text:
Some algebra and geometry for hierarchical models, applied to diagnostics
Version of Record online: 6 JAN 2002
1998 Royal Statistical Society
Journal of the Royal Statistical Society: Series B (Statistical Methodology)
Volume 60, Issue 3, pages 497–536, 1998
Additional Information
How to Cite
Hodges, J. S. (1998), Some algebra and geometry for hierarchical models, applied to diagnostics. Journal of the Royal Statistical Society: Series B (Statistical Methodology), 60: 497–536. doi: 10.1111/1467-9868.00137
Publication History
- Issue online: 6 JAN 2002
- Version of Record online: 6 JAN 2002
- Abstract
- Cited By
- Bayesian methods;
- Dynamic linear models;
- Multilevel models;
- Random-effect models;
- Spatial data;
- Time varying regression;
- Variance components
Recent advances in computing make it practical to use complex hierarchical models. However, the complexity makes it difficult to see how features of the data determine the fitted model. This paper describes an approach to diagnostics for hierarchical models, specifically linear hierarchical models with additive normal or t-errors. The key is to express hierarchical models in the form of ordinary linear models by adding artificial `cases' to the data set corresponding to the higher levels of the hierarchy. The error term of this linear model is not homoscedastic, but its covariance structure is much simpler than that usually used in variance component or random effects models. The re-expression has several advantages. First, it is extremely general, covering dynamic linear models, random effect and mixed effect models, and pairwise difference models, among others. Second, it makes more explicit the geometry of hierarchical models, by analogy with the geometry of linear models. Third, the analogy with linear models provides a rich source of ideas for diagnostics for all the parts of hierarchical models. This paper gives diagnostics to examine candidate added variables, transformations, collinearity, case influence and residuals.


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Posted: 7/28/2015
Chris b
You are clearly from the class there is in session now.my question is to you now that you have a few weeks left why did you stay? N tell me why you don't use your real name on here, I know that there is no Chris b in the lpn program. Is th school at times disfunctional and unorganised yes. But my question is why are you still there? If it is so awful why set there in the back of the room still? Why didn't you go somewhere else?


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2011-08-26 16:36:00
The search for a new Redmond Municipal Airport Manager begins round three. Mayor George Endicott says it's a very difficult process, getting the right person for the job: "Well, there's a few things. One, of course, they have to be technically competent on all the FAA rules and TSA, because we are a commercial airport. Then we have the general aviation side, you know the private pilots, so the person has to be able to deal with those folks. And then third, there's a lot of undeveloped land out there that we want developed, so you need someone that also has a business development acumen." Endicott says the candidate also has to get along with everyone else in the city, because they are part of the team. He says they have decided to hire a consultant to find other candidates for the position. He adds that Carrie Novick will stay on the job until they find her replacement.
King Solomon Lane closed between Ferguson Road and King David. (7/25)
Jones Road closed between Butler Market Road and Bennington Lane. (8/18)
Round-About Construction:
Murphy Road and Parrell Road closed with detours. (9/30)
Powell Butte Highway at Neff and Alfalfa Market Roads (8/31)
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Dead pixel group or what? (5D3)
Started May 7, 2014 | Discussions thread
Shop cameras & lenses ▾
Shift7 • Junior Member • Posts: 29
Dead pixel group or what? (5D3)
May 7, 2014
I have 5D3 which has quite big black spot on sensor. Tried to clean it, but it won't gave up. It evenly appears on F1.2 aperature, so I don't think that it is dust.
Maybe I can get rid of it somehow? See below image. One is sized to pixel size, so there is ±10 pixels which has variuos colour.
Maybe someone also had this problem?
Shift7's gear list:Shift7's gear list
Canon EOS-1Ds Mark III
Canon EOS 5D Mark III
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Blog: Night on the beers
Chris Brook-Carter | 25 September 2003
There is still plenty of work to be done, particularly in the US, which group marketing director Mark Sherrington called the company's "first and probably second, third and fourth priority". And SABMiller has yet to successfully convince it can turn any one of Miller, Peroni or Urquell from "global potential" into world-beater to rival the likes of Heineken or Budweiser.
But on a local level, the group - particularly in emerging markets - continues to lead the way. This understanding of the emerging markets was demonstrated in an interesting case study on its Polish acquisition Tyskie, which it bought in 1997. In that time SABMiller has taken the brand from a local player in the South of Poland, with only a 10.6% share of the Polish market, to the largest beer brand in Central and Eastern Europe, with a growth of 24%.
This weekend sees yet another "International Day" for a drinks category. Lucky us. Anyway, ahead of Sunday's International Cachaça Day, here's a wealth of information on Brazil's national spirit, cour...
The Coca-Cola Co's downward trajectory
In yet one more sign that The Coca-Cola Co is losing its lustre, the soft drinks maker has, for the first time, fallen out of the top ten of a 'world's biggest brands' ranking....
What a week for stats! Yesterday, the Beverage Marketing Corporation released figures to show the bottled water market had more than doubled over the past 15 years in the US....
Footy or beer? No, you can't have both
The Euro 2016 football tournament is almost upon us....
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Civil disobedience over potential 1/2-cent sales tax
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Vista Ridge High School
6888 Black Forest Road, Colorado Springs, CO 80923
Phone: 719.494.8800 Fax: 719.494.8838 Web Site
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You can make a solid case for Vista Ridge as the 4A Boys team that did the most to improve their standing 2015 to 2016, but there's another very strong case to be made...
Ben Kelley reveals some of the excitement of an approaching finish line with nobody close. Photo by Alan Versaw.
If you look closely at 4A Boys discus, it's not difficult to see the potential for a lot of points up and a lot of points down for some key contending teams. George...
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Unabridged audio CD; approximately 4 hours 58 minutes; 5 CDs; performed by Van Tracy.
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Publication Date: 2013
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Impact comes from influence, says leadership expert John C. Maxwell, and influence can be earned.
