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Looking at the “big picture cholesterol levels of meats buy vytorin without a prescription,” twice-exceptional students are important to blood cholesterol levels nz vytorin 20mg lowest price the future of our communities cholesterol what foods are high discount vytorin 20 mg without a prescription. Their unrealized potential can mean immeasurable societal costs: inspiring community leaders who are never elected cholesterol test interpretation buy discount vytorin 30 mg on-line, cures for diseases that are never discovered cholesterol test interference generic 20 mg vytorin overnight delivery, revolutionary inventions that are never patented; thrilling novels that are never written; and ground-breaking theories that are never conceived. Best practices include special education program ming and classroom accommodations that address both giftedness and disability. Unfortunately, there are only a few model programs of this type currently in existence in the country. One exemplary program is provided by the Montgomery County Public Schools in Maryland (see Montgomery Public Schools, 2003, in resources sec tion for more information). In school districts across the country there is a range of professionals who should be responsible for meeting the needs of twice-exceptional students, including special education teachers, related service providers, teachers of the gifted/talented, and mental health professionals. It is the responsibility of the district educational leaders to ensure that a variety of supports and services are available to meet the complex needs of twice-exceptional stu dents and their teachers. Professional Development School staff should participate in professional development to raise awareness of the characteristics of twice exceptional learners, services available in the district, and identification procedures used to identify these stu dents. Professional development activities might focus on definitions of the twice-exceptional population, identification, programming, and classroom practices. Training on learning strategies, accommodations, and communication would also be beneficial. Additionally, there should be shared planning time to allow gifted/talented and special education personnel, content experts, and school-based mental health professionals to collaborate. General education teachers should have the opportunity for meaningful communication with colleagues regarding particular students. Talent Development Opportunities Although this guide is focused on the needs of those twice-exceptional students who are academically gifted and disabled, it is important to keep in mind that they may also have special talents. Twice-exceptional stu dents must have the opportunity to develop and to excel in talent areas, such as arts, music, or dance. This could include mentorships, internships, independent study experience, nonacademic competition, community college programs, art and music programs, clubs (such as chess, language), and other enrichment activities. Schools should engage in meaningful, ongoing communication with families in order to gather information to assist in assessing and meeting individual stu dent needs. Linking student work with personal passions can be accomplished by asking for samples of student work that might be done at home, hobbies in which the child is involved, and the clubs/organizations to which the child belongs. School Counselors School counselors can provide a variety of direct (for example, person counseling) and indirect (for example, advocacy, working with parents) services to assist twice-exceptional students (McEachern & Bornot, 2001). Social and emotional difficulties are often present in the twice-exceptional population. Counselors may be helpful to these students by giving them the opportunity to address concerns related to self-concept, self esteem, and other specific concerns (for example, depression) that occur as a result of the frustration and con fusion of experiencing extremes of ability. School Psychologists Evaluations for disabilities must be conducted by trained professionals familiar with psychological and educa tional assessment. In most cases, the individual with this credential in a school will be the school psychologist. School psychologists should be trained in the nuances of twice-exceptional identification. They should have both the knowledge of various disabilities that impact student learning and psychosocial functioning as well as the knowledge of giftedness. School psychologists also provide counseling services in many schools and can assist twice-exceptional students address social and emotional difficulties. They often work with general educa tion teachers in implementing appropriate classroom behavioral programs. Other Specialists and Services Just like other students with disabilities, twice-exceptional students may benefit from occupational therapy, speech and language support, and other related services. They may be in need of assistive technology or health care services from the school nurse. It is important for educators to recognize that extremes of T ability can exist within any one student; students can have disabilities and still be considered gifted. When a youngster identified as gifted is not performing up to expectations, we should first question whether the student should be evaluated for a possible disability. Immediate removal from the gifted program should not be considered until the possibility of twice-exceptionality is ruled out. Likewise, it is important to identify giftedness in students who have disabilities as they may also require services to develop their gifts and talents. Lack of identification and appropriate services often contribute to a student’s low academic self-efficacy and self esteem. Students who understand their personal pattern of strengths and weaknesses are better equipped to actively participate in their learning. The ideal fit for a twice-exceptional student and his or her educational environ ment is one where both the student’s giftedness and disability are evenly accounted for through appropriate edu cation and services. Twice-excep tional students who are gifted and disabled are under-identified in our schools. As a result, they do not receive the most appropriate services