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An exhaustive lit search shows that only 5/85 SARS patients and 150/1397 COVID-19 patients were smokers, far below the 27% active smokers in china. Can anyone find a study that was missed?
In an earlier thread we saw about 27% of people in China were active smokers:
26.6% overall (307.6 million adults), 50.5% of men, and 2.1% of women currently smoked tobacco.
23.2% overall (268.9 million adults), 44.4% of men, and 1.6% of women currently smoked tobacco on a daily basis.
15.6% of ever daily smokers have quit.
I collected all the data I could find on SARS and nCoV-2019 and smoking. The results show that smokers are far underrepresented in the patients diagnosed for both illnesses for some reason
SARS 5/85 (5.9%)
COVID-19 150/1397 (10.7%)
Also, there are a few papers about smoking altering the expression of the putative "receptor" for these viruses (ACE2) in the respiratory tract, so that seems to be the likely mechanism. I organized this for myself but figured I may as well share it and see if anyone can point out something that was missed. This is meant to be exhaustive, but I could have (of course) missed some data. Can anyone find a paper that does not show far fewer smokers than expected from the population smoking rate? Note that the data also suggests that smokers who do get ill may more often have severe illness.
Smoking and ACE2
Quotes
We also found that ACE2 gene is expressed in specific cell types related to smoking history and location. In bronchial epithelium, ACE2 is actively expressed in goblet cells of current smokers and club cells of non-smokers. In alveoli, ACE2 is actively expressed in remodelled AT2 cells of former smokers. This may indicate that 2019-nCov infect respiratory tract through different paths in smokers, former smokers and non-smokers, and this may partially lead to different susceptibility, disease severity and treatment outcome.
Our study showed that cigarette smoke or direct nicotine inhalation inhibits the expression of angiotensin-converting enzyme 2/AT2R in multiple organs and cell types. In the lung, cigarette smoke (6 cigarettes/d, 12 wk) inhibited the expression of both angiotensin-converting enzyme 2 and AT2R.
The literature presented in this review strongly suggests that nicotine alters the homeostasis of the RAS by upregulating the detrimental angiotensin-converting enzyme (ACE)/angiotensin (ANG)-II/ANG II type 1 receptor axis and downregulating the compensatory ACE2/ANG-(1-7)/Mas receptor axis
All hospitalized patients (n = 242) (admission date from January 16 to February 3, 2020) in No. 7 Hospital of Wuhan, clinically diagnosed as “viral pneumonia” based on their clinical symptoms(fever or respiratory symptoms) with typical changes in chest radiology, were preliminarily involved in this study [...] In addition,only 9 (6.4%) patients had a history of smoking, and 7 of them were past smokers. It was reported that the prevalence of COPD in adults ≥40 years old was 13.7%, and 27.3% of adults in China were current cigarette smokers (data in 2018). The relationship between smoking and coronavirus infection is not clear, and the exact underlying causes of the lower incidence of COVID-19 in current smokers are still unknown.
This single-centre, retrospective, observational study was done at Wuhan Jin Yin-tan hospital (Wuhan, China)... We report the clinical courses and clinical outcomes of 52 critically ill patients from 710 laboratory-confirmed cases of SARS-CoV-2.
We extracted the data on 1,099 patients with laboratory-confirmed 2019-nCoV ARD from 552 hospitals in 31 provinces/provincial municipalities through January 29th, 2020
In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020 [...] By the end of Jan 25, 31 (31%) patients had been discharged and 11 (11%) patients had died; all other patients were still in hospital (table 1). The first two deaths were a 61-year-old man (patient 1) and a 69-year-old man (patient 2). They had no previous chronic underlying disease but had a long history of smoking...Of the remaining nine patients who died, eight patients had lymphopenia, seven had bilateral pneumonia, five were older than 60 years, three had hypertension, and one was a heavy smoker.
Patients were admitted to the Dazhou Central Hospital from 22 January 2020 to 10 February 2020, with final follow-up for the study on 11 February 2020.
All patients in the study had SARS, were managed in the two major Hong Kong hospitals (ie, Prince of Wales Hospital and United Christian Hospital), and had developed spontaneous pneumothorax during their hospitalization between March 10, 2003, and April 28, 2003 [...] None of the six patients had a history of smoking or pulmonary disease.
The index case of SARS in Singapore ocurred in a previously healthy 23-year-old woman of Chinese ethnicity who had stayed on the 9th floor of a hotel during a vacation to Hong Kong, February 20–25, 2003. A physician from southern China who stayed on the same floor of the hotel during this period is believed to have been the source of infection for this index patient and the index patients of outbreaks in Vietnam and Canada. [...] The demographic profiles of the index and 19 contact cases are shown (Table 1)... One patient was a smoker.
Between February 22 and March 22, 2003, we identified 10 epidemiologically linked patients (all southern Chinese) whose disease met the CDC case definition of March 17, 2003, of SARS at our hospital cluster (Queen Mary Hospital, Kwong Wah Hospital, and Pamela Youde Nethersole Eastern Hospital) in Hong Kong [...] Eight of the 10 patients had never smoked, 1 was a current smoker (25 cigarettes per day), and 1 was a former smoker (20 cigarettes per day) who had stopped five years earlier.
In this case-control study, 447 patients attended the SARS clinic based at the Prince of Wales Hospital, Hong Kong, between 12th March and 14th May 2003 [...] The results in this study show that smoking does not protect patients from contracting SARS. In this cohort a greater proportion of non-smokers contracted SARS than smokers, which may appear to support the initial rumours. However, a far greater proportion of non- smoking, female, health care workers contacted SARS cases than smokers and were therefore placed at much greater risk. When adjustments are made for gender, health care occupation and contact history, then smoking is shown to provide no protection. Even if smoking does protect patients against SARS, caution is required because of the many other hazardous effects associated with chronic smoking.7
At 11:30 on 8 April 2003, a 64-year-old man presented to the National University Hospital emergency department (ED) complain ing of light headedness for 3 days, and dry cough and body aches for 2 days. His general practitioner had recorded a temperature of 37.7 C. On further enquiry in the ED, he described mild dyspnoea and palpitations. For over 40 years, he had smoked 25 cigarettes a day, and had consumed at least 100 g of alcohol per day.
The Hong Kong newspaper reported that some people say there were few smokers amongst the cases reported in Guangdong, the province in southern China where the disease originated, which further fuelled the rumors. The Post said many smokers in mainland China had upped their cigarette consumption in response to the rumors, with many others actually taking up the habit.
Our pilot data suggest that cigarette smoke or nicotine inhalation inhibits the expression of ACE2/AT2R in multiple organs including the brain, heart and lungs https://grantome.com/grant/NIH/R01-HL135635-02
Xu 2020:
It has been reported that ACE2 is the main host cell receptor of 2019-nCoV and plays a crucial role in the entry of virus into the cell to cause the final infection. https://www.nature.com/articles/s41368-020-0074-x
This retrospective cohort study included two cohorts of adult inpatients (≥18 years old) from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China). All adult patients who were diagnosed with COVID-19 according to WHO interim guidance were screened, and those who died or were discharged between Dec 29, 2019 (ie, when the first patients were admitted), and Jan 31, 2020, were included in our study. Since these two hospitals were the only desig nated hospitals for transfer of patients with COVID-19 from other hospitals in Wuhan until Feb 1, 2020, our study enrolled all adult inpatients who were hospitalised for COVID-19 and had a definite outcome (dead or discharged) at the early stage of the outbreak.
None of the cases were healthcare workers and 8 (33.3%) had a history of recent travel to Hubei (Case 1 and 5 were residents of Hubei (marked with blue arrows), Case 3, 4, 6, 9, 13 and 17 have travelled to Hubei (marked with blue boxes), and the period in Hubei might be the suspected contact time. The suspected contact time of other cases who stay in Nanjing was marked with gray boxes according to the epi- demiological investigation). The diagnosis date of each case showed that the number of cases who have been to Hubei decreased since Jan 28, 2020 (Figure S1 in Supporting In- formation). Individuals of all ages were involved in the COVID-19 asymptomatic infection with age ranging from 5 to 95 years old (median: 32.5 years), whereas 20.8% (5/24) of the cases were aged below 15 years. Eight cases (33.3%) were males. Two cases had a history of smoking (Case 1 and Case 13), and 2 were diagnosed with diabetes and hy- pertension (Case 8 and Case 13).
This was a retrospective cohort study that collected data from patients with COVID-19 throughout China, under the coordination of the National Health Commission which mandated the reporting of clinical information from individual designated hospitals which admitted patients with COVID-19. After careful medical chart review, we compiled the clinical data of laboratory-confirmed hospitalized cases from 575 hospitals between November 21 st , 2019 and January 31 st , 2020. The diagnosis of COVID-19 was made based on the World Health Organization interim guidance [25]. Confirmed cases denoted the patients whose high-throughput sequencing or real-time reverse-transcription polymerase-chain-reaction (RT-PCR) assay findings for nasal and pharyngeal swab specimens were positive [3].
In the study, we explored potential host risk factors associated with severe cases at admission in a retrospective cohort of 487 patients in Zhejiang Province of China
40/487 patients had a smoking history (89.1% reported no, while 2.7% were unknown)
34/438 of mild disease had smoking history but it was 6/49 who had severe disease
During the observation period, total 107 laboratory-confirmed patients with COVID-19 from the cruise ship were hospitalized at the Self-Defense Forces Central Hospital in Japan. Three patients were excluded from this study because of their withdrawal to join this study. Therefore, the remaining 104 patients were analyzed. Clinical history, physical examination and chest CT scan were evaluated on the admission day, and blood tests were conducted within two days. The characteristics of the 104 patients are presented in Table 1. The age range was 25–93 years (median, 68 years; IQR, 46.75–75), and 47 patients (45.2%) were male. The most common nationality of patients was Eastern Asia, which included Japan and China. The observation period is from three to fifteen days (median, 10; IQR, 7–10 day). Fifty two patients (50.0 %) had comorbidities.
The clinical data of 167 SARS-CoV-2 infected patients treated in Chongqing Public Health Medical Center from January 2020 to March 2020 were collected. COVID-19 is diagnosed according to the WHO Interim Guidelines 6 . The severity of COVID -19 was defined according to the American Thoracic Society's Community Acquired Pneumonia Guidelines 7 . A confirmed case of SARS-CoV-2 infection was defined as a positive result on RT-PCR assay of nasal and pharyngeal swab specimens.
The study was conducted at the infectious disease department, Shenzhen Third People's Hospital in Shenzhen, China, from January 20, 2020, to March 25, 2020; final date of follow-up was March 25, 2020. [...] Five patients (age range, 36-73 years; 2 women) were treated with convalescent serum. None were smokers, and 4 of 5 had no preexisting medical conditions.
This is a meta-analysis, not new data. They found fewer papers than included above but still came to the same conclusion: Alqahtani 2020:
Concerning smoking and COVID-19, our data showed a pooled prevalence of 9% current smokers, (95% CI, 4%–14%), lower than the reported prevalence of smoking in China that was 25.2% (25.1–25.4) (52). Interestingly, we found that 22.30% (31/139) of current smokers and 46% (13/28) of ex-smokers had severe complications associated and greater mortality reaching 38.5% in current smokers.
A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents.
We included patients with laboratory-confirmed Covid-19 infection who were admitted to nine hospital ICUs in the Seattle region between February 24 and March 9, 2020. A confirmed case of Covid-19 was defined by a positive result on a reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay of a specimen collected on a nasopharyngeal swab. Only laboratory-confirmed cases were included. Twenty-four adults (18 years of age or older) were identified from nine hospitals, including three University of Washington (UW) Medicine Hospitals (Harborview Medical Center, UW Medical Center–Montlake, and Northwest campuses), the Virginia Mason Medical Center, and the Swedish Hospitals (First Hill and Cherry Hill). This group represents six of the eight adult acute care hospitals in the city of Seattle; hospitals connected to these systems in suburbs outside Seattle (UW–Valley Medical Center, Swedish–Issaquah, and Swedish–Edmonds) were also included in the group of nine. Pregnant women, prisoners, and children (those younger than 18 years of age) were excluded from the study. [...] Five patients (22%) were current or former smokers
Data from laboratory-confirmed COVID-19 cases reported to CDC from 50 states, four U.S. territories and affiliated islands, the District of Columbia, and New York City with February 12–March 28, 2020 onset dates were analyzed. Cases among persons repatriated to the United States from Wuhan, China, and the Diamond Princess cruise ship were excluded.
