Operative Adaptive Systems

2019 ◽  
pp. 92-133
Author(s):  
Louise K. Comfort
Keyword(s):  
Adaptive Systems ◽  
Rate Of Change ◽  
Earthquake Response ◽  
Major Earthquake ◽  
Local Functions ◽  
Recovery System ◽  
Response And Recovery ◽  
Response Systems ◽  
Over Time ◽  
Initial Category

This chapter details the findings and analysis for operative adaptive systems. Four earthquake response and recovery systems included in this study fall in this initial category of operative adaptive systems: the 1999 Duzce, Turkey, earthquake; the 2009 Padang, Indonesia, earthquake; the 2011 Tohoku, Japan, earthquake, tsunami, and nuclear breach; and the 2015 Nepal earthquakes. All four response systems share the characteristic of seeking to adapt rapidly to an environment suddenly altered by a major earthquake. Yet, the capacity of each governmental system to extend the process of adaptation beyond the immediate response into a newly re-stabilized recovery system varied markedly, depending on the scale of the destruction incurred, the scope of reconstruction required, and the rate of change over time needed for recovery. Moreover, while each of these four cases exhibited some capacity in technical and social areas, none had strong midlevel networks that could bridge national and local functions easily.

Emergent Adaptive Systems

2019 ◽  
pp. 134-175
Author(s):  
Louise K. Comfort
Keyword(s):  
Public Policy ◽  
Seismic Risk ◽  
Adaptive Systems ◽  
Organizational Capacity ◽  
Local Communities ◽  
Earthquake Response ◽  
Policy And Practice ◽  
Response Systems ◽  
China Earthquake ◽  
Taiwan Earthquake

This chapter reveals the findings and analysis that characterize emergent adaptive systems. Four earthquake response systems are characterized as emergent adaptive systems: the 1999 Marmara, Turkey, earthquake; the 1999 Chi Chi, Taiwan, earthquake; the 2005 Pakistan earthquake; and the 2008 Wenchuan, China, earthquake. Regarding awareness of seismic risk, scientists and researchers had studied and mapped seismic risk in each case, but this knowledge was not widely transmitted to the local communities in which the earthquakes occurred, nor was it integrated into public policy and practice. Regarding technical infrastructure for communication, each of the four earthquake-affected communities had modest technical infrastructures for communication, but they were not yet widely distributed through the communities. Similarly, in each of the four earthquake response systems, some organizational capacity existed in the communities prior to the events. This capacity allowed responsible actors to mobilize resources to meet immediate needs generated by the earthquakes, but in all four cases, the local capacity was easily overwhelmed by the size, scope, and severity of the events experienced and could not be sustained by the operational system that was generated.

Evolving Patterns of System Response

2019 ◽  
pp. 208-234
Author(s):  
Louise K. Comfort
Keyword(s):  
Information Exchange ◽  
System Response ◽  
Earthquake Response ◽  
External Resources ◽  
Organizational Infrastructure ◽  
Organizational Planning ◽  
Response And Recovery ◽  
Building Community ◽  
Response Systems ◽  
Social Organizational

This chapter provides a comparison across the set of 12 earthquake response systems, examining the degree of integration achieved between their internal capacity to adapt to an altered disaster environment for managing response operations, and their dependence on external resources, knowledge, and skills to implement coherent actions for response and recovery, based on analyses of External/Internal index values. Not surprisingly, the four subsets of earthquake response systems demonstrated capacity for adaptation to varying degrees, but importantly, the variance appeared not to depend on the presence of technical infrastructure alone. Nor did the variance depend on the robustness of the organizational infrastructure of planning and preparedness for a seismic event alone. Rather, the variance appeared to depend on the degree of integration of the technical infrastructure for communication into the organizational plans for seismic risk reduction. This integration of social/organizational planning with the advances of technical communications infrastructure produced a powerful vehicle for expanding communication and information exchange that creates a new pattern of building community resilience to disaster.

scholarly journals Factors associated with professional identity formation within psychiatry residency training: A longitudinal study

2021 ◽  
Author(s):  
Qian Hui Chew ◽  
Yvonne Steinert ◽  
Kang Sim
Keyword(s):  
Professional Identity ◽  
Identity Formation ◽  
Psychiatry Residency ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Developmental Stages ◽  
Rate Of Change ◽  
Psychiatry Residents ◽  
Factors Associated ◽  
Over Time