How to Influence People is a coachs playbook, a pastors guide, and a parents lifeline. From manager to teacher, salesperson to CEO, the ability to cultivate and direct influence is indispensable. In fact, you will find that learning to positively influence those around you is the only way to achieve real success in the many spheres of your complex life.
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Fun Stuff For Animal Lovers - PetsLady.com
Bored? Want more fun in your life?
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I'll Hug You To Death! The Animal Video Of The Day!!!by John P. Barker
Have you ever had that one aunt that you've not seen in a long time, and she gives you a hug that is so intense that you are worried you will pass out? If you recall that sensation, multiply it by 100 for what this cat must be feeling...
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Just because it is National Hug Your Cat Day doesn't mean that all cats want to be hugged. This fun Hug Me and Die T-Shirt will advertise your cat's aversion to such human displays of emotion.
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Recent Articles
Sometimes you have to ignore what your parents told you
Well, maybe ignore is a bit strong…
One of the recurring themes from my childhood was the not-infrequent exhortation from my mother: Don't go looking for trouble (probably not an uncommon theme for everyone out there in the studio audience). But one of the more common themes that I've been running into are those instances in which trouble was lurking in the weeds, but folks weren't necessarily successful in identifying/locating trouble spots. As near as I can tell, the worst thing that can happen during a survey (from a safety perspective) is when a surveyor identifies a condition or a practice about which you had no clue. It doesn't happen a lot, but it does happen (usually followed by "Wow, I didn't know that").
There are a number of reasons for such a happenstance—sometimes folks really don't know about something (though, dear reader, you are probably not in that number as we discuss a whole bunch of esoteric stuff). For instance, I still get a lot of folks who (and I have to believe that they are being completely candid) don't know that hand sanitizer expires (or medicated lotion soap…or disinfectant wipes) or they are supremely confident that that is someone else's concern (usually EVS when it comes to the many soaps, sanitizers, and disinfectants that populate the healthcare landscape). To my mind, it all goes back to the role of point of care/point of service folks (and I give the caregivers equal billing/accountability with the service-givers on this count) in being able to identify and report or otherwise manage risks in the physical environment.
But we as safety professionals have to be wicked diligent (as I pen this, it's the day after the Boston Marathon, so that's my gratuitous reference to Boston cultchah) in really working to ferret out all these little foibles, imperfections, etc. I think I've said this before in this forum (and no doubt will again), but whichever regulatory survey team shows up at your front/back/side door, they are going to find "stuff"—the human condition does not easily attain perfection, which leaves us vulnerable, vulnerable, vulnerable.
I recognize that everyone is stretched for time—too many meetings, too many spreadsheets, too many "too manys" to count—which only serves to "push" the maximization of the not-enough's (not enough time, not enough resources, not enough support) in this adventure. Think of it as a challenge—there are folks out there doing stuff you would rather they not do—sometimes you only see the result (damaged walls and doors, unsealed penetrations, spills, thrills, chills) and we all have to be more effective in keeping on top of things.
Past lessons learned are a wonderful thing, but sometimes you have to go at things a little differently, so go out there and find some trouble spots. You'll be glad you did!
If starboard is to port, does that make starboardal the opposite of portal?
Eventually, I will run out of these, but hopefully not before the EC portal is perfectly populated and otherwise polished off…
Late last week brought the announcement of new material being posted to The Joint Commission's Environment of Care portal, this month's offering focusing on those pesky compliance issues relating to ensuring that building and fire protection features are designed and maintained to minimize the effects of fire, smoke, and heat. The performance elements chosen for additional coverage relate to unprotected openings in fire-rated walls and floors (Can you say "penetrations"? I thought you could!); fire doors have functioning hardware—positive latching, self- or auto-closing—and compliant gaps and undercuts; and making sure that openings in 2-hour fire-rated walls are rated for 1.5 hours.
I guess when it comes down to the perennial survey findings, after egress-related issues, the construction and maintenance of fire-rated barriers is something akin to an old friend. Depending on how many of these puppies (rated barriers—walls and floors; and fire doors), the likelihood of there being some sort of imperfection is fairly good, and since the Life Safety portion of the survey process devotes so much more time (than in the old days) to the inspection of these locations, I can't say that it's an overwhelming shock that those imperfections are being identified during the survey process. Interestingly enough, at least at the moment, there is no component of the new posting aimed at the organizational leadership element (yes, Virginia, there is no fireside chat this month on this topic) and the information on the portal page (say that 10 times fast) is a wee bit to the sparse end of the spectrum (there are a couple of links to the Joint Commission Resources webpage for some free downloads), though there is an "example of improved compliance" that provides a flowchart representation of the importance of barrier management as a function of protecting patients (and allowing for evacuation to exist as a last resort). I don't know, it just seems like there's something missing from this month's update. (Mention of the BMP springs to mind. The spirit is represented in the free downloads—a pair of articles from EC News back in 2012, but no specific mention). I suppose one could make the case that there's not a whole heck of a lot to be said about the practical aspects about maintaining rated assemblies, inclusive of walls, floors, doors, etc. Again, perfection for these life safety features is most elusive and often fleeting. So the question becomes: how do you "capture" these deficiencies as close to their genesis as you can?
One favorite concept of mine (and it gets a mention in the free downloads) is the bounty system as a function of your permitting process—I think (in case you really hadn't noticed) that anything we can do to enlist the active participation of point of care/point of service staff in these activities—and what better way than to make a game of it? I guess it all comes down to a mix of reinforcing positive behaviors (for frontline staff who identify the miscreants without permits in return for cash and prizes—okay, maybe not so much) and discouraging negative behaviors (by giving the unpermitted miscreants the boot to give them time to ponder their wicked ways). I've never had the opportunity to actually operationalize an above the ceiling bounty system. Anyone out there have any success stories they could share? Or, indeed, if you have stories about bounty programs that didn't quite make the mark, those are always worth sharing.
