U.S. Nuclear Weapons Modernization - the Stockpile Life Extension Program

NASA Astrophysics Data System (ADS)

Cook, Donald

2016-03-01

Underground nuclear testing of U.S. nuclear weapons was halted by President George H.W. Bush in 1992 when he announced a moratorium. In 1993, the moratorium was extended by President Bill Clinton and, in 1995, a program of Stockpile Stewardship was put in its place. In 1996, President Clinton signed the Comprehensive Nuclear Test Ban Treaty (CTBT). Twenty years have passed since then. Over the same time, the average age of a nuclear weapon in the stockpile has increased from 6 years (1992) to nearly 29 years (2015). At its inception, achievement of the objectives of the Stockpile Stewardship Program (SSP) appeared possible but very difficult. The cost to design and construct several large facilities for precision experimentation in hydrodynamics and high energy density physics was large. The practical steps needed to move from computational platforms of less than 100 Mflops/sec to 10 Teraflops/sec and beyond were unknown. Today, most of the required facilities for SSP are in place and computational speed has been increased by more than six orders of magnitude. These, and the physicists and engineers in the complex of labs and plants within the National Nuclear Security Administration (NNSA) who put them in place, have been the basis for underpinning an annual decision, made by the weapons lab directors for each of the past 20 years, that resort to underground nuclear testing is not needed for maintaining confidence in the safety and reliability of the U.S stockpile. A key part of that decision has been annual assessment of the physical changes in stockpiled weapons. These weapons, quite simply, are systems that invariably and unstoppably age in the internal weapon environment of radioactive materials and complex interfaces of highly dissimilar organic and inorganic materials. Without an ongoing program to rebuild some components and replace other components to increase safety or security, i.e., life extending these weapons, either underground testing would again be

An Introduction to Risk with a Focus on Design Diversity in the Stockpile

DOE Office of Scientific and Technical Information (OSTI.GOV)

Noone, Bailey C

2012-08-13

The maintenance and security of nuclear weapons in the stockpile involves decisions based on risk analysis and quantitative measures of risk. Risk is a factor in all decisions, a particularly important factor in decisions of a large scale. One example of high-risk decisions we will discuss is the risk involved in design diversity within the stockpile of nuclear weapons arsenal. Risk is defined as 'possibility of loss or injury' and the 'degree of probability of such loss' (Kaplan and Garrick 12). To introduce the risk involved with maintaining the weapons stockpile we will draw a parallel to the design andmore » maintenance of Southwest Airlines fleet of Boeing 737 planes. The clear benefits for cost savings in maintenance of having a uniform fleet are what historically drove Southwest to have only Boeing 737s in their fleet. Less money and resources are need for maintenance, training, and materials. Naturally, risk accompanies those benefits. A defect in a part of the plane indicates a potential defect in that same part in all the planes of the fleet. As a result, safety, business, and credibility are at risk. How much variety or diversity does the fleet need to mitigate that risk? With that question in mind, a balance is needed to accommodate the different risks and benefits of the situation. In a similar way, risk is analyzed for the design and maintenance of nuclear weapons in the stockpile. In conclusion, risk must be as low as possible when it comes to the nuclear weapons stockpile. Design and care to keep the stockpile healthy involves all aspects of risk management. Design diversity is a method that helps to mitigate risk, and to help balance options in stockpile stewardship.« less

20 Years of Success: Science, Technology, and the Nuclear Weapons Stockpile

DOE Office of Scientific and Technical Information (OSTI.GOV)

None, None

On Oct. 22, 2015, NNSA celebrated the proven success of the Stockpile Stewardship Program at a half-day public event featuring remarks by Secretary of Energy Ernest Moniz, Secretary of State John Kerry, and Under Secretary for Nuclear Security and NNSA Administrator Lt. Gen. (retired) Frank G. Klotz. The event also featured remarks by Deputy Secretary of Energy Elizabeth Sherwood-Randall and NNSA Principal Deputy Administrator Madelyn Creedon.

Development of Designer Diamond Anvils for High Pressure-High-Temperature Experiments in Support of the Stockpile Stewardship Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yogesh K. Vohra

The focus of this program at the University of Alabama at Birmingham (UAB) is to develop the next generation of designer diamond anvils that can perform simultaneous joule heating and temperature profile measurements in a diamond anvil cell. A series of tungsten-rhenium thermocouples will be fabricated onto to the anvil and encapsulated by a chemical vapor deposited diamond layer to allow for a complete temperature profile measurement across the anvil. The tip of the diamond anvil will be engineered to reduce the thermal conductivity so that the tungsten-heating coils can be deposited on top of this layer. Several different approachesmore » will be investigated to engineer the tip of the diamond anvil for reduction in thermal conductivity (a) isotopic mixture of 12C and 13C in the diamond layer, (b) doping of diamond with impurities (nitrogen and/or boron), and (c) growing diamond in a higher concentration of methane in hydrogen plasma. Under this academic alliance with Lawrence Livermore National Laboratory (LLNL), PI and his graduate students will use the lithographic and diamond polishing facility at LLNL. This proposed next generation of designer diamond anvils will allow multi-tasking capability with the ability to measure electrical, magnetic, structural and thermal data on actinide materials with unparallel sensitivity in support of the stockpile stewardship program.« less

Advances and Challenges In Uncertainty Quantification with Application to Climate Prediction, ICF design and Science Stockpile Stewardship

NASA Astrophysics Data System (ADS)

Klein, R.; Woodward, C. S.; Johannesson, G.; Domyancic, D.; Covey, C. C.; Lucas, D. D.

2012-12-01

Uncertainty Quantification (UQ) is a critical field within 21st century simulation science that resides at the very center of the web of emerging predictive capabilities. The science of UQ holds the promise of giving much greater meaning to the results of complex large-scale simulations, allowing for quantifying and bounding uncertainties. This powerful capability will yield new insights into scientific predictions (e.g. Climate) of great impact on both national and international arenas, allow informed decisions on the design of critical experiments (e.g. ICF capsule design, MFE, NE) in many scientific fields, and assign confidence bounds to scientifically predictable outcomes (e.g. nuclear weapons design). In this talk I will discuss a major new strategic initiative (SI) we have developed at Lawrence Livermore National Laboratory to advance the science of Uncertainty Quantification at LLNL focusing in particular on (a) the research and development of new algorithms and methodologies of UQ as applied to multi-physics multi-scale codes, (b) incorporation of these advancements into a global UQ Pipeline (i.e. a computational superstructure) that will simplify user access to sophisticated tools for UQ studies as well as act as a self-guided, self-adapting UQ engine for UQ studies on extreme computing platforms and (c) use laboratory applications as a test bed for new algorithms and methodologies. The initial SI focus has been on applications for the quantification of uncertainty associated with Climate prediction, but the validated UQ methodologies we have developed are now being fed back into Science Based Stockpile Stewardship (SSS) and ICF UQ efforts. To make advancements in several of these UQ grand challenges, I will focus in talk on the following three research areas in our Strategic Initiative: Error Estimation in multi-physics and multi-scale codes ; Tackling the "Curse of High Dimensionality"; and development of an advanced UQ Computational Pipeline to enable

16 CFR 1210.20 - Stockpiling.

Code of Federal Regulations, 2011 CFR

2011-01-01

... STANDARD FOR CIGARETTE LIGHTERS Stockpiling § 1210.20 Stockpiling. (a) Definition. Stockpiling means to... cigarette lighters shall not manufacture or import lighters that do not comply with the requirements of this...

16 CFR 1210.20 - Stockpiling.

Code of Federal Regulations, 2010 CFR

2010-01-01

... STANDARD FOR CIGARETTE LIGHTERS Stockpiling § 1210.20 Stockpiling. (a) Definition. Stockpiling means to... cigarette lighters shall not manufacture or import lighters that do not comply with the requirements of this...

Right Size Determining the Staff Necessary to Sustain Simulation and Computing Capabilities for Nuclear Security

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nikkel, Daniel J.; Meisner, Robert

The Advanced Simulation and Computing Campaign, herein referred to as the ASC Program, is a core element of the science-based Stockpile Stewardship Program (SSP), which enables assessment, certification, and maintenance of the safety, security, and reliability of the U.S. nuclear stockpile without the need to resume nuclear testing. The use of advanced parallel computing has transitioned from proof-of-principle to become a critical element for assessing and certifying the stockpile. As the initiative phase of the ASC Program came to an end in the mid-2000s, the National Nuclear Security Administration redirected resources to other urgent priorities, and resulting staff reductions inmore » ASC occurred without the benefit of analysis of the impact on modern stockpile stewardship that is dependent on these new simulation capabilities. Consequently, in mid-2008 the ASC Program management commissioned a study to estimate the essential size and balance needed to sustain advanced simulation as a core component of stockpile stewardship. The ASC Program requires a minimum base staff size of 930 (which includes the number of staff necessary to maintain critical technical disciplines as well as to execute required programmatic tasks) to sustain its essential ongoing role in stockpile stewardship.« less

Revaluation of stockpile amount of PFOS-containing aqueous film-forming foam in Japan: gaps and pitfalls in the stockpile survey.

PubMed

Zushi, Yasuyuki; Yamamoto, Atsushi; Tsunemi, Kiyotaka; Masunaga, Shigeki

2017-03-01

Stockpiles of perfluoro-octane sulfonic acid (PFOS) containing aqueous film-forming foam (AFFF) have the potential to be emitted by leaching, spills, and during use in fire response and other processes. Several studies have discussed the high levels of stockpiled PFOS-containing AFFF and the risk they pose to the environment; however, there are large gaps in the amounts in Japan compared with other countries. For example, 300 tons are stockpiled in Canada, 2200-2600 tons in Switzerland, 1400 tons in Norway, and 19,000 tons in Japan from their reports for publication. The gap is considered to be a result of lack of surveys of several important sources. In this study, we revaluated the stockpile of AFFF in Japan to verify the reported value and identify the source of this gap based on information available in peer-reviewed papers, governmental reports, and business reports. The major reason for the gap between Japan and other countries was considered to be the survey of stockpiles in car-parking facilities, which accounted for 46.7% of the total amounts in Japan, but were not considered in other countries. These stockpiles indicate a high potential for accidental leaching or spilling of the AFFF by careless storage. Therefore, it is recommended that continual surveys of the AFFF stockpile in car-parking facilities be conducted in the rest of the world.

Stockpiling Ventilators for Influenza Pandemics.

PubMed

Huang, Hsin-Chan; Araz, Ozgur M; Morton, David P; Johnson, Gregory P; Damien, Paul; Clements, Bruce; Meyers, Lauren Ancel

2017-06-01

In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influenza patients in respiratory failure. As a case study, we consider the US state of Texas during mild, moderate, and severe pandemics. Optimal allocations prioritize local over central storage, even though the latter can be deployed adaptively, on the basis of real-time needs. This prioritization stems from high geographic correlations and the slightly lower treatment success assumed for centrally stockpiled ventilators. We developed our model and analysis in collaboration with academic researchers and a state public health agency and incorporated it into a Web-based decision-support tool for pandemic preparedness and response.

Stockpiling Ventilators for Influenza Pandemics

PubMed Central

Araz, Ozgur M.; Morton, David P.; Johnson, Gregory P.; Damien, Paul; Clements, Bruce; Meyers, Lauren Ancel

2017-01-01

In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influenza patients in respiratory failure. As a case study, we consider the US state of Texas during mild, moderate, and severe pandemics. Optimal allocations prioritize local over central storage, even though the latter can be deployed adaptively, on the basis of real-time needs. This prioritization stems from high geographic correlations and the slightly lower treatment success assumed for centrally stockpiled ventilators. We developed our model and analysis in collaboration with academic researchers and a state public health agency and incorporated it into a Web-based decision-support tool for pandemic preparedness and response. PMID:28518041

The development of global vaccine stockpiles

PubMed Central

Yen, Catherine; Hyde, Terri B; Costa, Alejandro J; Fernandez, Katya; Tam, John S; Hugonnet, Stéphane; Huvos, Anne M; Duclos, Philippe; Dietz, Vance J; Burkholder, Brenton T

2016-01-01

Global vaccine stockpiles, in which vaccines are reserved for use when needed for emergencies or supply shortages, have effectively provided countries with the capacity for rapid response to emergency situations, such as outbreaks of yellow fever and meningococcal meningitis. The high cost and insufficient supply of many vaccines, including oral cholera vaccine and pandemic influenza vaccine, have prompted discussion on expansion of the use of vaccine stockpiles to address a wider range of emerging and re-emerging diseases. However, the decision to establish and maintain a vaccine stockpile is complex and must take account of disease and vaccine characteristics, stockpile management, funding, and ethical concerns, such as equity. Past experience with global vaccine stockpiles provide valuable information about the processes for their establishment and maintenance. In this Review we explored existing literature and stockpile data to discuss the lessons learned and to inform the development of future vaccine stockpiles. PMID:25661473

16 CFR § 1210.20 - Stockpiling.

Code of Federal Regulations, 2013 CFR

2013-01-01

... STANDARD FOR CIGARETTE LIGHTERS Stockpiling § 1210.20 Stockpiling. (a) Definition. Stockpiling means to... cigarette lighters shall not manufacture or import lighters that do not comply with the requirements of this...

Biosolid stockpiles are a significant point source for greenhouse gas emissions.

PubMed

Majumder, Ramaprasad; Livesley, Stephen J; Gregory, David; Arndt, Stefan K

2014-10-01

The wastewater treatment process generates large amounts of sewage sludge that are dried and then often stored in biosolid stockpiles in treatment plants. Because the biosolids are rich in decomposable organic matter they could be a significant source for greenhouse gas (GHG) emissions, yet there are no direct measurements of GHG from stockpiles. We therefore measured the direct emissions of methane (CH4), nitrous oxide (N2O) and carbon dioxide (CO2) on a monthly basis from three different age classes of biosolid stockpiles at the Western Treatment Plant (WTP), Melbourne, Australia, from December 2009 to November 2011 using manual static chambers. All biosolid stockpiles were a significant point source for CH4 and N2O emissions. The youngest biosolids (<1 year old) had the greatest CH4 and N2O emissions of 60.2 kg of CO2-e per Mg of biosolid per year. Stockpiles that were between 1 and 3 years old emitted less overall GHG (∼29 kg CO2-e Mg(-1) yr(-1)) and the oldest stockpiles emitted the least GHG (∼10 kg CO2-e Mg(-1) yr(-1)). Methane emissions were negligible in all stockpiles but the relative contribution of N2O and CO2 changed with stockpile age. The youngest stockpile emitted two thirds of the GHG emission as N2O, while the 1-3 year old stockpile emitted an equal amount of N2O and CO2 and in the oldest stockpile CO2 emissions dominated. We did not detect any seasonal variability of GHG emissions and did not observe a correlation between GHG flux and environmental variables such as biosolid temperature, moisture content or nitrate and ammonium concentration. We also modeled CH4 emissions based on a first order decay model and the model based estimated annual CH4 emissions were higher as compared to the direct field based estimated annual CH4 emissions. Our results indicate that labile organic material in stockpiles is decomposed over time and that nitrogen decomposition processes lead to significant N2O emissions. Carbon decomposition favors CO2 over

The development of global vaccine stockpiles.

PubMed

Yen, Catherine; Hyde, Terri B; Costa, Alejandro J; Fernandez, Katya; Tam, John S; Hugonnet, Stéphane; Huvos, Anne M; Duclos, Philippe; Dietz, Vance J; Burkholder, Brenton T

2015-03-01

Global vaccine stockpiles, in which vaccines are reserved for use when needed for emergencies or supply shortages, have effectively provided countries with the capacity for rapid response to emergency situations, such as outbreaks of yellow fever and meningococcal meningitis. The high cost and insufficient supply of many vaccines, including oral cholera vaccine and pandemic influenza vaccine, have prompted discussion on expansion of the use of vaccine stockpiles to address a wider range of emerging and re-emerging diseases. However, the decision to establish and maintain a vaccine stockpile is complex and must take account of disease and vaccine characteristics, stockpile management, funding, and ethical concerns, such as equity. Past experience with global vaccine stockpiles provide valuable information about the processes for their establishment and maintenance. In this Review we explored existing literature and stockpile data to discuss the lessons learned and to inform the development of future vaccine stockpiles. Copyright © 2015 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

DOE PAGES

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu; ...

2017-10-11

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

Stockpile Model of Personal Protective Equipment in Taiwan.

PubMed

Chen, Yu-Ju; Chiang, Po-Jung; Cheng, Yu-Hsin; Huang, Chun-Wei; Kao, Hui-Yun; Chang, Chih-Kai; Huang, Hsun-Miao; Liu, Pei-Yin; Wang, Jen-Hsin; Chih, Yi-Chien; Chou, Shu-Mei; Yang, Chin-Hui; Chen, Chang-Hsun

The Taiwan Centers for Disease Control (Taiwan CDC) has established a 3-tier personal protective equipment (PPE) stockpiling framework that could maintain a minimum stockpile for the surge demand of PPE in the early stage of a pandemic. However, PPE stockpiling efforts must contend with increasing storage fees and expiration problems. In 2011, the Taiwan CDC initiated a stockpile replacement model in order to optimize the PPE stockpiling efficiency, ensure a minimum stockpile, use the government's limited funds more effectively, and achieve the goal of sustainable management. This stockpile replacement model employs a first-in-first-out principle in which the oldest stock in the central government stockpile is regularly replaced and replenished with the same amount of new and qualified products, ensuring the availability and maintenance of the minimum stockpiles. In addition, a joint electronic procurement platform has been established for merchandising the replaced PPE to local health authorities and medical and other institutions for their routine or epidemic use. In this article, we describe the PPE stockpile model in Taiwan, including the 3-tier stockpiling framework, the operational model, the components of the replacement system, implementation outcomes, epidemic supports, and the challenges and prospects of this model.

Stewardship mapping and assessment project: a framework for understanding community-based environmental stewardship

Treesearch

Erika S. Svendsen; Lindsay K. Campbell; Dana R. Fisher; James J.T. Connolly; Michelle L. Johnson; Nancy Falxa Sonti; Dexter H. Locke; Lynne M. Westphal; Cherie LeBlanc Fisher; Morgan Grove; Michele Romolini; Dale J. Blahna; Kathleen L. Wolf

2016-01-01

The Stewardship Mapping and Assessment Project (STEW-MAP) is designed to answer who, where, why and how environmental stewardship groups are caring for our urbanized landscapes. This report is intended to be a guide for those who wish to start STEW-MAP in their own city. It contains step-by-step directions for how to plan and implement a STEW-MAP project. STEW-MAP is...

Stockpile Model of Personal Protective Equipment in Taiwan

PubMed Central

Chen, Yu-Ju; Cheng, Yu-Hsin; Huang, Chun-Wei; Kao, Hui-Yun; Chang, Chih-Kai; Huang, Hsun-Miao; Liu, Pei-Yin; Wang, Jen-Hsin; Chih, Yi-Chien; Chou, Shu-Mei; Yang, Chin-Hui; Chen, Chang-Hsun

2017-01-01

The Taiwan Centers for Disease Control (Taiwan CDC) has established a 3-tier personal protective equipment (PPE) stockpiling framework that could maintain a minimum stockpile for the surge demand of PPE in the early stage of a pandemic. However, PPE stockpiling efforts must contend with increasing storage fees and expiration problems. In 2011, the Taiwan CDC initiated a stockpile replacement model in order to optimize the PPE stockpiling efficiency, ensure a minimum stockpile, use the government's limited funds more effectively, and achieve the goal of sustainable management. This stockpile replacement model employs a first-in-first-out principle in which the oldest stock in the central government stockpile is regularly replaced and replenished with the same amount of new and qualified products, ensuring the availability and maintenance of the minimum stockpiles. In addition, a joint electronic procurement platform has been established for merchandising the replaced PPE to local health authorities and medical and other institutions for their routine or epidemic use. In this article, we describe the PPE stockpile model in Taiwan, including the 3-tier stockpiling framework, the operational model, the components of the replacement system, implementation outcomes, epidemic supports, and the challenges and prospects of this model. PMID:28418743

Collaborative Decision Model on Stockpile Material of a Traditional Market Infrastructure using Value-Based HBU

NASA Astrophysics Data System (ADS)

Utomo, C.; Rahmawati, Y.; Pararta, D. L.; Ariesta, A.

2017-11-01

Readiness of infrastructure establishment is needed in the early phase of real estate development. To meet the needs of retail property in the form of traditional markets, the Government prepares to build a new 1300 units. Traditional market development requires infrastructure development. One of it is the preparation of sand material embankment as much as ± 200,000 m3. With a distance of 30 km, sand material can be delivered to the project site by dump trucks that can only be operated by 2 trip per day. The material is managed by using stockpile method. Decision of stockpile location requires multi person and multi criteria in a collaborative environment. The highest and the best use (HBU) criteria was used to construct a value-based decision hierarchy. Decision makers from five stakeholders analyzed the best of three locations by giving their own preference of development cost and HBU function. Analytical Hierarchy Process (AHP) based on satisfying options and cooperative game was applied for agreement options and coalition formation on collaborative decision. The result indicates that not all solutions become a possible location for the stockpile material. It shows the ‘best fit’ options process for all decision makers.

16 CFR 1207.12 - Stockpiling.

Code of Federal Regulations, 2010 CFR

2010-01-01

... STANDARD FOR SWIMMING POOL SLIDES § 1207.12 Stockpiling. (a) Definitions. As used in this section: (1) Stockpiling means manufacturing or importing swimming pool slides between the date of promulgation of part... importation) means the total number of swimming pool slides manufactured (or imported) during a stated time...

Roadmap to MaRIE January 2015

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barnes, Cris William

After the decision to end nuclear testing and the inception of the Stockpile Stewardship program, the condition of the stockpile was the primary mission driver. During the first two decades of stewardship, the primary program goal could be described as underwriting the Stockpile-to-Target Sequence (STS), the military requirements on the conditions the nuclear warheads needed to survive and still operate.

30 CFR 56.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Trimming stockpile and muckpile faces. 56.9314... Dumping Sites § 56.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be trimmed to prevent hazards to persons. ...

30 CFR 56.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Trimming stockpile and muckpile faces. 56.9314... Dumping Sites § 56.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be trimmed to prevent hazards to persons. ...

30 CFR 57.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Trimming stockpile and muckpile faces. 57.9314... Dumping Sites § 57.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be trimmed to prevent hazards to persons. ...

30 CFR 57.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Trimming stockpile and muckpile faces. 57.9314... Dumping Sites § 57.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be trimmed to prevent hazards to persons. ...

Material Stream Strategy for Lithium and Inorganics (U)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Safarik, Douglas Joseph; Dunn, Paul Stanton; Korzekwa, Deniece Rochelle

Design Agency Responsibilities: Manufacturing Support to meet Stockpile Stewardship goals for maintaining the nuclear stockpile through experimental and predictive modeling capability. Development and maintenance of Manufacturing Science expertise to assess material specifications and performance boundaries, and their relationship to processing parameters. Production Engineering Evaluations with competence in design requirements, material specifications, and manufacturing controls. Maintenance and enhancement of Aging Science expertise to support Stockpile Stewardship predictive science capability.

Urban ecological stewardship: understanding the structure, function and network of community-based urban land management

Treesearch

Erika s. Svendsen; Lindsay K. Campbell

2008-01-01

Urban environmental stewardship activities are on the rise in cities throughout the Northeast. Groups participating in stewardship activities range in age, size, and geography and represent an increasingly complex and dynamic arrangement of civil society, government and business sectors. To better understand the structure, function and network of these community-based...

30 CFR 56.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Trimming stockpile and muckpile faces. 56.9314 Section 56.9314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND... Dumping Sites § 56.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be...

30 CFR 57.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Trimming stockpile and muckpile faces. 57.9314 Section 57.9314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND... Dumping Sites § 57.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be...

30 CFR 57.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Trimming stockpile and muckpile faces. 57.9314 Section 57.9314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND... Dumping Sites § 57.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be...

30 CFR 57.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Trimming stockpile and muckpile faces. 57.9314 Section 57.9314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND... Dumping Sites § 57.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be...

30 CFR 56.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Trimming stockpile and muckpile faces. 56.9314 Section 56.9314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND... Dumping Sites § 56.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be...

30 CFR 56.9314 - Trimming stockpile and muckpile faces.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Trimming stockpile and muckpile faces. 56.9314 Section 56.9314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND... Dumping Sites § 56.9314 Trimming stockpile and muckpile faces. Stockpile and muckpile faces shall be...

Point-of-Prescription Interventions to Improve Antimicrobial Stewardship

PubMed Central

Hamilton, Keith W.; Gerber, Jeffrey S.; Moehring, Rebekah; Anderson, Deverick J.; Calderwood, Michael S.; Han, Jennifer H.; Mehta, Jimish M.; Pollack, Lori A.; Zaoutis, Theoklis; Srinivasan, Arjun; Camins, Bernard C.; Schwartz, David N.; Lautenbach, Ebbing

2015-01-01

Antimicrobial stewardship is pivotal to improving patient outcomes, reducing adverse events, decreasing healthcare costs, and preventing further emergence of antimicrobial resistance. In an era in which antimicrobial resistance is increasing, judicious antimicrobial use is the responsibility of every healthcare provider. Antimicrobial stewardship programs (ASPs) have made headway in improving antimicrobial prescribing using such “top-down” methods as formulary restriction and prospective audit with feedback; however, engagement of prescribers has not been fully explored. Strategies that include frontline prescribers and other unit-based healthcare providers have the potential to expand stewardship, both to augment existing centralized ASPs and to provide alternative approaches to perform stewardship at healthcare facilities with limited resources. This review discusses interventions focusing on antimicrobial prescribing at the point of prescription as well as a pilot project to engage unit-based healthcare providers in antimicrobial stewardship. PMID:25595748

Assuring Essential Industrial Base Requirements for Strategic & Critical Materials

DTIC Science & Technology

2012-05-23

pilot project to reclaim rhenium containing super alloys from jet engines • Viewed as a method to offset substantial reliance on foreign sources of...be candidates for National Defense Stockpile inventory Rhenium Upgrade 13 WARFIGHTER SUPPORT ENHANCEMENT STEWARDSHIP

Advancing antimicrobial stewardship: Summary of the 2015 CIDSC Report.

PubMed

Khan, F; Arthur, J; Maidment, L; Blue, D

2016-11-03

Antimicrobial resistance (AMR) is recognized as an important global public health concern that has a cross-cutting impact on human health, animal health, food and agriculture and the environment. The Communicable and Infectious Disease Steering Committee (CIDSC) of the Pan-Canadian Public Health Network (PHN) created a Task Group on Antimicrobial Stewardship to look at this issue from a Canadian perspective. To summarize the key findings of the Task Group Report that identified core components of antimicrobial stewardship programs, best practices, key challenges, gaps and recommendations to advance stewardship across jurisdictions. Search strategies were developed to identify scientific literature, grey literature and relevant websites on antimicrobial stewardship. The information was reviewed and based on this evidence, expert opinion and consensus-building, the Task Group identified core components, best practices, key challenges and gaps and developed recommendations to advance stewardship in Canada. The four components of a promising antimicrobial stewardship initiative were: leadership, interventions, monitoring/evaluation and future research. Best practices include a multi-sectoral/multipronged approach involving a wide range of stakeholders at the national, provincial/territorial, local and health care organizational levels. Key challenges and gaps identified were: the success and sustainability of stewardship undertakings require appropriate and sustained resourcing and expertise; there is limited evidence about how to effectively implement treatment guidance; and there is a challenge in ensuring accessibility, standardization and consistency of use among professionals. ​: Recommendations to the CIDSC about how to advance stewardship across jurisdictions included the following: institute a national infrastructure; develop best practices to implement stewardship programs; develop education and promote awareness; establish consistent evidence-based guidance

30 CFR 702.16 - Stockpiling of minerals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Stockpiling of minerals. 702.16 Section 702.16 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR GENERAL EXEMPTION FOR COAL EXTRACTION INCIDENTAL TO THE EXTRACTION OF OTHER MINERALS § 702.16 Stockpiling of...

30 CFR 702.16 - Stockpiling of minerals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Stockpiling of minerals. 702.16 Section 702.16 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR GENERAL EXEMPTION FOR COAL EXTRACTION INCIDENTAL TO THE EXTRACTION OF OTHER MINERALS § 702.16 Stockpiling of...

30 CFR 702.16 - Stockpiling of minerals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Stockpiling of minerals. 702.16 Section 702.16 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR GENERAL EXEMPTION FOR COAL EXTRACTION INCIDENTAL TO THE EXTRACTION OF OTHER MINERALS § 702.16 Stockpiling of...

30 CFR 702.16 - Stockpiling of minerals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Stockpiling of minerals. 702.16 Section 702.16 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR GENERAL EXEMPTION FOR COAL EXTRACTION INCIDENTAL TO THE EXTRACTION OF OTHER MINERALS § 702.16 Stockpiling of...

30 CFR 702.16 - Stockpiling of minerals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Stockpiling of minerals. 702.16 Section 702.16 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR GENERAL EXEMPTION FOR COAL EXTRACTION INCIDENTAL TO THE EXTRACTION OF OTHER MINERALS § 702.16 Stockpiling of...

Antimicrobial stewardship

PubMed Central

Chung, Gladys W.; Wu, Jia En; Yeo, Chay Leng; Chan, Douglas; Hsu, Li Yang

2013-01-01

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs. PMID:23302793

Feasibility and applicability of antimicrobial stewardship in immunocompromised patients.

PubMed

Robilotti, Elizabeth; Holubar, Marisa; Seo, Susan K; Deresinski, Stan

2017-08-01

Antimicrobial stewardship is the primary intervention in the battle against antimicrobial resistance, but clinicians do not always apply many key antimicrobial stewardship principles to patients with significant immune defects due to lack of data and fear of bad outcomes. We review evidence regarding the application of stewardship principles to immunocompromised patients, with a focus on solid organ and hematopoietic stem cell transplant recipients. Antimicrobial stewardship programs (ASPs), targeting immunocompromised patient populations such as oncology and transplant, are gaining traction. Emerging literature suggests that several stewardship interventions can be adapted to immunocompromised hosts and improve antimicrobial utilization, but data supporting improved outcomes is very limited. The application of antimicrobial stewardship principles to immunocompromised patients is feasible, necessary, and urgent. As antimicrobial stewardship programs gain momentum across a diverse range of healthcare settings more immunocompromised patients will fall under their purview. It is imperative that centers applying antimicrobial stewardship principles share their experience and establish collaborative research efforts to advance our knowledge base in applying antimicrobial stewardship initiatives to immunocompromised host populations, both in terms of programmatic success and patient outcomes.

Planning guidance for the Chemical Stockpile Emergency Preparedness Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shumpert, B.L.; Watson, A.P.; Sorensen, J.H.

1995-02-01

This planning guide was developed under the direction of the U.S. Army and the Federal Emergency Management Agency (FEMA) which jointly coordinate and direct the development of the Chemical Stockpile Emergency Preparedness Program (CSEPP). It was produced to assist state, local, and Army installation planners in formulating and coordinating plans for chemical events that may occur at the chemical agent stockpile storage locations in the continental United States. This document provides broad planning guidance for use by both on-post and off-post agencies and organizations in the development of a coordinated plan for responding to chemical events. It contains checklists tomore » assist in assuring that all important aspects are included in the plans and procedures developed at each Chemical Stockpile Disposal Program (CSDP) location. The checklists are supplemented by planning guidelines in the appendices which provide more detailed guidance regarding some issues. The planning guidance contained in this document will help ensure that adequate coordination between on-post and off-post planners occurs during the planning process. This planning guide broadly describes an adequate emergency planning base that assures that critical planning decisions will be made consistently at every chemical agent stockpile location. This planning guide includes material drawn from other documents developed by the FEMA, the Army, and other federal agencies with emergency preparedness program responsibilities. Some of this material has been developed specifically to meet the unique requirements of the CSEPP. In addition to this guidance, other location-specific documents, technical studies, and support studies should be used as needed to assist in the planning at each of the chemical agent stockpile locations to address the specific hazards and conditions at each location.« less

Assessing Environmental Stewardship Motivation

ERIC Educational Resources Information Center

Bramston, Paul; Pretty, Grace; Zammit, Charlie

2011-01-01

Environmental stewardship networks flourish across Australia. Although the environment benefits, this article looks to identify what volunteers draw from their stewardship. The authors adapted 16 questions that purportedly tap environmental stewardship motivation and administered them to a convenience sample of 318 university students and then to…

Place-Based Stewardship Education: Nurturing Aspirations to Protect the Rural Commons

ERIC Educational Resources Information Center

Gallay, Erin; Marckini-Polk, Lisa; Schroeder, Brandon; Flanagan, Constance

2016-01-01

In this mixed-methods study, we examine the potential of place-based stewardship education (PBSE) for nurturing rural students' community attachment and aspirations to contribute to the preservation of the environmental "commons." Analyzing pre- and post-experience surveys (n = 240) and open-ended responses (n = 275) collected from…

30 CFR 823.12 - Soil removal and stockpiling.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Soil removal and stockpiling. 823.12 Section... ON PRIME FARMLAND § 823.12 Soil removal and stockpiling. (a) Prime farmland soils shall be removed from the areas to be disturbed before drilling, blasting, or mining. (b) The minimum depth of soil and...

30 CFR 823.12 - Soil removal and stockpiling.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Soil removal and stockpiling. 823.12 Section... ON PRIME FARMLAND § 823.12 Soil removal and stockpiling. (a) Prime farmland soils shall be removed from the areas to be disturbed before drilling, blasting, or mining. (b) The minimum depth of soil and...

30 CFR 823.12 - Soil removal and stockpiling.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Soil removal and stockpiling. 823.12 Section... ON PRIME FARMLAND § 823.12 Soil removal and stockpiling. (a) Prime farmland soils shall be removed from the areas to be disturbed before drilling, blasting, or mining. (b) The minimum depth of soil and...

30 CFR 823.12 - Soil removal and stockpiling.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Soil removal and stockpiling. 823.12 Section... ON PRIME FARMLAND § 823.12 Soil removal and stockpiling. (a) Prime farmland soils shall be removed from the areas to be disturbed before drilling, blasting, or mining. (b) The minimum depth of soil and...

30 CFR 823.12 - Soil removal and stockpiling.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Soil removal and stockpiling. 823.12 Section... ON PRIME FARMLAND § 823.12 Soil removal and stockpiling. (a) Prime farmland soils shall be removed from the areas to be disturbed before drilling, blasting, or mining. (b) The minimum depth of soil and...

Antimicrobial Stewardship: The Need to Cover All Bases

PubMed Central

Friedman, N. Deborah

2013-01-01

Increasing antimicrobial resistance has necessitated an approach to guide the use of antibiotics. The necessity to guide antimicrobial use via stewardship has never been more urgent. The decline in anti-infective innovation and the failure of currently available antimicrobials to treat some serious infections forces clinicians to change those behaviors that drive antimicrobial resistance. The majority of antimicrobial stewardship (AMS) programs function in acute-care hospitals, however, hospitals are only one setting where antibiotics are prescribed. Antimicrobial use is also high in residential aged care facilities and in the community. Prescribing in aged care is influenced by the fact that elderly residents have lowered immunity, are susceptible to infection and are frequently colonized with multi-resistant organisms. While in the community, prescribers are faced with public misconceptions about the effectiveness of antibiotics for many upper respiratory tract illnesses. AMS programs in all of these locations must be sustainable over a long period of time in order to be effective. A future with effective antimicrobials to treat bacterial infection will depend on AMS covering all of these bases. This review discusses AMS in acute care hospitals, aged care and the community and emphasizes that AMS is critical to patient safety and relies on government, clinician and community engagement. PMID:27029310

Strategic national stockpile: overview and ventilator assets.

PubMed

Malatino, Eileen M

2008-01-01

Acquiring a resupply of critical medical assets following a national emergency will be crucial to saving lives. The Strategic National Stockpile is a national repository of various medications, vaccines, antidotes, and medical/surgical equipment that would be used to augment federal, state, and local public health agencies in the event of a terrorist attack or other public health emergency. Portable ventilators are included in the stockpile Managed Inventory. These ventilators and the ancillary equipment needed for one adult or one pediatric patient are kitted in a durable case that is staged and ready for deployment. A state that requires these assets initiates a request for federal assistance through established guidelines. This paper provides an overview of the Strategic National Stockpile, the types of ventilators and ancillary equipment currently available, and the process for requesting these assets.

Optimal vaccine stockpile design for an eradicated disease: application to polio.

PubMed

Tebbens, Radboud J Duintjer; Pallansch, Mark A; Alexander, James P; Thompson, Kimberly M

2010-06-11

Eradication of a disease promises significant health and financial benefits. Preserving those benefits, hopefully in perpetuity, requires preparing for the possibility that the causal agent could re-emerge (unintentionally or intentionally). In the case of a vaccine-preventable disease, creation and planning for the use of a vaccine stockpile becomes a primary concern. Doing so requires consideration of the dynamics at different levels, including the stockpile supply chain and transmission of the causal agent. This paper develops a mathematical framework for determining the optimal management of a vaccine stockpile over time. We apply the framework to the polio vaccine stockpile for the post-eradication era and present examples of solutions to one possible framing of the optimization problem. We use the framework to discuss issues relevant to the development and use of the polio vaccine stockpile, including capacity constraints, production and filling delays, risks associated with the stockpile, dynamics and uncertainty of vaccine needs, issues of funding, location, and serotype dependent behavior, and the implications of likely changes over time that might occur. This framework serves as a helpful context for discussions and analyses related to the process of designing and maintaining a stockpile for an eradicated disease. (c) 2010 Elsevier Ltd. All rights reserved.

The concept of stewardship in health policy.

PubMed Central

Saltman, R. B.; Ferroussier-Davis, O.

2000-01-01

There is widespread agreement that both the configuration and the application of state authority in the health sector should be realigned in the interest of achieving agreed policy objectives. The desired outcome is frequently characterized as a search for good governance serving the public interest. The present paper examines the proposal in The World Health Report 2000 that the concept of stewardship offers the appropriate basis for reconfiguration. We trace the development of stewardship from its initial religious formulation to more recent ecological and sociological permutations. Consideration is given to the potential of stewardship for encouraging state decision-making that is both normatively based and economically efficient. Various dilemmas that could impede or preclude such a shift in state behaviour are examined. We conclude that the concept of stewardship holds substantial promise if adequately developed and effectively implemented. PMID:10916910

Antibiotic losses from unprotected manure stockpiles.

PubMed

Dolliver, Holly A S; Gupta, Satish C

2008-01-01

Manure management is a major concern in livestock production systems. Although historically the primary concerns have been nutrients and pathogens, manure is also a source of emerging contaminants, such as antibiotics, to the environment. There is a growing concern that antibiotics in manure are reaching surface and ground waters and contributing to the development and spread of antibiotic resistance in the environment. One such pathway is through leaching and runoff from manure stockpiles. In this study, we quantified chlortetracycline, monensin, and tylosin losses in runoff from beef manure stockpiles during two separate but consecutive experiments representing different weather conditions (i.e., temperature and precipitation amount and form). Concentrations of chlortetracycline, monensin, and tylosin in runoff were positively correlated with initial concentrations of antibiotics in manure. The highest concentrations of chlortetracycline, monensin, and tylosin in runoff were 210, 3175, and 2544 microg L(-1), respectively. Relative antibiotic losses were primarily a function of water losses. In the experiment that had higher runoff water losses, antibiotic losses ranged from 1.2 to 1.8% of total extractable antibiotics in manure. In the experiment with lower runoff water losses, antibiotic losses varied from 0.2 to 0.6% of the total extractable antibiotics in manure. Manure analysis over time suggests that in situ degradation is an important mechanism for antibiotic losses. Degradation losses during manure stockpiling may exceed cumulative losses from runoff events. Storing manure in protected (i.e., covered) facilities could reduce the risk of aquatic contamination associated with manure stockpiling and other outdoor manure management practices.

Antibiotic stewardship: does it work in hospital practice? A review of the evidence base.

PubMed

Hulscher, M E J L; Prins, J M

2017-11-01

Guidelines for developing and implementing stewardship programmes include recommendations on appropriate antibiotic use to guide the stewardship team's choice of potential stewardship objectives. They also include recommendations on behavioural change interventions to guide the team's choice of potential interventions to ensure that professionals actually use antibiotics appropriately in daily practice. To summarize the evidence base of both appropriate antibiotic use recommendations (the 'what') and behavioural change interventions (the 'how') in hospital practice. Published systematic reviews/Medline. The literature shows low-quality evidence of the positive effects of appropriate antibiotic use in hospital patients. The literature shows that any behavioural change intervention might work to ensure that professionals actually perform appropriate antibiotic use recommendations in daily practice. Although effects were overall positive, there were large differences in improvement between studies that tested similar change interventions. The literature showed a clear need for studies that apply appropriate study designs- (randomized) controlled designs-to test the effectiveness of appropriate antibiotic use on achieving meaningful outcomes. Most current studies used designs prone to confounding by indication. In the process of selecting behavioural change interventions that might work best in a chosen setting, much should be learned from behavioural sciences. The challenge for stewardship teams lies in selecting change interventions on the careful assessment of barriers and facilitators, and on a theoretical base while linking determinants to change interventions. Future studies should apply more robust designs and evaluations when assessing behavioural change interventions. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Fiber digestion kinetics and protein degradability characteristics of stockpiled Tifton 85 bermudagrass.

PubMed

Sechler, S R; Mullenix, M K; Holland, C M; Muntifering, R B

2017-09-01

A 2-yr study was conducted to determine effects of N fertilization level on fiber digestion kinetics and protein degradability characteristics of stockpiled Tifton 85 bermudagrass (T85). Six 0.76-ha pastures of stockpiled T85 were cut to a 10-cm stubble height on August 1 of each yr and fertilized with 56 (56N), 112 (112N), or 168 (168N) kg N/ha (2 pastures/treatment). Fiber digestion kinetics included the 72-hr potential extent of NDF digestion (PED), rate of NDF digestion, and lag time. In yr 1 and 2, PED decreased over the stockpile season. Rates of NDF digestion did not differ ( > 0.05) among N fertilization treatments in either yr. In yr 1, rate of NDF digestion was greatest ( < 0.05) in October/November, and decreased beginning in December. In yr 2, rate of NDF digestion decreased ( < 0.05) in January compared with November, but digestion rates were similar for November and January 21 sampling dates. Lag time was greater ( < 0.05) for the 112N than 56N and 168N treatments, and increased ( < 0.05) across sampling dates in yr 1. In yr 2, lag time increased ( < 0.05) from 9.0 to 17.7 h across the season. In yr 1 and 2, a negative correlation ( < 0.05) between forage lignin concentration and both PED ( = -0.91 and -0.87 in yr 1 and 2, respectively) and rate of NDF digestion ( = -0.60 and -0.25 in yr 1 and 2, respectively) was observed. There was a trend ( = 0.06) for lignin concentration to be positively correlated with lag time ( = 0.39) in yr 1, and a strong relationship was observed in yr 2 ( = 0.91; < 0.05). The RDP fraction as a % of CP was ≥ 90% throughout both years. Concentration of RDP (% of total DM) decreased across the stockpiling season through January in yr 1 and 2. Results suggest that kinetic parameters of NDF digestion in stockpiled T85 were influenced more by temporal changes over the stockpile season than by N fertilization level. Supplement formulations based on kinetic parameters of fiber digestion may require periodic adjustment to insure

Healthcare system cost evaluation of antiviral stockpiling for pandemic influenza preparedness.

PubMed

Li, Yang; Hsu, Edbert B; Links, Jonathan M

2010-06-01

Healthcare workers need to be protected during a severe influenza outbreak; therefore, we evaluated 4 different antiviral strategies: (1) using antiviral medication for outbreak prophylaxis of all hospital employees; (2) using antiviral medication for postexposure prophylaxis (PEP) or treatment of all hospital employees; (3) using a combination of antiviral medication for outbreak prophylaxis of high-risk clinical staff and postexposure prophylaxis or treatment for all other staff; and (4) using antiviral medication for postexposure prophylaxis or treatment of high-risk clinical staff only. Three different purchasing options were applied to each of the 4 antiviral strategies: (1) just-in-time purchase during a severe influenza outbreak, (2) prepandemic stockpiling, or (3) stockpiling through contracts with pharmaceutical manufacturers to reserve a predetermined antiviral supply. Although outbreak prophylaxis of all hospital employees would offer the maximum protection, the large costs associated with such a purchase make this option unrealistic and impractical. In addition, even though postexposure prophylaxis or treatment of only high-risk clinical staff would incur the least expense, the assumed level of protection if these options were offered only to high-risk clinical staff may not be sufficient to maintain routine hospital operations, since needed non-high-risk staff would not be protected. Considering the potential benefits and drawbacks of stockpiling antiviral medication from a cost perspective, it does not appear feasible for hospitals to stockpile antiviral medication in large quantities prior to a severe influenza outbreak. This article focuses on the financial viability of stockpiling antiviral medication, but the potential impact of other factors on the decision to stockpile was also considered and will be explored in future analyses. While legal hurdles related to prescribing, storing, and dispensing antiviral medication can be addressed

Stockpiling hydrated lime-soil mixtures.

DOT National Transportation Integrated Search

2007-06-01

The concept and feasibility of stockpiling and reusing hydrated lime-soil mixtures to stabilize particular areas on stabilization projects after the mixing contractor has departed were examined. In chemical stabilization of subgrades, situations ofte...

Development of an antimicrobial stewardship-based infectious diseases elective that incorporates human patient simulation technology.

PubMed

Falcione, Bonnie A; Meyer, Susan M

2014-10-15

To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs.

Development of an Antimicrobial Stewardship-based Infectious Diseases Elective that Incorporates Human Patient Simulation Technology

PubMed Central

Meyer, Susan M.

2014-01-01

Objective. To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. Design. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Assessment. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. Conclusion. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs. PMID:25386016

Nuclear Deterrence and Stockpile Stewardship

Science.gov Websites

Los Alamos National Laboratory Search Site submit About Mission Business Newsroom Publications Los Innovation in New Mexico Los Alamos Collaboration for Explosives Detection (LACED) SensorNexus Exascale Computing Project (ECP) User Facilities Center for Integrated Nanotechnologies (CINT) Los Alamos Neutron

Nuclear materials stewardship: Our enduring mission

DOE Office of Scientific and Technical Information (OSTI.GOV)

Isaacs, T.H.

1998-12-31

The US Department of Energy (DOE) and its predecessors have handled a remarkably wide variety of nuclear materials over the past 50 yr. Two fundamental changes have occurred that shape the current landscape regarding nuclear materials. If one recognizes the implications and opportunities, one sees that the stewardship of nuclear materials will be a fundamental and important job of the DOE for the foreseeable future. The first change--the breakup of the Soviet Union and the resulting end to the nuclear arms race--altered US objectives. Previously, the focus was on materials production, weapon design, nuclear testing, and stockpile enhancements. Now themore » attention is on dismantlement of weapons, excess special nuclear material inventories, accompanying increased concern over the protection afforded to such materials; new arms control measures; and importantly, maintenance of the safety and reliability of the remaining arsenal without testing. The second change was the raised consciousness and sense of responsibility for dealing with the environmental legacies of past nuclear arms programs. Recognition of the need to clean up radioactive contamination, manage the wastes, conduct current operations responsibly, and restore the environment have led to the establishment of what is now the largest program in the DOE. Two additional features add to the challenge and drive the need for recognition of nuclear materials stewardship as a fundamental, enduring, and compelling mission of the DOE. The first is the extraordinary time frames. No matter what the future of nuclear weapons and no matter what the future of nuclear power, the DOE will be responsible for most of the country`s nuclear materials and wastes for generations. Even if the Yucca Mountain program is successful and on schedule, it will last more than 100 yr. Second, the use, management, and disposition of nuclear materials and wastes affect a variety of nationally important and diverse objectives, from

Stockpiling and Comprehensive Utilization of Red Mud Research Progress

PubMed Central

Liu, Dong-Yan; Wu, Chuan-Sheng

2012-01-01

With increasing production of red mud, the environmental problems caused by it are increasingly serious, and thus the integrated treatment of red mud is imminent. This article provides an overview of the composition and the basic characteristics of red mud. The research progress of safe stockpiling and comprehensive utilization of red mud is summarized. The safe stockpiling of red mud can be divided into two aspects: the design and safe operation of the stocking yard. The comprehensive utilization of red mud can be further divided into three aspects: the effective recycling of components, resource utilization and application in the field of environmental protection. This paper points out that the main focus of previous studies on red mud stockpiling is cost reproduction and land tenure. The recovery of resources from red mud has a high value-added, but low level industrialization. The use of red mud as a building material and filler material is the most effective way to reduce the stockpiling of red mud. Red mud used for environmental remediation materials is a new hotspot and worth promoting for its simple processing and low cost.

