Pediatric Discharge From the Emergency Department Against Medical Advice

In this Ethics Rounds we present a conflict regarding discharge planning for a febrile infant in the emergency department. The physician believes discharge would be unsafe and would constitute a discharge against medical advice. The child’s mother believes her son has been through an already extensive and painful evaluation and would prefer to monitor her well-appearing son closely at home with a safety plan and a next-day outpatient visit. Commentators assess this case from the perspective of best interest, harm-benefit, conflict management, and nondiscriminatory care principles and prioritize a high-quality informed consent process. They characterize the formalization of discharge against medical advice as problematic. Pediatricians, a pediatric resident, ethicists, an attorney, and mediator provide a range of perspectives to inform ethically justifiable options and conflict resolution practices.

Accomplishment of water safety plan using quality assurance tool in 2020-2021: A case study in a western city of Gilan province, Iran

Background: Water safety plan is a systematic approach to ensure the quality of water delivered to consumers from catchment to consumption. Methods: This study was conducted on the groundwater system of Talesh, Gilan, in 2020-2021. A Water Safety Plan (WSP) consists of 5 phases and 12 steps. In the implementation of this plan, all modules were reviewed. Software checklists were prepared and based on the background information in Talesh Water and Wastewater Company, interviews with experts and field visits were performed, and then, entered into WSP QA TOOL software. Results: Out of 440 raw scores, 222 points were obtained, indicating 50.45% compliance with WSP. The description system with the highest score (100%) and the management procedures with the lowest score (50%) were in line with this plan. The stages of development and supporting program and review of WSP cannot be evaluated due to the incomplete implementation of water safety plan in Talesh. Between different parts of the water supply system, more attention has been paid to production sources and points of use. Conclusion: This study identifies the inefficiency in dependence on the final tests and the necessary items in updating the supply system of Talesh. According to the study of the different stages of WSP, the system has a moderate level of safety.

Water Supply System Description and Risk Assessment in Brikama Water Treatment Plant System, West Coast Region, Gambia: WHO Water Safety Plan Based Approach

Background: Better water quality, improved sanitation and sound water resource management will improve public health and economic development in low-income countries. Water safety plan-based risk assessment and risk management from catchment to consumers are the modern and efficient approaches to safe drinking water supply established by World Health Organization. Thus, this paper aimed to assess risk from catchment level to consumers in the community of Brikama. Methods: This study report assessments of risk or hazards from catchment to consumers in Brikama Water Treatment Plant (BWTP), West Coast Region, The Gambia. The various means of data collection used include water quality monitoring, visual field inspection and questionnaire survey to explore data on where the water supply system goes wrong from catchment to consumers, so as to provide an improvement plan. Results: Overall, the day-to-day administration of services at BWTP was very impressive. The fencing of all the 17 boreholes at catchment sites has drastically reduced the risk of contamination including treatment systems and distribution lines. There are less risks observed and constant monitoring of the system was ensured. However, at the consumer end, there are some risks with poor practices associated with water handling, storage and hygiene measures at the household level. Some still use some unclean 20-liter containers to store water and indiscriminately kept drinking cups on the floor and unclean surfaces, and 50% lacked WASH knowledge related to water treatment, such as boiling and filtration at households. The overall perception of water storage, sanitation and hygiene practices could be rated moderately good. Conclusion: The overall findings of this study have shown tremendous achievement in the government's commitment to providing potable water to the people in Brikama Local Government Area. WASH education in the study area is recommended to avoid waterborne disease infections.

An Analysis Of Factors Affecting The Number Of Safety Incidents In Civil Aviation

Aviation is the youngest of the transport industries, yet despite its short history, it is considered one of the most important spheres of transport, both in terms of passenger and cargo transportation. Civil aviation is used by an increasing number of people, and the number of aircraft used by airlines around the world continues to grow. An inherent element that is a particularly important aspect of this mode of transportation is security. In civil aviation, there are numerous dangers associated with events occurring before the flight, during the flight, as well as those associated with the landing process. The events need to be controlled and their causes actively sought and ultimately prevented. The Polish Civil Aviation Authority, as part of the creation of the National Civil Aviation Safety Program, developed the National Safety Plan 2020-2023. The document covers threats identified in the Systemic, European, and National Areas. They are characterized and classified based on the materiality (significance) of the event. The aim of this article is to characterize and analyze selected factors (e.g. collisions with birds, helicopter events) that affect the number of safety incidents in civil aviation. The background of the study was the analysis and synthesis of the literature on the subject, while the main research method was the statistical analysis of historical data on aviation incidents. The data provided in Poland's National Security Plan 2020-2023 were used to distinguish the factors associated with the threats present and synthetically evaluate their impact. The analyses made it possible to identify areas of particular safety risks and form the basis for further detailed research.

Study of Long-Term Effectiveness of Water Safety Plan Applied to Microfiltered Water Dispensers to Improve Water Quality

The use of Microfiltered Water Dispensers (MWDs) is increasing in offices, companies, or commercial facilities, as a response to plastic pollution. Despite their widespread use, poor data are available about the water quality and pathogens developed. Starting from a high contamination found in MWDs, a Water Safety Plan (WSP) was implemented on 57 MWDs to improve the water quality. To assess the effectiveness of WSP during the period 2017–2021, the environmental monitoring of heterotrophic plate counts (HPCs) at 36 °C and 22 °C, Enterococcus spp., Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, and Clostridium perfringens, as prescribed by Italian regulation for drinking water, was conducted. A high level of HPCs at both temperatures was observed, over the regulation limit; contrarily, the pathogenic bacteria were absent. The contamination found was studied with respect to the temperature threshold of 25 °C, suggested by directives. No significant differences were found between samples above and below the threshold, while a significant decrease over the years was observed for HPCs at 36 °C (p = 0.0000000001) and 22 °C (p = 0.000006). The WSP implementation resulted in a 43.09% decrease for HPCs at 36 °C and a 24.26% decrease for HPCs at 22 °C. Moreover, during the SARS-CoV-2 pandemic, the WSP contributed to limit the microbial contamination, preserving the MWDs’ functionality and hygienic conditions and the drinking water quality.