Does Medical Staffing Influence Perceived Safety? An International Survey on Medical Crew Models in Helicopter Emergency Medical Services

Objective: The competence, composition, and number of crewmembers have generally been considered to influence the degree of patient care and safety in helicopter emergency medical services (HEMS), but evidence to support the advantages of one crew concept over another is ambiguous; additionally, the benefit of physicians as crewmembers is still highly debated. Methods: To compare perceived safety in different medical crew models, we surveyed international HEMS medical directors regarding the types of crew compositions their system currently used and their supportive rationales and to evaluate patient and flight safety within their services. Results: Perceived patient and flight safety is higher when HEMS is staffed with a dual medical crew in the cabin. Tradition and scientific evidence are the most common reasons for the choice of medical crew. Most respondents would rather retain their current crew configuration, but some would prefer to add a physician or supplement the physician with an assistant in the cabin. Conclusion: Our survey shows a wide variety of medical staffing models in HEMS and indicates that these differences are mainly related to medical competencies and the availability of an assistant in the medical cabin. The responses suggest that differences in medical staffing influence perceived flight and patient safety.publishedVersio

Sky-High Safety? A Qualitative Study of Physicians’ Experiences of Patient Safety in Norwegian Helicopter Emergency Services

Background Patients treated and transported by Helicopter Emergency Medical Services (HEMS) are prone to both flight and medical hazards, but incident reporting differs substantially between flight organizations and health care, and the extent of patient safety incidents is still unclear. Methods A qualitative descriptive study based on in-depth interviews with 8 experienced Norwegian HEMS physicians from 4 different bases from February to July 2020 using inductive qualitative content analysis. The study objectives were to explore the physicians’ experience with incident reporting and their perceived areas of risk in HEMS. Results/Findings The HEMS physicians stated that the limited number of formal incident reports was due to the “nature of the HEMS missions” and because reports were mainly relevant when deviating from procedures, which are sparse in HEMS. The physicians preferred informal rather than formal incident reporting systems and reporting to a colleague rather than a superior. The reasons were ease of use, better feedback, and less fear of consequences. Their perceived areas of risk were related to all the phases of a HEMS mission: the physician as the team leader, medication errors, the handover process, and the helicopter as a work platform. Conclusions The sparse, informal, and fragmented incident reporting provides a poor overview of patient safety risks in HEMS. Focusing on organizational factors and system responsibility and research on environmental and contextual factors are needed to further improve patient safety in HEMS.publishedVersio

Overscore Development

Overscore Development and the 3D Plaza initiative focus on one goal: To ignite Boise\u27s creative economy and engage citizens in making our city a destination for innovation. Boise’s greatest asset is the creativity of its citizens. Although recent years have seen the economy struggling locally and nationally, Boise entrepreneurs have continued to take risks and launch new and innovative businesses. Overscore Development set out to increase contact between this spirit of creative business and the Boise population at large. We accomplished this by developing the concept of a mixed-use structure that makes use of inventive retail space, open city government, and an urban Boise State University extension. These elements work together to create a third space where Boise citizens can share their lives in the area between commercial and community space

Proceedings of the 16th Annual Meeting of the Society for Pediatric Dermatology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75156/1/j.1525-1470.1992.tb00329.x.pd

Prazosin Reduces Alcohol Intake in an Animal Model of Alcohol Relapse

BACKGROUND: Many alcoholics and heavy drinkers undergo repeated cycles of alcohol abstinence followed by relapse to alcohol drinking; a pattern that contributes to escalated alcohol intake over time. In rodents, alcohol drinking that is interspersed with periods of alcohol deprivation (imposed abstinence) increases alcohol intake during reaccess to alcohol. This is termed the "alcohol deprivation effect" or "ADE" and is a model of alcohol relapse in humans. We have previously reported that prazosin reduces alcohol drinking during both brief and prolonged treatment in rats selectively bred for alcohol preference ("P" rats). This study explores whether prazosin prevents alcohol "relapse" in P rats, as reflected by a reduced or abolished ADE. METHODS: Adult male P rats were given 24-hour access to food and water and scheduled access to alcohol (15 and 30% v/v solutions presented concurrently) for 2 h/d. After 5 weeks, rats underwent imposed alcohol deprivation for 2 weeks, followed by alcohol reaccess for 2 weeks, and this pattern was repeated for a total of 3 cycles. Rats were injected with prazosin (0, 0.5, 1.0, or 2.0 mg/kg body weight, intraperitoneally) once a day for the first 5 days of each alcohol reaccess cycle. RESULTS: Alcohol intake increased on the first day of each alcohol reaccess cycle, demonstrating the formation of an ADE. The ADE was short-lived, lasting only 1 day, during each of the 3 cycles. Prazosin, in all doses tested, prevented the expression of an ADE in all 3 alcohol reaccess cycles. CONCLUSIONS: Prazosin decreases alcohol intake in P rats even in a situation that would be expected to increase alcohol drinking, namely following periods of alcohol deprivation. This suggests that prazosin may be effective in reducing alcohol relapse that often occurs during attempts to achieve permanent alcohol abstinence in treatment-seeking alcoholics and heavy drinkers

