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Grams, Ralph R., Georgina C. Peck, James K. Massey, and James J. Austin. "Review of Hospital Data Processing in the United States (1982?1984)." Journal of Medical Systems 9, no. 4 (August 1985): 175–269. http://dx.doi.org/10.1007/bf00992884.
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Bennett, PhD, DeeDee M. "Diversity in emergency management scholarship." Journal of Emergency Management 17, no. 2 (March 1, 2019): 148. http://dx.doi.org/10.5055/jem.2019.0407.
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Women and racial/ethnic minorities have long been underrepresented in the field of emergency management. This is true for both practice and research. The lack of women and racial/ethnic minorities in the profession and their perceived absence in research or scholarly study may have impacts on the effectiveness of response and recovery efforts as well as the broader scientific knowledge within the field. Historically, women and racial/ethnic minority communities have disproportionately experienced negative impacts following disasters. Earlier related studies have pointed to the underrepresentation as a contributing factor in community vulnerability. The scarcity of women in practice and as students in this field has been particularly evident in the United States. Using data from a recent survey of emergency management programs nationwide, this article reviews the concerns in research with regards to women and ethnic minority communities during disasters, efforts to increase representation of these groups in the field, and discusses the implications for practice, policy, and future research. The findings show that women have a strong presence in emergency management programs nationwide, and while specific data on racial and ethnic minorities are lacking, the observed increases reported in this article encourages further study.
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Pinet-Peralta, PhD, Luis M., Rick Bissell, PhD, Katrina Hein, BSc, MSc, and David Prakash, MSc. "Emergency management policies and natural hazards in the United States: A state-level analysis." Journal of Emergency Management 9, no. 2 (March 1, 2011): 27. http://dx.doi.org/10.5055/jem.2011.0051.
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Every year, natural hazards kill and injure hundreds of people and also have significant social, economic, and political effects on society. However, not all disasters or crises are the focus of state, regional, or national efforts to mitigate their effects. In this article, the authors use Wilson’s policy typology to describe the unintended consequences that disaster legislation has had on the distribution of costs and benefits of disaster relief programs in the United States. The data provide evidence that the concentration of disaster relief programs for natural disasters is not based on need and that interest groups commonly drive disaster policies to benefit those with the greatest risk for losses rather than those in greatest need. Policymakers can use this information to examine both intended and unintended consequences of disaster response and recovery policies and can orient the limited resources available toward those who are least capable of recovering from natural disasters.
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Saud, Pradip, Jingxin Wang, Benktesh D. Sharma, and Weiguo Liu. "Carbon impacts of hardwood lumber processing in the northeastern United States." Canadian Journal of Forest Research 45, no. 12 (December 2015): 1699–710. http://dx.doi.org/10.1139/cjfr-2015-0082.
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Carbon emission from hardwood lumber processing in different-sized sawmills under varying energy sources, management strategies, and potential carbon offsetting capacity through useful life (service life) of lumber in the northeastern United States was analyzed using analytical statistics such as analysis of variance (ANOVA), mixed-effect model, principal component analysis, and Monte Carlo simulation. Data obtained from a regional sawmill survey (Pennsylvania, New York, Ohio, and West Virginia), energy audit of sawmills, public databases, and relevant literature were analyzed for the gate-to-gate life cycle inventory framework. Results showed that mean carbon emission (megagrams (Mg) per thousand cubic metres (TCM)) for lumber processing significantly differs among sawmill sizes. The total carbon emission from electricity consumption and wood residue of lumber processing was approximately 62.5%, 80.3%, and 66.2% of carbon stored in lumber processed for small, medium, and large sawmills, respectively. Efficient management and potential opportunities of improvement in sawmills can significantly reduce carbon emission (10.96% ± 1.57%) from hardwood lumber processing. Carbon stock from lumber production could be enhanced by either reducing carbon emission from energy consumption or decreasing lumber export quantity. The carbon emission–loss ratio (CELR) suggested that after 100 years, nearly 50% of carbon stored in lumber would be still available for carbon accountability. Electricity generation from either a single resource (natural gas) or mixed resources as is the case in RFC EAST (eGrid subregion) would be beneficial in lowering carbon emission from sawmill processing.
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Barnes, Jessica, Larry Segars, Jason Wasserman, Patrick Karabon, and Tracey A. Taylor. "611. Infectious Disease Management of Homeless and Non-Homeless Populations in United States Emergency Departments." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S366. http://dx.doi.org/10.1093/ofid/ofaa439.805.
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Abstract Background Studies have long documented the increased emergency department usage in the United States by homeless persons compared to their housed counterparts, as well as an increased overall prevalence of infectious diseases. However, there is a gap in knowledge on the treatment that homeless persons receive for these infectious diseases within United States emergency departments compared to their housed counterparts. This study seeks to understand this potential difference in treatment, including diagnostic services tested, procedures performed, and medications prescribed. Methods This study utilized a retrospective, cohort study design to analyze data from the 2007-2010 National Hospital Ambulatory Medical Care Survey (NHAMCS) database. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures, and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. This provided an odds ratio to compare the two populations, which was then adjusted for confounding variables. Results Compared to private residence individuals, homeless persons were more likely (OR: 10.99, p< 0.05, CI: 1.08-111.40) to receive sutures or staples when presenting with an infectious disease in United States emergency departments. Compared to private residence persons, homeless individuals were less likely (OR: 0.29, p< 0.05, CI: 0.10-0.87) to be provided medications or immunizations when presenting with an infectious disease in United States emergency departments, and significant differences were detected in prescribing habits of multiple medication classes. Conclusion This study detected a significant difference in suturing/stapling and medication prescribing patterns for homeless persons with an infectious disease in United States emergency departments, compared to their housed counterparts. These results provide a platform for continual research. Disclosures All Authors: No reported disclosures
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Laney, Christine, Katherine LeVan, Claire Lunch, and Katherine Thibault. "Sample Management Across the National Ecological Observatory Network." Biodiversity Information Science and Standards 2 (May 18, 2018): e25351. http://dx.doi.org/10.3897/biss.2.25351.
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From 81 study sites across the United States, the US National Ecological Observatory Network (NEON), generates >75,000 samples per year. Samples range from soil and dust deposition material, tissue samples (e.g., small mammals and fish), DNA extracts, and whole organisms (e.g., ground beetles and ticks). Samples are collected, processed, and documented according to protocols that are standardized across study sites and according to the needs of the ecological research community for future studies. NEON has faced numerous challenges with managing data related to these many diverse physical samples, particularly when data are gathered at numerous steps throughout processing. Here, we share these challenges as well as solutions, including innovative semantically driven software tools and processing pipelines that manage data from each sample's point of collection to its ultimate fate (consumption, archive facility, or partnering data repository) while maintaining links across sample hierarchies.
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Mahmood, Rezaul, Ryan Boyles, Kevin Brinson, Christopher Fiebrich, Stuart Foster, Ken Hubbard, David Robinson, Jeff Andresen, and Dan Leathers. "Mesonets: Mesoscale Weather and Climate Observations for the United States." Bulletin of the American Meteorological Society 98, no. 7 (July 1, 2017): 1349–61. http://dx.doi.org/10.1175/bams-d-15-00258.1.
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Abstract Mesoscale in situ meteorological observations are essential for better understanding and forecasting the weather and climate and to aid in decision-making by a myriad of stakeholder communities. They include, for example, state environmental and emergency management agencies, the commercial sector, media, agriculture, and the general public. Over the last three decades, a number of mesoscale weather and climate observation networks have become operational. These networks are known as mesonets. Most are operated by universities and receive different levels of funding. It is important to communicate the current status and critical roles the mesonets play. Most mesonets collect standard meteorological data and in many cases ancillary near-surface data within both soil and water bodies. Observations are made by a relatively spatially dense array of stations, mostly at subhourly time scales. Data are relayed via various means of communication to mesonet offices, with derived products typically distributed in tabular, graph, and map formats in near–real time via the World Wide Web. Observed data and detailed metadata are also carefully archived. To ensure the highest-quality data, mesonets conduct regular testing and calibration of instruments and field technicians make site visits based on “maintenance tickets” and prescheduled frequencies. Most mesonets have developed close partnerships with a variety of local, state, and federal-level entities. The overall goal is to continue to maintain these networks for high-quality meteorological and climatological data collection, distribution, and decision-support tool development for the public good, education, and research.
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Kim, Jung Wook, and Kyujin Jung. "Does Voluntary Organizations’ Preparedness Matter in Enhancing Emergency Management of County Governments?" Lex localis - Journal of Local Self-Government 14, no. 1 (January 2, 2016): 1–17. http://dx.doi.org/10.4335/14.1.1-17(2016).