Not a really banger of a portal update this month (I wonder if the number of findings have been reduced yet—it will be interesting to see what type of impact the portal has on the number and nature of findings…), but I guess you can't hit a home run at every at bat. Play ball!
What is it they say about the best-laid plans? A chortle-free, portal-free zone!
Well, I don't know that I'm disappointed, per se, but I was expecting The Joint Commission to add something new to its physical environment portal, but that appears not to be the case. I guess this calls for an extended drum roll…
But that's not to say that our friends in Chicago have not been busy—anything but. In fact, it's been quite a preponderance of stuff this past few days, starting with the 2015 Top 5 most-cited standards. Anyone who bet the under on findings in the physical environment came up a bit short, but surely that can't be very much of a surprise. We've covered the particulars pretty much ad nauseum, but if there's anybody out there in the studio audience that has any specific questions regarding our top 5, I would be happy to do so again.
So we have the following:
EC.02.06.01—Maintaining a safe environment
IC.02.02.01—Reducing infection risk associated with equipment, devices. and supplies
EC.02.05.01—Managing utility system risks
LS.02.01.20—Maintaining egress integrity
LS.02.01.30—Building features provided and maintained to protect from fire and smoke hazards
I suppose a wee bit of shifting in terms of the order of things, but I can't say that there are any "shockahs" (after all, I am from Bawston) in the mix. Again, if someone has something specific they'd like me to discuss, I would be more than happy to do exactly that. Check out the online stuff; alternatively, you can also refer to the April edition of Perspectives.
But wait, there's more…
We also have some new/updated resources for Life Safety Code® compliance, including guidance on how the facility tour is going to be administered, a comprehensive list of documents that would be included in the survey process, information regarding PFI change and equivalency requests, and a bunch of other stuff. You can find all this information online. Something tells me that, at some point, you may be able to link to all this stuff from the Portal (if that is not already the case, that's what I would do).
And, to finish off a big week of new information, there is a new posting to help the Emergency Management cause. Namely, some resources having to do with the management of active shooter incidents, etc., featuring the joint resource for healthcare providers issued by the Departments of Homeland Security and Health and Human Services to assist with situational awareness and preparedness in the aftermath of the terrorist attacks in Brussels. The focus/intent being to use recent events as an opportunity to reinforce the importance of vigilance and security in our organizations. It is certainly an area for some concern (and, as always, an area of opportunity) and I think that it is very likely that this will continue to be a big piece of the survey puzzle when it comes to emergency management. The risks associated with acts of violence appear to be relatively unabated in society at large and it comes back to the healthcare safety and security professionals to ensure that our organizations are appropriately managing those risks to the extent possible and working towards an emergency response capability that keeps folks safe.
That's the wrap-up for this week; not sure if any fireside chats are looming close on the horizon, but rest assured, we will keep you apprised of any and all portal-related activity.
Welcome Spring!
What is the most dangerous place in your organization?
If you asked a dog the question in the title above, would it say, "Woof"? (Though some might say kitchen…I sometimes do.)
I've been encountering a fair number of roof-related opportunities and I wanted to give the topic an airing. I'm not entirely certain what prompted my thinking about rooftops (it's way beyond Christmas), but I can say that I've encountered a bit of a run on unsecured roof hatches/access doors in hospitals (and hotels, too—I suppose I spend as much time in hotels as I do in hospitals—a certain inescapable logic coming into play on that count).
I will admit that I'm no fan of hatches from a practical standpoint (being rather stout and not particularly tall in the physique department), but I'm kind of surprised at the number I've encountered that are not secured (and I'm not talking about something that's sort of secured, though I've seen some not-particularly-well-secured hatches as well). I know it's important for Facilities/Plant Ops staff to have access to roofs, as well as emergency responders, but leaving these types of locations without any security seems way beyond a reasonable strategy. We're certainly no stranger to the stories of patients wandering off (and I suppose you can't always predict who might be prone to wandering) and I don't know that I would want to hang my hat on the "remote" likelihood of someone "stumbling" on to an unsecured roof hatch, so I would ask you to please be attentive to the hatches and "batten them down" if they should have any level of uncontrolled access.
But just so we're clear, it goes beyond hatches. It is of critical importance that you have a very hardened perimeter for all your roof areas. I don't know how many times I've found propped, unattended doors because someone didn't feel comfortable "trusting" a vendor (e.g., window washers) with the key to the access door. And I think it is a very well-established truism that doors for which folks do not have keys tend to get propped (I bet we could distill that into some sort of mathematical equation) and the likelihood of the propping is in proportion (I'm guessing inverse, but maybe not) to the risks of leaving that door unsecured. It may even be worth considering having roof access doors and hatches on your "Elvis" list (i.e., that list of critical things to check when you know you've got surveyors in the building—oxygen cylinders, corridor clutter, etc.). It's all part of making absolutely sure that no one is inadvertently put at risk (I don't believe that folks would purposefully leave a roof door unsecured and unattended—and I hope there's no one out there to challenge that belief with a real life example).
Finally, don't forget about fall protection for the folks you allow on the roof, particularly if you have minimal or no parapets. Interestingly enough, our good friends at the Occupational Safety & Health Administration have a few choice thoughts regarding fall protection; you can start that journey here. Even if it's somebody working for a contractor, if you have a fall, your organization is likely to be mentioned as prominently as the contractor—and if you ask me, that's no way to get on the front page of the local newspaper. So, the secret word for the week is "protection": protection of patients, protection of staff, protection of contractors—it's all part of the mix.
Next up (unless my calendar is lying to me), we should have another fabulous edition of Portal Chortling, with perhaps a side of Fireside Chat. Stay tuned!
The physics of compliance: If you have no friction, you likely have no traction
Or those wheels are going to be slipping all over the place…
This week's offering is a little bit towards the random musings category, so hang on tight!