to meet their unique needs and are often underachievers in our classrooms. Along with all other children, they deserve a great public school that has the tools, resources and programs to meet their needs. The suggestions and recommendations offered in this guide are intended to serve as catalysts to initiate dia logue and encourage systemic change in schools and districts. Through efforts to improve assessment and identification processes and instructional practices, in collaboration with families and community partners, we can move closer to eliminating the achievement gaps that persist in our schools today. The law requires states to provide appropriate special education and related services to students meeting eligibility criteria under 13 disability categories. Gifted and Talented Federal law does not require that states and districts provide for the educational needs of gifted and talented learners. As a result, gifted programming decisions in the United States are made at the state and local levels. Although many states mandate that districts identify gifted students and provide services, few states specify the services, or the grade levels in which students must be served. In states without mandates, or in states that do not fund gifted services, it is up to local districts to determine whether to provide services and which talent areas will be served. Javits Program the Jacob Javits Gifted and Talented Students Education Act is the only federal program that specifically addresses the needs of gifted and talented children. The Javits program works through a national research center and demonstration and statewide grant projects. In fiscal year 2005 the Congress provided just over $11 million for the Javits program. The program focuses resources on identifying and serving students who are traditionally underrepresented in gifted and talented programs, particularly economically disadvantaged, limited English proficient, and disabled students, to help reduce gaps in achievement and to encourage equal educational opportunities for all U. Many states and districts have adopted the same or similar definitions for gifted and talented students, although identification procedures are not consistent and the instruments used vary widely. Best practices in the identification of gifted students with learning disabilities. Gifted students with learning disabilities: Implications and strategies for school counselors. The impact of giftedness on psychological well-being: What does the empirical literature say Gifted students with learning disabilities: Recommendations for identification and pro gramming. Social and emotional issues facing gifted and tal ented students: What have we learned and what should we do now Smart kids with learning dif culties: Overcoming obstacles and realizing potential. Recognizing talent: Cross-case study of two high potential students with cerebral palsy. Identification of giftedness in severely and profoundly hearing impaired students. Crossover children: A sourcebook for helping children who are gifted and learning disabled (2nd ed. Diverse populations of gifted children: Meeting their needs in the regular classroom and beyond. Uniquely Gifted: Identifying and meeting the needs of the twice-exceptional student. A Guidebook for twice-exceptional students: Supporting the achievement of gifted students with special needs. Students with both gifts and learning disabilities: Identification, assessment, and outcomes. Assouline of the University of Iowa, Mary Ruth Coleman, of the University of North Carolina, Rebecca D. Some of our most brilliant contributors to society may be found among this popula tion, including Stephen Hawking, Einstein, and Edison. Providing support for individ ual differences in all classroom settings is a goal of our national organizations. I am most pleased to see this publication come to fruition and be put in the hands of class room teachers who can make the critical difference in the lives of these students. Special Testing English Learner Supports For State and District Testing Accommodations Info Graphic Accommodations vs. National or Special requests, including reconsiderations, must be State or District testing submitted by the late registration deadline found at: deadlines, see your. Accommodations To request accommodations, examinees must provide documentation showing: • They have a professionally diagnosed disability that substantially limits one or more major life activity. The Bobath concept is an evolving approach to the management and treatment of children and adults with mobility difficulties caused by neurological conditions such as cerebral palsy and stroke. This therapeutic approach was originated by Berta and Karl Bobath over 50 years ago based upon their clinical experience using models of movement and neuroscience available at that time. The approach has since developed following research, evaluation, client responses and the latest knowledge on child development and neuroscience. Health professionals using the Bobath approach include physiotherapists, speech and language therapists, occupational therapists and doctors. The Bobath approach to treatment the Bobath treatment aims to improve the child’s posture and movement. Through specialised ways of handling, stiffness can be reduced, muscle control against gravity increased and fluctuating muscle activity stabilised. Depending on the severity of the condition, the child is better able to learn how to sit up, use his/her hands, to stand up and to walk. For instance, the way the child is picked up, carried, put down, or positioned when sitting, will enable parents/carers to enhance the child’s ability and function. The goals of treatment are influenced by several factors such as the functional needs in different contexts as expressed by the child and/or parents, the age of the child, severity of their condition, and their motivation. Some of the areas that will be assessed are: 1 • the postures and patterns of movement the child presents with in different situations, and analysis of underlying causes of the postures and patterns of movement. Handling a child using key points on the body allows the therapist to manipulate the child to use the most effective movements whilst limiting the use of unhelpful abnormal movement patterns.

