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PubMedDate not supplied

Disaster planning and emergency preparedness: lessons learned.

Following the terrorist attacks of September 11, 2001, the federal response plan was activated immediately, with most efforts focused on helping recovery workers at Ground Zero in New York City. Comprehensive pharmacy services were critical in protecting the health of those potentially exposed to anthrax at U.S. Postal Service facilities and the U.S. Capitol. Responding to anthrax attacks taught many valuable lessons to emergency workers on how to manage a bioterrorist attack. Because of its central place in the life of many American communities, pharmacy is a natural and important ally of public health.

Anthrax Vaccines↗
PubMed1982

Minimum guidelines and requirements for accessible design--Architectural and Transportation Barriers Compliance Board. Final rule.

The Architectural and Transportation Barriers Compliance Board hereby revises its "Minimum Guidelines and Requirements for Accessible Design" (guidelines and requirements). These revisions respond to concerns registered by certain Board members and to issues raised in comments submitted during the rulemaking process. The purpose of the revisions is to make the guidelines and requirements more cost effective and consistent with Federal and nationally recognized standards while still providing ready access and use. The guidelines and requirements, as revised, will provide a basis for consistent and improved accessibility standards to be issued under the Architectural Barriers Act by the General Services Administration, the Department of Housing and Urban Development, the Department of Defense, and the United States Postal Service. For clarity, the guidelines and requirements are published in their entirety with the revisions incorporated.

Architectural Accessibility↗
PubMed1997

Auto-faxing imaging reports to referring physicians.

One of the major service issues within Medical Imaging is delivering reports quickly to referring physicians. As an effort to improve service, Mount Sinai Hospital's Department of Medical Imaging implemented Auto-Fax to distribute imaging reports to physicians instead of the postal service. When a report is transcribed and then verified by the dictating radiologist, the radiology information system will automatically fax the result report to the referring physicians if subscribed to the Auto-Fax service. If not, the report will be printed and mailed out manually. A transmission log is kept recording the requisition number, time, date, fax number, number of pages, and transmission status of all reports faxed. The system will try three times to fax the report. If unsuccessful at all attempts, the report will be printed and sent out by mail. Referring physicians are required to sign an agreement that the receiving parties are responsible to ensure transmitted reports are kept confidential. Over 150 referring physicians have signed on for the service. Initial problems with missing cover pages, missing report pages, and reports not being received by physicians have been resolved. A recent survey of physicians receiving reports by Auto-Fax indicate that the service is very popular and has increased the speed with which transcribed report are received. Suggestions for improvement included faxing reports in batches, at specific times of the day, and directly to personal computers. Challenges reported included photocopying thermal paper faxes and sorting reports (for those offices with shared fax machines).

Diagnostic Imaging↗
PubMed2000

Use of new technology in endourology and laparoscopy by american urologists: internet and postal survey.

OBJECTIVES: To assess the use of new technology by American urologists. METHODS: Using the American Urological Association directory, surveys were sent via the U.S. postal service to 1000 randomly selected American urologists and 3065 urologists who had an Internet address listed in the directory. RESULTS: Responses were received from 601 urologists (415 postal, 186 Internet). Overall, 81% of survey respondents reported performing fewer or the same number of percutaneous procedures as compared with 3 to 4 years ago and 84% reported carrying out more or the same number of ureteroscopic procedures in the treatment of patients with stone disease. Open dismembered pyeloplasty (43%) and Acucise endopyelotomy (42%) were most frequently reported as the preferred treatment for adult patients with symptomatic ureteropelvic junction obstruction. Although 60% of respondents reported that they have taken a laparoscopy course, 67% currently do not perform any laparoscopy in their practice. In addition, only 7% of urologists stated that laparoscopy comprises more than 5% of their practice. When stratified by the number of years in practice, those in practice less than 10 years were more likely than those in practice 10 to 20 years and those in practice longer than 20 years to have performed an endopyelotomy (77%, 60%, and 48%, respectively, P <0.001) and to be currently performing laparoscopy (49%, 36%, and 18%, respectively, P <0.001). CONCLUSIONS: Compared with 3 to 4 years ago, American urologists are performing more ureteroscopy and fewer percutaneous stone procedures. Although most urologists have taken laparoscopy courses, this modality has not been widely incorporated into their practices at present.