However, chronic obstructive pulmonary diseases (COPD) are relatively less common in COVID-19 patients, with a prevalence of 1.1%-2.9%. 7-9 In a study involving 140 cases with COVID-19 on the association between allergies and infection, no patients were found to have asthma or allergic rhinitis. 8 […] Given the association between virus infection and asthma, 30 it is worth carefully monitoring asthmatic patients in this coronavirus epidemic. However, in pediatric cases, we did not find COVID-19 patients with a history of asthma (unpublished data). Maybe a distinct type 2 immune response may contribute to this low prevalence of asthma and allergy patients in COVID-19. The interaction between SARS-CoV-2 and asthma remains to be further investigated, especially considering that current medical resources have been mostly focused on COVID-19. https://www.ncbi.nlm.nih.gov/pubmed/32196678 COPD is one of the major drivers of mortality in China, accounting for nearly 1 million deaths annually4 and representing 30% of all deaths from COPD across the world. Why does China have such a high burden of COPD? One obvious reason is cigarette smoking. In a recent study, Fang and colleagues5 randomly recruited more than 60,000 adults 40 years of age and older across all major provinces in China and found (astonishingly) that 58% of the male participants were smokers. In stark contrast, only 4% of female participants were smokers. Consistent with these data, 19% of men and only 8% of women in this study demonstrated COPD changes on postbronchodilator spirometry. Alarmingly, these figures are significantly higher than those reported in previous population-based studies of COPD in China in the 2000s, which had estimated the prevalence to be ∼ 10% in males and 5% in females older than age 40 years.6 https://journal.chestnet.org/article/S0012-3692(18)31079-1/fulltext In The Lancet, Kewu Huang and colleagues, 6 on behalf of the China Pulmonary Health (CPH) Study Group, report key data from a national cross- sectional study in China done during 2012–15 and encompassing a representative cohort of more than 50 000 adults (21 446 men and 29 545 women with mean age 44 years). The investigators defined asthma as a self-reported history of diagnosis by a physician or as wheeze symptoms in the preceding 12 months, using the European Community Respiratory Health Survey. Additionally, they incorporated spirometry with reversibility testing. The overall prevalence of asthma in the weighted study cohort was found to be 4·2% (n=2032), whereas the prevalence of asthma with airflow limitation was 1·1% (n=670). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31349-2/fulltext
Update on 2020/04/05
A new review article concludes the same as the above post: Farsalinos 2020:
In fact, the consistently low prevalence of current smoking among Chinese patients with COVID-19 was further supported by the recent data recently released from the US CDC.28 From a total of 7162 patients in the US, only 1.3% were current smokers. low smoking prevalence was also observed among hospitalized non-ICU (2.1%) and ICU cases (1.1%), while the population smoking prevalence in the US is 13.8%. These observations raise a possible hypothesis that nicotine might reduce the risk for severe COVID-19. Hospitalization for COVID-19 will inevitably result in abrupt withdrawal of nicotine and its beneficial effect linked to this hypothesis in smokers or users of other nicotine products. This could, at least partly, explain the association between smoking and COVID-19 severity among hospitalized patients.27 Nicotine has been found to prevent acute lung injury in an animal ARDS model and has immunomodulatory effects.29,30 There is also evidence for an interaction between nicotine and the renin-angiotensin-aldosterone axis, although such interactions remain unclear.2-5 In any case, the observations of a consistently low prevalence of smoking among COVID-19 cases in China and the US, together with the potential mechanisms through which nicotine interacts with the inflammatory process and the renin-angiotensin-aldosterone axis involved in the development of COVID-19, warrant an urgent investigation of the clinical effects of pharmaceutical nicotine on COVID-19 susceptibility, progression and severity. The potential need to provide pharmaceutical nicotine products to smokers who experience an abrupt withdrawal of nicotine when hospitalized for COVID-19 or aim to follow medical advice to quit smoking to relieve underlying conditions that may increase vulnerability to serious or fatal symptoms should also be examined. https://www.qeios.com/read/article/561
Kim 2020:
Korea National Committee for Clinical Management of COVID-19 (KNCCMC) was organized in early February 2020 and consisted of infectious disease specialists or physicians of each hospital who took care of the confirmed COVID-19 patients. KNCCMC developed a standardized clinical record form (CRF) which was modified from the World Health Organization Global 2019-novel coronavirus clinical characterization CRF.16 Individual cases were reviewed and treatment and discharge plans were discussed during regular video conference calls three time a week. All of cases nationwide were enrolled in this study from the 1st to the 28th patient.
The study was conducted at NYU Langone Health... We obtained data from the electronic health record (Epic Systems, Verona, WI), which is an integrated EHR including all inpatient and outpatient visits in the health system, beginning on March 1, 2020 and ending on April 2, 2020. Follow up was complete through April 7, 2020. A confirmed case of Covid-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasopharyngeal or oropharyngeal swab specimens. [...] Surprisingly, though some have speculated that high rates of smoking in China explained some of the morbidity in those patients, we did not find smoking status to be associated with increased risk of hospitalization or critical illness. This is consistent with a handful of other studies that have previously shown a lack of association of smoking with pulmonary disease- associated ARDS (i.e. from pneumonia), as compared with non-pulmonary sepsis-associatedARDS. 29
To begin with, in severe cases, both COVID-19 and HAPE exhibit a decreased ratio of arterial oxygen partial pressure to fractional inspired oxygen (Pao2:FiO2 ratio) with concomitant hypoxia and tachypnea [4,5]. There also appears to be a tendency for low carbon dioxide levels in COVID-19 as the median partial pressure of carbon dioxide (PaCO2) level was 34 mmHg (inter-quartile range: 30-38; normal range: 35-48) in a recent JAMA article describing 138 hospitalized cases [6]. Initial exposure to hypoxia at high altitude leads to an immediate increase in ventilation that blows off large quantities of carbon dioxide, producing hypocapnia as well [7]. Furthermore, blood gases of non-acclimatized mountaineers with severe illness were accompanied by a significant decrease in arterial oxygen due to an increase in alveolar- arterial oxygen difference, although herein arterial PaCO2 did not change significantly [8]. In short, hypoxia and hypocapnia are seen in both conditions, but there is more. Radiologic findings of ground-glass opacities are present in up to 86% of patients with COVID- 19 with 76% having bilateral distribution and 33% peripheral [9]. Notably, lung cavitations, discrete pulmonary nodules, pleural effusions, and lymphadenopathy were absent [10]. In addition to this, patchy infiltrates are present [11]. Patients with HAPE also exhibit patchy infiltrates throughout the pulmonary fields, often in an asymmetric pattern and CT findings reveal increased lung markings and ground glass-like changes as well [12-14]. It has been shown that widespread ground-glass opacities are most commonly a manifestation of hydrostatic pulmonary edema and this is a central point to consider going forward [15].
Cigarettes as an aid to climbing Report, November 21 1922 Captain GJ Finch, who took part in the Mount Everest expedition, speaking at a meeting of the Royal Geographical Society, London, last evening on the equipment for high climbing, testified to the comfort of cigarette smoking at very high altitude. He said that he and two other members of the expedition camped at 25,000ft for over 26 hours and all that time they used no oxygen. About half an hour after arrival he noticed in a very marked fashion that unless he kept his mind on the question of breathing, making it a voluntary process instead of an involuntary one, he suffered from lack of air. He had 30 cigarettes with him, and as a measure of desperation he lit one. After deeply inhaling the smoke he and his companions found they could take their mind off the question of breathing altogether … The effect of a cigarette lasted at least three hours, and when the supply of cigarettes was exhausted they had recourse to oxygen, which enabled them to have their first sleep at this great altitude.
AMS, according to the Lake Louise score, was significantly lower in smokers; the value was 14.9%, 95% CI (6.8 to 23.0%) in smokers and 29.4%, 95% CI (23.5 to 35.3%) in non-smokers with an adjusted OR of 0.54, 95% CI (0.31 to 0.97) independent of gender, age and maximum altitude reached. […] Probably because of its influence on the blood’s oxygen transport as well as through its effects on vasoconstriction, smoking is a protective factor for the onset of AMS.
A prospective, single-center case series of 179 consecutive hospitalized patients from December 25 th , 2019 to February 7 th , 2020, with confirmed or suspected COVID-19 pneumonia were enrolled in this study from Wuhan Pulmonary Hospital, which is located in Wuhan, Hubei Province, China. Wuhan Pulmonary Hospital is situated in one of the endemic districts of COVID-19 outbreak and counts among the designated Hospitals assigned by the Chinese government.
This retrospective study focused on the initial clinical features of patients with suspected COVID‐19 who presented to the ED of the First Affiliated Hospital of USTC and the Infectious Hospital of the First Affiliated Hospital of USTC for the first time between 24 January 2020 and 20 February 2020. Patients were considered as suspected to have COVID‐19 based on symptoms, exposure history, and guidelines for the diagnosis and treatment of pneumonia caused by novel coronavirus infection (trial version III) published by the National Health Commission of the People's Republic of China.13 [...] There were 6 (19%) smokers among diagnosed patients and 13 (15%) among negative cases. [...] Smokers were equally distributed in both groups, indicating that smoking is not a specific risk factor for diagnosed patients. [...] The initial clinical features of patients suspected of having COVID‐19 in EDs outside Hubei were relatively mild.
The results in this report have been produced using data from the ISARIC COVID-19 database. For information, or to contribute to the collaboration, please contact [email protected]. Up to the date of this report, data have been entered for 10363 individuals from 240 sites across 25 countries. We thank all of the data contributors for collecting standardised data during these extraordinary times. We plan to issue this report of aggregate data weekly for the duration of the SARS-CoV-2/COVID-19 pandemic. [Figure 17 shows the vast majority of patients were from the UK]
For the present survey, the data of the first 50 patients hospitalized in the University Hospital Aachen from February to March 2020 with a positive SARS-CoV-2 result from initially obtained respiratory material were used
A retrospective study investigating the epidemiological, clinical and virological features of COVID-19 in designated hospitals of Zhejiang province between Jan 17 and Feb 7, 2020 was performed, followed by calculating the period of positive nuclear acid of COVID-19 in our hospital. All patients were diagnosed as COVID-19 according to WHO interim guidance 17 . and the preliminary data were reported to the authority of Zhejiang province.[...] As shown in Table 1, 51.65% of the 788 enrolled patients were male, with low rate of smoking (6.85%).[...] The ZJ01 patient is male, 30y, and had neither smoking history nor any co-existing condition.
In conclusion, the results of this preliminary meta-analysis based on Chinese patients suggest that active smoking does not apparently seem to be signicantly associated with enhanced risk of progressing towards severe disease in COVID-19. https://www.ejinme.com/article/S0953-6205(20)30110-2/fulltext
Update on 2020/04/22
Smoking and MERS: Alraddadi 2016:
Primary MERS-CoV cases were defined as cases in persons without known exposure to other MERS-CoV cases or recent (within 14 days) exposure to healthcare settings (3,5). MERS-CoV case-patients meeting this definition were presumed to have acquired infection through nonhuman contact... For each case-patient, we randomly selected up to 4 neighborhood controls matched by age and sex. For case-patients 18 to <25 years old, controls were matched within 5 years of age, and for those >25 years old, controls were matched within 10 years of age...Case-patients also were more likely than controls to currently smoke tobacco (37% vs. 19%, OR 3.14, 95% CI 1.10–9.24).
We provide evidence that DPP4 is upregulated in the lungs of smokers and COPD patients, which could partially explain why these individuals are more susceptible to MERS-CoV infection.
