Critical incident response (CIR) has evolved to require a high level of cultural competence, customization, and adaptability to meet the needs of client organizations while incorporating clinical best practices and current research. The Critical Incident Outcome Measure (CIOM) is a timely and pioneering evidence-based evaluative tool developed by Morneau Shepell over the course of a four-year period. The CIOM tool, based on the Workplace Outcomes Suite (WOS) tool originally developed in 2010, was developed in 2016 [Herlihy et.al., 2018]; beta tests and modifications, along with the publication of a validation paper, were completed in 2017; further feedback was incorporated and an implementation plan developed in 2018; and full program implementation began in 2019.
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Cybersecurity threat and incident managers in large organizations, especially in the financial sector, are confronted more and more with an increase in volume and complexity of threats and incidents. At the same time, these managers have to deal with many internal processes and criteria, in addition to requirements from external parties, such as regulators that pose an additional challenge to handling threats and incidents. Little research has been carried out to understand to what extent decision support can aid these professionals in managing threats and incidents. The purpose of this research was to develop decision support for cybersecurity threat and incident managers in the financial sector. To this end, we carried out a cognitive task analysis and the first two phases of a cognitive work analysis, based on two rounds of in-depth interviews with ten professionals from three financial institutions. Our results show that decision support should address the problem of balancing the bigger picture with details. That is, being able to simultaneously keep the broader operational context in mind as well as adequately investigating, containing and remediating a cyberattack. In close consultation with the three financial institutions involved, we developed a critical-thinking memory aid that follows typical incident response process steps, but adds big picture elements and critical thinking steps. This should make cybersecurity threat and incident managers more aware of the broader operational implications of threats and incidents while keeping a critical mindset. Although a summative evaluation was beyond the scope of the present research, we conducted iterative formative evaluations of the memory aid that show its potential.
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Computer security incident response teams (CSIRTs) respond to a computer security incident when the need arises. Failure of these teams can have far-reaching effects for the economy and national security. CSIRTs often have to work on an ad hoc basis, in close cooperation with other teams, and in time constrained environments. It could be argued that under these working conditions CSIRTs would be likely to encounter problems. A needs assessment was done to see to which extent this argument holds true. We constructed an incident response needs model to assist in identifying areas that require improvement. We envisioned a model consisting of four assessment categories: Organization, Team, Individual and Instrumental. Central to this is the idea that both problems and needs can have an organizational, team, individual, or technical origin or a combination of these levels. To gather data we conducted a literature review. This resulted in a comprehensive list of challenges and needs that could hinder or improve, respectively, the performance of CSIRTs. Then, semi-structured in depth interviews were held with team coordinators and team members of five public and private sector Dutch CSIRTs to ground these findings in practice and to identify gaps between current and desired incident handling practices. This paper presents the findings of our needs assessment and ends with a discussion of potential solutions to problems with performance in incident response. https://doi.org/10.3389/fpsyg.2017.02179 LinkedIn: https://www.linkedin.com/in/rickvanderkleij1/
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Background: Adverse outcome pathway (AOP) networks are versatile tools in toxicology and risk assessment that capture and visualize mechanisms driving toxicity originating from various data sources. They share a common structure consisting of a set of molecular initiating events and key events, connected by key event relationships, leading to the actual adverse outcome. AOP networks are to be considered living documents that should be frequently updated by feeding in new data. Such iterative optimization exercises are typically done manually, which not only is a time-consuming effort, but also bears the risk of overlooking critical data. The present study introduces a novel approach for AOP network optimization of a previously published AOP network on chemical-induced cholestasis using artificial intelligence to facilitate automated data collection followed by subsequent quantitative confidence assessment of molecular initiating events, key events, and key event relationships. Methods: Artificial intelligence-assisted data collection was performed by means of the free web platform Sysrev. Confidence levels of the tailored Bradford-Hill criteria were quantified for the purpose of weight-of-evidence assessment of the optimized AOP network. Scores were calculated for biological plausibility, empirical evidence, and essentiality, and were integrated into a total key event relationship confidence value. The optimized AOP network was visualized using Cytoscape with the node size representing the incidence of the key event and the edge size indicating the total confidence in the key event relationship. Results: This resulted in the identification of 38 and 135 unique key events and key event relationships, respectively. Transporter changes was the key event with the highest incidence, and formed the most confident key event relationship with the adverse outcome, cholestasis. Other important key events present in the AOP network include: nuclear receptor changes, intracellular bile acid accumulation, bile acid synthesis changes, oxidative stress, inflammation and apoptosis. Conclusions: This process led to the creation of an extensively informative AOP network focused on chemical-induced cholestasis. This optimized AOP network may serve as a mechanistic compass for the development of a battery of in vitro assays to reliably predict chemical-induced cholestatic injury.