Friction vs. traction: I think that just about everyone in the safety community has experienced some level of pushback when they've tried to enact some change of process/expectation/behaviors to enhance the safety of their organization. And in so doing, you've discovered that the healthcare culture really does embrace change—it grabs change by the throat, throws it on the ground, and kicks it until it stops moving. This usually comes down to the classic "I've worked here for umpty-ump years and it's never been a problem before," etc., and while it doesn't always seem so helpful in the moment, it does give you something in the way of useful feedback—they've actually noticed what you're trying to do. For example, I can recall a time when the thought of physicians actually wearing ID badges seemed like a fantasy. And yet, as we speak, it is actually happening in a whole bunch of places (maybe not as much as we would like, but you've got to start somewhere). Now admittedly, a lot of the move towards the use of ID badges comes down to the proliferation of access control technology, the end result is that compliance became more convenient (in the ongoing battle between convenience and compliance, all too often convenience kicks compliance's tailbone).
I would ask you to think about those stubborn deficiencies/behaviors that are perennially on your "needs attention" list and look at whether compliance is sufficiently convenient or has the operationalization of a compliance activity, say, the segregation of full and not full compressed gas cylinders, resulted in a process so complicated that it does not encourage compliance. In this case, I would say that more than 50% of the instances in which I find partially full or empty cylinders in the rack designated for full cylinders is because the racks for the "not full" cylinders were jammed with empties or partials and the only place left to safely store (remember, we've been nagging folks for about a decade on the proper storage of cylinders) the partial or empty cylinder is in the full rack. Perhaps the question that needs to be asked is whether there is enough space for the partial/empty cylinders; you can usually control the number of full cylinders being provided, but the number of partial/empties can ebb and flow over the course of a shift, a day, even over a week. I know it's tough to get folks to own up to having put a cylinder in the wrong place (or damaged a wall, but that's for another day), but I am fascinated by the action that results in someone doing something that they know they are not supposed to do. By the way, this is based on my firm belief that we've done enough education on this subject—and I would like to believe that the education that we've provided is sufficiently effective to at least get the message across. In looking at the misfiled cylinder as a failure mode—what happened in the process to result in the cylinder being in the wrong place. I can't imagine that it's being done purposely (it happens way too often—if it's purposeful, we might just as well give up), but there has to be something we can discern from these instances/practices that we can use to encourage compliance—make it more convenient, as it were. So, don't be afraid of a little friction as you pull these stubborn compliance issues apart. If things go too smoothly, there's probably a workaround lurking somewhere in the background. Remember, it's taking the path of "least resistance," not "no resistance."
The other random musing for the week is for those of you that may be in the middle of your post-survey process; be very judicious when you are creating your corrective actions plans. All too often, I see folks that have way overcommitted on their corrective action plans. Look very carefully at what the standard or performance element is actually requiring you to do and try to pick the route to compliance that work best operationally (meaning choose strategies that encourage compliance without overwhelming the participants—this is an analogue of the eternal question of how to eat an elephant). Don't commit to daily activities if you can get where you need to be by doing it weekly; don't commit to weekly if you can get where you need to be by doing it every other week; and so on. Also, I would advise trying to stay away from activities that don't make sense—operationally, logically, etc. I tend to say that logic doesn't always prevail, but I reserve that for direct dealings with regulatory surveyors. Once the surveyors are on their way, take the compliance results as data to make improvements—and focus on determining how you'll measure those improvements. It puts you in a much better position to avoid those findings in the future (and at some point, the regulatory folks are no doubt going to get ugly when it comes to repeat offenses). As with so many things in the safety and compliance realm: this is a journey, not a destination. And on that quasi-Zen note, I bid you a safe week!
A most mortal portal: Yes, Virginia, you need to have an inventory of your devices…all of 'em
And so, the flying fickle finger of compliance finally points portally (via The Joint Commission's Physical Environment Portal) in the direction of that most troublesome of standards, EC.02.03.05, and we return once again to the fireside of our intrepid duo, Messrs. George Mills of The Joint Commission and Dale Woodin of ASHE. There are two videos, one for the facilities audience and one for leadership (does anyone else find it fascinating that the duo dons neckwear for the leadership video?).
While I don't want to engage in revealing any spoilers, in the video, EC.02.03.05 is described as being "most prescriptive" and "frustrating" and also notes that Mr. Mills has taken some pains to "tear apart" the standard in past "Clarifications and Expectations" columns in Joint Commission Perspectives. Yet, yet, yet, approximately 40% of hospitals continue to get cited for deficiencies relative to the myriad components represented in this standard. I personally would love to see how this actually breaks down in terms of which of the 20+ performance elements are the most problematic (I can't imagine that there are some that "float" to the top more than any others), but the video does seem to indicate what the "problems" are:
- You have to have an inventory, by location, of each device class, meaning smoke detectors, heat detectors, pull stations, HVAC shutdown devices, water flows, tamper switches, fire extinguishers, etc. It seems to me that back in the day, there was a reluctance on the part of our Chicagoan friends to actually say the words that would indicate the need for an inventory. But it all comes down (or back—I think I've beaten this particular breathless equine once or twice in the past) to knowing that you inspected, tested, maintained, each device in the fire alarm system. So if you (or your vendor's documentation) do not specifically indicate that each device was demonstrably inspected, tested, maintained, then (buzzer sound): you lose!
- The documentation has to be available "upon request", so really, if you can't produce the current documentation PDQ, then (buzzer sound): you lose! You can only get credit for those inspection, testing and maintenance activities for which you have available documentation—if you didn't document it, you didn't do it. Period. End of story.
