The Transitional Medical Model: An innovative methodology for a community's disease outbreak and pandemic preparedness and response plan.

Infectious disease outbreaks, epidemics, and subsequent pandemics are not typical disasters in the sense that they often lack clearly delineated phases. As in any event that is biological in nature, its onset may be gradual with signs and symptoms that are so subtle that they go unrecognized, thus missing opportunities to invoke an early response and implement containment strategies. An infectious disease outbreak-whether caused by a novel virus, a particularly virulent influenza strain, or newly emerging or resistant bacteria with the capability of human-to-human transmission-can quickly degrade a community's healthcare infrastructure in advance of coordinated mitigation, preparation, and response activities. The Transitional Medical Model (TMM) was developed to aid communities with these crucial phases of disaster response as well as to assist with the initial steps within the recovery phase. The TMM is a methodology that provides a crosswalk between the routine operations and activities of a community's public health infrastructure with action steps associated with the mitigation, preparedness, response, and recovery phases of an infectious disease outbreak.

Online integrity monitoring in the protein A step of mAb production processes-increasing reliability and process robustness.

The purification of recombinant proteins and antibodies using large packed-bed columns is a key component in most biotechnology purification processes. Because of its efficiency and established practice in the industry, column chromatography is a state of the art technology with a proven capability for removal of impurities, viral clearance, and process efficiency. In general, the validation and monitoring of chromatographic operations-especially of critical process parameters-is required to ensure robust product quality and compliance with health authority expectations. One key aspect of chromatography that needs to be monitored is the integrity of the packed bed, since this is often critical to achieving sufficient separation of protein species. Identification of potential column integrity issues before they occur is important for both product quality and economic efficiency. In this article, we examine how transition analysis techniques can be utilized to monitor column integrity. A case study on the application of this method during a large scale Protein A capture step in an antibody purification process shows how it can assist with improving process knowledge and increasing the efficiency of manufacturing operations.

New graduate nurses' perception of the workplace: have they experienced bullying?

This study investigated the bullying experience in the workplace of newly licensed registered nurses (RNs). Preventing newly licensed nurses from leaving the profession is important, especially because there is a nursing shortage. Education of staff and administrators provides recognition of negative behaviors in the workplace. Participants in this research study included 135 newly licensed RN's from 5 nursing schools in Northwestern Ohio licensed in years 2007-2010. Quantitative methods and a descriptive design process included chi-square tests and descriptive statistical methods. Bullying workplace behaviors were identified by participants utilizing the survey tool, the Negative Acts Questionnaire-Revised, and a questionnaire on work relationships and bullies recognized in the workplace. Nursing peers, physicians, or a patient's family were the main sources of bullying, and 29.5% had considered leaving the nursing profession. Education of staff is imperative for providing recognition of negative behaviors in the workplace. Bullying occurs in the workplace and is affecting the new graduates' work performance. Retaining newly graduated nurses is the ultimate goal for maintaining RN's in the workforce.

Chromatographic peak alignment using derivative dynamic time warping.

Chromatogram overlays are frequently used to monitor inter-batch performance of bioprocess purification steps. However, the objective analysis of chromatograms is difficult due to peak shifts caused by variable phase durations or unexpected process holds. Furthermore, synchronization of batch process data may also be required prior to performing multivariate analysis techniques. Dynamic time warping was originally developed as a method for spoken word recognition, but shows potential in the objective analysis of time variant signals, such as manufacturing data. In this work we will discuss the application of dynamic time warping with a derivative weighting function to align chromatograms to facilitate process monitoring and fault detection. In addition, we will demonstrate the utility of this method as a preprocessing step for multivariate model development.

Emergency contraception knowledge among nurse practitioner students.

PURPOSE: The purpose of this study was to ascertain the knowledge level of nurse practitioner (NP) students about emergency contraception (EC), and to explore attitudes about EC that may intersect with willingness to prescribe EC. DATA SOURCES: Four hundred and sixty-seven NP students completed a 30-item web-based survey using Vovici survey software. CONCLUSIONS: Students who reported formal content on EC in their program of study showed significantly better mean knowledge scores (t= 5.279, df = 459, p < .001). Gaps in NP students' knowledge of EC mechanisms of action, understanding of indications and contraindications were apparent. Younger students (F(3,457) = 4.994, p < .002), those newer to nursing (F(4,456) = 6.641, p < .0005), and women's health NP students (F(4,445) = 3.488, p < .008), demonstrated significantly better knowledge. Attitudes regarding EC appeared to be tied to the respondent's knowledge about EC. IMPLICATIONS FOR PRACTICE: Knowledge is an important factor in informing NP practice decisions. Clinicians need accurate, evidence-based knowledge to provide health education and counseling to reproductive age women if unintended pregnancies are to be reduced.

An assessment of nurses' knowledge of botulism.

OBJECTIVE: To assess nurses' knowledge of botulism, a Centers for Disease Control Category A bioterrorism agent, one case of which constitutes an emergency. DESIGN: The study utilized survey research. SAMPLE: The cluster sample included 1,414 registered nurses. MEASURE: The survey gathered demographic data and nurses' knowledge of the background, manifestation and management of botulism. RESULTS: The mean percentage of correct answers for the sample was 25.95%, with a standard deviation (SD) of ±19.89%. Only 90 (6.3%) achieved 60% or more correct. Educational preparation, experience, specialty/area of practice and whether nurses had a class in disaster medicine were also examined and although differences were noted, none of these factors accounted for a score of 60% or above. CONCLUSIONS: The results of this study indicate the need for an assessment of the current education nurses receive about botulism.