Finkelstein’s test may help diagnose de Quervain’s disease by eliciting pain over the radial side of the wrist cholesterol medication that starts with a buy vytorin 30mg on line. The test is performed by ulnar deviation of the hand after a fist is made over the flexed thumb cholesterol levels diet cost of vytorin. Many causes other than de Quervain’s disease can generate pain with this maneuver cholesterol levels calculator vytorin 30mg for sale, including first carpometacarpal arthritis foods to keep cholesterol down discount vytorin 20mg overnight delivery, Wartenberg’s disease cholesterol chart south africa effective vytorin 20mg, and arthrosis of the radiocarpal and intercarpal joints. Anomalous tendons, multiple slips of the abductor pollicis longus tendon, and multiple subcompartments within the first compartment have been implicated as the cause for failure of nonoperative treatments, such as use of nonsteroidal antiinflammatory drugs, local steroid injection, and thumb and wrist immobilization. If nonoperative treatment fails, surgical release of the first dorsal compartment provides the best result. Compare the success rates of splinting, splinting with injection, injection, and operative management for the treatment of de Quervain’s tenosynovitis. What type of resistive exercise has been found most effective in decreasing lateral epicondylitis rehabilitation Studies indicate that isotonic eccentric exercises performed for 3 sets of 15 repetitions daily for 6 to 12 weeks have been most effective. Mild pain with performance is appropriate; however, care should be avoided to not worsen the patient’s condition. As tolerated, exercise to the wrist extensors should be performed with the elbow in extension and the forearm in pronation, with the arm resting on a supported surface. Some therapists believe that exercise should be performed progressively more quickly, while others believe that the exercises should be performed slowly to avoid reaggravation of the tissues. What long-standing rehabilitation problem may occur when proximal phalanx fractures do not allow for rigid fixation and early motion When range of motion exercises must be delayed to await fracture healing, adhesion of the flexor and extensor tendons to the fracture callus site is common. Extensor tendons lose 10% to 50% of their strength between postoperative days 5 and 21. Finger extension exercises are started at week 4, finger flexion strengthening at week 6, and resistive exercises at week 7. They are nourished in two ways—through the vincula, which are small blood vessel networks, and by synovial fluid diffusion. List and briefly describe the three rehabilitative approaches to the treatment of flexor tendons. This treatment approach is primarily used with children and other individuals who are unable to adhere to more complex protocols. These protocols exist on the theory that passive mobilization of the tendon will result in increased tendon excursion with fewer adhesions and increased healing of the tendon. The splints are worn for 3 to 6 weeks as appropriate with treatment, progressing according to the patient’s progress. Early active mobilization protocols apply a controlled amount of stress to the repaired tendons, encouraging increased tendon glide with fewer adhesions. Various subprotocols use varying techniques for applying the controlled stress, including, but not limited to, active contraction while using rubber band traction and active contraction in a tenodesis splint. Name the risks and benefits of early active tendon mobilization post flexor tendon repair. A review of 34 articles that compared rehabilitation approaches and rupture rates indicated: • Passive protocol—4% rupture rate (57/1598 patients) • Early active protocol—5% rupture rate (75/1598) • Of the 75 patients who ruptured with an early active protocol, 72 had a 2-strand core suture, 3 had a 4-strand core suture, and no patients ruptured with a 6-strand core suture. Describe the pyramid of progressive force exercises and how they apply to the treatment of flexor tendon repairs. The pyramid of progressive force exercises are nine exercises that progressively increase the tensile stress onto the flexor tendon repair in efforts to increase tendon excursion when a lag with treatment gains has occurred. The first four phases of the pyramid are performed with the wrist in a protected position: passive protected extension, place and hold, active composite fist, and hook and straight fists. Phases five through nine are performed with the wrist unprotected: isolated joint motion (blocking), splint discontinuation, resistive composite fist, resisted hook and straight fist, and resisted isolated joint motion. The pyramid allows