scholarly journals Elevator (Lift) Car Ventilation Design to Mitigate the Risk of Spread of COVID-19

2021 ◽  
Author(s):  
Pravin M. Tipnis ◽  
Vinay G. Vaidya
Keyword(s):  
Viral Load ◽  
Risk Mitigation ◽  
Ventilation System ◽  
Mitigation Strategies ◽  
Acceptable Level ◽  
Forced Ventilation ◽  
Operating Environment ◽  
Cdc Guidelines ◽  
Risk Mitigation Strategies ◽  
To Come

Abstract Recent studies, on the airborne transmission of the SARS-CoV-2 and the new CDC guidelines confirming the aerosol transmission of the virus, make immediate attention to the airflow in elevators imperative. While several versions have been thought of for contactless rides, there is little that has been considered for lessening the anticipated viral load in the elevator car.In this paper, a two-step approach is used. The first is the risk assessment, and the second is the risk mitigation through an improved lift car ventilation design. The risk is assessed by computing the probable viral load during the journey in a lift car. It is seen that the ventilation typically provided as per the minimum permissible requirements by codes is inadequate to handle the current situation.The computations show that one-minute exposure, to a coughing high emitter in the lift car, creates a viral load to dangerous levels well above the possible acceptable level of 10,000 virus copies/m3. To come up with the risk mitigation strategies, the required ventilation in the car was computed. The main recommendation suggests the use of forced ventilation using pressure fans and 3 to 6 air changes per minute depending on the operating environment. Such a design will help us achieve our objective of bringing the density of virus copies in the lift car to an acceptable level. A properly designed ventilation system for the elevator car will benefit in both pandemic situations as well as non-pandemic situations.

scholarly journals Empowering Organisations to Gain From Uncertainty: a Conceptualisation of Antifragility Through Leveraging Organisational Routines in Uncertain Environments

2021 ◽  
Vol 15 (3) ◽  
pp. 23-42
Author(s):  
Albert Munoz ◽  
Mathew Todres ◽  
Laura Rook
Keyword(s):  
Predictive Models ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Operating Environment ◽  
Uncertain Environments ◽  
Disruptive Innovations ◽  
Organisational Routines ◽  
Risk Mitigation Strategies ◽  
Temporal Action ◽  
Regular Patterns

Economic shifts, disruptive innovations, and competitive rivalries continuously reshape the operating environment of organisations. Such uncertainty impacts organisations and raises significant challenges. While many organisations tend to respond to uncertainty by adopting loss minimisation strategies, others see uncertainty as an opportunity to achieve gains. The latter view is exemplified in Taleb’s (2012) concept of ‘antifragility’, a property of systems that gain when exposed to uncertainty. For organisations, the challenge lies in the identification and execution of fundamental artefacts to accomplish work to achieve antifragile outcomes. One such artefact is the organisational routine; repeatable, regular patterns of behaviour and actions that influence performance. This paper conceptualises the intersection between antifragility, uncertainty management, and organisational routines literatures to identify four routine archetypes that can guide actions that contribute to organisational antifragility. Theoretically, this paper identifies how these archetypes arise from the interplay between temporal action (as tendencies towards proactive or reactive action) and risk mitigation strategies (as preference towards redundancies or flexibilities). Developed insights bring forth a foundation for predictive models of performance, and guidance for organisations aiming to thrive, rather than just survive, in uncertain environments. This paper concludes with the identification of further research avenues.

scholarly journals Use of failure modes and effects analysis to mitigate potential risks prior to implementation of an intravenous compounding technology

2021 ◽  
Author(s):  
Agnes Ann Feemster ◽  
Melissa Augustino ◽  
Rosemary Duncan ◽  
Anand Khandoobhai ◽  
Meghan Rowcliffe
Keyword(s):  
Medication Safety ◽  
Failure Modes ◽  
Risk Mitigation ◽  
New Technology ◽  
Hazard Index ◽  
Mitigation Strategies ◽  
Investigational Drug ◽  
Workflow Optimization ◽  
Proactive Approach ◽  
Risk Mitigation Strategies

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The purpose of this study was to identify potential failure points in a new chemotherapy preparation technology and to implement changes that prevent or minimize the consequences of those failures before they occur using the failure modes and effects analysis (FMEA) approach. Methods An FMEA was conducted by a team of medication safety pharmacists, oncology pharmacists and technicians, leadership from informatics, investigational drug, and medication safety services, and representatives from the technology vendor. Failure modes were scored using both Risk Priority Number (RPN) and Risk Hazard Index (RHI) scores. Results The chemotherapy preparation workflow was defined in a 41-step process with 16 failure modes. The RPN and RHI scores were identical for each failure mode because all failure modes were considered detectable. Five failure modes, all attributable to user error, were deemed to pose the highest risk. Mitigation strategies and system changes were identified for 2 failure modes, with subsequent system modifications resulting in reduced risk. Conclusion The FMEA was a useful tool for risk mitigation and workflow optimization prior to implementation of an intravenous compounding technology. The process of conducting this study served as a collaborative and proactive approach to reducing the potential for medication errors upon adoption of new technology into the chemotherapy preparation process.

