Backup Arrangements Research Articles

The Need for Surgery After Vascular or Cardiac Trauma, or Technical Adverse Events in the Congenital Cardiac Catheterization Laboratory.

Data on the frequency and outcome of surgical interventions as a result of adverse events (AE) encountered in the pediatric and congenital cardiac catheterization laboratory are limited. This study analyzes the outcomes of specific types of AE that are most likely to require immediate surgical intervention. Data from the C3PO registry were analyzed to identify specific types of significant vascular/cardiac trauma or technical adverse events (stent/device/coil embolization/migration). The relationship between these AE and an "adverse outcome" (defined as either surgery, ECMO, or death) were analyzed. Between 01/2014 and 12/2017, 25,731 cases were entered into the C3PO registry. Vascular or cardiac trauma were observed in 92 cases (0.36% cases in C3PO), and technical adverse events were observed in 176 cases (0.68% cases in C3PO). The two highest procedure type risk categories (PREDIC3T) accounted for 61% of the cases in the cardiac/vascular trauma cohort, and 34% in the technical AE cohort. For vascular/cardiac trauma, 24 (26%) had an adverse outcome, with ECMO in 8 (9%), surgery in 19 (20%), and death in 9 (10%). For technical AE 25 (14%) had an adverse outcome, with ECMO in 3 (2%), surgery in 23 (13%), and death in 3 (2%). Survival after cardiac surgery secondary to an AE was 68% for cardiac/vascular trauma, and 96% for technical adverse events. RF perforation of the pulmonary valve was the procedure most likely to result in cardiac/vascular trauma (10%), with 57% of those having an adverse outcome. Atrial septal interventions accounted for 29% of all adverse outcomes in the cardiac/vascular trauma cohort. Non-elective or emergent cases were associated with a significantly higher incidence of an adverse outcome for both, cardiac/vascular trauma (OR 7.1) and technical adverse events (OR 2.7). Surgery within the last 30days was associated with a significantly higher incidence of an adverse outcome for cardiac/vascular trauma only (OR 4.2). Significant cardiac/vascular trauma or stent/device/coil embolization/migration are rare, but high consequence AE. With appropriate surgical and ECMO backup, a high survival can be achieved. The potential need for and impact of immediate surgical backup seems to be higher for cardiac/vascular trauma (in particular after specific case types), than for device/coil migration/embolization, and as such case specific backup arrangements are required.

Laboratory service relocation: experience and lessons learned from relocating a biosafety level-3 clinical mycobacteriology service to a new facility.

We recount our experiences of relocating an active mycobacteriology reference level service in Karachi, Pakistan, from an older accredited biosafety level-3 facility to a newly constructed and environmentally validated facility. The service relocation planning, execution, and verification stages are described in detail. Lessons learned from our experience include establishing a service transfer plan, including relevant service staff, obtaining their buy-in on the plan, arranging backup service facilities or liaisons for the execution phase, and ensuring viable backup arrangements for troubleshooting during the verification phase of services in the new facility. Careful planning and inclusion of all stakeholders are critical to avoid service interruptions. This narrative is expected to support other laboratorians, scientists, and clinicians providing laboratory services to large population sectors who are looking to move their services to a new location while continuing to offer said services in a proficient and reliable manner.

Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation.

Attendance of skilled and experienced professionals at breech births has been associated with a reduction in adverse perinatal outcomes. We aimed to determine whether United Kingdom National Health Service (NHS) sites could reliably provide attendants with OptiBreech training and/or advanced proficiency (intervention feasibility) and consistent care (fidelity) that meets women's needs (acceptability), with low neonatal admission rates (safety) and recruitment adequate to support a clinical trial (trial feasibility). Mixed methods implementation evaluation was used. Settings were 13 services in England and Wales. Participants were 82 women requesting support for a vaginal breech birth (VBB) at term. Outcomes were descriptively analyzed. Twenty-one women were interviewed, and transcripts were analyzed using the Theoretical Framework of Acceptability. Iterative analysis informed subsequent interviews and the ongoing process of implementation across sites. Although we initially suggested multidisciplinary teams, actively recruiting Trusts yielded services where VBB care was provided through a dedicated clinic, organized and delivered primarily by a lead midwife who functioned as a specialist. This model achieved 87.5% fidelity with the intervention's goal of ensuring the attendance of OptiBreech-trained professionals. Neonatal outcomes remained stable, with an admission rate of 5.5%. Women reported care from specialist midwives as highly acceptable, but the model is vulnerable without a strategic effort to develop additional proficient team members. Dedicated clinics coordinated by specialist midwives appear to be an acceptable and feasible implementation strategy to test the safety and effectiveness of proficient team care for VBB in a clinical trial. Back-up arrangements should be maintained while additional members of the team develop proficiency.