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While voluntary organizations have played a critical role in preparing for and responding to disasters, few have intentionally examined the preparedness of voluntary organizations, which are fundamentally required to enhance local emergency management. The purpose of this research is to examine the relationship between the preparedness of voluntary organizations and their effectiveness on local emergency management. By using a survey data collected among county governments in the United States, this research tests the effect of voluntary organizations’ preparedness on local emergency management. The results show that the voluntary organizations' preparedness behaviors such as their participation in local emergency planning as well as training, education, and resources for local emergency management positively affect their effectiveness on local emergency management. The findings imply that systemic volunteer management can build more effective emergency management systems through cohesive and comprehensive collaboration between public and voluntary organizations.
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Lai, Anita, Elliott Tenpenny, David Nestler, Erik Hess, and Ian G. Stiell. "Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States’ settings." CJEM 18, no. 2 (June 22, 2015): 81–89. http://dx.doi.org/10.1017/cem.2015.43.
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AbstractIntroductionThe objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients.MethodsThis was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses.ResultsIn total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0).ConclusionsThe U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.
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Lentzos, Filippa. "The American biodefense industry: From emergency to nonemergence." Politics and the Life Sciences 26, no. 1 (March 2007): 15–23. http://dx.doi.org/10.2990/26_1_15.
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Since 1998, and especially since the “Amerithrax” emergency of 2001, the United States has ambitiously funded biodefense projects, intending not only to enhance detection and management of any biological-weapons attack but also to establish a robust domestic biodefense industry. I asked if the United States had fulfilled this latter intention. Using the RAND Corporation's RaDiUS database, I examined federal biodefense grants and contracts awarded from 1995 through most of 2005, noting recipient type, awarding unit, funding level, and the disease focus of research-and-development support. Patterns in these data as well as other sources suggest that the biodefense industry as late as 2005 remained in a nascent stage, with most firms small, precariously financed, and more responsive to funders' announcements and solicitations than to opportunities for self-directed innovation. A biodefense industry with investor-capital funding and retained earnings, with its own leading companies, with its own stock analysts, and with its own legitimacy in commercial and financial markets did not emerge over the period studied, nor does its emergence appear imminent.
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Guinto, Robyn, Patricia Greenberg, and Nasim Ahmed. "Emergency Management of Blunt Splenic Injury in Hypotensive Patients." American Surgeon 86, no. 6 (June 2020): 690–94. http://dx.doi.org/10.1177/0003134820923325.
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Objectives The purpose of this study is to examine the outcomes of splenic angioembolization (SAE) as the first modality for nonoperative management (NOM) in hypotensive patients with high-grade splenic injuries. Methods Data were collected from the 2007-2010 National Trauma Data Bank data sets of the United States. The data included patients with massive blunt splenic injuries with an Abbreviated Injury Scale (AIS) of 4 or 5, initial systolic blood pressure ≤90, and who underwent either a total splenectomy or SAE (Group 1 and Group 2, respectively) within 4 hours of hospital arrival. The outcomes of interest are in-hospital mortality and complications. Results Of the 1052 patients analyzed, 996 (94.7%) underwent total splenectomy while 56 (5.3%) underwent SAE. There were significant differences regarding injury mechanism ( P = .01) and the proportion of patients with an AIS of 5 (57.6% vs 39.3% respectively, P = .01). A significantly higher number of patients, however, developed organ space infections (3.9% vs 11.6%, P = .02) in Group 2. The multivariate logistic regression model for mortality, which accounted for demography, Glasgow Coma Scale Motor (GCSM) score, Injury Severity Score (ISS), AIS, time to procedure, and procedure type showed the procedure type was not a contributing factor to patient mortality, but higher age, ISS, and lower GCSM score were strong predictors of mortality. Conclusion The treatment of approximately 95% of hypotensive patients with massive splenic injury was total splenectomy. However, if the interventional radiology resources are immediately available, SAE can be used as a first intervention without an increased risk of mortality.
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Jaiswal, Kishor S., Douglas Bausch, Rui Chen, Jawhar Bouabid, and Hope Seligson. "Estimating Annualized Earthquake Losses for the Conterminous United States." Earthquake Spectra 31, no. 1_suppl (December 2015): S221—S243. http://dx.doi.org/10.1193/010915eqs005m.
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We make use of the most recent National Seismic Hazard Maps (the years 2008 and 2014 cycles), updated Census data on population, and economic exposure estimates of general building stock to quantify annualized earthquake loss (AEL) for the conterminous United States. The AEL analyses were performed using the Federal Emergency Management Agency's Hazus software, which facilitated a systematic comparison of the influence of the 2014 National Seismic Hazard Maps in terms of annualized loss estimates in different parts of the country. The losses from an individual earthquake could easily exceed many tens of billions of dollars, and the long-term averaged value of losses from all earthquakes within the conterminous United States has been estimated to be a few billion dollars per year. This study estimated nationwide losses to be approximately $4.5 billion per year (in 2012 dollars), roughly 80%of which can be attributed to the states of California, Oregon, and Washington. We document the change in estimated AELs arising solely from the change in the assumed hazard map. The change from the 2008 map to the 2014 map results in a 10% to 20% reduction in AELs for the highly seismic states of the Western United States, whereas the reduction is even more significant for the Central and Eastern United States.
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Jaffe, BS (Accounting), JD, James L. "Teaching emergency management students about money: “Without money you ain't doin bupkis”." Journal of Emergency Management 17, no. 3 (May 1, 2019): 181–98. http://dx.doi.org/10.5055/jem.2019.0417.
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The objective of this article is to address the glaring deficiency in educating emergency managers with regard to the financial aspects of Emergency Management (EM) and suggest curriculum changes. This article reviews 313 Higher Education Programs in EM located in 189 institutions of higher education in the United States to determine which include courses in the financial aspects of EM. The programs reviewed range from undergraduate certificates to PhD Degrees in EM. Of the 313 EM programs, only 78 [24.8 percent] have any courses discussing accounting, budgeting, economics, or finance either as a required or restricted elective course. Only nine [2.9 percent] courses focus on the financial issues of EM. Based upon the data reported, the author suggests changes in EM education as a starting point in the necessary discussion of what an EM educational program should cover.
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O’Brien, Daniel J., Donald W. Walsh, Colleen M. Terriff, and Alan H. Hall. "Empiric Management of Cyanide Toxicity Associated with Smoke Inhalation." Prehospital and Disaster Medicine 26, no. 5 (October 2011): 374–82. http://dx.doi.org/10.1017/s1049023x11006625.
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AbstractEnclosed-space smoke inhalation is the fifth most common cause of all unintentional injury deaths in the United States. Increasingly, cyanide has been recognized as a significant toxicant in many cases of smoke inhalation. However, it cannot be emergently verified. Failure to recognize the possibility of cyanide toxicity may result in inadequate treatment. Findings suggestive cyanide toxicity include: (1) a history of an enclosed-space fire scene in which smoke inhalation was likely; (2) the presence of oropharyngeal soot or carbonaceous expectorations; (3) any alteration of the level of consciousness, and particularly, otherwise inexplicable hypotension (systolic blood pressure ≤90 mmHg in adults). Prehospital studies have demonstrated the feasibility and safety of empiric treatment with hydroxocobalamin for patients with suspected smoke inhalation cyanide toxicity. Although United States Food and Drug Administration (FDA)-approved since 2006, the lack of efficacy data has stymied the routine use of this potentially lifesaving antidote. Based on a literature review and on-site observation of the Paris Fire Brigade, emergency management protocols to guide empiric and early hydroxocobalamin administration in smoke inhalation victims with high-risk presentations are proposed.
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Xu, H. Daniel, and Rashmita Basu. "How the United States Flunked the COVID-19 Test: Some Observations and Several Lessons." American Review of Public Administration 50, no. 6-7 (July 15, 2020): 568–76. http://dx.doi.org/10.1177/0275074020941701.
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The unprecedented COVID-19 pandemic has already caused enormous economic and human life losses in the United States and it is still ravaging the country. In this article, the authors argue that the pandemic has exposed key issues of concern in several areas of the American government system ranging from federalist intergovernmental relations to public health system and to health care policy. These issues of concern include the strained federal-state relations in emergency management, inadequate data collection and data reporting for disease surveillance and control, politicization and diminished role of science and evidence in administrative decision making, and underinvestment in public health programs especially in minority health. Based on their analysis, the authors admonish that it is critically important for the U.S. government to learn from the failed response to the pandemic and offer several recommendations for improving its response to future public health emergencies and research in public administration.
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Horney, PhD, MPH, Jennifer A., Mai Nguyen, PhD, John Cooper, PhD, Matt Simon, MA, Kristen Ricchetti-Masterson, MSPH, Shannon Grabich, MS, David Salvesen, PhD, and Philip Berke, PhD. "Accounting for vulnerable populations in rural hazard mitigation plans: Results of a survey of emergency managers." Journal of Emergency Management 11, no. 3 (February 16, 2017): 201. http://dx.doi.org/10.5055/jem.2013.0138.