A Low-Fidelity Stochastic Model of Viral Spread in Aircraft to Assess Risk Mitigation Strategies

2021 ◽  
Author(s):  
Leigh McCue
Keyword(s):  
Large Scale ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Traffic Network ◽  
Computationally Efficient ◽  
Passenger Compartment ◽  
Stochastic Effects ◽  
Viral Spread ◽  
Risk Mitigation Strategies ◽  
Baseline Health

Abstract The purpose of this work is to develop a computationally efficient model of viral spread that can be utilized to better understand influences of stochastic factors on a large-scale system - such as the air traffic network. A particle-based model of passengers and seats aboard a single-cabin 737-800 is developed for use as a demonstration of concept on tracking the propagation of a virus through the aircraft's passenger compartment over multiple flights. The model is sufficiently computationally efficient so as to be viable for Monte Carlo simulation to capture various stochastic effects, such as number of passengers, number of initially sick passengers, seating locations of passengers, and baseline health of each passenger. The computational tool is then exercised in demonstration for assessing risk mitigation of intervention strategies, such as passenger-driven cleaning of seating environments and elimination of middle seating.

scholarly journals Management of Cardiac Implantable Electrical Devices in Patients Undergoing Radiofrequency Ablation for Spine Pain: Physician Survey and Review of Guidelines

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. E335-E342
Author(s):  
Jason Friedrich
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Joint Pain ◽  
Risk Mitigation ◽  
Narrative Review ◽  
Mitigation Strategies ◽  
Web Based ◽  
Electrical Devices ◽  
Risk Mitigation Strategies

Background: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. Objectives: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. Study Design: Web-based provider survey and narrative review. Setting: Multispecialty pain clinic, academic medical center. Methods: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. Results: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. Limitations: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. Conclusions: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. Key words: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain

scholarly journals Restarting elective endoscopy safely amidst an evolving pandemic and the impact of patient perception

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher Nguyen ◽  
Kevin T. Kline ◽  
Shehzad Merwat ◽  
Sheharyar Merwat ◽  
Gurinder Luthra ◽  
...  
Keyword(s):  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Transmission Risk ◽  
Dynamic Monitoring ◽  
Successful Model ◽  
Outpatient Procedures ◽  
Risk Patients ◽  
Risk Mitigation Strategies ◽  
Spread Of Infection ◽  
The Impact

Abstract Background The COVID-19 pandemic has led to disruptions in elective and outpatient procedures. Guidance from the Centers for Medicare and Medicaid Services provided a framework for gradual reopening of outpatient clinical operations. As the infrastructure to restart endoscopy has been more clearly described, patient concerns regarding viral transmission during the procedure have been identified. Moreover, the efficacy of the measures in preventing transmission have not been clearly delineated. Methods We identified patients with pandemic-related procedure cancellations from 3/16/2020 to 4/20/2020. Patients were stratified into tier groups (1–4) by urgency. Procedures were performed using our hospital risk mitigation strategies to minimize transmission risk. Patients who subsequently developed symptoms or tested for COVID-19 were recorded. Results Among patients requiring emergent procedures, 57.14% could be scheduled at their originally intended interval. COVID-19 concerns represented the most common rescheduling barrier. No patients who underwent post-procedure testing were positive for COVID-19. No cases of endoscopy staff transmission were identified. Conclusions Non-COVID-19 related patient care during the pandemic is a challenging process that evolved with the spread of infection, requiring dynamic monitoring and protocol optimization. We describe our successful model for reopening endoscopy suites using a tier-based system for safe reintroduction of elective procedures while minimizing transmission to patients and staff. Important barriers included financial and transmission concerns that need to be addressed to enable the return to pre-pandemic utilization of elective endoscopic procedures.

scholarly journals Corporate Foreign Corrupt Practices and Director Liability

2014 ◽  
Vol 51 (3) ◽  
pp. 555
Author(s):  
Paul Blyschak
Keyword(s):  
Risk Mitigation ◽  
Civil Liability ◽  
Case Law ◽  
Corporate Law ◽  
Mitigation Strategies ◽  
Public Officials ◽  
Risk Mitigation Strategies ◽  
American Case ◽  
Director Liability

This article examines the various forms of potential liability faced by directors in their capacity as such in connection with corrupt practices engaged in by the corporations they serve. Although generally little discussed to date, Canadian directors do face potential civil liability associated with contraventions of the Corruption of Foreign Public Officials Act that are particular to their status as directors of a corporation. This article thus highlights this particular area of corporate law by reviewing both Canadian jurisprudence and American case law to decipher what lessons Canadian directors can learn in the absence of Canadian precedent similarly on point. Several key cases are highlighted and various risk mitigation strategies available to Canadian directors to guard against these potential liabilities are also discussed.

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