Investigating the impact of TBM downtimes on utilization factor based on sensitivity analysis

Tunnel boring machines (TBMs) are considered to be the most efficient tunneling method for long tunnels because of their higher productivity, adaptability to a variety of subsurface conditions, and providing a safer work environment. The number of TBMs utilized over the past decade has escalated, testimony to their continuing success and flexibility for application on projects of different diameter, length, and ground conditions. There are various guidelines available for TBM selection and for developing a suitable specification for a machine for a given project. Proper application of these guidelines is an essential part of machine selection to assure optimal performance of these machines in a given project. However, available guidelines are very general in nature and based on past experiences: they cannot take into account the many intricacies of a specific upcoming project including site set up and geology.This paper discusses use of Discrete Event Simulation (DES) to model tunneling activities, and demonstrates the ability of simulation to capture the interrelationships between the TBM, back-up system, and geologic interactions. The simulations provide insight into expectations for utilization of individual components as well as overall TBM system utilization. The simulation model can be constructed to enable estimation of the machine utilization under various site set up and back-up arrangements, and thus paves the way to quantitative assessment of the value of adding different capabilities on the machine and back-up system. Case studies are used to demonstrate the impact of some common tunneling activities in different ground conditions. In particular, DES was used to study the effect of eight different tunneling activities on the overall performance of the TBM. Significant differences in productivity can be seen by varying the specification of the TBM and system components. The results show the importance of selecting the right components for the back-up and their impact on overall machine utilization, leading to the possibility of allowing more methodic and fact-based selection of system components for optimal TBM performance.

Can small users recover from the cloud?

Large numbers of small organisations and prosumers have shifted away from managing data on their own devices and are now heavily reliant on service-providers for both storage and processing of their data. Most such entities are also dependent on those service-providers to perform backups and enable data recovery. Prior work defining users' backup needs was applied to this context in order to establish specifications for appropriate backup arrangements. A sample of service-providers was assessed against those specifications. Their backup and recovery mechanisms were found to fall seriously short of the need.

Child-Care Instability and Behavior Problems: Does Parenting Stress Mediate the Relationship?

Child care instability is associated with more behavior problems in young children, but the mechanisms of this relationship are not well understood. Theoretically, this relationship is likely to emerge, at least in part, because care instability leads to increased parenting stress. Moreover, low socioeconomic status and single-mother families may be more vulnerable to the effects of instability. This study tested these hypotheses using data from the Fragile Families and Child Wellbeing study (n=1,675) and structural equation modeling. Three types of child care instability were examined: long-term instability, multiplicity, and needing to use back-up arrangements. Overall, findings showed little evidence that parenting stress mediated the associations between care instability and child behavior problems among the full sample. Among single-mother and low-income families, however, needing to use back-up arrangements had small positive associations with parenting stress, which partially mediated the relationship between that type of care instability and child externalizing behavior problems.

Unstable and multiple child care arrangements and young children's behavior

Growing evidence suggests that child care instability is associated with child behavior problems, but existing studies confound different types of instability; use small, convenience samples; and/or control insufficiently for selection into child care arrangements. This study uses survey and calendar data from the Fragile Families and Child Well-Being Study to estimate the associations between three different types of child care instability—long-term instability, multiplicity, and the use of back-up arrangements—and children's internalizing, externalizing, and prosocial behaviors at age 3, controlling for a large number of child and family background characteristics. Long-term instability between birth and age 3, as measured in both the survey and calendar data, is associated with higher levels of externalizing behavior problems. Current multiplicity at age 3 (as measured by survey data) is associated with higher levels of both externalizing and internalizing behavior problems, but stable multiplicity over time (as measured using calendar data) is not. Finally, the use of back-up arrangements at age 3 is associated with higher levels of internalizing behaviors. We find no consistent differences in these results by the timing of instability, child gender, family income, or type of care.