The rate of current daily smokers was significantly lower in COVID-19 outpatients and inpatients (80.3% and 75.4%, respectively), as compared to that in the French general population with standardized incidence ratios according to sex and age of 0.197 [0.094 - 0.41] and 0.246 [0.148 - 0.408]. These ratios did not significantly differ between the two groups (P=0.63). Conclusions and relevance: Our cross sectional study in both COVID-19 out- and inpatients strongly suggests that daily smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population.
Using data from Sichuan Provincial Department of Health and the population-based multicentre cohort study, all microbiologically confirmed COVID-19 patients in Sichuan who met the national severe criteria were included from January 16 to March 15, 2020.
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Her right-hand man in crime is Dick Richard the 3rd, shyster lawyer, dirty accountant, & all around amoral scumbag player from MA&F who is simply looking to get into Amanda’s well-filled pants & overflowing pocketbook. She has vast tracts of land if you know what I mean. The best silicon bodywork that money can buy. A whole NU-U. She's 58 & looks 24. She Takes It On The Run. The newly hired day-to-day acting CEO is James “Jimmy” Foole. James is a bright, young, rising star that got bounced from Militech after using an AV-9 squadron to strafe a children’s birthday party. Jimmy had reasonable intel that suggested that the entire party was covertly under attack by SovOil sponsored memetic warfare & that it was being used as a cover to launch an assassination attempt against Night City’s current Mayor, Erika Annabelle, who at the time had a personal protection contract w/ Militech. While no one knows it, Jimmy was right - evil clowns. Sadly, shooting at children is generally frowned on, even in 2020, & it made the nightly Network54+ news, as well as ScreamTweets & DataTerm™ feeds, so Jimmy was let go before being headhunted by Phink to drive Meatwagon into the ditch. Jimmy, however, is not entirely on board or filled in on the specifics of Amanda’s plan or background embezzlement scheme. He firmly believes that he can turn the company around & tries to operate it as such while secretly being handicapped & sabotaged at every turn by Amanda & Dick. Jimmy’s left-hand woman & hardworking girl Friday is Carol in HR. Carol knows her shit. Carol has a Multi-Line Phone Splice, Dataterm™ Link, Cybermodem, TimeSquare Marquee+™, Secretarial Chipware, Human Perception, Interview, Library Search, & a law degree from Harvard. REO Meatwagon operates much like Trauma Team - they have a fleet of flying medical AV busses crammed full of crazies w/ guns & at least one Licensed Practicing Nurse (LPN) on board as well as somebody who has a legal valid drivers license; though the autopilot usually does most of the heavy lifting. Then, when they get a call, they go in, they extract their consumer, & they ferry them to the nearest hospital, REO Meatwagon licensed facility, or authorized Body Bank, (as appropriate) while providing the consumer with “stabilizing medical care” during transport. Typically this just means that they follow the color-coded flashcard diagram charts on how to hook the consumer up to the Portable Intern & Medscanner before shoving them (regardless of how injured) into the €100k Cryotank on the bottom of the bus, hitting the big red “auto-frost” button, & then letting the onboard €30k 3 CPU Int 9 computer w/ €800 Cryotank Operation medical software at +10 do its thing. REO Meatwagon is also licensed to provide “limited” “on-site” “emergency” “medical care” if a consumer does not wish to be transported to a “medical facility”. Many consumers have begun using REO Meatwagon as a replacement for the police to scare off assailants or resolve domestic quarrels as well as being called in for every other non-emergency medical issue under the sun. A REO Meatwagon Basic Black Plan\* is €299 a month & guarantees service arrival within 10-minutes. Extra service charges & fees may apply at the time of services rendered & the consumer is responsible for any fuel, ammunition, medical goods, services, or personnel expenses incurred during extraction, transportation, & delivery. A Gold Level Executive Plan\* is €399 a month & includes ammo & gas as well as priority service w/ a 7-minute arrival guarantee. It does not include medical goods & services or personnel expenses. A Platinum Level Premier Plan\* is €499 a month & includes top tier support w/ a 5-minute guaranteed arrival time & all additional fees & charges except for medical goods & services waived. \All REO Meatwagon service contract plans do not include any additional charges arising or resulting from any property damage incurred while providing REO Meatwagon brand medical protective services to the consumer. Any property damages incurred are solely the responsibility of the consumer & REO Meatwagon waives all indemnity & liability while providing the aforementioned REO Meatwagon care & services to the consumer.* REO Meatwagon, “Your safety is our priority, we won’t let any walls stand in our way!” While Trauma Team is the top-tier world-class provider courting triple-A corp clientele w/ government contracts, REO Meatwagon is not so lucky. The average REO Meatwagon consumer is having a rough go of things. They’re down, out, destitute, & have nowhere else to turn. They’re the homeless nomadic transients sleeping out on the streets or shoving quarters into coffin motels just for a warm monofoam mattress that only slightly smells like spunk & Lysol. They're the gangers defending their homes while being baited into shootouts w/ corrupt cops looking for a taste. They're the small business owners being squeezed & terrorized by state-sponsored jackbooted thermoptic ninja accountant repo-men. Edgerunners whose fortunes have swiftly turned south from sudden yet inevitable betrayals by a Mr. Johnson in a dark dimly lit alleyway firefight at 2 am. The joyboys, girls, enbies, & exotics who had a seriously bad encounter with a jacked-up John or pissed of CyberPimp. The crooks, criminals, proles, plebes, & ‘punks that have the rest of worlds boot planted firmly on their neck. The single mother of two working three jobs trying to make ends meet. The average John & Jane Does just struggling to keep their heads above water in the modern fast-paced cybernetically-powered always-on nightmare-fueled hellworld of 2020. All those poor souls stuck Ridin' The Storm Out. They're also not so timely or great in regards to their outstanding payments. REO Meatwagon is constantly in the red financially & scraping to get by themselves. Having to secretly fund a vanity shoe line doesn’t help. REO Meatwagon does not use AV-4’s. AV-4’s are cool. AV-4’s are expensive. Everybody uses AV-4’s. REO Meatwagon fields a fleet of AV-7’s manufactured by Toyota. These are cramped, poorly equipped, & have questionable safety features. Typically they're operated by a 4 man squad - Pilot, LPN, & 2 dedicated meat-shield bullet-sponge heavies. It’s a bonus if someone, like the Pilot, can work a Cybermodem w/ Controller Software, but it’s not vital since a heavy can usually kick in the door - though seeing through security cams & clearing traffic can prove to be useful. The AV-7 can seat up to 8 if 4 are willing to clip onto the outside & stand on the skids. Bit windy though. Cryotank/Passenger transport is under-mounted near the landing skids & armored to SP 35. Usually. They’re a little behind on the maintenance schedule in the motor pool. Trauma Teams AV-4 busses may be faster flat out, but the AV-7’s smaller size lets the onboard 3 CPU Int 9 computer w/ pirated Vector Thrust Piloting Software at +10 maneuver the craft through cramped & narrow urban environments while Trauma Team’s larger AV-4 is still stuck back at main street level & crushing parked cars like the outmoded ED-209 dinosaur that its. It also sports a chin-mounted ceramic flechette AP autocannon, flashing light bar, loudspeakers, spot & strobe lights, homing micro-missiles, & tear gas grenades. She may not stand up to heavier craft or hardcore ‘Borg heads but she can still clear out a strip mall or small office park! REO Meatwagon also has several (3, they have 3) AV-6’s in Night City. These are the heavy busses & real big boy toys. Faster than Trauma Team’s AV-4’s, these also hit harder, have an on-board 4 CPU Int 12 A.I. CompuSystem™, sport a Crew of up to 12 (16 if they’re really crammed in there), & have dual Cryotanks. Used for high priority consumers & major conflicts, these baby’s can kick butt & haul ass. Also typically staffed by the REO Meatwagon Crews least likely to shoot their own foot off. There may even be an actual doctor on board. Degree & everything. REO Meatwagon Crews often engage in what is derogatorily referred to as “Meat Jumping.” Trauma Team typically has the exclusive contract (such as in Night City) to provide government-sponsored paramedical services to citizens, thus they are the ones who receive the 911 calls. However, consumers are free to choose their own medical transport provider & REO Meatwagon monitors emergency scanners & then attempts to contact the consumer first while entering into a recorded verbal contract agreement for any services rendered. Though you can always visit them online. They have an App. Check the ZetaTech store & try Library Searching for REOMeatAPP. REO Meatwagon also issues emergency medic-alert transponders to their consumers, much like Trauma Team (Black requires manual operation while Gold & Platinum can also include vital sign monitors that are PhoneSplice & RadioLink compatible). Though see the above about being used as off-label police & mobile medical clinic. REO Meatwagon probably fields more of these calls than they do legitimate medical services requiring emergency transport. Often these are simple domestic disputes but occasionally it’s a legit call from someone under an actual assault or in real distress. Typically REO Meatwagon Crew’s resolve the issue & then shoot the consumer up with Speedheal & Syncomp 15 drugs from an airhypo before charging them €200 for an on-site Clinic Vist, €1650 for the SpeedHeal, €650 for the Syncomp 15, €50 for Tracer Button usage, ammo, gas, & a €150 processing fee. Tipping is considered optional but is strongly encouraged. 15% is the standard for good service, you know. Tips are applied to the final bill & then dispersed equally to all craft Crew on their bi-weekly paychecks. Unless that is, it was cash under the table. REO Meatwagon also engages in what is derogatorily referred to as “Meat Scooping” or “Vulturing”. This is when a pack of REO Meatwagon AV-7’s swoop in after a conflict in an attempt to harvest the bodies of unclaimed victims for Body Bank Bounties. After claiming a Bounty REO Meatwagon attempts to contact the victims next of kin or legal representatives to return the Bounty, minus a 20% transport & processing fee for their services, they then write off the rest of the returned Bounty as a charitable tax donation. They keep any unclaimed Bounties in an interest accruing escrow account for 12-18 months before “releasing the funds” if left unclaimed. REO Meatwagon Employees & Contractors earn a 10% commission on all Body Bank Bounties turned in. REO Meatwagon attempts to fully comply with all law enforcement officials & any legally issued lawful demands. If a consumer is engaged in a dispute with law enforcement officers, or other duly authorized corporate security entity, REO Meatwagon representatives & troubleshooters will make an attempt to speak to the consumer first to have them de-escalate & cease hostilities long enough for them to be extracted & safely escorted to medical facilities, but once engaged in a legally binding medical consumer transport contract REO Meatwagon agents are fully authorized to use force to extract their consumer & transport them safely to authorized medical facilities where law enforcement, or other duly authorized corporate security entities, may then contact the consumer about any further inquiries that they have. REO Meatwagon has a fully staffed medical & surgical facility located in downtown Night City in the remodeled Sofa Queen & China King complex - you can barely tell it was once a furniture store & Chinese restaurant. They also have the best cybernetic surgical suites & cloning facilities that the lowest overseas bidder can provide! They’re also fully staffed with the brightest bunch of fresh C grade medical & technical graduates from the midwest, as well as imported internationally, that can be legally brought in according to NorCal law! They can provide full hospital & surgical services, cybernetic implantation, cosmetic surgery, body banking, boutique services, as well as have on-site staffing barracks, day-care, employee lounge facilities, commissary, & they can grow people in their basement. REO Meatwagon additionally has satellite facilities located in key spots near (or in) the Combat Zone as well as scattered throughout the ‘burbs. These facilities are large enough to store & refuel a few AV-7’s as well as serve as walk-in Medical Clinic, provide boutique services, & include a small on-site barracks w/ limited stock employee lounge. REO Meatwagon main offices also have a 5 CPU Int 15 EBM Mainframe running a Mr. M.D.™ A.I., S.H.O.D.A.N. drone management, Phoenix Right Legal Advice™, & TurboTax software. The AV-7’s are all connected to the Net via Cell Service so Mr. M.D.™ can use S.H.O.D.A.N. to coordinate the busses as well as provide backup medical assistance or legal advice to on-site troubleshooters if required. Mr. M.D.