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Thermal comfort is determined by the combined effect of the six thermal comfort parameters: temperature, air moisture content, thermal radiation, air relative velocity, personal activity and clothing level as formulated by Fanger through his double heat balance equations. In conventional air conditioning systems, air temperature is the parameter that is normally controlled whilst others are assumed to have values within the specified ranges at the design stage. In Fanger’s double heat balance equation, thermal radiation factor appears as the mean radiant temperature (MRT), however, its impact on thermal comfort is often ignored. This paper discusses the impacts of the thermal radiation field which takes the forms of mean radiant temperature and radiation asymmetry on thermal comfort, building energy consumption and air-conditioning control. Several conditions and applications in which the effects of mean radiant temperature and radiation asymmetry cannot be ignored are discussed. Several misinterpretations that arise from the formula relating mean radiant temperature and the operative temperature are highlighted, coupled with a discussion on the lack of reliable and affordable devices that measure this parameter. The usefulness of the concept of the operative temperature as a measure of combined effect of mean radiant and air temperatures on occupant’s thermal comfort is critically questioned, especially in relation to the control strategy based on this derived parameter. Examples of systems which deliver comfort using thermal radiation are presented. Finally, the paper presents various options that need to be considered in the efforts to mitigate the impacts of the thermal radiant field on the occupants’ thermal comfort and building energy consumption.
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This study analyses how the social construction of integrity takes place within the context of football in the Netherlands. Combining a contextual approach to sports integrity with the analytic lens of sensemaking, this qualitative multi-method case study analyses – in one extreme case in Dutch youth amateur football – why and when the ‘incident’ was perceived as an ‘integrity issue’, and how the meaning of (the) integrity (issue) was socially constructed by (interactions between) stakeholders involved in the case. Our findings show why, when, and how moral norms and values are (not) debated and at stake, and that the social construction of sports integrity is intertwined with the institutional context and the role of secondary stakeholders. It provides insights that can help sports organizations to identify risks in their moral sports culure and to develop measures or policies to safeguard integrity in sport.
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To evaluate the construct validity and the inter-rater reliability of the Dutch Activity Measure for Post- Acute Care “6-clicks” Basic Mobility short form measuring the patient’s mobility in Dutch hospital care. First, the “6-clicks” was translated by using a forward-backward translation protocol. Next, 64 patients were assessed by the physiotherapist to determine the validity while being admitted to the Internal Medicine wards of a university medical center. Six hypotheses were tested regarding the construct “mobility” which showed that: Better “6-clicks” scores were related to less restrictive pre-admission living situations (p¼0.011), less restrictive discharge locations (p¼0.001), more independence in activities of daily living (p¼0.001) and less physiotherapy visits (p<0.001). A correlation was found between the “6-clicks” and length of stay (r¼0.408, p¼0.001), but not between the “6-clicks” and age (r¼0.180, p¼0.528). To determine the inter-rater reliability, an additional 50 patients were assessed by pairs of physiotherapists who independently scored the patients. Intraclass Correlation Coefficients of 0.920 (95%CI: 0.828–0.964) were found. The Kappa Coefficients for the individual items ranged from 0.649 (walking stairs) to 0.841 (sit-to-stand). The Dutch “6-clicks” shows a good construct validity and moderate-toexcellent inter-rater reliability when used to assess the mobility of hospitalized patients.
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Aggressive incidents occur frequently in health care facilities, such as psychiatric care and forensic psychiatric hospitals. Previous research suggests that civil psychiatric inpatients may display more aggression than forensic inpatients. However, there is a lack of research comparing these groups on the incident severity, even though both frequency and severity of aggression influence the impact on staff members. The purpose of this study is to compare the frequency and severity of inpatient aggression caused by forensic and civil psychiatric inpatients in the same Dutch forensic psychiatric hospital. Data on aggressive incidents occurring between January 1, 2014, and December 31, 2017, were gathered from hospital files and analyzed using the Modified Overt Aggression Scale, including sexual aggression (MOAS+). Multilevel random intercept models were used to analyze differences between forensic and civil psychiatric patients in severity of aggressive incidents. In all, 3,603 aggressive incidents were recorded, caused by 344 different patients. Civil psychiatric patients caused more aggressive incidents than forensic patients and female patients caused more inpatient aggression compared with male patients. Female forensic patients were found to cause the most severe incidents, followed by female civil psychiatric patients. Male forensic patients caused the least severe incidents. The findings have important clinical implications, such as corroborating the need for an intensive treatment program for aggressive and disruptive civil psychiatric patients, as well as emphasizing the importance of gender-responsive treatment
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Indecent exposure is often regarded as a nuisance offense and detailed studies into this topic are relatively rare. However, there is consensus that relatively high recidivism rates and risk of escalation to more severe offenses can be of serious concern among these perpetrators. This cohort study aims to increase our general knowledge on the basic characteristics of these offenses and includes all registered police cases of indecent exposure in the Netherlands between 2012 and 2020, including 6741 incidents, involving 4663 suspects and 3808 registered victims. This first study of a large cohort over a long period of time describes the basic characteristics of these incidents, the perpetrators and their victims, and visualizes the results to explore trends over time. Results show that a modal indecent exposure incident is perpetrated by a 25-year-old male, on foot, on a public road, on a Wednesday afternoon in July, masturbating and directing his genitals intentionally toward a 13-year-old girl. The age distribution of victims shows remarkable similarity to victims of sexual assault. Compared to the first year of the period studied, the number of annually reported incidents gradually declined to half in the last year of the study. Findings are discussed in light of the most prominent theories on exhibitionism. Issues and suggestions relevant to apprehension and treatment of perpetrators are identified and discussed.
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BACKGROUND: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
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