Now I certainly recognize that a combination of findings under EC.02.03.05 would drive a finding under the Leadership standards (to be exact, LD.04.01.05 EP 4), based on past survey reports. But apparently there is indeed a magic number of EC.02.03.05 EP findings that will result in the Leadership finding—three or more EPs out of compliance, then (bell rings): you win a discussion with your boss as to how you allowed (and I'm using that term in its most pejorative sense) such a thing to happen. At that point, for example, it is way too late to admit that the fire alarm and sprinkler testing vendors have not given you very useful reports (and something tells me that that particular conversation is not as rare as it ought to be). From watching the video (and in providing a neckwear-enhanced video specifically for your organization' s leaders and Mr. Mills indicates he had to edumacate his bosses too—we are not alone), there is a very clear expectation that you, the facility/safety professional, will make the effort to proactive communicate with your boss, particularly if you are experiencing service issues, etc., in getting these activities under control. You can certainly make the case that the protection of the entire organization can be compromised if your fire alarm and sprinkler systems are not appropriately maintained, so, really, any infrastructure concerns should be communicated in a timely fashion to the leadership of each organization to ensure that appropriate resources are allocated on an ongoing basis to make sure everything stays on an even keel.
At any rate, our duo takes great pains to point out that none of this stuff is new (the "seed" documents from NFPA 72, 25 and the like having been penned way back in the 20th century), but I do feel that the methodology for surveying has evolved/mutated over time. I mean, if it were really that simple, wouldn't this go away? They also point out that ASHE has a fair amount of information to assist you in your compliance efforts (ASHE Focus on Compliance: you can be especially warm for their forms) and there's even a PowerPoint presentation that The Joint Commission uses at the EC Base Camp presentations (you can link to the presentation on the left hand side of the portal page), which gives it the power of the Quadruple P—Portal PowerPoint Presentation! Ultimately, you've got to keep a really close eye on this stuff, aside from product expiration dates, the management of the various and sundry elements of EC.02.03.05 is among the most voluminous in sheer numbers—that's a lot of spheres to keep up in the air—and you only have to drop a couple to earn that lovely chat with your boss. I am absolutely convinced we can make it happen, so let's see what we can do to retire EC.02.03.05 from the top 10. (Or 20…wouldn't that be a fine thing?)
So many FSAs, so little time…and all we get is MBW
Flexible Spending Account, Federal Student Aid, Food Services of America, Focused Standards Assessment.
So, I am forced to pick one. While I'm sure the lot of them is most estimable in many ways, I suppose the choice is clear: the freaking Focused Standards Assessment (kind of makes it an FFSA, or a double-F S A…what the…).
Just to refresh things a bit, the FSA is a requirement of the accreditation process in which a healthcare organization (I'm thinking that if you weren't in healthcare, you probably would be choosing one of the other FSAs) reviews its compliance with a selected batch of Joint Commission accreditation requirements. The selections include elements from the National Patient Safety Goals, some direct and indirect impact standards and performance elements, high-risk areas, as well as the RFIs from your last survey—and I know you've continued to "work" those Measures of Success from your last survey. Ostensibly, this is very much an "open book" test, if you will—a test you get to grade for yourself and one for which there is no requirement to share the results with the teacher (in this case, The Joint Commission—I really don't understand why folks submit their results to TJC, but some do—I guess some things are just beyond my ken…).
The overarching intent is to establish a process that enhances an organization's continuous survey readiness activities (of course, as I see various and sundry survey results, I can't help but think that the effectiveness of this process would be tough to quantify). I guess it's somewhat less invasive than the DNV annual consultative visits, though you could certainly bring in consultants to fulfill the role of surveyor for this process if some fresh eyes are what your organization needs to keep things moving on the accreditation front.
I will freely admit to getting hung up a bit on the efficacy of this as a process; much like the required management plans (an exercise in compliance), this process doesn't necessarily bring a lot of value to the table. Unless you actually conduct a thorough evaluation of the organization's compliance with the 45 Environment of Care performance elements, 13 Emergency Management performance elements, 23 Life Safety performance elements (15 for healthcare occupancies, eight for ambulatory healthcare occupancies)—and who really has the time for all that—then does the process have any value beyond MBW (more busy work)? I throw the question out to you folks—the process is required by TJC, so I don't want anyone to get in trouble for sharing—but if anyone has made good use of this process, I would be very interested in hearing all about it.
This is my last piece on the FSA process for the moment, unless folks are clamoring for something in particular. I had intended to list the EPs individually, but I think my best advice is for you to check them out for yourself. That said, I have a quick and dirty checklist of the required elements (minus the EP numbers, but those are kind of etched into my brain at this point). If you want a copy, just email me at firstname.lastname@example.com.
Brother, can you spare any change…
In the interest of time and space (it's about time, it's about space, it's about two men in the strangest place…), I'm going to chunk the EM and LS risk areas that are now specifically included in the Focused Standards Assessment (FSA) process (previously, the risk areas were only in the EC chapter). Next week, I want to take one more chunk of your time to discuss now the FSA process (particularly as a function of what EPs the folks in Chicago have identified as being of critical importance/status). But for the moment, here are the add-ons for 2016:
Emergency Management
- participation of organizational leadership, including medical staff, in emergency planning activities (you need to have a clear documentation trail)
- your HVA; (interesting that they've decided to include this one—they must have found enough folks that have let the HVA process languish)
- your documented EM inventory (I think it's important to have a very clear definition of what this means for your organization)
- participation of leadership, including medical staff, in development of the emergency operations plan (again, documentation trail is important)
- the written EOP itself (not sure about this addition—on the face of it, it doesn't necessarily make a lot of sense from a practical standpoint)
- the annual review of the HVA (my advice is to package an analysis of the HVA with the review of the EOP and inventory)
- annual review of the objectives and scope of the EOP
- annual review of the inventory
- reviewing activations of the EOP to ensure you have enough activations of the right type (important to define an influx exercise, as well as, a scenario for an event without community support)
- identification of deficiencies and opportunities during those activations—this means don't try to "sell" a surveyor an exercise in which nothing went awry—if the exercise is correctly administered, there will always, always, always be deficiencies and/or opportunities. If you don't come up with any improvements, the you have, for all intents and purposes, wasted your time… (Perhaps a little harsh, but I think you hear what I'm saying)
Life Safety
- Maintenance of documentation of any inspections and approvals made by state or local fire control agencies (I think you could make a case for having this information attached to the presentation of waivers, particularly if you have specific approvals from state or local AHJs that could be represented as waivers)
- Door locking arrangements (be on the lookout for thumb latches and deadbolts on egress doors—there is much frowning when these arrangements are encountered during survey)
- Protection of hazardous areas (I think this extends beyond making sure that the hazardous areas you've identified are properly maintained into the realm of patient spaces that are converted to combustible storage. I think at this point, we've all see some evidence of this. Be on the lookout!)