The Nature of Scatter at the DARHT Facility and Suggestions for Improved Modeling of DARHT Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morneau, Rachel Anne

This report describes the US Stockpile Stewardship Program which is meant to sustain and evaluate nuclear weapon stockpile with no underground nuclear tests. This research will focus on DARHT, the Dual Axis Radiographic Hydrodynamic Test facility.

Data Governance and Stewardship: Designing Data Stewardship Entities and Advancing Data Access

PubMed Central

Rosenbaum, Sara

2010-01-01

U.S. health policy is engaged in a struggle over access to health information, in particular, the conditions under which information should be accessible for research when appropriate privacy protections and security safeguards are in place. The expanded use of health information—an inevitable step in an information age—is widely considered be essential to health system reform. Models exist for the creation of data-sharing arrangements that promote proper use of information in a safe and secure environment and with attention to ethical standards. Data stewardship is a concept with deep roots in the science and practice of data collection, sharing, and analysis. Reflecting the values of fair information practice, data stewardship denotes an approach to the management of data, particularly data that can identify individuals. The concept of a data steward is intended to convey a fiduciary (or trust) level of responsibility toward the data. Data governance is the process by which responsibilities of stewardship are conceptualized and carried out. As the concept of health information data stewardship advances in a technology-enabled environment, the question is whether legal barriers to data access and use will begin to give way. One possible answer may lie in defining the public interest in certain data uses, tying provider participation in federal health programs to the release of all-payer data to recognized data stewardship entities for aggregation and management, and enabling such entities to foster and enable the creation of knowledge through research. PMID:21054365

What is urban environmental stewardship? Constructing a practitioner-derived framework

Treesearch

M. Romolini; W. Brinkley; K.L. Wolf

2012-01-01

Agencies and organizations deploy various strategies in response to environmental challenges, including the formulation of policy, programs, and regulations. Citizen-based environmental stewardship is increasingly seen as an innovative and important approach to improving and conserving landscape health. A new research focus on the stewardship of urban natural resources...

Evaluating ecological monitoring of civic environmental stewardship in the Green-Duwamish watershed, Washington

Treesearch

Jacob C. Sheppard; Clare M. Ryan; Dale J. Blahna

2017-01-01

The ecological outcomes of civic environmental stewardship are poorly understood, especially at scales larger than individual sites. In this study we characterized civic environmental stewardship programs in the Green-Duwamish watershed in King County, WA, and evaluated the extent to which stewardship outcomes were monitored. We developed a four-step process based on...

Embedding Data Stewardship in Geoscience Australia

NASA Astrophysics Data System (ADS)

Bastrakova, I.; Fyfe, S.

2013-12-01

Ten years of technological innovation now enable vast amounts of data to be collected, managed, processed and shared. At the same time, organisations have witnessed government legislative and policy requirements for open access to public sector data, and a demand for flexibility in access to data by both machine-to-machine and human consumption. Geoscience Australia (GA) has adopted Data Stewardship as an organisation-wide initiative to improve the way we manage and share our data. The benefits to GA including: - Consolidated understanding of GA's data assets and their value to the Agency; - Recognition of the significant role of data custodianship and data management; - Well-defined governance, policies, standards, practices and accountabilities that promote the accessibility, quality and interoperability of GA's data; - Integration of disparate data sets into cohesive information products available online in real time and equally accessible to researchers, government, industry and the public. Although the theory behind data stewardship is well-defined and accepted and the benefits are generally well-understood, practical implementation requires an organisation to prepare for a long-term commitment of resources, both financial and human. Fundamentally this involves: 1. Raising awareness in the organisation of the need for data stewardship and the challenges this entails; 2. Establishing a data stewardship framework including a data governance office to set policy and drive organisational change; and 3. Embedding the functions and a culture of data stewardship into business as usual operations. GA holds a vast amount of data ranging from petabytes of Big Data to significant quantities of relatively small ';long tail' geoscientific observations and measurements. Over the past four years, GA has undertaken strategic activities that prepare us for Data Stewardship: - Organisation-wide audits of GA's data holdings and identification of custodians for each dataset

Data governance and stewardship: designing data stewardship entities and advancing data access.

PubMed

Rosenbaum, Sara

2010-10-01

U.S. health policy is engaged in a struggle over access to health information, in particular, the conditions under which information should be accessible for research when appropriate privacy protections and security safeguards are in place. The expanded use of health information-an inevitable step in an information age-is widely considered be essential to health system reform. Models exist for the creation of data-sharing arrangements that promote proper use of information in a safe and secure environment and with attention to ethical standards. Data stewardship is a concept with deep roots in the science and practice of data collection, sharing, and analysis. Reflecting the values of fair information practice, data stewardship denotes an approach to the management of data, particularly data that can identify individuals. The concept of a data steward is intended to convey a fiduciary (or trust) level of responsibility toward the data. Data governance is the process by which responsibilities of stewardship are conceptualized and carried out. As the concept of health information data stewardship advances in a technology-enabled environment, the question is whether legal barriers to data access and use will begin to give way. One possible answer may lie in defining the public interest in certain data uses, tying provider participation in federal health programs to the release of all-payer data to recognized data stewardship entities for aggregation and management, and enabling such entities to foster and enable the creation of knowledge through research. © Health Research and Educational Trust.

Dust emission modelling around a stockpile by using computational fluid dynamics and discrete element method

NASA Astrophysics Data System (ADS)

Derakhshani, S. M.; Schott, D. L.; Lodewijks, G.

2013-06-01

Dust emissions can have significant effects on the human health, environment and industry equipment. Understanding the dust generation process helps to select a suitable dust preventing approach and also is useful to evaluate the environmental impact of dust emission. To describe these processes, numerical methods such as Computational Fluid Dynamics (CFD) are widely used, however nowadays particle based methods like Discrete Element Method (DEM) allow researchers to model interaction between particles and fluid flow. In this study, air flow over a stockpile, dust emission, erosion and surface deformation of granular material in the form of stockpile are studied by using DEM and CFD as a coupled method. Two and three dimensional simulations are respectively developed for CFD and DEM methods to minimize CPU time. The standard κ-ɛ turbulence model is used in a fully developed turbulent flow. The continuous gas phase and the discrete particle phase link to each other through gas-particle void fractions and momentum transfer. In addition to stockpile deformation, dust dispersion is studied and finally the accuracy of stockpile deformation results obtained by CFD-DEM modelling will be validated by the agreement with the existing experimental data.

Environmental Stewardship: A Conceptual Review and Analytical Framework.

PubMed

Bennett, Nathan J; Whitty, Tara S; Finkbeiner, Elena; Pittman, Jeremy; Bassett, Hannah; Gelcich, Stefan; Allison, Edward H

2018-04-01

There has been increasing attention to and investment in local environmental stewardship in conservation and environmental management policies and programs globally. Yet environmental stewardship has not received adequate conceptual attention. Establishing a clear definition and comprehensive analytical framework could strengthen our ability to understand the factors that lead to the success or failure of environmental stewardship in different contexts and how to most effectively support and enable local efforts. Here we propose such a definition and framework. First, we define local environmental stewardship as the actions taken by individuals, groups or networks of actors, with various motivations and levels of capacity, to protect, care for or responsibly use the environment in pursuit of environmental and/or social outcomes in diverse social-ecological contexts. Next, drawing from a review of the environmental stewardship, management and governance literatures, we unpack the elements of this definition to develop an analytical framework that can facilitate research on local environmental stewardship. Finally, we discuss potential interventions and leverage points for promoting or supporting local stewardship and future applications of the framework to guide descriptive, evaluative, prescriptive or systematic analysis of environmental stewardship. Further application of this framework in diverse environmental and social contexts is recommended to refine the elements and develop insights that will guide and improve the outcomes of environmental stewardship initiatives and investments. Ultimately, our aim is to raise the profile of environmental stewardship as a valuable and holistic concept for guiding productive and sustained relationships with the environment.

Environmental Stewardship: A Conceptual Review and Analytical Framework

NASA Astrophysics Data System (ADS)

Bennett, Nathan J.; Whitty, Tara S.; Finkbeiner, Elena; Pittman, Jeremy; Bassett, Hannah; Gelcich, Stefan; Allison, Edward H.

2018-04-01

There has been increasing attention to and investment in local environmental stewardship in conservation and environmental management policies and programs globally. Yet environmental stewardship has not received adequate conceptual attention. Establishing a clear definition and comprehensive analytical framework could strengthen our ability to understand the factors that lead to the success or failure of environmental stewardship in different contexts and how to most effectively support and enable local efforts. Here we propose such a definition and framework. First, we define local environmental stewardship as the actions taken by individuals, groups or networks of actors, with various motivations and levels of capacity, to protect, care for or responsibly use the environment in pursuit of environmental and/or social outcomes in diverse social-ecological contexts. Next, drawing from a review of the environmental stewardship, management and governance literatures, we unpack the elements of this definition to develop an analytical framework that can facilitate research on local environmental stewardship. Finally, we discuss potential interventions and leverage points for promoting or supporting local stewardship and future applications of the framework to guide descriptive, evaluative, prescriptive or systematic analysis of environmental stewardship. Further application of this framework in diverse environmental and social contexts is recommended to refine the elements and develop insights that will guide and improve the outcomes of environmental stewardship initiatives and investments. Ultimately, our aim is to raise the profile of environmental stewardship as a valuable and holistic concept for guiding productive and sustained relationships with the environment.

Intergenerational equity and long-term stewardship plans.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hocking, E. K.

2002-02-05

For an untold number of contaminated sites throughout the world, stewardship will be inevitable. For many such sites, stewardship will be a reasonable approach because of the uncertainties associated with present and future site conditions and site contaminants, the limited performance of available technologies, the nonavailability of technologies, and the risk and cost associated with complete cleanup. Regardless of whether stewardship is a realistic approach to site situations or simply a convenient default, it could be required at most contaminated sites for multiple generations. Because the stewardship plan is required to protect the release of hazardous contaminants to the environment,more » some use restrictions will be put in place to provide that protection. These use restrictions will limit access to resources for as long as the protection is required. The intergenerational quality of long-term stewardship plans and their inherent limitations on resource use require that they be designed to achieve equity among the affected generations. Intergenerational equity, defined here as the fairness of access to resources across generations, could be achieved through a well-developed stewardship plan that provides future generations with the information they need to make wise decisions about resource use. Developing and implementing such a plan would take into account the failure mechanisms of the plan's components, feature short stewardship time blocks that would allow for periodic reassessments of the site and of the stewardship program's performance, and provide present and future generations with necessary site information.« less

Strategies for antiviral stockpiling for future influenza pandemics: a global epidemic-economic perspective

PubMed Central

Carrasco, Luis R.; Lee, Vernon J.; Chen, Mark I.; Matchar, David B.; Thompson, James P.; Cook, Alex R.

2011-01-01

Influenza pandemics present a global threat owing to their potential mortality and substantial economic impacts. Stockpiling antiviral drugs to manage a pandemic is an effective strategy to offset their negative impacts; however, little is known about the long-term optimal size of the stockpile under uncertainty and the characteristics of different countries. Using an epidemic–economic model we studied the effect on total mortality and costs of antiviral stockpile sizes for Brazil, China, Guatemala, India, Indonesia, New Zealand, Singapore, the UK, the USA and Zimbabwe. In the model, antivirals stockpiling considerably reduced mortality. There was greater potential avoidance of expected costs in the higher resourced countries (e.g. from $55 billion to $27 billion over a 30 year time horizon for the USA) and large avoidance of fatalities in those less resourced (e.g. from 11.4 to 2.3 million in Indonesia). Under perfect allocation, higher resourced countries should aim to store antiviral stockpiles able to cover at least 15 per cent of their population, rising to 25 per cent with 30 per cent misallocation, to minimize fatalities and economic costs. Stockpiling is estimated not to be cost-effective for two-thirds of the world's population under current antivirals pricing. Lower prices and international cooperation are necessary to make the life-saving potential of antivirals cost-effective in resource-limited countries. PMID:21296791

Strategies for antiviral stockpiling for future influenza pandemics: a global epidemic-economic perspective.

PubMed

Carrasco, Luis R; Lee, Vernon J; Chen, Mark I; Matchar, David B; Thompson, James P; Cook, Alex R

2011-09-07

Influenza pandemics present a global threat owing to their potential mortality and substantial economic impacts. Stockpiling antiviral drugs to manage a pandemic is an effective strategy to offset their negative impacts; however, little is known about the long-term optimal size of the stockpile under uncertainty and the characteristics of different countries. Using an epidemic-economic model we studied the effect on total mortality and costs of antiviral stockpile sizes for Brazil, China, Guatemala, India, Indonesia, New Zealand, Singapore, the UK, the USA and Zimbabwe. In the model, antivirals stockpiling considerably reduced mortality. There was greater potential avoidance of expected costs in the higher resourced countries (e.g. from $55 billion to $27 billion over a 30 year time horizon for the USA) and large avoidance of fatalities in those less resourced (e.g. from 11.4 to 2.3 million in Indonesia). Under perfect allocation, higher resourced countries should aim to store antiviral stockpiles able to cover at least 15 per cent of their population, rising to 25 per cent with 30 per cent misallocation, to minimize fatalities and economic costs. Stockpiling is estimated not to be cost-effective for two-thirds of the world's population under current antivirals pricing. Lower prices and international cooperation are necessary to make the life-saving potential of antivirals cost-effective in resource-limited countries.

Product stewardship in the composites industry

NASA Technical Reports Server (NTRS)

Aldrich, Donald C.; Merriman, Edmund A.

1994-01-01

The definition and purpose of Product Stewardship is discussed. Its' impact in the composites industry is stated. The report also outlines 12 ways that Product Stewardship can be utilized by consumers.

The organisational structure of urban environmental stewardship

Treesearch

Dana R. Fisher; Lindsay Campbell; Erika S. Svendsen

2012-01-01

How is the organisational structure of urban environmental stewardship groups related to the diverse ways that civic stewardship is taking place in urban settings? The findings of the limited number of studies that have explored the organisational structure of civic environmentalism are combined with the research on civic stewardship to answer this question. By...

30 CFR 77.211 - Draw-off tunnels; stockpiling and reclaiming operations; general.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Draw-off tunnels; stockpiling and reclaiming operations; general. 77.211 Section 77.211 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... WORK AREAS OF UNDERGROUND COAL MINES Surface Installations § 77.211 Draw-off tunnels; stockpiling and...

Ecosystem stewardship: good idea, but how?

USDA-ARS?s Scientific Manuscript database

Ecosystem stewardship and resilience-based management are admirable concepts that remain largely conceptual. Beyond a suite of general ideas, including linkages among ecological models, monitoring, stakeholder engagement, and social learning, there is not a replicable method to use the ideas in the ...

Evaluation of environmental effect of coal stockpile in Muara Telang, Banyuasin, Indonesia

NASA Astrophysics Data System (ADS)

Rusdianasari; Arita, Susila; Ibrahim, Eddy; Ngudiantoro

2013-04-01

Stockpile commonly serves as a temporary dump before the coal is transported through the waterways. This study investigated the effects of coal stockpiles on the surrounding environment: air, water, and soil. The location of the study is in the estuary of Telang, South-Sumatra, Indonesia, which is located at the edge of the river of Telang and close to the residential community. The monitoring of the environmental impact from the stockpile is intended to conduct an environmental assessment owing the existence and operations of coal accumulation. Enviromental impact analysis was conducted based on the value of the effluent, air pollution (dust), soil and water by determining the parameters of the coal wastewater pH, total suspended solid, ferrous dan ferrous metals contents. The results indicate that the total suspended particulate, total suspended solids, noise level, ferrous metal and manganese metal were 10-14 μg/Nm3 249-355 mg/L, 41.3 to 50.3 dBA, 6.074 to7.579 mg/L, and 1.987 to 2.678 mg/L, respectively. Meanwhile the pH of water and soil were 3 to 4 and 2.83 to 4.02 respectively. It is concluded that the pH value are beyond the threshold standard.

Private-well stewardship among a general population based sample of private well-owners.

PubMed

Malecki, Kristen M C; Schultz, Amy A; Severtson, Dolores J; Anderson, Henry A; VanDerslice, James A

2017-12-01

Private well stewardship, including on-going testing and treatment, can ensure private well users are able to maintain source-water quality and prevent exposures to potentially harmful constituents in primary drinking water supplies. Unlike municipal water supplies, private well users are largely responsible for their own testing and treatment and well stewardship is often minimal. The importance of factors influencing regular testing, and treatment behaviors, including knowledge, risk perception, convenience and social norms, can vary by geography and population characteristics. The primary goals of this study were to survey a general statewide population of private well users in Wisconsin in order to quantify testing and treatment patterns and gather data on motivations and barriers to well stewardship. The majority of respondents reported using and drinking well water daily but only about one half of respondents reported testing their wells in the last ten years and of these, only 10% reported testing in the last 12months. Bacteria and nitrates were contaminants most often tested; and, a private laboratory most often conducted testing. The most commonly reported water treatment was a water softener. Living in a particular geographic region and income were the most significant predictors of water testing and treatment. Iron and hardness, which influence water aesthetics but not always safety, were the most commonly reported water quality problems. Health concerns or perceived lack thereof were, respectively, motivators and barriers to testing and treatment. Limited knowledge of testing and treatment options were also identified as barriers. Results confirm previous findings that well stewardship practices are minimal and often context specific. Understanding the target population's perceptions of risk and knowledge are important elements to consider in identifying vulnerable populations and developing education and policy efforts to improve well stewardship

Chemical Stockpile Disposal Program. Transportation of Chemical Munitions at Reduced Temperature

DTIC Science & Technology

1987-08-01

ADA193346 Chemical Stockpile Disposal Program. Transportation of Chemical Munitions at Reduced Temperature. MITRE CORP MCLEAN VA AUG 1987...NO. ACCESSION NO. Aberdeen Proving Ground, fD 21010-5401 11. TITLE (Include Security Classification) Transportation of Chemical Munitions at Reducfd...Year, Month, Day) S. PAGE COUNT nal FROM TO Au USt 1987 65 16. SUPPLEMENTARY NOTATION Prepared for the Chemical Stockpile D’i sal Program Programmatic

Stewardship

ERIC Educational Resources Information Center

Canada, Benjamin O.

2005-01-01

In this article, the author found himself particularly drawn to a book he received in the mail--"Stewardship: Choosing Service Over Self-Interest" by Peter Block. Although the dictionary definition of steward is "one who manages another's property, finances or other affairs," from his vantage point as the first African-American superintendent in…

Antibiotic stewardship in community-acquired pneumonia.

PubMed

Viasus, Diego; Vecino-Moreno, Milly; De La Hoz, Juan M; Carratalà, Jordi

2017-04-01

Community-acquired pneumonia (CAP) continues to be associated with significant mortality and morbidity. As with other infectious diseases, in recent years there has been a marked increase in resistance to the antibiotics commonly used against the pathogens that cause CAP. Antimicrobial stewardship denotes coordinated interventions to improve and measure the appropriate use of antibiotics by encouraging the selection of optimal drug regimens. Areas covered: Several elements can be applied to antibiotic stewardship strategies for CAP in order to maintain or improve patient outcomes. In this regard, antibiotic de-escalation, duration of antibiotic treatment, adherence to CAP guidelines recommendations about empirical treatment, and switching from intravenous to oral antibiotic therapy may each be relevant in this context. Antimicrobial stewardship strategies, such as prospective audit with intervention and feedback, clinical pathways, and dedicated multidisciplinary teams, that have included some of these elements have demonstrated improvements in antimicrobial use for CAP without negatively affecting clinical outcomes. Expert commentary: Although there are a limited number of randomized clinical studies addressing antimicrobial stewardship strategies in CAP, there is evidence that antibiotic stewardship initiatives can be securely applied, providing benefits to both healthcare systems and patients.

Antibiotic Stewardship: New Frontier, Familiar Journey.

PubMed

Martin, Caren McHenry

2017-05-01

Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts.

Stockpiles and food availability in feeding facilities after the Great East Japan Earthquake.

PubMed

Nozue, Miho; Ishikawa-Takata, Kazuko; Sarukura, Nobuko; Sako, Kazuko; Tsuboyama-Kasaoka, Nobuyo

2014-01-01

Food stockpiles and methods of ensuring food availability after the Great East Japan Earthquake of March 11, 2011 have been studied. Questionnaires were sent to 1911 registered dietitians and general dietitians who were members of the Japan Dietetic Association in August 2012. Four hundred thirty-five dietitians (22.8%) completed the questionnaire about work involved in feeding facilities, types and administration of meals, and food stockpiles. Methods of ensuring food availability, preparation, and accommodating food for special dietary uses were recorded for the three-day period immediately following the earthquake, and the period from 4 days to one month after the earthquake. Three days after the earthquake, differences in administration of meals at feeding facilities providing three meals daily, food stockpiles, organization, contactable facilities, and how to contact them for food items were assessed. Sixty-nine percent of all feeding facilities in this study had stockpiles of food before the Great East Japan Earthquake. Administration of meals in feeding facilities and the possibility of contact with cooperative feeding facilities were found to correlate positively with ensuring the availability of food groups. Food scores were higher in facilities providing three meals daily by direct administration of meals and with accessible public administrators, cooperative facilities and suppliers, and facilities that were contactable by landline telephone, mobile phone, fax or email. The necessity for natural disaster-readiness through continuous stockpiling food at feeding facilities is confirmed. Each prospective feeding facility must be required to plan its stockpiles, their turnover and replaceability to maximise food security in the face of disaster.

Allocating forage to fall-calving cow-calf pairs strip-grazing stockpiled tall fescue.

PubMed

Curtis, L E; Kallenbach, R L; Roberts, C A

2008-03-01

In a 2-yr study, we evaluated the effect of different forage allocations on the performance of lactating beef cows and their calves grazing stockpiled tall fescue. Allocations of stockpiled tall fescue at 2.25, 3.00, 3.75, and 4.50% of cow-calf pair BW/d were set as experimental treatments. Conventional hay-feeding was also evaluated as a comparison to grazing stockpiled tall fescue. The experiment had a randomized complete block design with 3 replications and was divided into 3 phases each year. From early December to late February (phase 1) of each year, cows and calves grazed stockpiled tall fescue or were fed hay in the treatments described above. Immediately after phase 1, cows and calves were commingled and managed as a single group until weaning in April (phase 2) so that residual effects could be documented. Residual effects on cows were measured after the calves were weaned in April until mid-July (phase 3). During phase 1 of both years, apparent DMI of cow-calf pairs allocated stockpiled tall fescue at 4.50% of BW/d was 31% greater (P < 0.01) than those allocated 2.25% of BW/d. As allocation of stockpiled tall fescue increased from 2.25 to 4.50% of cow-calf BW/d, pasture utilization fell (P < 0.01) from 84 +/- 7% to 59 +/- 7%. During phase 1 of both years, cow BW losses increased linearly (P < 0.02) as forage allocations decreased, although the losses in yr 1 were almost double (P < 0.01) those in yr 2. During phases 2 and 3, few differences were noted across treatment groups, such that by the end of phase 3, cow BW in all treatments did not differ either year (P > 0.40). Calf ADG in phase 1 increased linearly (P < 0.01) with forage allocation (y = 0.063x + 0.513; R(2) = 0.91). However, calf gain per hectare decreased linearly (P < 0.01) as stockpiled tall fescue allocations increased (y = -26.5x + 212; R(2) = 0.97) such that gain per hectare for cow-calf pairs allocated stockpiled tall fescue at 4.50% BW/d was nearly 40% less (P < 0.01) than for those

Sinclair Stockpiles CFCs for Future Use.

ERIC Educational Resources Information Center

George, Stephen C.

1996-01-01

A Dayton (Ohio) community college's 21 buildings were cooled by a network of 5 chillers, all of which used soon-to-be-banned chlorofluorocarbons (CFCs). A reclamation program provides the college with reusable refrigerant and eliminates chiller replacement costs. Refrigerant from three of the old units is stockpiled for use in the two other…

Next Generation Cloud-based Science Data Systems and Their Implications on Data and Software Stewardship, Preservation, and Provenance

NASA Astrophysics Data System (ADS)

Hua, H.; Manipon, G.; Starch, M.

2017-12-01

NASA's upcoming missions are expected to be generating data volumes at least an order of magnitude larger than current missions. A significant increase in data processing, data rates, data volumes, and long-term data archive capabilities are needed. Consequently, new challenges are emerging that impact traditional data and software management approaches. At large-scales, next generation science data systems are exploring the move onto cloud computing paradigms to support these increased needs. New implications such as costs, data movement, collocation of data systems & archives, and moving processing closer to the data, may result in changes to the stewardship, preservation, and provenance of science data and software. With more science data systems being on-boarding onto cloud computing facilities, we can expect more Earth science data records to be both generated and kept in the cloud. But at large scales, the cost of processing and storing global data may impact architectural and system designs. Data systems will trade the cost of keeping data in the cloud with the data life-cycle approaches of moving "colder" data back to traditional on-premise facilities. How will this impact data citation and processing software stewardship? What are the impacts of cloud-based on-demand processing and its affect on reproducibility and provenance. Similarly, with more science processing software being moved onto cloud, virtual machines, and container based approaches, more opportunities arise for improved stewardship and preservation. But will the science community trust data reprocessed years or decades later? We will also explore emerging questions of the stewardship of the science data system software that is generating the science data records both during and after the life of mission.

Remote Antimicrobial Stewardship in Community Hospitals

PubMed Central

Wood, Zachary H.; Nicolsen, Nicole C.; Allen, Nichole; Cook, Paul P.

2015-01-01

Antimicrobial stewardship has become standard practice at university medical centers, but the practice is more difficult to implement in remote community hospitals that lack infectious diseases trained practitioners. Starting in 2011, six community hospitals within the Vidant Health system began an antimicrobial stewardship program utilizing pharmacists who reviewed charts remotely from Vidant Medical Center. Pharmacists made recommendations within the electronic medical record (EMR) to streamline, discontinue, or switch antimicrobial agents. Totals of charts reviewed, recommendations made, recommendations accepted, and categories of intervention were recorded. Linear regression was utilized to measure changes in antimicrobial use over time. For the four larger hospitals, recommendations for changes were made in an average of 45 charts per month per hospital and physician acceptance of the pharmacists’ recommendations varied between 83% and 88%. There was no significant decrease in total antimicrobial use, but much of the use was outside of the stewardship program’s review. Quinolone use decreased by more than 50% in two of the four larger hospitals. Remote antimicrobial stewardship utilizing an EMR is feasible in community hospitals and is generally received favorably by physicians. As more community hospitals adopt EMRs, there is an opportunity to expand antimicrobial stewardship beyond the academic medical center. PMID:27025642

Understanding social influences on wilderness fire stewardship decisions

Treesearch

Katie Knotek

2006-01-01

Federal land managers and the public engage in many decisions about stewardship of wilderness in the United States, including decisions about stewardship of fire. To date, social science research lacks a holistic examination of the decision-making context of managers and the public about stewardship of fire inside wilderness and across its boundaries. A conceptual...

Stockpile Dismantlement Database Training Materials

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1993-11-01

This document, the Stockpile Dismantlement Database (SDDB) training materials is designed to familiarize the user with the SDDB windowing system and the data entry steps for Component Characterization for Disposition. The foundation of information required for every part is depicted by using numbered graphic and text steps. The individual entering data is lead step by step through generic and specific examples. These training materials are intended to be supplements to individual on-the-job training.

Preserving Open Space via Community Stewardship.

ERIC Educational Resources Information Center

Lopez, Stephen

1983-01-01

When community groups assume stewardship of underused properties and turn them into recreational spaces, park agencies can save money on overhead and construction. Three stewardship projects in New York State, involving a playing field, gardening areas, and a historical restoration, are described. Criteria for successful projects are included. (PP)

Hedge math: Theoretical limits on minimum stockpile size across nuclear hedging strategies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lafleur, Jarret Marshall; Roesler, Alexander W.

2016-09-01

In June 2013, the Department of Defense published a congressionally mandated, unclassified update on the U.S. Nuclear Employment Strategy. Among the many updates in this document are three key ground rules for guiding the sizing of the non-deployed U.S. nuclear stockpile. Furthermore, these ground rules form an important and objective set of criteria against which potential future stockpile hedging strategies can be evaluated.

The Six Principles of Facilities Stewardship

ERIC Educational Resources Information Center

Kaiser, Harvey H.; Klein, Eva

2010-01-01

Facilities stewardship means high-level and pervasive commitment to optimize capital investments, in order to achieve a high-functioning and attractive campus. It includes a major commitment to capital asset preservation and quality. Stewardship is about the long view of an institution's past and future. It ultimately forms the backdrop for…

How can Multi-Professional Education Support Better Stewardship?

PubMed Central

Pereira, Nuno Rocha; Castro-Sanchez, Enrique; Nathwani, Dilip

2017-01-01

Antimicrobial stewardship is widely accepted as an efficient strategy to combat the growing threat of antimicrobial resistance. Education is one of the cornerstones of successful antimicrobial stewardship programs. There is also general agreement that antimicrobial stewardship is a team effort that must involve the whole continuum of healthcare workers. Providing adequate education for all different professionals although challenging is deemed crucial to achieve good results. This paper reviews the different strategies available to educate the multiple healthcare workers, discusses how education can improve antimicrobial stewardship programs and outlines some of the challenges faced and research gaps that need to be addressed in order to improve education in this field. PMID:28458801

The GSFC Combined Approach of ODC Stockpiling and Tribological Testing to Mitigate the Risks of ODC Elimination

NASA Technical Reports Server (NTRS)

Predmore, Roamer; Woods, Claudia; Hovanec, Andrew

1997-01-01

In response to the elimination of production of several Ozone Depleting Chemicals (ODCs) which have been widely used in successful space flight mechanism cleaning and lubricating procedures, GSFC developed and implemented an overall philosophy of mitigating the risks to flight hardware during the transition phase to ODC-Free cleaning procedures. One leg of that philosophy is the initiation of a several tier testing program which will deliver increasing amounts of information over the next few years, starting with original surface analysis comparisons between ODC and various ODC-Free cleaning technologies. The other leg is the stockpiling of an appropriate amount of ODC solvents such that all short term GSFC missions will be able to stay with or revert to heritage cleaning and lubricating procedures in the face of life issues. While tribological testing, mechanism life testing and space-flight experience will ultimately bring us into the 21st century with environmentally friendly means of cleaning long-life precision mechanism components, many satellites will be launched over the next few years with a number of important tribological questions unanswered. In order to prepare for this challenge, the Materials Engineering Branch in cooperation with the Electromechanical Branch launched an intensive review of all ongoing missions. The failure risk was determined for each long-life mechanism based on a number of parameters, including a comparison of flight solvents used to clean the heritage/life test hardware. Also studied was the ability of the mechanism manufacturers to stockpile ODCs based on state laws and company policies. A stockpiling strategy was constructed based on this information and subsequently implemented. This paper provides an overview of the GSFC ODC elimination risk mitigation philosophy as well as a detailed examination of the development of the ODC stockpiling plan.

Antimicrobial Stewardship Barriers and Goals in Pediatric Oncology and Bone Marrow Transplantation: A Survey of Antimicrobial Stewardship Practitioners.

PubMed

Wolf, Joshua; Sun, Yilun; Tang, Li; Newland, Jason G; Gerber, Jeffrey S; Van Dyke, Christie J; Hymes, Saul R; Yu, Diana; Carias, Delia C; Bryant, Penelope A

2016-03-01

We undertook a cross-sectional survey of antimicrobial stewardship clinicians in North America and Australasia regarding practices, goals, and barriers to implementation of stewardship for pediatric oncology patients. Goals and barriers were similar regardless of clinician or institutional characteristics and geographic location. Strategies addressing these factors could help optimize antimicrobial use.

77 FR 18879 - Meeting of the Regional Resource Stewardship Council

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... TENNESSEE VALLEY AUTHORITY Meeting of the Regional Resource Stewardship Council AGENCY: Tennessee Valley Authority (TVA). ACTION: Notice of meeting. SUMMARY: The TVA Regional Resource Stewardship Council... Stewardship Council, Tennessee Valley Authority, 400 West Summit Hill Drive, WT-11 B, Knoxville, Tennessee...

Stockpiling anti-viral drugs for a pandemic: the role of Manufacturer Reserve Programs.

PubMed

Harrington, Joseph E; Hsu, Edbert B

2010-05-01

To promote stockpiling of anti-viral drugs by non-government organizations such as hospitals, drug manufacturers have introduced Manufacturer Reserve Programs which, for an annual fee, provide the right to buy in the event of a severe outbreak of influenza. We show that these programs enhance drug manufacturer profits but could either increase or decrease the amount of pre-pandemic stockpiling of anti-viral drugs.

Hospital influenza pandemic stockpiling needs: A computer simulation.

PubMed

Abramovich, Mark N; Hershey, John C; Callies, Byron; Adalja, Amesh A; Tosh, Pritish K; Toner, Eric S

2017-03-01

A severe influenza pandemic could overwhelm hospitals but planning guidance that accounts for the dynamic interrelationships between planning elements is lacking. We developed a methodology to calculate pandemic supply needs based on operational considerations in hospitals and then tested the methodology at Mayo Clinic in Rochester, MN. We upgraded a previously designed computer modeling tool and input carefully researched resource data from the hospital to run 10,000 Monte Carlo simulations using various combinations of variables to determine resource needs across a spectrum of scenarios. Of 10,000 iterations, 1,315 fell within the parameters defined by our simulation design and logical constraints. From these valid iterations, we projected supply requirements by percentile for key supplies, pharmaceuticals, and personal protective equipment requirements needed in a severe pandemic. We projected supplies needs for a range of scenarios that use up to 100% of Mayo Clinic-Rochester's surge capacity of beds and ventilators. The results indicate that there are diminishing patient care benefits for stockpiling on the high side of the range, but that having some stockpile of critical resources, even if it is relatively modest, is most important. We were able to display the probabilities of needing various supply levels across a spectrum of scenarios. The tool could be used to model many other hospital preparedness issues, but validation in other settings is needed. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

2015 National Agenda for Digital Stewardship

DTIC Science & Technology

2014-09-01

tool and framework that explores the aspects of “benefit,” “risk,” “value,”’ “ quality ,” and “sustainability.” It is analyzing previous work on cost...evidence of the value of digital stewardship activities is needed. Improved and sharable metrics about the quality and success of digital stewardship...Significant Properties .................................. 38 5.3.4 Policy Research on Trust Frameworks

The Fact of the Matter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kippen, Karen Elizabeth; Montoya, Donald Raymond

For more than 20 years the science and engineering capabilities of the nation’s Stockpile Stewardship Program have allowed the United States to sustain a safe, secure, and effective nuclear deterrent. Most of the problems identifi ed within the nuclear stockpile are related to its aging materials. MaRIE will advance this record of excellence in addressing such materials problems.

77 FR 22772 - Environmental Management Site-Specific Advisory Board

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-17

... and environmental restoration; waste management and disposition; stabilization and disposition of non-stockpile nuclear materials; excess facilities; future land use and long-term stewardship; risk assessment...

Best Practices for Curriculum, Teaching, and Evaluation Components of Aquatic Stewardship Education.

ERIC Educational Resources Information Center

Siemer, William F.

This paper reviews the literature to outline principles and best practices for aquatic stewardship education. Stewardship education develops an internalized stewardship ethic and the skills needed for decision making and environmentally responsible actions. Successful stewardship education programs are designed to influence beliefs, values,…

A review of antimicrobial stewardship training in medical education

PubMed Central

Silverberg, Sarah L.; Zannella, Vanessa E.; Countryman, Drew; Ayala, Ana Patricia; Lenton, Erica; Friesen, Farah

2017-01-01

Objectives We reviewed the published literature on antimicrobial stewardship training in undergraduate and postgraduate medical education to determine which interventions have been implemented, the extent to which they have been evaluated, and to understand which are most effective. Methods We searched Ovid MEDLINE and EMBASE from inception to December 2016. Four thousand three hundred eighty-five (4385) articles were identified and underwent title and abstract review. Only those articles that addressed antimicrobial stewardship interventions for medical trainees were included in the final review. We employed Kirkpatrick’s four levels of evaluation (reaction, learning, behaviour, results) to categorize intervention evaluations. Results Our review included 48 articles. The types of intervention varied widely amongst studies worldwide. Didactic teaching was used heavily in all settings, while student-specific feedback was used primarily in the postgraduate setting. The high-level evaluation was sparse, with 22.9% reporting a Kirkpatrick Level 3 evaluation; seventeen reported no evaluation. All but one article reported positive results from the intervention. No articles evaluated the impact of an intervention on undergraduate trainees’ prescribing behaviour after graduation. Conclusions This study enhances our understanding of the extent of antimicrobial stewardship in the context of medical education. While our study demonstrates that medical schools are implementing antimicrobial stewardship interventions, rigorous evaluation of programs to determine whether such efforts are effective is lacking. We encourage more robust evaluation to establish effective, evidence-based approaches to training prescribers in light of the global challenge of antimicrobial resistance.  PMID:29035872

The GSFC Combined Approach of ODC Stockpiling and Tribological Testing to Mitigate the Risks of ODC Elimination

NASA Technical Reports Server (NTRS)

Predmore, Roamer; LeBoeuf, Claudia; Hovanec, Andrew

1997-01-01

In response to the elimination of production of several Ozone Depleting Chemicals (ODC's) which have been widely used in successful space flight mechanism cleaning and lubricating procedures, GSFC developed and implemented an overall philosophy of mitigating the risks to flight hardware during the transition phase to ODC-free cleaning procedures. The short term leg of the philosophy was the stockpiling of an appropriate amount of ODC solvents such that all short term GSFC missions will be able to stay with or revert to heritage cleaning and lubricating procedures in the face of life issues. The long-term leg of that philosophy was the initiation of a several tier testing program that will deliver increasing amounts of information over the next few years, starting with accelerated lubricant life tests that compare lubricant life on surfaces cleaned with ODC solvents with lubricant life on surfaces cleaned with ODC-free solvents. While tribological testing, mechanism life testing and space-flight experience will ultimately bring us into the 21st century with environmentally friendly means of cleaning long-life precision mechanism components, many satellites will be launched over the next few years before a number of important tribological questions can be answered. In order to prepare for this challenge, the Materials Engineering Branch in cooperation with the Electromechanical Branch launched an intensive review of all ongoing missions. The failure risk was determined for each long-life lubricated mechanism based on a number of parameters, including 4 comparison of flight solvents used to clean the heritage/life test hardware. Also studied was the ability of the mechanism manufacturers to stockpile ODC's based on state laws and company policies. A stockpiling strategy was constructed based on this information and subsequently implemented. This paper provides an overview of the GSFC ODC elimination risk mitigation philosophy as well as a detailed examination of the

78 FR 68028 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-13

... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... Defense Stockpile Market Impact Committee, co-chaired by the Departments of Commerce and State, is seeking public comments on the potential market impact of the proposed Fiscal Year 2015 National Defense...

76 FR 58463 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-21

... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... Stockpile Market Impact Committee (MIC), co-chaired by the Departments of Commerce and State, is seeking public comments on the potential market impact of the proposed disposal levels of materials for the...

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

STOCKPILED PRAIRIEGRASS PROVIDES HIGH-QUALITY FALL GRAZING FOR LAMBS

USDA-ARS?s Scientific Manuscript database

New varieties of prairiegrass (Bromus catharticus Vahl. = B. willdenowii Kunth.) exhibit improved persistence over ‘Matua’ under USA growing conditions, but animal performance data is lacking. We evaluated performance of lambs grazing stockpiled ‘Dixon’ prairiegrass on West Virginia hill pasture in...

Eco-Visualization: Promoting Environmental Stewardship in the Museum

ERIC Educational Resources Information Center

Holmes, Tiffany

2007-01-01

Eco-visualizations are artworks that reinterpret environmental data with custom software to promote stewardship. Eco-visualization technology offers a new way to dynamically picture environmental data and make it meaningful to a museum population. The questions are: How might museums create new projects and programs around place-based information?…

77 FR 16205 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-20

... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... National Defense Stockpile Market Impact Committee, co-chaired by the Departments of Commerce and State, is seeking public comments on the potential market impact of the proposed supplement to the Fiscal Year 2012...

77 FR 42271 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-18

... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... National Defense Stockpile Market Impact Committee, co-chaired by the Departments of Commerce and State, is seeking public comments on the potential market impact of the proposed supplement to the Fiscal Year 2013...

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Mathematical Modeling.

PubMed

Barnes, Sean L; Kasaie, Parastu; Anderson, Deverick J; Rubin, Michael

2016-11-01

Mathematical modeling is a valuable methodology used to study healthcare epidemiology and antimicrobial stewardship, particularly when more traditional study approaches are infeasible, unethical, costly, or time consuming. We focus on 2 of the most common types of mathematical modeling, namely compartmental modeling and agent-based modeling, which provide important advantages-such as shorter developmental timelines and opportunities for extensive experimentation-over observational and experimental approaches. We summarize these advantages and disadvantages via specific examples and highlight recent advances in the methodology. A checklist is provided to serve as a guideline in the development of mathematical models in healthcare epidemiology and antimicrobial stewardship. Infect Control Hosp Epidemiol 2016;1-7.

Modeling the filtration ability of stockpiled filtering facepiece

NASA Astrophysics Data System (ADS)

Rottach, Dana R.

2016-03-01

Filtering facepiece respirators (FFR) are often stockpiled for use during public health emergencies such as an infectious disease outbreak or pandemic. While many stockpile administrators are aware of shelf life limitations, environmental conditions can lead to premature degradation. Filtration performance of a set of FFR retrieved from a storage room with failed environmental controls was measured. Though within the expected shelf life, the filtration ability of several respirators was degraded, allowing twice the penetration of fresh samples. The traditional picture of small particle capture by fibrous filter media qualitatively separates the effect of inertial impaction, interception from the streamline, diffusion, settling, and electrostatic attraction. Most of these mechanisms depend upon stable conformational properties. However, common FFR rely on electrets to achieve their high performance, and over time heat and humidity can cause the electrostatic media to degrade. An extension of the Langevin model with correlations to classical filtration concepts will be presented. The new computational model will be used to predict the change in filter effectiveness as the filter media changes with time.

Evaluation of pharmacy generalists performing antimicrobial stewardship services.

PubMed

Carreno, Joseph J; Kenney, Rachel M; Bloome, Mary; McDonnell, Jane; Rodriguez, Jennifer; Weinmann, Allison; Kilgore, Paul E; Davis, Susan L

2015-08-01

Improvements in medication use achieved by pharmacy generalists using a care bundle approach to antimicrobial stewardship are reported. A six-month prospective, repeated-treatment, quasi-experimental study involving three month-long intervention periods and three month-long control periods was conducted in the setting of an existing antimicrobial stewardship program at a large hospital. The intervention involved prospective audit and feedback conducted by pharmacy generalists who were trained in an antimicrobial stewardship care bundle approach. During control months, a pharmacy generalist who was not trained in antimicrobial stewardship rounded with the multidisciplinary team and provided standard-of-care pharmacy services. The primary endpoint was compliance with a care bundle of four antimicrobial stewardship metrics: documentation of indication for therapy in the medical record, selection of empirical therapy according to institutional guidelines, documented performance of indicated culture testing, and deescalation of therapy when indicated. Two-hundred eighty-six patients were enrolled in the study: 124 in the intervention group and 162 in the control group. The cumulative rate of full compliance with all care bundle components during the six-month study was significantly greater during intervention months than during control months (68.5% versus 45.7%, p < 0.001). After adjusting for infection type, antimicrobial stewardship provided by an intervention-group pharmacist was associated with improved care bundle compliance (adjusted odds ratio, 2.70; p < 0.001). No significant differences in patient outcomes during intervention and control months were detected. Pharmacy generalists trained to comply with a systematic care bundle approach enhanced the quality of antimicrobial management. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Becoming Rooted in the Stewardship Way of Life.

ERIC Educational Resources Information Center

Voboril, Bob

2003-01-01

Criticizes how Catholic schools have been forced to survive by adopting a purchase mentality. The solution is to embrace the stewardship way of life. Points out that stewardship takes a while to take effect, but once it does it will create a counter cultural attitude toward one's income and assets. (MZ)

Serendipity and Stewardship: Teaching with the Spirit in a Secular Classroom

ERIC Educational Resources Information Center

Hall, Bradford J.

2009-01-01

Can one appropriately teach with the spirit in a secular classroom? This chapter addresses the question by exploring how the concepts of serendipity and stewardship encourage a form of spirituality that is inclusive and appropriate for the university setting. Serendipity and stewardship work hand in hand. Stewardship resists the temptation of…

The Italian Hub of Population Biobanks as a Potential Tool for Improving Public Health Stewardship

PubMed Central

Napolitano, Mariarosaria; Santoro, Filippo; Belardelli, Filippo; Federici, Antonio

2013-01-01

In Italy, a country that is experiencing the decentralization of health services from central to regional level of government, the Minister of Health is proposing stewardship as a model of governance for the public health system. Stewardship favors efficiency in the policy decision-making process, based on reciprocal trust, and tends to be more ethical. The embryonic proposal to test stewardship in the field of population-based research was advanced during the launching conference Challenges and Opportunities of the Italian Hub of Population Biobanks (HIBP) held in 2012 in Rome. Resources collected by population biobanks (i.e., blood and its derivatives, and/or DNA isolated from any type of biological samples and relative associated data) have, in fact, a recognized scientific value for the investigation of links between genetics, health and life style, and epidemiological outcomes through population biobank-based studies, and are essential to planning effective and qualified interventions for public health. The current economic crisis requires a strong push to rationalize investment in health policies. In particular, population biobank-based studies require financial commitment, often of long duration, for the realization of their goals. Thus, innovative solutions to allow fast integration of scientific knowledge into political health strategy are required. During the conference in Rome, it was proposed to test the stewardship model by its application to the inter-relationship between population biobank-based studies and disease prevention. Stewardship minimizes barriers to innovation and uses information more effectively to better develop new strategies for prevention and/or treatment. In the months following the conference, the proposal was defined more clearly, and the HIBP network became a potential tool for testing and implementing this model in the Italian Public Health prevention system. PMID:23840926

Regional Stewardship and the Redefinition of Higher Education

ERIC Educational Resources Information Center

Simpson, Timothy Leahy

2010-01-01

Inspired by the late John Gardner, in May 2000 the "Alliance for Regional Stewardship" (ARS) was formed as a "peer-to-peer network of regional leaders working across boundaries to solve tough community problems." According to the ARS, regional stewardship is the leadership needed to address the complex problems of one's time.…

Radioisotopic Thermoelectric Generator (RTG) Surveillance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mulford, Roberta Nancy

2016-09-29

This lecture discusses stockpile stewardship efforts and the role surveillance plays in the process. Performance of the RTGs is described, and the question of the absence of anticipated He is addressed.