Child↗
PubMed2004

Climate for work group creativity and innovation: Norwegian validation of the team climate inventory (TCI).

The present study assessed the psychometric properties and the validity of the Norwegian translation of the Team Climate Inventory (TCI). The TCI is a measure of climate for innovation within groups at work and is based on the four-factor theory of climate for innovation (West, 1990). Cronbach's alpha revealed satisfactory reliabilities and exploratory factor analysis successfully extracted the four original factors as well as a fifth factor that has also been reported in other studies (N = 195 teams from a wide range of professions). Results from confirmatory factor analysis, using a different sample (N = 106 teams from the Norwegian public postal service), suggested that the five-factor solution had the most parsimonious fit. Criterion validity was explored by correlating TCI scores from 92 post offices and 395 postal distribution teams with customer satisfaction scores. Significant positive relationships were found between three of four TCI scales and customer satisfaction.

Consumer Behavior↗
PubMed2000

Internet and postal survey of endourologic practice patterns among American urologists.

PURPOSE: We determine endourological practice patterns among American urologists for the management of distal ureteral calculi, ureteropelvic junction obstruction, staghorn calculi and the use of ureteral stents with extracorporeal shock wave lithotripsy (ESWLdagger). MATERIALS AND METHODS: Surveys were mailed by the United States postal service to 1,000 American urologists selected randomly from the American Urological Association membership roster. The same survey was sent via the Internet to 3,065 American urologists with an electronic mail address listed in the roster. RESULTS: Responses were received from 1,029 urologists (postal 601, Internet 428). Ureteroscopy was the preferred treatment for all distal ureteral calculi less than or equal to 10 mm. Acucisedouble dagger endopyelotomy was the most frequently selected therapy for adults with ureteropelvic junction obstruction (50.3%, 514 of 1,022). Open pyeloplasty was recommended by a significantly greater percentage of urologists in practice longer than 15 years compared with the remaining survey respondents (166 of 485, 34.2% versus 92 of 427, 21.5%). For patients with renal pelvic stones 10, 15 or 20 mm. who are treated with ESWL routine stent placement was preferred by 25.3% (259 of 1,022), 57.1% (584 of 1,022) and 87.1% (888 of 1, 019) of urologists, respectively. Percutaneous nephrolithotomy was preferred for patients with staghorn calculi by 80.5% (828 of 1,028) of survey respondents. CONCLUSIONS: Most urologists follow the American Urological Association practice guidelines for patients with distal ureteral calculi and staghorn stones. There is a significant difference of opinion regarding the use of stents with ESWL. No clear consensus has been reached concerning the management of adults with ureteropelvic junction obstruction. These data may be useful in designing physician education programs and/or future investigations to help define standard treatment practices for urological diseases.

Adult↗
PubMed2000

Evaluation of a workplace brief intervention for excessive alcohol consumption: the workscreen project.

BACKGROUND: The workplace provides a useful setting for early identification and intervention with individuals who have unhealthy lifestyles. The objective was to evaluate the effects of a workplace-based lifestyle intervention (Workscreen) to reduce excessive drinking. METHOD: There were eight Australia Post networks randomly allocated to experimental and control conditions, comprising 67 worksites and 1206 employees. The experimental condition involved a broad spectrum lifestyle campaign, incorporating support from management, employee awareness of health, and brief interventions for high-risk behaviors, including excessive alcohol use. Focus groups identified relevant cultural factors. Changes in workplace culture and employee behavior were assessed 10 months after baseline. Males and females were analyzed separately. RESULTS: Over half of APOST employees participated at each screening point. In the experimental condition 61% of employees overall and 58% of those identified as excessive drinkers in Phase 1 responded to the lifestyle campaign by attending health assessments. Analyses focusing on the organization as a whole did not reveal significant reductions in excessive alcohol consumption among men or women. However, a significant reduction in number of drinks was observed in the experimental condition among women for whom completion of baseline and follow-up could be confirmed (P < 0.001). CONCLUSIONS: The present study indicates that a workplace-based lifestyle campaign can assist self-selected employees in reducing their alcohol consumption. There was a moderately high level of participation among those identified as drinking excessively, which supports our approach of embedding a low-intensity alcohol program within the context of a broader health promotion campaign.