Tree thinning and fire affect ectomycorrhizal fungal communities and enzyme activities

Common ecological restoration treatments such as thinning trees and prescribed burning could result in changes to soil fungal communities and changes to the function of those communities. Ectomycorrhizal fungi are especially likely to be affected as they are symbionts on plant roots and exhibit host and niche preferences. Ectomycorrhizal fungi also produce extracellular enzymes that are important in soil nutrient cycling. We conducted a community survey of ectomycorrhizal fungi and assayed ectomycorrhizal root tip enzyme activity using substrate plugs in northern Mississippi upland oak–pine woodland plots differing in restoration history to explore the influence of woodland restoration on ectomycorrhizalfungal community composition and function. Restoration treatment was significant in explaining the occurrence of the most common fungal species (Russula xerampelina) and the most common family (Thelephoraceae) in the ectomycorrhizal fungal community survey. Highest potential laccase, peroxidase, and N-acetyl-b-D-glucosaminidase enzyme activity were found in a prescribed burn plot, and the lowest enzyme activities at a wildfire plot, where richness of ectomycorrhizal fungi was also lower. Different fungal families displayed significantly different enzymatic capabilities, with Hydnangiaceae having the highest laccase activity and Tuberaceae having significantly higher peroxidase and chitinase activity than several other families. These results suggest that restoration treatments can affect ectomycorrhizal fungal community composition and function, and better understanding these changes can aid understanding of the niches of ectomycorrhizal fungi and the impacts of restoration

A subsystems approach for parameter estimation of ODE models of hybrid systems

We present a new method for parameter identification of ODE system descriptions based on data measurements. Our method works by splitting the system into a number of subsystems and working on each of them separately, thereby being easily parallelisable, and can also deal with noise in the observations.Comment: In Proceedings HSB 2012, arXiv:1208.315

Beyond the bipolar seesaw: toward a process understanding of interhemispheric coupling

The thermal bipolar ocean seesaw hypothesis was advanced by Stocker and Johnsen (2003) as the ‘simplest possible thermodynamic model’ to explain the time relationship between Dansgaard–Oeschger (DO) and Antarctic Isotope Maxima (AIM) events. In this review we combine palaeoclimate observations, theory and general circulation model experiments to advance from the conceptual model toward a process understanding of interhemispheric coupling and the forcing of AIM events. We present four main results: (1) Changes in Atlantic heat transport invoked by the thermal seesaw are partially compensated by opposing changes in heat transport by the global atmosphere and Pacific Ocean. This compensation is an integral part of interhemispheric coupling, with a major influence on the global pattern of climate anomalies. (2) We support the role of a heat reservoir in interhemispheric coupling but argue that its location is the global interior ocean to the north of the Antarctic Circumpolar Current (ACC), not the commonly assumed Southern Ocean. (3) Energy budget analysis indicates that the process driving Antarctic warming during AIM events is an increase in poleward atmospheric heat and moisture transport following sea ice retreat and surface warming over the Southern Ocean. (4) The Antarctic sea ice retreat is itself driven by eddy-heat fluxes across the ACC, amplified by sea-ice–albedo feedbacks. The lag of Antarctic warming after AMOC collapse reflects the time required for heat to accumulate in the ocean interior north of the ACC (predominantly the upper 1500 m), before it can be mixed across this dynamic barrier by eddies

Convective Storm Life Cycle and Environments near the Sierras de Córdoba, Argentina

Satellite observations have revealed that some of the world's most intense deep convective storms occur near the Sierras de Córdoba, Argentina, South America. A C-band, dual-polarization Doppler weather radar recently installed in the city of Córdoba in 2015 is now providing a high-resolution radar perspective of this intense convection. Radar data from two austral spring and summer seasons (2015-17) are used to document the convective life cycle, while reanalysis data are utilized to construct storm environments across this region. Most of the storms in the region are multicellular and initiate most frequently during the early afternoon and late evening hours near and just east of the Sierras de Córdoba. Annually, the peak occurrence of these storms is during the austral summer months of December, January, and February. These Córdoba radar-based statistics are shown to be comparable to statistics derived from Tropical Rainfall Measuring Mission Precipitation Radar data. While generally similar to storm environments in the United States, storm environments in central Argentina tend to be characterized by larger CAPE and weaker low-level vertical wind shear. One of the more intriguing results is the relatively fast transition from first storms to larger mesoscale convective systems, compared with locations in the central United States.Fil: Mulholland, Jake P.. University of Illinois at Urbana; Estados UnidosFil: Nesbitt, Stephen William. University of Illinois at Urbana; Estados UnidosFil: Trapp, Robert J.. University of Illinois at Urbana; Estados UnidosFil: Rasmussen, Kristen L.. State University of Colorado - Fort Collins; Estados UnidosFil: Salio, Paola Veronica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones del Mar y la Atmósfera. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmósfera; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmósfera; Argentin