Investigating the ways in which health information technology can promote antimicrobial stewardship: a conceptual overview.

PubMed

King, Abby; Cresswell, Kathrin M; Coleman, Jamie J; Pontefract, Sarah K; Slee, Ann; Williams, Robin; Sheikh, Aziz

2017-08-01

Antimicrobial resistance is now recognised as a threat to health worldwide. Antimicrobial stewardship aims to promote the responsible use of antibiotics and is high on international and national policy agendas. Health information technology has the potential to support antimicrobial stewardship in a number of ways, but this field is still poorly characterised and understood. Building on a recent systematic review and expert roundtable discussions, we take a lifecycle perspective of antibiotic use in hospitals and identify potential targets for health information technology-based interventions to support antimicrobial stewardship. We aim for this work to help chart a future research agenda in this critically important area.

75 FR 20991 - NACEPT Subcommittee on Promoting Environmental Stewardship

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9141-2] NACEPT Subcommittee on Promoting Environmental Stewardship AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of meeting. SUMMARY: Under the... (NACEPT) is to advise the U.S. Environmental Protection Agency on how to promote environmental stewardship...

Organizational ethics in Catholic health care: honoring stewardship and the work environment.

PubMed

Magill, G

2001-04-01

Organizational ethics refers to the integration of values into decision making, policies, and behavior throughout the multi-disciplinary environment of a health care organization. Based upon Catholic social ethics, stewardship is at the heart of organizational ethics in health care in this sense: stewardship provides the hermeneutic filter that enables basic ethical principles to be realized practically, within the context of the Catholic theology of work, to concerns in health care. This general argument can shed light on the specific topic of non-executive compensation programs as an illustration of organizational ethics in health care.

Experience With Rapid Microarray-Based Diagnostic Technology and Antimicrobial Stewardship for Patients With Gram-Positive Bacteremia.

PubMed

Neuner, Elizabeth A; Pallotta, Andrea M; Lam, Simon W; Stowe, David; Gordon, Steven M; Procop, Gary W; Richter, Sandra S

2016-11-01

OBJECTIVE To describe the impact of rapid diagnostic microarray technology and antimicrobial stewardship for patients with Gram-positive blood cultures. DESIGN Retrospective pre-intervention/post-intervention study. SETTING A 1,200-bed academic medical center. PATIENTS Inpatients with blood cultures positive for Staphylococcus aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae, S. pyogenes, S. agalactiae, S. anginosus, Streptococcus spp., and Listeria monocytogenes during the 6 months before and after implementation of Verigene Gram-positive blood culture microarray (BC-GP) with an antimicrobial stewardship intervention. METHODS Before the intervention, no rapid diagnostic technology was used or antimicrobial stewardship intervention was undertaken, except for the use of peptide nucleic acid fluorescent in situ hybridization and MRSA agar to identify staphylococcal isolates. After the intervention, all Gram-positive blood cultures underwent BC-GP microarray and the antimicrobial stewardship intervention consisting of real-time notification and pharmacist review. RESULTS In total, 513 patients with bacteremia were included in this study: 280 patients with S. aureus, 150 patients with enterococci, 82 patients with stretococci, and 1 patient with L. monocytogenes. The number of antimicrobial switches was similar in the pre-BC-GP (52%; 155 of 300) and post-BC-GP (50%; 107 of 213) periods. The time to antimicrobial switch was significantly shorter in the post-BC-GP group than in the pre-BC-GP group: 48±41 hours versus 75±46 hours, respectively (P<.001). The most common antimicrobial switch was de-escalation and time to de-escalation, was significantly shorter in the post-BC-GP group than in the pre-BC-GP group: 53±41 hours versus 82±48 hours, respectively (P<.001). There was no difference in mortality or hospital length of stay as a result of the intervention. CONCLUSIONS The combination of a rapid microarray diagnostic test with an antimicrobial

Engaging Pharmacy Students, Residents, and Fellows in Antimicrobial Stewardship.

PubMed

Chahine, Elias B; El-Lababidi, Rania M; Sourial, Mariette

2015-12-01

Antimicrobial stewardship programs are mainly established by infectious diseases physicians and infectious diseases-trained clinical pharmacists with the goal of optimizing patients' outcomes while halting antimicrobial resistance, decreasing adverse events, and controlling health care cost. The role of the infectious diseases-trained clinical pharmacist in antimicrobial stewardship is well established; however, there are not enough formally trained pharmacists to assume the challenging responsibilities of the steward coordinator. The purpose of this article was to review the available literature and resources and propose a model to engage introductory pharmacy practice experience students, advanced pharmacy practice experience students, postgraduate year (PGY) 1 pharmacy residents, PGY2 infectious diseases pharmacy residents, and PGY2 or PGY3 infectious diseases pharmacy fellows in antimicrobial stewardship. Further studies are needed to assess and document the impact of pharmacy students and postgraduate trainees on antimicrobial stewardship programs. © The Author(s) 2013.

Characteristics of stewardship in the Chicago Wilderness Region

Treesearch

Lynne M. Westphal; Amelie Y. Davis; Cindy Copp; Laurel M. Ross; Mark J. Bouman; Cherie L. Fisher; Mark K. Johnston

2014-01-01

We report on the early results of a survey-based assessment of stewardship activities within the Chicago Wilderness region, work conducted as a part of the Chicago ULTRA-Ex project. Chicago Wilderness is a 270 member alliance focused on preserving and enhancing biodiversity throughout northern Illinois and parts of Wisconsin, Indiana and Michigan (USA). The results...

Stockpiled "Tifton 85" bermudagrass for cow-calf production as influenced by nitrogen fertilization.

PubMed

Holland, Courteney McNamee; Marchant, Kaleb; Kriese-Anderson, Lisa; Gamble, Brian; Muntifering, Russell

2018-05-28

A 2-yr study was conducted to determine the effects of rate of N fertilization on productivity and nutritive value of stockpiled "Tifton 85" bermudagrass for lactating-cow and calf performance. On 31 October 2012 (year 1) and 11 November 2013 (year 2), 16 Angus × Simmental cows (mean initial BW for both years, 647 ± 23 kg) and their calves (mean age for both years, 16 ± 3 d) were assigned randomly to 0.76-ha paddocks (2 cow-calf pairs/paddock) of stockpiled "Tifton 85" bermudagrass pasture that had been cut to a 10-cm stubble height in early August and fertilized with either 56 (56N), 112 (112N), or 168 (168N) kg N/ha (2 paddocks/treatment), or to replicate 0.41-ha paddocks (2 cow-calf pairs/paddock) of dormant pasture with free-choice access to August-cut "Tifton 85" bermudagrass hay plus 2.7 kg whole cottonseed daily (HAY). Cows were allowed access to strips of ungrazed forage by moving polytape every 3 to 4 d to maintain a DM harvest efficiency of approximately 75%. In year 1, forage mass (6,113 kg DM/ha), IVDMD (60.9%), and grazing d/ha (314) were not different (P > 0.05) among the stockpile treatments over a 116-d grazing period; mean forage IVDMD (60.1%) and CP (12.7%) in the stockpiled treatments were greater (P < 0.05) than the HAY treatment. Stockpiled forage CP concentration was greater (P < 0.05) for the 168N than 56N and 112N treatments and was greater (P < 0.05) for the 56N than 112N treatment. In year 2, mean forage CP concentration was greater (P < 0.05) for the 168N (14.5%) than 56N (11.3%), 112N (12.0%), and HAY (9.0%) treatments; mean stockpiled forage IVDMD (59.5%) was greater (P < 0.05) than the HAY treatment (46.3%); and mean forage mass for the 168N treatment (5,017 kg DM/ha) was 378 kg and 298 kg DM/ha greater (P < 0.05) than the 112N and 56N treatments, respectively. Mean cow BW (611 ± 147 kg), body condition scores (5.5 ± 0.6), and milk production (9.0 ± 6.0 kg/d) were not different (P > 0.05) among treatments. Mean blood urea-N (BUN

A cost-effectiveness analysis of two different antimicrobial stewardship programs.

PubMed

Okumura, Lucas Miyake; Riveros, Bruno Salgado; Gomes-da-Silva, Monica Maria; Veroneze, Izelandia

2016-01-01

There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

Antimicrobial stewardship programs: interventions and associated outcomes.

PubMed

Patel, Dimple; Lawson, Wendy; Guglielmo, B Joseph

2008-04-01

Guidelines regarding antimicrobial stewardship programs recommend an infectious diseases-trained physician and an infectious diseases-trained pharmacist as core members. Inclusion of clinical microbiologists, infection-control practitioners, information systems experts and hospital epidemiologists is considered optimal. Recommended stewardship interventions include prospective audit and intervention, formulary restriction, education, guideline development, clinical pathway development, antimicrobial order forms and the de-escalation of therapy. The primary outcome associated with these interventions has been the associated cost savings; however, few published investigations have taken into account the overall cost of the intervention. Over the past 5 years, there has been an increased focus upon interventions intended to decrease bacterial resistance or reduce superinfection, including infections associated with Clostridium difficile colitis. Few programs have been associated with a reduction in antimicrobial drug adverse events. Antimicrobial stewardship programs are becoming increasingly associated with clear benefits and will be integral in the in-patient healthcare setting.

Institutional plan FY 1999--FY 2004

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-10-01

Los Alamos has a well-defined and nationally important mission: to reduce the global nuclear danger. This central national security mission consists of four main elements: stockpile stewardship, nuclear materials management, nonproliferation and arms control, and cleanup of the environmental legacy of nuclear weapons activities. The Laboratory provides support for and ensures confidence in the nation`s nuclear stockpile without nuclear testing. This challenge requires the Laboratory to continually hone its scientific acumen and technological capabilities to perform this task reliably using an interdisciplinary approach and advanced experimental and modeling techniques. In the last two National Defense Authorization Acts, Congress identified themore » need to protect the nation from the proliferation of weapons of mass destruction, which includes nuclear, chemical, and biological weapons, and their potential use by terrorists. Los Alamos is applying multidisciplinary science and engineering skills to address these problems. In addition, the Laboratory`s critical programmatic roles in stockpile stewardship and threat reduction are complemented by its waste management operations and environmental restoration work. Information on specific programs is available in Section 2 of this document.« less

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

PubMed Central

Schwartz, David N.; Weinstein, Robert A.

2016-01-01

SUMMARY Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs. PMID:27974411

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship.

PubMed

Morency-Potvin, Philippe; Schwartz, David N; Weinstein, Robert A

2017-01-01

Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs. Copyright © 2016 American Society for Microbiology.

Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship.

PubMed

Messacar, Kevin; Parker, Sarah K; Todd, James K; Dominguez, Samuel R

2017-03-01

New rapid molecular diagnostic technologies for infectious diseases enable expedited accurate microbiological diagnoses. However, diagnostic stewardship and antimicrobial stewardship are necessary to ensure that these technologies conserve, rather than consume, additional health care resources and optimally affect patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and to direct testing toward appropriate patients. Antimicrobial stewardship is needed to ensure prompt appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside. This minireview outlines the roles of diagnostic stewardship and antimicrobial stewardship in the implementation of rapid molecular infectious disease diagnostics. Copyright © 2017 American Society for Microbiology.

After the Bell: Developing an Awareness of Pet Stewardship

ERIC Educational Resources Information Center

Farenga, Stephen J.; Ness, Daniel; Hutchinson, Michael

2008-01-01

Given the commonness of pets in communities throughout the United States, Canada, and Australia, among other countries, pet stewardship should be a natural topic of study for the integration of science, mathematics, and technology. Therefore, the term "stewardship" will be examined by applying observation and research to shape our…

Branching Out: The North Carolina Forest Stewardship Activity Guide.

ERIC Educational Resources Information Center

Chesson, Gail

Stewardship is the responsibility of individuals to maintain and improve their natural resources and surroundings. The Forest Stewardship Program (FSP) in North Carolina aims at enhancing the management of all forest resources on private lands. This activity guide is designed to help youth appreciate and understand forests and natural…

Identifying and Predicting Profiles of Medical Noncompliance: Pediatric Caregivers' Antibiotic Stewardship.

PubMed

Smith, Rachel A; Kim, Youllee; M'Ikanatha, Nkuchia M

2018-05-14

Sometimes compliance with medical recommendations is problematic. We investigated pediatric caregivers' (N = 606) patterns of noncompliance with antibiotic stewardship based on the obstacle hypothesis. We tested predictors of noncompliance framed by the obstacle hypothesis, dissonance theory, and psychological reactance. The results revealed four profiles of caregivers' stewardship: one marked by compliance (Stewards) and three marked by types of noncompliance (Stockers, Persuaders, and Dissenters). The covariate analysis showed that, although psychological reactance predicted being noncompliant, it was types of obstacles and discrepant experiences that predicted caregivers' patterns of noncompliance with antibiotic stewardship. Campaign planning often focuses on identifying the belief most associated with the targeted outcome, such as compliance. Noncompliance research, however, points out that persuaders may be successful to the extent to which they anticipate obstacles to compliance and address them in their influence attempts. A shift from medical noncompliance to patient engagement also affords an opportunity to consider how some recommendations create obstacles for others and to find positive ways to embrace conflicting needs, tensions, and reasons for refusal in order to promote collective goals.

The Future of the U.S. Nuclear Weapons Program

NASA Astrophysics Data System (ADS)

Brooks, Linton F.

2007-03-01

This paper will examine our plans for the future of the U.S. nuclear weapons program including efforts to ``transform'' the stockpile and supporting infrastructure. We proceed from the premise that the United States will need a safe, secure, and reliable nuclear deterrent for the foreseeable future. Moreover, the Stockpile Stewardship Program is working. Today's stockpile---comprised of legacy warheads left over from the Cold War---is safe and reliable. That said, we see increased risk, absent nuclear testing, in assuring the long-term safety and reliability of our current stockpile. Nor is today's nuclear weapons complex sufficiently ``responsive'' to fixing technical problems in the stockpile, or to potential adverse geopolitical change. Our task is to work to ensure that the U.S. nuclear weapons enterprise, including the stockpile and supporting infrastructure, meets long-term national security needs. Our approach is to develop and field replacement warheads for the legacy stockpile---so-called Reliable Replacement Warheads (RRW)---as a means to transform both the nuclear stockpile and supporting infrastructure.

Organizing urban ecosystem services through environmental stewardship governance in New York City

Treesearch

James J. Connolly; Erika S. Svendsen; Dana R. Fisher; Lindsay K. Campbell

2013-01-01

How do stewardship groups contribute to the management of urban ecosystem services? In this paper, we integrate the research on environmental stewardship with the social-ecological systems literature to explain how stewardship groups serve as bridge organizations between public agencies and civic organizations, working across scales and sectors to build the flexible...

Planning the Transition to Long-Term Stewardship for the River Corridor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cearlock, C.S.; Lerch, J.A.; Sands, J.P.

2007-07-01

Long-term stewardship refers to all activities necessary to ensure protection of human health and the environment following completion of remediation, disposal, or stabilization of a site or a portion of a site. Efforts to establish the proposed approach and criteria to be met for long-term stewardship in the river corridor of the Hanford Site in Richland, Washington, are currently being established and a draft plan is expected to be completed in mid-2007 to facilitate planning for a smooth and seamless transition to long-term stewardship. Once the initial criteria have been established, supporting information will be gathered as the work proceeds.more » Near the end of cleanup actions under the River Corridor Closure Contract, these criteria will be finalized in a long-term stewardship plan that documents how the criteria have been met. In addition, the final long-term stewardship plan will also contain a proposed Finding of Suitability to Transfer in accordance with Comprehensive Environmental Response, Compensation, and Liability Act of 1980 Section 120(h) [1]. This final long-term stewardship plan will provide the foundation for post-River Corridor Closure Contract and management activities in the river corridor pending actual property transfer from the U.S. Department of Energy. (authors)« less

Advanced Simulation and Computing Fiscal Year 2016 Implementation Plan, Version 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCoy, M.; Archer, B.; Hendrickson, B.

2015-08-27

The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The purpose of this IP is to outline key work requirements to be performed and to control individualmore » work activities within the scope of work. Contractors may not deviate from this plan without a revised WA or subsequent IP.« less

National Defense Stockpile Program. Phase 1. Development and Analyses

DTIC Science & Technology

1990-03-01

G- 12 G-4. Wartime Essential Civilian Tellurium Requirements .......................... G-19 G-5. Estimated Wartime Tellurium Supply and...Order Processing Flowchart for Tellurium .................................. 1-9 1-4. Structure of World Tellurium Production and U.S. Imports, 1983...hafnium, rhenium, tellurium , yttrium and zirconium. Most of the stockpile candidates considered in this report already have significant applications in the

Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions.

PubMed

Stenehjem, Edward; Hyun, David Y; Septimus, Ed; Yu, Kalvin C; Meyer, Marc; Raj, Deepa; Srinivasan, Arjun

2017-08-15

Antibiotic stewardship programs (ASPs) improve antibiotic prescribing. Seventy-three percent of US hospitals have <200 beds. Small hospitals (<200 beds) have similar rates of antibiotic prescribing compared to large hospitals, but the majority of small hospitals lack ASPs that satisfy the Centers for Disease Control and Prevention's core elements. All hospitals, regardless of size, are now required to have ASPs by The Joint Commission, and the Centers for Medicare and Medicaid Services has proposed a similar requirement. Very few studies have described the successful implementation of ASPs in small hospitals. We describe barriers commonly encountered in small hospitals when constructing an antibiotic stewardship team, obtaining appropriate metrics of antibiotic prescribing, implementing antibiotic stewardship interventions, obtaining financial resources, and utilizing the microbiology laboratory. We propose potential solutions that tailor stewardship activities to the needs of the facility and the resources typically available. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

75 FR 48742 - Renewal of the Regional Resource Stewardship Council Charter

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-11

... its natural resource stewardship activities through a balanced and broad range of diverse views and... for public input regarding stewardship issues. Dated: July 26, 2010. Anda A. Ray, Senior Vice...

ASC FY17 Implementation Plan, Rev. 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hamilton, P. G.

The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computationalmore » resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resources, including technical staff, hardware, simulation software, and computer science solutions.« less

Family forest stewardship: do owners need a financial incentive?

Treesearch

Michael A. Kilgore; Stephanie Snyder; Steven Taff; Joseph Schertz

2008-01-01

This study assessed family forest owner interest in formally committing to the types of land use and management practices that characterize good stewardship if compensated for doing so, using Minnesota's Sustainable Forest Incentives Act (SFIA) as a proxy measure of forest stewardship. The SFIA provides an annual payment in return for obtaining and using a forest...

Los Alamos Explosives Performance Key to Stockpile Stewardship

ScienceCinema

Dattelbaum, Dana

2018-02-14

As the U.S. Nuclear Deterrent ages, one essential factor in making sure that the weapons will continue to perform as designed is understanding the fundamental properties of the high explosives that are part of a nuclear weapons system. As nuclear weapons go through life extension programs, some changes may be advantageous, particularly through the addition of what are known as "insensitive" high explosives that are much less likely to accidentally detonate than the already very safe "conventional" high explosives that are used in most weapons. At Los Alamos National Laboratory explosives research includes a wide variety of both large- and small-scale experiments that include small contained detonations, gas and powder gun firings, larger outdoor detonations, large-scale hydrodynamic tests, and at the Nevada Nuclear Security Site, underground sub-critical experiments.

Los Alamos Explosives Performance Key to Stockpile Stewardship

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dattelbaum, Dana

2014-11-03

As the U.S. Nuclear Deterrent ages, one essential factor in making sure that the weapons will continue to perform as designed is understanding the fundamental properties of the high explosives that are part of a nuclear weapons system. As nuclear weapons go through life extension programs, some changes may be advantageous, particularly through the addition of what are known as "insensitive" high explosives that are much less likely to accidentally detonate than the already very safe "conventional" high explosives that are used in most weapons. At Los Alamos National Laboratory explosives research includes a wide variety of both large- andmore » small-scale experiments that include small contained detonations, gas and powder gun firings, larger outdoor detonations, large-scale hydrodynamic tests, and at the Nevada Nuclear Security Site, underground sub-critical experiments.« less

A&M. Special shielding materials. Stockpile of magnetite, used for making ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

A&M. Special shielding materials. Stockpile of magnetite, used for making high-density concrete, and loading conveyor near TAN-607 construction site. Date: September 25, 1953. INEEL negative no. 8710 - Idaho National Engineering Laboratory, Test Area North, Scoville, Butte County, ID

Report: Ongoing Management Improvements and Further Evaluation Vital to EPA Stewardship and Voluntary Programs

EPA Pesticide Factsheets

Report #2005-P-00007, February 17, 2005. We asked stakeholders to define stewardship, list motivators and obstacles to participating in stewardship programs, and outline key roles for EPA to play to foster participating in environmental stewardship.

Government stewardship of the for-profit private health sector in Afghanistan

PubMed Central

Sayedi, Omarzaman; Irani, Laili; Archer, Lauren C.; Sears, Kathleen; Sharma, Suneeta

2017-01-01

Abstract Background: Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. Aim: We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. Methods: We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives. Results: The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them. Conclusions: The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that

Government stewardship of the for-profit private health sector in Afghanistan.

PubMed

Cross, Harry E; Sayedi, Omarzaman; Irani, Laili; Archer, Lauren C; Sears, Kathleen; Sharma, Suneeta

2017-04-01

Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives. The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them. The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that enhanced stewardship functions in the MoPH are leading to a

Nitrogen rate and application timing affect the yield and risk associated with stockpiling tall fescue for winter grazing

USDA-ARS?s Scientific Manuscript database

Stockpiled tall fescue can provide economical winter feed for grazing livestock in the mid-Atlantic of the United States. The objective of this study was to evaluate the effect of N rate and application timing on the yield of stockpiled tall fescue. Four N rates ranging from 0 to 120 lb N/acre wer...

Open-pit coal mine production sequencing incorporating grade blending and stockpiling options: An application from an Indian mine

NASA Astrophysics Data System (ADS)

Kumar, Ashish; Chatterjee, Snehamoy

2017-05-01

Production scheduling is a crucial aspect of the mining industry. An optimal and efficient production schedule can increase the profits manifold and reduce the amount of waste to be handled. Production scheduling for coal mines is necessary to maintain consistency in the quality and quantity parameters of coal supplied to power plants. Irregularity in the quality parameters of the coal can lead to heavy losses in coal-fired power plants. Moreover, the stockpiling of coal poses environmental and fire problems owing to low incubation periods. This article proposes a production scheduling formulation for open-pit coal mines including stockpiling and blending opportunities, which play a major role in maintaining the quality and quantity of supplied coal. The proposed formulation was applied to a large open-pit coal mine in India. This contribution provides an efficient production scheduling formulation for coal mines after utilizing the stockpile coal within the incubation periods with the maximization of discounted cash flows. At the same time, consistency is maintained in the quality and quantity of coal to power plants through blending and stockpiling options to ensure smooth functioning.

NIF Operations Management Plan, August 2011

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Wonterghem, Bruno M.

Lawrence Livermore National Laboratory’s (LLNL) National Ignition Facility (NIF) is a key component of the National Nuclear Security Administration’s (NNSA) Stockpile Stewardship Program, whose purpose is to maintain the safety, reliability, and effectiveness of our nation’s nuclear stockpile without underground nuclear testing. The NIF is crucial to the Stockpile Stewardship Program because it is the only facility that can create the conditions of extreme temperature and pressure—conditions that exist only in stars or in exploding nuclear weapons—that are relevant to understanding how our modern nuclear weapons operate. As such, the NIF’s primary mission is to attain fusion ignition in themore » laboratory. Fusion ignition not only supports Stockpile Stewardship needs, but also provides the basis for future decisions about fusion’s potential as a long-term energy source. Additionally, NIF provides scientists with access to high-energy-density regimes that can yield new insight and understanding in the areas of astrophysics, hydrodynamics, material properties, plasma physics, and radiative properties. The use of the NIF to support the Stockpile Stewardship Program and the advancement of basic high-energy-density science understanding is planned and managed through program-level execution plans and NIF directorate-level management teams. An example of a plan is the National Ignition Campaign Execution Plan. The NIF Operations Management Plan provides an overview of the NIF Operations organization and describes how the NIF is supported by the LLNL infrastructure and how it is safely and responsibly managed and operated. Detailed information on NIF management of the organization is found in a series of supporting plans, policies, and procedures. A list of related acronyms can be found in Appendix A of this document. The purpose of this document is to provide a roadmap of how the NIF Operations organization functions. It provides a guide to

An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage

PubMed Central

Pakyz, Amy L.; Moczygemba, Leticia R.; Wang, Hui; Stevens, Michael P.; Edmond, Michael B.

2015-01-01

Objectives To determine whether an antimicrobial stewardship ‘intensity’ score predicts hospital antimicrobial usage. Methods An antimicrobial stewardship score for 44 academic medical centres was developed that comprised two main categories: resources (antimicrobial stewardship programme personnel and automated surveillance software) and strategies (preauthorization, audit with intervention and feedback, education, guidelines and clinical pathways, parenteral to oral therapy programmes, de-escalation of therapy, antimicrobial order forms and dose optimization). Multiple regression analyses were used to assess whether the composite score and also the categories were associated with either total or antimicrobial stewardship programme-target antimicrobial use as measured in days of therapy. Results The mean antimicrobial stewardship programme score was 55 (SD 21); the total composite score was not significantly associated with total or target antimicrobial use [estimate –0.49 (95% CI –2.30 to 0.89)], while the category strategies was significantly and negatively associated with target antimicrobial use [–5.91 (95% CI –9.51 to –2.31)]. Conclusions The strategy component of a score developed to measure the intensity of antimicrobial stewardship was associated with the amount of antimicrobials used. Thus, the number and types of strategies employed by antimicrobial stewardship programmes may be of particular importance in programme effectiveness. PMID:25614043

Greenhouse gas emissions from dairy open lot and manure stockpile in northern China: A case study.

PubMed

Ding, Luyu; Lu, Qikun; Xie, Lina; Liu, Jie; Cao, Wei; Shi, Zhengxiang; Li, Baoming; Wang, Chaoyuan; Zhang, Guoqiang; Ren, Shixi

2016-03-01

The open lots and manure stockpiles of dairy farm are major sources of greenhouse gas (GHG) emissions in typical dairy cow housing and manure management system in China. GHG (CO(2), CH(4) and N(2)O) emissions from the ground level of brick-paved open lots and uncovered manure stockpiles were estimated according to the field measurements of a typical dairy farm in Beijing by closed chambers in four consecutive seasons. Location variation and manure removal strategy impacts were assessed on GHG emissions from the open lots. Estimated CO(2), CH(4) and N(2)O emissions from the ground level of the open lots were 137.5±64.7 kg hd(-1) yr(-1), 0.45±0.21 kg hd(-1) yr(-1) and 0.13±0.08 kg hd(-1) yr(-1), respectively. There were remarkable location variations of GHG emissions from different zones (cubicle zone vs. aisle zone) of the open lot. However, the emissions from the whole open lot were less affected by the locations. After manure removal, lower CH(4) but higher N(2)O emitted from the open lot. Estimated CO(2), CH(4) and N(2)O emissions from stockpile with a stacking height of 55±12 cm were 858.9±375.8 kg hd(-1) yr(-1), 8.5±5.4 kg hd(-1) yr(-1) and 2.3±1.1 kg hd(-1) yr(-1), respectively. In situ storage duration, which estimated by manure volatile solid contents (VS), would affect GHG emissions from stockpiles. Much higher N(2)O was emitted from stockpiles in summer due to longer manure storage. This study deals with greenhouse gas (GHG) emissions from open lots and stockpiles. It's an increasing area of concern in some livestock producing countries. The Intergovernmental Panel on Climate Change (IPCC) methodology is commonly used for estimation of national GHG emission inventories. There is a shortage of on-farm information to evaluate the accuracy of these equations and default emission factors. This work provides valuable information for improving accounting practices within China or for similar manure management practice in other countries.

Advanced Technology System Scheduling Governance Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ang, Jim; Carnes, Brian; Hoang, Thuc

In the fall of 2005, the Advanced Simulation and Computing (ASC) Program appointed a team to formulate a governance model for allocating resources and scheduling the stockpile stewardship workload on ASC capability systems. This update to the original document takes into account the new technical challenges and roles for advanced technology (AT) systems and the new ASC Program workload categories that must be supported. The goal of this updated model is to effectively allocate and schedule AT computing resources among all three National Nuclear Security Administration (NNSA) laboratories for weapons deliverables that merit priority on this class of resource. Themore » process outlined below describes how proposed work can be evaluated and approved for resource allocations while preserving high effective utilization of the systems. This approach will provide the broadest possible benefit to the Stockpile Stewardship Program (SSP).« less

Characteristics of Pediatric Antimicrobial Stewardship Programs: Current Status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative

PubMed Central

McPherson, Christopher; Lee, Brian R.; Terrill, Cindy; Hersh, Adam L.; Gerber, Jeffrey S.; Kronman, Matthew P.; Newland, Jason G.

2018-01-01

In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention’s (CDC) seven core elements of a successful ASP within a large subset of US Children’s Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a dedicated ASP pharmacist or drug expert (88%) were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources. PMID:29370071

Characteristics of Pediatric Antimicrobial Stewardship Programs: Current Status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative.

PubMed

McPherson, Christopher; Lee, Brian R; Terrill, Cindy; Hersh, Adam L; Gerber, Jeffrey S; Kronman, Matthew P; Newland, Jason G

2018-01-25

In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention's (CDC) seven core elements of a successful ASP within a large subset of US Children's Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a dedicated ASP pharmacist or drug expert (88%) were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources.

Effective antibiotic stewardship in spinal cord injury: Challenges and a way forward.

PubMed

Skelton, Felicia; Suda, Katie; Evans, Charlesnika; Trautner, Barbara

2018-01-11

Context Antibiotic stewardship, defined as a multidisciplinary program to reduce the misuse of antibiotics, and in turn, antibiotic resistance, is a high priority. Persons with spinal cord injury/disorder (SCI/D) are vulnerable to receiving multiple courses of antibiotics over their lifetime given frequent healthcare exposure, and have high rates of bacterial infection with multi-drug resistant organisms. Additional challenges to evaluating appropriate use of antibiotics in this population include bacterial colonization in the urine and the differences in the presenting signs and symptoms of infection. Therefore, Veterans Health Administration (VHA) facilities with SCI/D centers need effective antibiotic stewardship programs. Results We analyzed the results of a 2012 VHA-wide survey evaluating available antibiotic stewardship resources, and compared the resources present at facilities with SCI/D (n=23) versus non-SCI/D facilities (n=107). VHA facilities with SCI/D centers are more likely to have components of an antibiotic stewardship program that have led to reduced antibiotic use in previous studies. They are also more likely to have personnel with infectious diseases training. Conclusion VHA facilities with SCI/D centers have the resources needed for antibiotic stewardship. The next step will be to determine how to implement effective antibiotic stewardship tailored for this patient care setting.

A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative.

PubMed

Kelly, Allison A; Jones, Makoto M; Echevarria, Kelly L; Kralovic, Stephen M; Samore, Matthew H; Goetz, Matthew B; Madaras-Kelly, Karl J; Simbartl, Loretta A; Morreale, Anthony P; Neuhauser, Melinda M; Roselle, Gary A

2017-05-01

OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.

Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey.

PubMed

Chou, Ann F; Graber, Christopher J; Jones, Makoto; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Kelly, Allison; Glassman, Peter A

2016-06-01

BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hecker, Siegfried; Gottemoeller, Rose; Reis, Victor H.

A short oral history of the NNSA's Stockpile Stewardship Program, produced in association with the 20th anniversary of the program. It features Siegfried Hecker, Rose Gottemoeller, Victor Reis, Charles McMillan, Joan Rohlfing, Omar Hurricane, Roger Hagengruber, and John Taylor.

Nature connection, outdoor play, and environmental stewardship in residential environmental education

NASA Astrophysics Data System (ADS)

Andrejewski, Robert G.

A lack of exposure to the natural world has led to a generation of children disconnected from nature. This phenomenon has profound negative implications for the physical and psychological well being of today's youth. Residential environmental education provides one avenue to connect children to nature. One purpose of this study was to investigate the role of Outdoor School, a residential environmental education program, on ecological knowledge, children's connection to nature, school belonging, outdoor play attitude, environmental stewardship attitude, outdoor play behavior, and environmental stewardship behavior, as reported by participants. A quasi-experimental research design was utilized in the study. A total of 228 fifth grade students (156 treatment, 72 control) from central Pennsylvania participated. The results of the program evaluation indicated that Outdoor School was successful in achieving significant, positive gains in the areas of ecological knowledge, connection to nature, outdoor play behavior, and environmental stewardship behavior. No change was found from pretest to post-test in outdoor play attitudes, environmental stewardship attitudes, and school belonging. Additionally, the study addressed gaps in the literature regarding the relationship between connection to nature, environmental stewardship, and outdoor play using two different approaches. An adaptation of the Theory of Planned Behavior (TPB) was used to predict outdoor play behavior in children. In this model, favorable attitudes, subjective norms, and perceived behavioral control lead to intentions to perform a given behavior. Intention to perform the behavior is the best predictor for behavior performance. For this study, participants' feeling of connection to nature was added as an affective independent variable. This model explained 45% of the variance in outdoor play. The hypothesis that a connection to nature would be a significant predictor of both attitudes toward outdoor play was

Environmental stewardship: Pathways to community cohesion and cultivating meaningful engagement

Treesearch

Sachi Arakawa; Sonya Sachdeva; Vivek Shandas

2018-01-01

What pathways do people take on the journey to stewardship and what rewards do they reap? Numerous studies emphasize the underlying values, whether moral, spiritual, or religious, which provide the foundation for engaging in environmental behavior. Yet, many cases of stewardship are founded not on lofty environmental ideals but on pragmatic, localized ambitions. As...

Legally invisible: stewardship for Aboriginal and Torres Strait Islander health

PubMed Central

Howse, Genevieve

2015-01-01

Abstract Objectives: The need to improve access to good health care for Aboriginal and Torres Strait Islander people has been the subject of policy debate for decades, but progress is hampered by complex policy and administrative arrangements and lack of clarity about the responsibilities of governments. This study aimed to identify the current legal basis of those responsibilities and define options available to Australian governments to enact enduring responsibility for Aboriginal health care. Methods: This study used a framework for public health law research and conducted a mapping study to examine the current legal underpinnings for stewardship and governance for Aboriginal health and health care. More than 200 pieces of health legislation were analysed in the context of the common and statutory law and health policy goals. Results: Very little specific recognition of the needs of Aboriginal people was found, and nothing that creates responsibility for stewardship and governance. The continuing absence of a legislative framework to address and protect Aboriginal health can be traced back to the founding doctrine of terra nullius (unoccupied land). Conclusions: We considered the results applying both a human rights perspective and the perspective of therapeutic jurisprudence. We suggest that national law for health stewardship would provide a strong foundation for progress, and should itself be based on recognition of Australia's First Peoples in the Australian Constitution, as is currently proposed. PMID:25903648

Sharing Responsibility for Data Stewardship Between Scientists and Curators

NASA Astrophysics Data System (ADS)

Hedstrom, M. L.

2012-12-01

Data stewardship is becoming increasingly important to support accurate conclusions from new forms of data, integration of and computation across heterogeneous data types, interactions between models and data, replication of results, data governance and long-term archiving. In addition to increasing recognition of the importance of data management, data science, and data curation by US and international scientific agencies, the National Academies of Science Board on Research Data and Information is sponsoring a study on Data Curation Education and Workforce Issues. Effective data stewardship requires a distributed effort among scientists who produce data, IT staff and/or vendors who provide data storage and computational facilities and services, and curators who enhance data quality, manage data governance, provide access to third parties, and assume responsibility for long-term archiving of data. The expertise necessary for scientific data management includes a mix of knowledge of the scientific domain; an understanding of domain data requirements, standards, ontologies and analytical methods; facility with leading edge information technology; and knowledge of data governance, standards, and best practices for long-term preservation and access that rarely are found in a single individual. Rather than developing data science and data curation as new and distinct occupations, this paper examines the set of tasks required for data stewardship. The paper proposes an alternative model that embeds data stewardship in scientific workflows and coordinates hand-offs between instruments, repositories, analytical processing, publishers, distributors, and archives. This model forms the basis for defining knowledge and skill requirements for specific actors in the processes required for data stewardship and the corresponding educational and training needs.

Pesticide Environmental Stewardship Program Member Handbook

EPA Pesticide Factsheets

This Pesticide Environmental Stewardship Program (PESP) handbook is a resource with information to help prospective members to learn about PESP, to understand how the program works, and to assist in applying for membership.

Community pharmacists-Leaders for antibiotic stewardship in respiratory tract infection.

PubMed

Essack, S; Bell, J; Shephard, A

2018-04-01

Hospital-based pharmacists are established antibiotic stewards, but the potential for community pharmacists is largely untapped. This commentary explores the potential leadership role of the community pharmacist in antibiotic stewardship using upper respiratory tract infection (URTI) as an example. Community pharmacists are well placed for antibiotic stewardship, possessing the capability (knowledge of medicines), opportunity (contact with prescribers and patients) and inherent commitment. Providing further motivation with information on patient education has great potential to change patient behaviour with respect to consulting a healthcare professional for an antibiotic prescription. A Global Respiratory Infection Partnership pharmacy-led educational initiative was shown to have a positive impact and can promote appropriate self-management of URTI and reduce levels of inappropriate antibiotic use. Community pharmacists are ideally placed as antibiotic stewards to lead the quest to contain the threat of antibiotic resistance. © 2017 John Wiley & Sons Ltd.

77 FR 33239 - Prairie Stewardship Plan/Environmental Impact Statement, San Juan Island National Historical Park

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... Stewardship Plan/Environmental Impact Statement, San Juan Island National Historical Park AGENCY: National... Prairie Stewardship Plan, San Juan Island National Historical Park, Washington. SUMMARY: Pursuant to the... initiating the preparation of an Environmental Impact Statement (EIS) for a Prairie Stewardship Plan, as...

STEWARDSHIP: A Conceptual Imperative For Managerial Effectiveness In The Nigerian Health System.

PubMed

2007-12-01

Unacceptable health status indicators such as high infant and maternal mortality rates and low life expectancy have continued unabated inspite of government efforts to change it. This paper espouses the concept of stewardship as a selfless, ethical, cost effective and outcome oriented approach to governance. It is believed that through stewardship approach governments would improve the health status of their populations considerably. The paper implores not only government and health care managers but the Nigerian society also to imbibe the concept of stewardship to make the development of a result-oriented health system easy.

Treating Wisely: The Surgeon's Role in Antibiotic Stewardship.

PubMed

Leeds, Ira L; Fabrizio, Anne; Cosgrove, Sara E; Wick, Elizabeth C

2017-05-01

: Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

The challenge of wilderness stewardship

Treesearch

David J. Parsons; David N. Cole

2003-01-01

The 1964 Wilderness Act and subsequent wilderness legislation have resulted in the designation of over 106 million acres of the United States as wilderness. Charged with the responsibility of protecting a significant portion of federal lands as wilderness, the federal land management agencies with responsibility for wilderness stewardship (Bureau of Land Management,...

77 FR 38267 - Information Collection; Role of Communities in Stewardship Contracting Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

...) Nature of roles played by the entities involved in developing agreement or contract plans, (c) Benefits... Collection; Role of Communities in Stewardship Contracting Projects AGENCY: Forest Service, USDA. ACTION... revision of a currently approved information collection, Role of Communities in Stewardship Contracting...

Optimizing adherence to advice from antimicrobial stewardship audit and feedback rounds.

PubMed

Rawlins, Matthew D M; Sanfilippo, Frank M; Ingram, Paul R; McLellan, Duncan G J; Crawford, Colin; D'Orsogna, Luca; Dyer, John

2018-02-01

We examined adherence to antimicrobial stewardship prospective audit and feedback rounds in a rehabilitation service compared with the remainder of the acute hospital, and explored the reasons for this. Between October 2014 and December 2015, we retrospectively assessed the rate of non-adherence to advice from antimicrobial stewardship prospective audit and feedback rounds between the rehabilitation service and the acute hospital, along with the source of the patient referral. Compared with the rehabilitation service, acute hospital medical staff were almost twice as likely to not adhere to advice provided on antimicrobial stewardship prospective audit and feedback rounds (13.8% vs. 7.6%, p < 0.0001, relative risk 1.8 [95% confidence interval 1.3, 2.5]). In the rehabilitation service, referrals were more likely to come from medical staff (61.9% vs. 16.3%, p < 0.0001). These findings may be explained by regular, direct engagement of the antimicrobial stewardship team with the rehabilitation service clinical team, a model potentially applicable to other settings.

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCoy, Michel; Archer, Bill; Hendrickson, Bruce

The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computationalmore » resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resource, including technical staff, hardware, simulation software, and computer science solutions. ASC is now focused on increasing predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (sufficient resolution, dimensionality, and scientific details), and quantifying critical margins and uncertainties. Resolving each issue requires increasingly difficult analyses because the aging process has progressively moved the stockpile further away from the original test base. Where possible, the program also enables the use of high performance computing (HPC) and simulation tools to address broader national security needs, such as foreign nuclear weapon assessments and counter nuclear terrorism.« less

From National Defense Stockpile (NDS) to Strategic Materials Security Program (SMSP): Evidence and Analytic Support. Volume 1

DTIC Science & Technology

2010-05-01

textiles include “soft” body armor; spall liners for combat vehicles; flame protection garments; and protective braided sleeves for hoses and cable...summarizes the results of an Interim Base Case analysis of those materials as well. Chapter Four offers IDA’s initial ideas regarding opportunities that...process in the requirements analysis process by which the department determines the NDS goals, or stockpile requirements, it will recommend to the

STEWARDSHIP: A Conceptual Imperative For Managerial Effectiveness In The Nigerian Health System

PubMed Central

2007-01-01

Unacceptable health status indicators such as high infant and maternal mortality rates and low life expectancy have continued unabated inspite of government efforts to change it. This paper espouses the concept of stewardship as a selfless, ethical, cost effective and outcome oriented approach to governance. It is believed that through stewardship approach governments would improve the health status of their populations considerably. The paper implores not only government and health care managers but the Nigerian society also to imbibe the concept of stewardship to make the development of a result-oriented health system easy. PMID:25161436

Antimicrobial stewardship in long term care facilities: what is effective?

PubMed

Nicolle, Lindsay E

2014-02-12

Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection - limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection - were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.

U1A Complex

ScienceCinema

None

2018-01-16

Some of the most sophisticated experiments in the stockpile stewardship program are conducted in an environmentally safe manner, nearly 1000 feet below the ground at the site. The U1a complex a sprawling underground laboratory and tunnel complex is home to a number of unique capabilities.

Data stewardship - a fundamental part of the scientific method (Invited)

NASA Astrophysics Data System (ADS)

Foster, C.; Ross, J.; Wyborn, L. A.

2013-12-01

This paper emphasises the importance of data stewardship as a fundamental part of the scientific method, and the need to effect cultural change to ensure engagement by earth scientists. It is differentiated from the science of data stewardship per se. Earth System science generates vast quantities of data, and in the past, data analysis has been constrained by compute power, such that sub-sampling of data often provided the only way to reach an outcome. This is analogous to Kahneman's System 1 heuristic, with its simplistic and often erroneous outcomes. The development of HPC has liberated earth sciences such that the complexity and heterogeneity of natural systems can be utilised in modelling at any scale, global, or regional, or local; for example, movement of crustal fluids. Paradoxically, now that compute power is available, it is the stewardship of the data that is presenting the main challenges. There is a wide spectrum of issues: from effectively handling and accessing acquired data volumes [e.g. satellite feeds per day/hour]; through agreed taxonomy to effect machine to machine analyses; to idiosyncratic approaches by individual scientists. Except for the latter, most agree that data stewardship is essential. Indeed it is an essential part of the science workflow. As science struggles to engage and inform on issues of community importance, such as shale gas and fraccing, all parties must have equal access to data used for decision making; without that, there will be no social licence to operate or indeed access to additional science funding (Heidorn, 2008). The stewardship of scientific data is an essential part of the science process; but often it is regarded, wrongly, as entirely in the domain of data custodians or stewards. Geoscience Australia has developed a set of six principles that apply to all science activities within the agency: Relevance to Government Collaborative science Quality science Transparent science Communicated science Sustained

7 CFR 1450.207 - Conservation plan, forest stewardship plan, or equivalent plan.

Code of Federal Regulations, 2014 CFR

2014-01-01

... conservation plan, forest stewardship plan, or equivalent plan, such approval may be waived by CCC. (b) The... purposes as determined by CCC. (c) If applicable, a tree planting plan must be developed and included in the conservation plan, forest stewardship plan, or equivalent plan. Such tree planting plan may allow...

7 CFR 1450.207 - Conservation plan, forest stewardship plan, or equivalent plan.

Code of Federal Regulations, 2013 CFR

2013-01-01

... conservation plan, forest stewardship plan, or equivalent plan, such approval may be waived by CCC. (b) The... purposes as determined by CCC. (c) If applicable, a tree planting plan must be developed and included in the conservation plan, forest stewardship plan, or equivalent plan. Such tree planting plan may allow...

7 CFR 1450.207 - Conservation plan, forest stewardship plan, or equivalent plan.

Code of Federal Regulations, 2012 CFR

2012-01-01

... conservation plan, forest stewardship plan, or equivalent plan, such approval may be waived by CCC. (b) The... purposes as determined by CCC. (c) If applicable, a tree planting plan must be developed and included in the conservation plan, forest stewardship plan, or equivalent plan. Such tree planting plan may allow...

7 CFR 1450.207 - Conservation plan, forest stewardship plan, or equivalent plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

... conservation plan, forest stewardship plan, or equivalent plan, such approval may be waived by CCC. (b) The... purposes as determined by CCC. (c) If applicable, a tree planting plan must be developed and included in the conservation plan, forest stewardship plan, or equivalent plan. Such tree planting plan may allow...

Communicating the value and benefits of silviculture through partnerships and collaborative stewardship

Treesearch

1997-01-01

Opening comments to this session share observations on the current management climate within the USDA Forest Service. Partnerships and collaborative stewardship as agency philosophy are discussed. Silviculturists roles, as scientists and managers are compared, and the need for internal and external cooperation stressed as we strive to meet forest stewardship goals....

Strategies and challenges of antimicrobial stewardship in long-term care facilities.

PubMed

Dyar, O J; Pagani, L; Pulcini, C

2015-01-01

As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Initiatives and resources to promote antimicrobial stewardship.

PubMed

Paño-Pardo, José Ramón; Campos, José; Natera Kindelán, Clara; Ramos, Antonio

2013-09-01

The development of an antimicrobial stewardship program (ASP) requires institutional support. However, obtaining sufficient institutional support is often a complex task that requires convincing the hospital's managers of the benefits of these programs. Additionally, in the design and implementation of an ASP, antimicrobial stewardship (AS) leaders need tools for diverse purposes, such as measuring antimicrobial consumption, education and training and designing protocols. In this review we provide useful information for AS promoters to facilitate the task of designing and implementing an ASP. First, we summarize information about various institutions that promote AS and include evidence that supports the need for and benefits of these programs. Then, several campaigns promoting AS are described. Finally, online resources for professionals dealing with AS are briefly summarized. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Scientific evidence and research in antimicrobial stewardship.