Abstract Introduction Conceptual frameworks for professional identity (PI) formation highlight the importance of developmental stages and socialization as the learner progresses from legitimate peripheral to full participation. Based on extant literature and clinical impressions, the authors aimed to explore factors associated with PI formation in psychiatry residents over time, and hypothesized that time in training, seniority status, and duration of exposure to psychiatry prior to residency would be associated with PI formation. Methods Eighty out of 96 psychiatry residents (response rate, 83.3%) from the National Psychiatry Residency Program in Singapore participated and rated their PI development using the Professional Self Identity Questionnaire (PSIQ) across four timepoints from January 2016–December 2019. The residents were classified as junior (first 3 years) or senior residents (years 4–5). Linear mixed model analyses were conducted, with time in training, seniority status (junior versus senior residents), duration of psychiatry postings prior to residency, and their interaction as associated factors with PI over time. Results Time in training, seniority, and duration of psychiatry postings before residency (all p < 0.01) were significantly associated with higher PSIQ scores at baseline. Over time, although all residents had increases in PSIQ scores, this rate of change did not differ significantly between junior and senior residents. Discussion Exposure to psychiatry postings before residency, time in learning, and seniority are factors which influence PI development in residents. This has implications for psychiatry residency selection and training, adequate clinical exposure during training rotations, and continual support for new and senior residents to foster PI formation over time.

scholarly journals Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

2021 ◽  
Vol 18 (S1) ◽  
Author(s):  
Martin K. Mutua ◽  
Yohannes D. Wado ◽  
Monica Malata ◽  
Caroline W. Kabiru ◽  
Elsie Akwara ◽  
...  
Keyword(s):  
Family Planning ◽  
West Africa ◽  
Adolescent Girls ◽  
Young Women ◽  
Rate Of Change ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Sexually Active ◽  
Sub Saharan ◽  
Over Time

Abstract Background The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. Methods We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. Results Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique. Conclusion Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach

Circulation ◽  
2021 ◽  
Author(s):  
Charles DeCarlo ◽  
Christopher A. Latz ◽  
Laura T. Boitano ◽  
Young Kim ◽  
Adam Tanious ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Radiographic Progression ◽  
Intramural Hematoma ◽  
Rate Of Change ◽  
Change Over Time ◽  
Modern Approach ◽  
Ulcer Size ◽  
Risk Of Death ◽  
Over Time

Background: Literature detailing the natural history of asymptomatic penetrating aortic ulcers (PAU) is sparse and lacks long-term follow-up. This study sought to determine the rate of asymptomatic PAU growth over time and adverse events from asymptomatic PAU. Methods: A cohort of patients with asymptomatic PAU from 2005-2020 was followed. One ulcer was followed per patient. Primary endpoints were change in size over time and the composite of symptoms, radiographic progression, rupture, and intervention; cumulative incidence function estimated the incidence of the composite outcome. Ulcer size and rate of change were modeled using a linear mixed effects model. Patient and anatomic factors were evaluated as potential predictors of the outcomes. Results: There were 273 patients identified. Mean age was 75.5±9.6 years; 66.4% were male. The majority of ulcers were in the descending thoracic aorta (53.9%), followed by abdominal aorta (41.4%), and aortic arch (4.8%). Fusiform aneurysmal disease was present in 21.6% of patients at a separate location; 2.6% had an associated intramural hematoma; 23.6% had at least one other PAU. Symptoms developed in one patient who ruptured; 8 patients (2.9%) underwent an intervention for PAU (one for rupture, 2 for radiographic progression, 5 for size/growth) at a median of 3.1 years (IQR:1.0-6.5) after diagnosis. Five and 10-year cumulative incidence of the primary outcome, adjusted for competing risk of death, was 3.6% (95% CI: 1.6-6.9%) and 6.5% (95% CI: 3.1-11.4%), respectively. For 191 patients with multiple CT scans (760 total CT's) with median radiographic follow-up of 3.50 years (IQR:1.20-6.63 years), mean initial ulcer width, ulcer depth, and total diameter in millimeters (mm) was 13.6, 8.5, and 31.4, respectively. Small, but statistically significant change over time was observed for ulcer width (0.23 mm/year) and total diameter (0.24 mm/year); ulcer depth did not significantly change over time. Hypertension, hyperlipidemia, diabetes, initial ulcer width>20 mm, thrombosed PAU, and associated saccular aneurysm were associated with larger changes in ulcer size over time, however the magnitude of difference was small, ranging from 0.4-1.9 mm/year. Conclusions: Asymptomatic PAU displayed minimal growth and infrequent complications including rupture. Asymptomatic PAU may be conservatively managed with serial imaging and risk-factor modification.