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Rural areas of the United States are uniquely vulnerable to the impacts of natural disasters. One possible way to mitigate vulnerability to disasters in rural communities is to have a high-quality hazard mitigation plan in place. To understand the resources available for hazard mitigation planning and determine how well hazard mitigation plans in rural counties meet the needs of vulnerable populations, we surveyed the lead planning or emergency management official responsible for hazard mitigation plans in 96 rural counties in eight states in the Southeastern United States. In most counties, emergency management was responsible for implementing the county’s hazard mitigation plan and the majority of counties had experienced a presidentially declared disaster in the last 5 years. Our research findings demonstrated that there were differences in subjective measures of vulnerability (as reported by survey respondents) and objective measures of vulnerability (as determined by US Census data). In addition, although few counties surveyed included outreach to vulnerable groups as a part of their hazard mitigation planning process, a majority felt that their hazard mitigation plan addressed the needs of vulnerable populations “well” or “very well.” These differences could result in increased vulnerabilities in rural areas, particularlyfor certain vulnerable groups.
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Cross, Rachael N., and Daphne S. LaDue. "When Uncertainty is Certain: A Nuanced Trust between Emergency Managers and Forecast Information in the Southeastern United States." Weather, Climate, and Society 13, no. 1 (January 2021): 137–46. http://dx.doi.org/10.1175/wcas-d-20-0017.1.
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AbstractWeather forecasting is not an exact science, and, in regions near the southern end of the Appalachian Mountains, the vastly different types of topography and frequency of rapidly forming storms can result in high uncertainty in severe weather forecasts. NOAA created its VORTEX-Southeast (SE) research program to tackle these unique challenges and integrate them with social science research to increase the survivability of southeastern U.S. weather. As part of VORTEX-SE, this study focused on the severe weather preparation and decision-making of emergency management and, in particular, how uncertainty in severe weather forecasts impacted the relationship between emergency managers (EMs) and weather providers. We conducted in-depth, critical incident background interviews with 35 emergency management personnel across 14 counties. An inductive, data-driven analysis approach revealed several factors contributing to an added layer of practical uncertainty beyond the meteorological forecast uncertainty that impacted and helped to explain the nature of trust in the EM–National Weather Service (NWS) relationship. No- or short-notice events, null events, gaps in information, and differences in perspectives when compared with weather forecasters have led emergency managers to modify their procedures in ways that position them to adapt quickly to unexpected changes in the forecast. The need to do so creates a complex, nuanced trust between these groups. This paper explains how EMs developed a nuanced trust of forecast information, how that trust is a recognition of the inherent uncertainty in severe weather forecasts, and how to strengthen the NWS–EM relationship.
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Alvarez, Al'ai, Anne Messman, Melissa Platt, Megan Healy, Elaine Josephson, Shawn London, and Douglas Char. "The Impact of Due Process and Disruptions on Emergency Medicine Education in the United States." WestJEM 21.2 March Issue 21, no. 2 (January 27, 2020): 423–28. http://dx.doi.org/10.5811/westjem.2019.10.42800.
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Introduction: Academic Emergency Medicine (EM) departments are not immune to natural disasters, economic or political forces that disrupt a training program’s operations and educational mission. Due process concerns are closely intertwined with the challenges that program disruption brings. Due process is a protection whereby an individual will not lose rights without access to a fair procedural process. Effects of natural disasters similarly create disruptions in the physical structure of training programs that at times have led to the displacement of faculty and trainees. Variation exists in the implementation of transitions amongst training sites across the country, and its impact on residency programs, faculty, residents and medical students. Methods: We reviewed the available literature regarding due process in emergency medicine. We also reviewed recent examples of training programs that underwent disruptions. We used this data to create a set of best practices regarding the handling of disruptions and due process in academic EM. Results: Despite recommendations from organized medicine, there is currently no standard to protect due process rights for faculty in emergency medicine training programs. Especially at times of disruption, the due process rights of the faculty become relevant, as the multiple parties involved in a transition work together to protect the best interests of the faculty, program, residents and students. Amongst training sites across the country, there exist variations in the scope and impact of due process on residency programs, faculty, residents and medical students. Conclusion: We report on the current climate of due process for training programs, individual faculty, residents and medical students that may be affected by disruptions in management. We outline recommendations that hospitals, training programs, institutions and academic societies can implement to enhance due process and ensure the educational mission of a residency program is given due consideration during times of transition.
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op den Buijs, Jorn, Marten Pijl, and Andreas Landgraf. "Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States." JMIR Medical Informatics 9, no. 3 (March 8, 2021): e25121. http://dx.doi.org/10.2196/25121.
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Background Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. Objective The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. Methods Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. Results German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. Conclusions Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.
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Tang, Liyaning, Logan Griffith, Matt Stevens, and Mary Hardie. "Social media analytics in the construction industry comparison study between China and the United States." Engineering, Construction and Architectural Management 27, no. 8 (June 18, 2020): 1877–89. http://dx.doi.org/10.1108/ecam-12-2019-0717.
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PurposeThe purpose of this paper is to discover similarities and differences in the construction industry in China and the United States by using data analytic tools on data crawled from social media platforms.Design/methodology/approachThe method comprised comprehensive data analytics using network link analysis and natural language processing tools to discover similarities and differences of social networks, topics of interests and sentiments and emotions on different social media platforms.FindingsFrom the research, it showed that all clusters (construction company, construction worker, construction media and construction union) shared similar trends on follower-following ratios and sentiment analysis in both social media platforms. The biggest difference between the two countries is that public accounts (e.g. company, media and union) on Twitter posted more on public interests, including safety and energy.Research limitations/implicationsThe research contributes to knowledge about an alternative method of data collection for both academia and industry practitioners. Statistical bias can be introduced by only using social media platform data. The analyzed four clusters can be further divided to reflect more fine-grained groups of construction industries. The results can be integrated into other analyses based on traditional methodologies of data collection such as questionnaire surveys or interviews.Originality/valueThe research provides a comparative study of the construction industries in China and the USA among four clusters using social media platform data.
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Surovtsev, A. S., I. A. Awtzinov, Y. A. Turovsky, and S. V. Borzunov. "Model for improving the reliability of safety systems in the technological processing of hazardous industries." Proceedings of the Voronezh State University of Engineering Technologies 80, no. 4 (March 21, 2019): 116–27. http://dx.doi.org/10.20914/2310-1202-2018-4-116-127.
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The problem of safety provisioning in technological processes, which aims the reducing the probability of accidents is considered. Classification of technological process states from the point of view of accident prevention system is offered. The set of such states consists of: normal functioning, pre-emergency, emergency and accident. The state of normal functioning and pre-emergency state assume the absence of irreversible changes in the technological processes. It is considered the case when the operator has to form some management actions which are aimed to stabilize the process, when the process is in the pre-accident state. It is shown an example of a data flow diagram, which includes also the human operator, the tracking system, and the system of manual and automatic control in additional to the standard components of such systems. By using the data flow diagram, it is defined the sequence of stages which occur when the process in transferred from the pre-emergency states to the state of normal operation. A method for assessing the possibility of transferring a technological process from a pre-emergency state to a normal operating in proposed. This method consists in estimating the time relation between the available and the necessary for stabilization of the system. The time required for stabilization consists of the time delay of the measuring device, the latency of the operator and the response time of the actuator. The delay time of the measuring device and the response time of the actuator are determined by the conditions of the technological process. The model for estimating the latency of the person is based on the law “force-time” is developed. A study of the boundary cases of the formula for estimating the available and the necessary time is carried out. Stimulation modelling is conducted, which results are used to estimating the ways of optimizing the technological process in order to improve the reliability of the accident prevention system.
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Kuruvilla, Abey, and Suraj M. Alexander. "Predicting Ambulance Diverson." International Journal of Information Systems in the Service Sector 2, no. 1 (January 2010): 1–10. http://dx.doi.org/10.4018/jisss.2010093001.
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The high utilization level of emergency departments in hospitals across the United States has resulted in the serious and persistent problem of ambulance diversion. This problem is magnified by the cascading effect it has on neighboring hospitals, delays in emergency care, and the potential for patients’ clinical deterioration. We provide a predictive tool that would give advance warning to hospitals of the impending likelihood of diversion. We hope that with a predictive instrument, such as the one described in this article, hospitals can take preventive or mitigating actions. The proposed model, which uses logistic and multinomial regression, is evaluated using real data from the Emergency Management System (EM Systems) and 911 call data from Firstwatch® for the Metropolitan Ambulance Services Trust (MAST) of Kansas City, Missouri. The information in these systems that was significant in predicting diversion includes recent 911 calls, season, day of the week, and time of day. The model illustrates the feasibility of predicting the probability of impending diversion using available information. We strongly recommend that other locations, nationwide and abroad, develop and use similar models for predicting diversion.
