Occurrence Of Frequent Events Research Articles

РАБОТЫ П. ХЮНА: НАРРАТОЛОГИЧЕСКАЯ ИНТЕРПРЕТАЦИЯ КАТЕГОРИИ СОБЫТИЯ

A significant phenomenon in modern narratology is a complex concept of eventfulness, which P. Hühn has been developing for many years in several books and numerous articles. In his theoretical elaborations P. Hühn relies on a close reading of individual texts, considered in comparative and historical context. P. Hühn interprets event as a hermeneutic category, reflecting not only objectively existing intratextual structures, but also the significance of changes in narrative situation for perceiving subject, which can be a character as well as a narrator or an implicit / real reader. For P. Hühn an event is not any change of situation, but a change that is relevant, unexpected and unusual, so the researcher links it not to a minimalist definition of narrative, as many other narratologists do, but to the concept of tellability. Hühn refers to Lotman’s plot model and R. Shank and P. Abelson’s theory of cognitive schemata as a theoretical bases, he also demonstrates their complementarity in the practical analysis of artistic narratives. P. Hühn puts special accent on the historical and cultural variability of eventfulness, which manifests itself, on the one hand, in a more or less frequent occurrence of events in literary narratives, and on the other hand, in the variablity of changes that might be interpreted as events in different historical and cultural contexts. An important feature of P. Hühn’s theory is the analysis of events on several narrative levels – not only on the level of happenings (the level of the story / histoire), but also on the levels of presentation and reception. Another original element of Hühn’s theory is the notion of non-event that covers cases when the absence of relevant and unexpected changes is perceived as an event, since it contradicts readers’ expectations. Hühn analyses eventfullness not only in fictional prose, but also in dramatic and lyrical works.

Improving Pediatric Resident Safety Event Reporting Using Quality Improvement Methods.

Safety event reporting systems facilitate identification of system-level targets to improve patient safety. Resident physicians report few safety events despite their role as frontline providers and the frequent occurrence of events. The objective of this study is to increase the number of pediatric resident safety event submissions from <1 to 4 submissions per 14-day period within 12 months. We conducted an iterative quality improvement process with 39 pediatric residents at a children's hospital. Interventions focused on 4 key drivers: user-friendly event submission process, resident buy-in, nonpunitive safety culture, and data transparency. The primary outcome measure of number of pediatric resident event submissions was analyzed by using statistical process control. Balancing measures included time from submission to feedback, duplicate submissions, and nonevent submissions. As a control, the primary outcome measure was monitored for nonpediatric residents during the same period. The mean number of pediatric resident event submissions increased from 0.9 to 5.7 submissions per 14 days. Impactful interventions included a designated space in the resident workroom to list safety events to submit, monthly project updates, and an interresident competition. There were no duplicate submissions or nonevent submissions in the postintervention period. Time to feedback in the postintervention period had both upward and downward shifts, with >8 consecutive points above and below the baseline period's centerline. The control group showed no sustained change in event submissions. Our improvement process was associated with significant increase in pediatric resident safety event submissions without an increase in the number of submissions categorized as duplicates or nonevents.

Organization and Preparedness of Emergency and Disaster Medical Response Teams: Obstacles and Challenges

Background: Rising trend of emergencies and disasters in the world has caused a lot of damage to the health care facility infrastructures. This has led the health needs of the affected population to be the first and most requirement in emergencies and disasters. In most countries for the timely and appropriate response to the health needs of the affected areas, structured and organized teams are formed. Given the frequent occurrence of events in Iran and the adverse effects of emergencies and disasters on the community health, this study aimed to investigate the obstacles and challenges associated with the organization and preparation of Iran’s Emergencies and Disasters Medical Response Teams (EDMRT). Materials and Methods: In this study, a qualitative approach with a content analysis method was used to explore and extract the obstacles and challenges of the medical response teams in the field of organization and preparation. Data collection was done through 18 in-depth, unstructured, and semi-structured interviews with 16 experts and experienced people who were purposefully selected. Besides the interview, field visits and related reports were used to confirm or reject the findings. Data analysis was done by the qualitative approach recommended by Graneheim. Results: The obstacles and challenges associated with the organization and preparation of teams were obtained under 1 theme, 2 categories, and 10 subcategories. The main theme was “team management”. The categories included unorganized groups and frangible readiness. Concepts of the team; unknown structure, lack of effective leadership/command, poor supervision of proctor organization, membership; complex process, heterogeneous composition are the sub-categories related to the first category. And concepts of local level; disable to establishment a team; disaster medicine, unfamiliar concept; lack of air care team; dependence versus self-sufficiency; non-systematically support; and inappropriate location of deployment are the sub-categories of the second category Conclusion: The results of the study show that the current structures for medical response in emergencies and disasters have numerous challenges in terms of organization and preparedness. This defect harms the performance and effectiveness of medical response teams and an obstacle to the overall policy of reducing damages in disasters. The present study illustrates the need to review and refine the organization and preparedness processes associated with the current structure of medical response teams in emergencies and disasters. Of course, it is recommended that a more comprehensive study be conducted to identify and address the other areas of influence in these teams, such as legal considerations, health and safety, and related security issues.