a guide to make an objective decision with the recovery of a flexor tendon, rather than strictly adhering to a flexor tendon “cookbook” approach. Describe the difference between the congenital anomalies camptodactyly and clinodactyly. This flexion deformity is caused by tightening of the skin, ligaments, and tendons; abnormal musculature; and irregularly shaped bones. It commonly occurs bilaterally at the middle phalanx of the small finger into radial deviation. The deformity is caused by shortening of the phalanx, most often on the radial side of the digit. Describe the benefits of pressure therapy in the therapeutic management of a burned hand. Pressure therapy is an essential key to preventing or controlling hypertrophic scarring after a burn. Pressure garments applying approximately 25 mm Hg of pressure will help control scarring by decreasing circulation to the maturing scar tissue, thereby preventing excessive growth of the scar tissue. Pressure garments are typically elastic customized garments worn over the affected area 24 hours a day. What scar contractures can potentially occur after a burn to the dorsum of the hand Burns to the palmar surface of the hand can potentially result in the loss of thumb and finger extension and abduction. Transfer of a muscle-tendon unit will result in what change in muscle grade, using a 0 to 5 muscle grading scale Other variables can affect and decrease the muscle grade of a transfer; however, loss is not automatic. Subsequentdeformities, including joint instabilities and subluxations, occur because of the lost integrity of the ligaments and tendons. What are common wrist and hand deformities developed by patients with a diagnosis of systemic lupus erythematosus It is a 3-phase process: • Phase 1—reestablishing laterality (right-to-left orientation) • Phase 2—motor imagery performed with or without a mirror box. The patient imagines the affected limb in a variety of positions without moving the affected hand. Define Raynaud’s phenomenon and discuss its etiology, clinical presentation, and treatment. It is often experienced by individuals with vascular disorders, including systemic lupus erythematosus and atherosclerosis, as well as with rheumatoid arthritis. It is also commonly seen in response to repeated digital trauma, vibration, and prolonged cold exposure. The presenting symptoms of Raynaud’s phenomenon often include a “triple response” of vascular changes, although not all individuals experience three color changes, and the order of the color changes varies. Typically the digit(s) will assume a blanched appearance (lack of blood flow because of vasospasm), then cyanosis (venous pooling), and then a reddening of the digit(s) as arterial blood flow returns to the digit(s). Treatment for this disorder consists of surgical removal of the proximal obstruction, patient education on the effects of smoking and caffeine, avoidance of cold and vibration and of vasoconstrictive medications, biofeedback, and use of oral vasodilatory medications. Effectiveness of different methods of resistance exercises in lateral epicondylosis—A systematic review. Complex regional pain syndrome: A systemic review of the literature, the past, present, and future management. The effect of a therapy protocol for increasing correction of severely contracted proximal interphalangeal joints caused by Dupuytren disease and treated with collagenase injection. Treatment of deQuervain’s tenosynovitis: A prospective study of the results of injection of steroids and immobilization in a splint. What drug can be used to attempt to release a Dupuytren’s contracture when a cord is present What diagnosis is the pyramid of progressive force exercises primarily used for in the clinical decision-making process Typically, fractures of the metacarpal necks of the ring and small fingers are called boxer’s fractures. Usually boxer’s fractures can be treated nonoperatively with closed reduction and casting. The acceptable degree of angulation is undecided, but most surgeons accept up to 10 to 15 degrees in the second and third digits, 30 to 35 degrees in the fourth, and 50 degrees in the fifth. This injury usually occurs during catching a ball (hence the name) or striking something with the finger extended and the tendon tight. The extensor tendon can pull directly off the dorsal distal phalanx or be associated with a dorsal articular fracture. Surgery should be performed soon after injury, especially if the tendonis completely retracted to the palm. The angulation of proximal phalanx fractures, like that of most fractures, depends on two factors: the mechanism of injury and the muscles acting as a deforming force on the fractured bone. The proximal fragment is flexed