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Palmer, Pamela P., Judith A. Walker, Asad E. Patanwala, Carin A. Hagberg, and John A. House. "Cost of Intravenous Analgesia for the Management of Acute Pain in the Emergency Department is Substantial in the United States." Journal of Health Economics and Outcomes Research 5, no. 1 (March 13, 2017): 1–15. http://dx.doi.org/10.36469/9793.
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Background: Pain is a leading cause of admission to the emergency department (ED) and moderate-to-severe acute pain in medically supervised settings is often treated with intravenous (IV) opioids. With novel noninvasive analgesic products in development for this indication, it is important to assess the costs associated with IV administration of opioids. Materials and Methods: A retrospective observational study of data derived from the Premier database was conducted. All ED encounters of adult patients treated with IV opioids during a 2-year time period, who were charged for at least one IV opioid administration in the ED were included. Hospital reported costs were used to estimate the costs to administer IV opioids. Results: Over a 24 month-period, 7.3 million encounters, which included the administration of IV opioids took place in 614 US EDs. The mean cost per encounter of IV administration of an initial dose of the three most frequently prescribed opioids were: morphine $145, hydromorphone $146, and fentanyl $147. The main driver of the total costs is the cost of nursing time and equipment cost to set up and maintain an IV infusion ($140 ± 60). Adding a second dose of opioid, brings the average costs to $151-$154. If costs associated with the management of opioid-related adverse events and IV-related complications are also added, the total costs can amount to $269-$273. Of these 7.3 million encounters, 4.3 million (58%) did not lead to hospital admission of the patient and, therefore, the patient may have only required an IV catheter for opioid administration. Conclusions: IV opioid use in the ED is indicated for moderate-to-severe pain but is associated with significant costs. In subjects who are discharged from the ED and may not have required an IV for reasons other than opioid administration, rapid-onset analgesics for moderate-to-severe pain that do not require IV administration could lead to direct cost reductions and improved care.
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Deng, Hansen, John K. Yue, Ethan A. Winkler, Sanjay S. Dhall, Geoffrey T. Manley, and Phiroz E. Tarapore. "Pediatric firearm-related traumatic brain injury in United States trauma centers." Journal of Neurosurgery: Pediatrics 24, no. 5 (November 2019): 498–508. http://dx.doi.org/10.3171/2019.5.peds19119.
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OBJECTIVEPediatric firearm injury is a leading cause of death and disability in the youth of the United States. The epidemiology of and outcomes following gunshot wounds to the head (GSWHs) are in need of systematic characterization. Here, the authors analyzed pediatric GSWHs from a population-based sample to identify predictors of prolonged hospitalization, morbidity, and death.METHODSAll patients younger than 18 years of age and diagnosed with a GSWH in the National Sample Program (NSP) of the National Trauma Data Bank (NTDB) in 2003–2012 were eligible for inclusion in this study. Variables of interest included injury intent, firearm type, site of incident, age, sex, race, health insurance, geographic region, trauma center level, isolated traumatic brain injury (TBI), hypotension in the emergency department, Glasgow Coma Scale (GCS) score, and Injury Severity Score (ISS). Risk predictors for a prolonged hospital stay, morbidity, and mortality were identified. Odds ratios, mean increases or decreases (B), and 95% confidence intervals were reported. Statistical significance was assessed at α < 0.001 accounting for multiple comparisons.RESULTSIn a weighted sample of 2847 pediatric patients with GSWHs, the mean age was 14.8 ± 3.3 years, 79.2% were male, and 59.0% had severe TBI (GCS score 3–8). The mechanism of assault (63.0%), the handgun as firearm (45.6%), and an injury incurred in a residential area (40.6%) were most common. The mean hospital length of stay was 11.6 ± 14.4 days for the survivors, for whom suicide injuries involved longer hospitalizations (B = 5.9-day increase, 95% CI 3.3–8.6, p < 0.001) relative to those for accidental injuries. Mortality was 45.1% overall but was greater with injury due to suicidal intent (mortality 71.5%, p < 0.001) or caused by a shotgun (mortality 56.5%, p < 0.001). Lower GCS scores, higher ISSs, and emergency room hypotension predicted poorer outcomes. Patients with private insurance had lower mortality odds than those with Medicare/Medicaid (OR 2.4, 95% CI 1.7–3.4, p < 0.001) or government insurance (OR 3.6, 95% CI 2.2–5.8, p < 0.001). Management at level II centers, compared to level I, was associated with lower odds of returning home (OR 0.3, 95% CI 0.2–0.5, p < 0.001).CONCLUSIONSFrom 2003 to 2012, with regard to pediatric TBI hospitalizations due to GSWHs, their proportion remained stable, those caused by accidental injuries decreased, and those attributable to suicide increased. Overall mortality was 45%. Hypotension, cranial and overall injury severity, and suicidal intent were associated with poor prognoses. Patients treated at level II trauma centers had lower odds of being discharged home. Given the spectrum of risk factors that predispose children to GSWHs, emphasis on screening, parental education, and standardization of critical care management is needed to improve outcomes.
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Zhang, Xingyu, Joyce Kim, Rachel E. Patzer, Stephen R. Pitts, Aaron Patzer, and Justin D. Schrager. "Prediction of Emergency Department Hospital Admission Based on Natural Language Processing and Neural Networks." Methods of Information in Medicine 56, no. 05 (2017): 377–89. http://dx.doi.org/10.3414/me17-01-0024.
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SummaryObjective: To describe and compare logistic regression and neural network modeling strategies to predict hospital admission or transfer following initial presentation to Emergency Department (ED) triage with and without the addition of natural language processing elements.Methods: Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a cross-sectional probability sample of United States EDs from 2012 and 2013 survey years, we developed several predictive models with the outcome being admission to the hospital or transfer vs. discharge home. We included patient characteristics immediately available after the patient has presented to the ED and undergone a triage process. We used this information to construct logistic regression (LR) and multilayer neural network models (MLNN) which included natural language processing (NLP) and principal component analysis from the patient’s reason for visit. Ten-fold cross validation was used to test the predictive capacity of each model and receiver operating curves (AUC) were then calculated for each model.Results: Of the 47,200 ED visits from 642 hospitals, 6,335 (13.42%) resulted in hospital admission (or transfer). A total of 48 principal components were extracted by NLP from the reason for visit fields, which explained 75% of the overall variance for hospitalization. In the model including only structured variables, the AUC was 0.824 (95% CI 0.818-0.830) for logistic regression and 0.823 (95% CI 0.817-0.829) for MLNN. Models including only free-text information generated AUC of 0.742 (95% CI 0.7310.753) for logistic regression and 0.753 (95% CI 0.742-0.764) for MLNN. When both structured variables and free text variables were included, the AUC reached 0.846 (95% CI 0.839-0.853) for logistic regression and 0.844 (95% CI 0.836-0.852) for MLNN.Conclusions: The predictive accuracy of hospital admission or transfer for patients who presented to ED triage overall was good, and was improved with the inclusion of free text data from a patient’s reason for visit regardless of modeling approach. Natural language processing and neural networks that incorporate patient-reported outcome free text may increase predictive accuracy for hospital admission.
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Jensen, PhD, Jessica, and John Carr, MS. "Predisaster integration of Community Emergency Response Teams." Journal of Emergency Management 13, no. 1 (February 25, 2016): 25. http://dx.doi.org/10.5055/jem.2015.0215.
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Objective: The Community Emergency Response Team (CERT) program has been increasingly used within local emergency management systems since the United States’ Federal Emergency Management Agency (FEMA) adopted and began promoting the program in 1993. The objective of this study was to explore the integration of CERT programs within local emergency management systems predisaster.Design: Qualitative, semi-structured telephone interviews were used to collect data from a purposive sample of CERT program coordinators.Setting: Telephone interviews were conducted with CERT program coordinators in FEMA Region VII (Iowa, Kansas, Missouri, and Nebraska).Subjects, participants: Twenty-five local county emergency managers participated in this study.Results: This study found that the integration of CERTs varied significantly. The extent to which most teams were integrated allowed them to be placed along an integration continuum and classified as one of three types including Least Integrated, Somewhat Integrated, and Highly Integrated. Other team characteristics seemed to covary with the team integration. A phenomenon of team Piggy Backing—where the integration of the team was no longer relevant—was also found. Conclusions: This study concludes by making a key recommendation that could benefit any CERT—add a module to the CERT training curriculum designed to integrate the individuals associated with the CERT program within their local emergency management system.