- Appropriate protection of your fire alarm control panel (for want of a smoke detector…)
- Appropriate availability of K-type fire extinguishers (this includes appropriate signage—that's been a fairly frequent flyer in surveys of late)
- Appropriate fire separations between healthcare and ambulatory healthcare occupancies (a simple thing to keep an eye on—or is it? You tell me…)
- Protection of hazardous areas in ambulatory healthcare occupancies (same as above)
- Protection of fire alarm control panels in ambulatory occupancies (same as above)
I would imagine that a fair amount of thought goes into deciding what to include in the FSA (and, in the aggregate, the number of EPs they want assessed in this process has gotten decidedly chunkier—I guess sometimes more is more), so next week we'll chat a bit about what it all means.
Plus ça change, plus c'est la même chose: Vive Le Joint Commission!
I apologize for not having gotten to this sooner, but sometimes the wind comes out of nowhere and you find yourself heading in a rather unexpected direction (I've never spent so much time in Texas!).
With the advent of each new year, our three-lettered friends in Chicago unveil the changes to the accreditation standards for the upcoming cycle. Most of the changes in the EC/LS/EM world (with a couple of fairly notable exceptions—more on those in a moment) have to do with a shift in focus for the Focused Standards Assessment (FSA) process as a function of the various specific risk areas (I will freely admit that this is a wee bit convoluted, but should not necessarily come as a surprise). At any rate, as part of the accreditation process, each organization is supposed to evaluate its compliance based on specific areas of concern/risk identified by The Joint Commission. Thus for 2016, some of the risks to be evaluated have gone away (at least for the moment) and other have been added to the mix:
Please remember: These are not going away entirely, they just don't have to be included in your organization's FSA process!
So, we bid adieu to specific analysis of the safety, hazardous materials, medical equipment, and utility systems management plans (leaving security and fire safety in the mix) and we say bonjour to the identification of safety and security risks (as you may have noted, I'm not indicating the specific standard and EP numbers—our friends get a little protective of their content, but if you really need to check out the numbers, please see your organization's accreditation manual).
We say goodbye to implementing our hazardous material and waste spill/exposure procedures, the monitoring of gases and vapors, and proper routine storage and prompt disposal of trash; and say hello to the hazardous materials and waste inventory, the actual written hazmat and waste spill/exposure procedures, minimization of hazmat risks, ensuring that you have proper permits, licenses, etc., for hazardous materials, and labeling of hazardous materials.
We say howdy to a focused look at fire drills, including the critiques.
We greet a focus on the testing documentation relating to duct detectors, electromechanical releasing devices, heat detectors, manual fire alarm boxes and smoke detectors, as well as the documentation relating to fire dampers.
We say auf wiedersehen to focusing on the selection, etc., of medical equipment, the written inventory of medical equipment, SMDA reporting, inspection, testing and maintenance of non-high risk medical equipment, and performance testing of all sterilizers.
We say guten tag to the written utility components inventory, written frequencies for maintenance, inspection and testing of utility system components, written procedures for utility system disruptions, and minimization of pathogenic, biological agents in aerosolizing water systems.
We say konichiwa to a focus on the provision of safe and suitable interior spaces for patients and the maintenance of ventilation, temperature and humidity in all those other pesky areas (e.g., soiled utility rooms, clean utility rooms, etc.).
We say hola to a focus on whether or not staff (including LIPs) are familiar with their roles and responsibilities relative to the environment of care (I predict that this is one is going to start showing up on the top 10 list soon unless there is a dramatic shift in survey focus).
And we say "Hey-diddly-ho, good neighbor" to the use of hazard surveillance rounds to identify environmental deficiencies, hazards, and unsafe hazards, as well as ensuring that you have a good mix of participants in your EC Committee activities, particularly the analysis of data—clinical, administrative, and support services have to be represented.
Now, there are three standards changes that went into effect on January 1, 2016: one a shift to a different spot in the standards, one a fairly clarifying clarification, and one about which I am not quite sure what to make, though I somehow fear the worst…
The requirement for the results of staff dosimetry monitoring (CT, PET, nuclear medicine) to be reviewed at least quarterly shift from Safety to Hazardous Materials. The EP number remains the same (and I can give you 17 reasons for that…), but it's only a shift in where it would be scored (another important reason for making sure that you have a solid relationship between your EOC Committee and your Radiation Safety Committee—I'm a great believer in having compliance information in a location where surveyors are more likely to encounter it: EOC Committee minutes).
The requirement for managing the risks associated with smoking activities was clarified to indicate that the risks have to be managed regardless of the smoking types (e-cigarettes and personal vaporizers are officially in the mix); I'm presuming that this is helpful to folks who have perhaps faced some resistance in this area.
And finally (we'll cover the EM and LS changes next time—nothing particularly scary, but a little too voluminous for this rather dauntingly wordy blog post), the requirements based around the inspection, testing and maintenance of non-high-risk utility system equipment components has gone from a "C" Element of Performance (EP) to an "A" EP (they did remove the Method of Success requirement for a deficient finding in this area—I suspect that was as much for their own sanity as anything else. Plus, it never really made a great deal of sense to figure out how to monitor something over four months' time that frequently occurs every six or 12 months). My sense is that they are making the change to increase the "cite-ability" of managing utility systems equipment; now they only need to find one instance of noncompliance for a finding. I don't know that I've seen a ton of findings in this area, but I can't honestly say that I've been doing a close count of the OFI section of the reports, so it may be that they're seeing a trend with the non-high-risk utility equipment that makes them think we're not doing as good a job managing as we should, but that is wholly and completely conjecture on my part. I will, of course, be keeping a close eye on this one; I have a sneaking suspicion that the focus on utility systems equipment is going to continue into the immediate future and this might just become another pressure point.