Risk in Practice

2019 ◽  
pp. 59-75
Author(s):  
Louise K. Comfort
Keyword(s):  
Seismic Risk ◽  
Adaptive Systems ◽  
Path Dependence ◽  
Extreme Event ◽  
Initial Conditions ◽  
Cultural Dimension ◽  
Moderate Degree ◽  
Different Types ◽  
New Ideas ◽  
Response Systems

This chapter examines the four different types of response systems that were identified by degree of adaptation to the problem of seismic risk. Auto-adaptive systems are those that are high on technical infrastructure, high on organizational flexibility, and high on cultural openness to new ideas and strategies of action. Operative adaptive systems are those systems that demonstrate awareness of seismic risk and a moderate degree of professional planning and preparedness to reduce risk of losses. Emergent adaptive systems are those systems that are low on technical structure but show some degree of flexibility in organizational processes and beginning openness to new information and new strategies of action in the cultural dimension. Meanwhile, nonadaptive systems are those systems unable to mobilize effective response operations independently after an extreme event, and virtually all assistance comes from external sources. In practice, initial conditions influenced the formation of response systems following earthquakes in all 12 cases, leading to different types of adaptation. The path dependence that follows from each distinctive set of initial conditions illustrates both the promise and the challenge of shaping communities that are resilient to seismic risk.

Abstract 15416: Longitudinal Assessment of Electrical-Mechanical Interactions in Children and Young Adults With Repaired Tetralogy of Fallot

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Suellen M Yin ◽  
Laura M Mercer-rosa ◽  
Jungwon Min ◽  
Elizabeth Goldmuntz ◽  
Victoria L Vetter
Keyword(s):  
Young Adults ◽  
Sudden Cardiac Death ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Cardiac Death ◽  
Volume Ratio ◽  
Rate Of Change ◽  
Ventricular Ectopy ◽  
Repaired Tetralogy Of Fallot ◽  
Over Time

Introduction: Electrical-mechanical interactions contribute to arrhythmias, sudden cardiac death, and right ventricular remodeling in repaired tetralogy of Fallot (TOF). Hypothesis: There are significant changes in electrocardiographic properties and electrical-mechanical interactions that occur over time after complete TOF repair and with pulmonary valve replacement (PVR). Methods: This retrospective cohort study of 177 patients, initially recruited for a cross-sectional research protocol, underwent complete TOF repair at 0.3±0.9 years with 21.5±4.2 years of clinical follow-up. We assessed ECG, Holter, cardiopulmonary exercise testing (CPET), and MRI data. We used linear mixed effects models to examine QRS duration (QRSd) and its rate of change over time, associations between comparable ECG and MRI, Holter and MRI, ECG and Holter, ECG and CPET, and pre-PVR and post-PVR results. Results: QRSd increased after TOF repair, but the rate of change decreased from 5.2 ms/year 1 year post-operatively to 1.7 ms/year 20 years post-operatively. Twenty years from TOF repair, post-operative arrhythmias included ventricular ectopy: ventricular tachycardia (4 of 20 patients) on Holter and premature ventricular contractions (14 of 19 patients) on CPET. QRSd was positively associated with right ventricular (RV) volumes, RV:left ventricular (LV) end-diastolic volume ratio, and complex ventricular ectopy on Holter; and negatively associated with RV ejection fraction (EF). The association between QRSd and RV volumes was weaker post-PVR. QRSd and its rate of change were associated with increased LV volume post-PVR. Complex ventricular ectopy was associated with lower LV EF, and significant atrial ectopy was associated with higher LV mass-to-volume ratio. Conclusions: Substantial ventricular ectopy occurs in adolescents and young adults after repair of TOF. Electrophysiologic changes included QRSd prolongation that progressively slowed. QRSd and its rate of change were associated with published risk factors for arrhythmia and sudden cardiac death, and with indications for PVR. Our ongoing research aims to identify an optimal threshold of pre-PVR QRSd and its rate of change that preserves bi-ventricular electrical-mechanical coupling post-PVR.

Emergency Management Professional Development

2013 ◽  
pp. 651-665 ◽  
Author(s):  
Marianne Robin Russo
Keyword(s):  
Professional Development ◽  
Emergency Management ◽  
21St Century ◽  
Social Communication ◽  
Information Communication ◽  
Social Communication Skills ◽  
Emergency Personnel ◽  
The Social ◽  
Response And Recovery ◽  
Response Systems

Although there is current research describing technology efforts utilized in the 21st century as it relates to emergency management, there are adult educational factors to examine regarding Information Communication Technology (ICT) and the Social Communication Skills (SCS) of emergency personnel. Technology is quickly evolving and the the population is becoming increasingly more diverse, driving the efforts of emergency personnel to harness more technological emergency advances and navigate the culture of each community to assure effective emergency measures are taken. Within the ICT and SCS framework, emergency management must concern itself with: (a) the basic tenets of emergency management; (b) the changing and new nature of global threats in the 21st century; (c) evolving emergency management technologies; (d) social considerations when interfacing with the communities served; and (e) recommendations for those who are involved in emergency management mitigation, preparation, response, and recovery emergency efforts. All of these factors revolve around the education and re-education of adults; therefore, the focus of this chapter explores subsequent educational implications for the emergency personnel workforce as well as positive results for affected communities. This chapter proposes a larger implication, one of emergency personnel professional development within technology-based response systems as well as the cultivation of social communication in an effort to build a Sense of Community (SOC) with the diverse citizenry they serve. Emergency first responders, as well as other emergency personnel, must be educated in technology and social skills to better serve the community and to become a part of a holistic community. It is in this way that safety, and ultimately social justice, efforts for specific groups who may be marginalized and disenfranchised during an emergency are enhanced.

scholarly journals Net protein contribution of beef feedlots from 2006 to 2017

2019 ◽  
Vol 3 (4) ◽  
pp. 1575-1584 ◽  
Author(s):  
Jessica R Baber ◽  
Jason E Sawyer ◽  
Ben P Holland ◽  
Kendall J Karr ◽  
Alyssa B Word ◽  
...  
Keyword(s):  
Conversion Efficiency ◽  
Protein Quality ◽  
Rate Of Change ◽  
Parameter Estimates ◽  
Protein Requirements ◽  
High Quality Protein ◽  
Cereal Grain ◽  
Net Protein ◽  
Over Time ◽  
Edible Protein

Abstract: Feedlot efficiency increases as technologies are adopted and new feed ingredients, especially byproducts, become available and incorporated into diets. Byproduct availability increased in response to the renewable fuels standard of 2005, creating substantial amounts of feedstuffs best used by ruminants. Cereal grains have been partially replaced with human-inedible byproducts, as they provide comparable levels of energy in cattle diets. To evaluate the effects of changes in diet and feedlot production practices on net protein contribution (NPC) and human-edible protein conversion efficiency (HePCE) across time, a deterministic NPC model was used. NPC was assessed for the feedlot industry using lot level production data from 2006 to 2017 for eight commercial feedlots. Ingredient and nutrient composition was collected for a representative starter and finisher diet fed for each year from each feedlot. NPC was calculated by multiplying human-edible protein (HeP) in beef produced per unit of HeP in feed by the protein quality ratio (PQR). Systems with NPC &gt;1 positively contribute to meeting human protein requirements; NPC &lt; 1 indicates competition with humans for HeP. NPC was regressed on year to evaluate temporal change in NPC. Feedlots were categorized as increasing NPC (INC; slope &gt; 0) or constant NPC (CON; slope = 0) according to regression parameter estimates. Four feedlots were categorized as INC and four were CON. The rate of change in PQR was similar for CON and INC (P ≥ 0.79), although rates of change among INC and CON differed for byproduct and cereal grain inclusion (P ≤ 0.01) across years evaluated. Feedlots categorized as INC reduced HeP consumed by 2.39% per year, but CON feedlots did not reduce HeP consumed each year (0.28%). Cattle received and shipped by INC were lighter than those in CON feedlots (P &lt; 0.01). Across years, INC produced more HeP (20.9 vs. 19.2 kg/hd) than CON (P &lt; 0.01), and both feedlot types tended to improve HeP gained over time (0.1 kg per year; P = 0.10). Differences in slope over time for INC and CON were observed for conversion efficiency of HeP (P &lt; 0.01). NPC increased 0.027 units per year for INC (P &lt; 0.01) and was 0.94 in 2017. NPC by the feedlot sector improved from 2006 to 2017, decreasing the amount of human-edible feeds required to produce more high-quality protein from beef.

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