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Tupan, Tupan, and Kamaludin Kamaludin. "PUBLICATION OF RESEARCH DATA MANAGEMENT IN OPEN ACCESS JOURNAL ANALYSIS BASED ON SCOPUS DATA." BACA: JURNAL DOKUMENTASI DAN INFORMASI 41, no. 2 (December 11, 2020): 215. http://dx.doi.org/10.14203/j.baca.v41i2.701.
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The study aims to determine: (1) the number of open access resources for research data management publications indexed by Scopus, including the year of publication, source of publication, authors, institutions, countries, types of documents and funding agencies; (2) mapping research data management based on keywords. The results of the study showed that the number of open access resources for research data management publications has started since 1981 and the number has continued to increase starting in 2014 and the highest number occurred in 2019, namely 49 publications. The most publicized journals that open access to research data management was the Data Science Journal, which was 11 publications. The most productive author of conducting research data management publications was Cox, A.M. and Pinfield, S. The largest institutions contributing to the publication of open access research data management were the University of Toronto and New York University. The countries that contributed the most were the United States with 50 publications, then China with 38 publications. The most open access research data management in the form of articles as many as 107 and 37 conference paper publications. The institutions that provided the most funding sponsors were the Deutsche Forschungsgemeinschaft and the National Science Foundation. The results of keyword mapping with VOSViewer showed that big data, research data management, information management, data management, medical research topics, software, information processing, and metadata were the most researched topics.
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Tang, Sherry, Priyanka Patel, Jagdish Khubchandani, and George T. Grossberg. "The Psychogeriatric Patient in the Emergency Room: Focus on Management and Disposition." ISRN Psychiatry 2014 (March 10, 2014): 1–5. http://dx.doi.org/10.1155/2014/413572.
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Background. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. Methods. Data was collected on patients 65 years of age or older arriving at the ER of a large urban hospital in the USA (January 2009–December 2010). Results. Of the total subjects (n=95) included in the study, majority were females (66.3%) with an average age of 75.5 years. The chief complaint for psychogeriatric patients coming to the ER was delirium (61.6%). Caucasians were significantly more likely than African-American patients to get a psychiatric consult (33% versus 9%). Patients with delirium were less likely than patients with other psychiatric complaints to get a psychiatric consult in the ER (1.2% versus 47.2%) and less likely to be referred to a psychiatric inpatient unit compared to patients with other psychiatric complaints (2.4% versus 16.7%). Conclusion. Even though delirium is the most common reason for ER visits among psychogeriatric patients, very few delirium patients got a psychiatric consultation in the ER. A well-equipped geriatric psychiatry unit can manage delirium and associated causes.
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Emrich, Christopher T., and Susan L. Cutter. "Social Vulnerability to Climate-Sensitive Hazards in the Southern United States." Weather, Climate, and Society 3, no. 3 (July 1, 2011): 193–208. http://dx.doi.org/10.1175/2011wcas1092.1.
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Abstract The southern United States is no stranger to hazard and disaster events. Intense hurricanes, drought, flooding, and other climate-sensitive hazards are commonplace and have outnumbered similar events in other areas of the United States annually in both scale and magnitude by a ratio of almost 4:1 during the past 10 years. While losses from climate-sensitive hazards are forecast to increase in the coming years, not all of the populations residing within these hazard zones have the same capacity to prepare for, respond to, cope with, and rebound from disaster events. The identification of these vulnerable populations and their location relative to zones of known or probably future hazard exposure is necessary for the development and implementation of effective adaptation, mitigation, and emergency management strategies. This paper provides an approach to regional assessments of hazards vulnerability by describing and integrating hazard zone information on four climate-sensitive hazards with socioeconomic and demographic data to create an index showing both the areal extent of hazard exposure and social vulnerability for the southern United States. When examined together, these maps provide an assessment of the likely spatial impacts of these climate-sensitive hazards and their variability. The identification of hotspots—counties with elevated exposures and elevated social vulnerability—highlights the distribution of the most at risk counties and the driving factors behind them. Results provide the evidentiary basis for developing targeted strategic initiatives for disaster risk reduction including preparedness for response and recovery and longer-term adaptation in those most vulnerable and highly impacted areas.
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Bundy, PhD, Sarah J. "A course in disaster mitigation." Journal of Emergency Management 14, no. 1 (January 1, 2016): 55. http://dx.doi.org/10.5055/jem.2016.0272.
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While endeavors are underway within the emergency management discipline to develop a unique body of foundational knowledge, widespread acknowledgement and agreement within the emergency management scholarly community of the existence of theoretical foundations and the consistent incorporation of these elements into emergency management research and teaching are still lacking. This article offers an outline of a US-based undergraduate course in mitigation theory and practice that is based on a synthesis of the academic literature related to disaster mitigation as a means to advance the discourse on foundational knowledge and curriculum development. The course outline proposes a set of concepts, theories, propositions, and empirical data that would arguably be fundamental for students in gaining a comprehensive understanding of mitigation in the United States and suggests how that information can be organized and presented in a meaningful way.
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Lattanzio, BSE, Mario, and Danny Peterson, PhD, CEM. "EOC preparedness: Are we ready?" Journal of Emergency Management 3, no. 6 (November 1, 2005): 50. http://dx.doi.org/10.5055/jem.2005.0065.
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Emergency operations centers (EOCs) are extremely important facilities for responding to and recovering from various disasters. With the dramatic increase of available technology, EOC operations have evolved well beyond the days of dial telephones and paper messaging. The question addressed in this study is whether we are doing enough to ensure that this critically important emergency-management (EM) function is operating at peak performance. A survey was used to collect data from EM agencies across the United States. Based on the results of this survey, the authors concluded that designing and developing an EOC simulator might enhance US preparedness efforts.
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Song, Michael, Haili Zhang, and Jinjin Heng. "Creating Sustainable Innovativeness through Big Data and Big Data Analytics Capability: From the Perspective of the Information Processing Theory." Sustainability 12, no. 5 (March 5, 2020): 1984. http://dx.doi.org/10.3390/su12051984.
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Service innovativeness is a key sustainable competitive advantage that increases sustainability of enterprise development. Literature suggests that big data and big data analytics capability (BDAC) enhance sustainable performance. Yet, no studies have examined how big data and BDAC affect service innovativeness. To fill this research gap, based on the information processing theory (IPT), we examine how fits and misfits between big data and BDAC affect service innovativeness. To increase cross-national generalizability of the study results, we collected data from 1403 new service development (NSD) projects in the United States, China and Singapore. Dummy regression method was used to test the model. The results indicate that for all three countries, high big data and high BDAC has the greatest effect on sustainable innovativeness. In China, fits are always better than misfits for creating sustainable innovativeness. In the U.S., high big data is always better for increasing sustainable innovativeness than low big data is. In contrast, in Singapore, high BDAC is always better for enhancing sustainable innovativeness than low BDAC is. This study extends the IPT and enriches cross-national research of big data and BDAC. We conclude the article with suggestions of research limitations and future research directions.
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Houtchens, Bruce A., Terry P. Clemmer, Harry C. Holloway, Alexander A. Kiselev, James S. Logan, Ronald C. Merrell, Arnauld E. Nicogossian, et al. "Telemedicine and International Disaster Response: Medical Consultation to Armenia and Russia Via a Telemedicine Spacebridge." Prehospital and Disaster Medicine 8, no. 1 (March 1993): 57–66. http://dx.doi.org/10.1017/s1049023x00040024.
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AbstractIntroduction:The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa.Methods:During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas.Results:Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47 and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent.Conclusion:These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
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Baugher, T. Auxt, J. Schupp, K. Ellis, J. Remcheck, E. Winzeler, R. Duncan, S. Johnson, et al. "String Blossom Thinner Designed for Variable Tree Forms Increases Crop Load Management Efficiency in Trials in Four United States Peach-growing Regions." HortTechnology 20, no. 2 (April 2010): 409–14. http://dx.doi.org/10.21273/horttech.20.2.409.
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Hand thinning is a necessary and costly management practice in peach (Prunus persica) production. Stone fruit producers are finding it increasingly difficult to find a workforce to manually thin fruit crops, and the cost of farm labor is increasing. A new “hybrid” string thinner prototype designed to adjust crop load in vase or angled tree canopies was evaluated in processing and fresh fruit plantings in varying production systems in four U.S. growing regions in 2009. Data were uniformly collected across regions to determine blossom removal rate, fruit set, labor required for follow-up green fruit hand thinning, fruit size distribution at harvest, yield, and economic impact. String thinner trials with the variable tree forms demonstrated reduced labor costs compared with hand-thinned controls and increased crop value due to a larger distribution of fruit in marketable and higher market value sizes. Blossom removal ranged from 17% to 56%, hand thinning requirement was reduced by 19% to 100%, and fruit yield and size distribution improved in at least one string-thinning treatment per experiment. Net economic impact at optimum tractor and spindle speeds was $462 to $1490 and $264 to $934 per acre for processing and fresh market peaches, respectively. Case study interviews of growers who thinned a total of 154 acres indicated that commercial adoption of string-thinning technology would likely have positive impacts on the work place environment.
