.25, 95% CI (2.17 to 4.86), p<0.0001), alterations to intact skin (OR=1.98, 95% CI (1.30 to 3.00), p=0.0014), pressure area related pain (OR=1.56, 95% CI (0.93 to 2.63), p=0.0931). (2) Multivariable logistic regression model to account for overdispersion: presence of category 1 PU (OR=3.20, 95% CI (2.11 to 4.85), p<0.0001), alterations to intact skin (OR=1.90, 95% CI (1.24 to 2.91), p=0.0032), pressure area related pain (OR=1.85, 95% CI (1.07 to 3.20), p=0.0271), pre-existing category 2 PU (OR=2.09, 95% CI (1.35 to 3.23), p=0.0009), presence of chronic wound (OR=1.66, 95% CI (1.06 to 2.62), p=0.0277), Braden activity (p=0.0476). (3) Accelerated failure time model: presence of category 1 PU (AF=2.32, 95% CI (1.73 to 3.12), p<0.0001), pressure area related pain (AF=2.28, 95% CI (1.59 to 3.27), p<0.0001). (4) 2-level random-intercept logistic regression model: skin status which comprised 2 levels (versus healthy skin); alterations to intact skin (OR=4.65, 95% CI (3.01 to 7.18), p<0.0001), presence of category 1 PU (OR=17.30, 95% CI (11.09 to 27.00), p<0.0001) and pressure area related pain (OR=2.25, 95% CI (1.53 to 3.29), p<0.0001). Conclusions This is the first study to assess pain as a predictor of category ≥2 PU development. In all 4 models, pain emerged as a risk factor associated with an increased probability of category ≥2 PU development

The Effects of Text Message Reminder on Blood Donor Show Rate

Introduction: Declining blood collection endangers the blood supply at a time when the health care system is requiring an increasingly greater amount of blood products. Blood donation centers are challenged to recruit and develop first-time donors into reliable repeat donors, thereby ensuring a sufficient blood supply. Communication strategies such as e-mail reminders have been shown to be an effective communications tool to promote blood collection. Alternatively, Text Messaging has been shown effective in primary care and preventative medicine. Text messaging improved patient compliance with a schedule of vaccine dosing, as well as improving patient attendance at outpatient clinics. Additionally, text messaging reminders have been shown to be as effective as phone reminders in increasing patient attendance at outpatient appointments. Finally, text messaging has been shown to be useful for managing self-care such as smoking cessation, monitoring asthmatic symptoms, and diabetes control. We investigated whether offering the use a text message reminder to donors would increase attendance at donation events, demonstrating that text messaging can be an effective tool in maintaining a pool of blood donors.https://scholarworks.uvm.edu/comphp_gallery/1008/thumbnail.jp

The Role of Expert Opinion in Projecting Long-Term Survival Outcomes Beyond the Horizon of a Clinical Trial

INTRODUCTION: Clinical trials often have short follow-ups, and long-term outcomes such as survival must be extrapolated. Current extrapolation methods often produce a wide range of survival values. To minimize uncertainty in projections, we developed a novel method that incorporates formally elicited expert opinion in a Bayesian analysis and used it to extrapolate survival in the placebo arm of DAPA-CKD, a phase 3 trial of dapagliflozin in patients with chronic kidney disease (NCT03036150). METHODS: A summary of mortality data from 13 studies that included DAPA-CKD-like populations and training on elicitation were provided to six experts. An elicitation survey was used to gather the experts' 10- and 20-year survival estimates for patients in the placebo arm of DAPA-CKD. These estimates were combined with DAPA-CKD mortality and general population mortality (GPM) data in a Bayesian analysis to extrapolate long-term survival using seven parametric distributions. Results were compared with those from standard frequentist approaches (with and without GPM data) that do not incorporate expert opinion. RESULTS: The group expert-elicited estimate for 20-year survival was 31% (lower estimate, 10%; upper estimate, 40%). In the Bayesian analysis, the 20-year extrapolated survival across the seven distributions was 14.9-39.1%, a range that was 2.4- and 1.6-fold smaller than those produced by the frequentist methods (0.0-56.9% without and 0.0-39.2% with GPM data). CONCLUSIONS: Using expert opinion in a Bayesian analysis provided a robust method for extrapolating long-term survival in the placebo arm of DAPA-CKD. The method could be applied to other populations with limited survival data