™ only occasionally gets stuck in a loop popping virtual Vicodin & thinking that it's lupus before needing a swift reboot to the processor to get Back On The Road Again. REO Meatwagon Employment is open to any legal citizen with a valid SIN. Those with a Class V Vector Craft operators license can fly the bus - It’s an Easy (10) Piloting Task to pass the drivers test, though navigating the Night City DMV may prove more difficult. Talk to Carol. Certified LPN’s are qualified to be on-board medics - That usually requires an Average (15) First-Aid Task & a 12-month online NCU course. Regular hourly employees can make €12-14 an hour depending on skillset while Drivers & Nurses can make €15-18 depending on qualifications. There is a €1.50 shift differential for Graveyard & an extra €1 pay increase after 90 days w/ annual yearly evaluations & COLA increases scheduled for all Employees & Contractors. Hazard Pay for Active Combat Situations (ACS's) are paid out in half-hour blocks at time & a half. They also provide full medical & dental for employees & their spouses as well as up to 4 dependent children, clones, or uplifted hyper-intelligent cyberpets. Plus, employees can earn up to 6 weeks of PTO accruable per year & REO Meatwagon can provide tuition reimbursement & course credits for any applicable on-the-job training. Talk to Carol in HR for the specifics. OT is available NOW! REO Meatwagon also employs freelance contractors. These contractors must sign liability waivers, nondisclosure agreements, a 12-month non-compete contract, as well as provide REO Meatwagon w/ a current fingerprint, voice print, retinal print, & “biological sample” for “identification” & “medical” purposes. They are not required to be legal citizens nor hold SINs. REO Meatwagon pays contractors at the same rate as regular employees. Contractors, however, are not eligible to earn benefits. Contractors may be paid in REOMeatCoin (which may be used to purchase any REOMeatwagon branded product, including legal cyberware & installation, as well as goods purchased from the REOMeatwagon Vending Machines & Commissary) or regular debit account CredChip. Employees can also choose to receive REOMeatCoin which occasionally provides discounts on select REOMeatwagon brand goods & services. Paychecks are issued bi-weekly. Talk to Carol for more details or how to set up a direct deposit. REO Meatwagon provides its field troubleshooters company issued dark red SP14 Uniwear Jumpsuits w/ a -1 EV Penalty & emblazoned w/ the REO Meatwagon company logo, a Company issued I.D. containing an IFF transponder & RFID chip w/ company keys, as well as a SP20 nylon "Gianni" combat helmet w/ Anti-Flare Transpari-Shield™ Technology & Breath Filter, IFF receiver, UV w/ Spotlight, Thermal, Image Enhancement, Automapper™, Chipjack, E-book connector plugs, side-mounted Digital A/V Recorder, & Scrambled Radio Link back to the AV-7. There is also a Toolbelt, Flashlight, McCoy Airhypo, Medkit, ZetaTech E-book, Militech Electronics Taser, Flashbang, Tear Gas canister, a Militech Arms Avenger pistol w/ 2 spare clips, & holster. REO Meatwagon AV-7 busses include a €30k on-board computer w/ VehicleLink & is loaded with Biology, Cryotank Operation, Diagnose, Pharmaceutical, Pilot Vector Thrust, & Rifle software at +10. They also have Radio & Cell Communications suite w/ Wide Band Scanner, a Surgical Set, Portable Intern, Drug Analyzer, Travel Kit, box of Slap Patches, economy pack of SpeedHeal & Synthacomp 15, 4 pints of Blood Substitute™, pack of RapiDetox, box of Trauma 1, other funny colored drugs, a couple of cans of Spray Skin & Shower In A Can, a DermaStapler, LPU™, collapsable stretcher, prybar, 20-ton hydraulic jack, small 1-2 man battering ram, heavy-gauge bolt cutters, Thermite-In-A-Tube, box of Road Flares & Safety Markers, Tech Tool Kit, 1 container of assorted bungee cords & roll of duct tape, Microwaver, Sternmeyer Stakeout w/ 10 spare rounds, 4 extra Flashbangs & Tear Gas canisters, & 4 Militech Ronin Light Assault rifles w/ carry strap, uniform clip, & 2 spare clip each. REO Meatwagon Employees & Contractors are also free to supplement their work equipment w/ anything legal they feel like bringing in. Please do not use your cellphone while at work. If this becomes a problem you will all have to leave your phones in your lockers while out on patrol. Thank You & Keep Pushin’ - the MGT REO Meatwagon Employees or Contractors wishing to be in it for the long haul can also sign up for REO Meatwagon Premiere Employment. This includes a 10k sign-on bonus as well as FREE REO Meatwagon brand implanted Tracking Monitor & Skin Watch! Contractors must also choose from either a Paste™ brand Cortex Bomb or Biotechnica brand NeuroToxin Release Sacs. If employment is terminated within the first 24 months the Employee or Contractor must return the sign-on bonus prorated at €420 per month of employment. REO Meatwagon routinely screens all of its Employees & Contractors for any illicit drug or cyberware usage at least once every 12-24 months while providing employees & contractors ample written notice of any upcoming compliance checks. Failure results in a sternly worded written reprimand & asking the Employee or Contractor to please remove any offending illegal contraband from REO Meatwagon property or premises. If an Employee or Contractor earns two or three more written reprimands Carol in HR may have to contact NCPD over the illegal contraband & no one really wants that. Thank you for your compliance & welcome to the REO Meatwagon Crew! TLDR: Roll With The Changes. REO Meatwagon, "We'll get you out in one piece or retrieve as many of them as we can find! That's the REO Meatwagon service guarantee!"
I am considering applying for a position that hasn't been filled in over a year. I am looking for some perspective from people who have worked in forensics and could point out any "red flags" that I might not see before I apply. I am worried that the job hasn't been filled because it is undesirable for some reason. First, some background on me... I am looking for a part-time job after staying home with my children for several years. I have a B.A. in Biology and a M.A.T. in Teaching Secondary Science. Prior to kids, I was a secondary public school teacher. My husband works in law enforcement and I want to change gears from education to serving the public in a different way. I have no education or work experience related to the job posting, however, I have a friend that works for the department who says they would provide fingerprint training. I have a strong background in science and am confident I could preform all duties competently. The pertinent details of the job posting... (This posting is from a large county Police Department outside of a major east coast city.) Forensic Identification Examiner - Latent Prints - Non-Merit $50.00 Hourly Regular Schedule: 20 hours per week Examples of Duties Under general supervision, examines, analyzes and identifies latent prints in support of police investigations, and prepares and gives expert testimony in court.
Compares known finger, palm, and foot prints with latent print impressions to determine identity for use in police investigations.
Follows established procedures for maintaining chain of custody.
Testifies in court proceedings as an expert in latent print analysis.
Prepares charts, photographs, and other materials for court presentations. Maintains reference files of latent prints of value in outstanding cases.
Participates in both internal and external proficiency test.
EXAMPLES OF OTHER DUTIES Obtains prints from deceased persons. Classifies fingerprint cards. Searches manual and automated fingerprint files. Gives lectures and presentations to police recruits, community and school groups, and other interested parties. Performs other related duties as required. Qualifications Certification by the International Association for Identification in latent print identification OR Possession of a high school diploma or an appropriate equivalent Plus completion of advanced technical or college level coursework or training equivalent to the F.B.I.'s advanced latent fingerprint techniques training,andat least two years' work experience performing casework in latent fingerprint examinations. Additional experience in a law enforcement analysis of department methods, policies, systems, procedures and techniques may be substituted on a year-for-year basis up to a maximum of four years for the required education. Proof of Licenses, Certifications and EducationApplicants are required to submit proof of licenses, certifications and education beyond high school to meet the required and preferred qualifications of the position. Diplomas or transcripts must show the applicant's major field of study. Copies and unofficial transcripts are acceptable. Preferred QualificationsWork experience performing casework in latent fingerprint examinations. EXAMINATION PROCEDUREApplicants will be qualified based on an evaluation of their training and experience, as stated on their application, which includes answers to the supplemental questions. Applicants must state the dates and duties of past and present experience clearly and completely for evaluation purposes. Conditions of Employment The work of this classification entails frequent walking, standing, lifting, and exposure to hazardous conditions, including chemicals and bio-hazards, such as human bodily fluids. Medical Examination and Employment Background InvestigationApplicants selected for an appointment to a position in Baltimore County must successfully complete a physical examination and drug screen and an employment background investigation, including, but not limited to a criminal background, education, and fingerprint check. Thank you in advance!
Hotel room and kitchen hygiene essentials you should know about
A clean and hygienic hotel can turn an average stay experience for a guest into a luxurious one. While lavish and well-appointed amenities and a cosy bed is what a guest may look forward to during their stay, cleanliness and sanitation still ranks top on their priority list. Clean and ambient rooms can help hotels to double their ROIs whereas unclean rooms, unhygienic food handling and poor facilities can impact customer loyalty. Not only are guest less likely to return, there is also a real possibility of a disease outbreak. Thus, it becomes essential to constantly monitor hygiene practices adopted by hotels, especially in the key revenue-driving segments, i.e. rooms and kitchens, owing to their high operational and commercial value. Market leaders and industry experts share their insight on the practices that have a major impact on a hotel’s hygiene standards. Waste management Managing the waste effectively plays a crucial role in maintaining a hotel’s hygiene as well as in saving costs. “The solid waste at Grand Hyatt Kochi Bolgatty is segregated in three bins, which are colour coded. Green bins are used for biodegradable waste, whereas blue is used to collect paper and plastic and red is used for glass bottles and tins," says Grand Hyatt, Kochi Bolgatty's hygiene manager Shalini Jain. “Segregation starts from the kitchen and when the bins are hal-full, theyare carried to the garbage area and put in the chiller to prevent bacterial growth. The biodegradable waste is collected by the vendor for cattle feed. Besides, used oil is also collected from the kitchen and given to the soap industries on a monthly basis. Waste water is used in the STP plant, for watering the plant in the garden and in the cooling tower.” At Crowne Plaza Today New Delhi Okhla, the wet and dry garbage are segregated separately. “The wet garbage (waste of vegetables etc) is used in biogas plants, whereas the dry garbage is collected at the garbage room and then handed over to an authorised outside vendor," says its room division manager, Payal Mehta. The waste generated at Novotel Goa Dona Sylvia is used in the generation of compost of around 100kg every day as well as in the hotel’s organic vegetable garden. The compost made out of the waste is stored efficiently and is ready to use in a week’s time. At the sewage water treatment plant, the waste water is treated and used for gardening of the entire resort, which is spread across 20 acres. Cleaning procedures and schedules Whether it is within rooms and plush suites or in a busy kitchen, a well-charted-out sanitation plan can work wonders for a hotel’s ambience. It also ensures that these spaces are cleaned at regular intervals, thereby reducing the risk of bacteria formation. “It is not easy for a housekeeper or a kitchen steward to maintain the busier areas. A proper schedule helps to instill discipline,” says Bhushan Shetye, Executive Housekeeper, Novotel Goa Dona Sylvia. “it is important for every associate to have a proper work flow, with the timings charted out. The person in charge should do a thorough cleaning while the area is not busy and maintain it throughout the day.” Most hotels have a set structure and schedule that is followed to ensure none of the areas are ignored or missed. Sai Khavle, Executive Housekeeper, Holiday Inn Mumbai International Airport says, “As a practice, we have regular inspection of rooms that includes a checklist, daily deep cleaning cycle, and mystery audits to ascertain process compliance as part of the hygiene and cleanliness process within hotel rooms. Each guest room is scanned and inspected. Regular pest inspection and treatments are conducted every month to avoid bugs in bed. The staff makes sure that the hotel is clean and sanitised at all times, and the schedules are in place and being followed.” Jain reports that the cleaning schedule for rooms and the kitchen has been divided into daily and weekly ones. The weekly schedule involves deep cleaning of these spaces. Detailed hygiene plans with checklists and visual reinforcements help to maintain the hotel. Apart from cleaning schedules, a quick clean-up of the kitchen and the restaurants should be conducted. “The spills, crumbs and the mess from the stove, floors, table and counters should be cleaned immediately and sanitised. Special care should be taken when the spills involve raw meat; a disinfecting spray should be used on priority to prevent the spread of bacteria. The liquid spills on the floor should be addressed first, especially from the safety point of view, as a wet floor may cause accidents,” suggests Khavle. She further adds that the dishes should be washed, dried and placed in a proper manner, in order to avoid their piling up in the sink, making the kitchen all the more messy. The leftover ingredients should be transferred to airtight containers and stored in the refrigerator or freezer. Handling the food right Cleaning, hygiene and best sanitation practices are an integral part of every food handler’s job. It goes without saying that the highest standards of hygiene and sanitation best practices should be followed in the F&B areas to prevent any cross-contamination and health hazards. “Measures such as periodic checks, colour-coded practices, temperature logs, maintaining storage best practices as well as HACCAP standards are some of the best practices that should be followed in the food cooking and service areas,” highlights Shetye. Besides, “while handling the food,” says Lakshmanan Ramanathan, General Manager, The Westin Chennai Velachery, “care should be taken that all food is date labelled. All chemicals should be stored away from the food processing areas. And most importantly, the packaging of the product, its expiry date, temperature and weight as per the order should be checked by the chef in a timely manner,” adds Ramanathan. As a precautionary measure, “we use nitrile gloves for ready-to-eat food, high-risk items, etc. We have colour-coded equipment and tools for segregation. Separate rooms are allocated for seafood, meat, fruit and vegetable. Knee-operated hand-washing station is available in each area of the