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Garcia, Macarena, Nikolay Lipskiy, James Tyson, Roniqua Watkins, E. Stein Esser, and Teresa Kinley. "Centers for Disease Control and Prevention 2019 novel coronavirus disease (COVID-19) information management: addressing national health-care and public health needs for standardized data definitions and codified vocabulary for data exchange." Journal of the American Medical Informatics Association 27, no. 9 (September 1, 2020): 1476–87. http://dx.doi.org/10.1093/jamia/ocaa141.
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Abstract Objective The 2019 novel coronavirus disease (COVID-19) outbreak progressed rapidly from a public health (PH) emergency of international concern (World Health Organization [WHO], 30 January 2020) to a pandemic (WHO, 11 March 2020). The declaration of a national emergency in the United States (13 March 2020) necessitated the addition and modification of terminology related to COVID-19 and development of the disease’s case definition. During this period, the Centers for Disease Control and Prevention (CDC) and standard development organizations released guidance on data standards for reporting COVID-19 clinical encounters, laboratory results, cause-of-death certifications, and other surveillance processes for COVID-19 PH emergency operations. The CDC COVID-19 Information Management Repository was created to address the need for PH and health-care stakeholders at local and national levels to easily obtain access to comprehensive and up-to-date information management resources. Materials and Methods We introduce the clinical and health-care informatics community to the CDC COVID-19 Information Management Repository: a new, national COVID-19 information management tool. We provide a description of COVID-19 informatics resources, including data requirements for COVID-19 data reporting. Results We demonstrate the CDC COVID-19 Information Management Repository’s categorization and management of critical COVID-19 informatics documentation and standards. We also describe COVID-19 data exchange standards, forms, and specifications. Conclusions This information will be valuable to clinical and PH informaticians, epidemiologists, data analysts, standards developers and implementers, and information technology managers involved in the development of COVID-19 situational awareness and response reporting and analytics.
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Milewski, Matthew D., Lanna Feldman, Benton E. Heyworth, Dennis E. Kramer, Patricia E. Miller, Mininder S. Kocher, and Yi-Meng Yen. "INCREASED INCIDENCE OF ACUTE PATELLAR INSTABILITY AND PATELLAR INSTABILITY SURGERY ACROSS THE UNITED STATES IN PEDIATRIC & ADOLESCENT PATIENTS." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (March 1, 2019): 2325967119S0011. http://dx.doi.org/10.1177/2325967119s00110.
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Background: Participation in organized sports has been increasing over the last several decades for pediatric and adolescent athletes in this country. It is hypothesized that the overall incidence of acute patellar dislocation in this population would increase with more sports participation. Newer surgical techniques for patellar stabilization have also become popular and have been adapted for younger populations. The purpose of the current study was to evaluate the trend in the frequency of patellar dislocations treated at pediatric hospitals in the U.S. versus patients receiving surgical intervention for patellar dislocation. Methods: The Pediatric Health Information System (PHIS) database was queried for all patients 18 years or younger who underwent orthopaedic surgery between 2004 and 2014. A cohort of patients treated surgically for patellar dislocation was compared to a cohort of patients seen in the Emergency Department for management of a patellar dislocation. Data sets from 25 of the 48 pediatric hospitals participating in the PHIS initiative reported data consistently for the study time period and were included in the analysis. The rate of patellar dislocation surgeries per 1,000 pediatric orthopedic surgeries was analyzed for the 11-year period. Linear modeling was used to assess sex-based and overall trends. Results: During the study period, there were 447,285 orthopaedic surgeries at 25 institutions, which included 3,481 patellar dislocation procedures, suggesting a rate of 7.8 per 1,000 orthopaedic surgeries. An additional 5,244 patellar dislocations treated in the emergency room were identified. Over the study period, the number of patellar dislocation procedures increased 2.1-fold (95% CI = 1.4-3.0), while all surgeries increased 1.7-fold (95% CI = 1.3-2.0). There was only a 1.2-fold increase in patellar dislocation procedures relative to total pediatric orthopedic procedures. Emergency Department treatment of patellar dislocation increased 2.8-fold. Females yielded similar trends between operative and Emergency Department treatment of patellar instability (2.2-fold and 2.3 –fold, respectively); while males experienced a higher trend in the need for Emergency Department treatment compared to operative treatment (3.0-fold versus 2.0-fold, respectively). Conclusion / Significance: This study shows a significant rise in the rate of acute patellar instability events in pediatric and adolescent patients across the country. Interestingly, surgery for patellar instability increased by only slightly more than the rate of all pediatric orthopaedic procedures. Further research is needed to evaluate the link between increased acute patellar instability and risk for chronic patellar instability along with the potential need for surgical intervention.
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Lad, Shivanand P., Chirag G. Patil, Eleonora Maries Lad, and Maxwell Boakye. "Trends in pathological vertebral fractures in the United States: 1993 to 2004." Journal of Neurosurgery: Spine 7, no. 3 (September 2007): 305–10. http://dx.doi.org/10.3171/spi-07/09/305.
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Object Pathological vertebral fractures (PVFs) are an increasingly important cause of disability and have many clinical and economic implications. The authors examined trends in epidemiology and surgical management of pathological vertebral fractures in the US between 1993 and 2004. Methods The Nationwide Inpatient Sample database was used to analyze data collected from 1993 through 2004 to determine general trends in PVFs. Patients with PVFs were identified using the appropriate International Classification of Diseases, 9th Revision (ICD-9) diagnostic code (ICD-9 733.13). Trends in vertebral augmentation procedures and spinal fusions as well as comparison with incidences of other major pathological fractures, such as hip and upper limb, were also examined. Results In 2004, there were more than 55,000 inpatient admissions for PVFs. The majority of patients admitted were women (78%) in the 65 to 84 year–age group (60%). Medicare accounted for greater than 80% of insurance, and nearly 50% of all patients were admitted from the emergency department. The mean duration of hospitalization has continued to decrease, from 8.1 days in 1993 to 5.4 days in 2004. The mortality rate has remained relatively constant at approximately 1.5%. The discharge disposition has continued to change with an increasing number of patients being discharged to other institutions such as nursing homes and rehabilitation facilities. There was a staggering increase in the number of vertebral augmentation procedures performed between 1993 and 2004. The “national bill” for inpatient hospitalizations for PVFs totaled $1.3 billion in 2004. Conclusions With the continued aging of the population, PVFs represent an important cause of disability and a significant source of healthcare resource utilization.
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Pestian, John, Henry Nasrallah, Pawel Matykiewicz, Aurora Bennett, and Antoon Leenaars. "Suicide Note Classification Using Natural Language Processing: A Content Analysis." Biomedical Informatics Insights 3 (January 2010): BII.S4706. http://dx.doi.org/10.4137/bii.s4706.
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Suicide is the second leading cause of death among 25–34 year olds and the third leading cause of death among 15–25 year olds in the United States. In the Emergency Department, where suicidal patients often present, estimating the risk of repeated attempts is generally left to clinical judgment. This paper presents our second attempt to determine the role of computational algorithms in understanding a suicidal patient's thoughts, as represented by suicide notes. We focus on developing methods of natural language processing that distinguish between genuine and elicited suicide notes. We hypothesize that machine learning algorithms can categorize suicide notes as well as mental health professionals and psychiatric physician trainees do. The data used are comprised of suicide notes from 33 suicide completers and matched to 33 elicited notes from healthy control group members. Eleven mental health professionals and 31 psychiatric trainees were asked to decide if a note was genuine or elicited. Their decisions were compared to nine different machine-learning algorithms. The results indicate that trainees accurately classified notes 49% of the time, mental health professionals accurately classified notes 63% of the time, and the best machine learning algorithm accurately classified the notes 78% of the time. This is an important step in developing an evidence-based predictor of repeated suicide attempts because it shows that natural language processing can aid in distinguishing between classes of suicidal notes.
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Tréguer, Félix. "The Virus of Surveillance: How the covid-19 Pandemic Is Fuelling Technologies of Control." Political Anthropological Research on International Social Sciences 2, no. 1 (July 13, 2021): 16–46. http://dx.doi.org/10.1163/25903276-bja10018.
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Abstract While it is too early to provide a definitive analysis of the impact that the covid-19 health crisis will have on digital state surveillance, this article aims to provide a first assessment. It starts by situating states’ response to the crisis in the longer history of epidemics and their connections to what philosopher Michel Foucault called “regimes of power.” By surveying various surveillance discourses and practices in countries like France, Italy, the United Kingdom, the United States or Israel in the Spring of 2020, the article identifies three key trends magnified by the crisis, namely, the crystallisation of new public-private assemblages in the management of health data, a shift towards health-based justification regimes for legitimising controversial surveillance and urban policing technologies, as well as mounting human rights threats and oversight failures in a context marked by a “state of health emergency”.
