Concept: Donald Rumsfeld
Suicide risk assessment aims to reduce uncertainty in order to focus treatment and supervision on those who are judged to be more likely to die by suicide. In this article we consider recent meta-analytic research that highlights the difference between uncertainty about suicide due to chance factors (aleatory uncertainty) and uncertainty that results from lack of knowledge (epistemic uncertainty). We conclude that much of the uncertainty about suicide is aleatory rather than epistemic, and discuss the implications for clinicians.
Although the phenomenon of transposition has been known for over 60 years, its overarching importance in modifying and streamlining genomes took some time to recognize. In spite of a robust understanding of transposition of some TE, there remain a number of important TE groups with potential high genome impact and unknown transposition mechanisms and yet others, only recently identified by bioinformatics, yet to be formally confirmed as mobile. Here, we point to some areas of limited understanding concerning well established important TE groups with DDE Tpases, to address central gaps in our knowledge of characterised Tn with other types of Tpases and finally, to highlight new potentially mobile DNA species. It is not exhaustive. Examples have been chosen to provide encouragement in the continued exploration of the considerable prokaryotic mobilome especially in light of the current threat to public health posed by the spread of multiple Ab®.
Cardiothoracic surgery residents often enter their training with fairly limited prior exposure to the field. Obviously, they need to master the essential knowledge and skills of the discipline during their training. In addition to following a didactic curriculum of one sort or another, much of the necessary knowledge and understanding will accrue from their experiences caring for and operating on the patients who will be under their auspices, not only during their formal training but also after they finish their training. Some of these cases and situations, such as elective cases, allow for careful preparation, while some more urgent or emergent cases require generic, advance preparation in order to be ready to perform optimally in these cases when they arise. And then there will always be cases for which one will not be able to prepare in any meaningful way, and these types of cases will require creativity and innovation “on the fly." I will describe three cases, which are examples of each of these situations, with suggestions on how to handle each type of situation optimally. I will describe the preparation, such as it was for each, in some detail to help the reader understand how it felt to deal with each of these cases. The technical details of each of these cases resulted in a publication, which will be cited in the references, should the reader want to learn more about them.
- Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
- Published about 5 years ago
The 2010 Department of Defense (DoD) Instruction 6000.16, Military Health Support for Stability Operations, established medical stability operations as a core military mission. National military leaders appreciated that to better manage risks for US military personnel operating in far forward locations, reduce cost and footprint requirements for operations, and aid partner nations with providing service to relevant populations in underserviced/undergoverned the US military would need to be employed strategically in efforts to build partner nation medical capacity. Medical Stability Operations has evolved into Global Health Engagement in the lexicon of planners but the goal is still the same. This article used a technical report authored by the RAND Corporation as the basis of a case study of a Special Operations Command Africa (SOCAF) Mission to the country of Niger to build a casualty evacuation capability. The case study evaluates the utility of a hypothetical framework developed by the RAND researchers relative to the actual events and outcomes of an actual mission. The principal finding is that the RAND technical report is of value to planners, Operators, and trainers as a systematic approach to successful building partner capacity in health (BPC-H) missions. The article also offers several examples of metrics that aid leadership in making better decisions as to when corrective actions might be required.
Abstract Purpose. Given the need for comprehensive and multidisciplinary active living interventions, this article describes an innovative partnership for park design and evaluation. Design. The Trust for Public Land partnered with the RAND Corporation and the San Francisco Department of Public Health to generate context-sensitive active park design, establish evaluation methods, and build the framework for future collaboration. Setting. These partners worked together from 2009 to 2012 to design, renovate, and study parks in San Francisco, California. Subjects. The three partnering organizations are the focus of this article. Intervention. The Trust for Public Land’s Parks for People-Bay Area Program raised more than $16 million to renovate three San Francisco parks, which served as the intervention for a study that initially brought the three partnering organizations together. Measures. The authors, who represent the three partners, collaborated to develop the lessons learned. Analysis. This article is a description and commentary about a partnership that emphasized community involvement and rigorous evaluation. Results. Lessons learned and elements for successful partnerships include collaborating with organizations with differing expertise, deciding upon goals initially, finding a common language, involving local communities, and recognizing the importance and appropriate role of evaluations. Conclusion. The model for collaboration and community involvement presented supports and encourages other organizations to use strategic, multidisciplinary partnerships and highlights the importance of evaluation.