kitchen,” explains Jain. Crowne Plaza Today New Delhi Okhla has enforced the ‘Glove Policy’ as a hygiene practice for the kitchen staff to eliminate contamination of food with bare hands, states Mehta. Different time schedules have been set for receiving food items such as vegetable and meat with a view to prevent contamination. A standardoperating- procedure (SOP) is set for food vehicles, which plays an important role in avoiding contaminations of the ingredients that is flown from far-flung places. Hygiene rules for F&B spaces: • Staff hygiene: Wearing proper clothing and footwear for food processing is the best way to not just maintain hygiene in the kitchens, but also convey an image of a spic-and-span space. Long nails are an ideal home for bacteria and need to be kept short. An alarm system should be placed in the kitchen areas to remind the team to wash hands on regular intervals. • Clean floors: Kitchen floors tend to get messy very quickly with dust, crumbs, food particles and other matter. Besides the daily sweeping schedule, Khavle suggests that the floor should be mopped with a proper floor cleaner or disinfectant every week. Khavle also emphasises the use of the right type of solutions for different kinds of floorings. A carpet must be vacuumed and cleaned of stains every day and shampooed once a month. The marble surfaces should be dry and wet mopped by using a disinfectant, and polished once in three months. At Crowne Plaza New Delhi Okhla, Mehta informs that they use Diversey’s R1 and R2 chemicals with chemical dilution dispenser, which help to eliminate the chance of improper dilution. “Besides, a professional vacuum cleaner having an airflow of 129cfm, with HEPA-certified exhaust filters, also ensures zero-dust flow back to the air and offers ideal suction cleaning of the surface.” A good way to sanitise and clean the floor is “by using chlorine solution, especially in high-risk areas, says Jain. “This will help in removal of solid particles and debris.” Disinfecting high-usage accessories According to Jain, all touch-points like door handles, remote controls, light switches and headboards should be sanitised with 20 neutral sanitisers every day. In order to limit the spread of bacteria, Mehta says that high-usage items should be sanitised every day and wiped with proper disinfectant (Diversey R2) chemicals that possess cleaning and sanitising properties. A colour-coded microfiber duster should be used to avoid cross contamination. "Accessories such as remote controls should be sanitised during every check out of guest rooms, whereas light switches should be sanitised during the dusting procedure,” states Ramanathan. Segregating cleaning products Labelling of each chemical is a must in the chemical room and also in the kitchen areas for identification, states Jain. Further, she says, the training of the associates should be conducted on a regular basis and an in-hand demonstration of how to use the chemical effectively should be conveyed. For spotless and germ-free cleaning in the kitchen, Jain recommends the use of solid based chemicals that are free from phosphate and have a lower carbon footprint. In terms of chemical usage, Ramanathan suggests that its application should be based as per the intended surface to be cleaned. Also, the chemicals should be aptly measured and used as per the required area. In-house hygiene labs In order to maintain a high-level of quality in food and water, more hotels are now setting up their own hygiene labs. Hotels such as Grand Hyatt Kochi Bolgatty, Crowne Plaza Today New Delhi Okhla and Holiday Inn Mumbai International Airport boast in-house labs that test food and water samples. At our hygiene lab, says Jain, “we conduct microbial testing of raw materials, finished products and water. Also, regular hand swab and equipment swab are done for checking and ensuring effective hygiene”. Apart from checking food and water quality, “TDS and hardness of water is also checked at our in-house lab at Crowne Plaza Today New Delhi Okhla”, says Mehta. As an everyday practice, the samples of food and water are tested prior to serving them to guests, adds Khavle. Trending hygiene solutions The world is grappling with the unique Coronavirus outbreak. Diversey, a market leader in providing cleaning and hygiene solutions, has launched its 'Infection Prevention' range catering to its hospitality customers, which includes Oxivir and Virex. It is designed for efficient sanitisation and disinfection. “In the personal hygiene segment, we have introduced a range for hand-hygiene called SoftCare,” says Aurodeepa Rath, Corporate Communication, Diversey India Hygiene Pvt. Ltd. As far as laundry operations go, says Rath, we provide Clax solutions to hotels. Besides efficient washing, Clax Advanced, as a process, ensures a significant saving on energy as well as resources, offering an edge to the property in terms of its sustainability score. Clax Magic is a specialised kit that comes handy for fighting stains. For kitchens, Diversey has launched dishwashing tablets, called the Suma Dime. These tablets can be used on multiple surfaces and are phosphate-and-chlorine-free. Similarly, for pre-soaking application, Suma Carbon K21+ is suitable for soft metals/anodized surfaces. For outdoor and common surfaces, Diversey launched SmartdoseTM last year, with its Taski range. The bottles come with an in-built pump that ensures an easy and accurate dispensing of chemicals. Ecolab, which is widely known for its hygiene solutions, has also launched several offerings catering to the hospitality segment. For instance, the flooring cleaning solutions by Ecolab has Neutral PH chemicals for sensitive surfaces such as marble and granite (natural stone), where acidic or alkaline chemicals cannot be used. The dosing system introduced by the brand helps in accurate dosing and dilution of cleaning chemicals for housekeeping and kitchen areas. A key offering by the brand is a kitchen surface sanitizer, Oasis 146, which takes care of all the surfaces on which the food is actually cooked, and of the chopping boards and knives to avoid cross contamination. HK disinfectant cleaner, 20 Neutral, helps to disinfect all guest and staff areas in the hotel and is used across all touch-points to avoid contamination. Maintenance of kitchen equipment It is important to ensure that the tools and equipment used within food processing in hotels are sanitised. According to Sangeet Soni, Housekeeping manager, Hyatt Pune Kalyani Nagar, the use of metal detectable and food safety equipment in kitchens is a standard measure, which must be followed by food manufacturing industries to make sure there are no contaminants being brought into the space. Further, he says, a de-greasing compound should be sprayed on the surfaces of the commercial hood to break up the residue. If scraping is required, plastic scrapers and nylon sponges should be used to avoid damaging the surface of the hood. “To maintain hygiene in the kitchen, equipment such as a blast chiller, chopping board sanitiser, UV knife sanitiser, multiple type of dishwashing machines, a steam cleaner, hot and cold holding and Alto sham should be used,” contends Jain. Linen and mattresses The furnishings and mattresses consists a lot more bacteria than visible to the naked eye. According to Mehta, “The room linen at Crowne Plaza Today New Delhi Okhla is washed every day after the departure of guests and on alternate days for stay-over guests. In order to remove stains and maintain the brightness of the linen, Hypo Magic (chlorine bleach) and Sonril (oxygen bleach) are used. Besides, Clax 200 and Aligro are used for washing bed linen. Clax RR Sour is used as the final step of washing the linen. This ensures that no residue of chemicals remains in the linen whereas Clax Xtra soft is used in towels to ensure the softness of the towel.” According to Khavle, “Linen should be washed every day. However, the furnishing should be washed once in a quarter. The chemicals used for linen at Holiday Inn Mumbai International Airport are emulsifier, detergent, bleach and neutraliser, besides hot water that is above 75 degree Celsius. The mattresses are cleaned using a steam cleaner, which is more like a vacuum cleaner using a steam that not only pulls out the dust also helps to sanitise the mattress.” Upholstered headboards are shampooed on a weekly basis at Novotel Goa Dona Sylvia. “The mattresses are checked regularly for any bedbugs or stains, and they are protected using the mattress protector. They are shampooed and cleaned using hot steam. Pillow covers are regularly changed and washed using low temperature Johnson Diversey chemical at 60 degree,” adds Shetye. Failure to uphold hygiene practices in the hospitality industry can lead to bad reviews, damaged reputations, and a less-than-pleasant stay for guests. However, hotels need to look beyond the obvious areas to ensure effective waste management and cleaning procedures, particularly in the times of Coronavirus to avoid a health hazard. https://www.hotelierindia.com/operations/10217-hotel-room-and-kitchen-hygiene-essentials-you-should-know-about
Channel Form Prediction of Chinda Creek: A Critical Factor to Sustainable Management of Flood Disaster in Port Harcourt, Niger Delta Nigeria- Juniper publishers
Abstract Flooding have been identified by different scholars as a major challenge facing communities, hence this study examines the role of water bodies in the control and management of flood. The study was conducted in Chinda Creek in Ogbogoro section of the New Calabar River, Niger Delta Nigeria. Measurement of study variables was done, this was to identify the influence of velocity, sediment yield, depth and discharge on channel morphology. The channel length measured 643.275m and was divided into 30 sample points were measurement of the study variables were taken. The result from the correlation revealed that channel morphology of Chinda Creek is significantly correlated with discharge and depth. Nevertheless, it has positive correlation with velocity, bed load and suspended sediment load but their correlation were not significant. Multiple regression analysis was used and the result showed that only two variables, discharge and velocity provided 94.8% explanation for the variation in channel morphology. Hence the study recommended planned sand mining of the creek to increase its capacity for discharge as well as serve as a flood control mechanism in the study area. Keywords: Flood; Disaster; Management; Sustainability; Channel; Prediction Go to
Stream channels have similar forms and processes throughout the world. Water and sediment discharge create channels as they flow through drainage networks. Obstructions and bends formed from resistant material can locally control channel form by influencing flow and sediment deposition [1]. In forest streams where structural elements such as woody debris, bedrock, and boulders are commonly abundant, these effects are particularly important.Sediment load, water discharge, and structural elements, the controlling independent variables of channel morphology determine the shape of the channel along the stream network. The form of any channel cross section reflects a balance between the channel’s capacity to carry sediment away from that point and the influx of sediment to that point. A stable channel is one whose morphology, roughness, and gradient have adjusted to allow passage of the sediment load contributed from upstream [2]. Characteristics of the banks also influence the cross-sectional shape of the channel and help to regulate channel width at any point in the stream. Chinda Creek which is a tributary of the New Calabar River is an alluvial river, in that it flows through sands, silts, or clays deposited by flowing water [1]. Natural alluvial rivers are usually wide with an aspect ratio (width to depth) of 10 meters or greater [3] and the boundary can be moulded into various configurations as was demonstrated in the seminal work of Gilbert in Roberts [4]. With alluvial rivers, the channel geometry is influenced not only by the flow of water but by the sediment transported by the water. When the flow discharge changes, the sediment transport changes and, in turn, the channel geometry usually changes.Morphological change in stream channels may be a result of stream side forest harvesting. Millar [5] developed a model to predict stream channel morphology based on the condition of riparian vegetation. This model was tested on a portion of Slesse Creek (a tributary to the Chilliwack River) downstream of an old-growth area in the headwaters. The riparian area was extensively logged in the 1950s and 1960s, and has subsequently become parkland. The model predicted that in the presence of dense riparian vegetation, Slesse Creek would form meandering channel morphology, and that in the absence of dense riparian vegetation it would form a braided channel.These predictions were then confirmed using pre- and post-logging air photos. However, corresponding changes in stream morphology may change stage discharge relationships and thereby increase or decrease peak flood stages [6]. Thus, predicting changes in base level and channel morphologies are important steps toward understanding future stream behaviors and risks. A few key relationships describe the physics governing channel processes and illustrate controls on channel response. Conservation of energy and mass describe sediment transport and the flow of water through both the channel network and any point along a channel. Other relationships describe energy dissipation by channel roughness elements, the influence of boundary shear stress on sediment transport and the geometry of the active transport zone. A common problem faced by geomorphologists is the identification of the dominant process responsible for creation of a particular form. Arising from this, it is the interest of the study to examine the influence of hydraulic parameters such as depth, discharge, velocity; bed load and suspended sediment load on channel morphology and also identify the major factors controlling morphological change in the area. The study therefore intends to develop a model which predicts channel morphology from hydraulic parameters with the intent to identify its role in sustainable flood disaster management. Go to