“That's cool, you’re a musician and you drink”: Exploring entertainers’ accounts of their unique workplace relationship with alcohol

This qualitative research investigates the alcohol experiences of entertainers who perform within licensed premises. Previous, mainly quantitative, studies have found that entertainers, specifically musicians, are an occupational group who drink excessively. This qualitative study draws on a wider sample of entertainers to examine their accounts of drinking in the workplace and the explanations they provide for this. We conducted individual semi-structured interviews (n = 24) with band-members, variety acts and DJs in Glasgow, Scotland. This revealed a workplace characterised by continual opportunities for often free alcohol consumption. Unlike most occupations, for entertainers ‘drinking-on-the-job’ was normative, expected, and sometimes encouraged by peers, the public, employers or sponsors. Entertainers also experienced performance-related incentives to drink before, during and/or after a show; including anxiety, matching their intoxication level to the audience's, and ‘reward-drinking’. This qualitative research confirms the unique nature of the entertainer-alcohol link, even in comparison to that found within other leisure industry occupations. While providing some explanation as to why entertainers might drink excessively, participants’ accounts also suggested potential strategies for avoiding the negative outcomes of workplace drinking

Exploring the Efficacy of Hormone Replacement Therapy:A Network Meta-Analysis

Hormone Replacement Therapy (HRT), an FDA-approved treatment for menopausal conditions was found to be associated with increased risk of endometrial cancer and reduced oestrogen. Studies showing benefits of HRT in preventing chronic diseases lead to development of clinical guidelines by American College of Physicians. This study aims to assess effectiveness of HRT treatments across cardiometabolic measures including Triglycerides (TG), Follicle-Stimulating Hormone, LDL cholesterol, HDL cholesterol, and Estradiol in menopausal women. It reports gaps in scientific knowledge and clinical practice to enhance current guidelines and policies.Methods: A systematic methodology designed and published in PROSPERO (CRD42022346057) to report network meta-epidemiology analysis was utilised. We used databases by PubMed, Web of Science, ScienceDirect, EMBASE and MEDLINE for studies published between 30th of April 1980-2022. Effects of HRT treatments were explored using a mixed treatment comparison (MTC) model. Fixed and random-effects models were used to address heterogeneity in published studies. Publication bias was assessed and corrected using funnel plots and Egger’s test.Results: Of 45 eligible studies, our findings indicate a significant statistical heterogeneity between HRTs and reduction of TG, SFH, LDL-C alongside increase of HDL-C and Estradiol among menopausal women. The analysis suggests a lack of direct evidence to support their efficacy in reducing TG, SFH and LDL-C levels or to substantiate HRT’s effectiveness in increasing HDL-C and Estradiol. The results showed no significant publication bias in the meta-analysis of included studies.Conclusion: Our findings demonstrate that use of HRT interventions among menopausal women may reduce TG, FSH and LDL-C levels and increase levels of HDL-C and estradiol via oral and oral + transdermal administration. Our study reaffirms efficacy of HRT in supporting favourable lipid profile in menopausal women whilst highlighting the need for robust and inclusive epidemiology studies and clinical trials to further develop clinical guidelines and policies

Pan-viral serology implicates enteroviruses in acute flaccid myelitis.

Since 2012, the United States of America has experienced a biennial spike in pediatric acute flaccid myelitis (AFM)1-6. Epidemiologic evidence suggests non-polio enteroviruses (EVs) are a potential etiology, yet EV RNA is rarely detected in cerebrospinal fluid (CSF)2. CSF from children with AFM (n = 42) and other pediatric neurologic disease controls (n = 58) were investigated for intrathecal antiviral antibodies, using a phage display library expressing 481,966 overlapping peptides derived from all known vertebrate and arboviruses (VirScan). Metagenomic next-generation sequencing (mNGS) of AFM CSF RNA (n = 20 cases) was also performed, both unbiased sequencing and with targeted enrichment for EVs. Using VirScan, the viral family significantly enriched by the CSF of AFM cases relative to controls was Picornaviridae, with the most enriched Picornaviridae peptides belonging to the genus Enterovirus (n = 29/42 cases versus 4/58 controls). EV VP1 ELISA confirmed this finding (n = 22/26 cases versus 7/50 controls). mNGS did not detect additional EV RNA. Despite rare detection of EV RNA, pan-viral serology frequently identified high levels of CSF EV-specific antibodies in AFM compared with controls, providing further evidence for a causal role of non-polio EVs in AFM