Adolescent↗
PubMed2001

[How are beginning students in surgery selected? Results of a survey of German consultant surgeons].

AIM: After finishing medical school it is getting more and more difficult for medical students to get one of the rare positions in a surgical training program. Only a good career plan and an intelligent strategy for the first steps in surgical life seem to be an advantage for that competition. On the other hand the selection of basic surgical trainees only based on the curriculum vitae and brief interviews may not be satisfying. The aim of this investigation was to answer the following questions: 1. How do consultant surgeons select their basic trainees? 2. How important is the applicant's record and the interview? 3. Which educational and personal criteria are important for the selection? 4. How can medical students improve their chance of getting a position in a surgical training program. METHODS: Using an anonymous and standardized questionnaire 39 chiefs of university departments of surgery and 44 consultant surgeons each from general and local hospitals were interviewed concerning their selection process and criteria required for application in their training program. The candidates were chosen from an official address list (Deutsche Chirurgie 98, Berufsverband der Deutschen Chirurgen). The questionnaire was sent to the candidates by official postal service together with a prepaid return envelope. RESULTS: Twenty-eight chiefs of university departments of surgery (71.8%) and 29 (65.9%) and 20 (45.5%) of the interviewed consultant surgeons in general and local hospitals responded to the 89-item questionnaire. It turned out that the majority of applications were send to the clinics at the applicant's initiation. Personal relationships or networks are important. Position advertisements are not important. 85.1% of the responders are satisfied with their procedure of selection, nevertheless, 43.4% are interested in recruiting markets. In detail, chiefs of surgical departments in university clinics get a mean of 12.3 (5-50) applications for basic surgical training per month, consultant surgeons in general hospitals 6.5 (4-20), those in local hospitals 5.6 (2-10). The completion and the contents of the doctor's thesis, former research efforts, foreign languages, computer knowledge and other qualifications are the most important criteria in the selection process. Reliability, loyalty, physical and psychological stability, organising and planning ability, stamina, sociability and independence are the most valued personal skills. CONCLUSIONS: Despite the satisfaction with the established common selection process, the high rate of participation in our study shows how important this subject is ranked by leading surgeons. It turned out that besides professional qualification, personal skills are a major criterion in the selection of basic surgical trainees.

Clinical Competence↗
PubMed2002

Responding to the threat of bioterrorism: a microbial ecology perspective--the case of anthrax.

Anthrax is a disease of herbivores caused by the gram-positive bacterium Bacillus anthracis. It can affect cattle, sheep, swine, horses and various species of wildlife. The routes for the spread among wildlife are reviewed. There are three kinds of human anthrax--inhalation, cutaneous, and intestinal anthrax--which differ in their routes of infection and outcomes. In the United States, confirmation of cases is made by the isolation of B. anthracis and by biochemical tests. Vaccination is not recommended for the general public; civilians who should be vaccinated include those who, in their work places, come in contact with products potentially contaminated with B. anthracis spores, and people engaged in research or diagnostic activities. After September 11, 2001, there were bioterrorism anthrax attacks in the United States: anthrax-laced letters sent to multiple locations were the source of infectious B. anthracis. The US Postal Service issued recommendations to prevent the danger of hazardous exposure to the bacterium. B. anthracis spores can spread easily and persist for very long times, which makes decontamination of buildings very difficult. Early detection, rapid diagnosis, and well-coordinated public health response are the key to minimizing casualties. The US Government is seeking new ways to deter bioterrorism, including a tighter control of research on infectious agents, even though pathogens such as B. anthracis are widely spread in nature and easy to grow. It is necessary to define the boundary between defensive and offensive biological weapons research. Deterring bioterrorism should not restrict critical scientific research.