Changes in channel morphology following large sediment inputs have been demonstrated in several regions. Lisle [7] showed a decrease in pool depths following a large flood and associated channel aggradation. Madej & Ozaki [8] quantified the decreases in both pool depth and frequency associated with a sediment pulse. The model for predicting morphologic change developed by Millar [5] indicated that Narrowlake Creek is a transitional watershed, but it was not sensitive enough to accurately predict the apparent shift from a meandering to a braided morphology.This reinforces the notion that stream side forest harvesting does affect stream channels in the Central Interior, though not necessarily in a way that can be readily predicted from hydrology models or empirical analysis. While it is impossible to quantify the exact amount of channel widening in Narrowlake Creek directly associated with forest harvesting, the cumulative effects of logging and natural disturbance have led to channel change throughout the logged portions of the watershed. The predictive model Millar [5] developed a tool for Slesse Creek, Canada and will be important for future prescription development in watersheds. However, for transitional systems like Narrowlake Creek in Vancouver, model predictions indicate that cautionary measures for either floodplain protection or restoration must be undertaken. The linkages between logging activity and channel morphology are complicated. Predictive models have great value as tools that can be used to assist in successful watershed protection and restoration, but it will be important that they are not been used without watershed analyses, particularly in the case of transitional systems. The biological implications of the Millar (2000) model, as indicated by the Narrow lake Creek and Slesse Creek case studies in Canada, are profound and worth the effort of further analyses and adjustment to provide a useful tool for both watershed protection and restoration. Similarly, Oyegun [9] in his study on channel morphology prediction using urbanization index, discharge and sediment yield of the upper Ogunpa River discovered that discharge was a major determinant of channel form and therefore was able to develop a model for channel morphology prediction using the above variables. This was also the same in the case of Oku [10] whose study revealed a significant correlation between discharge and channel shape and size of Ntawogba creek in Port Harcourt where discharge was the main determinant of channel morphology amidst several other variables. As cited by Oku [10], Faniran & Jeje stated that the geology of a basin is a determining factor of channel shape and size characteristics, his work of the Rima basin revealed that despite discharge and other basin shape and size predicting and determining variables that channel geological characteristics determines the level of carving and enlargement of a channel. Various studies carried out by several geomorphologist from both local and international have an agreement that channel form prediction as well as determinant variables seem to follow a trend irrespective of climatic conditions. Go to
The study was conducted in Chinda Creek in Ogbogoro town in Obio/Akpor Local Government area of Rivers State, which is located at latitude 4° 50’42.00’’N and longitude 6° 55’44.10’’. The community is about 1.37 kilometres away from the creek which lies at latitude 4° 50’2.43’’N and longitude 6° 56’6.26’’E. The total length of the creek to an adjoining creek called Okolo- Nbelekwuru is 1.93 kilometres, connecting to the New Calabar River, the total length is 3.04 kilometres. Field studies and river measurement of Chinda Creek in Ogbogoro section of the New Calabar River was done. This was to enable the examination of the influence of velocity, sediment yield, depth and discharge on channel morphology. To do this, measurement of velocity, depth, discharge and sediment yield of the channel were taken. The length of the channel was determined with the aid of a measuring tape, and the channel measured 643 meters. This was divided 30 sample points as data collection points for the entire channel at an interval of 21.4m each.
To determine the velocity of flow in the channel, according to the International Irrigation Management Institute report no T-7, several methods of velocity measurement were identified, but in the case of this study the two point method was used. This implies that instead of taking measurements on the water surface alone, velocity measurements was taken both on the surface and beneath, precisely at 0.2m and 0.8m respectively. This is because the flow depth of the river exceeds 0.76m [11]. Therefore velocity meter measurements were taken at 0.2 and 0.8m of the flow depth, d. This was done with the use of a digital water velocity metre. The mean velocity was obtained by averaging the velocities measured at 0.2 and 0.8m of the flow depth. Thus, the mean velocity V, in the reach would be: 📷
To determine discharge, the principle to obtain the discharge per unit width (m2/sec) is to determine the product of mean velocity in the vertical per unit area. This method remains the same whether the measurements are carried out under permanent or non-permanent flow conditions. The total discharge of the channel was calculated from the measurement of velocity in the channel, noting that discharge per unit width q (m2/sec) which is the product of mean velocity in the vertical (m/sec) and the water depth (d) at the vertical at the moment of measurement. Therefore discharge Q =VA (2) Where V =mean velocity, A = cross sectional area.
To measure the bed load, the Handheld Bedload- US BLH-84 sediment sampler was used [12]. The reason for the choice is that it is mechanically simple, and can be used at depths up to 3m. To carry out the measurement, it was done at each sample point in the channel. To calculate this, the sediment transport formula been put forward by Chang et al [12] was used. 📷 In which, gb = transport in kg/s wi = weight of bedload sample in kg. wi = weight of bedload sample in kg. hs = width of sampler nozzle in meter b = section width of the stream in meter.
To measure the suspended load as well, the Depth-Integrating Suspended-Sediment Wading Type Sampler Model DH 48 was used. The sampler container is held in place and sealed against a rubber gasket in the sampler head, by a hand-operated springtensioned clamp at the rear of the sampler. This when immersed into the channel was removed after every 5 minutes and emptied into separate clean used bottled water containers for the 30 sample points. The content was there after filtered to determine the weight of the clastic particles in the water sample. since the sampler have a volume of 470cc, the researcher ensured that the volume of water collected did not exceed 440cc but fell within the range of 375cc to 440cc. To achieve this, enough time was given during submergence of the sampler to ensure that the volume of the sampled water falls within the acceptable standard.
The ultimate goal of the data collection process was basically to access the relationships between the various independent variables of discharge, velocity depth, bedload and suspended sediment yield on one hand and the channel morphology on the other hand. The data set of Chinda Creek was collected with the aid of a calibrated leveling staff and measuring tape. Within the context of the present study, channel morphology, which is the shape of the channel, refers to the cross sectional area of the channel at various sampled points of the basin. In order words, the average channel width and depths were measured and their products were stated in square metre. This was done using Cuencia [13] formula for estimating cross sectional area. Area = width x depth (4) The cross sectional area of the thirty (30) sample points was determined. However, from the data generated the mean cross sectional area of the channel was 10.7223 with a standard deviation of 3.70872.
Tables and charts were used in the presentation of data while in the analysis bivariate and multivariate analytical techniques (Correlation matrix and multiple regression analysis) were used. The model equation of the stepwise multiple regression analysis is as follows:
This section examined the predictive capacity of the hydrological parameters of discharge, velocity, depth, suspended sediment yield and bed load of channel morphology in Chinda creek using the SPSS multiple regression (R) statistical tool. Below is a correlation matrix table which identifies the relationship between the dependent variable of channel morphology and the independent variables of velocity, depth, discharge, bed load and suspended sediment yield (Table 1). 📷 (*0.05 significant level). The above shows the correlation matrix of five independent variables of velocity, depth, discharge, bed load and suspended load on the dependent variable of channel morphology of Chinda Creek in Ogbogoro. The testing of various relationships are shown in the summary on Table 1. With the student “t” statistic at 0.05 significant levels revealed that the channel morphology of Chinda Creek is significantly correlated with discharge and depth. Nevertheless, it has positive correlation with velocity, bed load and suspended sediment load but their correlation are not significant [14,15]. The finding of the study is of importance to geomorphological studies, such that even though velocity, bed load and suspended sediment load does not significantly correlate with channel morphology of Chinda Creek, it indirectly contributes to the existing channel form. In other words, discharge is partly a function of velocity. Table 2 above, shows that only two variables discharge and velocity entered the regression equation. Discharge alone provided 59% explanation for variation in channel Morphology for the study creek while velocity accounts for 35.8% of same. Hence the total explanation provided for the variation in channel morphology by the independent variables of discharge and velocity is 94.8%. 📷 Source: SPSS Analysis result In conclusion, this study has revealed that discharge and velocity are the predictors of channel morphology in Chinda Creek. It should also be noted that suspended sediment yield, bed load and depth are indirect predictors of channel morphology in Chinda Creek. This is because they correlate positively with channel morphology and also have positive correlation with velocity and discharge which are the direct predictors, with net effect resulting in increased velocity and discharge. More so, the five independent variables of the study directly or indirectly affect channel morphology of Chinda Creek. This shows that channel morphology of Chinda Creek correlates positively with discharge, velocity, depth, suspended sediment yield and bed load. The stepwise multiple regression as shown in Table 3 above revealed that discharge and velocity explains the change in the channel morphology. This is because it accounted 94.8% change in the channel morphology. 📷 Thus, the hypothesized model developed by this study is of the form, Y =10.348 + 1.312X1- 0.808X2 ----------- (6) Where, Y = Channel morphology X1 = Discharge X2 = Velocity In order to determine the significance of this relationship, Table 4 below was used. From the Table 4 above, the analysis of variance chart above shows two independent variables that significantly explain variation in Chinda Creek morphology, jointly explained about 94.8% of the variation of channel morphology of Chinda Creek. Given an F calculated value of 246.68 which is greater than the table value of 3.35, reveals that discharge and velocity influence channel morphology of Chinda Creek. This therefore implies that channel morphology is influenced by hydraulic parameters. 📷 (*0.05 significance level). Go to
The analysis showed a positive correlation between discharge and channel morphology. The relationship was statistically significant at 95% level. The multivariate technique used in the SPSS computer programme of the step-wise multiple regression analysis revealed that discharge was the most single predictor of Chinda Creek morphology as it explains 59% of the variation in the existing channel morphology of Chinda Creek. From the analysis of the study, the developed a model helped in predicting channel morphology using suspended sediment yield, bed load, velocity, discharge and depth, which is of the form: Y =10.348 + 1.312X1- 0.808X2 -------------- (7) Where, Y = dependent variable (channel morphology) X1 = discharge (independent variable) X2 = velocity (independent variable) One of the findings of the study is that the channel has high discharge. It also revealed that discharge and velocity are the major predictors of the channel form, with discharge providing 59% of the variation in channel morphology of Chinda Creek. The implication of this is that discharge has helped in the clearing of the creek a tributary to a major river the New Calabar River. Velocity also provided 35.8% of the variation in channel morphology of Chinda Creek, this has contributed immensely to increasing the rate of flow in the channel and the amount of water the channel discharges. The study therefore recommends that a planned sand mining of the creek should be done, to ensure that it has more capacity for discharge as well as serve as a flood control mechanism in Ogbogoro community noting its role in the control of flood within the rural catchment. This will also allow traffic flow for water transportation while generating revenue for the Government and the community through the sand mining process. With the growing demand for land space especially within rural catchments, exposure of the earth surface as well as concretization of the surfaces are possible, hence the the tendency to increase surface run off of the area. There is therefore need for annual and bi-annual study of the state of the streams, creeks and other water bodies within rural catchment to determine their role in flood control as a means to curb the menace of flooding which is a major environmental hazard in the Port Harcourt region. To Know More About Journal of Oceanography Please Click on: https://juniperpublishers.com/ofoaj/index.php To Know More About Open Access Journals Publishers Please Click on: Juniper Publishers
A Guide to Digital, Physical, and Legal Patient Safety
https://preview.redd.it/u22z5pnfn7931.jpg?width=495&format=pjpg&auto=webp&s=64149429fd54d4f7258aed4c75473b24d1effb6b Today’s health care consumer is protected by digital, physical, and legal patient safety rules and regulations. Hospitalists, administrators, physicians, nurses, and others in a hospital setting must be aware of the required physical safeguards, rules, and regulations in place to protect patients’ physical wellbeing and digital and legal patient information and records at all times. Physical safeguards also include the physical steps, procedures, and policies required to secure the Covered Entity (CE) or the CE’s Business Associates’ (BAs) electronic data and HIT systems, equipment, and building structures in use. These safeguards should address protection against physical and environmental threats as well as possible unauthorized intrusions in the health care environment.