PubMed

Almirante, Benito; Garnacho-Montero, José; Pachón, Jerónimo; Pascual, Álvaro; Rodríguez-Baño, Jesús

2013-09-01

Evaluating the impact of antibiotic stewardship programs is challenging. There is evidence that they are effective in terms of reducing the consumption and cost of antibiotics, although establishing their impact on antimicrobial resistance (beyond restrictive policies in outbreaks caused by specific antimicrobial resistant organisms) and clinical outcomes is more difficult. Proper definitions of exposure and outcome variables, the use of advanced and appropriate statistical analyses and well-designed quasi-experimental studies would more accurately support the conclusions. Cluster randomized trials should be used whenever possible and appropriate, although the limitations of this approach should also be acknowledged. These issues are reviewed in this paper. We conclude that there are good research opportunities in the field of antibiotic stewardship. Copyright © 2013 Elsevier España, S.L. All rights reserved.

An Elective Course on Antimicrobial Stewardship.

PubMed

Gauthier, Timothy P; Sherman, Elizabeth M; Unger, Nathan R

2015-12-25

To implement an antimicrobial stewardship (AS) elective course for second-year and third-year pharmacy students and to assess its impact on students' perceptions regarding the application of AS principles. A 2-credit elective course focusing on principles of AS incorporated prelecture didactic recordings with primary literature and guideline-based reading assignments, in-class active-learning group work and student-led presentations, and student-generated examination items. Perceptions were assessed by precourse and postcourse survey items. Graded course assessments included completion of preclass assignments (readings, prerecorded lecture and writing assessment items), in-class active participation and group presentations, a midpoint examination, and a final examination. An AS-themed elective course in a doctor of pharmacy curriculum incorporating preclass, self-directed learning and in-class group-based active-learning strategies positively impacted students' perceived understanding of AS strategies.

An Elective Course on Antimicrobial Stewardship

PubMed Central

Sherman, Elizabeth M.; Unger, Nathan R.

2015-01-01

Objective. To implement an antimicrobial stewardship (AS) elective course for second-year and third-year pharmacy students and to assess its impact on students’ perceptions regarding the application of AS principles. Design. A 2-credit elective course focusing on principles of AS incorporated prelecture didactic recordings with primary literature and guideline-based reading assignments, in-class active-learning group work and student-led presentations, and student-generated examination items. Assessment. Perceptions were assessed by precourse and postcourse survey items. Graded course assessments included completion of preclass assignments (readings, prerecorded lecture and writing assessment items), in-class active participation and group presentations, a midpoint examination, and a final examination. Conclusion. An AS-themed elective course in a doctor of pharmacy curriculum incorporating preclass, self-directed learning and in-class group-based active-learning strategies positively impacted students’ perceived understanding of AS strategies. PMID:26889069

Big Explosives Experimental Facility - BEEF

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

The Big Explosives Experimental Facility or BEEF is a ten acre fenced high explosive testing facility that provides data to support stockpile stewardship and other national security programs. At BEEF conventional high explosives experiments are safely conducted providing sophisticated diagnostics such as high speed optics and x-ray radiography.

Big Explosives Experimental Facility - BEEF

ScienceCinema

None

2018-01-16

The Big Explosives Experimental Facility or BEEF is a ten acre fenced high explosive testing facility that provides data to support stockpile stewardship and other national security programs. At BEEF conventional high explosives experiments are safely conducted providing sophisticated diagnostics such as high speed optics and x-ray radiography.

ICMR programme on Antibiotic Stewardship, Prevention of Infection & Control (ASPIC).

PubMed

Chandy, Sujith J; Michael, Joy Sarojini; Veeraraghavan, Balaji; Abraham, O C; Bachhav, Sagar S; Kshirsagar, Nilima A

2014-02-01

Antimicrobial resistance and hospital infections have increased alarmingly in India. Antibiotic stewardship and hospital infection control are two broad strategies which have been employed globally to contain the problems of resistance and infections. For this to succeed, it is important to bring on board the various stakeholders in hospitals, especially the clinical pharmacologists. The discipline of clinical pharmacology needs to be involved in themes such as antimicrobial resistance and hospital infection which truly impact patient care. Clinical pharmacologists need to collaborate with faculty in other disciplines such as microbiology to achieve good outcomes for optimal patient care in the hospital setting. The ASPIC programme was initiated by the Indian Council of Medical Research (ICMR) in response to the above need and was designed to bring together faculty from clinical pharmacology, microbiology and other disciplines to collaborate on initiating and improving antibiotic stewardship and concurrently curbing hospital infections through feasible infection control practices. This programme involves the participation of 20 centres per year throughout the country which come together for a training workshop. Topics pertaining to the above areas are discussed in addition to planning a project which helps to improve antibiotic stewardship and infection control practices in the various centres. It is hoped that this programme would empower hospitals and institutions throughout the country to improve antibiotic stewardship and infection control and ultimately contain antimicrobial resistance.

Taimi Lynne Hoag Award for Environmental Stewardship

EPA Pesticide Factsheets

The Region 5 Tribal Operation Committee established this Award in the name of Taimi Hoag to recognize significant contributions in environmental management and/or environmental stewardship by a tribal government leader, program manager, or staff person.

Optimizing Tactics for Use of the U.S. Antiviral Strategic National Stockpile for Pandemic Influenza

PubMed Central

Dimitrov, Nedialko B.; Goll, Sebastian; Hupert, Nathaniel; Pourbohloul, Babak; Meyers, Lauren Ancel

2011-01-01

In 2009, public health agencies across the globe worked to mitigate the impact of the swine-origin influenza A (pH1N1) virus. These efforts included intensified surveillance, social distancing, hygiene measures, and the targeted use of antiviral medications to prevent infection (prophylaxis). In addition, aggressive antiviral treatment was recommended for certain patient subgroups to reduce the severity and duration of symptoms. To assist States and other localities meet these needs, the U.S. Government distributed a quarter of the antiviral medications in the Strategic National Stockpile within weeks of the pandemic's start. However, there are no quantitative models guiding the geo-temporal distribution of the remainder of the Stockpile in relation to pandemic spread or severity. We present a tactical optimization model for distributing this stockpile for treatment of infected cases during the early stages of a pandemic like 2009 pH1N1, prior to the wide availability of a strain-specific vaccine. Our optimization method efficiently searches large sets of intervention strategies applied to a stochastic network model of pandemic influenza transmission within and among U.S. cities. The resulting optimized strategies depend on the transmissability of the virus and postulated rates of antiviral uptake and wastage (through misallocation or loss). Our results suggest that an aggressive community-based antiviral treatment strategy involving early, widespread, pro-rata distribution of antivirals to States can contribute to slowing the transmission of mildly transmissible strains, like pH1N1. For more highly transmissible strains, outcomes of antiviral use are more heavily impacted by choice of distribution intervals, quantities per shipment, and timing of shipments in relation to pandemic spread. This study supports previous modeling results suggesting that appropriate antiviral treatment may be an effective mitigation strategy during the early stages of future influenza

Stewardship of the Evolving Scholarly Record: From the Invisible Hand to Conscious Coordination

ERIC Educational Resources Information Center

Lavoie, Brian; Malpas, Constance

2015-01-01

The long-term future of the scholarly record in its fullest expression cannot be effectively secured with stewardship strategies designed for print materials. The features of the evolving scholarly record suggest that traditional stewardship strategies, built on an "invisible hand" approach that relies on the uncoordinated,…

The cause and effect of exclusionary zoning within a jurisdiction, and, The stockpile of petroleum needed to contain OPEC's price shocks

NASA Astrophysics Data System (ADS)

Vatter, Marc H.

In Part I, I model a jurisdiction where residents differ by income, and housing confers benefits on neighbors. By majority vote, residents choose minima on consumption of housing that differ by neighborhood, and they separate into neighborhoods by income. In practice, such laws take the form of minimum lot sizes, bans on multi-family units, building codes, and other restrictions. This policy maximizes a benefit-cost welfare criterion. Alternative policies include no minima and a uniform minimum citywide, based on libertarian and utilitarian welfare criteria, respectively. I compare the policies in terms of efficiency, implementability, and distributional consequences, and give numerical examples based on U.S. data. Willingness to pay for the benefit-cost optimum is convex in income. This helps to explain why neighborhood stratification by income has outpaced stratification of income itself in U.S metropolitan areas since 1970. In the examples, gains to a rich household are in the thousands and losses to the poor in the hundreds of dollars annually. In Part II, I estimate the stockpile of petroleum sufficient to contain a price shock perpetrated by the OPEC. I estimate world demand for petroleum such that the long run price elasticity exceeds that in the short run, and supply from non-OPEC producers with a similar kind of lagged response. Given this structure for elasticities, OPEC profits from sudden increases in price. I simulate interaction among consumers, non-OPEC producers, OPEC, and an International Energy Agency (IEA) that punishes OPEC by releasing oil onto the market. I endow the IEA with increasingly large stockpiles until they suffice to limit price shocks to specified levels. Every 5 reduction in the shock raises present-valued world GDP by about 650 billion. The IEA now has 1.4 billion barrels of petroleum, including 700 million in the U.S. Strategic Petroleum Reserve. A 3 billion barrel stockpile would suffice to reduce a 35 price shock to 20, raising

NOAA's Scientific Data Stewardship Program

NASA Astrophysics Data System (ADS)

Bates, J. J.

2004-12-01

The NOAA mission is to understand and predict changes in the Earth's environment and conserve and manage coastal and marine resources to meet the Nation's economic, social and environmental needs. NOAA has responsibility for long-term archiving of the United States environmental data and has recently integrated several data management functions into a concept called Scientific Data Stewardship. Scientific Data Stewardship a new paradigm in data management consisting of an integrated suite of functions to preserve and exploit the full scientific value of NOAA's, and the world's, environmental data These functions include careful monitoring of observing system performance for long-term applications, the generation of authoritative long-term climate records from multiple observing platforms, and the proper archival of and timely access to data and metadata. NOAA has developed a conceptual framework to implement the functions of scientific data stewardship. This framework has five objectives: 1) develop real-time monitoring of all satellite observing systems for climate applications, 2) process large volumes of satellite data extending up to decades in length to account for systematic errors and to eliminate artifacts in the raw data (referred to as fundamental climate data records, FCDRs), 3) generate retrieved geophysical parameters from the FCDRs (referred to as thematic climate data records TCDRs) including combining observations from all sources, 4) conduct monitoring and research by analyzing data sets to uncover climate trends and to provide evaluation and feedback for steps 2) and 3), and 5) provide archives of metadata, FCDRs, and TCDRs, and facilitate distribution of these data to the user community. The term `climate data record' and related terms, such as climate data set, have been used for some time, but the climate community has yet to settle on a concensus definition. A recent United States National Academy of Sciences report recommends using the

7 CFR 1470.22 - Conservation stewardship plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION STEWARDSHIP PROGRAM Contracts... process as outlined in the National Planning Procedures Handbook to encourage participants to address... the participant's decisions that describes the schedule of conservation activities to be implemented...

Science& Technology Review December 2002

DOE Office of Scientific and Technical Information (OSTI.GOV)

Budil, K S

2002-10-28

This issue has the following articles: (1) ''Doing It All: Sustaining Our Working Solutions, Rising to New Challenges''; (2) ''Emerging from the Cold War: Stockpile Stewardship and Beyond''--When the Cold War ended, Lawrence Livermore stepped up to a new national challenge--maintaining the safety and reliability of the U.S. nuclear stockpile without underground testing. (3) ''Machines from Interlocking Molecules''--Fundamental chemistry and physics research will enable scientists to control and use individual molecules. (4) ''Laser Zaps Communication Bottleneck''--Using laser communications, the U.S. military will be able to transmit data from advanced remote sensors in real time.

Effects of fescue type and sampling date on the ruminal disappearance kinetics of autumn-stockpiled tall fescue.

PubMed

Flores, R; Coblentz, W K; Ogden, R K; Coffey, K P; Looper, M L; West, C P; Rosenkrans, C F

2007-06-01

Two tall fescue (Festuca arundinacea Schreb.) forages, one an experimental host plant/endophyte association containing a novel endophyte (HM4) that produces low or nil concentrations of ergot alkaloids, and the other a typical association of Kentucky 31 tall fescue and the wild-type endophyte (Neotyphodium coenophialum; E+), were autumn-stockpiled following late-summer clipping and fertilization with 56 kg/ha of N to assess the nutritive value and ruminal disappearance kinetics of autumn-stockpiled tall fescue forages. Beginning on December 4, 2003, sixteen 361 +/- 56.4-kg replacement dairy heifers were stratified by weight and breeding and assigned to one of four 1.6-ha pastures (2 each of E+ and HM4) that were strip-grazed throughout the winter. Pastures were sampled before grazing was initiated (December 4), each time heifers were allowed access to a fresh strip (December 26, January 15, and February 4), and when the study was terminated (February 26). For fiber components, there were no interactions between fescue type and sampling date for either pregrazed or postgrazed forages. Over sampling dates, neutral detergent fiber (NDF; 56.5 to 67.8%), acid detergent fiber (27.7 to 34.9%), hemicellulose (28.8 to 34.0%), cellulose (25.0 to 28.1%), and lignin (3.61 to 10.05%) varied with sampling date, but patterns were almost exclusively curvilinear with time. Ruminal disappearance rate of dry matter (DM) was not affected by any treatment factor (overall mean for both pregrazed and postgrazed forages = 0.050 h(- 1)); similar responses were observed for NDF disappearance (overall mean = 0.048 h(- 1)). Interactions of fescue type and sampling date were observed for both pregrazed and postgrazed forages with respect to effective ruminal disappearance of DM; however, estimates were relatively high for all forages (overall mean = 64.0%). Effective disappearance of NDF was relatively extensive for all forages (overall mean = 55.4% of NDF). Based on the results of this trial

Improving Wellbeing and Environmental Stewardship Through Volunteering in Nature.

PubMed

Molsher, Robyn; Townsend, Mardie

2016-03-01

Environmental volunteering (EV) can provide a unique way to optimise the wellbeing of participants while fostering environmental stewardship. However, the potential of EV to create human health benefits remains an under-researched area. This study provides evidence for improved wellbeing and mood state for 32 participants from diverse backgrounds undertaking EV activities. Most participants also reported improved environmental stewardship with a greatly improved understanding of the environment and the need to conserve it. Other benefits included: 31% of those seeking work obtained it; and 50% joined a volunteer group at program completion. EV provides a unique mechanism to enhance the wellbeing of the participants, while conserving the environment.

PFOA Stewardship Program Baseline Year Summary Report

EPA Pesticide Factsheets

In 2006, EPA and the eight major companies in the industry launched the 2010/15 PFOA Stewardship Program, in which companies committed to reduce global facility emissions and product content of PFOA and related chemicals by 95 percent by 2010, and to work

Wilderness stewardship in America today and what we can do to improve it

Treesearch

Ken Cordell; Chris Barns; David Brownlie; Tom Carlson; Chad Dawson; William Koch; Garry Oye; Chris Ryan

2016-01-01

The authors of this article are recently retired wilderness professionals from universities or federal agencies. We were asked to share our observations about how wilderness stewardship is being managed in America today. We based our observations on our many years of combined professional wilderness career experience as managers, trainers, scientists, educators, and...

Antimicrobial Stewardship and Urinary Tract Infections

PubMed Central

Abbo, Lilian M.; Hooton, Thomas M.

2014-01-01

Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections. PMID:27025743

Airport Capital Improvement Planning: Stewardship for Airport Development

DOT National Transportation Integrated Search

1997-09-01

"Airport Capital Improvement Planning: Stewardship for Airport Development", was : originally written in October, 1995. It documented an effort to implement the : concept of capital improvement planning with the airport development industry. : Airpor...

Promoting knowledge integration of scientific principles and environmental stewardship: Assessing an issue-based approach to teaching evolution and marine conservation

NASA Astrophysics Data System (ADS)

Zimmerman, Timothy David

2005-11-01

Students and citizens need to apply science to important issues every day. Yet the design of science curricula that foster integration of science and everyday decisions is not well understood. For example, can curricula be designed that help learners apply scientific reasons for choosing only environmentally sustainable seafood for dinner? Learners must develop integrated understandings of scientific principles, prior experiences, and current decisions in order to comprehend how everyday decisions impact environmental resources. In order to investigate how such integrated understandings can be promoted within school science classes, research was conducted with an inquiry-oriented curriculum that utilizes technology and a visit to an informal learning environment (aquarium) to promote the integration of scientific principles (adaptation) with environmental stewardship. This research used a knowledge integration approach to teaching and learning that provided a framework for promoting the application of science to environmental issues. Marine biology, often forsaken in classrooms for terrestrial biology, served as the scientific context for the curriculum. The curriculum design incorporated a three-phase pedagogical strategy and new technology tools to help students integrate knowledge and experiences across the classroom and aquarium learning environments. The research design and assessment protocols included comparisons among and within student populations using two versions of the curriculum: an issue-based version and a principle-based version. These inquiry curricula were tested with sophomore biology students attending a marine-focused academy within a coastal California high school. Pretest-posttest outcomes were compared between and within the curricular treatments. Additionally, comparisons were made between the inquiry groups and seniors in an Advanced Placement biology course who attend the same high school. Results indicate that the inquiry curricula

[Practical approach to infection control and antimicrobial stewardship by medical technologists].

PubMed

Komori, Toshiaki; Yamada, Yukiji; Kimura, Takeshi; Kosaka, Tadashi; Nakanishi, Masaki; Fujitomo, Yumiko; Fujita, Naohisa

2013-04-01

Since establishing an antimicrobial management team (AMT) in 2003, we have been promoting both appropriate diagnosis and treatment and improving the prognosis of hospitalized patients with infections. AMT is composed of 4 doctors, 2 nurses, 2 pharmacists and one medical technologist. AMT members meet twice a week and discuss patients with positive blood cultures, with prescribed anti-MRSA drugs and suspected infections. Antimicrobial prescription and clinical laboratory data are obtained from the database of electric medical records and microbiological data from the laboratory database system. The initial step in infection control and antimicrobial stewardship is an accurate diagnosis of infection. Clinical microbiology laboratories play a critical role in infection control and antimicrobial stewardship by reporting accurate and timely results of both bacterial identification and antimicrobial susceptibility tests. Medical technologists are required to develop better competency and proficiency about clinical microbiology in both infection control and antimicrobial stewardship.

DOE Office of Scientific and Technical Information (OSTI.GOV)

O'Brien, K H

Nuclear weapons play an essential role in United States (U.S.) National Security Policy and a succession of official reviews has concluded that nuclear weapons will continue to have a role for the foreseeable future. Under the evolving U.S. government policy, it is clear that role will be quite different from what it was during the Cold War. The nuclear-weapons stockpile as well as the nuclear-weapons enterprise needs to continue to change to reflect this evolving role. Stockpile reductions in the early 1990s and the Stockpile Stewardship Program (SSP), established after the cessation of nuclear testing in 1992, began this processmore » of change. Further evolution is needed to address changing security environments, to enable further reductions in the number of stockpiled weapons, and to create a nuclear enterprise that is cost effective and sustainable for the long term. The SSP has successfully maintained the U.S. nuclear stockpile for more than a decade, since the end of nuclear testing. Current plans foresee maintaining warheads produced in the 1980s until about 2040. These warheads continue to age and they are expensive to refurbish. The current Life Extension Program plans for these legacy warheads are straining both the nuclear-weapons production and certification infrastructure making it difficult to respond rapidly to problems or changes in requirements. Furthermore, refurbishing and preserving Cold-War-era nuclear weapons requires refurbishing and preserving an infrastructure geared to support old technology. Stockpile Stewardship could continue this refurbishment approach, but an alternative approach could be considered that is more focused on sustainable technologies, and developing a more responsive nuclear weapons infrastructure. Guided by what we have learned from SSP during the last decade, the stewardship program can be evolved to address this increasing challenge using its computational and experimental tools and capabilities. This approach

Performance by Fall-Calving Cows Grazing Tall Fescue Pastures With Different Proportions Stockpiled

USDA-ARS?s Scientific Manuscript database

Tall fescue [Lolium arundinaceum (Schreb.) S.J. Darbyshire.] is often stockpiled to reduce winter feed costs for cattle. Over two consecutive years, a total of 158 Gelbvieh × Angus fall-calving cows (1318 plus/minus 13.2 lb) were allocated randomly to one of eight 24-acre tall fescue pastures on 18 ...

Performance by Fall-Calving Cows Grazing Tall Fescue Pastures with Different Proportions Stockpiled

USDA-ARS?s Scientific Manuscript database

Tall fescue [Lolium arundinaceum (Schreb.) Darbysh.] is often stockpiled to reduce winter feed costs for cattle. Over two consecutive years, a total of 158 Gelbvieh × Angus fall-calving cows (599 ± 6.0 kg) were allocated randomly to one of eight 10-ha tall fescue pastures (subdivided into six 1.6-h...

Urban non-timber forest products stewardship practices among foragers in Seattle, Washington (USA)

Treesearch

R.J. McLain; Melissa R. Poe; Lauren S. Urgenson; Dale J. Blahna; Lita P. Buttolph

2017-01-01

Our research seeks to expand the concept of urban environmental stewardship to include the everyday stewardship practices of urban nontimber forest products foragers. Ethnographic data from 58 urban foragers and 18 land stewards in the city of Seattle (USA) revealed that foragers reported using a variety of practices to enhance and minimize negative desirable species...

Optimizing Antibiotic Use in Nursing Homes Through Antibiotic Stewardship.

PubMed

Sloane, Philip D; Huslage, Kirk; Kistler, Christine E; Zimmerman, Sheryl

2016-01-01

Antibiotic stewardship is becoming a requirement for nursing homes. Programs should be interdisciplinary and multifaceted; should have support from nursing home administrators; and should aim to promote antibiotics only when needed, not just in case. Recommended components include use of evidence-based guidelines; ongoing monitoring of antibiotic prescriptions, cultures, and study results; monitoring of health outcomes; use of nursing home-specific antibiograms; regular reporting and feedback to medical providers and nurses; and education of residents and families. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Antibiotic stewardship through the EU project "ABS International".

PubMed

Allerberger, Franz; Frank, Annegret; Gareis, Roland

2008-01-01

The increasing problem of antimicrobial resistance requires implementation of antibiotic stewardship (ABS) programs. The project "ABS International--implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the European Union" was started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (antibiotic list, guides for antibiotic treatment and surgical prophylaxis, antibiotic-related organization) and valid process measures, as well as quality indicators for antibiotic use were developed. Specific ABS tools are being implemented in up to five healthcare facilities in each country. Although ABS International clearly focuses on healthcare institutions, future antimicrobial stewardship programs must also cover public education and antibiotic prescribing in primary care.

Integrating human and natural systems in community psychology: an ecological model of stewardship behavior.

PubMed

Moskell, Christine; Allred, Shorna Broussard

2013-03-01

Community psychology (CP) research on the natural environment lacks a theoretical framework for analyzing the complex relationship between human systems and the natural world. We introduce other academic fields concerned with the interactions between humans and the natural environment, including environmental sociology and coupled human and natural systems. To demonstrate how the natural environment can be included within CP's ecological framework, we propose an ecological model of urban forest stewardship action. Although ecological models of behavior in CP have previously modeled health behaviors, we argue that these frameworks are also applicable to actions that positively influence the natural environment. We chose the environmental action of urban forest stewardship because cities across the United States are planting millions of trees and increased citizen participation in urban tree planting and stewardship will be needed to sustain the benefits provided by urban trees. We used the framework of an ecological model of behavior to illustrate multiple levels of factors that may promote or hinder involvement in urban forest stewardship actions. The implications of our model for the development of multi-level ecological interventions to foster stewardship actions are discussed, as well as directions for future research to further test and refine the model.

Improving patient care through implementation of an antimicrobial stewardship program.

PubMed

Palmer, Hannah R; Weston, Jaye; Gentry, Layne; Salazar, Miguel; Putney, Kimberly; Frost, Craig; Tipton, Joyce A; Cottreau, Jessica; Tam, Vincent H; Garey, Kevin W

2011-11-15

The implementation of an antimicrobial stewardship program at a health system is described. In 2008, the Center for Antimicrobial Stewardship and Epidemiology (CASE) was formed at St. Luke's Episcopal Hospital (SLEH) to improve the quality of care for patients as it related to antimicrobial therapy. The charter of CASE contained specific aims for improving patient care, furthering clinical research, and training the next generation of clinical infectious diseases pharmacists. The CASE team consists of at least two infectious diseases pharmacists and one physician (the medical director) who provide direct oversight for antimicrobial utilization within the hospital. The CASE medical director, an infectious diseases physician, is responsible for overseeing the activities of the center. With the oversight of the CASE advisory board, the medical director develops and implements the antimicrobial stewardship and management policies for SLEH. Another key innovative feature of CASE is its extensive involvement in training new infectious diseases pharmacists and conducting research. CASE uses a model in which a clinical scenario or problem is identified, a research project is undertaken to further elucidate the problem, and policy changes are made to improve patient outcomes. The CASE team is supported by a CASE advisory board, a CASE research collaborative including university faculty, and a dedicated training program for pharmacy fellows, residents, and students. Implementation of an antimicrobial stewardship program at a health system helped decrease the inappropriate use of antibiotics, improve patient care and outcomes, further clinical research, and increase training opportunities for future clinical infectious diseases pharmacists.

7 CFR 1470.22 - Conservation stewardship plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., and (iii) Documenting the participant's conservation objectives to reach and exceed stewardship thresholds; (2) A plan map delineating enrolled land with associated acreage amounts; (3) In the case where a... participant's transition to or participation in the National Organic Program; (4) In the case where a...

Antifungal stewardship considerations for adults and pediatrics.

PubMed

Hamdy, Rana F; Zaoutis, Theoklis E; Seo, Susan K

2017-08-18

Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via post-prescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

A model "go-kit" for use at Strategic National Stockpile Points of Dispensing.

PubMed

May, Larissa; Cote, Timothy; Hardeman, Bernard; Gonzalez, Gabriela R; Adams, Sherry B; Blair, Roderick K; Pane, Gregg

2007-01-01

The Strategic National Stockpile (SNS) is a national repository of pharmaceuticals and other medical supplies forseeably needed during a medical disaster. In the event of SNS deployment, state and local public health authorities must be prepared to receive, distribute, and dispense the materials. We propose a cache of supplies, termed the "POD go-kit," prepared in advance and locally available prior to the establishment of Points of Dispensing (POD) for SNS material. Characteristics of the preassembled go-kit are its multiplicity of use, ease of storage and transportation, minimal redundancy with SNS material, and packaging in a manner consistent with POD function. The POD go-kit is assembled into 4 separate "subkits": administrative supplies, patient routing supplies, dispensing supplies, and POD staff protection supplies. Incorporating existing practices from the SNS Listserv, this article itemizes the contents of the POD go-kit and its subkits and provides a rationale for its packaging. The Division of Strategic National Stockpile (DSNS) has not certified the proposed "POD go-kit" as a standardized POD go-kit.

Perceptions and Practices of Community Pharmacists towards Antimicrobial Stewardship in the State of Selangor, Malaysia.

PubMed

Khan, Muhammad Umair; Hassali, Mohamed Azmi Ahmad; Ahmad, Akram; Elkalmi, Ramadan Mohamed; Zaidi, Syed Tabish Razi; Dhingra, Sameer

2016-01-01

Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship. A cross-sectional study was conducted among community pharmacists between March-April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data. A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05). The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized interventions would be critical to bridging these

Perceptions and Practices of Community Pharmacists towards Antimicrobial Stewardship in the State of Selangor, Malaysia

PubMed Central

Khan, Muhammad Umair; Hassali, Mohamed Azmi Ahmad; Ahmad, Akram; Elkalmi, Ramadan Mohamed; Zaidi, Syed Tabish Razi; Dhingra, Sameer

2016-01-01

Background Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship. Methods A cross-sectional study was conducted among community pharmacists between March–April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data. Results A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05). Conclusion The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized

Faith community nursing demonstrates good stewardship of community benefit dollars through cost savings and cost avoidance.

PubMed

Brown, Ameldia R; Coppola, Patricia; Giacona, Marian; Petriches, Anne; Stockwell, Mary Ann

2009-01-01

Health systems seeking responsible stewardship of community benefit dollars supporting Faith Community Nursing Networks require demonstration of positive measurable health outcomes. Faith Community Nurses (FCNs) answer the call for measurable outcomes by documenting cost savings and cost avoidances to families, communities, and health systems associated with their interventions. Using a spreadsheet tool based on Medicare reimbursements and diagnostic-related groupings, 3 networks of FCNs have together shown more than 600 000 (for calendar year 2008) healthcare dollars saved by avoidance of unnecessary acute care visits and extended care placements. The cost-benefit ratio of support dollars to cost savings and cost avoidance demonstrates that support of FCNs is good stewardship of community benefit dollars.

Predicting volunteer commitment in environmental stewardship programmes

Treesearch

Robert L. Ryan; Rachel Kaplan; Robert E. Grese

2001-01-01

The natural environment benefits greatly from the work of volunteers in environmental stewardship programmes. However, little is known about volunteers' motivations for continued participation in these programmes. This study looked at the relationship between volunteer commitment and motivation, as well as the effect that volunteering has on participants'...

Using Watershed Stewardship to Build Sustainability and Resilience

EPA Science Inventory

This presentation is designed to help build understanding of how stewardship of water resources can help local communities develop sustainably and become more resilient; discuss how monitoring can engage communities and increase environmental awareness; and explore how monitoring...

Donor Relations: The Essential Guide to Stewardship Policies, Procedures, and Protocol. The Newcomer Series.

ERIC Educational Resources Information Center

Taylor, Karla, Ed.; Joyce, Shannon, Ed.

This book discusses various facets of stewardship as it applies specifically to philanthropy and donor relations for institutions of higher education. Stewardship is defined as a way of preserving opportunities for further support, as the legal and public relations protection of institutions, and as a "right" thing to do. Following an…

Stewardship, Learning, and Memory in Disaster Resilience

ERIC Educational Resources Information Center

Tidball, Keith G.; Krasny, Marianne E.; Svendsen, Erika; Campbell, Lindsay; Helphand, Kenneth

2010-01-01

In this contribution, we propose and explore the following hypothesis: civic ecology practices, including urban community forestry, community gardening, and other self-organized forms of stewardship of green spaces in cities, are manifestations of how memories of the role of greening in healing can be instrumentalized through social learning to…

Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America

PubMed Central

Barlam, Tamar F.; Cosgrove, Sara E.; Abbo, Lilian M.; MacDougall, Conan; Schuetz, Audrey N.; Septimus, Edward J.; Srinivasan, Arjun; Dellit, Timothy H.; Falck-Ytter, Yngve T.; Fishman, Neil O.; Hamilton, Cindy W.; Jenkins, Timothy C.; Lipsett, Pamela A.; Malani, Preeti N.; May, Larissa S.; Moran, Gregory J.; Neuhauser, Melinda M.; Newland, Jason G.; Ohl, Christopher A.; Samore, Matthew H.; Seo, Susan K.; Trivedi, Kavita K.

2016-01-01

Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics. PMID:27080992

Interoperability Across the Stewardship Spectrum in the DataONE Repository Federation

NASA Astrophysics Data System (ADS)

Jones, M. B.; Vieglais, D.; Wilson, B. E.

2016-12-01

Thousands of earth and environmental science repositories serve many researchers and communities, each with their own community and legal mandates, sustainability models, and historical infrastructure. These repositories span the stewardship spectrum from highly curated collections that employ large numbers of staff members to review and improve data, to small, minimal budget repositories that accept data caveat emptor and where all responsibility for quality lies with the submitter. Each repository fills a niche, providing services that meet the stewardship tradeoffs of one or more communities. We have reviewed these stewardship tradeoffs for several DataONE member repositories ranging from minimally (KNB) to highly curated (Arctic Data Center), as well as general purpose (Dryad) to highly discipline or project specific (NEON). The rationale behind different levels of stewardship reflect resolution of these tradeoffs. Some repositories aim to encourage extensive uptake by keeping processes simple and minimizing the amount of information collected, but this limits the long-term utility of the data and the search, discovery, and integration systems that are possible. Other repositories require extensive metadata input, review, and assessment, allowing for excellent preservation, discovery, and integration but at the cost of significant time for submitters and expense for curatorial staff. DataONE recognizes these different levels of curation, and attempts to embrace them to create a federation that is useful across the stewardship spectrum. DataONE provides a tiered model for repositories with growing utility of DataONE services at higher tiers of curation. The lowest tier supports read-only access to data and requires little more than title and contact metadata. Repositories can gradually phase in support for higher levels of metadata and services as needed. These tiered capabilities are possible through flexible support for multiple metadata standards and services

Stewardship, learning, and memory in disaster resilience

Treesearch

Keith G. Tidball; Marianne E. Krasny; Erika Svendsen; Lindsay Campbell; Kenneth Helphand

2010-01-01

In this contribution, we propose and explore the following hypothesis: civic ecology practices, including urban community forestry, community gardening, and other self-organized forms of stewardship of green spaces in cities, are manifestations of how memories of the role of greening in healing can be instrumentalized through social learning to foster social-ecological...

Stewardship and accountability.

PubMed

Osborne, Karen; Osborne, Robert

2005-01-01

In March 2003 The Chronicle for Philanthropy reported a sea change in fund development. After 25 years of consistent research on donor motivation, a study came out with new information. Donors ranked on a scale of 1-10 what mattered most to them when considering giving. Until now, most donors reported that a belief in the mission of the organization and the desire to have an impact on the people served was their number one motivation. Certainly gratitude for life-saving or life-changing service made that belief in mission and impact that much more powerful as a motivation. Improving their community was consistently the number two reason for giving. But, according to the 2003 survey, something changed. Six of the 10 reasons involve stewardship and accountability.

Local Government Implementation of Long-Term Stewardship at Two DOE Facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

John Pendergrass; Roman Czebiniak; Kelly Mott

2003-08-13

The Department of Energy (DOE) is responsible for cleaning up the radioactive and chemical contamination that resulted from the production of nuclear weapons. At more than one hundred sites throughout the country DOE will leave some contamination in place after the cleanup is complete. In order to protect human health and the environment from the remaining contamination DOE, U.S. Environmental Protection Agency (EPA), state environmental regulatory agencies, local governments, citizens and other entities will need to undertake long-term stewardship of such sites. Long-term stewardship includes a wide range of actions needed to protect human health in the environment for asmore » long as the risk from the contamination remains above acceptable levels, such as barriers, caps, and other engineering controls and land use controls, signs, notices, records, and other institutional controls. In this report the Environmental Law Institute (ELI) and the Energy Communities Alliance (ECA) examine how local governments, state environmental agencies, and real property professionals implement long-term stewardship at two DOE facilities, Losa Alamos National Laboratory and Oak Ridge Reservation.« less

CDC, TJC Urge Providers To Up Their Game on Antibiotic Stewardship.

PubMed

Srinivasan, Arjun; Vento, Todd

2017-03-01

With data showing continued increases in the use of antibiotics, even in cases in which such prescribing is unnecessary and ill-advised, both the CDC and TJC are pushing initiatives aimed at improving antibiotic stewardship. The initiatives stress the importance of patient and provider education, the tracking of antibiotic use and resistance, and the need for top-level support. Although smaller hospitals face challenges in meeting the new standards, some health systems are getting around the problem through the use of telemedicine. The CDC is pushing hospitals to implement seven core elements that the agency maintains are critical to an effective antibiotic stewardship program. TJC has established a new standard requiring all hospitals to create antibiotic stewardship programs that are steered by a multidisciplinary team. Intermountain Healthcare in Salt Lake City is helping smaller hospitals in its network meet these new TJC and CDC directives by supplying support and expertise via telemedicine. The telehealth program also enables both emergency and inpatient providers to access infectious disease expertise when patients present with issues of concern.

The Karuk tribe, planetary stewardship, and world renewal on the middle Klamath River, California

Treesearch

Frank K. Lake; William Tripp; R. Reed

2010-01-01

In the Karuk Tribe’s worldview, planetary stewardship is maintained through the place-based spiritual and cultural philosophy of World Renewal. A philosophy of Renewal reaffirms the responsibility of humans as stewards as well as a critical ecosystem component. The Tribe believes in renewal of the human-environment relationship that is compatible with ecological...

A database system for characterization of munitions items in conventional ammunition demilitarization stockpiles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chun, K.C.; Chiu, S.Y.; Ditmars, J.D.

1994-05-01

The MIDAS (Munition Items Disposition Action System) database system is an electronic data management system capable of storage and retrieval of information on the detailed structures and material compositions of munitions items designated for demilitarization. The types of such munitions range from bulk propellants and small arms to projectiles and cluster bombs. The database system is also capable of processing data on the quantities of inert, PEP (propellant, explosives and pyrotechnics) and packaging materials associated with munitions, components, or parts, and the quantities of chemical compounds associated with parts made of PEP materials. Development of the MIDAS database system hasmore » been undertaken by the US Army to support disposition of unwanted ammunition stockpiles. The inventory of such stockpiles currently includes several thousand items, which total tens of thousands of tons, and is still growing. Providing systematic procedures for disposing of all unwanted conventional munitions is the mission of the MIDAS Demilitarization Program. To carry out this mission, all munitions listed in the Single Manager for Conventional Ammunition inventory must be characterized, and alternatives for resource recovery and recycling and/or disposal of munitions in the demilitarization inventory must be identified.« less

Spatially explicit data: stewardship and ethical challenges in science.

PubMed

Hartter, Joel; Ryan, Sadie J; Mackenzie, Catrina A; Parker, John N; Strasser, Carly A

2013-09-01

Scholarly communication is at an unprecedented turning point created in part by the increasing saliency of data stewardship and data sharing. Formal data management plans represent a new emphasis in research, enabling access to data at higher volumes and more quickly, and the potential for replication and augmentation of existing research. Data sharing has recently transformed the practice, scope, content, and applicability of research in several disciplines, in particular in relation to spatially specific data. This lends exciting potentiality, but the most effective ways in which to implement such changes, particularly for disciplines involving human subjects and other sensitive information, demand consideration. Data management plans, stewardship, and sharing, impart distinctive technical, sociological, and ethical challenges that remain to be adequately identified and remedied. Here, we consider these and propose potential solutions for their amelioration.

Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.

PubMed

Heath, Barbara; Bernhardt, Jaime; Michalski, Thomas J; Crnich, Christopher J; Moehring, Rebekah; Schmader, Kenneth E; Olds, Danielle; Higgins, Patricia A; Jump, Robin L P

2016-03-01

We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc.

Antimicrobial Stewardship Programs: Comparison of a Program with Infectious Diseases Pharmacist Support to a Program with a Geographic Pharmacist Staffing Model

PubMed Central

Ma, Andrew; Clegg, Daniel; Fugit, Randolph V.; Pepe, Anthony; Goetz, Matthew Bidwell; Graber, Christopher J.

2015-01-01

Background: Stewardship of antimicrobial agents is an essential function of hospital pharmacies. The ideal pharmacist staffing model for antimicrobial stewardship programs is not known. Objective: To inform staffing decisions for antimicrobial stewardship teams, we aimed to compare an antimicrobial stewardship program with a dedicated Infectious Diseases (ID) pharmacist (Dedicated ID Pharmacist Hospital) to a program relying on ward pharmacists for stewardship activities (Geographic Model Hospital). Methods: We reviewed a randomly selected sample of 290 cases of inpatient parenteral antibiotic use. The electronic medical record was reviewed for compliance with indicators of appropriate antimicrobial stewardship. Results: At the hospital staffed by a dedicated ID pharmacist, 96.8% of patients received initial antimicrobial therapy that adhered to local treatment guidelines compared to 87% of patients at the hospital that assigned antimicrobial stewardship duties to ward pharmacists (P < .002). Therapy was modified within 24 hours of availability of laboratory data in 86.7% of cases at the Dedicated ID Pharmacist Hospital versus 72.6% of cases at the Geographic Model Hospital (P < .03). When a patient’s illness was determined not to be caused by a bacterial infection, antibiotics were discontinued in 78.0% of cases at the Dedicated ID Pharmacist Hospital and in 33.3% of cases at the Geographic Model Hospital (P < .0002). Conclusion: An antimicrobial stewardship program with a dedicated ID pharmacist was associated with greater adherence to recommended antimicrobial therapy practices when compared to a stewardship program that relied on ward pharmacists. PMID:26405339

Nosocomial Candidiasis: Antifungal Stewardship and the Importance of Rapid Diagnosis.

PubMed

Pfaller, Michael A; Castanheira, Mariana

2016-01-01

Candidemia and other forms of candidiasis are associated with considerable excess mortality and costs. Despite the addition of several new antifungal agents with improved spectrum and potency, the frequency of Candida infection and associated mortality have not decreased in the past two decades. The lack of rapid and sensitive diagnostic tests has led to considerable overuse of antifungal agents resulting in increased costs, selection pressure for resistance, unnecessary drug toxicity, and adverse drug interactions. Both the lack of timely diagnostic tests and emergence of antifungal resistance pose considerable problems for antifungal stewardship. Whereas antifungal stewardship with a focus on nosocomial candidiasis should be able to improve the administration of antifungal therapy in terms of drug selection, proper dose and duration, source control and de-escalation therapy, an important parameter, timeliness of antifungal therapy, remains a victim of slow and insensitive diagnostic tests. Fortunately, new proteomic and molecular diagnostic tools are improving the time to species identification and detection. In this review we will describe the potential impact that rapid diagnostic testing and antifungal stewardship can have on the management of nosocomial candidiasis. © The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Should remaining stockpiles of smallpox virus (variola) be destroyed?

PubMed

Weinstein, Raymond S

2011-04-01

In 2011, the World Health Organization will recommend the fate of existing smallpox stockpiles, but circumstances have changed since the complete destruction of these cultures was first proposed. Recent studies suggest that variola and its experimental surrogate, vaccinia, have a remarkable ability to modify the human immune response through complex mechanisms that scientists are only just beginning to unravel. Further study that might require intact virus is essential. Moreover, modern science now has the capability to recreate smallpox or a smallpox-like organism in the laboratory in addition to the risk of nature re-creating it as it did once before. These factors strongly suggest that relegating smallpox to the autoclave of extinction would be ill advised.

Algal biochar enhances the re-vegetation of stockpiled mine soils with native grass.

PubMed

Roberts, David A; Cole, Andrew J; Paul, Nicholas A; de Nys, Rocky

2015-09-15

In most countries the mining industry is required to rehabilitate disturbed land with native vegetation. A typical approach is to stockpile soils during mining and then use this soil to recreate landforms after mining. Soil that has been stockpiled for an extended period typically contains little or no organic matter and nutrient, making soil rehabilitation a slow and difficult process. Here, we take freshwater macroalgae (Oedogonium) cultivated in waste water at a coal-fired power station and use it as a feedstock for the production of biochar, then use this biochar to enhance the rehabilitation of two types of stockpiled soil - a ferrosol and a sodosol - from the adjacent coal mine. While the biomass had relatively high concentrations of some metals, due to its cultivation in waste water, the resulting biochar did not leach metals into the pore water of soil-biochar mixtures. The biochar did, however, contribute essential trace elements (particularly K) to soil pore water. The biochar had very strong positive effects on the establishment and growth of a native plant (Kangaroo grass, Themeda australis) in both of the soils. The addition of the algal biochar to both soils at 10 t ha(-1) reduced the time to germination by the grass and increased the growth and production of plant biomass. Somewhat surprisingly, there was no beneficial effect of a higher application rate (25 t ha(-1)) of the biochar in the ferrosol, which highlights the importance of matching biochar application rates to the requirements of different types of soil. Nevertheless, we demonstrate that algal biochar can be produced from biomass cultivated in waste water and used at low application rates to improve the rehabilitation of a variety of soils typical of coal mines. This novel process links biomass production in waste water to end use of the biomass in land rehabilitation, simultaneously addressing two environmental issues associated with coal-mining and processing. Copyright © 2015

Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes.

PubMed

Chung, Gladys W; Wu, Jia En; Yeo, Chay Leng; Chan, Douglas; Hsu, Li Yang

2013-02-15

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs.

Penicillin skin testing: potential implications for antimicrobial stewardship.

PubMed

Unger, Nathan R; Gauthier, Timothy P; Cheung, Linda W

2013-08-01

As the progression of multidrug-resistant organisms and lack of novel antibiotics move us closer toward a potential postantibiotic era, it is paramount to preserve the longevity of current therapeutic agents. Moreover, novel interventions for antimicrobial stewardship programs are integral to combating antimicrobial resistance worldwide. One unique method that may decrease the use of second-line antibiotics (e.g., fluoroquinolones, vancomycin) while facilitating access to a preferred β-lactam regimen in numerous health care settings is a penicillin skin test. Provided that up to 10% of patients have a reported penicillin allergy, of whom ~10% have true IgE-mediated hypersensitivity, significant potential exists to utilize a penicillin skin test to safely identify those who may receive penicillin or a β-lactam antibiotic. In this article, we provide information on the background, associated costs, currently available literature, pharmacists' role, antimicrobial stewardship implications, potential barriers, and misconceptions, as well as future directions associated with the penicillin skin test. © 2013 Pharmacotherapy Publications, Inc.

An Interprofessional Curriculum on Antimicrobial Stewardship Improves Knowledge and Attitudes Toward Appropriate Antimicrobial Use and Collaboration

PubMed Central

Schwartz, Brian S.; Kim, Lisa; Nanamori, Mari; Shekarchian, Sharmin; Chin-Hong, Peter V.

2017-01-01

Abstract Background. Inappropriate antimicrobial use can threaten patient safety and is the focus of collaborative physician and pharmacist antimicrobial stewardship teams. However, antimicrobial stewardship is not comprehensively taught in medical or pharmacy school curricula. Addressing this deficiency can teach an important concept as well as model interprofessional healthcare. Methods. We created an antimicrobial stewardship curriculum consisting of an online learning module and workshop session that combined medical and pharmacy students, with faculty from both professions. Learners worked through interactive, branched-logic clinical cases relating to appropriate antimicrobial use. We surveyed participants before and after the curriculum using validated questions to assess knowledge and attitudes regarding antimicrobial stewardship and interprofessional collaboration. Results were analyzed using paired χ2 and t tests and mixed-effects logistic regression. Results. Analysis was performed with the 745 students (425 medical students, 320 pharmacy students) who completed both pre- and postcurriculum surveys over 3 years. After completing the curriculum, significantly more students perceived that they were able to describe the role of each profession in appropriate antimicrobial use (34% vs 82%, P < .001), communicate in a manner that engaged the interprofessional team (75% vs 94%, P < .001), and describe collaborative approaches to appropriate antimicrobial use (49% vs 92%, P < .001). Student favorability ratings were high for the online learning module (85%) and small group workshop (93%). Conclusions. A curriculum on antimicrobial stewardship consisting of independent learning and an interprofessional workshop significantly increased knowledge and attitudes towards collaborative antimicrobial stewardship among preclinical medical and pharmacy students. PMID:28480231

An Interprofessional Curriculum on Antimicrobial Stewardship Improves Knowledge and Attitudes Toward Appropriate Antimicrobial Use and Collaboration.