Anthrax↗
PubMed1978

Ergonomics in the design and evaluation of a system for "postal video letter coding".

In co-operation with the German Central Post Office for Technological Development, the authors designed and investigated the task of and workplace for "Postal video-letter-coding". Experiments including measures of performance, errors, heart rate, arrhythmia, EMG's, and EOG's were used to experiment with variations in the design of displays, codes, keyboards, shifts and rest pauses. As a result of this work the following recommendations have been made by the authors and accepted by the authorities: An optimal display configuration has been developed with two vertically arranged tv displays. Coding-rules are to be simplified by modifications of the postcode. The usual flat keyboard has been replaced by an inclined and angular keyboard. Night-shifts must be avoided because of the tedious nature of the task. A work-rest-schedule of 50 min work and 10 min rest is proposed. In 1978 the complete work-system-design will be introduced in the standard postal service.

Journal Article↗
PubMed1996

Ergonomic investigation of letter-carrier satchels: part I. Field study.

A field study was conducted to compare four satchels designed for the purposes of manually carrying and delivering mail. The satchels differed primarily in the presence/absence of a waist belt, the number and design of the shoulder strap(s) and the number of pouches. The evaluation consisted of questionnaires and interviews of slightly more than 300 letter carriers employed by the United States Postal Service. The questionnaires focused on 10 main areas of interest; ease of adjustability and handling, comfort, suitability and durability of materials, anthropometric applications, impact on other activities, ease of motion in retrieving mail, ease of motion in carrying the satchel, versatility of use in diverse climates, protection of mail from damage due to rain and snow, and defense against dog attacks. The primary conclusion was that the satchel with two shoulder straps and two pouches, which results in more symmetric loading than the other satchels, is the most desirable of the satchels tested. However, there are problems with the satchel that need to be addressed, such as concerns about the use of the satchel for defense from dog attacks.

Journal Article↗
PubMed1996

Ergonomic investigation of letter-carrier satchels: part II. Biomechanical laboratory study.

A biomechanical investigation of four satchels designed for the purposes of manually carrying and delivering mail was conducted. Twenty United States Postal Service carriers participated in the study. The satchels differed primarily in the presence/absence of a waist belt, the number and design of the shoulder straps, and the number of pouches. The biomechanical analyses were comprised of postural (shoulder and hip) deviation measurements, estimated compressive forces at the L5/S1 joint, soft tissue pressure on the shoulder, spinal torsion during mail retrieval, force distribution between the feet, and an anthropometric evaluation. The results indicated that a satchel with two shoulder straps and two pouches was more desirable than the single-pouch satchels from a biomechanics standpoint.

Journal Article↗
PubMed1991

Sensitivity and specificity of saliva thiocyanate and cotinine for cigarette smoking: a comparison of two collection methods.

Saliva samples returned by mail were compared to duplicates returned by interviewers in terms of the sensitivity and specificity of cotinine and thiocyanate analyses performed on those samples to detect tobacco use. Compared to the samples returned by interviewers, those returned through the mail were slightly lower in specificity but similar in sensitivity. These findings confirm that saliva samples do not deteriorate during transit via the postal service, although substantial questions remain that concern the validity of such samples in the evaluation of cessation programs.

Adolescent↗
PubMed1994

Effect of a monetary incentive on response to a mail survey.