by the interossei, which insert into its base, and the distal fragment is pulled into hyperextension by the central slip, which inserts into the base of the middle phalanx. Bennett’s fracture typically results from an axial force directed against a partially flexed metacarpal (often in a fight). The smaller of the two fracture fragments stays in place, attached to the anterior oblique ligament. The rest of the digit is pulled dorsally and radially by the abductor pollicis longus, whereas the more distal attachment of the adductor pollicis contributes additional dorsal displacement. Rolando’s fracture involves more comminution with the two fragments; usually a third large dorsal fragment in a Y or T-shaped pattern is also present. Lateral dislocations are caused by an abduction or adduction force across the extended finger, usually in such sports as basketball, football, and wrestling. If the dislocation is treated with buddy taping, a boutonniere deformity probably will result. If the ligament is avulsed, it is reattached with a bone anchor or tied over a button. How are metacarpophalangeal radial collateral ligament tears of the thumb treated The ligament rarely displaces, similar to a Stener lesion; therefore, immobilization can allow for complete ligament tears to heal. Some are advocating surgical repair to avoid subjective instability and joint degenerative changes. Lateral: the radiolunatocapitate should form a straight line with the third metacarpal joint. Flexion, extension, radial deviation, and ulnar deviation views, along with the previously mentioned, are enough to diagnose 90% of wrist injuries. Special views • Scaphoid-radial oblique (supinated posteroanterior view)—with the forearm pronated 45 degrees from neutral, a full profile view of the scaphoid is obtained. The most common of the three is Colles’ fracture, which is extraarticular with dorsal angulation, displacement, and shortening. Barton’s fracture is an intraarticular shear fracture that may be dorsal or volar. A chauffeur’s fracture is an intraarticular, triangular-shaped fracture involving the radial styloid.

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However cholesterol medication warning discount 20mg vytorin free shipping, both circumstances can involve 24 hour shifts and the need to cholesterol test definition order cheap vytorin perform under conditions where one’s actions can have life and death consequences cholesterol under 100 20 mg vytorin free shipping. However cholesterol test error margin buy 30mg vytorin with amex, the many variables and unique situations prevent drawing firm conclusions from the many published studies total cholesterol levels nz discount vytorin 30 mg without prescription. While performance on simulation exercises and alertness measures can reflect worker abilities, the most compelling evidence comes from real world outcomes, such as job performance, patient safety and crashes (Taffinder et al. One adverse outcome and the resultant public examination of conditions lead to events z that mandated reform. And if cross-sectional study results are to be generalized across sites, those studies should include a broad range of locales, conditions and personnel, and they require appropriate means to validate the collected data. Because work schedules are such an integral component of people’s lives, workers’ full participation in scheduling issues is mandatory. The United Kingdom also is in the process of reforming postgraduate medical training to reduce working hours, using a phased reduction aimed to reduce weekly work hours to 48 by 2112. An explicit component is acknowledging the economic and work force consequences of reduced hours, and the gradual reduction allows expanding medical student numbers to cover the additional duties (Beecham, 1999). Lawyer and journalist Sidney Zion actually did — to the benefit of patients and doctors-in-training nationwide. After his 18-year-old daughter Libby died within 24 hours of an emergency hospital admission in 1984, Zion learned that her chief doctors had been medical residents covering dozens of patients and receiving relatively little supervision. Just about everyone involved in the Libby Zion case — her father, her doctors and the people who testified at the trial that eventually resulted — has a different account of what happened. Libby was a college freshman with a history of depression who came to New York Hospital in Manhattan on the evening of Oct. Unable to diagnose her condition definitively, the emergency room physicians admitted her for hydration and observation. As the physician of record, Raymond Sherman, a senior clinician who had treated several members of the Zion family, approved the decision