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Irvin, Charlene B., and Jenny G. Atas. "Management of Evacuee Surge from a Disaster Area: Solutions to Avoid Non-Emergent, Emergency Department Visits." Prehospital and Disaster Medicine 22, no. 3 (June 2007): 220–23. http://dx.doi.org/10.1017/s1049023x00004702.
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AbstractIntroduction:Many emergency departments (EDs) in the United States experience daily overcrowding, and a rapid influx of evacuees fleeing a disaster area can pose a substantial burden. Some of these evacuees may require ED care. However, others lack an alternative to the ED to address non-emergent medical concerns (prescription refills or outpatient referral).Objective:The objective of this study was to describe a successful multidisciplinary Hurricane Katrina Evacuation Center, explain the services offered, and determine the center's effects on referrals to local EDs.Methods:Data were collected concerning the number of patients utilizing the medical evaluation center and compared to the total number of evacuees to determine the proportion that utilized medical care. The data concerning patients given prescriptions was obtained by the estimation of the two medical directors of the Center, and therefore, is inexact.Results:During the five weeks the center was operational, 631 of 716 evacuees (88%) requested medical evaluation, and >80% of those had prescriptions written. Only four (<1%) patients were transported to local EDs.Conclusion:An evacuee evaluation center provides a convenient non-ED alternative for evacuees to address their non-emergent medical concerns and can be used to ease their transition to a new location.
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Gordon, D. L., and R. A. Cowley. "Educating for the Future of Emergency Medical Services Systems." Prehospital and Disaster Medicine 2, no. 1-4 (1986): 171–74. http://dx.doi.org/10.1017/s1049023x00030739.
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A bachelor's degree in EMS management was the initial course of studies in an academic program designed to prepare people to work in a variety of occupations in EMS.This paper includes a brief history of that program, its purposes, goals and curriculum and the first data on follow up of its graduates.In the United States of America, the Emergency Medical Systems (EMS) act of 1973 stimulated people from a variety of fields and backgrounds to work together to develop and manage emergency systems of care; it also raised the question of how to prepare people to meet the future needs of the system. At that time, and with few exceptions, there was little or no academic involvement directed to the concept of the system of EMS and there was a dearth of persons with predictable knowledge and skills in this area. The apparent need for preparing leadership personnel for EMS became the focus of thinking by the Maryland Institute of Emergency Medical Services Systems (MIEMSS) and the University of Maryland, Baltimore County (UMBC).
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Andress, K., and E. Downey. "(A146) Disaster Patient Tracking – Local, State and Federal Interoperability during a Multi-Hospital Evacuation Exercise." Prehospital and Disaster Medicine 26, S1 (May 2011): s42. http://dx.doi.org/10.1017/s1049023x11001476.
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IntroductionAssociated with hospital evacuation is the need to track multiple patient evacuees from point of origination to final hospital reception. Patient tracking, a component of the hospital emergency operations plan, is vital to patient care; family association, resource management, financial reimbursement, risk management, and repatriation. Tracking strategies and plans can include a variety of vendors, hardware, software, and coordination issues. Hospital evacuee tracking plans and platforms exist at multiple jurisdictional levels but may not be interoperable.MethodsThree patient tracking platforms representing a local, state and federal application were used during a multi-hospital evacuation exercise, initiated in New Orleans, Louisiana, May 2010. Simulated patients were flown and tracked to multiple patient reception centers in the southern United States, including the Federal Coordinating Center in Shreveport, Louisiana, and receiving National Disaster Medical System hospitals. This review summarizes tracking operations, patient data characteristics captured and interoperability at the Shreveport reception location.Results7 New Orleans hospitals entered 51 patients for evacuation into Louisiana's web-based, At-Risk-Registry (ARR) database including 8 patient identifiers each. ARR data was shared with federal and Louisiana Region 7 patient evacuee receivers for flight manifest construction and reception planning. 34 ARR evacuee patients were indicated for the Shreveport, Louisiana, reception site. 34 patients with 6 identifying characteristics were entered from ARR into EMTrack, the local patient tracking system. A C130 arrived with a TRAC2ES manifest of 20 simulated patients with 6 patient data characteristics. The local tracking system was reconfigured for the hardcopy manifest; simulated patients were received at the airport; transported and received at local hospitals.ConclusionsTracking system interoperability may be challenged by tracking technologies, jurisdictional requirements and degree of implementation at the local, state and federal level. Tracking should be standardized based on national recommendations with local systems remaining flexible for just-in-time requirements.
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O’Connor, Jaclyn, and Suprat Saely Wilson. "Intravenous Lipid Emulsion for Management of Systemic Toxic Effects of Drugs." AACN Advanced Critical Care 27, no. 4 (October 1, 2016): 394–404. http://dx.doi.org/10.4037/aacnacc2016570.
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The incidence of toxic effects of drugs leading to emergency department visits has increased in the United States in the past several years. Most of these patients can be adequately managed by supportive care alone. However, pharmacological antidotes may be necessary, particularly in patients with hemodynamic instability. In severe cases refractory to conventional antidote therapy, rescue therapy with intravenous lipid emulsion (ILE) may be necessary. Traditionally, ILE has been used as an antidote of choice in treating toxic effects of local anesthetics. But data continue to emerge on the successful use of ILE to treat overdoses of drugs other than local anesthetics, particularly lipophilic medications. The recommended ILE dose is a 1.5 mL/kg bolus followed by infusion of 15 mL/kg per hour, with repeat dosing permissible for continued hemodynamic instability. Use of ILE should be considered early as a rescue therapy in the settings of lipophilic medication overdoses when cardiovascular compromise or cardiac arrest is present.
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Smith-Miller, Cheryl A., Diane C. Berry, and Cass T. Miller. "The Space Between: Transformative Learning and Type 2 Diabetes Self-Management." Hispanic Health Care International 18, no. 2 (November 26, 2019): 85–97. http://dx.doi.org/10.1177/1540415319888435.
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Introduction: Immigrant populations experience higher type 2 diabetes mellitus (T2DM) prevalence rates and worse health outcomes secondary to T2DM than native-born populations. But as the largest immigrant population in the United States, the experience of T2DM diagnosis and self-management among Spanish-speaking, limited English-language proficient Latinx immigrants remains largely unexamined. This study used semistructured interviews to explore these phenomena among a cohort of 30 recent Latinx immigrants. Method: All aspects of data collection were conducted in Spanish. Quantitative and qualitative data were collected. Data analysis included descriptive statistical procedures. Qualitative data analysis was conducted using a grounded theory approach. Results: Patterns in the data analysis of 30 interviews identified accepting T2DM as a common transitional process that required significant changes in individuals’ self-perspective and ways of being. Accepting T2DM was identified by the participants as a precursor to treatment initiation. And while for most participants this transition period was brief, for some it took months to years. Distinct transitional stages were identified, categorized, and considered within the context of several theoretical orientations and were observed to align with those in transformative learning. Conclusion: Understanding differing responses and processing of a T2DM diagnosis could be leveraged to better support patients’ acceptance and transition into treatment.
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Jeffery, Alvin D., Sharon Hewner, Lisiane Pruinelli, Deborah Lekan, Mikyoung Lee, Grace Gao, Laura Holbrook, and Martha Sylvia. "Risk prediction and segmentation models used in the United States for assessing risk in whole populations: a critical literature review with implications for nurses’ role in population health management." JAMIA Open 2, no. 1 (January 4, 2019): 205–14. http://dx.doi.org/10.1093/jamiaopen/ooy053.
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Abstract Objective We sought to assess the current state of risk prediction and segmentation models (RPSM) that focus on whole populations. Materials Academic literature databases (ie MEDLINE, Embase, Cochrane Library, PROSPERO, and CINAHL), environmental scan, and Google search engine. Methods We conducted a critical review of the literature focused on RPSMs predicting hospitalizations, emergency department visits, or health care costs. Results We identified 35 distinct RPSMs among 37 different journal articles (n = 31), websites (n = 4), and abstracts (n = 2). Most RPSMs (57%) defined their population as health plan enrollees while fewer RPSMs (26%) included an age-defined population (26%) and/or geographic boundary (26%). Most RPSMs (51%) focused on predicting hospital admissions, followed by costs (43%) and emergency department visits (31%), with some models predicting more than one outcome. The most common predictors were age, gender, and diagnostic codes included in 82%, 77%, and 69% of models, respectively. Discussion Our critical review of existing RPSMs has identified a lack of comprehensive models that integrate data from multiple sources for application to whole populations. Highly depending on diagnostic codes to define high-risk populations overlooks the functional, social, and behavioral factors that are of great significance to health. Conclusion More emphasis on including nonbilling data and providing holistic perspectives of individuals is needed in RPSMs. Nursing-generated data could be beneficial in addressing this gap, as they are structured, frequently generated, and tend to focus on key health status elements like functional status and social/behavioral determinants of health.