Considerations for the vertical evacuation of hospitalized patients under emergency conditions.

Hospitals and other healthcare institutions in the twenty-first century face myriad challenges to their survival against a number of threats from many sources. A number of those threats, eg, internal, external, accidental, or intentional, may require the prompt evacuation of both patients and staff Although rare, this possibility is becoming more frequent in the United States. Unfortunately, despite accrediting agencies' mandates, there is a profound paucity of strategic and tactical guidelines in the medical literature. The purpose of this article is to present a strategic methodology for evacuation, particularly emergent evacuation, within the National Incident Command System/Hospital Incident Command System framework and to explore the tactics that should be considered when relocating multiple patients in various degrees of medical compromise.

Single-Breath-Count Test: an important adjunct in the triaging of patients in a mass-casualty incident due to botulism.

Clostridium botulinum toxins, the most poisonous substance known to humankind, are considered to be a [US] Centers for Disease Control and Prevention Category A bioterrorist agent. Despite this concern, little has been published with regard to the tactical aspects of triaging a mass-casualty event involving botulism victims arriving at an emergency department. Because neuromuscular-ventilatory failure is a principal reason for botulism's early morbidity and mortality, using a quick and sensitive test to evaluate this possibility is imperative. The purpose of this article is to propose the adoption of the Single-Breath-Count Test (SBCT). The ease and validity of the use of the SBCT in evaluating complications associated with various neuromuscular disorders make it an attractive adjunct for triage during a mass-casualty incident due to botulism. While education, immune globulin, antitoxin, and invasive airway techniques are well-recognized steps in treating botulism, incorporating a time-honored technique such as the SBCT, will be an important addition to the triage process.

Using an H1N1 vaccination drive-through to introduce healthcare students and their faculty to disaster medicine.

Currently, the H1N1 pandemic does not approach the worst-case scenarios that have been predicted by the Centers for Disease Control and Prevention and the World Health Organization. Nevertheless, its impact, fueled by its predilection for nontraditional victims, assorted governmental miscalculations, and journalistic hyperbole, has led to an environment of both fear and skepticism. In this environment, the healthcare infrastructure must sift through relevant data, set aside political rhetoric, weigh the risk-benefit ratio of health-related mandates and recommendations, interact with diverse agencies and departments, and still attend to the medical, psychological, and educational needs of its patients and the community at large. Despite the challenges presented by the H1N1 pandemic, there is also an opportunity for expanded interdisciplinary education. Recent and past events, here and abroad, have demonstrated that in times of great healthcare need, professional students, through either volunteerism or impressments, have been an important asset in disaster medicine and mass gatherings. The current H1N1 situation affords healthcare educators an opportunity to expose the current generation of students to disaster medicine and management of care for aggregates and populations. This educational motive is reinforced by the students' own altruistic desire to not only volunteer in a pandemic but also to act on the belief that it is their obligation. Therefore, the purpose of this article is to describe the preparedness and response roles of healthcare students and their faculty at a major university during the H1N1 crisis as an introduction to the interdisciplinary approach to disaster medicine and mass gatherings.

The transitional medical model: an innovative methodology for a community's disease outbreak and pandemic preparedness and response plan.

Infectious disease outbreaks, epidemics, and subsequent pandemics are not typical disasters in the sense that they often lack clearly delineated phases. As in any event that is biological in nature, its onset may be gradual with signs and symptoms that are so subtle that they go unrecognized, thus missing opportunities to invoke an early response and implement containment strategies. An infectious disease outbreak-whether caused by a novel virus, a particularly virulent influenza strain, or newly emerging or resistant bacteria with the capability of human-to-human transmission--can quickly degrade a community's healthcare infrastructure in advance of coordinated mitigation, preparation, and response activities. The Transitional Medical Model (TMM) was developed to aid communities with these crucial phases of disaster response as well as to assist with the initial steps within the recovery phase. The TMM is a methodology that provides a crosswalk between the routine operations and activities of a community's public health infrastructure with action steps associated with the mitigation, preparedness, response, and recovery phases of an infectious disease outbreak.

Botulism Questionnaire: a tactical tool for community use in a mass casualty incident.

A botulism-induced mass casualty incident has the potential to severely compromise a community's health-care infrastructure, based upon its lethality, rare occurrence, and duration of symptoms, which require extensive support and care. Although early recognition and treatment with antitoxin or botulism immunoglobulin are essential to the effective management of this type of an incident, the two major challenges in recognition and treatment are the hundreds, if not thousands, of casualties or potential casualties requiring rapid screening and the fact that most clinicians remain ignorant of the management of botulism. The purpose of this article is to present the Botulism Questionnaire, which will assist with the screening of casualties, provide educational and diagnostic cues for clinicians and the lay public, and create a layer of protection for the health-care infrastructure. The applications of this questionnaire in various formats, the numerous points of distribution, and the variety of platforms from which it can be launched will be explored.

An algorithm for the evaluation and management of red, yellow, and green zone patients during a botulism mass casualty incident.

Botulinum toxin is one of the most toxic substances known to humankind. It is one among the six Category A agents in the CDC bioterrorism lexicon. This suggests that, while the possibility of a botulism mass casualty incident (MCI) is remote, its unique acute and long-term ramifications must be addressed and planned for. However, an in-depth knowledge of the disease and its tactical management in the acute MCI phase is inconsistent or superficial among healthcare personnel. Therefore, an algorithm has been developed to assist first receivers with the initial management of multiple probable and potential botulism patients when equipment resources are strained and when expert personnel are not readily available. The algorithm is specifically structured to assist with the identification and management of potential respiratory deterioration of suspected botulism patients.