PubMed

MacDougall, Conan; Schwartz, Brian S; Kim, Lisa; Nanamori, Mari; Shekarchian, Sharmin; Chin-Hong, Peter V

2017-01-01

Inappropriate antimicrobial use can threaten patient safety and is the focus of collaborative physician and pharmacist antimicrobial stewardship teams. However, antimicrobial stewardship is not comprehensively taught in medical or pharmacy school curricula. Addressing this deficiency can teach an important concept as well as model interprofessional healthcare. We created an antimicrobial stewardship curriculum consisting of an online learning module and workshop session that combined medical and pharmacy students, with faculty from both professions. Learners worked through interactive, branched-logic clinical cases relating to appropriate antimicrobial use. We surveyed participants before and after the curriculum using validated questions to assess knowledge and attitudes regarding antimicrobial stewardship and interprofessional collaboration. Results were analyzed using paired χ 2 and t tests and mixed-effects logistic regression. Analysis was performed with the 745 students (425 medical students, 320 pharmacy students) who completed both pre- and postcurriculum surveys over 3 years. After completing the curriculum, significantly more students perceived that they were able to describe the role of each profession in appropriate antimicrobial use (34% vs 82%, P < .001), communicate in a manner that engaged the interprofessional team (75% vs 94%, P < .001), and describe collaborative approaches to appropriate antimicrobial use (49% vs 92%, P < .001). Student favorability ratings were high for the online learning module (85%) and small group workshop (93%). A curriculum on antimicrobial stewardship consisting of independent learning and an interprofessional workshop significantly increased knowledge and attitudes towards collaborative antimicrobial stewardship among preclinical medical and pharmacy students. © The Author 2017. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era.

PubMed

Desai, Sachin N; Pezzoli, Lorenzo; Alberti, Kathryn P; Martin, Stephen; Costa, Alejandro; Perea, William; Legros, Dominique

2017-03-04

Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings.

A Clostridium difficile infection (CDI) stewardship initiative improves adherence to practice guidelines for management of CDI.

PubMed

Jury, Lucy A; Tomas, Myreen; Kundrapu, Sirisha; Sitzlar, Brett; Donskey, Curtis J

2013-11-01

A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription of empirical CDI therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of CDI. The initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.

36 CFR 230.6 - Landowner forest stewardship plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., Tree Farm management plans, or similar plans meet or can be amended to meet Landowner Forest... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Landowner forest stewardship plan. 230.6 Section 230.6 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE...

36 CFR 230.6 - Landowner forest stewardship plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Tree Farm management plans, or similar plans meet or can be amended to meet Landowner Forest... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Landowner forest stewardship plan. 230.6 Section 230.6 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE...

Worldwide Emerging Environmental Issues Affecting the U.S. Military. June 2005 Report

DTIC Science & Technology

2005-06-01

Trade and Environment issues that help promote environmental protection and improve enforcement of environmental law; and Expand Partnerships for...in view of the Army’s Strategy for the Environment and the CEC’s Partnerships for Environmental Stewardship strategies. Source: CEC Ministerial...reducing mercury use, emissions, wastes and surplus stockpiles, and participating in partnerships with organizations and countries requesting assistance. If

Nurse and Medical Provider Perspectives on Antibiotic Stewardship in Nursing Homes.

PubMed

Scales, Kezia; Zimmerman, Sheryl; Reed, David; Beeber, Anna Song; Kistler, Christine E; Preisser, John S; Weiner, Bryan J; Ward, Kimberly; Fann, Amy; Sloane, Philip D

2017-01-01

To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs). Cross-sectional survey. NHs in North Carolina (N = 31). Nursing staff (n = 182) and medical providers (n = 50). Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship. Open-ended questions on barriers to antibiotic stewardship were also asked. Linear mixed modeling was used to analyze differences between respondent groups and to test for associations with individual and organizational characteristics. All respondents supported reducing antibiotic use, although medical providers' support was significantly stronger (P = .005). When asked about their perception of residents' and family members' preference for antibiotic use in the case of suspected infection and the influence of that preference on antibiotic-prescribing decisions, respondents indicated that residents and families favor antibiotic use and influence prescribing decisions. Nurses reported a stronger perception than medical providers that families prefer antibiotics (P = .04) and influence prescribing decisions (P = .02). All respondents reported commitment and efficacy to change practices (mean 4.0-4.1 for nurses and 3.6-3.9 for medical providers on a 5-point scale). Four significant associations related to organizational and individual characteristics were found: directors of nursing and specialist nurses reported greater self-efficacy for changing practice than other nurses (P = .003), medical providers with a subspecialty (e.g., geriatrics) reported greater self-efficacy (P = .007) and commitment to change (P = .001) than those without a subspecialty, and medical providers specializing in hospice and palliative care rated family influence (P = .006) higher than those with other subspecialties

Framework for Optimal Global Vaccine Stockpile Design for Vaccine-Preventable Diseases: Application to Measles and Cholera Vaccines as Contrasting Examples.

PubMed

Thompson, Kimberly M; Duintjer Tebbens, Radboud J

2016-07-01

Managing the dynamics of vaccine supply and demand represents a significant challenge with very high stakes. Insufficient vaccine supplies can necessitate rationing, lead to preventable adverse health outcomes, delay the achievements of elimination or eradication goals, and/or pose reputation risks for public health authorities and/or manufacturers. This article explores the dynamics of global vaccine supply and demand to consider the opportunities to develop and maintain optimal global vaccine stockpiles for universal vaccines, characterized by large global demand (for which we use measles vaccines as an example), and nonuniversal (including new and niche) vaccines (for which we use oral cholera vaccine as an example). We contrast our approach with other vaccine stockpile optimization frameworks previously developed for the United States pediatric vaccine stockpile to address disruptions in supply and global emergency response vaccine stockpiles to provide on-demand vaccines for use in outbreaks. For measles vaccine, we explore the complexity that arises due to different formulations and presentations of vaccines, consideration of rubella, and the context of regional elimination goals. We conclude that global health policy leaders and stakeholders should procure and maintain appropriate global vaccine rotating stocks for measles and rubella vaccine now to support current regional elimination goals, and should probably also do so for other vaccines to help prevent and control endemic or epidemic diseases. This work suggests the need to better model global vaccine supplies to improve efficiency in the vaccine supply chain, ensure adequate supplies to support elimination and eradication initiatives, and support progress toward the goals of the Global Vaccine Action Plan. © 2014 Society for Risk Analysis.

Earth Stewardship: An initiative by the Ecological Society of America to foster engagement to sustain Planet Earth

USGS Publications Warehouse

Chapin, F. Stuart; Pickett, S.T.A.; Power, Mary E.; Collins, Scott L.; Baron, Jill S.; Inouye, David W.; Turner, Monica G.

2017-01-01

The Ecological Society of America (ESA) has responded to the growing commitment among ecologists to make their science relevant to society through a series of concerted efforts, including the Sustainable Biosphere Initiative (1991), scientific assessment of ecosystem management (1996), ESA’s vision for the future (2003), Rapid Response Teams that respond to environmental crises (2005), and the Earth Stewardship Initiative (2009). During the past 25 years, ESA launched five new journals, largely reflecting the expansion of scholarship linking ecology with broader societal issues. The goal of the Earth Stewardship Initiative is to raise awareness and to explore ways for ecologists and other scientists to contribute more effectively to the sustainability of our planet. This has occurred through four approaches: (1) articulation of the stewardship concept in ESA publications and Website, (2) selection of meeting themes and symposia, (3) engagement of ESA sections in implementing the initiative, and (4) outreach beyond ecology through collaborations and demonstration projects. Collaborations include societies and groups of Earth and social scientists, practitioners and policy makers, religious and business leaders, federal agencies, and artists and writers. The Earth Stewardship Initiative is a work in progress, so next steps likely include continued nurturing of these emerging collaborations, advancing the development of sustainability and stewardship theory, improving communication of stewardship science, and identifying opportunities for scientists and civil society to take actions that move the Earth toward a more sustainable trajectory.

ESIP's Emerging Provenance and Context Content Standard Use Cases: Developing Examples and Models for Data Stewardship

NASA Astrophysics Data System (ADS)

Ramdeen, S.; Hills, D. J.

2013-12-01

Earth science data collections range from individual researchers' private collections to large-scale data warehouses, from computer-generated data to field or lab based observations. These collections require stewardship. Fundamentally, stewardship ensures long term preservation and the provision of access to the user community. In particular, stewardship includes capturing appropriate metadata and documentation--and thus the context of the data's creation and any changes they underwent over time --to enable data reuse. But scientists and science data managers must translate these ideas into practice. How does one balance the needs of current and (projected) future stakeholders? In 2011, the Data Stewardship Committee (DSC) of the Federation of Earth Science Information Partners (ESIP) began developing the Provenance and Context Content Standard (PCCS). As an emerging standard, PCCS provides a framework for 'what' must be captured or preserved as opposed to describing only 'how' it should be done. Originally based on the experiences of NASA and NOAA researchers within ESIP, the standard currently provides data managers with content items aligned to eight key categories. While the categories and content items are based on data life cycles of remote sensing missions, they can be generalized to cover a broader set of activities, for example, preservation of physical objects. These categories will include the information needed to ensure the long-term understandability and usability of earth science data products. In addition to the PCCS, the DSC is developing a series of use cases based on the perspectives of the data archiver, data user, and the data consumer that will connect theory and practice. These cases will act as specifications for developing PCCS-based systems. They will also provide for examination of the categories and content items covered in the PCCS to determine if any additions are needed to cover the various use cases, and also provide rationale and

Mixed methods analysis of urban environmental stewardship networks

Treesearch

James J.T. Connolly; Erika S. Svendsen; Dana R. Fisher; Lindsay K. Campbell

2015-01-01

While mixed methods approaches to research have been accepted practice within the social sciences for several decades (Tashakkori and Teddlie 2003), the rising demand for cross-disciplinary analyses of socio-environmental processes has necessitated a renewed examination of this approach within environmental studies. Urban environmental stewardship is one area where it...

75 FR 54852 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-09

... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... Market Impact Committee, co-chaired by the Departments of Commerce and State, is seeking public comments on the potential market impact of the proposed disposal levels of excess materials for the Fiscal...

Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era

PubMed Central

Desai, Sachin N.; Pezzoli, Lorenzo; Alberti, Kathryn P.; Martin, Stephen; Costa, Alejandro; Perea, William; Legros, Dominique

2017-01-01

ABSTRACT Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings. PMID:27813703

Introducing Nuclear Data Evaluations of Prompt Fission Neutron Spectra

DOE Office of Scientific and Technical Information (OSTI.GOV)

Neudecker, Denise

2015-06-17

Nuclear data evaluations provide recommended data sets for nuclear data applications such as reactor physics, stockpile stewardship or nuclear medicine. The evaluated data are often based on information from multiple experimental data sets and nuclear theory using statistical methods. Therefore, they are collaborative efforts of evaluators, theoreticians, experimentalists, benchmark experts, statisticians and application area scientists. In this talk, an introductions is given to the field of nuclear data evaluation at the specific example of a recent evaluation of the outgoing neutron energy spectrum emitted promptly after fission from 239Pu and induced by neutrons from thermal to 30 MeV.

A Mixed-Methods Pilot Study to Assess Perceptions of Antimicrobial Stewardship in Nursing Homes

PubMed Central

Carter, Rebecca R.; Montpetite, Michelle M.; Jump, Robin L. P.

2016-01-01

Objectives Practicing antimicrobial stewardship in nursing homes faces many challenges, particularly in non-academic settings. We sought to identify features of community nursing home environments that are associated with lower rates of overall antibiotic use. Design In this pilot study, we used an explanatory sequential design that incorporated comparative feedback about antibiotic use to inform a discussion about antimicrobial stewardship practices among community nursing homes. Measurements For the quantitative phase, we measured the number of antibiotic prescriptions, length of therapy and days of therapy/1000 days of care at 6 nursing homes. For the qualitative phase, we conducted semi-structured interviews with healthcare workers in leadership positions at 5 community nursing homes. Transcripts from the recorded interviews were assessed using emergent thematic analysis. For the triangulation phase, we evaluated themes from the semi-structured interviews in the context of each NHs antibiotic use. Results The number of antibiotic prescriptions ranged from 172 to 1244, with 50% to 83% written for ≤ 7 days. All nursing homes reported a similar proportion of fluoroquinolone use (27–32% days of therapy). Triangulation yielded 6 themes for which the environment at each facility ranged from less to more supportive antimicrobial stewardship: practice patterns, external influences, infection control, leadership, communication and facility culture. All nursing homes reported pressure from well-intentioned family members to prescribe antibiotics. Nursing homes with shorter lengths of therapy and lower overall antibiotic use were consonant with an environment more supportive of antimicrobial stewardship. Conclusion Our findings suggest several features of nursing homes that are supportive of antimicrobial stewardship: practice patterns grounded in established diagnostic criteria, proactive infection control and prevention, open communication and interconnectedness

2010/2015 PFOA Stewardship Program - 2014 Annual Progress Reports

EPA Pesticide Factsheets

In 2006, EPA and the eight major companies in the industry launched the 2010/15 PFOA Stewardship Program, in which companies committed to reduce global facility emissions and product content of PFOA and related chemicals by 95 percent by 2010, and to work

Antimicrobial Stewardship Programs: Appropriate Measures and Metrics to Study their Impact.

PubMed

Morris, Andrew M

Antimicrobial stewardship is a new field that struggles to find the right balance between meaningful and useful metrics to study the impact of antimicrobial stewardship programs (ASPs). ASP metrics primarily measure antimicrobial use, although microbiological resistance and clinical outcomes are also important measures of the impact an ASP has on a hospital and its patient population. Antimicrobial measures looking at consumption are the most commonly used measures, and are focused on defined daily doses, days of therapy, and costs, usually standardized per 1,000 patient-days. Each measure provides slightly different information, with their own upsides and downfalls. Point prevalence measurement of antimicrobial use is an increasingly used approach to understanding consumption that does not entirely rely on sophisticated electronic information systems, and is also replicable. Appropriateness measures hold appeal and promise, but have not been developed to the degree that makes them useful and widely applicable. The primary reason why antimicrobial stewardship is necessary is the growth of antimicrobial resistance. Accordingly, antimicrobial resistance is an important metric of the impact of an ASP. The most common approach to measuring resistance for ASP purposes is to report rates of common or important community- or nosocomial-acquired antimicrobial-resistant organisms, such as methicillin-resistant Staphylococcus aureus and Clostridium difficile. Such an approach is dependent on detection methods, community rates of resistance, and co-interventions, and therefore may not be the most accurate or reflective measure of antimicrobial stewardship interventions. Development of an index to reflect the net burden of resistance holds theoretical promise, but has yet to be realized. Finally, programs must consider patient outcome measures. Mortality is the most objective and reliable method, but has several drawbacks. Disease- or organism-specific mortality, or cure, are

Biologics industry challenges for developing diagnostic tests for the National Veterinary Stockpile.

PubMed

Hardham, J M; Lamichhane, C M

2013-01-01

Veterinary diagnostic products generated ~$3 billion US dollars in global sales in 2010. This industry is poised to undergo tremendous changes in the next decade as technological advances move diagnostic products from the traditional laboratory-based and handheld immunologic assays towards highly technical, point of care devices with increased sensitivity, specificity, and complexity. Despite these opportunities for advancing diagnostic products, the industry continues to face numerous challenges in developing diagnostic products for emerging and foreign animal diseases. Because of the need to deliver a return on the investment, research and development dollars continue to be focused on infectious diseases that have a negative impact on current domestic herd health, production systems, or companion animal health. Overcoming the administrative, legal, fiscal, and technological barriers to provide veterinary diagnostic products for the National Veterinary Stockpile will reduce the threat of natural or intentional spread of foreign diseases and increase the security of the food supply in the US.

Antibiotic stewardship and empirical antibiotic treatment: How can they get along?

PubMed

Zuccaro, Valentina; Columpsi, Paola; Sacchi, Paolo; Lucà, Maria Grazia; Fagiuoli, Stefano; Bruno, Raffaele

2017-06-01

The aim of this review is to focus on the recent knowledge on antibiotic stewardship and empiric antibiotic treatment in cirrhotic patients. The application of antimicrobial stewardship (AMS) rules appears to be the most appropriate strategy to globally manage cirrhotic patients with infectious complications: indeed they represent a unique way to provide both early diagnosis and appropriate therapy in order to avoid not only antibiotic over-prescription but, more importantly, selection and spread of antimicrobial resistance. Moreover, cirrhotic patients must be considered "frail" and susceptible to healthcare associated infections: applying AMS policies would assure a cost reduction and thus contribute to the improvement of public health strategies. Copyright © 2017. Published by Elsevier Ltd.

Livermore Accelerator Source for Radionuclide Science (LASRS)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anderson, Scott; Bleuel, Darren; Johnson, Micah

The Livermore Accelerator Source for Radionuclide Science (LASRS) will generate intense photon and neutron beams to address important gaps in the study of radionuclide science that directly impact Stockpile Stewardship, Nuclear Forensics, and Nuclear Material Detection. The co-location of MeV-scale neutral and photon sources with radiochemical analytics provides a unique facility to meet current and future challenges in nuclear security and nuclear science.

How DARHT Works - the World's Most Powerful X-ray Machine

ScienceCinema

None

2018-06-01

The Dual Axis Radiographic Hydrodynamic Test (DARHT) facility at Los Alamos National Laboratory is an essential scientific tool that supports Stockpile Stewardship at the Laboratory. The World's most powerful x-ray machine, it's used to take high-speed images of mock nuclear devices - data that is used to confirm and modify advanced computer codes in assuring the safety, security, and effectiveness of the U.S. nuclear deterrent.

Volume Computation of a Stockpile - a Study Case Comparing GPS and Uav Measurements in AN Open Pit Quarry

NASA Astrophysics Data System (ADS)

Raeva, P. L.; Filipova, S. L.; Filipov, D. G.

2016-06-01

The following paper aims to test and evaluate the accuracy of UAV data for volumetric measurements to the conventional GNSS techniques. For this purpose, an appropriate open pit quarry has been chosen. Two sets of measurements were performed. Firstly, a stockpile was measured by GNSS technologies and later other terrestrial GNSS measurements for modelling the berms of the quarry were taken. Secondly, the area of the whole quarry including the stockpile site was mapped by a UAV flight. Having considered how dynamic our world is, new techniques and methods should be presented in numerous fields. For instance, the management of an open pit quarry requires gaining, processing and storing a large amount of information which is constantly changing with time. Fast and precise acquisition of measurements regarding the process taking place in a quarry is the key to an effective and stable maintenance. In other words, this means getting an objective evaluations of the processes, using up-to-date technologies and reliable accuracy of the results. Often legislations concerning mine engineering state that the volumetric calculations are to present ±3% accuracy of the whole amount. On one hand, extremely precise measurements could be performed by GNSS technologies, however, it could be really time consuming. On the other hand, UAV photogrammetry presents a fast, accurate method for mapping large areas and calculating stockpiles volumes. The study case was performed as a part of a master thesis.

Defining Best Practices in Boating, Fishing, and Stewardship Education.

ERIC Educational Resources Information Center

Fedler, Anthony J., Ed.

The Recreational Boating and Fishing Foundation (RBFF) aims to increase participation in recreational boating and fishing and thereby increase public awareness, appreciation, and stewardship of aquatic natural resources. This document contains a summary and 11 commissioned papers from an RBFF workshop to create guidelines for best educational…

Assessment of Undergraduate Students' Environmental Stewardship Reasoning and Knowledge

ERIC Educational Resources Information Center

Hartman, Christie-Joy Brodrick; DeMars, Christine E.; Griscom, Heather Peckham; Butner, Harold Martin

2017-01-01

Purpose: The purpose of this paper is to present a public university's design and implementation of an assessment approach that measures the change in undergraduate students' environmental stewardship reasoning and knowledge abilities over time. Design/methodology/approach: In support of a university's strategic emphasis on environmental…

LX-17-1 Stockpile Returned Material Lot Comparison

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gagliardi, F.; Pease, S.; Willey, T.

2015-02-18

Many different lots of LX-17 have been produced over the years. Two varieties of LX-17, LX-17-0 and LX-17-1, have at one point or another been a part of the Livermore stockpile systems. LX-17-0 was made with dry-aminated TATB whereas LX-17-1 was made with wet-aminated TATB. Both versions have the same TATB to Kel-F 800 mass ratio of 92.5%/7.5%. Both kinds of LX-17 were formulated at Holston during the late 1970s or early to mid-1980s and were certified to have met the necessary specifications that cover the purity, particle size range, explosive to binder ratio, etc. In recent years, Trevor Willymore » and others have performed a detailed evaluation of solid parts made from each of the LX-17 lots manufactured at Holston. Using the Advanced Light Source at LBNL, Willey and his colleagues radiographed many samples from isostatic pressings using the same scanning conditions. In their investigation they identified that even though the bulk composition can be the same, there may exist a large spread in how smoothly the TATB and binder were distributed within the radiographed volume of different lots of material.1 Overall, the dry-aminated TATB-based material, LX-17-0, had a smooth TATB and binder distribution, whereas the wet-aminated TATB-based LX-17-1 showed a wide range of binder distributions. The results for five different LX-17-1 lots are shown in Figure 1. The wide variation in material distribution has raised the question about whether or not this sort variability will cause significant differences in mechanical behavior.« less

Advanced Simulation & Computing FY15 Implementation Plan Volume 2, Rev. 0.5

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCoy, Michel; Archer, Bill; Matzen, M. Keith

2014-09-16

The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities andmore » computational resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resource, including technical staff, hardware, simulation software, and computer science solutions. As the program approaches the end of its second decade, ASC is intently focused on increasing predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (sufficient resolution, dimensionality, and scientific details), quantify critical margins and uncertainties, and resolve increasingly difficult analyses needed for the SSP. Where possible, the program also enables the use of high-performance simulation and computing tools to address broader national security needs, such as foreign nuclear weapon assessments and counternuclear terrorism.« less

Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation

PubMed Central

Cardone, Franco; Cheung, Daphne; Han, Angela; Born, Karen B.; Alexander, Lisa; Levinson, Wendy; Wong, Brian M.

2017-01-01

Background: Resource stewardship is being increasingly recognized as an essential competency for physicians, but medical schools are just beginning to integrate this into education. We describe the evaluation of Choosing Wisely Canada's Students and Trainees Advocating for Resource Stewardship (STARS) campaign, a student-led campaign to advance resource stewardship education in medical schools across Canada. Methods: We evaluated the campaign 6 months after its launch, in November 2015. STARS students were administered a telephone survey eliciting a description of the initiatives that they had implemented or planned to implement at their schools to promote resource stewardship, and exploring their perceptions of facilitators of and barriers to successful implementation of their initiatives. We used a mixed-methods approach to analyze and summarize the data. Results: Twenty-seven (82%) of the 33 eligible students representing all 17 medical schools responded. In 14 schools (82%), students led various local activities (e.g., interest groups, campaign weeks) to raise awareness about resource stewardship among medical students and faculty. Students contributed to curriculum change (both planned and implemented) at 10 schools (59%). Thematic analysis revealed key program characteristics that facilitated success (e.g., pan-Canadian student network, local faculty champion) as well as barriers to implementing change (e.g., complex processes to change curriculum, hierarchical nature of medical school). Interpretation: This student-led campaign, with support from local faculty and Choosing Wisely Canada staff, led to awareness-building activities and early curricula change at medical schools across Canada. Future plans will build on the initial momentum created by the STARS campaign to sustain and spread local initiatives. PMID:29263153

Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry.

PubMed

Berrevoets, Marvin Ah; Ten Oever, Jaap; Sprong, Tom; van Hest, Reinier M; Groothuis, Ingeborg; van Heijl, Inger; Schouten, Jeroen A; Hulscher, Marlies E; Kullberg, Bart-Jan

2017-08-15

The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of antibiotic use are monitored by antimicrobial stewardship teams (A-teams) and can be used as indicators for the stewardship registry. In this pilot study we aimed to determine which stewardship objectives are eligible for the envisioned registry. We performed an observational pilot study among five Dutch hospitals. We assessed which of the 14 validated stewardship objectives (11 process of care recommendations and 3 structure of care recommendations) the A-teams monitored and documented in individual patients. They provided, where possible, data to compute quality indicator (QI) performance scores in line with recently developed QIs to measure appropriate antibiotic use in hospitalized adults for the period of January 2015 through December 2015 RESULTS: All hospitals had a local antibiotic guideline describing recommended antimicrobial use. All A-teams monitored the performance of bedside consultations in Staphylococcus aureus bacteremia and the prescription of restricted antimicrobials. Documentation and reporting were the best for the use of restricted antimicrobials: 80% of the A-teams could report data. Lack of time and the absence of an electronic medical record system enabling documentation during the daily work flow were the main barriers hindering documentation and reporting. Five out of 11 stewardship objectives were actively monitored by A-teams. Without extra effort, 4 A-teams could report on the quality of use of restricted antibiotics. Therefore, this aspect of antibiotic use should be the starting point of the national antimicrobial stewardship registry. Our registry is expected to become a powerful tool to evaluate progress and impact of antimicrobial

Social and institutional influences on wilderness fire stewardship

Treesearch

Katie Knotek

2005-01-01

One of the priority research areas at the Aldo Leopold Wilderness Research Institute addresses the “need for improved information to guide the stewardship of fire as a natural process in wilderness while protecting social and ecological values inside and outside wilderness.” This research topic area was developed with the knowledge that wildland fire, as a natural...

[The absence of stewardship in the Chilean health authority after the 2004 health reform].

PubMed

Herrera, Tania; Sánchez, Sergio

2014-11-26

Stewardship is the most important political function of a health system. It is a government responsibility carried out by the health authority. Among other dimensions, it is also a meta-function that includes conduction and regulation. The Health Authority and Management Act, which came about from the health reform of 2004, separated the functions of service provision and stewardship with the aim of strengthening the role of the health authority. However, the current structure of the health system contains overlapping functions between the different entities that leads to lack of coordination and inconsistencies, and a greater weight on individual health actions at the expense of collective ones. Consequently, a properly funded national health strategy to improve the health of the population is missing. Additionally, the components of citizen participation and governance are weak. It is necessary, therefore, to revisit the Chilean health structure in order to develop one that truly enables the exercise of the health authority’s stewardship role.

Associations between antimicrobial stewardship program elements and Clostridium difficile infection performance.

PubMed

Barlow, Giulia; Patterson, Julie; Stultz, Jeremy; Pakyz, Amy L

2017-12-01

Hospitals are categorized as better, no different, or worse at a national level based on their Clostridium difficile infection performance. Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown. We found that a higher proportion of hospitals with either a worse or no different rank used a postprescription audit and feedback strategy than hospitals with a better rank. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

75 FR 31609 - Conservation Stewardship Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-03

...Section 2301 of the Food, Conservation, and Energy Act of 2008 (2008 Act) amended the Food Security Act of 1985 to establish the Conservation Stewardship Program (CSP). On July 29, 2009, the Natural Resources Conservation Service (NRCS) published an interim final rule for CSP with a 60-day public comment period. On September 21, 2009, the public comment period was extended 30 days. NRCS is publishing a final rule that addresses the comments received on the interim final rule and makes other minor adjustments to improve clarity of the rule.

US antibiotic stewardship and penicillin allergy.

PubMed

Wada, Kara J; Calhoun, Karen H

2017-06-01

The purpose of this review is to improve otolaryngologists' antibiotic stewardship by detailing current approaches to penicillin allergy. Although up to 15% of hospitalized patients in the United States have a penicillin allergy recorded on their charts, fewer than 10% of these have a true penicillin allergy. Using a combination of a detailed allergy history, skin testing and graded-dose administration, many patients whose charts say 'penicillin-allergic' can safely be treated with penicillin and cross-reacting antibiotics. This permits use of narrower-spectrum antibiotics and saves money.

Ecosystem stewardship: sustainability strategies for a rapidly changing planet

Treesearch

F. Stuart Chapin; Stephen R. Carpenter; Gary P. Kofinas; Carl Folke; Nick Abel; William C. Clark; Per Olsson; D. Mark Stafford Smith; Brian Walker; Oran R. Young; Fikret Berkes; Reinette Biggs; J. Morgan Grove; Rosamond L. Naylor; Evelyn Pinkerton; Will Steffen; Frederick J. Swanson

2010-01-01

Ecosystem stewardship is an action-oriented framework intended to foster the social-ecological sustainability of a rapidly changing planet. Recent developments identify three strategies that make optimal use of current understanding in an environment of inevitable uncertainty and abrupt change: reducing the magnitude of, and exposure and sensitivity to, known stresses...

Soil microbial characteristics and seed bank dynamics of stock-piled top soils in ther western Rio Grande Plains

USDA-ARS?s Scientific Manuscript database

Increased energy extraction has impacted rangelands throughout the western U.S. Ecological restoration can be enhanced with proper management of affected top soils. Little information exists on effects of stockpiling on soil microbial community composition and functionality and seed bank dynamics. T...

[Measurement of antimicrobial consumption using DDD per 100 bed-days versus DDD per 100 discharges after the implementation of an antimicrobial stewardship program].

PubMed

Collado, Roberto; Losa, Juan Emilio; Álvaro, Elena Alba; Toro, Piedad; Moreno, Leonor; Pérez, Montserrat

2015-12-01

Monitoring antimicrobial consumption in hospitals is a necessary measure. The indicators commonly employed do not clearly reflect the antibiotic selection pressure. The objective of this study is to evaluate two different methods that analyze antimicrobial consumption based on DDD, per stay and per discharge, before and after the implementation an antimicrobial stewardship program. Comparative pre-post study of antimicrobial consumption with the implementation of an antimicrobial stewardship program using DDD per 100 bed-days and DDD per 100 discharges as indicators. Hospital bed days remained stable and discharges increased slightly along the period of study Antibiotic consumption in DDD per 100 bed-days decreased by 2.5% versus 3.8% when expressed as DDD per 100 discharges. Antifungal consumption decreased by more than 50%. When average hospital stay decreases, reductions in the consumption of antimicrobials with an antimicrobial stewardship program system occur at the expense of reducing the number of patients receiving treatment, while increases occur due to longer durations of treatment.

A study on possible use of Urtica dioica (common nettle) plants as uranium (234U, 238U) contamination bioindicator near phosphogypsum stockpile.

PubMed

Olszewski, Grzegorz; Boryło, Alicja; Skwarzec, Bogdan

The aim of this study was to determine uranium concentrations in common nettle ( Urtica dioica ) plants and corresponding soils samples which were collected from the area of phosphogypsum stockpile in Wiślinka (northern Poland). The uranium concentrations in roots depended on its concentrations in soils. Calculated BCF and TF values showed that soils characteristics and air deposition affect uranium absorption and that different uranium species have different affinities to U . dioica plants. The values of 234 U/ 238 U activity ratio indicate natural origin of these radioisotopes in analyzed plants. Uranium concentration in plants roots is negatively weakly correlated with distance from phosphogypsum stockpile.

75 FR 12231 - NACEPT Subcommittee on Promoting Environmental Stewardship

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-15

... the Federal Advisory Committee Act, Public Law 92-463, EPA gives notice of a conference call of the... sectors, as appropriate, in order to enhance human health and environmental protection. A copy of the... Environmental Stewardship will hold a public teleconference on Thursday, April 1, 2010 (1 p.m.-3 p.m. Eastern...

A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

PubMed

Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U

2008-09-15

Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World

Stewardship of very large digital data archives

NASA Technical Reports Server (NTRS)

Savage, Patric

1991-01-01

An archive is a permanent store. There are relatively few very large digital data archives in existence. Most business records are expired within five or ten years. Many kinds of business records that do have long lives are embedded in data bases that are continually updated and re-issued cyclically. Also, a great deal of permanent business records are actually archived as microfilm, fiche, or optical disk images - their digital version being an operational convenience rather than an archive. The problems forseen in stewarding the very large digital data archives that will accumulate during the mission of the Earth Observing System (EOS) are addressed. It focuses on the function of shepherding archived digital data into an endless future. Stewardship entails storing and protecting the archive and providing meaningful service to the community of users. The steward will (1) provide against loss due to physical phenomena; (2) assure that data is not lost due to storage technology obsolescence; and (3) maintain data in a current formatting methodology.

Watershed management contributions to land stewardship: A literature review

Treesearch

Malchus B. Baker; Peter F. Folliott; Carleton B. Edminster; Karen L. Mora; Madelyn C. Dillon

2000-01-01

An international conference to increase people's awareness of the contributions that watershed management can make to future land stewardship was held in Tucson, Arizona, March 13-16, 2000. This bibliography is a compilation of the synthesis and poster papers presented at the conference along with the literature cited in these papers on watershed research projects...

Challenges for a Sustainable Financial Foundation for Antimicrobial Stewardship.

PubMed

Dik, Jan-Willem H; Sinha, Bhanu

2017-03-30

Antimicrobial resistance is a worldwide threat and a problem with large clinical and economic impact. Antimicrobial Stewardship Programs are a solution to curb resistance development. A problem of resistance is a separation of actions and consequences, financial and clinical. Such a separation makes it difficult to create support among stakeholders leading to a lack of sense of responsibility. To counteract the resistance development it is important to perform diagnostics and know how to interpret the results. One should see diagnostics, therapy and resistance as one single process. Within this process all involved stakeholders need to work together on a more institutional level. We suggest therefore a solution: combining diagnostics and therapy into one single financial product . Such a product should act as an incentive to perform correct diagnostics. It also makes it easier to cover the costs of an antimicrobial stewardship program, which is often overlooked. Finally, such a product involves all stakeholders in the process and does not lay the costs at one stakeholder and the benefits somewhere else, solving the misbalance that is present nowadays.

Land Stewardship in the 21st Century: The Contributions of Watershed Management; 2000 March 13-16; Tucson, AZ

Treesearch

Peter F. Ffolliott; Malchus B. Baker; Carleton B. Edminster; Madelyn C. Dillon; Karen L. Mora

2000-01-01

The purpose of this conference was to increase awareness through exploration and evaluation of global, national, and regional perspectives about the potential contributions that watershed management can make to the conservation, sustainable development, and use of natural resources in ecosystem-based land stewardship in the 21st century. The conference consisted of 2...

Preparative scale separation of thulium from erbium for neutron capture cross section measurements - Part: Preparative scale

DOE PAGES

Birnbaum, Eva R.; Bene, Balazs J.; Taylor, Wayne Allen; ...

2016-06-04

Here, this paper discusses the development of a separation method for isolation of Tm-171 from a half-gram irradiated erbium target in support of stockpile stewardship and astrophysics research. The developed procedure is based on cation exchange separation using alpha-hydroxyisobutyric acid (α-HIBA) as chelating agent. It is able to achieve either a decontamination factor of 1.4(4) × 10 5 with 68.9(3) % recovery or 95.4(3) % recovery with a decontamination factor of 5.82(7) × 10 3 for a mock 500-mg target containing 17.9 mg thulium in a single pass-through at room temperature.

A survey to optimize the design of an antimicrobial stewardship smartphone app at an academic medical center.

PubMed

Markley, J Daniel; Pakyz, Amy; Bernard, Shaina; Lee, Kimberly; Appelbaum, Nital; Bearman, Gonzalo; Stevens, Michael P

2017-03-01

Mobile medical apps are commonly used by health care professionals and could be used by antimicrobial stewardship programs to enhance adherence to local recommendations. We conducted a survey of health care workers to inform the design of an antimicrobial stewardship smartphone app. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance.

PubMed

Lanbeck, Peter; Ragnarson Tennvall, Gunnel; Resman, Fredrik

2016-07-27

Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.

Assessment of polycyclic aromatic hydrocarbons (PAHs) contamination in surface soil of coal stockpile sites in South Kalimantan, Indonesia.

PubMed

Mizwar, Andy; Priatmadi, Bambang Joko; Abdi, Chairul; Trihadiningrum, Yulinah

2016-03-01

Concentrations, spatial distribution, and sources of 16 polycyclic aromatic hydrocarbons (PAHs), listed as priority pollutants by the United States Environmental Protection Agency (USEPA), were investigated in surface soils of three different coal stockpile, agricultural, and residential sites in South Kalimantan Province, Indonesia. Total PAHs concentration ranged from 4.69 to 22.67 mg kg(-1)-dw. PAHs concentrations in soil of coal stockpile sites were higher than those in agricultural and residential soil. A complex of petrogenic origin and pyrolytic sources was found within the study area, as suggested by the isomeric ratios of PAHs. The results of principal component analysis and multiple linear regressions (PCA/MLR) showed that three sources contributed to the PAHs in the study area, including biomass and coal combustion (48.46%), raw coal (35.49%), and vehicular emission (16.05%). The high value of total benzo[a]pyrene equivalent concentration (B[a]Peq) suggests that local residents are exposed to a high carcinogenic potential.

Pharmacist-driven antimicrobial stewardship in intensive care units in East China: A multicenter prospective cohort study.

PubMed

Li, Zhongwang; Cheng, Baoli; Zhang, Kai; Xie, Guohao; Wang, Yan; Hou, Jinchao; Chu, Lihua; Zhao, Jialian; Xu, Zhijun; Lu, Zhongqiu; Sun, Huaqin; Zhang, Jian; Wang, Zhiyi; Wu, Haiya; Fang, Xiangming

2017-09-01

Antimicrobial stewardship programs, particularly pharmacist-driven programs, help reduce the unnecessary use of antimicrobial agents. The objective of this study was to assess the influence of pharmacist-driven antimicrobial stewardship on antimicrobial use, multidrug resistance, and patient outcomes in adult intensive care units in China. We conducted a multicenter prospective cohort study with a sample of 577 patients. A total of 353 patients were included under a pharmacist-driven antimicrobial stewardship program, whereas the remaining 224 patients served as controls. The primary outcome was all-cause hospital mortality. The pharmacist-driven antimicrobial stewardship program had a lower hospital mortality rate compared with the nonpharmacist program (19.3% vs 29.0%; P = .007). Furthermore, logistic regression analysis indicated that the pharmacist-driven program independently predicted hospital mortality (odds ratio, 0.57; 95% confidence interval, 0.36-0.91; P = .017) after adjustment. Meanwhile, this strategy had a lower rate of multidrug resistance (23.8% vs 31.7%; P = .037). Moreover, the strategy optimized antimicrobial use, such as having a shorter duration of empirical antimicrobial therapy (2.7 days; interquartile range [IQR], 1.7-4.6 vs 3.0; IQR, 1.9-6.2; P = .002) and accumulated duration of antimicrobial treatment (4.0; IQR, 2.0-7.0 vs 5.0; IQR, 3.0-9.5; P = .030). Pharmacist-driven antimicrobial stewardship in an intensive care unit decreased patient mortality and the emergence of multidrug resistance, and optimized antimicrobial agent use. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The Intersection Between Colonization Resistance, Antimicrobial Stewardship, and Clostridium difficile.

PubMed

Rosa, Rossana; Donskey, Curtis J; Munoz-Price, L Silvia

2018-06-07

Colonization resistance refers to the innate defense provided by the indigenous microbiota against colonization by pathogenic organisms. We aim to describe how this line of defense is deployed against Clostridium difficile and what the implications are for interventions directed by Antimicrobial Stewardship Programs. The indigenous microbiota provides colonization resistance through depletion of nutrients, prevention of access to adherence sites within the gut mucosa, production of inhibitory substances, and stimulation of the host's immune system. The ability to quantify colonization resistance could provide information regarding periods of maximal vulnerability to colonization with pathogens and also allow the identification of mechanisms of restoration of colonization resistance. Methods utilized to determine the composition of the gut microbiota include sequencing technologies and measurement of concentration of specific bacterial metabolites. Use of innovations in the quantification of colonization resistance can expand the role of Antimicrobial Stewardship from prevention of disruption of the indigenous microbiota to restoration of colonization resistance.

Stewardship to tackle global phosphorus inefficiency: The case of Europe.

PubMed

Withers, Paul J A; van Dijk, Kimo C; Neset, Tina-Simone S; Nesme, Thomas; Oenema, Oene; Rubæk, Gitte H; Schoumans, Oscar F; Smit, Bert; Pellerin, Sylvain

2015-03-01

The inefficient use of phosphorus (P) in the food chain is a threat to the global aquatic environment and the health and well-being of citizens, and it is depleting an essential finite natural resource critical for future food security and ecosystem function. We outline a strategic framework of 5R stewardship (Re-align P inputs, Reduce P losses, Recycle P in bioresources, Recover P in wastes, and Redefine P in food systems) to help identify and deliver a range of integrated, cost-effective, and feasible technological innovations to improve P use efficiency in society and reduce Europe's dependence on P imports. Their combined adoption facilitated by interactive policies, co-operation between upstream and downstream stakeholders (researchers, investors, producers, distributors, and consumers), and more harmonized approaches to P accounting would maximize the resource and environmental benefits and help deliver a more competitive, circular, and sustainable European economy. The case of Europe provides a blueprint for global P stewardship.

Advanced Simulation and Computing Fiscal Year 14 Implementation Plan, Rev. 0.5

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meisner, Robert; McCoy, Michel; Archer, Bill

2013-09-11

The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities andmore » computational resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is now focused on increasing predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (sufficient resolution, dimensionality, and scientific details), quantify critical margins and uncertainties, and resolve increasingly difficult analyses needed for the SSP. Moreover, ASC’s business model is integrated and focused on requirements-driven products that address long-standing technical questions related to enhanced predictive

Pharmaceutical lobbying and pandemic stockpiling of Tamiflu: a qualitative study of arguments and tactics.

PubMed

Vilhelmsson, Andreas; Mulinari, Shai

2017-08-09

Little is known about how pharmaceutical companies lobby authorities or experts regarding procurement or the use of vaccines and antivirals. This paper investigates how members of Denmark's pandemic planning committee experienced lobbying efforts by Roche, manufacturer of Tamiflu, the antiviral that was stockpiled before the 2009 A(H1N1) pandemic. Analysis of interviews with six of seven members of the Danish core pandemic committee, supplemented with documentary analysis. We sought to identify (1) arguments and (2) tactics used in lobbying, and to characterize interviewees' views on the impact of (3) lobbying and (4) scientific evidence on the decision to stockpile Tamiflu. Roche lobbied directly (in its own name) and through a seemingly independent third party. Roche used two arguments: (1) the procurement agreement had to be signed quickly because the drug would be delivered on a first-come, first-served basis and (2) Denmark was especially vulnerable to an influenza crisis because it had smaller Tamiflu stocks than other countries. Most interviewees suspected that lobbying had an impact on Tamiflu procurement. Our study highlights risks posed by pharmaceutical lobbying. Arguments and tactics deployed by Roche are likely to be repeated whenever many countries are negotiating drug procurements in a monopolistic market. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health.

Impact of an Antimicrobial Stewardship Program on Antibiotic Use at a Nonfreestanding Children's Hospital.

PubMed

Turner, R Brigg; Valcarlos, Elena; Loeffler, Ann M; Gilbert, Michael; Chan, Dominic

2017-09-01

Pediatric stewardship programs have been successful at reducing unnecessary antibiotic use. Data from nonfreestanding children's hospitals are currently limited. This study is an analysis of antibiotic use after implementation of an antimicrobial stewardship program at a community nonfreestanding children's hospital. In April 2013, an antimicrobial stewardship program that consisted of physician-group engagement and pharmacist prospective auditing and feedback was initiated. We compared antibiotic use in the preintervention period (April 2012 to March 2013) with that in the postintervention period (April 2013 to March 2015) in all units except the neonatal intensive care unit and the emergency department. In addition, drug-acquisition costs, antibiotic-specific use, death, length of stay, and case-mix index were examined. Antibiotic use decreased by 16.8% (95% confidence interval, 18.0% to -9.2%; P < .001) in the postintervention period. Vancomycin use decreased by 38% (P = .001), whereas antipseudomonal β-lactam use was unaltered. Drug-acquisition cost savings were estimated to be $67 000/year over the 2-year postintervention period. Lengths of stay and mortality rates were unchanged in the postintervention period after adjusting for case-mix index. Implementation of a simple stewardship initiative with limited resources at a community nonfreestanding children's hospital effectively reduced antibiotic use without an overt negative impact on overall clinical outcomes. The results of this study suggest that nonfreestanding children's hospitals can achieve substantial reductions in antibiotic use despite limited resources. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The scope and value of an anticoagulation stewardship program at a community teaching hospital.

PubMed

Wychowski, Maura K; Ruscio, Christina I; Kouides, Peter A; Sham, Ronald L

2017-04-01

To report the impact of an inpatient anticoagulation stewardship program at a community hospital to promote optimal anticoagulant use. The anticoagulation team (ACT) stewardship program consists of two clinical pharmacists and hematologists to provide oversight of anticoagulants, high cost reversal agents including prothrombin complex concentrate (PCC, Kcentra™), and heparin-induced thrombocytopenia (HIT) management. Intervention data and number of charts reviewed were collected. Average cost avoidance data was applied to ACT interventions to estimate cost savings. The PCC analysis was conducted via retrospective chart review during the pre-intervention period. Prospective monitoring continued in the post-intervention period to determine the percentage of PCC use within the institution's guidelines or approved by ACT or hematology. A total of 19,445 patient charts were reviewed, and 1930 (10%) contained stewardship opportunity. Of the interventions, 71% were provided to the medical service and 22% to surgical services with acceptance rates of 91 and 83%, respectively. Intervention cost-avoidance calculated to be $694,217. Regarding HIT interventions, 52% of interventions involved pharmacokinetic/pharmacodynamics optimization in 18 patients with suspected or confirmed HIT. Regarding PCC use, 55.8% of PCC orders were considered inappropriate in the pre-invention period versus 2.6% post-intervention. Appropriate PCC doses per month post-intervention were consistent with pre-intervention doses (7.67 vs. 6.73, respectively). The projected annual PCC cost savings is $385,473. The overall estimated financial impact of ACT is $799,690 saved. Implementation of an anticoagulation stewardship program reduced costs and improved clinical outcomes. It is also expected that anticoagulant optimization and provider education improved overall safety.

Antimicrobial Stewardship: A Call to Action for Surgeons

PubMed Central

Duane, Therese M.; Catena, Fausto; Tessier, Jeffrey M.; Coccolini, Federico; Kao, Lillian S.; De Simone, Belinda; Labricciosa, Francesco M.; May, Addison K.; Ansaloni, Luca; Mazuski, John E.

2016-01-01

Abstract Despite current antimicrobial stewardship programs (ASPs) being advocated by infectious disease specialists and discussed by national and international policy makers, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals. The ASPs incorporate a variety of strategies to optimize antimicrobial agent use in the hospital, yet the exact set of interventions essential to ASP success remains unknown. Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antimicrobial agent use within an institution. To effectively accomplish this standardization, providers who actively engage in antimicrobial agent prescribing should participate in the establishment and support of these programs. Hence, surgeons need to play a major role in these collaborations. Surgeons must be aware that judicious antibiotic utilization is an integral part of any stewardship program and necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. The battle against antibiotic resistance should be fought by all healthcare professionals. If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders. If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients. PMID:27828764

Scientific Data Stewardship in the 21'st Century

NASA Astrophysics Data System (ADS)

Mabie, J. J.; Redmon, R.; Bullett, T.; Kihn, E. A.; Conkright, R.; Manley, J.; Horan, K.

2008-12-01

The Ionosonde Program at the National Geophysical Data Center (NGDC) serves as a case study for how to approach data stewardship in the 21'st century. As the number and sophistication of scientific instruments increase, along with the volumes and complexity of data that need to be preserved for future generations, the old approach of simply storing data in a library, physical or electronic, is no longer sufficient to ensure the long term preservation of our important environmental data. To ensure the data can be accessed, understood, and used by future generations, the data stewards must be familiar with the observation process before the data reach the archive and the scientific applications to which the data may be called to serve. This familiarity is best obtained by active participation. In the NGDC Ionosonde Program team, we strive to have activity and expertise in ionosonde field operations and scientific data analysis in addition to our core mission of preservation and distribution of data and metadata. We believe this approach produces superior data quality, proper documentation and evaluation tools for data customers as part of the archive process. We are presenting the Ionosonde Program as an example of modern scientific data stewardship.