Physical Safeguards
The hospital is a complex physical environment. It’s important for all hospital staff to implement and practice good health habits on a personal and team level. The hospital has a myriad of regulatory compliance issues to consider along with patient safety, including HIPAA (Health Insurance Portability and Accountability Act of 1996), EMTALA (Emergency Medical Treatment and Active Labor Act), and Medicare/Medicaid payments regulations in addition to its own corporate governance policies. Of course, it’s the legal and ethical duty of the hospital to protect the patient’s physical body from material harm when he or she is in the hospital. Safety guards and procedures should be strictly followed at all times.
Hospital Environmental Health
Dangers are always present in the hospital, including hazardous chemicals, infectious materials, chemotherapeutic agents, and radioactive matter, among others. Occupational safety and health administrators must work to ensure patient protection from exposure to these elements. A fire or resulting smoke from a hospital fire could be dangerous for the hospital’s most vulnerable patients. Life Safety Codes are in place for that reason. The Environmental Protection Agency (EPA) and local/municipal governments are required to enforce the laws and/or regulations concerning fire safety and hazardous materials in the hospital. The hospital should review its fire and safety plan, fire drills/alarm notifications, fire safety equipment/maintenance and protective building features, hazardous materials/exposure control plan, waste containment, and personal protective equipment as part of the annual risk assessment.
Hospital Security
All people in the hospital—patients, staff, and members of the public—must be protected from harm in the hospital. Hospital security includes multiple factors. Day-to-day concerns referenced above or major accidents could threaten the hospital environment. Since many people travel to and from the hospital each day, it’s important to protect individuals from potential altercations and robberies (including the robbery of physical goods or stolen identification). Potential events could cause temporary overcrowding in the hospital. It’s essential for the hospital to consider these and other potential scenarios that affect safety and security. Local, state, and federal laws address many situations but it’s also essential for the hospital to consider coordination with a local emergency, fire, and police personnel. As part of the yearly risk assessment, the hospital should review policies relating to security technology/security personnel, response to disruptive behaviors, monitor of materials in/out of the hospital building, and security of hazardous drugs/material/waste. There should also be an accurate WebID medical license verification system available to make sure that every doctor’s license is accurate.
Digital Privacy and Security in the Hospital
The hospital collects and uses patient information to treat its patients. It also collects personal financial information as part of its billing practices. Digital privacy is the patient’s right. Federal law requires the hospital to establish proper systems and procedures to protect the patient’s private information from prying eyes. Workstations, devices, computers, and networks in use at the hospital must be secure. Each hospital must have proper security procedures and policies in place. Media controls, disposal of sensitive information, and access of information must be considered as part of the hospital’s compliance. Patients have the right to sue the hospital and/or individual practitioners when private information is improperly accessed or breached.
Legal Malpractice Risks
Security of electronic health records (EHR) in the hospital and medical practice can advance both patient safety and the practice of medicine. However, it’s important for the hospital to know that, as new technology is adopted, potential liability risks are present. Hospital staff can access patient information through EHR or via health information exchanges. Patients’ hospital charts, lab results, medication histories, radiology images, and reports are accessed, exchanged, and reviewed. Patient injury can result from the hospital’s inability to make patient information available to providers treating him or her. If the patient injury occurs from this type of information access error, the patient (or his/her family) may be able to file a legal malpractice claim against the hospital or individual providers. This article was originally published as A Guide to Digital, Physical, and Legal Patient Safety
[Long] Due diligence checklist for purchasing an existing business. It's a little dull and lengthy, but really comprehensive.
I thought this could of some use as a resource for people here. A friend of mine is a lawyer that specialized in business acquisitions. Sorry if this is not the right subreddit for this Please provide the following documents for __________________. (the “Company”): Business Due Diligence A. FINANCIAL:
Quarterly financial statements for the past three years and access to audit work papers
Accountants’ letters to management for the past years
Schedule of deposit accounts maintained by the Company
All loan/credit agreements, security documents, letters of credit, indemnity letters and guarantees under which the Company is the borrower or the lender
Any compliance letters relating to the Company delivered to lenders under loan agreements during the past three years
Any management consulting reports, financial projections, internal budgets or studies regarding the Company for the past three years
All documents pursuant to which the Company is a guarantor or is otherwise contingently liable for the obligations of another entity
All legal bills and accounting bills submitted to the Company during the past three years
Describe each balance sheet account, as of the most recently completed monthly financial statements, identifying its components and the supporting calculation, including:
(b) Inventory including part number, part name, quantity on hand, cost per unit, book value, annual usage, age, condition, with an analysis of direct labor, direct materials and overhead, as well as net realizable value and obsolescence (c) Property, plant and equipment, including identification of items not actively used in operations, and appraisals (d) Prepaid expenses and other assets, including intangible assets (e) Accrued expenses, including, but not limited to, warranty, vacations, pensions and welfare benefit plans, health claims, post-retirement benefits, workers compensation and general liability insurance, taxes, rebates, refunds and contingent liabilities
Schedule of actual results of operations, versus budget, for the past three years
Schedule of gross profit by product
Schedule of cost of goods sold for year to date and the past three years.
Comparative detail of selling, general and administrative expenses for year to date and past three years
Schedule of capital expenditures for the year to date and the past three years, segregated by major category
Description and schedule of reserves
Description and schedule of prepaid expenses and other assets
Description of potential lawsuits, warranty, returns, complaints, etc. and schedule of contingent liabilities
Schedule of aged accounts receivable
Schedule of aged accounts payable and accrued expenses for current period and the past three years
Schedule of related party transactions for the past three years
Schedule of transactions not in ordinary course of business for the past three years
Description and schedule of purchase accounting entries made (including supporting valuations and appraisals) for each acquisition for the past three years
Description of the management information system
B. TAXES:
Income tax returns, property tax returns, sales tax returns, excise tax returns, employment tax returns and withholding tax returns for the past three years
Description of the status of present or past tax audits
Audit and revenue agent reports, 30-day letters, 90-day letters and private letter rulings and requests therefor
All agreements waiving statute of limitations or extending the time for tax assessment
Schedule of tax attributes (including the amount and year of expiration)
Schedule of all tax accounting methods and elections
All tax provision workpapers
Schedule of balance sheet accounts, including analysis of the deferred tax account and an analysis of any tax reserves (cushion)
All internal correspondence concerning taxes and correspondence involving any taxing authority for the past six years
Description of the impact of recapture rules, including depreciation, investment tax credit and LIFO inventory, if any
Tax basis balance sheets
Schedule of the tax basis of all assets, including costs, accumulated depreciation and depreciation methods for all categories of tangible assets
Most recent appraisals for tangible assets, if any, including value, original cost, amortization and method used and remaining amortization
Tax permits or licenses
C. OPERATIONS:
Who is responsible for pricing decisions
Describe pricing structures, pricing strategies for both purchases and sales, and purchase and sales terms
Describe how sales strategy differs from competitors
Schedule of sales for the past three years broken down by:
customer
product (total sales, gross profit and volume)
Describe special discounts and credit terms offered to customers
A list of agents who perform for the Company marketing, sales, or distributorship services including compensation/commission terms and regions; provide all agreements with sales personnel/agents
Marketing plans and budgets
Schedule of advertising and marketing consultants, including fee arrangements
Describe industry trends and anticipated developments which could impact sales
A list of the suppliers of the Company and purchase value
Agreements with each supplier
Describe process of sourcing parts
D. BUSINESS PRACTICES:
What is the procedure for reporting wrong-doing (breach or violation of the Company’s policies and procedures)?
What areas of business are considered to be the highest risk of non-compliance with policies, standards, laws or regulations? Why? What action has been taken to address the risk areas?
Has the Company or any of its employees or any customers or suppliers been the subject of any government investigation into alleged civil or criminal misconduct; any government prosecution; any quasi-public body investigation, allegation, or litigation into wrongdoing or misconduct, any allegations of wrongdoing by private parties, provided that the wrongdoing in question had a material effect on the performance of employment duties?
Has any officer or employee of the Company been terminated or otherwise disciplined for misconduct? Have there been any internal investigations conducted into employee wrongdoing?
Is the Company in compliance with the FCPA and other government regulations relating to foreign practices, exports/imports
E. QUALITY AND REGULATORY MATTERS
Regulatory and ISO certificates and corresponding Operating Specifications
Policies and Procedures pertaining to Quality Assurance
Typical Records Package for a completed repair job
Internal Audit Reports
Quality Metrics
Purchase and Repair Vendor Lists
List of outsourced functions relating to purchase and repairs
Square footage by functional area of the facilities
All licenses, permits and certifications of employees, including mechanics, engineers, inspectors, quality control personnel, etc.
Last three years audit reports by government agencies, customers, and third parties
Summary of all outstanding product warranties in force
Description of export compliance programs and manuals
F. REPAIRS/TECHNICAL
All repairs that require use of proprietary information and the party who owns the proprietary property
All repair processes or manufacturing processes under development
G. INSURANCE
Current and past insurance policies of any kind and self-insurance plans
Correspondence and claims filed to recover under any insurance policy and loss runs summarizing the history of claims
Bonds currently in force
Actuarial forecast, loss experience and schedule of outstanding claims for workers’ compensation, general liability, property and other liability insurance
Description of any coverage disputes in the past 5 years
Current and past certificates of insurance issued for the benefit of the Company
II. LEGAL DUE DILIGENCE A. CORPORATE
Articles of Incorporation, Bylaws and minute books
Schedule of percentage ownership of all corporations, partnerships, and other entities the Company owns, directly or indirectly
Company’s policy and procedure manuals (employee handbooks)
Schedule of states and jurisdictions where the Company is qualified to do business
Schedule of fictitious names used during the past ten years
All stock records, stock ledgers and canceled stock certificates, including warrants and options
All agreements or plans relating to commitments to issue securities, including proxies, voting trusts and other arrangements
Schedule of officers, directors and senior management
Organizational chart of employees
B. REAL ESTATE
Legal description and addresses of all owned or leased real property (“Real Property”)
Description of the use and its zoning classifications of the Real Property
Leases, deeds, easements, declarations, restrictive covenants, title reports, title commitments, abstracts of title, mortgages, deeds of trust and other documents affecting the Real Property
Surveys, appraisals and evaluations of physical capacities for the Real Property
Any communications alleging any breach or violation of law, rule or regulations applicable to the Real Property or any intent to make assessments thereon
Permits, certificates and licenses related to the ownership or use of the Real Property
Real estate tax bills for the Real Property for the past five years
Warranties affecting the Real Property, including restrictions on use
9 Address of each piece of real property (both present and former) owned, leased or used by the Company C. TANGIBLE PROPERTY
Schedule of product inventory and description of valuation method
Schedule of tangible property (“Personal Property”)
All bills of sale and other documents of title relating to Personal Property
All leases relating to Personal Property
All conditional sale contracts and security agreements relating to Personal Property
All permits and licenses relating to Personal Property
D. ENVIRONMENTAL, HEALTH AND SAFETY MATTERS
All environmental audits, reports or studies covering the Real Property
Correspondence with governmental agencies concerning any environmental matters, including any remote site matters, for the past five years
Any “Declaration of Environmental Restrictions” or any other restriction on the use or transfer of the Real Property that have been proposed or executed in connection with the Real Property
Files concerning any claim that the Company or Real Property has violated any laws or regulations relating to protection of the environment and any claim asserted by any party for property damage relating to releases of hazardous substances from facilities owned or leased by the Company
Any documents relating to the investigation and/or removal of any underground storage tanks at the Real Property
Any documents relating to previous sales of the Real Property which address environmental matters, including indemnification agreements and reports regarding the investigation and/or assessment of environmental conditions
Any documents relating to off-site locations at which any waste from the Real Property is or has been disposed of at any time
Any documents relating to liability or potential liability associated with the off-site disposal of waste
Lists of transporters of hazardous waste and time periods the transporters were used
All current and pending environmental permits
Description of the Company’s environment, health, and safety management systems, policy, organizational structure, and responsibilities
Surveys or summaries of the use of asbestos, or material presumed to contain asbestos, at the Company’s facilities
OSHA citations and litigation for Real Property
Results of employee hazard risk analysis
List of all environmental, health and safety (“EHS”) training programs, assessments of required training and methods to determine training is up to date
List of all EHS summaries or status reports, including the past year reports
The past three-year OSHA 200 logs
Department of Transportation registrations
E. INTELLECTUAL PROPERTY
Schedule of issued and pending patents, trademarks, copyrights and trade secrets, including all applications therefor
Agreements dealing with patents, trademarks, copyrights and trade secrets of the Company or any third party
Correspondence to or from the Company inquiring about a possible license or the status of a patent, trademark, copyright or trade secret or any application therefor
Schedule of all confidential information that the Company licensed or otherwise acquired from a third party
Agreements with directors, officers, employees, agents and independent consultants of the Company relating to non-disclosure of trade secrets, development and assignment of inventions, non-competition and similar matters
Joint venture agreements, joint development agreements and all other agreements that contain intellectual property clauses
Prospective agreements currently in negotiation that contain intellectual property clauses
Sales, or other agreements that contain general or special warranties and/or indemnifications against any form of intellectual property infringement
F. EMPLOYEE/EMPLOYEE BENEFIT MATTERS
Agreements with or relating to agents, officers, directors, shareholders or employees (“Employees”)
Schedule of Employees with title, respective salaries, location, years of service, date and amount of last salary increase, citizenship/immigration/work permit status
List of employees who have departed in last three years, including position at Company
Schedule of all “employee pension benefit plans” or “employee welfare benefit plans” maintained (or, in the case of defined benefit pension plans and multi-employer pension plans, ever maintained) by the Company or to which the Company contributes, together with the most recent plan and trust documents, the most recent summary plan descriptions, the current financial status of such plans and the related insurance policies
Employee handbook, policy guides and description of policies regarding daily hours of work and rest periods; pay practices with respect to illness, vacations, leaves of absence, holidays, personal time; policies regarding overtime compensation and any other employment policies.