Backup Agreements in Fashion Buying—The Value of Upstream Flexibility

We focus on backup agreements between a catalog company and manufacturers—a scheme to provide upstream sourcing flexibility for fashion merchandise. A backup agreement states that if the catalog company commits to a number of units for the season, the manufacturer holds back a constant fraction of the commitment and delivers the remaining units before the start of the fashion season. After observing early demand, the catalog company can order up to this backup quantity for the original purchase cost and receive quick delivery but will pay a penalty cost for any of the backup units it does not buy. In representative contracts with five companies, the fraction held as backup varies from 20% to 33% and the penalty ranges from 0 to 20% of cost. We model this inventory problem and derive the optimal solution. We provide results from a retrospective parallel test of the model against buyer decisions in 1993 based on a data set from the women's fashion department at a catalog company (Catco). The results indicate that backup arrangements can have a substantial impact on expected profits and may result in an increase in the committed quantity. Also, these arrangements may maintain the manufacturer's expected profit for a wide range of parameters.

Disaster preparedness of home health care agencies in San Diego county

A questionnaire was sent to 53 home health care agencies in San Diego to assess their state of disaster readiness. Thirty agencies returned completed questionnaires. Of these, 90% have written disaster plans, but only 33% conduct regular drills to practice' their written plans. A 24-h telephone number is available to patients at 96% of the agencies. One-fourth of the agencies serving ventilator-dependent patients do not make utility companies swam of their special needs. Of 11 hospital-sponsored agencies, 18% include backup agreements with other agencies, while 79% of non-hospital-sponsored agencies have planned such backup. The majority (92%) of “private-for-profit” agencies have backup arrangements, but only 38% of the public or nonprofit agencies have such arrangements. Additionally, 31% of the home health care agencies do not feel they would be able to meet the needs of their clients in the event of a disaster. Specific recommendations for such agencies in developing disaster plans, and exercising them, are made.

The unresolved child care dilemma: care for the acutely ill child.

The frequency of childhood illness, the exclusion practices of most licensed child care programs, and the limited sick leave policies of many employers all combine to create a particularly difficult dilemma for the working parent. A comprehensive solution to the problem of caring for the sick child must be tackled on three primary fronts: provision of expanded sick leave benefits and/or greater flexibility in the performance of job duties to enable working parents to care for children's illnesses without jeopardy to employment; development of clear regulatory guidelines and supplemental resources to enable care givers to accommodate a mildly ill child in the child's usual child care setting; replication of successful model programs, partially underwritten by public and/or private support, to assist parents with the costs of backup arrangements for the care of sick children when needed.

Interdisciplinary collaboration: psychiatric medical backup in the outpatient clinic.

The provision of psychiatric medical backup to nonphysician therapists is currently an important issue in inpatient and outpatient practice. Like all team approaches, backup offers the possibility of increased efficiency, professional growth, and access to treatment. At the same time, the psychiatrist providing medical backup is confronted with practical and ethical dilemmas in meeting his or her responsibilities. The authors define the role of psychiatrist medical backup and propose a collaborative model for outpatient practice. Issues to be considered in the planning of backup arrangements are discussed. The importance of clear role definition and communication between collaborators is emphasized.

Experience with the morris electronic switching system

On November 17, 1960, an Electronic Central Office at Morris, Ill., was formally dedicated. While this office was a Bell Telephone Laboratories experimental trial, it provided 24-hour-per-day commercial-grade service with no backup arrangements. The trial was of 14 1/2 months' duration and served the needs of 435 telephone customers. The majority of customers were also provided with one or more new services. Results of the trial furnished conclusive evidence as to the feasibility of electronic switching systems (ESS) and provided many answers needed in the design of future systems.

Selective Tripping of Low-Voltage Air Circuit Breakers

Selective or sequential tripping in low-voltage air circuit breaker application provides for removal from the system of a faulted part only, leaving the rest of the system in operation. Present standard circuit breakers generally are not suitable. Solution of the problem is through direct-acting series tripping means with distinct current-time characteristics in ranges of overcurrent and fault current, with minimum time to complete interruption the objective. This subjects the circuit breaker to the very severe duty of having to carry short-circuit currents for appreciable times, whereas standard circuit breakers have been designed to open instantaneously. Modified standard circuit breakers may be applied to selective tripping, with limitations of application based upon (1) rated interrupting capacity and (2) series trip coil rating. As tests show that modified standard circuit breakers will carry short-circuit current for necessary times, they also may be applied with relay schemes requiring delayed tripping. In systems using cascade or backup arrangements of circuit breakers, little is gained by selective tripping. It is recommended that for a particular installation choice be made between selective tripping and cascade arrangement, according to relative importance of advantages of each.