7 CFR 1469.7 - Benchmark condition inventory and conservation stewardship plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Benchmark condition inventory and conservation...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General Provisions § 1469.7 Benchmark condition inventory and conservation stewardship...

Applying a Data Stewardship Maturity Matrix to the NOAA Observing System Portfolio Integrated Assessment Process

NASA Astrophysics Data System (ADS)

Peng, G.; Austin, M.

2017-12-01

Identification and prioritization of targeted user community needs are not always considered until after data has been created and archived. Gaps in data curation and documentation in the data production and delivery phases limit data's broad utility specifically for decision makers. Expert understanding and knowledge of a particular dataset is often required as a part of the data and metadata curation process to establish the credibility of the data and support informed decision-making. To enhance curation practices, content from NOAA's Observing System Integrated Assessment (NOSIA) Value Tree, NOAA's Data Catalog/Digital Object Identifier (DOI) projects (collection-level metadata) have been integrated with Data/Stewardship Maturity Matrices (data and stewardship quality information) focused on assessment of user community needs. This results in user focused evidence based decision making tools created by NOAA's National Environmental Satellite, Data, and Information Service (NESDIS) through identification and assessment of data content gaps related to scientific knowledge and application to key areas of societal benefit. Through enabling user need feedback from the beginning of data creation through archive allows users to determine the quality and value of data that is fit for purpose. Data gap assessment and prioritization are presented in a user-friendly way using the data stewardship maturity matrices as measurement of data management quality. These decision maker tools encourages data producers and data providers/stewards to consider users' needs prior to data creation and dissemination resulting in user driven data requirements increasing return on investment. A use case focused on need for NOAA observations linked societal benefit will be used to demonstrate the value of these tools.

Toward Better Pain Management: The Development of a "Pain Stewardship Program" in a Tertiary Children's Hospital.

PubMed

Brenn, B Randall; Choudhry, Dinesh K; Sacks, Karen; Como-Fluehr, Sandra; Strain, Robert

2016-09-01

Despite increased focus on pediatric pain, uncontrolled pain is still a problem for hospitalized pediatric inpatients. A program was designed to find patients with uncontrolled pain and develop a framework to oversee their pain management. This report details the development of a pain stewardship program with data from the first year of its activity. Hospitalized inpatients in a tertiary care pediatric center in the mid-Atlantic region were included in the study. Pain scores are recorded every 4 hours in the hospital electronic health record. A report was constructed to find all patients with an average pain score ≥7 in the preceding 12 hours. The charts of these patients were reviewed by our anesthesia pain service, and all patients were grouped into 1 of the following action categories: (1) no action required; (2) telephone call to the patient's attending physician; (3) one-time consultation; (4) consultation with ongoing management; or (5) patient was already on the anesthesia pain service. Demographic data, pain regimens, and outcomes were recorded in a prospectively collected database. There were 843 records on 441 unique patients. Only 22% required action to be taken by the anesthesia pain service. The pain stewardship database revealed that patients with sickle cell disease or abdominal pain required more frequent attention. An electronic health record-based pain stewardship program is an important step in identifying all children in the hospital with undermanaged pain, and it provides a warning system that may improve patient care, outcomes, and satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

The Gateway Paper--stewardship and governance in the health sector in Pakistan.

PubMed

Nishtar, Sania

2006-12-01

As an opening for a dialogue on health reforms in the country, the Gateway Paper places emphasis on strengthening the stewardship function of mandated State agencies in Pakistan with particular attention to two key areas. Firstly, greater emphasis on a stewardship role for the Ministry and departments of health in the context of inter-sectoral scope of health and secondly, a stronger role for the State agencies as regulators of healthcare within the country. The Gateway Paper envisages that the role of State agencies will become more critical as new models of financing health and delivering services are structured given that these entail regulation of private sector providers, providing oversight for ensuring a system for ongoing education and implementation of frameworks for public-private partnerships. The Gateway Paper refers to stewardship with reference to analysis and overview of health policies within the country, their relationship with evidence, their follow-up into planning and finally their implementation. The Paper also provides an insight into policies from a process-related as well as content and program related perspectives. In doing so a number of questions relating to the evidence and policy disconnect; issues at strategic and operational levels of planning, and governance-related impediments to program implementation have been discussed and a viewpoint articulated on an approach to addressing these challenges.

Human resources needed to perform antimicrobial stewardship teams' activities in French hospitals.

PubMed

Le Coz, P; Carlet, J; Roblot, F; Pulcini, C

2016-06-01

In January 2015, the French ministry of Health set up a task force on antibiotic resistance. Members of the task force's "antimicrobial stewardship" group conducted a study to evaluate the human resources needed to implement all the required activities of the multidisciplinary antimicrobial stewardship teams (AST - antibiotic/infectious disease lead supervisors, microbiologists, and pharmacists) in French healthcare facilities. We conducted an online cross-sectional nationwide survey. The questionnaire was designed based on regulatory texts and experts' consensus. The survey took place between March and May 2015. We used the mailing list of the French Infectious Diseases Society (SPILF) to send out questionnaires. A total of 65 healthcare facilities completed the questionnaire. The human resources needed to implement all AST's activities were estimated at 3.6 full-time equivalent (FTE) positions/1000 acute care beds for antibiotic/infectious disease lead supervisors, at 2.5 FTE/1000 beds for pharmacists, and at 0.6 FTE/1000 beds for microbiologists. This almost amounts to a total of 2000 FTE positions for all healthcare facilities (public and private) in France and to an annual cost of 200 million euros. Dedicated and sustainable funding for AST is urgently needed to implement comprehensive and functional AST programs in all healthcare facilities. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

GIS for environmental stewardship and streamlining: an overview of state DOT practices

DOT National Transportation Integrated Search

2005-01-31

The Federal Highway Administration (FHWA) supports the adoption and development of Geographic Information System (GIS) technologies to promote environmental streamlining and stewardship (referred to as GIS4EST). While several States have already appl...

Integration of Cloud Technologies for Data Stewardship at the NOAA National Centers for Environmental Information (NCEI)

NASA Astrophysics Data System (ADS)

Casey, K. S.; Hausman, S. A.

2016-02-01

In the last year, the NOAA National Oceanographic Data Center (NODC) and its siblings, the National Climatic Data Center and National Geophysical Data Center, were merged into one organization, the NOAA National Centers for Environmental Information (NCEI). Combining its expertise under one management has helped NCEI accelerate its efforts to embrace and integrate private, public, and hybrid cloud environments into its range of data stewardship services. These services span a range of tiers, from basic, long-term preservation and access, through enhanced access and scientific quality control, to authoritative product development and international-level services. Throughout these tiers of stewardship, partnerships and pilot projects have been launched to identify technological and policy-oriented challenges, to establish solutions to these problems, and to highlight success stories for emulation during operational integration of the cloud into NCEI's data stewardship activities. Some of these pilot activities including data storage, access, and reprocessing in Amazon Web Services, the OneStop data discovery and access framework project, and a set of Cooperative Research and Development Agreements under the Big Data Project with Amazon, Google, IBM, Microsoft, and the Open Cloud Consortium. Progress in these efforts will be highlighted along with a future vision of how NCEI could leverage hybrid cloud deployments and federated systems across NOAA to enable effective data stewardship for its oceanographic, atmospheric, climatic, and geophysical Big Data.

Stewardship: A Biblical Model for the Formation of Christian Scholars

ERIC Educational Resources Information Center

Smith, Julien C. H.; Scales, T. Laine

2013-01-01

This article explores theological dimensions of the academic vocation, taking its cue from the research undertaken by the Carnegie Initiative on the Doctorate, which envisions the scholar as a steward of an academic discipline. We contend, however, that the Christian scholar's sense of stewardship extends beyond one's academic…

Place-Conscious Capacity-Building: A Systemic Model for the Revitalisation and Renewal of Rural Schools and Communities through University-Based Regional Stewardship

ERIC Educational Resources Information Center

Johnson, Jerry; Thompson, Aaron; Naugle, Kim

2009-01-01

This paper sets forth a model of regional stewardship developed and implemented at a post-compulsory institution serving rural communities in central Appalachia, a region that is among the most impoverished in the United States. The model, termed place-conscious capacity-building, emphasises culturally-responsive methodologies and the strategic…

Antimicrobial Stewardship in a Community Hospital: Attacking the More Difficult Problems

PubMed Central

Philmon, Carla L.; Johnson, Gregory D.; Ward, William S.; Rivers, LaToya L.; Williamson, Sharon A.; Goodman, Edward L.

2014-01-01

Background: Antibiotic stewardship has been proposed as an important way to reduce or prevent antibiotic resistance. In 2001, a community hospital implemented an antimicrobial management program. It was successful in reducing antimicrobial utilization and expenditure. In 2011, with the implementation of a data-mining tool, the program was expanded and its focus transitioned from control of antimicrobial use to guiding judicious antimicrobial prescribing. Objective: To test the hypothesis that adding a data-mining tool to an existing antimicrobial stewardship program will further increase appropriate use of antimicrobials. Design: Interventional study with historical comparison. Methods: Rules and alerts were built into the data-mining tool to aid in identifying inappropriate antibiotic utilization. Decentralized pharmacists acted on alerts for intravenous (IV) to oral conversion, perioperative antibiotic duration, and restricted antimicrobials. An Infectious Diseases (ID) Pharmacist and ID Physician/Hospital Epidemiologist focused on all other identified alert types such as antibiotic de-escalation, bug-drug mismatch, and double coverage. Electronic chart notes and phone calls to physicians were utilized to make recommendations. Results: During 2012, 2,003 antimicrobial interventions were made with a 90% acceptance rate. Targeted broad-spectrum antimicrobial use decreased by 15% in 2012 compared to 2010, which represented cost savings of $1,621,730. There were no statistically significant changes in antimicrobial resistance, and no adverse patient outcomes were noted. Conclusions: The addition of a data-mining tool to an antimicrobial stewardship program can further decrease inappropriate use of antimicrobials, provide a greater reduction in overall antimicrobial use, and provide increased cost savings without negatively affecting patient outcomes. PMID:25477615

Estimating Landholders’ Probability of Participating in a Stewardship Program, and the Implications for Spatial Conservation Priorities

PubMed Central

Adams, Vanessa M.; Pressey, Robert L.; Stoeckl, Natalie

2014-01-01

The need to integrate social and economic factors into conservation planning has become a focus of academic discussions and has important practical implications for the implementation of conservation areas, both private and public. We conducted a survey in the Daly Catchment, Northern Territory, to inform the design and implementation of a stewardship payment program. We used a choice model to estimate the likely level of participation in two legal arrangements - conservation covenants and management agreements - based on payment level and proportion of properties required to be managed. We then spatially predicted landholders’ probability of participating at the resolution of individual properties and incorporated these predictions into conservation planning software to examine the potential for the stewardship program to meet conservation objectives. We found that the properties that were least costly, per unit area, to manage were also the least likely to participate. This highlights a tension between planning for a cost-effective program and planning for a program that targets properties with the highest probability of participation. PMID:24892520

Project FLOSSIE: Marine Data Stewardship at the Waterline

NASA Astrophysics Data System (ADS)

Bouchard, R. H.; Jensen, R. E.; Riley, R. E.

2016-02-01

There are more than 10 million wave records from platforms of the National Data Buoy Center (NDBC) that are archived by National Oceanic and Atmospheric Administration (NOAA). A considerable number of these were measured from the 61 NOMAD (Navy Oceanographic Meteorological Automatic Device) hulls that NDBC has used to make wave measurements since October 1979. Many of these measurements were made before the era of modern marine data stewardship. These long records lend themselves to investigations of climate trends and variability either directly by the measurements themselves, or indirectly by validating long-term numerical wave models or remote sensing applications. However studies (e.g., Gemmrich et al. 2011) indicate that discontinuities and increased variability of the measurements can arise from changing wave systems and platforms. The value of these records is undermined by the lack of understanding or documentation of technology changes - a critical component of data stewardship. To support its mission of long-term understanding of coastal waves and wave models, the U.S. Army Corps of Engineers, Coastal Hydraulics Laboratory (CHL) sponsored the FLOSSIE Project to gage the effects of technology changes on the long-term wave measurements from NOMAD hulls. On behalf of CHL, NDBC engineering and operations integrated old, new, and leading edge technologies on one NOMAD hull. The hull was successfully deployed in July 2015 at the Wave Evaluation and Testing area off of Monterey Bay, CA. The area hosts an NDBC 3-m hull with cross-generational-technologies and a reference standard in a Datawell Waverider buoy. Thus cross-generational and cross-platform inter-comparisons can be performed simultaneously to an accepted standard. The analysis goes beyond the bulk wave parameters. The analysis will examine the energy and directional distributions over the frequency range of wind-generated waves. The project is named in honor of the pioneering World War II Naval

Exceptions or alternatives to labeling requirements for products held by the Strategic National Stockpile. Final rule.

PubMed

2012-02-06

The Food and Drug Administration (FDA) is adopting as a final rule, without change, the interim final rule that issued regulations permitting FDA Center Directors to grant exceptions or alternatives to certain regulatory labeling requirements applicable to human drugs, biological products, or medical devices that are or will be included in the Strategic National Stockpile (SNS). FDA is taking this action to complete the rulemaking initiated with the interim final rule.

Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital

PubMed Central

Niwa, T; Shinoda, Y; Suzuki, A; Ohmori, T; Yasuda, M; Ohta, H; Fukao, A; Kitaichi, K; Matsuura, K; Sugiyama, T; Murakami, N; Itoh, Y

2012-01-01

Background Antimicrobial stewardship has not always prevailed in a wide variety of medical institutions in Japan. Methods The infection control team was involved in the review of individual use of antibiotics in all inpatients (6348 and 6507 patients/year during the first and second annual interventions, respectively) receiving intravenous antibiotics, according to the published guidelines, consultation with physicians before prescription of antimicrobial agents and organisation of education programme on infection control for all medical staff. The outcomes of extensive implementation of antimicrobial stewardship were evaluated from the standpoint of antimicrobial use density, treatment duration, duration of hospital stay, occurrence of antimicrobial-resistant bacteria and medical expenses. Results Prolonged use of antibiotics over 2 weeks was significantly reduced after active implementation of antimicrobial stewardship (2.9% vs. 5.2%, p < 0.001). Significant reduction in the antimicrobial consumption was observed in the second-generation cephalosporins (p = 0.03), carbapenems (p = 0.003), aminoglycosides (p < 0.001), leading to a reduction in the cost of antibiotics by 11.7%. The appearance of methicillin-resistant Staphylococcus aureus and the proportion of Serratia marcescens to Gram-negative bacteria decreased significantly from 47.6% to 39.5% (p = 0.026) and from 3.7% to 2.0% (p = 0.026), respectively. Moreover, the mean hospital stay was shortened by 2.9 days after active implementation of antimicrobial stewardship. Conclusion Extensive implementation of antimicrobial stewardship led to a decrease in the inappropriate use of antibiotics, saving in medical expenses, reduction in the development of antimicrobial resistance and shortening of hospital stay. PMID:22846073

Enhancing stewardship of community-engaged research through governance.

PubMed

Oetzel, John G; Villegas, Malia; Zenone, Heather; White Hat, Emily R; Wallerstein, Nina; Duran, Bonnie

2015-06-01

We explored the relationship of community-engaged research final approval type (tribal government, health board, or public health office (TG/HB); agency staff or advisory board; or individual or no community approval) with governance processes, productivity, and perceived outcomes. We identified 294 federally funded community-engaged research projects in 2009 from the National Institutes of Health's Research Portfolio Online Reporting Tools, Centers for Disease Control and Prevention's Prevention Research Centers, and Native American Research Centers for Health databases. Two hundred (68.0%) investigators completed a survey about governance processes and productivity measures; 312 partners (77.2% of 404 invited) and 138 investigators (69.0% of 200 invited) completed a survey about perceived outcomes. Projects with TG/HB approval had increased likelihood of community control of resources (odds ratios [ORs] ≥ 4.80). Projects with other approvals had decreased likelihood of development or revision of institutional review board policies (ORs ≤ 0.37), having written agreements (ORs ≤ 0.17), and agreements about publishing (ORs ≤ 0.28), data use (ORs ≤ 0.17), and publishing approval (ORs ≤ 0.14). Community-engaged research projects with TG/HB approval had strong stewardship of project resources and agreements. Governance as stewardship protects community interests; thus, is an ethical imperative for communities, especially native communities, to adopt.

Enhancing Stewardship of Community-Engaged Research Through Governance

PubMed Central

Villegas, Malia; Zenone, Heather; White Hat, Emily R.; Wallerstein, Nina; Duran, Bonnie

2015-01-01

Objectives. We explored the relationship of community-engaged research final approval type (tribal government, health board, or public health office (TG/HB); agency staff or advisory board; or individual or no community approval) with governance processes, productivity, and perceived outcomes. Methods. We identified 294 federally funded community-engaged research projects in 2009 from the National Institutes of Health’s Research Portfolio Online Reporting Tools, Centers for Disease Control and Prevention’s Prevention Research Centers, and Native American Research Centers for Health databases. Two hundred (68.0%) investigators completed a survey about governance processes and productivity measures; 312 partners (77.2% of 404 invited) and 138 investigators (69.0% of 200 invited) completed a survey about perceived outcomes. Results. Projects with TG/HB approval had increased likelihood of community control of resources (odds ratios [ORs] ≥ 4.80). Projects with other approvals had decreased likelihood of development or revision of institutional review board policies (ORs ≤ 0.37), having written agreements (ORs ≤ 0.17), and agreements about publishing (ORs ≤ 0.28), data use (ORs ≤ 0.17), and publishing approval (ORs ≤ 0.14). Conclusions. Community-engaged research projects with TG/HB approval had strong stewardship of project resources and agreements. Governance as stewardship protects community interests; thus, is an ethical imperative for communities, especially native communities, to adopt. PMID:25880952

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program

PubMed Central

Reed, Erica E.; Stevenson, Kurt B.; West, Jessica E.; Bauer, Karri A.; Goff, Debra A.

2013-01-01

In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come. PMID:23154323

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program.

PubMed

Reed, Erica E; Stevenson, Kurt B; West, Jessica E; Bauer, Karri A; Goff, Debra A

2013-02-15

In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come.

Evaluation of Penicillin Allergy in the Hospitalized Patient: Opportunities for Antimicrobial Stewardship.

PubMed

Chen, Justin R; Khan, David A

2017-06-01

Penicillin allergy is often misdiagnosed and is associated with adverse consequences, but testing is infrequently done in the hospital setting. This article reviews historical and contemporary innovations in inpatient penicillin allergy testing and its impact on antimicrobial stewardship. Adoption of the electronic medical record allows rapid identification of admitted patients carrying a penicillin allergy diagnosis. Collaboration with clinical pharmacists and the development of computerized clinical guidelines facilitates increased testing and appropriate use of penicillin and related β-lactams. Education of patients and their outpatient providers is the key to retaining the benefits of penicillin allergy de-labeling. Penicillin allergy testing is feasible in the hospital and offers tangible benefits towards antimicrobial stewardship. Allergists should take the lead in this endeavor and work towards overcoming personnel limitations by partnering with other health care providers and incorporating technology that improves the efficiency of allergy evaluation.

Recreation, values and stewardship: Rethinking why people engage in environmental behaviors in parks and protected areas: Chapter 19

USGS Publications Warehouse

van Riper, Carena J.; Sharp, Ryan; Bagstad, Kenneth J.; Vagias, Wade M.; Kwenye, Jane; Depper, Gina; Freimund, Wayne

2016-01-01

Successfully promoting and encouraging the adoption of environmental stewardship behavior is an important responsibility for public land management agencies. Although people increasingly report high levels of concern about environmental issues, widespread patterns of stewardship behavior have not followed suit (Moore 2002). One concept that can be applied in social science research to explain behavior change is that of values. More specifically, held and assigned values lie at the heart of understanding why people around the world continue to live in unsustainable ways that impact parks and protected areas. A held value is an individual psychological orientation defined by Rokeach as “an enduring belief that a specific mode of conduct or endstate of existence is personally and socially preferable” (1973, 550). Held values are at the core of human cognition, and as such, influence attitudes and behavior. Assigned values on the other hand, according to Brown (1984), are the perceived qualities of an environment that are based on and deduced from held values. In other words, assigned values are considered the material and nonmaterial benefits that people believe they obtain from ecosystems. Held and assigned values predict stewardship behaviors (Figure 1). During the 2013 George Wright Society Conference on Parks, Protected Areas, and Cultural Sites, we organized a session to improve our understanding of why individuals and groups choose to engage in stewardship behaviors that benefit the environment. We used held and assigned values as vehicles to explore what people cared about in diverse landscapes, review select case studies from across the globe, and question how best to incorporate visitor perspectives into protected area management decisions and policymaking. In addition to sharing project results, we also discussed the importance of accounting for multiple and often competing value perspectives, potential ways to integrate disciplinary perspectives on

Recommendations for Best Professional Practices in Fishing, Boating and Stewardship Education.

ERIC Educational Resources Information Center

Fedler, Anthony J.; Matthews, Bruce E.

2001-01-01

To implement its mission of increasing participation in fishing and boating and the stewardship of related resources, the Recreational Boating and Fishing Foundation solicited input from 11 experts in related fields. They identified 10 principles for education programs and recommended best practices in four educational areas: program planning,…

Water, climate change, and forests: watershed stewardship for a changing climate

Treesearch

Michael J. Furniss; Brian P. Staab; Sherry Hazelhurst; Cathrine F. Clifton; Kenneth B. Roby; Bonnie L. Ilhadrt; Albert H. Todd; Leslie M. Reid; Sarah J. Hines; Karen A. Bennett; Charles H. Luce; Pamela J. Edwards

2010-01-01

Water from forested watersheds provides irreplaceable habitat for aquatic and riparian species and supports our homes, farms, industries, and energy production. Secure, high-quality water from forests is fundamental to our prosperity and our stewardship responsibility.Yet population pressures, land uses, and rapid climate change combine to seriously...

A Long History of Supercomputing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grider, Gary

As part of its national security science mission, Los Alamos National Laboratory and HPC have a long, entwined history dating back to the earliest days of computing. From bringing the first problem to the nation’s first computer to building the first machine to break the petaflop barrier, Los Alamos holds many “firsts” in HPC breakthroughs. Today, supercomputers are integral to stockpile stewardship and the Laboratory continues to work with vendors in developing the future of HPC.

77 FR 6820 - Proposed Information Collection; Comment Request: Creating Stewardship Through Biodiversity...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-09

... Information Collection; Comment Request: Creating Stewardship Through Biodiversity Discovery in National Parks... collection (IC) described below. This collection will survey participants of Biodiversity Discovery efforts... Biodiversity Discovery refers to a variety of efforts to discover living organisms through public involvement...

LDRD Final Report 15-ERD-037 Matthews

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matthews, Manyalibo J.

2017-10-26

The physics and materials science involved in laser materials processing of metals was studied experimentally using custom-built test beds and in situ diagnostics. Special attention was given to laser-based powder bed fusion additive manufacturing processes, a technology critically important to the stockpile stewardship program in NNSA. New light has been shed on several phenomena such as laser-driven spatter, material displacement and morphology changes. The results presented here and in publications generated by this work have proven impactful and useful to both internal and external communities. New directions in additive manufacturing research at LLNL have been enabled, along with new scientificmore » capabilities that can serve future program needs.« less

Citizen monitoring and restoration: Volunteers and community involvement in wilderness stewardship

Treesearch

Laurie Yung

2007-01-01

Citizen monitoring and restoration is increasingly viewed as a means to involve local communities in wilderness stewardship. This paper examines research on volunteers participating in five monitoring and restoration programs in Western Montana. Volunteers reported that they gained valuable skills, felt more connected with local wilderness areas, and made an important...

A Partnership Model for Training Episodic Environmental Stewardship 4-H Volunteers

ERIC Educational Resources Information Center

Young, Jane Chin; Alexander, Janice; Smith, Martin H.

2013-01-01

The Marin Environmental Stewardship pilot project demonstrates the potential for a partnership model that brings together external and internal collaborators to recruit and train episodic 4-H volunteers to meet environmental education needs within a community. The clientele served by the volunteers trained through the project was at-risk, urban…

Gasoline toxicology: overview of regulatory and product stewardship programs.

PubMed

Swick, Derek; Jaques, Andrew; Walker, J C; Estreicher, Herb

2014-11-01

Significant efforts have been made to characterize the toxicological properties of gasoline. There have been both mandatory and voluntary toxicology testing programs to generate hazard characterization data for gasoline, the refinery process streams used to blend gasoline, and individual chemical constituents found in gasoline. The Clean Air Act (CAA) (Clean Air Act, 2012: § 7401, et seq.) is the primary tool for the U.S. Environmental Protection Agency (EPA) to regulate gasoline and this supplement presents the results of the Section 211(b) Alternative Tier 2 studies required for CAA Fuel and Fuel Additive registration. Gasoline blending streams have also been evaluated by EPA under the voluntary High Production Volume (HPV) Challenge Program through which the petroleum industry provide data on over 80 refinery streams used in gasoline. Product stewardship efforts by companies and associations such as the American Petroleum Institute (API), Conservation of Clean Air and Water Europe (CONCAWE), and the Petroleum Product Stewardship Council (PPSC) have contributed a significant amount of hazard characterization data on gasoline and related substances. The hazard of gasoline and anticipated exposure to gasoline vapor has been well characterized for risk assessment purposes. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Antibiotic Stewardship Initiatives as Part of the UK 5-Year Antimicrobial Resistance Strategy

PubMed Central

Johnson, Alan P.; Ashiru-Oredope, Diane; Beech, Elizabeth

2015-01-01

Antibiotic use is a major driver for the emergence and spread of antibiotic resistance. Antimicrobial stewardship programmes aim to improve antibiotic prescribing with the objectives of optimizing clinical outcomes while at the same time minimizing unintended consequences such as adverse effects and the selection of antibiotic resistance. In 2013, a five-year national strategy for tackling antimicrobial resistance was published in the UK. The overarching goal of the strategy is to slow the development and spread of resistance and to this end it has three strategic aims, namely to improve knowledge and understanding of resistance, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. This article reviews the antimicrobial stewardship activities included in the strategy and describes their implementation and evaluation. PMID:27025636

Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme.

PubMed

Nathwani, Dilip; Sneddon, Jacqueline; Malcolm, William; Wiuff, Camilla; Patton, Andrea; Hurding, Simon; Eastaway, Anne; Seaton, R Andrew; Watson, Emma; Gillies, Elizabeth; Davey, Peter; Bennie, Marion

2011-07-01

In 2008, the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) was published by the Scottish Government. One of the key actions was initiation of the Scottish Antimicrobial Prescribing Group (SAPG), hosted within the Scottish Medicines Consortium, to take forward national implementation of the key recommendations of this action plan. The primary objective of SAPG is to co-ordinate and deliver a national framework or programme of work for antimicrobial stewardship. This programme, led by SAPG, is delivered by NHS National Services Scotland (Health Protection Scotland and Information Services Division), NHS Quality Improvement Scotland, and NHS National Education Scotland as well as NHS board Antimicrobial Management Teams. Between 2008 and 2010, SAPG has achieved a number of early successes, which are the subject of this review: (i) through measures to optimise prescribing in hospital and primary care, combined with infection prevention measures, SAPG has contributed significantly to reducing Clostridium difficile infection rates in Scotland; (ii) there has been engagement of all key stakeholders at local and national levels to ensure an integrated approach to antimicrobial stewardship within the wider healthcare-associated infection agenda; (iii) development and implementation of data management systems to support quality improvement; (iv) development of training materials on antimicrobial stewardship for healthcare professionals; and (v) improving clinical management of infections (e.g. community-acquired pneumonia) through quality improvement methodology. The early successes achieved by SAPG demonstrate that this delivery model is effective and provides the leadership and focus required to implement antimicrobial stewardship to improve antimicrobial prescribing and infection management across NHS Scotland. Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

University Research Program in Robotics - "Technologies for Micro-Electrical-Mechanical Systems in directed Stockpile Work (DSW) Radiation and Campaigns", Final Technical Annual Report, Project Period 9/1/06 - 8/31/07

DOE Office of Scientific and Technical Information (OSTI.GOV)

James S. Tulenko; Carl D. Crane

The University Research Program in Robotics (URPR) is an integrated group of universities performing fundamental research that addresses broad-based robotics and automation needs of the NNSA Directed Stockpile Work (DSW) and Campaigns. The URPR mission is to provide improved capabilities in robotics science and engineering to meet the future needs of all weapon systems and other associated NNSA/DOE activities.

Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention.

PubMed

Pollack, Loria A; Srinivasan, Arjun

2014-10-15

The proven benefits of antibiotic stewardship programs (ASPs) for optimizing antibiotic use and minimizing adverse events, such as Clostridium difficile and antibiotic resistance, have prompted the Centers for Disease Control and Prevention (CDC) to recommend that all hospitals have an ASP. This article summarizes Core Elements of Hospital Antibiotic Stewardship Programs, a recently released CDC document focused on defining the infrastructure and practices of coordinated multidisciplinary programs to improve antibiotic use and patient care in US hospitals. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Environmental stewardship practices of veterinary professionals and educators related to use and disposal of pharmaceuticals and personal care products.

PubMed

Lam, Jennifer; Chan, Samuel S; Conway, Flaxen D L; Stone, David

2018-03-01

OBJECTIVE To document the environmental stewardship practices (decisions and actions regarding use and disposal) of pet and human pharmaceuticals and personal care products (PPCPs) among pet-owning veterinary-care professionals (practicing veterinarians, veterinary students, and veterinary technicians and trainees) and environmental educators. DESIGN Internet-based cross-sectional survey. SAMPLE 191 pet owners (103 veterinary-care professionals and 88 environmental educators). PROCEDURES Study participants were recruited by means of a 2-part internet survey distributed to veterinary-care professional and environmental educator networks of individuals residing in Washington state, Oregon, and southern California. Survey questions addressed motivators for environmental stewardship practices (ie, decisions and actions regarding use and disposal of pet and human PPCPs). RESULTS Data were collected from 191 respondents; the response rate for individuals who self-selected to opt in was 78% (191/246). Of the 191 respondents, 42 (22%) stored pet pharmaceuticals indefinitely. The most common disposal method was the garbage (88/191 [46%]). Veterinary-care professionals counseled clients infrequently regarding environmental stewardship practices for PPCPs. Fifty-five percent (105/191) of all respondents preferred more environmentally friendly and clinically effective PPCPs. CONCLUSIONS AND CLINICAL RELEVANCE Results of the present survey emphasized the urgent need for improved educational resources to minimize environmental contamination from improper disposal of PPCPs. Environmental and economic motivations among pet owners in the veterinary-care and education professions indicate further opportunities for outreach and institutional support.

The challenge of measuring emergency preparedness: integrating component metrics to build system-level measures for strategic national stockpile operations.

PubMed

Jackson, Brian A; Faith, Kay Sullivan

2013-02-01

Although significant progress has been made in measuring public health emergency preparedness, system-level performance measures are lacking. This report examines a potential approach to such measures for Strategic National Stockpile (SNS) operations. We adapted an engineering analytic technique used to assess the reliability of technological systems-failure mode and effects analysis-to assess preparedness. That technique, which includes systematic mapping of the response system and identification of possible breakdowns that affect performance, provides a path to use data from existing SNS assessment tools to estimate likely future performance of the system overall. Systems models of SNS operations were constructed and failure mode analyses were performed for each component. Linking data from existing assessments, including the technical assistance review and functional drills, to reliability assessment was demonstrated using publicly available information. The use of failure mode and effects estimates to assess overall response system reliability was demonstrated with a simple simulation example. Reliability analysis appears an attractive way to integrate information from the substantial investment in detailed assessments for stockpile delivery and dispensing to provide a view of likely future response performance.

Sandia Dynamic Materials Program Strategic Plan.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Flicker, Dawn Gustine; Benage, John F.; Desjarlais, Michael P.

2017-05-01

Materials in nuclear and conventional weapons can reach multi-megabar pressures and 1000s of degree temperatures on timescales ranging from microseconds to nanoseconds. Understanding the response of complex materials under these conditions is important for designing and assessing changes to nuclear weapons. In the next few decades, a major concern will be evaluating the behavior of aging materials and remanufactured components. The science to enable the program to underwrite decisions quickly and confidently on use, remanufacturing, and replacement of these materials will be critical to NNSA’s new Stockpile Responsiveness Program. Material response is also important for assessing the risks posed bymore » adversaries or proliferants. Dynamic materials research, which refers to the use of high-speed experiments to produce extreme conditions in matter, is an important part of NNSA’s Stockpile Stewardship Program.« less

Highlights of the national evaluation of the Forest Stewardship Planning Program

Treesearch

R.J. Moulton; J.D. Esseks

2001-01-01

In 1998 and 1999, a nationwide random sample of 1238 nonindustrial private (NIPF) landowners with approved multiple resource Forest Stewardship Plans were interviewed to determine if this program is meeting its Congressional mandate of promoting sustainable management of forest resources on NIPF ownerships. It was found that two-thirds of program participants had never...

Watershed management contributions to land stewardship: Case studies in the Southeast

Treesearch

Wayne T. Swank; David R. Tilley

2000-01-01

We describe three examples of watershed management studies, at different spatial scales, that provide approaches and information useful in enhancing natural resource stewardship in the southern Appalachians. A multiple use “pilot” study, initiated 35 years ago at the Coweeta Hydrologic Laboratory, demonstrates that southern Appalachian forests can be successfully...

Evaluating the forest stewardship program through a national survey of participants

Treesearch

J.D. Esseks; R.J. Moulton

2000-01-01

This paper reports findings from a national survey of 1,231 participants in the Forest Stewardship Program (FSP) of USDA's Forest Service. Launched in 1991, the FSP provides technical assistance through state forestry agencies to help landowners develop management plans for their non-industrial forestland. The survey allowed us to address five main evaluative...

Minnesota anglers' fisheries-related value orientations and their stewardship of fish resources

USGS Publications Warehouse

Bruskotter, J.T.; Fulton, D.C.

2008-01-01

Research on natural resource-related values and value orientations has grown substantially over the past decade. However, existing studies have focused almost exclusively on value orientations related to wildlife and forests. This article reports data from two mail surveys of Minnesota anglers used to develop scales for measuring fisheries-related value orientations. We report results of regression analyses examining the relationship between anglers' value orientations and norms concerning fisheries stewardship and the use of technological aids to angling. Results indicate 10 items reliably measure three value orientations we termed utilitarianism, dominance, and protectionism. Regression analyses suggest anglers' stewardship norms are influenced by all three value orientation types, while support for the use of technological aids was related with protectionism and utilitarianism, but not dominance. Results suggest anglers' fisheries-related value orientations cannot be adequately captured using single domain scales. Implications for the study of natural resources-related value orientations are discussed. Copyright ?? Taylor & Francis Group, LLC.

From Cleanup to Stewardship. A companion report to Accelerating Cleanup: Paths to Closure and background information to support the scoping process required for the 1998 PEIS Settlement Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

None, None

1999-10-01

Long-term stewardship is expected to be needed at more than 100 DOE sites after DOE's Environmental Management program completes disposal, stabilization, and restoration operations to address waste and contamination resulting from nuclear research and nuclear weapons production conducted over the past 50 years. From Cleanup to stewardship provides background information on the Department of Energy (DOE) long-term stewardship obligations and activities. This document begins to examine the transition from cleanup to long-term stewardship, and it fulfills the Secretary's commitment to the President in the 1999 Performance Agreement to provide a companion report to the Department's Accelerating Cleanup: Paths to Closuremore » report. It also provides background information to support the scoping process required for a study on long-term stewardship required by a 1998 Settlement Agreement.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Antolak, Arlyn J.

Particle accelerators play a key role in a broad set of defense and security applications including war-fighter and asset protection, cargo inspection, nonproliferation, materials characterization and stockpile stewardship. Accelerators can replace the high activity radioactive sources that pose a security threat for developing a radiological dispersal device and be used to produce isotopes for medical, industrial, and re-search purposes. Lastly, we present an overview of current and emerging accelerator technologies relevant to addressing the needs of defense and security.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hughes, R. O.; Burke, J. T.; Casperson, R. J.

Hyperion is a new high-efficiency charged-particle γ-ray detector array which consists of a segmented silicon telescope for charged-particle detection and up to fourteen high-purity germanium clover detectors for the detection of coincident γ rays. The array will be used in nuclear physics measurements and Stockpile Stewardship studies and replaces the STARLiTeR array. In conclusion, this article discusses the features of the array and presents data collected with the array in the commissioning experiment.

The hyperion particle-γ detector array

DOE PAGES

Hughes, R. O.; Burke, J. T.; Casperson, R. J.; ...

2017-03-08

Hyperion is a new high-efficiency charged-particle γ-ray detector array which consists of a segmented silicon telescope for charged-particle detection and up to fourteen high-purity germanium clover detectors for the detection of coincident γ rays. The array will be used in nuclear physics measurements and Stockpile Stewardship studies and replaces the STARLiTeR array. In conclusion, this article discusses the features of the array and presents data collected with the array in the commissioning experiment.

Overview of Accelerator Applications for Security and Defense

DOE PAGES

Antolak, Arlyn J.

2015-01-01

Particle accelerators play a key role in a broad set of defense and security applications including war-fighter and asset protection, cargo inspection, nonproliferation, materials characterization and stockpile stewardship. Accelerators can replace the high activity radioactive sources that pose a security threat for developing a radiological dispersal device and be used to produce isotopes for medical, industrial, and re-search purposes. Lastly, we present an overview of current and emerging accelerator technologies relevant to addressing the needs of defense and security.

Joint the Center for Applied Scientific Computing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gamblin, Todd; Bremer, Timo; Van Essen, Brian

The Center for Applied Scientific Computing serves as Livermore Lab’s window to the broader computer science, computational physics, applied mathematics, and data science research communities. In collaboration with academic, industrial, and other government laboratory partners, we conduct world-class scientific research and development on problems critical to national security. CASC applies the power of high-performance computing and the efficiency of modern computational methods to the realms of stockpile stewardship, cyber and energy security, and knowledge discovery for intelligence applications.

Analysing the Stewardship Function in Botswana’s Health System: Reflecting on the Past, Looking to the Future

PubMed Central

Seitio-Kgokgwe, Onalenna; Gauld, Robin DC; Hill, Philip C.; Barnett, Pauline

2016-01-01

Background: In many parts of the world, ongoing deficiencies in health systems compromise the delivery of health interventions. The World Health Organization (WHO) identified four functions that health systems need to perform to achieve their goals: Efforts to strengthen health systems focus on the way these functions are carried out. While a number of studies on health systems functions have been conducted, the stewardship function has received limited attention. In this article, we evaluate the extent to which the Botswana Ministry of Health (MoH) undertook its stewardship role. Methods: We used the WHO Health Systems Performance Assessment Frame (HSPAF) to guide analysis of the stewardship function of the Botswana’s MoH focusing on formulation of national health policies, exerting influence through health regulation, and coalition building. Data were abstracted from published and unpublished documents. We interviewed 54 key informants comprising staff of the MoH (N = 40) and stakeholder organizations (N = 14). Data from documents was analyzed through content analysis. Interviews were transcribed and analyzed through thematic analysis. Results: A lack of capacity for health policy development was identified. Significant policy gaps existed in some areas. Challenges were reported in policy implementation. While the MoH made efforts in developing various statutes that regulated different aspects of the health system, some gaps existed in the regulatory framework. Poor enforcement of legislation was a challenge. Although the MoH had a high number of stakeholders, the mechanisms for stakeholder engagement in the planning processes were weak. Conclusion: Problems in the exercise of the stewardship function posed challenges in ensuring accountability and limited the health system’s ability to benefit from its stakeholders. Ongoing efforts to establish a District Health System under control of the MoH, attempts to improve service delivery at a national level and

Informing rangeland stewardship with research: lessons learned from Yolo County, California

Treesearch

Vance Russell; Chris Rose; Miles DaPrato

2008-01-01

Approximately 70 percent of the contiguous United States is in private lands with half of this total in row crop or rangelands. Audubon California’s Landowner Stewardship Program engages with farmers and ranchers on conservation and restoration projects in a manner compatible with existing agricultural operations. To assess the success of these efforts, Audubon,...

Understanding micro-processes of institutionalization: stewardship contracting and national forest management

Treesearch

Cassandra Moseley; Susan Charnley

2014-01-01

This paper examines micro-processes of institutionalization, using the case of stewardship contracting within the US Forest Service. Our basic premise is that, until a new policy becomes an everyday practice among local actors, it will not become institutionalized at the macro-scale. We find that micro-processes of institutionalization are driven by a mixture of large-...

Medical table: A major tool for antimicrobial stewardship policy.

PubMed

Roger, P-M; Demonchy, E; Risso, K; Courjon, J; Leroux, S; Leroux, E; Cua, É

2017-09-01

Infectious diseases are unpredictable, with heterogeneous clinical presentations, diverse pathogens, and various susceptibility rates to anti-infective agents. These features lead to a wide variety of clinical practices, which in turn strongly limits their evaluation. We have been using a medical table since 2005 to monitor the medical activity in our department. The observation of heterogeneous therapeutic practices led to drafting up our own antibiotic guidelines and to implementing a continuous evaluation of their observance and impact on morbidity and mortality associated with infectious diseases, including adverse effects of antibiotics, duration of hospital stay, use of intensive care, and deaths. The 10-year analysis of medical practices using the medical table is based on more than 10,000 hospitalizations. It shows simplified antibiotic therapies and a reduction in infection-related morbidity and mortality. The medical table is a major tool for antimicrobial stewardship, leading to constant benefits for patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Community College Education Foundations and Transformational Philanthropy: Resource Management, Stewardship and Professionalism.

ERIC Educational Resources Information Center

LaBeouf, Joanne P.

This paper argues that, as institutional revenues continue to decline, community college administrators must not only work at developing a robust foundation with an identifiable process similar to that of a private nonprofit foundation, but also provide professional stewardship in its operation. The author used a qualitative, evaluative approach…

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit.

PubMed

Nzegwu, Nneka I; Rychalsky, Michelle R; Nallu, Loren A; Song, Xuemei; Deng, Yanhong; Natusch, Amber M; Baltimore, Robert S; Paci, George R; Bizzarro, Matthew J

2017-10-01

OBJECTIVE To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP). DESIGN Quasi-experimental, interrupted time-series study. SETTING A 54-bed, level IV NICU in a regional academic and tertiary referral center. PATIENTS AND PARTICIPANTS All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion. INTERVENTION Implementation of a NICU-specific ASP beginning July 2012. METHODS We convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance. RESULTS Antibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time. CONCLUSIONS Implementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices. Infect Control Hosp Epidemiol 2017;38:1137-1143.

Public Health, Law, and Local Control: Destruction of the US Chemical Weapons Stockpile

PubMed Central

Greenberg, Michael R.

2003-01-01

Destruction of US chemical weapons has begun at one of the 8 sites in the continental United States, was completed on Johnston Island in the Pacific Ocean, and is scheduled to begin in at least 3 other locations during the upcoming year. About 25% of the stockpile and 38% of the munitions had been destroyed as of December 31, 2002. However, the program has become controversial with regard to choice of technology, emergency management, and cost. This controversy is in large part due to efforts by some state and local governments and activist groups to play a more central role in a decisionmaking process that was once fully controlled by the US Army. PMID:12893599

NASA'S Earth Science Data Stewardship Activities

NASA Technical Reports Server (NTRS)

Lowe, Dawn R.; Murphy, Kevin J.; Ramapriyan, Hampapuram

2015-01-01

NASA has been collecting Earth observation data for over 50 years using instruments on board satellites, aircraft and ground-based systems. With the inception of the Earth Observing System (EOS) Program in 1990, NASA established the Earth Science Data and Information System (ESDIS) Project and initiated development of the Earth Observing System Data and Information System (EOSDIS). A set of Distributed Active Archive Centers (DAACs) was established at locations based on science discipline expertise. Today, EOSDIS consists of 12 DAACs and 12 Science Investigator-led Processing Systems (SIPS), processing data from the EOS missions, as well as the Suomi National Polar Orbiting Partnership mission, and other satellite and airborne missions. The DAACs archive and distribute the vast majority of data from NASA’s Earth science missions, with data holdings exceeding 12 petabytes The data held by EOSDIS are available to all users consistent with NASA’s free and open data policy, which has been in effect since 1990. The EOSDIS archives consist of raw instrument data counts (level 0 data), as well as higher level standard products (e.g., geophysical parameters, products mapped to standard spatio-temporal grids, results of Earth system models using multi-instrument observations, and long time series of Earth System Data Records resulting from multiple satellite observations of a given type of phenomenon). EOSDIS data stewardship responsibilities include ensuring that the data and information content are reliable, of high quality, easily accessible, and usable for as long as they are considered to be of value.

15 CFR Supplement No. 2 to Part 745 - States Parties to the Convention on the Prohibition of the Development, Production, Stockpiling...

Code of Federal Regulations, 2012 CFR

2012-01-01

... the Prohibition of the Development, Production, Stockpiling, and Use of Chemical Weapons and on Their... REGULATIONS CHEMICAL WEAPONS CONVENTION REQUIREMENTS Pt. 745, Supp. 2 Supplement No. 2 to Part 745—States... Chemical Weapons and on Their Destruction List of States Parties as of May 21, 2009 Afghanistan Albania...

15 CFR Supplement No. 2 to Part 745 - States Parties to the Convention on the Prohibition of the Development, Production, Stockpiling...

Code of Federal Regulations, 2013 CFR

2013-01-01

... the Prohibition of the Development, Production, Stockpiling, and Use of Chemical Weapons and on Their... REGULATIONS CHEMICAL WEAPONS CONVENTION REQUIREMENTS Pt. 745, Supp. 2 Supplement No. 2 to Part 745—States... Chemical Weapons and on Their Destruction List of States Parties as of May 21, 2009 Afghanistan Albania...

15 CFR Supplement No. 2 to Part 745 - States Parties to the Convention on the Prohibition of the Development, Production, Stockpiling...

Code of Federal Regulations, 2014 CFR

2014-01-01

... the Prohibition of the Development, Production, Stockpiling, and Use of Chemical Weapons and on Their... REGULATIONS CHEMICAL WEAPONS CONVENTION REQUIREMENTS Pt. 745, Supp. 2 Supplement No. 2 to Part 745—States... Chemical Weapons and on Their Destruction List of States Parties as of May 21, 2009 Afghanistan Albania...

Memorandum of Understanding on Long-Term Stewardship at Federal Facilities in the United States

EPA Pesticide Factsheets

The purpose of this Memorandum of Understanding is to provide a common understanding and basis for discussion and coordination between the Environmental Council of the States and relevant federal agencies regarding Long-Term Stewardship.

Influence of a 5-year serial infection control and antibiotic stewardship intervention on cardiac surgical site infections.