by phone. On the hospital ward where she was sent, Libby was evaluated by two residents: Luise Weinstein, an intern eight months out of medical school, and Gregg Stone, who had one additional year of training. Stone termed it a “viral syndrome with hysterical symptoms,” suggesting that Libby was overreacting to a relatively mild illness. The doctors prescribed a shot of meperidine, a painkiller and sedative, to control her shaking. Stone went to sleep in an adjacent building, where he would be available, if necessary, by beeper. Weinstein ordered physical restraints to hold the patient down and prevent her from hurting herself. She also prescribed an injection of haloperidol, another medication aimed at calming the patient. Weinstein called her parents, telling them doctors had done everything they could. To the doctors at the hospital, the case was an inexplicable “bad outcome” in which a healthy young woman had died of a mysterious infection. But the more Sidney Zion learned of the circumstances of Libby’s death, the more he rejected this assertion. He became convinced his daughter’s death was due to inadequate staffing at the teaching hospital. And he grew determined to ensure that others not fall victim to the same gaps in the teaching hospital system that he blamed for his daughter’s death. Second, Sidney Zion questioned the use of restraints and shots for an increasingly agitated patient. To the distress of his daughter’s doctors, Zion began to refer to her death as a “murder. Over time, entanglements faced by her physicians the image of the bedraggled, and the New York Medical Center. It unsupervised intern wreaking damage provides a sobering perspective for all in hospitals would be featured in the who practice or are cared for in U. In May 1986 Manhattan District Attorney Robert Morgenthau agreed to let a grand jury consider murder charges. Although it declined to indict, the jury issued a report strongly criticizing “the supervision of interns and junior residents at a hospital in New York County. Bell, an outspoken primary care physician at the Albert Einstein College of Medicine in the Bronx, to evaluate the training and supervision of doctors in the state. In 1989, New York state adopted the Bell Commission’s recommendations that residents could not work more than 80 hours a week or more than 24 consecutive hours. Still, some physicians resisted work hour reform efforts, and they argued one simply could not become a qualified doctor without experiencing firsthand what happened during the often unpredictable first 36 hours of a patient’s illness. Historians these days tend to distrust the idea that the actions of specific people truly cause large-scale change. Rather, many argue, change more commonly results from a complex interplay of cultural and political factors. To be sure, it took the social changes of the 1960s and 1970s to make graduate medical education susceptible to reform from the outside. But Sidney Zion sped things up considerably, ensuring that Libby had not died in vain. In presenting its case, the hospital introduced a claim, unsupported by toxicology testing and vigorously disputed by the plaintiffs, that Libby Zion had died as a result of cocaine ingestion that she had concealed from her doctors. Indeed, it is quite possible that without this rage, he might not have accomplished what he did. Zion was “aggressive, narcissistic, self-indulgent, pushy, persistent and paranoid,” psychiatrist Willard Gaylin memorably wrote in the Nation, “but that is precisely the stuff successful reformers are made of. According to the National Volunteer Fire Council, each of those categories is approximately 73 percent of the 1. For example, fire fighters include individuals assigned to engines, trucks and special response units; those with paramedic training; and officers and employees assigned to the Fire Inspector office, training division and other specialized units. Superimposed on the variability in job descriptions are the unique characteristics of different fire departments/bureaus/districts and stations within those organizations. Wildland fire fighters’ job structures differ from other fire fighters, in that they usually are deployed to sites for two weeks of intense work. The effects of their long work hours relate to physical exhaustion, in addition to sleep loss. We and others have documented that fire fighters are a high-risk group, with an increased prevalence of obesity, hypertension, high cholesterol levels, certain malignancies and chronic musculoskeletal complaints (Elliot et al. Fire fighters’ cardiovascular risks, combined with episodic intense physical exertion involving extreme heat and life-threatening situations, may account for