Most recent IRS determination letters regarding the qualified status of all plans
List of pending disputes with employee benefit plan participants
Form 5500 (or 5500-C’s) for the past five years
Most recent financial statements, including participant account balances, which pertain to any employee benefit plan
Description of the eligibility requirements for post-retirement medical, life or severance benefits, including plan documents, summary plan descriptions and other information supplied to any Employee
Fringe benefits arrangements provided to any Employee
Description of management development program and advancement process, selection and succession planning process, performance review, feedback and training process
Description of separation practices, including all severance or similar compensation, benefits, practices or commitments
List of employees intending to retire or resign including name, responsibilities, compensation
Schedule of labor turnover rates for the past three years
G. LABOR MATTERS
Agreements with labor organizations, if any
Settlements (formal or informal) relating to employee relations
Schedule of all labor disputes, grievances, strikes and litigation involving any Employee and/or the Company
Schedule of all worker compensation claims filed and a history of loss experience
Schedule of unemployment compensation claims and the status of unemployment accounts
Schedule of all Fair Labor Standards Act claims
H. LEGAL MATTERS
Schedule of all pending or threatened litigation and claims (judicial, administrative and arbitration) by or against the Company or to which the Company is a party
Judgments or decrees to which the Company or any of its properties is subject
Notices and correspondence received from any governmental agency alleging any violation of law, rule or regulation
Correspondence with civil rights, work safety, labor relations or environmental agencies
Settlement agreements in any litigation, arbitration or other legal proceeding relating to the Company
Description of all modification, repair and rework programs and policies
Schedule of threatened, pending and resolved warranty claims asserted against the Company for the past three years
Description and warranties extended for the past three years
I. CONTRACTS/COMMITMENTS
Product sale order forms or agreements
Agreements with suppliers, customers and sales representatives
Contracts not made in the ordinary course of business
Joint venture, partnership or similar agreements
Shareholders’ agreements
Stock option agreements
Contracts with any director, officer or shareholder or subsidiary of any such person
Advertising and marketing contracts
Permits and licenses currently used in the operation of the business
Purchase contracts to which the Company is a party for supplies in excess of normal requirements of the business or which are not terminable without cost to the Company upon 30 days’ notice or which involve more than $5,000
Contracts for performance of services by the Company which are not terminable without cost to the Company
Business acquisition or transaction documents
Agreements pursuant to which the Company disposed of any asset formerly used by the Company for a price of $10,000 or more or pursuant to which the Company disposed of any operation
Contracts, purchase orders and proposals related to current capital improvements, facilities rearrangement, etc.
Asset appraisals for the past three years
Agreements that restrict any shareholder’s right to transfer stock
Inter-company agreements, including inter-company debt and transfer pricing
Power of attorney (tax, customs agents, or others)
List of all contracts or arrangements which may be terminated upon, or contain a penalty, obligation or action triggered by, a change of ownership of 5% or more of the Company
Schedule of all information systems hardware and software and license agreements relating to Company software
Form agreements used by the Company not included above
Other material contracts involving the Company not otherwise covered in the list above
J. GOVERNMENT CONTRACTS
A list and description of all current contracts between (1) the Company and the government of the United States of America or any political subdivision thereof, (2) the Company and the government of the state or any political subdivision thereof where the Company has facilities, operations, or employees, (3) the Company and any foreign government or a political subdivision thereof (collectively “Government”)
Reports received from any agency of the entities of the Government alleging noncompliance with any contracting requirement
Details of current Government contract disputes and/or litigation
Listing and detailed description (location, age, condition, replacement value) of any Government-owned equipment located in or used in any Company facility or operation
Description of any past or present investigations, administrative proceedings or suspensions
Documents addressing export sales and operations, marketing and distribution arrangements
Export/import licenses issued by the U.S. Departments of State, Commerce or Treasury, and any foreign government agencies or instrumentalities
Assessing the Safety Operations Processes of an LPG Storage Plant
https://www.aeplglobe.com/blog/assessing-safety-operations-processes-lpg-storage-plant/ In an LPG Bottling plant, there are several risks to be prevented. It is essential for LPG tank manufacturers to implement safety measures for prevention of any undesired incident on site. Firstly, the best practices for LPG tank installation generally involve evaluation of standard safety operations procedures. Knowledge of LPG and safety Since LPG is odourless and not visible to naked eyes, a distinct odour is added to the gas to detect any leakage. The knowledge of qualified staff about LPG along with long-lasting products parts are essentials for a safer LPG storage plant. LPG is widely used and structured safety guidelines can reduce the risks involved in its usage. Also, LPG is heavier than air in low-level areas so this feature of LPG makes it difficult to detect any leakage. Factors like these have to be considered by the experts managing the LPG filling station installations. LPG leakage can lead to a fire, bursting of the storage tank and more undesired hazards. System thinking ideas along with simulation tools are utilized by manufacturers to assess the risks. Identification of risks helps to put a plan in place for safety management of LPG storage plants. A set of well-documented rules and control mechanisms along with safety training for workers ensures successful implementation of the safety processes designed by the experts. Assessment for storing LPG LPG can be harmful until it has been safely utilized by the end user. To ensure the safer use of LP gas, the LPG tank installation, storage and discharge should be carried out as per industry standard safety best practices. The Standard Operating Procedures (SOPs) play an important role in the prevention of LPG related hazards. The evaluation of safety procedures ensures that SOPs are designed by LPG tank manufacturers as per the scale and specifications of the LPG storage plant. The assessment also helps prepare safety procedure manuals and other communication materials for workers to understand and manage risks related to the LPG storage space. Understanding the risks of an LPG bottling plant will help device safety plans to prevent incidents and in case of an incident, tackle the situation in the best possible way to ensure minimum damage by following the safety protocols. Here is a chart describing the likely sequence of events that can take place after LPG release: 📷 Source:http://www.dgfasli.nic.in/newslettejan_mar2001.pdf Following are some of the key operational areas to be assessed for a safer LPG bottling plant:
As per a document published by DGFASLI, the impact of a breakage in the LPG pipeline is affected by the diameter of the pipeline. Reducing the diameter of the LPG gas pipeline will ensure that the gas leakage will lead to lesser damage to life and property.
The chances of LPG discharge line breakage can be minimized if the line is placed through the roof of the LPG storage tanks.
LPG tank installations have to be made as per a set capacity to avoid leakage. Small capacity tanks take lesser time to discharge the gas while emptying the tanks.
The LPG storage tanks should be kept at a sufficient distance from each other. Isolated tanks reduce the possibility of a greater safety concern i.e. one tank leakage triggering the bursting of the other.
Experienced LPG tank manufacturers and LPG vaporizer manufacturers are aware of the risk assessments and safety procedures to avoid mishaps at LPG plants. For efficient and safer LPG tank installations, you need the expertise of highly experienced LPG Tank manufacturers. AEPL’s team of engineering experts have a background of numerous successful LPG filling station installations. To know more, contact AEPL experts at +918097051488
hazardous materials identification system chart video
Promote a Safer Work Environment Provides reinforcement of your safety protocols Informs employees on the Hazardous Materials Identification System Brightly colored and concise and easy to understand Laminated 1 / EA HMIS Hazardous Materials Identification System File Name: HMIS Hazardous Materials Identification System Page 2 of 2 HMIS FLAMMABILITY HAZARD RATING CHART 0=MINIMAL HAZARD Materials that will not burn. 1=SLIGHT HAZARD Materials that must be preheated before ignition will occur. Includes liquids, solids and semi solids The Hazardous Materials Identification System was developed by The National Paint and Coatings. Association. The HMIS label consists of a five part rectangle: 1) Chemical Identification. 2) Chronic Health Hazard Indicator and Acute Health Hazard Rating. 3) Flammability Rating. The Hazardous Materials Identification System (HMIS) is a hazard rating system that uses color bar labels to identify and provide information about chemical hazards. It was developed by, and is proprietary to the National Paint Coatings Association (NPCA), now known as the American Coatings Association (ACA). Hazardous Materials Label Identification Poster OSHA requires all chemicals in the workplace to be labeled in a manner that warns of any hazards the chemical may present. Our 22” X 26” poster outlines crucial information in an easy to read format that explains the NFPA and HMIS hazardous material labeling system. Standard System for the Identification of the Hazards of Materials for Emergency Response 1. What is ... While the system is simple in application, the hazard evaluation should be performed by persons who are ... 704 and the Fire Protection Guide to Hazardous Materials, 2010 edition can be purchased by clicking on the ... PHMSA has released the "DOT Chart 16 - Hazardous Materials Markings, Labeling and Placarding Guide" in print as well as searchable mobile applications for both iOS and Android platforms to assist shippers, carriers, and other stakeholders to quickly access information regarding hazardous materials markings, labels and placards. Hazardous Materials Identification System (HMIS) is a voluntary hazard rating scheme developed by American Coatings Association (ACA) to help employers comply with workplace labeling requirements of the U.S. Occupational Safety and Health Administration's (OSHA) revised Hazard Communication Standard (HCS). New: Visit the Hazardous Substance Assessment page to see classification information for select chemicals. The Workplace Hazardous Materials Information System (WHMIS) is Canada's national hazard communication standard. The key elements of the system are hazard classification, cautionary labelling of containers, the provision of (material) safety data sheets ((M)SDSs) and worker education and ... HMIS: Hazardous Materials Identification System HMIS: Health Hazard Rating Chart * Chronic Hazard - Chronic(long-term) health effects may result repeated overexposure. 0= Minimal Hazard - No significant risk to health 1= Slight Hazard - Irritation or minor reversible injury possible 2= Moderate Hazard - Temporary or minor injury may occur.
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