Search

There are multiple dam failures and dam safety incidents every year in the United States. There are currently no standard policy requirements for when or how to conduct failure or incident investigations. In order to understand the state of the industry, this study reviewed 58 different dam failure or incident investigation reports based on incidents that occurred in the United States from 1960 through 2022. The investigations ranged from well-known failures/incidents of large dams such as Oroville Dam and Teton Dam, to little known structures such as Hawkins Dam, a small dam in the state of Washington that had a spillway failure in 2014. The investigations were analyzed and evaluated for characteristics such as the length of time for the investigation team to get on-site, the amount of time to complete the full investigation, what organization funded the investigation, independence of the investigation team, scope of the investigation, and several other parameters. Based on the analysis, investigations after the year 2000 have seen more time pass before the investigation team can visit the site and investigations have taken longer to complete. Investigations are often not fully independent, are most commonly funded by federal agencies, and often do not investigate human, programmatic factors, or consequences. This paper makes 10 recommendations for improving investigations in the future, including recommended definitions for incidents and failures. In this paper, the authors recommend that (1) a dam safety incident be defined as a potential failure mode has initiated and progressed but has not led to an uncontrolled release from the reservoir; (2) a high flow release be defined as: An incident when there are consequences downstream of a dam due to controlled flows passed by the dam, not due to the failure of a dam or dam component; and (3) that dam failures be separated into three types based on the severity of downstream consequences. [ABSTRACT FROM AUTHOR]

The article argues that the United States government have been exporting domestic legal rules and norms into the international arena through bilateral and regional trade agreements. The free trade agreements build a common body of law which typically represents American legal standards and interpretations. Law is being exported from economically powerful countries, such as the US, to economically disadvantaged states.

Explores the advantages and disadvantages of offshore labor outsourcing strategy applied by U.S. business enterprises. Impact of outsourcing on the employment rate in the country; Analysis of outsourcing trend in the nation between 1987 and 1997; Legislation implemented relating to offshore labor outsourcing,.

Presents perspectives of lawyers on the law of inequitable conduct, claim construction, and the doctrine of equivalents of the Federal Circuit of the U.S. Court of Appeals. Requirement for the language of the asserted claims to be construed before any determination can be made regarding infringement or invalidity; Importance for the court to look first to the intrinsic evidence of record of the patent when interpreting claims; Selection for a patentee to prove infringement either literally or under the doctrine of equivalents.

Provides information on the power given to tribal government and the enforcement of Indian alcohol policy in the U.S. Establishment of tribal governments and the imposition of alcohol policy in non-Indian communities; Views on the delegation of powers allotted by the U.S. Congress; Political and social condition of the Yakama Reservation.

Provides information on the June 2003 special issue of "Concurrency and Computation: Practice and Experience" journal featuring research papers from the International Conference on Cluster Computing held in Newport Beach, California in October 2001. Highlights of the event; Selection of papers for publication in the journal; Topics covered by the research papers accepted by the journal for its special issue.