heart attacks causing half of on-the-job deaths (Kales et al. Much less data are available on work-related morbidity and mortality for other groups of first Management strategies have been responders. Among all occupations, the highest risk developed to minimize the adverse health of cardiovascular disease is with law enforcement consequences of the sleep loss and officers (Calvert, Merling & Burnett, 1999), whose circadian disruption of shift work and life expectancies are 15 years less than the average extended work hours. In general, they are employed for pre-hospital care by private companies, public municipalities and hospitals. When assessing the effects of long work hours, many other variables must be considered. Specifics of the job description, work structure and its context and characteristics of the individual employee all may affect outcomes. Accordingly, those issues must be taken into account when generalizing study findings and applying any conclusions to other settings. As a result, in presenting information, we have tried to provide specifics concerning the study group and methodology when describing information. The National Fire Fighter Near-Miss Reporting System is a voluntary, non-punitive means to capture and learn from incidents and near-incidents, and its 2006 summary report provides a convenience sample of the many different shift structures of fire fighters (Figure 4. Among reports submitted to the Near-Miss Reporting System, 12 percent indicated that their department had 2 shifts (days and nights) of 10 to 14 hours length. The majority of reports were from departments using three platoons or shifts deployed in rotations. Thirty percent reported 24 on/48-off formats, and 23 percent indicated alternative 24 hour rotations. The latter usually is an on-off-on-off-on then 4 off schedule (depending on nuances, called 3/4, modified Detroit or modified Berkeley). More than 19 variations on those basic three platoon rotation patterns are in use. Most departments have a Kelly or off day every 8th shift to reduce the number of hours worked from becoming overtime. Some departments maintain a fourth smaller platoon to staff Kelly days and leaves. The result is a work week that for most fire fighters averages 48 to 56 hours, not counting overtime. In the last few years, a 48 hours on and 96 hours off schedule has become more popular. In the Near-Miss reports, 3 percent of departments listed the newer 48-on/96-off schedule. The format originated in Southern California, because fire fighters were unable to afford local housing and faced long commutes, which were reduced in half with that schedule. Because it represents a new work format, descriptive information is available from departments adopting that schedule, which is summarized in Section 4. Distribution of Work Schedules in 2006 Near-Miss Accident Reports* *The Near-Miss Reporting System is a convenience sample and may under represent volun teer fire fighters. Only approximately one-third of reports are from volunteer departments, when nationwide volunteer departments represent 71 percent of fire departments. For example, a staffing pattern might be 12 hour shifts, with a maximum of three in a row, with a guarantee of 48 hours per week and an attempt to provide employees 60 hours each week. The staffing patterns are complex, and web-services are available to aid in meeting those demands, such as Among those workers, because of helicopters and fixed-wing craft pilot regulations, which limit work hours, staffing patterns for pilots and medical personnel differ; pilots generally work 10 to 14 hour shifts, while the medical teams are approximately equally divided as working either 10 to 12 hour shifts or 24 hour schedules. There is scheduling diversity among air medical transport work sites, depending on work load, whether privately operated or hospital-based and other factors (Frakes & Kelly, 2004). In general, fire fighters have an established tradition of working 24 hour shifts, and few complaints are registered about that pattern. Those who question the wisdom of that scheduling format, on the grounds of either safety or economics (Philpot, 2005), have received harsh criticism from fire fighters submitting comments (Firehouse Forum, 2003). Pertinent issues included responding to events when on duty for more than 15 hours, driving home from busy 24 hour shifts and fatigue when awoken for early morning calls. The near-miss records have a place for incident time, but summary reports indicate that for most submissions, that information is not included, and specifics concerning the relationship between time of day and near-misses is not available.

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