PubMed

Frenette, Charles; Sperlea, David; Tesolin, Joey; Patterson, Connie; Thirion, Daniel J G

2016-09-01

Surgical site infections (SSIs) complicate surgery, resulting in higher morbidity and mortality. Infection control bundles and antibiotic stewardship can be effective at reducing SSIs. The influence of long-term serial interventions is unclear. The goal of this retrospective quasiexperimental study was to assess the influence of a 5-year serial infection control and antibiotic stewardship intervention on SSIs. The multidisciplinary program actively implemented pre-, intra-, and postoperative strategies over a 5-year period from 2009-2014 for all patients undergoing coronary artery bypass graft (CABG), valve replacement, or both at a tertiary care public institution. Outcomes are compared with a 2-year preinterventions period (2007-2009) and 1-year postinterventions period (2014-2015). A total of 6,518 procedures were included. After interventions, the overall combined infection rate for CABG, CABG and valve, and valve procedures decreased by 66.3%, from 11.9%-4.0% (odds ratio, 0.34; 95% confidence interval, 0.23-0.49; P < .001). A significant decrease of >50% (P < .001) relative rate was observed in overall, sternum, leg, CABG, and combined CABG and valve infection rates when comparing pre- and postinterventions groups. The antibiotic stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 46.8%, from 39.8%-86.6% (95% confidence interval, 41.0-52.4; P < .001). Long-term, serial comprehensive infection control and antibiotic stewardship interventions decrease overall SSIs in patients undergoing CABG and valve replacement procedures. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Development and impact of a massive open online course (MOOC) for antimicrobial stewardship.

PubMed

Sneddon, Jacqueline; Barlow, Gavin; Bradley, Sally; Brink, Adrian; Chandy, Sujith J; Nathwani, Dilip

2018-04-01

The University of Dundee and the BSAC developed a massive open online course (MOOC) to address the global need for education to support antimicrobial stewardship in low- and middle-income countries. An interactive course, Antimicrobial Stewardship: Managing Antibiotic Resistance, was developed and delivered via the FutureLearn© platform. The course ran over four 6 week periods during 2015 and 2016 supported by educators and was evaluated via data on uptake and feedback from learners on impact on clinical practice. In total, 32 944 people, 70% of them healthcare professionals, from 163 countries joined the course from Europe (49%), Asia (16%), Africa (13%), North America (9%), Australia (8%) and South America (5%). Between 33% and 37% of joiners in each run completed at least one step in any week of the course and 219 participants responded to a post-course survey. The course was rated good or excellent by 208 (95%) of the participants, and 83 (38%) intended to implement stewardship interventions in their own setting. A follow-up survey 6 months later suggested that 49% had implemented such interventions. The MOOC has addressed a global learning need by providing education free at the point of access, and learning from its development will help others embarking upon similar educational solutions. Initial quantitative and qualitative feedback suggests it has engaged participants and complements traditional educational methods. Measuring its real impact on clinical practice remains a challenge. The FutureLearn© platform offers flexibility for MOOCs to be sustainable through modification to remove educator facilitation but maintain active participant discussion.

Dramatic effects of a new antimicrobial stewardship program in a rural community hospital.

PubMed

Libertin, Claudia R; Watson, Stephanie H; Tillett, William L; Peterson, Joy H

2017-09-01

New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia. An educational grand rounds lecture series was provided before implementation of the ASP to all prescribers. After implementation, algorithms to aid the selection of empirical antibiotics for specific infectious disease syndromes based on local antibiograms were provided to prescribers to improve this selection. Rates of C difficile infections, total targeted antimicrobial costs, and drug utilization rates were calculated for 1 year pre-ASP implementation (2013) and 1 year post-ASP implementation (October 2014-December 2015). The patient safety metric of C difficile infections decreased from 3.35 cases per 1,000 occupied bed days (OBDs) in 2013 to 1.35 cases per 1,000 OBDs in 2015. Total targeted antimicrobial costs decreased 50% from $16.93 per patient day in 2013 to $8.44 per patient day in 2015. Overall antimicrobial use decreased 10% from before the ASP initiative to 1 year after it. Annualized savings were $280,000 in 1 year, based on drug savings only. Judicious use of antimicrobials and resources can improve a patient safety metric and decrease costs dramatically in rural institutions where the average hospital census is <100 patients per day. The savings would allow the institutions to spend better while improving the use of antimicrobials. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights

Science and society: the role of long-term studies in environmental stewardship

Treesearch

Charles T. Driscoll; Kathleen F. Lambert; F. Stuart Chapin; David J. Nowak; Thomas A. Spies; Frederick J. Swanson; David B. Kittredge; Clarisse M. Hart

2012-01-01

Long-term research should play a crucial role in addressing grand challenges in environmental stewardship. We examine the efforts of five Long Term Ecological Research Network sites to enhance policy, management, and conservation decisions for forest ecosystems. In these case studies, we explore the approaches used to inform policy on atmospheric deposition, public...

Wilderness stewardship challenges in the uKhahlamba Drakensberg Park World Heritage Site

Treesearch

Sonja Krüger

2007-01-01

The location of the uKhahlamba Drakensberg Park wilderness areas along an international border and within a World Heritage Site and Transfrontier Conservation Area, provides unique opportunities and challenges for the stewardship of these areas. Although the wilderness areas were proclaimed more than 30 years ago, wilderness-specific planning, management and monitoring...

Watershed Stewardship Education Program--A Multidisciplinary Extension Education Program for Oregon's Watershed Councils.

ERIC Educational Resources Information Center

Conway, Flaxen D. L.; Godwin, Derek; Cloughesy, Mike; Nierenberg, Tara

2003-01-01

The Watershed Stewardship Education Program (WSEP) is a multidisciplinary Oregon Extension designed to help watershed councils, landowners, and others work effectively together on water management. Components include practical, easy-to-use educational materials, training in effective collaboration, a Master Watershed Stewards program, and advanced…

Training should be the first step toward an antifungal stewardship program.

PubMed

Valerio, Maricela; Muñoz, Patricia; Rodríguez-González, Carmen; Sanjurjo, María; Guinea, Jesús; Bouza, Emilio

2015-04-01

The frequency of use of systemic antifungal agents has increased significantly in most tertiary centers. However, antifungal stewardship has received very little attention. The objective of this article was to assess the knowledge of prescribing physicians in our institution as a first step in the development of an antifungal stewardship program. Attending physicians from the departments that prescribe most antifungals were invited to complete a questionnaire based on current guidelines on diagnosis and therapy of invasive candidiasis and invasive aspergillosis (IA). The survey was completed by 60.8% (200/329) of the physicians who were invited to participate. The physicians belonged to the following departments: medical (60%), pediatric (19%), intensive care (15.5%), and surgical (5.5%). The mean (±SD) score of correct responses was 5.16±1.73. In the case of candidiasis, only 55% of the physicians clearly distinguished between colonization and infection, and 17.5% knew the local rate of fluconazole resistance. Thirty-three percent knew the accepted indications for antifungal prophylaxis, and 23% the indications for empirical therapy. However, most physicians knew which antifungals to choose when starting empirical therapy (73.5%). As for aspergillosis, most physicians (67%) could differentiate between colonization and infection, and 34.5% knew the diagnostic value of galactomannan. The radiological features of IA were well recognized by 64%, but only 31.5% were aware of the first line of treatment for IA, and 36% of the recommended duration of therapy. The usefulness of antifungal levels was known by 67%. This simple, easily completed questionnaire enabled us to identify which areas of our training strategy could be improved. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Risk communications and the Chemical Stockpile Emergency Preparedness Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vogt, B.M.

1995-12-31

One of the greater challenges the Army faces is effectively dealing with the concerns of the public, local officials and the news media on the disposal of aging chemical agents. This paper describes the method developed for the Chemical Stockpile Emergency Preparedness Program (CSEPP). The purpose was to provide a fairly comprehensive document on risk communication research and recommended practices as they related to the CSEPP. Using the communications perspective suggested by Covello and colleagues, the existing practices of communicating risk information about chemical weapons and the associated efforts in emergency planning, storage and eventual disposal are described. Risk communicationmore » problems specific to the CSEPP are then examined and described via scenarios. A framework is developed that distinguishes between the major components of risk communication, flow and intent. Within this framework, the research and recommendations are summarized as to direction of flow -- dialogue, or two-way interaction, versus monologue, or one-way communication -- and that of intent -- exchange versus persuasion. The findings and recommendations are synthesized and related to risk events for the CSEPP as posited in the scenarios.« less

Outpatient Antibiotic Use and the Need for Increased Antibiotic Stewardship Efforts.

PubMed

Zetts, Rachel M; Stoesz, Andrea; Smith, Brian A; Hyun, David Y

2018-06-01

Antibiotic-resistant infections pose a growing threat to public health. Antibiotic use, regardless of whether it is warranted, is a primary factor in the development of resistance. In the United States, the majority of antibiotic health care expenditures are due to prescribing in outpatient settings. Much of this prescribing is inappropriate, with research showing that at least 30% of antibiotic use in outpatient settings is unnecessary. In this State of the Art Review article, we provide an overview of the latest research on outpatient antibiotic prescribing practices in the United States. Although many of the researchers in these studies describe antibiotic prescribing across all patient age groups, we highlight prescribing in pediatric populations when data are available. We then describe the various factors that can influence a physician's prescribing decisions and drive inappropriate antibiotic use and the potential role of behavioral science in enhancing stewardship interventions to address these drivers. Finally, we highlight the role that a wide range of health care stakeholders can play in aiding the expansion of outpatient stewardship efforts that are needed to fully address the threat of antibiotic resistance. Copyright © 2018 by the American Academy of Pediatrics.

A Long History of Supercomputing

ScienceCinema

Grider, Gary

2018-06-13

As part of its national security science mission, Los Alamos National Laboratory and HPC have a long, entwined history dating back to the earliest days of computing. From bringing the first problem to the nation’s first computer to building the first machine to break the petaflop barrier, Los Alamos holds many “firsts” in HPC breakthroughs. Today, supercomputers are integral to stockpile stewardship and the Laboratory continues to work with vendors in developing the future of HPC.

Evaluation of Antimicrobial Stewardship-Related Alerts Using a Clinical Decision Support System.

PubMed

Ghamrawi, Riane J; Kantorovich, Alexander; Bauer, Seth R; Pallotta, Andrea M; Sekeres, Jennifer K; Gordon, Steven M; Neuner, Elizabeth A

2017-11-01

Background: Information technology, including clinical decision support systems (CDSS), have an increasingly important and growing role in identifying opportunities for antimicrobial stewardship-related interventions. Objective: The aim of this study was to describe and compare types and outcomes of CDSS-built antimicrobial stewardship alerts. Methods: Fifteen alerts were evaluated in the initial antimicrobial stewardship program (ASP) review. Preimplementation, alerts were reviewed retrospectively. Postimplementation, alerts were reviewed in real-time. Data collection included total number of actionable alerts, recommendation acceptance rates, and time spent on each alert. Time to de-escalation to narrower spectrum agents was collected. Results: In total, 749 alerts were evaluated. Overall, 306 (41%) alerts were actionable (173 preimplementation, 133 postimplementation). Rates of actionable alerts were similar for custom-built and prebuilt alert types (39% [53 of 135] vs 41% [253 of 614], P = .68]. In the postimplementation group, an intervention was attempted in 97% of actionable alerts and 70% of interventions were accepted. The median time spent per alert was 7 minutes (interquartile range [IQR], 5-13 minutes; 15 [12-17] minutes for actionable alerts vs 6 [5-7] minutes for nonactionable alerts, P < .001). In cases where the antimicrobial was eventually de-escalated, the median time to de-escalation was 28.8 hours (95% confidence interval [CI], 10.0-69.1 hours) preimplementation vs 4.7 hours (95% CI, 2.4-22.1 hours) postimplementation, P < .001. Conclusions: CDSS have played an important role in ASPs to help identify opportunities to optimize antimicrobial use through prebuilt and custom-built alerts. As ASP roles continue to expand, focusing time on customizing institution specific alerts will be of vital importance to help redistribute time needed to manage other ASP tasks and opportunities.

Strategic Plan for Sustainable Energy Management and Environmental Stewardship for Los Angeles Unified School District

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walker, A.; Beattie, D.; Thomas, K.

2007-11-01

This Strategic Plan for Sustainable Energy Management and Environmental Stewardship states goals, measures progress toward goals and how actions are monitored to achieve continuous improvement for the Los Angeles Unified School District.

Fit Assessment of N95 Filtering-Facepiece Respirators in the U.S. Centers for Disease Control and Prevention Strategic National Stockpile.

PubMed

Bergman, Michael; Zhuang, Ziqing; Brochu, Elizabeth; Palmiero, Andrew

National Institute for Occupational Safety and Health (NIOSH)-approved N95 filtering-facepiece respirators (FFR) are currently stockpiled by the U.S. Centers for Disease Control and Prevention (CDC) for emergency deployment to healthcare facilities in the event of a widespread emergency such as an influenza pandemic. This study assessed the fit of N95 FFRs purchased for the CDC Strategic National Stockpile. The study addresses the question of whether the fit achieved by specific respirator sizes relates to facial size categories as defined by two NIOSH fit test panels. Fit test data were analyzed from 229 test subjects who performed a nine-donning fit test on seven N95 FFR models using a quantitative fit test protocol. An initial respirator model selection process was used to determine if the subject could achieve an adequate fit on a particular model; subjects then tested the adequately fitting model for the nine-donning fit test. Only data for models which provided an adequate initial fit (through the model selection process) for a subject were analyzed for this study. For the nine-donning fit test, six of the seven respirator models accommodated the fit of subjects (as indicated by geometric mean fit factor > 100) for not only the intended NIOSH bivariate and PCA panel sizes corresponding to the respirator size, but also for other panel sizes which were tested for each model. The model which showed poor performance may not be accurately represented because only two subjects passed the initial selection criteria to use this model. Findings are supportive of the current selection of facial dimensions for the new NIOSH panels. The various FFR models selected for the CDC Strategic National Stockpile provide a range of sizing options to fit a variety of facial sizes.

Fit Assessment of N95 Filtering-Facepiece Respirators in the U.S. Centers for Disease Control and Prevention Strategic National Stockpile

PubMed Central

Bergman, Michael; Zhuang, Ziqing; Brochu, Elizabeth; Palmiero, Andrew

2016-01-01

National Institute for Occupational Safety and Health (NIOSH)-approved N95 filtering-facepiece respirators (FFR) are currently stockpiled by the U.S. Centers for Disease Control and Prevention (CDC) for emergency deployment to healthcare facilities in the event of a widespread emergency such as an influenza pandemic. This study assessed the fit of N95 FFRs purchased for the CDC Strategic National Stockpile. The study addresses the question of whether the fit achieved by specific respirator sizes relates to facial size categories as defined by two NIOSH fit test panels. Fit test data were analyzed from 229 test subjects who performed a nine-donning fit test on seven N95 FFR models using a quantitative fit test protocol. An initial respirator model selection process was used to determine if the subject could achieve an adequate fit on a particular model; subjects then tested the adequately fitting model for the nine-donning fit test. Only data for models which provided an adequate initial fit (through the model selection process) for a subject were analyzed for this study. For the nine-donning fit test, six of the seven respirator models accommodated the fit of subjects (as indicated by geometric mean fit factor > 100) for not only the intended NIOSH bivariate and PCA panel sizes corresponding to the respirator size, but also for other panel sizes which were tested for each model. The model which showed poor performance may not be accurately represented because only two subjects passed the initial selection criteria to use this model. Findings are supportive of the current selection of facial dimensions for the new NIOSH panels. The various FFR models selected for the CDC Strategic National Stockpile provide a range of sizing options to fit a variety of facial sizes. PMID:26877587

Between land and sea: divergent data stewardship practices in deep-sea biosphere research

NASA Astrophysics Data System (ADS)

Cummings, R.; Darch, P.

2013-12-01

Data in deep-sea biosphere research often live a double life. While the original data generated on IODP expeditions are highly structured, professionally curated, and widely shared, the downstream data practices of deep-sea biosphere laboratories are far more localized and ad hoc. These divergent data practices make it difficult to track the provenance of datasets from the cruise ships to the laboratory or to integrate IODP data with laboratory data. An in-depth study of the divergent data practices in deep-sea biosphere research allows us to: - Better understand the social and technical forces that shape data stewardship throughout the data lifecycle; - Develop policy, infrastructure, and best practices to improve data stewardship in small labs; - Track provenance of datasets from IODP cruises to labs and publications; - Create linkages between laboratory findings, cruise data, and IODP samples. In this paper, we present findings from the first year of a case study of the Center for Dark Energy Biosphere Investigations (C-DEBI), an NSF Science and Technology Center that studies life beneath the seafloor. Our methods include observation in laboratories, interviews, document analysis, and participation in scientific meetings. Our research uncovers the data stewardship norms of geologists, biologists, chemists, and hydrologists conducting multi-disciplinary research. Our research team found that data stewardship on cruises is a clearly defined task performed by an IODP curator, while downstream it is a distributed task that develops in response to local need and to the extent necessary for the immediate research team. IODP data are expensive to collect and challenging to obtain, often costing $50,000/day and requiring researchers to work twelve hours a day onboard the ships. To maximize this research investment, a highly trained IODP data curator controls data stewardship on the cruise and applies best practices such as standardized formats, proper labeling, and

Mapping Antimicrobial Stewardship in Undergraduate Medical, Dental, Pharmacy, Nursing and Veterinary Education in the United Kingdom.

PubMed

Castro-Sánchez, Enrique; Drumright, Lydia N; Gharbi, Myriam; Farrell, Susan; Holmes, Alison H

2016-01-01

To investigate the teaching of antimicrobial stewardship (AS) in undergraduate healthcare educational degree programmes in the United Kingdom (UK). Cross-sectional survey of undergraduate programmes in human and veterinary medicine, dentistry, pharmacy and nursing in the UK. The main outcome measures included prevalence of AS teaching; stewardship principles taught; estimated hours apportioned; mode of content delivery and teaching strategies; evaluation methodologies; and frequency of multidisciplinary learning. 80% (112/140) of programmes responded adequately. The majority of programmes teach AS principles (88/109, 80.7%). 'Adopting necessary infection prevention and control precautions' was the most frequently taught principle (83/88, 94.3%), followed by 'timely collection of microbiological samples for microscopy, culture and sensitivity' (73/88, 82.9%) and 'minimisation of unnecessary antimicrobial prescribing' (72/88, 81.8%). The 'use of intravenous administration only to patients who are severely ill, or unable to tolerate oral treatment' was reported in ~50% of courses. Only 32/88 (36.3%) programmes included all recommended principles. Antimicrobial stewardship principles are included in most undergraduate healthcare and veterinary degree programmes in the UK. However, future professionals responsible for using antimicrobials receive disparate education. Education may be boosted by standardisation and strengthening of less frequently discussed principles.

Mapping Antimicrobial Stewardship in Undergraduate Medical, Dental, Pharmacy, Nursing and Veterinary Education in the United Kingdom

PubMed Central

Castro-Sánchez, Enrique; Drumright, Lydia N.; Gharbi, Myriam; Farrell, Susan; Holmes, Alison H.

2016-01-01

Objectives To investigate the teaching of antimicrobial stewardship (AS) in undergraduate healthcare educational degree programmes in the United Kingdom (UK). Participants and Methods Cross-sectional survey of undergraduate programmes in human and veterinary medicine, dentistry, pharmacy and nursing in the UK. The main outcome measures included prevalence of AS teaching; stewardship principles taught; estimated hours apportioned; mode of content delivery and teaching strategies; evaluation methodologies; and frequency of multidisciplinary learning. Results 80% (112/140) of programmes responded adequately. The majority of programmes teach AS principles (88/109, 80.7%). ‘Adopting necessary infection prevention and control precautions’ was the most frequently taught principle (83/88, 94.3%), followed by 'timely collection of microbiological samples for microscopy, culture and sensitivity’ (73/88, 82.9%) and ‘minimisation of unnecessary antimicrobial prescribing’ (72/88, 81.8%). The ‘use of intravenous administration only to patients who are severely ill, or unable to tolerate oral treatment’ was reported in ~50% of courses. Only 32/88 (36.3%) programmes included all recommended principles. Discussion Antimicrobial stewardship principles are included in most undergraduate healthcare and veterinary degree programmes in the UK. However, future professionals responsible for using antimicrobials receive disparate education. Education may be boosted by standardisation and strengthening of less frequently discussed principles. PMID:26928009

Campaign Preparation for Complex Initiatives: A Person-Centered Approach to Audience Segmentation of Parents' Antibiotic Stewardship.

PubMed

Smith, Rachel A; MacGeorge, Erina L; Hackman, Nicole M; M'ikanatha, Nkuchia M

2017-10-25

The evolution of antibiotic resistance is outpacing the speed at which new antibiotics will reach the marketplace. To slow the rate of resistance, people need to engage in antibiotic stewardship, which includes acts to prevent the spread of bacteria and judicious use of antibiotics to treat infections. This study identified the patterns and predictors of antibiotic stewardship behaviors of parents (N = 516) related to their children. The latent class analysis revealed three profiles of parental stewardship, labeled Stewards, Requesters, and Non-Stewards. The findings implied different campaign goals: to encourage Stewards to follow through on their intentions, to encourage Requesters to stop asking providers for antibiotics when their children have ear infections, and to influence Non-Stewards to accept medical advice when an antibiotic is not indicated and to dispose of leftover antibiotics. The covariate analysis provided theoretical insight into the strategies to pursue in campaigns targeting these three groups. For example, parents who perceived antibiotic-resistant infections as less serious health conditions, felt less worry when thinking about their child getting an antibiotic-resistant infection, and had stronger misattributions of antibiotics' efficacy to treat multiple symptoms were more likely to be Requesters and Non-Stewards, instead of Stewards.

Antimicrobial Stewardship Among Hospitalized Patients with Influenza Respiratory Tract Infections

PubMed Central

Lindsay, Patrick; Taggart, Linda; Leung, Elizabeth; Havey, Thomas

2017-01-01

Abstract Background Overlap between Influenza and bacterial respiratory illnesses contributes to the inappropriate use of antibiotics. One major study from the United States suggests a significant number of patients are being treated with antibiotics inappropriately. This paper however, did not perform an intervention to evaluate whether an Antimicrobial Stewardship Program (ASP) is effective in decreasing inappropriate antibiotic use. Appropriate use of antibiotics in Influenza patients has not been formally assessed in Canadian healthcare systems. Given ASP’s have been shown to be effective in previous studies, an opportunity has arisen for implementation in the setting of antibiotics in patients with Influenza, which has not previously been studied Methods We retrospectively identified all adults admitted to hospital who tested positive for Influenza from January 2016 to January 2017. We assessed the appropriateness of antibiotic use during the patient’s admission, evaluating whether antibiotics have been used according to standard of care for community acquired pneumonia. Antibiotic use and length of duration pre and post Stewardship implementation will be analyzed. After data has been collected, the results of this retrospective cohort study will inform the implementation of an ASP Results Eighty-one patients recorded positive Influenza tests. Twenty-six were collected from ICU patients and were excluded. Mean time to diagnosis from swab collection and final diagnosis was 2.8 days. Of the 55 non-ICU patients, 13 (24%) patients were continued on antibiotics after the diagnosis of Influenza was confirmed, with an average of 4.7 days of antibiotic use. It was deemed that 9 of these patients were continued appropriately on antibiotics with 4 patients having CXR infiltrate, 4 patients immunocompromised and 1 blood culture positive with strep pneumonia. Four (8%) patients were treated inappropriately with antibiotics for >24 hours after positive Influenza

Evaluating environmental education, citizen science, and stewardship through naturalist programs.

PubMed

Merenlender, Adina M; Crall, Alycia W; Drill, Sabrina; Prysby, Michelle; Ballard, Heidi

2016-12-01

Amateur naturalists have played an important role in the study and conservation of nature since the 17th century. Today, naturalist groups make important contributions to bridge the gap between conservation science and practice around the world. We examined data from 2 regional naturalist programs to understand participant motivations, barriers, and perspectives as well as the actions they take to advance science, stewardship, and community engagement. These programs provide certification-based natural history and conservation science training for adults that is followed by volunteer service in citizen science, education, and stewardship. Studies in California and Virginia include quantitative and qualitative evaluation data collected through pre- and postcourse surveys, interviews, and long-term tracking of volunteer hours. Motivations of participants focused on learning about the local environment and plants and animals, connecting with nature, becoming certified, and spending time with people who have similar interests. Over half the participants surveyed were over 50 years old, two-thirds were women, and a majority reported household incomes of over $50,000 (60% in California, 85% in Virginia), and <20% of those surveyed in both states described themselves as nonwhite. Thus, these programs need to improve participation by a wider spectrum of the public. We interviewed younger and underrepresented adults to examine barriers to participation in citizen science. The primary barrier was lack of time due to the need to work and focus on career advancement. Survey data revealed that participants' ecological knowledge, scientific skills, and belief in their ability to address environmental issues increased after training. Documented conservation actions taken by the participants include invasive plant management, habitat restoration, and cleanups of natural areas and streams. Long-term data from Virginia on volunteer hours dedicated to environmental citizen science

Supporting Data Stewardship Throughout the Data Life Cycle in the Solid Earth Sciences

NASA Astrophysics Data System (ADS)

Ferrini, V.; Lehnert, K. A.; Carbotte, S. M.; Hsu, L.

2013-12-01

is based first and foremost on the scientific needs of its user community. As data stewardship becomes a more integral component of the scientific workflow, IEDA investigator support services (e.g. Data Management Plan Tool and Data Compliance Reporting Tool) continue to evolve with the goal of lessening the 'burden' of data management for individual investigators by increasing awareness and facilitating the adoption of data management practices. We will highlight a variety of IEDA system components that support investigators throughout the data life cycle, and will discuss lessons learned and future directions.

Antimicrobial Therapy for Legionnaire's Disease: Antibiotic Stewardship Implications.

PubMed

Cunha, Cheston B; Cunha, Burke A

2017-03-01

Legionnaire's disease is a common cause of community-acquired pneumonia (CAP). Although no single clinical feature is diagnostic, if characteristic extrapulmonary findings are present a presumptive clinical syndromic diagnosis is possible. Depending on geographic location, season, and physician awareness, Legionnaire's disease may be included in the differential diagnosis of CAP. Some antibiotics effective against Legionella sp are also effective in treating the typical bacterial causes of CAP. From an antimicrobial stewardship program (ASP) perspective, monotherapy is preferred to double-drug therapy. From an ASP and pharmacoeconomic standpoint, monotherapy with doxycycline or a respiratory quinolone provides optimal cost effective therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.

PubMed

Baur, David; Gladstone, Beryl Primrose; Burkert, Francesco; Carrara, Elena; Foschi, Federico; Döbele, Stefanie; Tacconelli, Evelina

2017-09-01

Antibiotic stewardship programmes have been shown to reduce antibiotic use and hospital costs. We aimed to evaluate evidence of the effect of antibiotic stewardship on the incidence of infections and colonisation with antibiotic-resistant bacteria. For this systematic review and meta-analysis, we searched PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published from Jan 1, 1960, to May 31, 2016, that analysed the effect of antibiotic stewardship programmes on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infections in hospital inpatients. Two authors independently assessed the eligibility of trials and extracted data. Studies involving long-term care facilities were excluded. The main outcomes were incidence ratios (IRs) of target infections and colonisation per 1000 patient-days before and after implementation of antibiotic stewardship. Meta-analyses were done with random-effect models and heterogeneity was calculated with the I 2 method. We included 32 studies in the meta-analysis, comprising 9 056 241 patient-days and 159 estimates of IRs. Antibiotic stewardship programmes reduced the incidence of infections and colonisation with multidrug-resistant Gram-negative bacteria (51% reduction; IR 0·49, 95% CI 0·35-0·68; p<0·0001), extended-spectrum β-lactamase-producing Gram-negative bacteria (48%; 0·52, 0·27-0·98; p=0·0428), and meticillin-resistant Staphylococcus aureus (37%; 0·63, 0·45-0·88; p=0·0065), as well as the incidence of C difficile infections (32%; 0·68, 0·53-0·88; p=0·0029). Antibiotic stewardship programmes were more effective when implemented with infection control measures (IR 0·69, 0·54-0·88; p=0·0030), especially hand-hygiene interventions (0·34, 0·21-0·54; p<0·0001), than when implemented alone. Antibiotic stewardship did not affect the IRs of vancomycin

Chemical Stockpile Disposal Program. Risk Analysis of the Disposal of Chemical Munitions at Regional or National Sites.

DTIC Science & Technology

1987-08-01

THE DISPOSAL OF CNEM.. CU) GA TECHNOLOGIES INC SRN DIEGO CA A H SARSELL ET AL. RUG 97 GA-C- i @563 UNLRSS FIED S APEO-CDE-IS- 9 ?SIGDRAA±5-85-D-822...F/ 15/.3 NL I ihhhhhhhhhhhhlm I fflfflffllfllfllfllf smhhhhhhhhhhh ~1.02 U.,5 A I *Pig- FiLE copy CHEMICAL STOCKPILE DISPOSAL PROGRAM RISK ANALYSIS...vr~. ’ . - a ’ a’ ’- . ,I1 - .V [ N- VW; W UU V. , U .U : , r ,,, - . ..... . SECURITY CLASSIFICATION OF THIS PAGE IM : I omApproved

Impact of an antimicrobial stewardship intervention on appropriateness of prescribing for community-acquired pneumonia in an Australian regional hospital.

PubMed

Bond, Stuart E; Boutlis, Craig S; Yeo, Wilfred W; Miyakis, Spiros

2017-05-01

Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral hospital comparing management of adult patients with CAP before and after an educational intervention. We demonstrated a reduction in duration of therapy and reduced inappropriate use of ceftriaxone-based regimens for non-severe CAP. © 2017 Royal Australasian College of Physicians.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chrzanowski, P; Walter, K

For the Laboratory and staff, 2006 was a year of outstanding achievements. As our many accomplishments in this annual report illustrate, the Laboratory's focus on important problems that affect our nation's security and our researchers breakthroughs in science and technology have led to major successes. As a national laboratory that is part of the Department of Energy's National Nuclear Security Administration (DOE/NNSA), Livermore is a key contributor to the Stockpile Stewardship Program for maintaining the safety, security, and reliability of the nation's nuclear weapons stockpile. The program has been highly successful, and our annual report features some of the Laboratory'smore » significant stockpile stewardship accomplishments in 2006. A notable example is a long-term study with Los Alamos National Laboratory, which found that weapon pit performance will not sharply degrade from the aging effects on plutonium. The conclusion was based on a wide range of nonnuclear experiments, detailed simulations, theoretical advances, and thorough analyses of the results of past nuclear tests. The study was a superb scientific effort. The continuing success of stockpile stewardship enabled NNSA in 2006 to lay out Complex 2030, a vision for a transformed nuclear weapons complex that is more responsive, cost efficient, and highly secure. One of the ways our Laboratory will help lead this transformation is through the design and development of reliable replacement warheads (RRWs). Compared to current designs, these warheads would have enhanced performance margins and security features and would be less costly to manufacture and maintain in a smaller, modernized production complex. In early 2007, NNSA selected Lawrence Livermore and Sandia National Laboratories-California to develop ''RRW-1'' for the U.S. Navy. Design efforts for the RRW, the plutonium aging work, and many other stockpile stewardship accomplishments rely on computer simulations performed on NNSA's Advanced

Long-Term Outcomes of an Antimicrobial Stewardship Program Implemented in a Hospital with Low Baseline Antibiotic Use

PubMed Central

Jenkins, Timothy C.; Knepper, Bryan C.; Shihadeh, Katherine; Haas, Michelle K.; Sabel, Allison L.; Steele, Andrew W.; Wilson, Michael L.; Price, Connie S.; Burman, William J.; Mehler, Philip S.

2016-01-01

Objective To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use Design Quasi-experimental, interrupted-time series study Setting 525-bed public safety-net hospital Intervention Implementation of a formal ASP in July 2008 Methods We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008 – September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005 – June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset C. difficile infection, and other patient-centered measures. Results During the preintervention period, total antibacterial and antipseudomonal use were declining (−9.2 and −5.5 DOT/1000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (−3.7 and −2.2 DOT/1000 PD, respectively), resulting in a slope change of 5.5 DOT/1000 PD per quarter for total antibacterial use (P = .10) and 3.3 DOT/100 PD per quarter for antipseudomonal use (P = .01). Antibiotic expenditures declined markedly during the stewardship period (−$295.42/1000PD per quarter, p=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. Conclusion In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures; however, this study highlights limitations of commonly used stewardship outcome measures. PMID:25740560

Science and Technology Review June 2000

DOE Office of Scientific and Technical Information (OSTI.GOV)

de Pruneda, J.H.

2000-06-01

This issue contains the following articles: (1) ''Accelerating on the ASCI Challenge''. (2) ''New Day Daws in Supercomputing'' When the ASCI White supercomputer comes online this summer, DOE's Stockpile Stewardship Program will make another significant advanced toward helping to ensure the safety, reliability, and performance of the nation's nuclear weapons. (3) ''Uncovering the Secrets of Actinides'' Researchers are obtaining fundamental information about the actinides, a group of elements with a key role in nuclear weapons and fuels. (4) ''A Predictable Structure for Aerogels''. (5) ''Tibet--Where Continents Collide''.

Lawrence Livermore National Laboratories Perspective on Code Development and High Performance Computing Resources in Support of the National HED/ICF Effort

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clouse, C. J.; Edwards, M. J.; McCoy, M. G.

2015-07-07

Through its Advanced Scientific Computing (ASC) and Inertial Confinement Fusion (ICF) code development efforts, Lawrence Livermore National Laboratory (LLNL) provides a world leading numerical simulation capability for the National HED/ICF program in support of the Stockpile Stewardship Program (SSP). In addition the ASC effort provides high performance computing platform capabilities upon which these codes are run. LLNL remains committed to, and will work with, the national HED/ICF program community to help insure numerical simulation needs are met and to make those capabilities available, consistent with programmatic priorities and available resources.

Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care.

PubMed

Wu, Lisa Dong-Ying; Walker, Sandra A N; Elligsen, Marion; Palmay, Lesley; Simor, Andrew; Daneman, Nick

2015-01-01

Antimicrobial stewardship may be important in long-term care facilities because of unnecessary or inappropriate antibiotic use observed in these residents, coupled with their increased vulnerability to health care-associated infections. To assess antibiotic use in a long-term care facility in order to identify potential antimicrobial stewardship needs. A retrospective descriptive study was conducted at the Veterans Centre, a long-term care facility at Sunnybrook Health Sciences Centre, Toronto, Ontario. All residents taking one or more antibiotics (n = 326) were included as participants. Antibiotic-use data for patients residing in the facility between April 1, 2011, and March 31, 2012, were collected and analyzed. Totals of 358 patient encounters, 835 antibiotic prescriptions, and 193 positive culture results were documented during the study period. For 36% (302/835) of antibiotic prescriptions, the duration was more than 7 days. Cephalosporins (30%; 251/835) and fluoroquinolones (28%; 235/835) were the most frequently prescribed antibiotic classes. Urine was the most common source of samples for culture (60%; 116/193). Characteristics of antimicrobial use at this long-term care facility that might benefit from further evaluation included potentially excessive use of fluoroquinolones and cephalosporins and potentially excessive duration of antibiotic use for individual patients.

Antimicrobial stewardship: English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR).

PubMed

Ashiru-Oredope, Diane; Hopkins, Susan

2013-11-01

The clinical, public health and economic implications of antimicrobial resistance present a major threat to future healthcare. Antimicrobial use is a major driver of resistance, and antimicrobial stewardship programmes are increasingly being advocated as a means of improving the quality of prescribing. However, to increase their impact and assess their success, a better understanding of antimicrobial usage, both in primary and secondary care, and linkage with antimicrobial resistance data are required. In England, national summaries of primary care dispensing data are issued annually by the Health and Social Care Information Centre. However, there is currently no routine public reporting of antimicrobial usage in hospitals. In response to the threat posed by antimicrobial resistance, as highlighted in the Report of the Chief Medical Officer and on the request of the Department of Health, Public Health England has developed a new national programme, the English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). The programme will bring together the elements of antimicrobial utilization and resistance surveillance in both primary and secondary care settings, alongside the development of quality measures and methods to monitor unintended outcomes of antimicrobial stewardship and both public and professional behaviour interventions. This article reports on the background to the programme development, the current oversight group membership and the public reporting structure.

Association of Inpatient Antimicrobial Utilization Measures with Antimicrobial Stewardship Activities and Facility Characteristics of Veterans Affairs Medical Centers.

PubMed

Graber, Christopher J; Jones, Makoto M; Chou, Ann F; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew H; Glassman, Peter A

2017-05-01

Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012. In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals. From the survey, we identified 34 variables across 3 domains (evidence, organizational context, and facilitation) that were assessed using multivariable least absolute shrinkage and selection operator regression against 4 antimicrobial utilization measures from 2012: aggregate acute care antimicrobial use, antimicrobial use in patients with non-infectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and double anaerobic coverage. All 130 VA facilities with acute care services. Variables associated with at least 3 favorable changes in antimicrobial utilization included presence of postgraduate physician/pharmacy training programs, number of antimicrobial-specific order sets, frequency of systematic de-escalation review, presence of pharmacists and/or infectious diseases (ID) attendings on acute care ward teams, and formal ID training of the lead ASP pharmacist. Variables associated with 2 unfavorable measures included bed size, the level of engagement with VA Antimicrobial Stewardship Task Force online resources, and utilization of antimicrobial stop orders. Formalization of ASP processes and presence of pharmacy and ID expertise are associated with favorable utilization. Systematic de-escalation review and order set establishment may be high-yield interventions. Journal of Hospital Medicine 2017;12:301-309. © 2017 Society of Hospital Medicine

The Critical Role of Stewardship in Fund Raising: The Coaches vs. Cancer Campaign.

ERIC Educational Resources Information Center

Worley, Debra A.; Little, Jennifer K.

2002-01-01

Examines the critical role of stewardship in the process of fund raising. Uses the Coaches vs. Cancer campaign to illustrate the limitations of the public relations ROPE (research, objectives, planning, and evaluation) model in explaining fund raising success, and supports K.S. Kelly's contention that addition of a fifth step to the model, the…

Stockpiled pre-pandemic H5N1 influenza virus vaccines with AS03 adjuvant provide cross-protection from H5N2 clade 2.3.4.4 virus challenge in ferrets

PubMed Central

Sun, Xiangjie; Belser, Jessica A.; Pulit-Penaloza, Joanna A.; Creager, Hannah M.; Guo, Zhu; Jefferson, Stacie N.; Liu, Feng; York, Ian A.; Stevens, James; Maines, Taronna R.; Jernigan, Daniel B.; Katz, Jacqueline M.; Levine, Min Z.; Tumpey, Terrence M.

2018-01-01

Avian influenza viruses, notably H5 subtype viruses, pose a continuous threat to public health due to their pandemic potential. In recent years, influenza virus H5 subtype split vaccines with novel oil-in-water emulsion based adjuvants (e.g. AS03, MF59) have been shown to be safe, immunogenic, and able to induce broad immune responses in clinical trials, providing strong scientific support for vaccine stockpiling. However, whether such vaccines can provide protection from infection with emerging, antigenically distinct clades of H5 viruses has not been adequately addressed. Here, we selected two AS03-adjuvanted H5N1 vaccines from the US national prepandemic influenza vaccine stockpile and assessed whether the 2004–05 vaccines could provide protection against a 2014 highly pathogenic avian influenza (HPAI) H5N2 virus (A/northern pintail/Washington/40964/2014), a clade 2.3.4.4 virus responsible for mass culling of poultry in North America. Ferrets received two doses of adjuvanted vaccine containing 7.5 μg of hemagglutinin (HA) from A/Vietnam/1203/2004 (clade 1) or A/Anhui/1/2005 (clade 2.3.4) virus either in a homologous or heterologous prime-boost vaccination regime. We found that both vaccination regimens elicited robust antibody responses against the 2004–05 vaccine viruses and could reduce virus-induced morbidity and viral replication in the lower respiratory tract upon heterologous challenge despite the low level of cross-reactive antibody titers to the challenge H5N2 virus. This study supports the value of existing stockpiled 2004–05 influenza H5N1 vaccines, combined with AS03-adjuvant for early use in the event of an emerging pandemic with H5N2-like clade 2.3.4.4 viruses. PMID:28554058

Performance of beef cows and calves fed different sources of rumen-degradable protein when grazing stockpiled limpograss pastures.

PubMed

Aguiar, A D; Vendramini, J M B; Arthington, J D; Sollenberger, L E; DiLorenzo, N; Hersom, M J

2015-04-01

/100 mol) as well as branched-chain VFA (1.3 ± 2.2 mol/100 mol) concentrations in the rumen. In addition, there was no difference (P = 0.91) in PUN (7.9 ± 0.3 mg/dL) concentration between treatments. Therefore, urea can be as effective as CSM as the main source of RDP in the molasses-based supplement offered to mature lactating beef cows grazing stockpiled limpograss pastures.

Use of PNA FISH for blood cultures growing Gram-positive cocci in chains without a concomitant antibiotic stewardship intervention does not improve time to appropriate antibiotic therapy.

PubMed

Cosgrove, Sara E; Li, David X; Tamma, Pranita D; Avdic, Edina; Hadhazy, Eric; Wakefield, Teresa; Gherna, Michael; Carroll, Karen C

2016-09-01

Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) is a rapid diagnostic assay that can identify certain organisms growing in blood cultures 30-90 min from the time of positive Gram-stain. Existing studies have demonstrated a clinical utility with this assay when antibiotic stewardship programs assist clinicians with interpreting the results. However, the benefit of these rapid assays in the absence of concomitant antibiotic stewardship involvement is unclear. In this randomized study of 220 patients with enterococcal or streptococcal bacteremia, we found that PNA FISH, in the absence of concomitant input from an antibiotic stewardship program, had no impact on time to effective or optimal therapy, length of hospital stay, or in-hospital mortality. Our results suggest that in the absence of guidance from an antibiotic stewardship program, the clinical benefits of rapid diagnostic microbiological tools may be reduced. Copyright © 2016 Elsevier Inc. All rights reserved.

Stewardship of Integrity in Scientific Communication.

PubMed

Albertine, Kurt H

2018-06-14

Integrity in the pursuit of discovery through application of the scientific method and reporting the results is an obligation for each of us as scientists. We cannot let the value of science be diminished because discovering knowledge is vital to understand ourselves and our impacts on the earth. We support the value of science by our stewardship of integrity in the conduct, training, reporting, and proposing of scientific investigation. The players who have these responsibilities are authors, reviewers, editors, and readers. Each role has to be played with vigilance for ethical behavior, including compliance with regulations for protections of study subjects, use of select agents and biohazards, regulations of use of stem cells, resource sharing, posting datasets to public repositories, etc. The positive take-home message is that the scientific community is taking steps in behavior to protect the integrity of science. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

Lab interdependencies and the advanced design and production technologies (ADaPT) initiative

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hayes, D.

1995-10-01

I am delighted to be here today. I was left with a very strong impression this morning about the large degree of integration that has been achieved in the science-based stockpile stewardship program in the last year. When Vic Reis convened this program last February, many of you same people from Energy Research, Defense Programs, and the external community were there. We talked about areas of investments: in credible capability and industrial interaction, the impact on the research community, and so on. The product was the published quality function deployment chart. The activities on the chart were important, but theymore » did not have coherence. In listening to the presentations this morning, particularly the last four, I hear a high degree of coherence and integration, which is very pleasing.« less

Teacher Candidates' Perceptions of the Emphasis on Stewardship in Their Initial Teacher Licensure Program

ERIC Educational Resources Information Center

Yontz, Brian David

2010-01-01

The stewardship of schools is central to the renewal and preservation of that which is precious in our nation's schools. This study examined perceptions of future teachers as to the degree to which their teacher preparation program emphasized the idea of stewarding schools. With a theoretical foundation that initial teacher preparation provides…

Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals: The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) Participatory Intervention Study.

PubMed

Sikkens, Jonne J; van Agtmael, Michiel A; Peters, Edgar J G; Lettinga, Kamilla D; van der Kuip, Martijn; Vandenbroucke-Grauls, Christina M J E; Wagner, Cordula; Kramer, Mark H H

2017-08-01

Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. We offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing. Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time. A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531

Aspen's Global 100: Beyond Grey Pinstripes 2009-2010--Preparing MBAs for Social and Environmental Stewardship

ERIC Educational Resources Information Center

Aspen Institute, 2009

2009-01-01

Beyond Grey Pinstripes is a research survey and alternative ranking of business schools that spotlights innovative full-time MBA programs leading the way in integrating social and environmental stewardship into their curriculum and scholarly research. These schools are preparing today's students--tomorrow's leaders--for future market realities by…

Effectiveness of landowner assistance activities: an examination of the USDA Forest Service's Forest Stewardship Program

Treesearch

Brett J. Butler; Marla Markowski-Lindsay; Stephanie Snyder; Paul Catanzaro; David B. Kittredge; Kyle Andrejczyk; Brenton J. Dickinson; Derya Eryilmaz; Jaketon H. Hewes; Paula Randler; Donna Tadle; Michael A. Kilgore

2014-01-01

The USDA Forest Service's Forest Stewardship Program (FSP) is the nation's most prominent private forestry assistance program. We examined the FSP using a multiple analytic approach: analysis of annual FSP accomplishments, survey of state FSP coordinators, analytic comparison of family forest owners receiving and not receiving forestry practice assistance,...

Science and stewardship to protect and sustain wilderness values: Eighth World Wilderness Congress symposium

Treesearch

Alan Watson; Janet Sproull; Liese Dean

2007-01-01

The Eighth World Wilderness Congress met in Anchorage, Alaska, in 2005. The symposium on science and stewardship to protect and sustain wilderness values was the largest of multiple symposia held in conjunction with the Congress. The papers contained in this proceedings were generated at this symposium, submitted by the author or authors for consideration for inclusion...

Antimicrobial Stewardship in the Emergency Department and Guidelines for Development

PubMed Central

May, Larissa; Cosgrove, Sara; L’Archeveque, Michelle; Talan, David A.; Payne, Perry; Rothman, Richard E.

2013-01-01

Antimicrobial resistance is a mounting public health concern. Emergency departments (EDs) represent a particularly important setting for addressing inappropriate antimicrobial prescribing practices, given the frequent use of antibiotics in this setting that sits at the interface of the community and the hospital. This article outlines the importance of antimicrobial stewardship in the ED setting and provides practical recommendations drawn from existing evidence for the application of various strategies and tools that could be implemented in the ED including advancement of clinical guidelines, clinical decision support systems, rapid diagnostics, and expansion of ED pharmacist programs. PMID:23122955

Analysis of S.139, the Climate Stewardship Act of 2003

EIA Publications

2003-01-01

On January 9, 2003, Senators John McCain and Joseph I. Lieberman introduced Senate Bill 139 (S.139), the Climate Stewardship Act of 2003, in the U.S. Senate. S.139 would require the Administrator of the U.S. Environmental Protection Agency (EPA) to promulgate regulations to limit greenhouse gas emissions. On January 28, 2003, Senator James M. Inhofe requested that the Energy Information Administration (EIA) perform a comprehensive analysis of S.139. On April 2, 2003, Senators McCain and Lieberman, cosponsors of S.139, made a further request for analyses of their bill. This Service Report responds to both requests.

Aquaculture and environmental stewardship: Milford shellfish biology seminar—1991

NASA Astrophysics Data System (ADS)

Blogoslawski, Walter J.