Abstract: During the early period of the COVID-19 pandemic there was a substantial decrease in pediatric emergency department (PED) visitation. The intent of this study is to report PED utilization during the COVID-19 pandemic in an urban pediatric referral center located close to the epicenter in the northeastern US.A retrospective analysis of medical records of patients visiting the PED at Robert Wood Johnson University Hospital (RWJUH) was performed. Data included: daily census, admission rate, Emergency Severity Index, and ICD-10 diagnosis codes for the period of February through July, 2018 to 2020.By the week of March 26th, visits had decreased by 70% compared to the average of the previous 2 years. This census nadir lasted for 6 weeks. At 5 weeks postnadir the average daily census recovered to levels 40% lower than prior year norms and remained at that level during subsequent months. The greatest decreases were seen in low-acuity visits. Visits for behavioral health and fractures decreased by approximately 50% and 70%, respectively, but recovered to prior year norms by June and July of 2020. Visits for asthma exacerbation decreased by as much as 87% and remained at record lows for the remainder of the study period.A substantial and persistent decrease in PED visitation was experienced during the COVID-19 pandemic. Whereas visits for behavioral health and fractures have recovered to prior year norms, visits for asthma exacerbation remain at record lows. Further research is needed to ascertain the causes of these changes, including patient perceptions of the PED., Competing Interests: The authors have no funding and conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Crohn disease is a chronic inflammatory disorder involving the gastrointestinal tract, characterized by episodic flares and times of remission. Underlying structural damage occurs progressively, with recurrent bouts of inflammation. The diagnosis and management of this disease process is dependent on several clinical, laboratory, imaging, endoscopic, and histologic factors. In recent years, with the maturation of CT enterography, and MR enterography, imaging has played an increasingly important role in relation to Crohn Disease. In addition to these specialized examination modalities, ultrasound and routine CT have potential uses. Fluoroscopy, radiography, and nuclear medicine may be less beneficial depending on the clinical scenario. The imaging modality best suited to evaluating this disease may change, depending on the target population, severity of presentation, and specific clinical situation. This document presents seven clinical scenarios (variants) in both the adult and pediatric populations and rates the appropriateness of the available imaging options. They are summarized in a consolidated table, and the underlying rationale and supporting literature are presented in the accompanying narrative. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment., (Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The Atlanta Classification by the Acute Pancreatitis Classification Working Group recently modified the terminology for the clinical course and the morphologic changes identified on imaging, primarily contrast- enhanced multidetector computed tomography (MDCT). The two distinct clinical courses of the disease are classified as (1) early phase, which lasts approximately 1 week, and (2) late phase, which starts after the first week and can last for months after the initial episode. The two, primary, morphologic changes are acute, interstitial edematous and necrotizing pancreatitis. Timing of imaging, primarily MDCT, is based on the clinical phases and is, therefore, important for these imaging guidelines. Ultrasound's role is to detect gallstones after the first episode. MDCT plays a primary role in the management of acutely ill patients, only after a minimum of 48-72 hours and generally after one week. MR plays a supplementary role to MDCT. Follow-up MDCT guides management and therapy: percutaneous aspiration of fluid collections and/or placement of large caliber catheters in infected necrosis.

Acute right upper quadrant pain is a common presenting symptom in patients with acute cholecystitis. When acute cholecystitis is suspected in patients with right upper quadrant pain, in most clinical scenarios, the initial imaging modality of choice is ultrasound. Although cholescintigraphy has been shown to have slightly higher sensitivity and specificity for diagnosis, ultrasound is preferred as the initial study for a variety of reasons, including greater availability, shorter examination time, lack of ionizing radiation, morphologic evaluation, confirmation of the presence or absence of gallstones, evaluation of bile ducts, and identification or exclusion of alternative diagnoses. CT or MRI may be helpful in equivocal cases and may identify complications of acute cholecystitis. When ultrasound findings are inconclusive, MRI is the preferred imaging test in pregnant patients who present with right upper quadrant pain. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment., (Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Families with children with special health care needs may present a challenge for disaster responders. This study examined the level of personal disaster preparedness among this at-risk population in relation to the general population, and explores whether special health care needs or perception of disaster risk affects preparedness levels. A convenience sample of 145 families presenting to an urban tertiary care children's hospital was surveyed using a previously validated instrument to gather information on levels of preparedness and factors influencing preparedness. In spite of significant special health care needs and concern about disasters, families remain unprepared for a disaster event. Health care and psychosocial support workers are in a unique position to increase preparedness levels in this at-risk population.

Objective: This study was designed to assess the impact of a brief educational video shown to parents during an emergency department visit for minor febrile illnesses. We hypothesized that a video about home management of fever would reduce medically unnecessary return emergency department visits for future febrile episodes., Methods: A convenience sample of 280 caregivers presenting to one urban pediatric emergency department was enrolled in this prospective, randomized cohort study. All the caregivers presented with a child aged 3 to 36 months with complaint of fever and were independently triaged as nonemergent. A pretest and posttest were administered to assess baseline knowledge and attitudes about fever. One hundred forty subjects were randomized to view either an 11-minute video about home management of fever or a control video about child safety. Subjects were tracked prospectively, and all return visits for fever complaints were independently reviewed by 3 pediatric emergency physicians to determine medical necessity., Results: There were no differences between the fever video and the control groups in baseline demographics (eg, demographically comparable). The fever video group had a significant improvement in several measures relating to knowledge and attitudes about childhood fever. There was no statistical difference between the intervention and control groups in subsequent return visits or in the determination of medical necessity., Conclusions: A brief standardized video about home management of fever improved caregiver knowledge of fever but did not decrease emergency department use or increase medical necessity for subsequent febrile episodes.