As a closing thought relative to the FSA and risk area discussion, I think we can reasonably intuit that (particularly since the FSA process, represents a process for self-reporting) the expectation is for folks to be looking very carefully at the requirements contained within the above-noted areas and that your compliance plans relative to those requirements will be well in hand come survey. For some reason, this shift "smells" like an approach that's going to be that much more focused on organizational leadership when there are gaps (and ask anyone who's had a bumpy survey these past couple of years—leadership gets dragged into the fray on a regular basis). The fact of the matter is that they will find something deficient in your facility—if they don't, they didn't look hard enough. It's about having processes in place to recognize and manage those deficiencies appropriately (and yes, I recognize that I am running the risk of repeating myself). This is big-time crazy focus on this stuff—and we need to be continuously improving how we go about doing it (whatever "it" might be).
Back next week to cover the EM/LS stuff. Arrivederci for now!
This American Hospital: HAIs resulting from exposure to lead
As I think I've mentioned in the past, I listen to a fair amount of public radio when I'm in the car, and this past Saturday, I stumbled (I've found that my errands don't always coincide with the start and end of programs—thank the gods of radio for podcasts and other forms of re-broadcast) into the middle of a story that I found quite compelling. The program itself is called This American Life and emanates from WBEZ in Chicago; the nominal purpose of the program is to provide a forum for the airing of stories about (natch!) This American Life, which allows it to cover a lot of ground. I always find the stories pretty interesting/compelling, etc., but this past weekend's episode really got me thinking about the ongoing struggles faced by hospitals as they try to balance security, workplace violence management, the management of behavioral health patients, education of staff in being able to effectively manage crisis situations, etc. Basically, the whole gamut of issues relating to the continuing disenfranchisement of the behavioral health patient community. There are some places that do pretty well with this, but I think the opportunities to do better far outweigh the improvements made so far (that's as close to editorializing as I'm going to do for the moment).
As I think about it, while Joint Commission compliance is probably THE hot button item when it comes to the management of risks and conditions in the physical environment, I truly believe that, at least for the folks who are typically responsible for managing the physical environment, this topic is by far the more complicated—very much in line with the prevention of healthcare-acquired infections—and, interestingly enough, there can be a crossover, but more on that in a moment.
The story deals with a "delusional" (my quotes) patient who, in the course of his stay in a hospital (you can find out a lot of the details by listening to the episode, which can be found here) encountered a situation in which he did indeed contract an HAI because of an exposure to lead, namely a bullet fired by a police officer in this patient's hospital room. Now (trying not to sound too old), back in my days of operational responsibility, I have overseen dealings with behavioral health patients, on-duty police officers discharging their weapons in the ED, folks injured as a result of physical encounters with patients, etc. But I have to tell you (and at least some of this is the power of the storytelling in conjunction with the story being told), the sequence outlined in the episode is about as harrowing as you could imagine: not very good decisions are made and sustained; family members are perhaps not embraced as a source of useful information (I'm trying to avoid more editorializing—but tell me the story doesn't ring some bells with you, particularly if you've had operational responsibility for security), staff are perhaps not as well-prepared as they might otherwise be—a real cluster of ugliness.
I know things are never as cut and dried as they seem to be in the aftermath; you might find the "official" response from the hospital a little curious (I did as well, but I understood the forces in play—sounds like there might still be some lingering litigation), but this type of confluence of events is all too easy to imagine. I think it's definitely in the best interests for the safety/security community to advocate for the management of these types of patients based on the underlying causes (mental illness, behavioral health issues) and not just a panicked response to the symptoms. Yes, we will always have that quotient of patients who are just [insert epithet of your choice here]. But safe care can't be sacrificed in the rush—safe for the patients, safe for the staff.


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Started when they were packed with snow and I forced them.
01 saturn sedan wipers wont go down all the way when off on 2001 Saturn SL
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Price: high > low
Babies for Sale in Baraboo, WI(1 - 4 of 4)
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associate recruiter jobs
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GEICO - Indianapolis, IN
Ask a recruiter for more details. Our insurance sales associates take inbound sales calls from highly interested potential policyholders....
Civil Engineer
Van Cleef Engineering Associates - Bethlehem, PA
No phone calls or recruiter or agency inquiries. Van Cleef Engineering Associates (VCEA) is a mid-size consulting civil engineering firm with offices in New...
Structural/Bridge Engineer
Van Cleef Engineering Associates / Cherry Weber & Associates - Freehold, NJ
Cherry, Weber and Associates (a wholly owned subsidiary of Van Cleef Engineering Associates) currently has a position available in the Freehold, New Jersey...
Sales Executive - IT Services - Columbus, OH Area
Paradigm Computer Consulting - Columbus, OH
Paradigm Computer Consulting, Inc. a leading IT solutions founded in 1994, has an exciting career opportunity in our Columbus office for a highly motivated...
Litigation Associate (3+ years min)
Medical Malpractice Defense Law Firm - Las Vegas, NV
Come be a part of a growing law firm with diverse practice areas which seeks a bright, experienced Litigation Associate to join its Las Vegas office....
Highway Engineer
Cherry, Weber & Associates - Freehold, NJ
Douglas Cherry & Associates, Cherry, Weber & Associates is a wholly owned subsidiary of Van Cleef Engineering Associates and has as its primary focus in...
Forklift Driver/Warehouse Associate
The New Haven Companies Inc. (New Haven Moving Equipment) San Fernando CA - San Fernando, CA
Recruiters, please don't contact this job poster. Warehouse Associate/Forklift Operator (SAN FERNANDO)....