1992-07-01

For the past 11 years the annual Shellfish Biology Seminar at Milford CT has provided a unique forum for aquaculture scientists and industry officials to exchange information about estuaries facing increased pollution problems, especially Long Island Sound and the Great South Bay. Because these two areas are so rich in productivity and diversity, fish and shellfish farmers utilize their waters, shellfish beds, and shore land for hatcheries and grow-out facilities. These individuals seek better management of the coastal estuarine environment and its resources, providing a working example of environmental stewardship. In aquaculture, good science is required to understand the complex variables and interaction of estuarine currents, tides, temperature, and cycles of reproduction. Aquaculturists are beginning to understand the need for specific nutrients and how the wastes of one species can be utilized for enhanced production of another species. Over the years, this meeting has formed an amalgam of both the aquaculture industry and research scientists where both groups foster mutual environmental concern. Science is able to focus on the theoretical aspects of pollutant damage. while the aquaculture industry is able to define the problem and need for assistance to eliminate pollutants from their crops—shellfish and finfish. Overfishing is not an issue at these meetings, as the group accepts the damage already done to wild resources and seeks new technologies to grow food sources under controlled and stable market conditions. Therefore, it could be said that the seminar serves as a meeting ground where the theoretical knowledge of scientific study finds practical application in the industry and is fueled by the needs of that industry. This ideal blend of the two groups produces better management of the resource and a safer environment—the goal of stewardship.

The effectiveness of agricultural stewardship for improving water quality at the catchment scale: Experiences from an NVZ and ECSFDI watershed

NASA Astrophysics Data System (ADS)

Kay, Paul; Grayson, Richard; Phillips, Martin; Stanley, Karen; Dodsworth, Alan; Hanson, Ann; Walker, Andrew; Foulger, Miles; McDonnell, Iain; Taylor, Simon

2012-02-01

SummaryAgriculture is estimated to be responsible for 70% of nitrate and 30-50% of phosphorus pollution, contributing to ecological and water treatment problems. Despite the fact that significant gaps remain in our understanding, it is known that agricultural stewardship can be highly effective in controlling water pollution at the plot and field scales. Knowledge at the catchment scale is, to a large extent, entirely lacking though and this is of paramount concern given that the catchment is the management unit used by regulatory authorities. The few studies that have examined the impact of agricultural stewardship at the catchment scale have found that Nitrate Vulnerable Zones (NVZs) in the UK have resulted in little improvement in water quality which concurs with the current catchment study. In addition to NVZs, there was little evidence to suggest that the England Catchment Sensitive Farming Delivery Initiative had impacted water quality and suggestions have been made for improvements, such as ensuring that stewardship measures are used in key pollution source areas and their implementation and impacts are monitored more closely. This will be essential if agricultural catchment management schemes are going to provide the benefits expected of them. Nevertheless, more intensive monitoring than that carried out by regulators showed a significant trend in decreasing winter nitrate peaks in some streams which is hypothesised to be due to recent reduced inorganic fertiliser application as a result of increasing prices. It was concluded that, collectively, these findings indicate that agricultural stewardship measures have the potential to improve water quality at the catchment scale but that voluntary schemes with insufficient financial reward or regulatory pressure are unlikely to be successful.

Fighting antibiotic resistance in Portuguese hospitals: Understanding antibiotic prescription behaviours to better design antibiotic stewardship programmes.

PubMed

Simões, Alexandra S; Alves, Daniela A; Gregório, João; Couto, Isabel; Dias, Sónia; Póvoa, Pedro; Viveiros, Miguel; Gonçalves, Luzia; Lapão, Luís V

2018-06-01

Since physicians play an important role in antibiotic usage, it is vital to understand their antibiotic-prescribing behaviour and knowledge on antimicrobial resistance in order to develop and implement effective antibiotic stewardship interventions. The aim of this study was to evaluate Portuguese physicians' knowledge and to understand prescription behaviours, difficulties and barriers in their antibiotic prescription process in order to promote better and well-adapted antibiotic stewardship policies. This study was conducted in 2016 using a self-administered questionnaire to physicians in two tertiary public hospitals from two different regions in Portugal. Participating physicians [response rate 47.6% (30/63)] identified antibiotic resistance as a global problem; however, one-third did not recognise antibiotic resistance as a major problem on their own hospital. Factors that most influenced antibiotic prescription were 'microbiology laboratory results', 'patient clinical situation' and patient 'co-morbidities'. On the other hand, 'colleagues' opinion' and 'costs control' were considered as less determining factors. Regarding difficulties and bottlenecks in the antibiotic prescription process, participant physicians reported 'lack of (or delayed) microbiological results' and 'no access to antibiotic susceptibility patterns' as major barriers. 'Education and training' was considered the most effective intervention to improve antibiotic prescription. These results suggest that the design and implementation of antibiotic stewardship interventions should provide better data management and sharing tools between physicians and the microbiology laboratory, especially through the creation of antimicrobial prescribing guidelines according to hospital epidemiology, and easy access to hospital antibiotic susceptibility patterns and epidemiological data. Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights

Environmental stewardship footprint research: linking human agency and ecosystem health in the Puget Sound region

Treesearch

Kathleen L. Wolf; Dale J. Blahna; Weston Brinkley; Michele Romolini

2013-01-01

Urbanization processes challenge ecosystem health in many metropolitan areas. New policy and program approaches are needed to restore and sustain natural systems as public agencies and organizations face greater demands and declining budgets. Environmental stewardship is an often overlooked intervention strategy, and the full potential of civic engagement by citizens...

Development and Validation of Two Scales to Measure Elaboration and Behaviors Associated with Stewardship in Children

ERIC Educational Resources Information Center

Vezeau, Susan Lynn; Powell, Robert B.; Stern, Marc J.; Moore, D. DeWayne; Wright, Brett A.

2017-01-01

This investigation examines the development of two scales that measure elaboration and behaviors associated with stewardship in children. The scales were developed using confirmatory factor analysis to investigate their construct validity, reliability, and psychometric properties. Results suggest that a second-order factor model structure provides…

Antimicrobial stewardship programs: how to start and steer a successful program.

PubMed

Drew, Richard H

2009-03-01

Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials by selecting the appropriate dose, duration, and route of administration. The appropriate use of antimicrobials has the potential to improve efficacy, reduce treatment-related costs, minimize drug-related adverse events, and limit the potential for emergence of antimicrobial resistance. To summarize ASP tactics that can improve the appropriate use of antimicrobials in the hospital setting. Several measures can be used to implement such programs and gain multidisciplinary support while addressing common barriers. Implementation of an ASP requires a multidisciplinary approach with an infectious diseases physician and a clinical pharmacist with infectious diseases training as its core team members. As identified by recently published guidelines, 2 proactive strategies for promoting antimicrobial stewardship include: (1) formulary restriction and pre-authorization, and (2) prospective audit with intervention and feedback. Other supplemental strategies involve education, guidelines and clinical pathways, antimicrobial order forms, de-escalation of therapy, intravenous-to-oral (IV-to-PO) switch therapy, and dose optimization. Several barriers exist to successful implementation of ASPs. These include obtaining adequate administrative support and compensation for team members. Gaining physician acceptance can also be challenging if there is a perceived loss of autonomy in clinical decision making. ASPs have the potential to reduce antimicrobial resistance, health care costs, and drug-related adverse events while improving clinical outcomes. The efforts and expense required to implement and maintain ASPs are more than justified given their potential benefits to both the hospital and the patient.

A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department.

PubMed

Losier, Mia; Ramsey, Tasha D; Wilby, Kyle John; Black, Emily K

2017-09-01

To improve antimicrobial utilization, development and implementation of antimicrobial stewardship programs in the emergency department (ED) has been recommended. The primary objective of this review was to characterize antimicrobial stewardship (AMS) in the ED and to identify interventions that improve patient outcomes or process of care and/or reduce consequences of antimicrobial use. This study was completed as a systematic review. The following databases were searched from inception through November, 2016: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Web of Science. Randomized controlled trials, nonrandomized controlled trials, controlled and uncontrolled before-and-after studies, interrupted time series studies, and repeated-measures studies evaluating AMS interventions in the ED were included in the review. Studies published in languages other than English were excluded. A total of 43 studies meeting inclusion criteria were identified from our search. Patient or provider education and guideline or clinical pathway implementation were the most commonly reported interventions. Few studies reported on audit and feedback, and no study evaluated preauthorization. Impact of interventions showed variable results. Where identified, benefits of AMS interventions primarily included improvement in delivery of care or a decrease in antimicrobial utilization; however, most studies were rated as having unclear or high risk of bias. AMS interventions in the ED may improve patient care. However, the optimal combination of interventions is unclear. Additional studies with more rigorous design evaluating core components of AMS programs, including prospective audit and feedback are needed.

Comparative Analysis of Sustainable Approaches and Systems for Scientific Data Stewardship

NASA Astrophysics Data System (ADS)

Downs, R. R.; Chen, R. S.

2012-12-01

Sustainable data systems are critical components of the cyberinfrastructure needed to provide long-term stewardship of scientific data, including Earth science data, throughout their entire life cycle. A variety of approaches may help ensure the sustainability of such systems, but these approaches must be able to survive the demands of competing priorities and decreasing budgets. Analyzing and comparing alternative approaches can identify viable aspects of each approach and inform decisions for developing, managing, and supporting the cyberinfrastructure needed to facilitate discovery, access, and analysis of data by future communities of users. A typology of sustainability approaches is proposed, and example use cases are offered for comparing the approaches over time. These examples demonstrate the potential strengths and weaknesses of each approach under various conditions and with regard to different objectives, e.g., open vs. limited access. By applying the results of these analyses to their particular circumstances, systems stakeholders can assess their options for a sustainable systems approach along with other metrics and identify alternative strategies to ensure the sustainability of the scientific data and information for which they are responsible. In addition, comparing sustainability approaches should inform the design of new systems and the improvement of existing systems to meet the needs for long-term stewardship of scientific data, and support education and workforce development efforts needed to ensure that the appropriate scientific and technical skills are available to operate and further develop sustainable cyberinfrastructure.

Keepers of Our Digital Future: An Assessment of the National Digital Stewardship Residencies, 2013-2016

ERIC Educational Resources Information Center

Mink, Meridith Beck

2016-01-01

In September 2015, the Institute of Museum and Library Services (IMLS) awarded the Council on Library and Information Resources (CLIR) a grant to investigate the early impacts of the National Digital Stewardship Residency (NDSR) programs, in order to inform subsequent development of similar programs by others with a vested interest in building…

Guiding concepts for park and wilderness stewardship in an era of global environmental change

Treesearch

Richard J. Hobbs; David N. Cole; Laurie Yung; Erika S. Zavaleta; Gregory H. Aplet; F. Stuart Chapin; Peter B. Landres; David J. Parsons; Nathan L. Stephenson; Peter S. White; David M. Graber; Eric S. Higgs; Connie Millar; John M. Randall; Kathy A. Tonnessen; Stephen Woodley

2010-01-01

The major challenge to stewardship of protected areas is to decide where, when, and how to intervene in physical and biological processes, to conserve what we value in these places. To make such decisions, planners and managers must articulate more clearly the purposes of parks, what is valued, and what needs to be sustained. A key aim for conservation today is the...

National Pharmaceutical Stockpile drill analysis using XML data collection on wireless Java phones.

PubMed

Karras, B T; Huq, S Huq; Bliss, D; Lober, W B

2002-01-01

This study describes an informatics effort to track subjects through a National Pharmaceutical Stockpile (NPS) distribution drill. The drill took place in Seattle on 1/24/2002. Washington and the State Department of Health are among the first in the nation to stage a NPS drill testing the distribution of medications to mock patients, thereby testing the treatment capacity of the plan given a post-anthrax exposure scenario. The goal of the Public Health Informatics Group at the University of Washington (www.phig.washington.edu) was to use informatics approaches to monitor subject numbers and elapsed time. This study compares accuracy of time measurements using a mobile phone Java application to traditional paper recording in a live drill of the NPS. Pearson correlation = 1.0 in 2 of 3 stations. Differences in last station measurements can be explained by delay in recording of the exit time. We discuss development of the application itself and lessons learned. (MeSH Bioterrorism, Informatics, Public Health)

Impact of an antimicrobial stewardship program with multidisciplinary cooperation in a community public teaching hospital in Taiwan.

PubMed

Lin, Yu-Shiuan; Lin, I-Fen; Yen, Yung-Feng; Lin, Pei-Ching; Shiu, Yu-Chih; Hu, Hsing-Yi; Yang, Ying-Pi

2013-11-01

Reports of antimicrobial stewardship programs (ASPs) in community hospitals are limited, with the major focus on specific agents, small settings, or short time periods. Here we present the outcomes of cost control, consumption restraint, and quality of care after a 3-year multidisciplinary ASP in a 415-bed community public teaching hospital. Three strategies for improving antimicrobial stewardship were implemented: education, clinical pharmacists-based intervention, and regular outcome announcement. The steering panel of the program was a committee composed of infection specialists, attending physicians, clinical pharmacists, nurses, and medical laboratorists. Semiannual data from July 2009 to June 2012 was analyzed. Antibiotic costs declined from $21,464 to $12,146 per 1,000 patient-days (-43.4%). Approximately $2.5 million was saved in 3 years, and estimated labor cost was $3,935 per month. Defined daily dose per 1,000 patient-days were diminished from 906.7 to 717.5 (-20.9%). Significant reductions were found in the consumption of aminoglycosides, first-generation cephalosporins, and aminopenicillins. However, through comprehensive auditing, increasing consumption of fourth-generation cephalosporins and fluoroquinolones was noticed. No significant difference in the quality of care (ie, length of stay, incidence of health care associated infections, and mortality) was observed. The multidisciplinary ASP was beneficial to reduce antibiotic cost and consumption. The strategies were practical and worthy to be recommended to community health care settings. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jacobs, R

The Physics and Advanced Technologies (PAT) Directorate was created in July 2000 by Bruce Tarter, Director of Lawrence Livermore National Laboratory (LLNL). The Director called for the new organization to execute and support programs that apply cutting-edge physics and advanced technology to develop integrated solutions to problems in national security, fusion energy, information science, health care, and other national grand challenges. When I was appointed a year later as the PAT Directorate's first Associate Director, I initiated a strategic planning project to develop a vision, mission, and long-term goals for the Directorate. We adopted the goal of becoming a leadermore » in frontier physics and technology for twenty-first-century national security missions: Stockpile Stewardship, homeland security, energy independence, and the exploration of space. Our mission is to: (1) Help ensure the scientific excellence and vitality of the major LLNL programs through its leadership role in performing basic and applied multidisciplinary research and development with programmatic impact, and by recruiting and retaining science and technology leaders; (2) Create future opportunities and directions for LLNL and its major programs by growing new program areas and cutting-edge capabilities that are synergistic with, and supportive of, its national security mission; (3) Provide a direct conduit to the academic and high-tech industrial sectors for LLNL and its national security programs, through which the Laboratory gains access to frontier science and technology, and can impact the science and technology communities; (4) Leverage unique Laboratory capabilities, to advance the state universe. This inaugural PAT Annual Report begins a series that will chronicle our progress towards fulfilling this mission. I believe the report demonstrates that the PAT Directorate has a strong base of capabilities and accomplishments on which to build in meeting its goals. Some of the

Impact of an antiretroviral stewardship strategy on medication error rates.

PubMed

Shea, Katherine M; Hobbs, Athena Lv; Shumake, Jason D; Templet, Derek J; Padilla-Tolentino, Eimeira; Mondy, Kristin E

2018-05-02

The impact of an antiretroviral stewardship strategy on medication error rates was evaluated. This single-center, retrospective, comparative cohort study included patients at least 18 years of age infected with human immunodeficiency virus (HIV) who were receiving antiretrovirals and admitted to the hospital. A multicomponent approach was developed and implemented and included modifications to the order-entry and verification system, pharmacist education, and a pharmacist-led antiretroviral therapy checklist. Pharmacists performed prospective audits using the checklist at the time of order verification. To assess the impact of the intervention, a retrospective review was performed before and after implementation to assess antiretroviral errors. Totals of 208 and 24 errors were identified before and after the intervention, respectively, resulting in a significant reduction in the overall error rate ( p < 0.001). In the postintervention group, significantly lower medication error rates were found in both patient admissions containing at least 1 medication error ( p < 0.001) and those with 2 or more errors ( p < 0.001). Significant reductions were also identified in each error type, including incorrect/incomplete medication regimen, incorrect dosing regimen, incorrect renal dose adjustment, incorrect administration, and the presence of a major drug-drug interaction. A regression tree selected ritonavir as the only specific medication that best predicted more errors preintervention ( p < 0.001); however, no antiretrovirals reliably predicted errors postintervention. An antiretroviral stewardship strategy for hospitalized HIV patients including prospective audit by staff pharmacists through use of an antiretroviral medication therapy checklist at the time of order verification decreased error rates. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Nutrigenomics and the stewardship of scientific promises.

PubMed

Penders, Bart; Goven, Joanna

2010-09-01

Here we analyze the rise and establishment of nutrigenomics versus nutrition science from a political perspective. We argue that the exceptionalist status of nutrigenomics has been brought about by a carefully orchestrated economy of expectation, enabling the nutrigenomics community to develop its own research agenda that differs significantly from that of nutrition science. Nutrigenomics promotes research specifically directed towards the heterogeneity of dietary guidelines, while nutrition science pursues a public health goal dominated by homogeneous health messages. Through the development of genomic technology and the protective niche created by large global funding initiatives, this heterogeneity-research agenda has been able to develop itself. Those pursuing and supporting it have, through nutrigenomics' economy of expectation, influenced public opinion, and regulatory and political structures dealing with food and health. With many big global nutrigenomics initiatives slowly approaching their end, this article hints at some of the possible political consequences of its economy of expectation and suggests that a "stewardship" of promises and expectations is in order

Unmaking the bomb: Verifying limits on the stockpiles of nuclear weapons

NASA Astrophysics Data System (ADS)

Glaser, Alexander

2017-11-01

Verifying limits on the stockpiles of nuclear weapons may require the ability for international in-spectors to account for individual warheads, even when non-deployed, and to confirm the authenticity of nuclear warheads prior to dismantlement. These are fundamentally new challenges for nuclear verification, and they have been known for some time; unfortunately, due to a lack of sense of urgency, research in this area has not made substantial progress over the past 20 years. This chapter explores the central outstanding issues and offers a number of possible paths forward. In the case of confirming numerical limits, these in-clude innovative tagging techniques and approaches solely based on declarations using modern crypto-graphic escrow schemes; with regard to warhead confirmation, there has recently been increasing interest in developing fundamentally new measurement approaches where, in one form or another, sensitive infor-mation is not acquired in the first place. Overall, new international R&D efforts could more usefully focus on non-intrusive technologies and approaches, which may show more promise for early demonstration and adoption. In the meantime, while warhead dismantlements remain unverified, nuclear weapon states ought to begin to document warhead assembly, refurbishment, and dismantlement activities and movements of warheads and warhead components through the weapons complex in ways that international inspectors will find credible at a later time. Again, such a process could be enabled by modern cryptographic techniques such as blockchaining. Finally, and perhaps most importantly, it is important to recognize that the main reason for the complexity of technologies and approaches needed for nuclear disarmament verification is the requirement to protect information that nuclear weapon states consider sensitive. Ultimately, if information security concerns cannot be resolved to the satisfaction of all stakeholders, an alternative would be to "reveal the

Patient and public understanding and knowledge of antimicrobial resistance and stewardship in a UK hospital: should public campaigns change focus?

PubMed

Micallef, Christianne; Kildonaviciute, Kornelija; Castro-Sánchez, Enrique; Scibor-Stepien, Aleksandra; Santos, Reem; Aliyu, Sani H; Cooke, Fiona J; Pacey, Sarah; Holmes, Alison H; Enoch, David A

2017-01-01

The rising global tide of antimicrobial resistance is a well-described phenomenon. Employing effective and innovative antimicrobial stewardship strategies is an essential approach to combat this public health threat. Education of the public and patients is paramount to enable the success of such strategies. A panel of hospital multidisciplinary healthcare professionals was set up and a short quiz containing true/false statements around antimicrobial stewardship and resistance was designed and piloted. An educational leaflet with the correct replies and supporting information was also produced and disseminated. Participants were recruited on a single day (18 November 2015) from the hospital outpatient clinics and the hospital outpatient pharmacy waiting room. One hundred and forty-five completed quizzes were returned, providing a total of 1450 answers. Overall, 934 of 1450 (64%) statements were scored correctly whilst 481 (33%) were scored incorrectly; 35 (3%) statements were left unscored. We speculate that these results may demonstrate that respondents understood the statements, as only a small proportion of statements were left unanswered. The question dealing with the definition of antimicrobial resistance and the question dealing with the definition of antimicrobial stewardship obtained the most incorrect replies (85% and 72%, respectively). However, a specific factual recall question regarding only one microorganism (MRSA) received the most correct responses (99%). We describe a simple, innovative method of engagement with patients and the general public to help educate and disseminate important public health messages around antimicrobial resistance and stewardship. We also identified the need for public health campaigns to address the knowledge gaps found around this topic. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

A study on possible use of Urtica dioica (common nettle) plant as polonium (210)Po and lead (210)Pb contamination biomonitor in the area of phosphogypsum stockpile.

PubMed

Olszewski, Grzegorz; Boryło, Alicja; Skwarzec, Bogdan

2016-04-01

The aim of this study was to test a possible use of Urtica dioica (common nettle) plant as a biomonitor of polonium (210)Po and lead (210)Pb contamination near phosphogypsum stacks by determining concentrations of these radionuclides in samples collected from the area of phosphogypsum stockpile in Wiślinka (northern Poland). The (210)Po and (210)Pb contents in roots depended on their concentrations in soils. Bioconcentration factor values from soil to root of the plant did not depend on (210)Po and (210)Pb contents in soils that leads to the conclusion that different polonium and lead species have different affinities to U. dioica plants. The main sources of both analyzed radionuclides in green parts of plants are wet and dry air deposition and transportation from soil. The values of (210)Po/(210)Pb activity ratio indicate natural origin of these radioisotopes in analyzed plants. (210)Po and (210)Pb concentration in U. dioica roots is negatively weakly correlated with distance from phosphogypsum stockpile.

The global wilderness seminar for government agencies: a meeting at the crossroads of wildlands stewardship

Treesearch

Nancy Roeper; Peter Landres; Don Fisher

2006-01-01

Two days before the 8th World Wilderness Congress began in Alaska, nearly 200 government wildlands managers from 17 countries met to share ideas about common challenges and to explore ways to improve wildland stewardship globally. The goal for this Global Wilderness Seminar for Government Agencies was to lay the foundation for an operating peer network of government...

Considering a new domain for antimicrobial stewardship: Topical antibiotics in the open surgical wound.

PubMed

Edmiston, Charles E; Leaper, David; Spencer, Maureen; Truitt, Karen; Litz Fauerbach, Loretta; Graham, Denise; Johnson, Helen Boehm

2017-11-01

The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs (ASPs), which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread. Given the risks inherent in their use and the lack of evidence supporting it, the practice should be monitored as a core part of ASPs, and alternative agents, such as antiseptics, should be considered. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections

PubMed Central

Patel, Twisha S.; Kaakeh, Rola; Nagel, Jerod L.; Newton, Duane W.

2016-01-01

ABSTRACT Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions

Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections.

PubMed

Patel, Twisha S; Kaakeh, Rola; Nagel, Jerod L; Newton, Duane W; Stevenson, James G

2017-01-01

Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total

Mapping educational opportunities for healthcare workers on antimicrobial resistance and stewardship around the world.

PubMed

Rogers Van Katwyk, Susan; Jones, Sara L; Hoffman, Steven J

2018-02-05

Antimicrobial resistance is an important global issue facing society. Healthcare workers need to be engaged in solving this problem, as advocates for rational antimicrobial use, stewards of sustainable effectiveness, and educators of their patients. To fulfill this role, healthcare workers need access to training and educational resources on antimicrobial resistance. To better understand the resources available to healthcare workers, we undertook a global environmental scan of educational programs and resources targeting healthcare workers on the topic of antimicrobial resistance and antimicrobial stewardship. Programs were identified through contact with key experts, web searching, and academic literature searching. We summarized programs in tabular form, including participating organizations, region, and intended audience. We developed a coding system to classify programs by program type and participating organization type, assigning multiple codes as necessary and creating summary charts for program types, organization types, and intended audience to illustrate the breadth of available resources. We identified 94 educational initiatives related to antimicrobial resistance and antimicrobial stewardship, which represent a diverse array of programs including courses, workshops, conferences, guidelines, public outreach materials, and online-resource websites. These resources were developed by a combination of government bodies, professional societies, universities, non-profit and community organizations, hospitals and healthcare centers, and insurance companies and industry. Most programs either targeted healthcare workers collectively or specifically targeted physicians. A smaller number of programs were aimed at other healthcare worker groups including pharmacists, nurses, midwives, and healthcare students. Our environmental scan shows that there are many organizations working to develop and share educational resources for healthcare workers on antimicrobial

4-H and Forestry Afterschool Clubs: A Collaboration to Foster Stewardship Attitudes and Behaviors in Youth

ERIC Educational Resources Information Center

Gupta, Angela S.; Grant, Samantha; Strauss, Andrea Lorek

2012-01-01

The University of Minnesota Extension's 4-H and Forestry Afterschool program combined the 4-H structure and various forestry curricula to foster positive attitudes towards the environment and stewardship-related behaviors as these may serve as precursors to later choices that benefit the environment. Evaluation of third through fifth grade club…

The resistance tsunami, antimicrobial stewardship, and the golden age of microbiology.

PubMed

Prescott, John F

2014-07-16

Modern medicine is built on antibiotics. Antibiotics are something that we take for granted. We have however spent over 60 years educating bacteria to become resistant, and the global resistance tsunami has caught everyone unawares. Since bacteria have changed, we also have to change, and to change most of the practices of how we use antibiotics. Because the development of new antibiotics is so expensive, a stewardship approach may help to preserve those that we have now while we work to develop new antibiotics and to develop other approaches to controlling and treating infections. We need to adopt the ethic of Good Stewardship Practice (GSP) as an active and dynamic process of continuous improvement in antibiotic use, a process with many steps of different sizes involving everyone involved in antibiotic use. All antibiotic users have an important role to play in GSP. Although the resistance situation is pessimistic, and the future of antibiotics looks uncertain, we are fortunately entering what may be seen as the golden age of microbiology. This encompasses an astonishing array of technologies for rapid pathogen and resistance gene detection, for clone identification by genome sequencing, for identification of novel bacterial genes and for identification of the Achilles' heels of different pathogens. Future antibiotics may have to be far more targeted to the individual pathogen and the site of infection. A global tax on antibiotics might reduce their use while funding the cost of developing new antibiotics and new approaches to control of infectious diseases. Copyright © 2014 Elsevier B.V. All rights reserved.

78 FR 12352 - Notice of Intent To Prepare an Environmental Impact Statement for the Wilderness Stewardship Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... Park, Clallam, Grays Harbor, Jefferson and Mason County, WA AGENCY: National Park Service, Interior... Act of 1969 (Pub. L. 91-190) Olympic National Park is initiating the conservation planning and... Superintendent Sarah Creachbaum, Olympic National Park, Attn: Wilderness Stewardship Plan, 600 East Park Ave...

Recognizing Stewardship Practices as Indicators of Social Resilience: In Living Memorials and in a Community Garden

Treesearch

Heather McMillen; Lindsay Campbell; Erika Svendsen; Renae Reynolds

2016-01-01

Resilience theory has received increased attention from researchers across a range of disciplines who have developed frameworks and articulated categories of indicators; however, there has been less discussion of how to recognize, and therefore support, social resilience at the community level, especially in urban areas. The value of urban environmental stewardship for...

LONG-TERM STEWARDSHIP AT DOE HANFORD SITE - 12575

DOE Office of Scientific and Technical Information (OSTI.GOV)

MOREN RJ; GRINDSTAFF KD

2012-01-11

The U.S. Department of Energy's (DOE) Hanford Site is located in southeast Washington and consists of 1,518 square kilometers (586 square miles) of land. Established in 1943 as part of the Manhattan Project, Hanford workers produced plutonium for our nation's nuclear defense program until the mid 1980's. Since then, the site has been in cleanup mode that is being accomplished in phases. As we achieve remedial objectives and complete active cleanup, DOE will manage Hanford land under the Long-Term Stewardship (LTS) Program until completion of cleanup and the site becomes ready for transfer to the post cleanup landlord - currentlymore » planned for DOE's Office of Legacy Management (LM). We define Hanford's LTS Program in the ''Hanford Long-Term Stewardship Program Plan,'' (DOE/RL-201 0-35)[1], which describes the scope including the relationship between the cleanup projects and the LTS Program. DOE designed the LTS Program to manage and provide surveillance and maintenance (S&M) of institutional controls and associated monitoring of closed waste sites to ensure the protection of human health and the environment. DOE's Richland Operations Office (DOE-RL) and Hanford cleanup and operations contractors collaboratively developed this program over several years. The program's scope also includes 15 key activities that are identified in the DOE Program Plan (DOE/RL-2010-35). The LTS Program will transition 14 land segments through 2016. The combined land mass is approximately 570 square kilometers (220 square miles), with over 1,300 active and inactive waste sites and 3,363 wells. Land segments vary from buffer zone property with no known contamination to cocooned reactor buildings, demolished support facilities, and remediated cribs and trenches. DOE-RL will transition land management responsibilities from cleanup contractors to the Mission Support Contract (MSC), who will then administer the LTS Program for DOE-RL. This process requires an environment of cooperation

Advanced Simulation and Computing: A Summary Report to the Director's Review

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCoy, M G; Peck, T

2003-06-01

It has now been three years since the Advanced Simulation and Computing Program (ASCI), as managed by Defense and Nuclear Technologies (DNT) Directorate, has been reviewed by this Director's Review Committee (DRC). Since that time, there has been considerable progress for all components of the ASCI Program, and these developments will be highlighted in this document and in the presentations planned for June 9 and 10, 2003. There have also been some name changes. Today, the Program is called ''Advanced Simulation and Computing,'' Although it retains the familiar acronym ASCI, the initiative nature of the effort has given way tomore » sustained services as an integral part of the Stockpile Stewardship Program (SSP). All computing efforts at LLNL and the other two Defense Program (DP) laboratories are funded and managed under ASCI. This includes the so-called legacy codes, which remain essential tools in stockpile stewardship. The contract between the Department of Energy (DOE) and the University of California (UC) specifies an independent appraisal of Directorate technical work and programmatic management. Such represents the work of this DNT Review Committee. Beginning this year, the Laboratory is implementing a new review system. This process was negotiated between UC, the National Nuclear Security Administration (NNSA), and the Laboratory Directors. Central to this approach are eight performance objectives that focus on key programmatic and administrative goals. Associated with each of these objectives are a number of performance measures to more clearly characterize the attainment of the objectives. Each performance measure has a lead directorate and one or more contributing directorates. Each measure has an evaluation plan and has identified expected documentation to be included in the ''Assessment File''.« less

How to educate prescribers in antimicrobial stewardship practices

PubMed Central

Pulcini, Céline; Gyssens, Inge C.

2013-01-01

Widespread antimicrobial use has compromised its value, leading to a crisis of antimicrobial resistance. A major cause of misuse is insufficient knowledge of prescribing of antimicrobials in many categories of professionals. An important principle of antimicrobial stewardship is avoiding selection pressure in the patient, both on pathogen and commensal by avoiding unnecessary use, choosing the least broad-spectrum antibiotic, adequate doses, a good timing and the shortest possible duration. Up to now, most educational efforts have been targeted at professionals (mostly medical doctors) after their training and at the adult public. In the past few years, progress has been made in educating children. It is now crucial that academia and ministries of Health and Education jointly focus on an adapted undergraduate medical/professional curriculum that teaches all necessary principles of microbiology, infectious diseases and clinical pharmacology, with emphasis on the principles of prudent prescribing. PMID:23361336

Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings

PubMed Central

Anderson, Deverick J.; Cochran, Ronda L.; Hicks, Lauri A.; Srinivasan, Arjun; Dodds Ashley, Elizabeth S.

2017-01-01

Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with 4 criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: 2 measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy over patient days, and redundant therapy events. Fourteen metrics rated >6 in all criteria except feasibility were identified as targets for future development. PMID:27927866

Long-term outcomes of an antimicrobial stewardship program implemented in a hospital with low baseline antibiotic use.

PubMed

Jenkins, Timothy C; Knepper, Bryan C; Shihadeh, Katherine; Haas, Michelle K; Sabel, Allison L; Steele, Andrew W; Wilson, Michael L; Price, Connie S; Burman, William J; Mehler, Philip S

2015-06-01

To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use. Quasi-experimental, interrupted time-series study. Public safety net hospital with 525 beds. Implementation of a formal ASP in July 2008. We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008-September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005-June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1,000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset Clostridium difficile infection, and other patient-centered measures. During the preintervention period, total antibacterial and antipseudomonal use were declining (-9.2 and -5.5 DOT/1,000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (-3.7 and -2.2 DOT/1,000 PD, respectively), resulting in a slope change of 5.5 DOT/1,000 PD per quarter for total antibacterial use (P=.10) and 3.3 DOT/1,000 PD per quarter for antipseudomonal use (P=.01). Antibiotic expenditures declined markedly during the stewardship period (-$295.42/1,000 PD per quarter, P=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures. Common ASP outcome measures have limitations.

[Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

PubMed

Roth-Deubel, André N; Molina-Marín, Gloria

2013-01-01

Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

A special issue of the Journal of Forestry - Wilderness science and its role in wilderness stewardship

Treesearch

Susan F. Fox

2016-01-01

This special issue of the Journal of Forestry provides an overview of America’s National Wilderness Preservation System and highlights the important role that science serves in informing wilderness stewardship. The lead authors of the articles in this volume selected the Journal because it is highly respected and widely circulated among foresters and federal...

Stewardship as a Means to Create Organizational Reform: A View into Minnesota 4-H Youth Development

ERIC Educational Resources Information Center

Skuza, Jennifer A.; Freeman, Dorothy M.; Bremseth, Tamara J.; Doering, Shirley A.; Quinlan, Robert B.; Morreim, Patricia A.; Deidrick, James C.

2010-01-01

Minnesota 4-H Youth Development (MN 4-H) used stewardship as a means to create organizational reform to address the public use of the 4-H name and emblem in terms of risk management, real estate and equipment, and finances. A task force implemented a participatory process with colleagues and stakeholders to build and implement the reform effort.…

Integrating Information Networks for Collective Planetary Stewardship

NASA Astrophysics Data System (ADS)

Tiwari, A.

2016-12-01

Responsible behaviour resulting from climate literacy in global environmental movement is limited to policy and planning institutions in the Global South, while remaining absent for ends-user. Thus, planetary stewardship exists only at earth system boundaries where pressures sink to the local scale while ethics remains afloat. Existing citizen participation is restricted within policy spheres, appearing synonymous to enforcements in social psychology. Much, accounted reason is that existing information mechanisms operate mostly through linear exchanges between institutions and users, therefore reinforcing only hierarchical relationships. This study discloses such relationships that contribute to broad networking gaps through information demand assessment of stakeholders in a dozen development projects based in South Asia. Two parameters widely used for this purpose are: a. Feedback: Ends-user feedback to improve consumption literacy of climate sensitive resources (through consumption displays, billing, advisory services ecolabelling, sensors) and, b. Institutional Policy: Rewarding punishing to enforce desired behaviour (subsidies, taxation). Research answered: 1. Who gets the information (Equity in Information Distribution)? As existing information publishing mechanisms are designed by and for analysts, 2. How information translates to climate action Transparency of Execution)? Findings suggested that climate goals manifested in economic policy, than environmental policy, have potential clear short-term benefits and costs, and coincide with people's economic goals Also grassroots roles for responsible behaviour are empowered with presence of end user information. Barier free climate communication process and decision making is ensured among multiplicity of stakeholders with often conflicting perspectives. Research finds significance where collaboration among information networks can better translate regional policies into local action for climate adaptation and

What does it take to get family forest owners to enroll in a forest stewardship-type program?

Treesearch

Michael A. Kilgore; Stephanie A. Snyder; Joseph Schertz; Steven J. Taff

2008-01-01

We estimated the probability of enrollment and factors influencing participation in a forest stewardship-type program, Minnesota's Sustainable Forest Incentives Act, using data from a mail survey of over 1000 randomly-selected Minnesota family forest owners. Of the 15 variables tested, only five were significant predictors of a landowner's interest in...

Assessing the distribution of environmental stewardship organizations and their relationship to the demographics of Los Angeles County

Treesearch

Krystle M. Golly

2017-01-01

An equal distribution of environmental stewardship organizations across the urban landscape provides an environment that facilitates community empowerment. The systemic issues found in Los Angeles County play an important role in the social development of the area. Through the utilization of modern technology and geographical mapping software, spatial distribution of...

Energy Market and Economic Impacts of S. 280, the Climate Stewardship and Innovation Act of 2007, Supplement to

EIA Publications

2007-01-01

This paper responds to a September 18, 2007, letter from Senators Barrasso, Inhofe, and Voinovich, seeking further energy and economic analysis to supplement information presented in the Energy Information Administration's (EIA) recent analysis of S.280, the Climate Stewardship and Innovation Act of 2007.

Longitudinal evaluation of a World Wide Web-based antimicrobial stewardship program: assessing factors associated with approval patterns and trends over time.

PubMed

Venugopal, Vidya; Lehmann, Christoph U; Diener-West, Marie; Agwu, Allison L

2014-02-01

The Johns Hopkins Children's Medical and Surgery Center developed a Web-based Antimicrobial Stewardship Program (ASP) in 2005. The present study aimed to assess longitudinal antimicrobial request and approval patterns for this ASP. We analyzed a total of 16,229 antimicrobial requests for 3,542 patients between June 1, 2005, and June 30, 2009. Antimicrobial approval was the outcome of interest. We assessed gaming by studying trends in automatically approved requests. Nonparametric tests for trend were performed to detect changes in approval patterns. Multiple logistic regression was used to identify factors associated with approval. The vast majority (91.3%) of antimicrobial requests were approved, with an increase of 6.1% over time (P < .01). Renewal requests were more likely than primary requests (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.45-2.04) to be approved. Antiviral requests had higher odds of approval than antibiotic requests (aOR, 1.27; 95% CI, 1.04-1.56). Compared with requests by medical services, requests by surgical services had lower odds of approval (aOR, 0.70; 95% CI, 0.59-0.83), whereas pediatric intensive care requests had higher odds of approval (aOR, 1.18; 95% CI, 1.00-1.40). The number of auto-approved requests remained consistent. The Web-based ASP allows management of a large number of antimicrobial requests, without apparent gaming. Observed differences in approval patterns based on patient, requestor, and antimicrobial factors may inform the development of ASPs and evaluation of provider education and training. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Quasi-Experimental Designs.

PubMed

Schweizer, Marin L; Braun, Barbara I; Milstone, Aaron M

2016-10-01

Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt, nonrandomized interventions. Quasi-experimental studies can be categorized into 3 major types: interrupted time-series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies. Infect Control Hosp Epidemiol 2016;1-6.

Falcon: automated optimization method for arbitrary assessment criteria

DOEpatents

Yang, Tser-Yuan; Moses, Edward I.; Hartmann-Siantar, Christine

2001-01-01

FALCON is a method for automatic multivariable optimization for arbitrary assessment criteria that can be applied to numerous fields where outcome simulation is combined with optimization and assessment criteria. A specific implementation of FALCON is for automatic radiation therapy treatment planning. In this application, FALCON implements dose calculations into the planning process and optimizes available beam delivery modifier parameters to determine the treatment plan that best meets clinical decision-making criteria. FALCON is described in the context of the optimization of external-beam radiation therapy and intensity modulated radiation therapy (IMRT), but the concepts could also be applied to internal (brachytherapy) radiotherapy. The radiation beams could consist of photons or any charged or uncharged particles. The concept of optimizing source distributions can be applied to complex radiography (e.g. flash x-ray or proton) to improve the imaging capabilities of facilities proposed for science-based stockpile stewardship.

Enhancing antimicrobial stewardship by strengthening the veterinary drug regulatory framework

PubMed Central

Mehrotra, M; Li, X-Z; Ireland, MJ

2017-01-01

Antimicrobial resistance is a major and growing public health threat. Recently, Health Canada introduced multiple regulatory changes to strengthen the oversight of antimicrobial drugs for veterinary use. These changes aim specifically at increasing control over importation of veterinary drugs and active pharmaceutical ingredients, mandatory reporting of antimicrobial sales data from manufacturers, importers and compounders and facilitating access to low risk veterinary health products. Additional policy changes under existing authorities are also being made to enhance veterinary supervision of antimicrobial use and to remove production claims for food animals from labels of medically important antimicrobial drugs. These important interlinked initiatives are aimed towards enhancing antimicrobial stewardship in Canada to preserve the effectiveness of existing antimicrobials and to protect the health of Canadians. PMID:29770050

When Antimicrobial Stewardship Isn′t Watching: The Educational Impact of Critical Care Prospective Audit and Feedback

PubMed Central

Fleming, Dimitra; Ali, Karim F.; Matelski, John; D'Sa, Ryan; Powis, Jeff

2016-01-01

Prospective audit and feedback (PAF) is an effective strategy to optimize antimicrobial use in the critical care setting, yet whether skills gained during PAF influence future antimicrobial prescribing is uncertain. This multisite study demonstrates that knowledge learned during PAF is translated and incorporated into the practice of critical care physicians even when not supported by an antimicrobial stewardship program. PMID:27382599

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship – Quasi-Experimental Designs

PubMed Central

Schweizer, Marin L.; Braun, Barbara I.; Milstone, Aaron M.

2016-01-01

Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt non-randomized interventions. Quasi-experimental studies can be categorized into three major types: interrupted time series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies. PMID:27267457

Development and Validation of an Instrument for Assessing Climate Change Knowledge and Perceptions: The Climate Stewardship Survey (CSS)

ERIC Educational Resources Information Center

Walker, Scott L.; McNeal, Karen S.

2013-01-01

The Climate Stewardship Survey (CSS) was developed to measure knowledge and perceptions of global climate change, while also considering information sources that respondents 'trust.' The CSS was drafted using a three-stage approach: development of salient scales, writing individual items, and field testing and analyses. Construct validity and…

Implementation of a Mobile Clinical Decision Support Application to Augment Local Antimicrobial Stewardship.

PubMed

Hoff, Brian M; Ford, Diana C; Ince, Dilek; Ernst, Erika J; Livorsi, Daniel J; Heintz, Brett H; Masse, Vincent; Brownlee, Michael J; Ford, Bradley A

2018-01-01

Medical applications for mobile devices allow clinicians to leverage microbiological data and standardized guidelines to treat patients with infectious diseases. We report the implementation of a mobile clinical decision support (CDS) application to augment local antimicrobial stewardship. We detail the implementation of our mobile CDS application over 20 months. Application utilization data were collected and evaluated using descriptive statistics to quantify the impact of our implementation. Project initiation focused on engaging key stakeholders, developing a business case, and selecting a mobile platform. The preimplementation phase included content development, creation of a pathway for content approval within the hospital committee structure, engaging clinical leaders, and formatting the first version of the guide. Implementation involved a media campaign, staff education, and integration within the electronic medical record and hospital mobile devices. The postimplementation phase required ongoing quality improvement, revision of outdated content, and repeated staff education. The evaluation phase included a guide utilization analysis, reporting to hospital leadership, and sustainability and innovation planning. The mobile application was downloaded 3056 times and accessed 9259 times during the study period. The companion web viewer was accessed 8214 times. Successful implementation of a customizable mobile CDS tool enabled our team to expand beyond microbiological data to clinical diagnosis, treatment, and antimicrobial stewardship, broadening our influence on antimicrobial prescribing and incorporating utilization data to inspire new quality and safety initiatives. Further studies are needed to assess the impact on antimicrobial utilization, infection control measures, and patient care outcomes.

Impact of an Infection Control and Antimicrobial Stewardship Program on Solid Organ Transplantation and Hepatobiliary Surgical Site Infections.

PubMed

Frenette, Charles; Sperlea, David; Leharova, Yveta; Thirion, Daniel J G

2016-12-01

OBJECTIVE The goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs). METHODS This study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation were included. Outcomes were compared between a preintervention group (2010-2011) and a postintervention group (2012-2014). RESULTS A total of 1,424 procedures averaged an overall SSI rate of 11.2%. After implementation of the interventions, a decrease of 52.8% in SSI rates from 17.4% to 8.2% was observed (P50% (relative rate; P<.001) was observed in superficial incisional and organ-space infections between pre- and postintervention groups. In addition, a 54.9% decrease from 19.7% to 8.9% (P<.001; OR, 2.2; 95% CI, 1.4-3.5) and a 51.6% decrease from 15.5% to 7.5% (P=.001; OR, 2.2; 95% CI, 1.4-3.5) were observed for SSI rates in hepatobiliary surgery and solid organ transplantation, respectively. The antimicrobial stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 15.2% (absolute rate) from 45.1% to 60.3% (P<.003; 95% CI, 5.4-24.9). CONCLUSIONS A long-term serial infection control and antimicrobial stewardship intervention decreased SSIs among patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation. Infect Control Hosp Epidemiol 2016;1468-1474.

H. R. 2594: This Act may be cited as the Wetlands Stewardship Trusts Act of 1991, introduced in the US House of Representatives, One Hundred Second Congress, First Session, June 7, 1991

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1991-01-01

This bill was introduced into the US House of Representatives on June 7, 1991 to provide for the designation of Wetlands Stewardship Trusts. This legislation amended the Internal Revenue Code of 1986 to establish special rules for contributions of wetlands and riparian lands to Wetlands Stewardship Trusts. Key features of the bill address the following: tax treatment of donations of wetlands and riparian lands to Wetlands Stewardship Trusts; amortization of expenditures to restore wetlands and riparian lands; expenditures for restoring wetlands and riparian lands; exclusion from gross income for amounts received from compatible uses of wetlands or riparian lands; andmore » income from compatible uses of wetlands or riparian lands.« less

Antimicrobial stewardship through telemedicine and its impact on multi-drug resistance.

PubMed

Dos Santos, Rodrigo P; Dalmora, Camila H; Lukasewicz, Stephani A; Carvalho, Otávio; Deutschendorf, Caroline; Lima, Raquel; Leitzke, Tiago; Correa, Nilson C; Gambetta, Marcelo V

2018-01-01

Introduction Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates. Methods We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model. Results After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, β = -0.80; P < 0.01; trend change, β = -0.01; P = 0.98), first-generation cephalosporins (level change, β = -0.91; P < 0.01; trend change, β = +0.01; P = 0.96), vancomycin (level change, β = -0.47; P = 0.04; trend change, β = +0.17; P = 0.66) and polymyxins (level change, β = -0.15; P = 0.56; trend change, β = -1.75; P < 0.01) were identified. There was an increase in the consumption of amoxicillin + clavulanate (level change, β = +0.84; P < 0.01; trend change, β = +0.14; P = 0.41) and cefuroxime (level change, β = +0.21; P = 0.17; trend change, β = +0.66; P = 0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, β = +0.66; P = 0.01; trend change, β = -1.26; P < 0.01) was observed. Conclusions Telemedicine, which provides a tool for decision support and immediate access to experienced specialists, can promote better antibiotic selection and reductions in bacterial resistance.

Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for Pharmacists.

PubMed

Bishop, Bryan M

2016-12-01

Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance. © The Author(s) 2015.

Science and stewardship to protect and sustain wilderness values: Proceedings of the Ninth World Wilderness Congress Symposium

Treesearch

Brooke B. McBride

2011-01-01

WILD9 convened in Merida, Yucatan, Mexico, in 2009 with a challenging agenda. For more than eight days, 1,800 delegates from more than 50 nations gathered to feel, think, and act (siente, piensa, actua) on many important conservation issues requiring international cooperation. The compilation of papers from the Symposium on Science and Stewardship to Protect and...

Urban environmental stewardship and changes in vegetative cover and building footprint in New York City neighborhoods (2000-2010)

Treesearch

Dexter H. Locke; Kristen L. King; Erika S. Svendsen; Lindsay K. