Critical incident monitoring in paediatric and adult critical care: from reporting to improved patient outcomes?

PURPOSE OF REVIEW: Critical incident reporting alone does not necessarily improve patient safety or even patient outcomes. Substantial improvement has been made by focusing on the further two steps of critical incident monitoring, that is, the analysis of critical incidents and implementation of system changes. The system approach to patient safety had an impact on the view about the patient's role in safety. This review aims to analyse recent advances in the technique of reporting, the analysis of reported incidents, and the implementation of actual system improvements. It also explores how families should be approached about safety issues. RECENT FINDINGS: It is essential to make as many critical incidents as possible known to the intensive care team. Several factors have been shown to increase the reporting rate: anonymity, regular feedback about the errors reported, and the existence of a safety climate. Risk scoring of critical incident reports and root cause analysis may help in the analysis of incidents. Research suggests that patients can be successfully involved in safety. SUMMARY: A persisting high number of reported incidents is anticipated and regarded as continuing good safety culture. However, only the implementation of system changes, based on incident reports, and also involving the expertise of patients and their families, has the potential to improve patient outcome. Hard outcome criteria, such as standardized mortality ratio, have not yet been shown to improve as a result of critical incident monitoring.

Rebirth of a neighborhood: In streetscape design

This study involves one of the eight neighborhoods in the City of Miami named Little Havana. Little Havana, once a flourishing Hispanic community during the 1960s through the 1980s, is now experiencing housing deterioration, economic disinvestment, and increased social needs. ^ Although the City developed a Community Development Plan for the neighborhood addressing the neighborhood problems, needs, and objectives, it failed to address and take advantage of the area's prominent commercial street, Calle Ocho, as a cultural catalyst for the revitalization of the neighborhood. With an urban study and understanding of the area's needs for transit system improvements, program analysis, and a valuable architectural inventory, an intervention project can be developed. The project will capitalize on the area's historical and cultural assets and serve as a step towards altering the area's decline and revitalizing the street and community to recapture the energy present during the early years of the massive Cuban migration. ^

Iowa Autism Council; Priories Moving Iowa Forward, 2013

Department of Education should continue data collection regarding quality educational services for ASD students in Iowa. The council requires adequate data to continue to make sound recommendations on system improvements for Iowa students.

Iowa Autism Council; 2014 Priories Moving Iowa Forward

Department of Education should continue data collection regarding quality educational services for ASD students in Iowa. The council requires adequate data to continue to make sound recommendations on system improvements for Iowa students.

Evaluating Risks of Dam-Reservoir Systems Using Efficient Importance Sampling

The occurrence frequency of failure events serve as critical indexes representing the safety status of dam-reservoir systems. Although overtopping is the most common failure mode with significant consequences, this type of event, in most cases, has a small probability. Estimation of such rare event risks for dam-reservoir systems with crude Monte Carlo (CMC) simulation techniques requires a prohibitively large number of trials, where significant computational resources are required to reach the satisfied estimation results. Otherwise, estimation of the disturbances would not be accurate enough. In order to reduce the computation expenses and improve the risk estimation efficiency, an importance sampling (IS) based simulation approach is proposed in this dissertation to address the overtopping risks of dam-reservoir systems. Deliverables of this study mainly include the following five aspects: 1) the reservoir inflow hydrograph model; 2) the dam-reservoir system operation model; 3) the CMC simulation framework; 4) the IS-based Monte Carlo (ISMC) simulation framework; and 5) the overtopping risk estimation comparison of both CMC and ISMC simulation. In a broader sense, this study meets the following three expectations: 1) to address the natural stochastic characteristics of the dam-reservoir system, such as the reservoir inflow rate; 2) to build up the fundamental CMC and ISMC simulation frameworks of the dam-reservoir system in order to estimate the overtopping risks; and 3) to compare the simulation results and the computational performance in order to demonstrate the ISMC simulation advantages. The estimation results of overtopping probability could be used to guide the future dam safety investigations and studies, and to supplement the conventional analyses in decision making on the dam-reservoir system improvements. At the same time, the proposed methodology of ISMC simulation is reasonably robust and proved to improve the overtopping risk estimation. The more accurate estimation, the smaller variance, and the reduced CPU time, expand the application of Monte Carlo (MC) technique on evaluating rare event risks for infrastructures.

Record of Decision, Council Bluffs Interstate System(I-29, I-80 and I-480) Improvements Project, October 15, 2005

The Federal Highway Administration (FHWA) approves the selection of the Reconstruction of All or Part of the Interstate (Construction Alternative) as the Preferred Alternative to provide improvements to the interstate system in the Omaha/Council Bluffs metropolitan area, extending across the Missouri River on Interstate 80 to east of the Interstate 480 interchange in Omaha, Nebraska. The study considered long-term, broad-based transportation improvements along Interstate I-29 (I-29), I-80, and I-480, including approximately 18 mainline miles of interstate and 14 interchanges (3 system, 11 service), that would add capacity and correct functional issues along the mainline and interchanges and upgrade the I-80 Missouri River Crossing.