Change in the Recent Warming Trend of Sea Surface Temperature in the East Sea (Sea of Japan) over Decades (1982–2018)

Long-term trends of sea surface temperature (SST) of the East Sea (Sea of Japan, EJS) were estimated by using 37-year-long satellite data, for the observation period from 1982 to 2018. Overall, the SST tended to increase with time, for all analyzed regions. However, the warming trend was steeper in the earlier decades since the 1980s and slowed down during the recent two decades. Based on the analysis of the occurrence of events with extreme SST (high in the summertime and low in the wintertime), a shift toward the more frequent occurrence of events with extremely high SST and the less frequent occurrence of events with extremely low SST has been observed. This supports the observations of the consistent warming of the EJS. However, seasonal trends revealed continuous SST warming in the summertime, but frequent extreme SST cooling in the wintertime, in recent decades. The observed reduction in the warming rates occurred more frequently in specific regions of the EJS, where the occurrence frequency of events with extremely low SST was unusually high in the recent decade. The recent tendency toward the SST cooling was distinctively connected with variations in the Arctic Oscillation index. This suggests that changes in the Arctic Ocean environment likely affect the recently observed SST changes in the EJS, as one of the marginal seas in the mid-latitude region far from the polar region.

Late Myocardial Ischemic Events After Saphenous Vein Graft Intervention—Importance of Initially “Nonsignificant” Vein Graft Lesions

Patients undergoing percutaneous coronary revascularization (PCR) for narrowed saphenous vein grafts (SVGs) have a high incidence of subsequent cardiac events, but the relative contribution of treated and untreated SVGs, and of native coronary narrowings to late events is uncertain. This study evaluated the role of progression of SVG disease at untreated sites to cardiac events in these patients. All patients with successful PCR of SVG lesions who were enrolled in clinical trials with mandated repeat angiography from 1990 to 1994 were studied. One hundred three patients (age 63 ± 8 years, 82% men, ejection fraction 54 ± 12%, graft age 8 ± 4 years), contributing 1,095 analyzable 15- to 25-mm SVG segments were followed 29 ± 13 months (4 patients were lost to follow-up). Actuarial event-free (death, myocardial infarction, bypass surgery, or PCR) and overall survival at 12 months were 47 ± 5% and 94 ± 2%, respectively. Fifty-six percent of all early (≤12 months) events resulted from ischemia from recurrence at initially treated SVG sites, 26% at nontreated SVG sites, and 14% at nontreated native coronary sites. By 36 months, event-free and overall survival were 25 ± 6% and 86 ± 4%, respectively. Events occurring >12 months after initial treatment resulted most frequently from ischemia from progression of narrowing at untreated SVG sites (46%). Ischemic events from initially untreated SVG sites were correlated with initial percent stenosis (initial, 41% to 50%; 45% events, 31% to 40%; 18% events, ≤30%; 2% events, p <0.001) and reference SVG diameter (p = 0.003). Recurrent ischemic events from initially treated SVG sites were independently correlated with initial percent stenosis (initial >75%; 43% events, 50% to 75%; 27% events, <50%; 18% events, p = 0.01), but not with final percent stenosis. The frequent occurrence of events from nontreated 41% to 50% stenoses suggests a need for increased surveillance in patients with these lesions. The low incidence of events from initially treated lesions <50% suggests that the hypothesis that “nonsignificant” 41% to 50% lesions might best be treated at the time other more severe narrowings are treated should be examined.One hundred three patients undergoing coronary intervention of vein graft narrowings were followed 29 ± 13 months to ascertain correlates of recurrent ischemic events >12 months (36 months event-free survival = 25 ± 6%). Late recurrent events were most closely associated with progression of narrowings 41% to 50%, and to a lesser extent 31% to 40%, at baseline study.