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Convergys - Appleton, WI
RECRUITER ENTER THE APPLICABLE LANGUAGE:. The Customer Support Associate I position interfaces with customers via inbound calls, outbound calls, or through the...
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Recruiters, please don't contact this job poster.Do NOT contact us with unsolicited services or offers.Required experience:....
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Recruiters, please do not contact this job poster. Ability to help lead and develop a team, creating a positive work environment, training and providing...


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Chicago, ILUSA
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Are you interested in exploring the great cultural events that are available in Chicago and the surrounding area? Have you missed one too many exhibits because you were trying to find someone to attend with and share the experience. Let's seek out the interesting and unique exhibits at the major museums and also explore some of the museums and exhibits that are off the beaten path.
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of course it is. the fact that a woman has a legal right to choose is not opinion. however, whether or not you agree and support or disgaree with that legal right "is" your opinion. there is no getting around that. your spinning notwithstanding.<quoted text>
My pro-choice position is not opinion.
you said your personal opinion regarding abortion or any of the choices available would not make any difference to a woman making her own choice.I never said it was relevant to any woman. I said it is relevant to this debate. My personal opinion regarding the choices, is not relevant to the debate.
"What possible difference could it make to any woman making her own choice how I feel about any of it?"
tell me again what you "never" said.
as long as you're responding, i'm manipulating.You're not manipulating anyone. In fact, it's YOU who is being ridiculous. And childish.
Enjoy your impotence.
what i can't manipulate is a coward like you into answering the question posed, pusillanimous one.


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Watch for proposals that are positioned as 'pro-business,' such as lowering statutory tax rates or modifying state apportionment formulas to favor instate businesses.
What does STR stand for?
STR stands for Statutory Tax Rate
This definition appears very rarely and is found in the following Acronym Finder categories:
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[FIGURE B OMITTED] Distribution of Returns and Income Across Taxable Income Brackets In this section, the total amount of each type of income is disaggregated into cells defined by the statutory tax rate brackets (corporate statutory income tax brackets are provided for reference in Figure C).
6% (1) Net of tax, calculated utilizing the federal statutory tax rate of 35% (2) Net of tax, calculated utilizing the UK statutory tax rate in effect in Q2 2010 of 28% (3) Net debt is defined as total debt less cash and cash equivalents and is calculated using a 2-point average (4) Calculated using a 2-point average SOURCE Raytheon Company
For example, if you were looking to move to Brazil the low statutory tax rate could be considered a welcome reward, yet the higher overall tax burden should be evaluated alongside other potential risks.
The "cumulative incremental" compensation expense disclosed during the same period, multiplied by the company's current blended statutory tax rate when it adopts Statement no.
[ILLUSTRATION OMITTED] The United States has tax treaties with many countries, which may reduce the statutory tax rate for income paid to U.
The United States has tax treaties with many countries, which generally will reduce the statutory tax rate for income paid to U.
Based on the statutory tax rate that each state imposes.


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Check BNN and Bulbanews for up-to-date Pokémon news and discuss it on the forums or in our IRC channel #bulbagarden on irc.systemnet.info.
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Cleveland Cavaliers parade
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£3,000 reward after dog was stabbed during burglary
A Cumbrian businessman is offering a £3,000 reward for information after his pet dog was stabbed and left for dead by would-be burglar.
A Cumbrian businessman is offering a £3,000 reward for information after his pet dog was stabbed and left for dead by would-be burglar.
A dog who was stabbed during a robbery is 'lucky to be alive' according to her vet.
13-year-old Sky was attacked at the garden centre where she lives with her owner, Peter Scott.
But her vet says things could have been very different:
"It appears to have been something that has been relatively blunt that's been stabbed in at the chest. I'm guessing she's been jumping up at somebody and they've stabbed in. We think probably a jemmy bar or a crow bar, we can't say for certain. It's not a knife would, it's something sharp enough but still fairly blunt.
"Fortunately there's a breast bone in front. If it had been either side, if she hadn't come up mid-line, it might have gone through into the chest cavity and that would have been it. She wouldn't have made it basically."
A 34-year-old man has been jailed for 16 months, for possessing the most serious class of child porn - with some victims aged two-years-old.
A family from Dumfries say their lives have been turned upside down due to a number of failings made by staff in Ward 7 at DGRI.
Sunshine and showers on Saturday, occasionally heavy with thunder. Better day Sunday


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Bowling Grn Jobs
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Tommy John to Have Miguel Sano Surgery
Tommy John's worst fears came true this weekend.
The highly-retired former pitcher has a tear in his U.S. work visa and will need Miguel Sano surgery. John will fly to the Dominican Republic this week to undergo a study of his bones in order to determine his true age.
John was injured while walking to an AARP meeting.
It's a bummer for canasta fans who can't wait for John to return to his place at the table in between two other 70-year-old former athletes.
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But with repairs completed on Annfield Park and others due on Old Wrexham Road, I am pleased the council are finally taking action.
What does RECOMP stand for?
RECOMP stands for Repairs Completed
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Samples in periodicals archive:
The statement said there had been a steady increase in the actual values of repairs completed on each vessel and the final revenue figures could cross $143 million.
The Toolbox uses existing repair knowledge and a database of repair history records can be searched for similar repairs on other aircraft in the fleet, or repairs completed on a specific area of the aircraft.
2 million masonry facade restoration and roof repairs completed last month by contractor C & D Restoration, Inc.
In addition, Ashland reported that it expects to have repairs completed in about four weeks to a 25,000 barrel-per-day crude oil processing unit at the Catlettsburg refinery.
With our repairs completed and this season's race meet well underway, we can now focus fully on plans to implement slot machine gaming at Fair Grounds.
The tank batteries for oil storage are in place, the repaired water disposal well online, the submersible pump and new production tubing in place, an upgraded electrical power supply line installed and control panel repairs completed.
The drop in property cash flows is primarily due to an increase in property taxes and additional repairs completed in 2005.