Council Bluffs Interstate System (I-29, I-80 and I-480) Improvements Project, February 28, 2005

The Iowa Department of Transportation (Iowa DOT), Nebraska Department of Roads (NDOR), and the Federal Highway Administration (FHWA) are proposing to improve the interstate system around Council Bluffs with improvements extending across the Missouri River on I-80 to east of the I-480 interchange in Omaha, Nebraska, see Figure 1-1. The study considers long-term, broad-based transportation improvements along I-80, I-29, and I-480, including approximately 18 mainline miles of interstate and 14 interchanges (3 system1, 11 service), that would add capacity and correct functional issues along the mainline and interchanges and upgrade the I-80 Missouri River Crossing. These improvements, once implemented, would bring the segments of I-80 and I-29 up to current engineering standards and modernize the roadway to accommodate future traffic needs

Record of Decision Council Bluffs Interstate System (I-29, I-80 and I-480) Improvements Project TIER 1 Environmental Impact Statement Council Bluffs, Iowa to Omaha, Nebraska FHWA-IA- EIS-04-01F Project Number: IM-029-3(62)54—13-78 Submitted Pursuant to 42 USC 4332(2)(c) and 49 USC 303, October 2008

The Federal Highway Administration (FHWA) approves the selection of the Reconstruction of All or Part of the Interstate (Construction Alternative) as the Preferred Alternative to provide improvements to the interstate system in the Omaha/Council Bluffs metropolitan area, extending across the Missouri River on Interstate 80 to east of the Interstate 480 interchange in Omaha, Nebraska. The study considered long-term, broad-based transportation improvements along Interstate I-29 (I-29), I-80, and I-480, including approximately 18 mainline miles of interstate and 14 interchanges (3 system, 11 service), that would add capacity and correct functional issues along the mainline and interchanges and upgrade the I-80 Missouri River Crossing. FHWA also approves the decisions to provide full access between West Broadway and I-29, design the I-80/I-29 overlap section as a dual-divided freeway, and locating the new I-80 Missouri River Bridge north of the existing bridge. Improvements to the interstate system, once implemented, would bring the segments of I-80 and I-29 (see Figure 1) up to current engineering standards and accommodate future traffic needs. This Record of Decision (ROD) concludes Tier 1 of the Council Bluffs Interstate System (CBIS) Improvements Project. Tier 1 included an examination of the area’s transportation needs, a study of alternatives to satisfy them, and broad consideration of potential environmental and social impacts. The Tier 1 evaluation consisted of a sufficient level of engineering and environmental detail to assist decision makers in selecting a preferred transportation strategy. During Tier 1 a Draft EIS (FHWA-IA- EIS-04-01D) was developed which was approved by FHWA, Iowa DOT, and Nebraska Department of Roads (NDOR) in November 2004 with comments accepted through March 15, 2005. The Draft EIS summarized the alternatives that were considered to address the transportation needs around Council Bluffs; identified reconstruction of all or part of the interstate, the “Construction Alternative,” as the Preferred Alternative; identified three system-level decisions that needed to be made at the Tier 1 level; and invited comment on the issues. The Final EIS (FHWA-IA- EIS-04-01F) further documented the Construction Alternative as the Preferred Alternative and identified the recommended decisions for the three system level decisions that needed to be made in Tier 1. This ROD defines the Selected Alternative determined in the Tier 1 studies.

Looking in the wrong place for healthcare improvements: a system dynamics study of an accident and emergency department

Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two significant findings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource deficit to a different patient group.

Performance Analysis and Improvements for the Future Aeronautical Mobile Airport Communications System (AeroMACS)

This thesis deals with the development of the upcoming aeronautical mobile airport communications system (AeroMACS) system. We analyzed the performance of AeroMACS and we investigated potential solutions for enhancing its performance. Since the most critical results correspond to the channel scenario having less diversity1, we tackled this problem investigating potential solutions for increasing the diversity of the system and therefore improving its performance. We accounted different forms of diversity as space diversity and time diversity. More specifically, space (antenna and cooperative) diversity and time diversity are analyzed as countermeasures for the harsh fading conditions that are typical of airport environments. Among the analyzed techniques, two novel concepts are introduced, namely unequal diversity coding and flexible packet level codes. The proposed techniques have been analyzed on a novel airport channel model, derived from a measurement campaign at the airport of Munich (Germany). The introduced techniques largely improve the performance of the conventional AeroMACS link; representing thus appealing solutions for the long term evolution of the system.

Instituto de Sistemas Fotovoltaicos de Concentración concentration photovoltaics hybrid system first year of operation and improvements

A photovoltaic (PV) hybrid system combines PV with other forms of electricity generation, usually a diesel generator. The system presented in this paper uses concentration photovoltaic (CPV) as the main generator in combination with a storage system and the grid, configured as the backup power supply. The load of the system consists of an air conditioning system of an office building. This paper presents the results obtained from the first months of operation of the CPV hybrid system installed at Instituto de Sistemas Fotovoltaicos de Concentración facilities together with exhaustive simulations in order to model the system behaviour and be able to improve the self-consumption ratio. This system represents a first approach to the use of a CPV in office buildings complemented by an existing AC-coupled hybrid system. The contribution of this paper to the analysis of this new system and the existing tools available for its simulation, at least a part of it, can be considered as a starting point for the development of these kinds of systems.

The British system of education: being a complete epitome of the improvements and inventions practised by Joseph Lancaster: to which is added, a Report of the trustees of the Lancaster school at Georgetown, Col.

Mode of access: Internet.

Improvements in education, as it respects the industrious classes of the community: containing among other important particulars, an account of the institution for the education of one thousand poor children, Borough Road, Southwark; and of the new system of education on which it is conducted.

Shoemaker 12885.

Improvements in education; abridged. Containing a complete epitome of the system of education invented and practiced by the author, Joseph Lancaster.

Mode of access: Internet.

Infant education; or remarks on the importance of educating the infant poor, from the age of eighteen months to seven years. With an account of the Spitalfields' Infant School, and the system of instruction there adopted. To which is added, the latest improvements, and a list of schools already established, in England.

Later editions have title: The infant system.