We assessed the effect of a $1 incentive on response to a two-page questionnaire which was sent to 8356 female cosmetologists between 22 and 36 years old. The study population was randomly assigned to one of three groups in which a $1 incentive was enclosed with either the first or second mailing, or with none of the mailings. Ten percent of questionnaires were returned by the postal service because of an incorrect address or death of the addressee and were omitted from response calculations. Of the remaining questionnaires, 79% were completed and returned after up to three mailings. The cumulative response was highest among cosmetologists who received a $1 incentive with the first mailing, (81%; 95% confidence interval (CI), 80 to 82), intermediate among those who received $1 with the second mailing (78%, 95% CI, 77 to 79), and lowest among cosmetologists who received no incentive (74%; 95% CI, 70 to 78). Characteristics of cosmetologists who responded after having received a "41 incentive were similar to those who responded without having received an incentive. The higher costs per response incurred by the use of an incentive must be weighed against the benefit of higher response.

Adult↗
PubMed1998

External quality assessment (EQA) of Belgian clinical laboratories. The telematics paradigm.

Technology that enables communication between information systems has recently become cheaper and more powerful. It is therefore timely to consider the effects of the introduction of such techniques in external quality assessment (EQA) schemes on both users and organizers. Traditionally, results are returned to EQA organizers as hand-written numbers on structured forms. These data are then manually entered into a computer. The process is time-consuming, slow (as it depends on the postal service), prone to error at every transcription stage, and expensive, as clerical staff must be employed to input the data. Computer-to-computer communication allows this process to be improved. A telematics system for electronic data interchange has been developed for the Belgian EQA programme and it offers several advantages, such as the use of standardized semantics, expression of results in laboratory familiar units, possible interface with the Laboratory Information System, faster data analysis, shorter report time and long-term performance evaluation.

Belgium↗
PubMed1992

Users' perceptions of mail-service pharmacy.

This survey studied the satisfaction of university employees with the mail-service pharmacy option of their major health insurance provider. Nearly 92% reported good or excellent satisfaction with the mail order service. Of the 76.5% who reported receiving drug information brochures with some or all of their prescriptions, 91.5% rated the information excellent or good. When asked what sources they used to get additional information, 31.2% used a mail service pharmacist. These data suggest that mail order pharmacies, which have increased volume 50% per year since 1981, can expect to maintain and expand their market share. All pharmacy sectors should use this information to determine ways to enhance their competitive position.

Consumer Behavior↗
PubMed2002

Current laparoscopic practice patterns in urology: results of a survey among urologists in Germany and Switzerland.

OBJECTIVES: A survey was performed to assess the current practice patterns in laparoscopy among urologists in Germany and Switzerland. METHODS: Using the database directory of the German and Swiss Urological Association urological departments were identified. A detailed questionnaire was designed and sent by postal service. Responding questionnaires were analyzed. RESULTS: The overall response rate was 64%. Fifty-four percent of respondents in Germany and 33% in Switzerland already perform laparoscopy; another 50% and 56% are planning to introduce laparoscopy. Thirty-six percent think that laparoscopy is economical and 77% await shortening of hospital stay. Major concerns are: Economical aspects, lengthy learning curve, investment, and lack of scientific data. The number of laparoscopic procedures during 12 months was registered for 19 indications. More than 40 procedures for one indication are performed by only 6% of the departments. CONCLUSIONS: The survey reveals an increasing number of departments performing laparoscopy and broad acceptance of the technology but combined with some major concerns. Currently only a minority of the departments perform more than 40 procedures for one indication suggesting that at present laparoscopy is mainly a center-based technology.

Data Collection↗
PubMedDate not supplied

On-line learning in changing environments with applications in supervised and unsupervised learning.

An adaptive on-line algorithm extending the learning of learning idea is proposed and theoretically motivated. Relying only on gradient flow information it can be applied to learning continuous functions or distributions, even when no explicit loss function is given and the Hessian is not available. The framework is applied for unsupervised and supervised learning. Its efficiency is demonstrated for drifting and switching non-stationary blind separation tasks of acoustic signals. Furthermore applications to classification (US postal service data set) and time-series prediction in changing environments are presented.

Algorithms↗