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Collins, PhD, Matthew Lloyd. "A case study of the law enforcement/emergency medical services response to the Virginia Tech mass casualty incident on April 16, 2007." Journal of Emergency Management 5, no. 5 (September 1, 2007): 17. http://dx.doi.org/10.5055/jem.2007.0020.
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The April 16, 2007, shooting rampage on the Virginia Polytechnic Institute and State University (Virginia Tech) campus, carried out by Seung-Hui Cho, was the worst gun-related massacre in the history of the United States. The purpose of this article is twofold. First, it examines the emergency management literature on interagency communication, collaboration, and coordination as it relates to the Virginia Tech mass casualty incident (MCI). Second, the article presents a single instrumental case study that focuses on the bounded case of the Virginia Tech MCI. Through multiple sources of data collection to include observations, interviews, and document analysis, this study found that 14 law enforcement agencies and 13 emergency medical services agencies responded to the Virginia Tech MCI. With only two exceptions, the law enforcement agencies involved in the response to this MCI responded informally or self-deployed (arrived without being dispatched). However, all of the emergency medical services agencies that responded were formally dispatched. Lessons learned from the emergency management literature review and the case study will be discussed. In conclusion, policy recommendations, which will be generalizable to other rural university campuses and rural organizational settings, will be made.
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Partridge, Robert, Kevin King, and Lawrence Proano. "Medical Support for Emergency Relief Workers After Typhoon Sudal in Yap, Micronesia." Prehospital and Disaster Medicine 21, no. 3 (June 2006): 215–19. http://dx.doi.org/10.1017/s1049023x00003708.
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AbstractIntroduction:On 09 April 2004, Typhoon Sudal struck the Island of Yap in the Federated States of Micronesia (FSM). Over 90% of homes, public utilities, and public property were damaged or destroyed. Nearly 10% of the population was displaced to shelters, and the majority of the population was without drinking water or power. United States disaster workers were deployed to Yap for three months to assist in the recovery and relief efforts.Objective:The objective of this study was to evaluate the acute healthcare needs of the US disaster relief population serving in a remote setting with limited medical resources.Methods:A retrospective chart review of all disaster relief workers presenting to an emergency clinic in Yap during the disaster relief effort from April 2004–July 2004 was performed. Investigators extracted demographic data, chief complaints, medical histories, medical management, disposition, and outcome data from the clinic charts.Results:Together, the 60 disaster workers present on Yap during the relief effort made 163 patient contacts in the disaster emergency clinic. A total of 92% of patient contacts were for minor medical complaints or minor trauma, 13% were for upper-respiratory infections, 9% were for gastrointestinal illness, and 9% were for dermatological problems. Eight percent of visits were for serious medical problems or trauma. Life-threatening illnesses or injuries did not occur.Conclusions:Disaster relief workers on Yap frequently utilized the disaster relief clinic. In general, disaster workers remained healthy during the relief effort in Yap, and most injuries and illnesses were minor. On-site medical providers resulted in rapid care and stabilization, and after treatment, disaster workers were able to return to duty.
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Ehrenman, Gayle. "Rebuilding Iraq." Mechanical Engineering 125, no. 06 (June 1, 2003): 48–51. http://dx.doi.org/10.1115/1.2003-jun-4.
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This article focuses on various engineering efforts required to reconstruct post-war Iraq. The two most crucial infrastructure issues, by all accounts, are water and electricity, and the ability to deliver clean, treated drinking water is largely dependent on the availability of a reliable source of electricity. Thus, from an engineering standpoint, restoring electricity should be the number one priority. Work has already begun to restore the electric, water, and sanitation infrastructure. The first phase of reconstruction, providing emergency supplies of water and humanitarian aid, began even before the war was over. United States Agency for International Development is in the process of tackling the long-term infrastructure needs of Iraq. The organization has issued nine procurement contracts for reconstruction work. SkyLink Air and Logistic Support Inc. has been signed to provide an assessment of civilian airports, collaboration on their repair, and ongoing management of the airports for receiving and processing humanitarian aid and reconstruction material.
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Potashman, Michele H., Chakkarin Burudpakdee, Weiying Wang, Yanyan Zhu, and Kenneth R. Carson. "Clinical and Economic Burden Of Peripheral T-Cell Lymphoma In The United States." Blood 122, no. 21 (November 15, 2013): 2963. http://dx.doi.org/10.1182/blood.v122.21.2963.2963.
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Abstract Background Peripheral T-cell lymphoma (PTCL) is an aggressive and heterogeneous subtype of non-Hodgkin lymphoma (NHL). PTCL has a poor prognosis due to advanced stage at presentation, and generally poor response to standard chemotherapy. According to recent SEER estimates, PTCL accounts for about 4% of all NHL cases in the United States each year. To date, few studies have assessed the clinical and economic burden of PTCL. Methods MarketScan data for commercially insured and Medicare supplemental patients were used to retrospectively identify unique PTCL patients. Patients were identified by ICD-9-CM diagnosis codes between October 1, 2007 and June 30, 2011. The time of first PTCL diagnosis code served as the index date, and a second PTCL diagnosis date was used for confirmation. All patients were required to have at least 6 months of continuous enrollment before and 12 months of continuous enrollment after their index date. Patients were excluded if aged <18 years, date of birth or gender were missing, or if they had received a stem cell transplant (SCT) prior to PTCL diagnosis. The control group includes patients that may have any other malignant (excluding PTCL) or non-malignant condition and are considered to represent an average insured patient population from the payer perspective. The control group was matched based on age, sex, region, plan type, payer type, and length of enrollment. Mean cost per month was measured and annualized to provide average yearly costs. Healthcare costs included hospitalizations, pharmacy services, office visits, emergency room visits, hospice stays, SCT, and other patient-related costs (lab procedures, radiology procedures, blood transfusions, and other ancillary procedures). Results Of 2820 patients with ≥1 PTCL diagnosis, 1000 patients were identified that met all inclusion criteria (mean age 56 years, 58% male), and were matched to the control group. On an average annual basis, PTCL patients were hospitalized more often (0.9 vs 0.1 hospitalizations), and experienced a longer length of stay (6.4 vs 4 days) compared with matched controls. In addition, PTCL patients had a higher utilization of office visits (16.2 vs 4.1 visits), pharmacy services (34.2 vs 11.6 prescriptions), emergency room visits (0.8 vs 0.2 visits), and hospice care (0.6 vs 0.1 stays). PTCL patients also experienced higher comorbidities (mean Charlson Comorbidity Index of 1.72 vs 0.39, as determined at index date). Overall, PTCL patients incurred much higher average annual costs compared with matched patients ($75,934.08 vs $4660.64; Table), driven mainly by hospitalizations (32.2% of overall costs) and pharmacy services (19.6% of overall costs). Conclusions PTCL is associated with high resource utilization rates and high overall costs. The development of efficacious treatments for PTCL may offer better disease management and may reduce the clinical and economic burden of PTCL. Disclosures: Potashman: Millennium: The Takeda Oncology Company: Employment. Burudpakdee:Millennium: The Takeda Oncology Company: Consulting researcher Other. Wang:Millennium: The Takeda Oncology Company: Consulting researcher Other, Research Funding. Zhu:Millennium: The Takeda Oncology Company: Employment. Carson:Millennium: The Takeda Oncology Company: Consultancy, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Celgene: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Spectrum, Inc.: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Kyowa Hakko Kirin Pharma, Inc.: Research Funding.
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Whitman, Robert V., Thalia Anagnos, Charles A. Kircher, Henry J. Lagorio, R. Scott Lawson, and Philip Schneider. "Development of a National Earthquake Loss Estimation Methodology." Earthquake Spectra 13, no. 4 (November 1997): 643–61. http://dx.doi.org/10.1193/1.1585973.
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This paper summarizes the development of a geographic information system (GIS)-based regional loss estimation methodology for the United States funded as part of a four-and-one-half year project by the Federal Emergency Management Agency (FEMA) through the National Institute of Building Sciences (NIBS). The methodology incorporates state-of-the-art approaches for: characterizing earth science hazards, including ground shaking, liquefaction, and landsliding; estimating damage and losses to buildings and lifelines; estimating casualties, shelter requirements and economic losses; and data entry to support loss estimates. The history of the methodology development; the methodology's scope, framework, and limitations; supporting GIS software; potential user applications; and future developments are discussed.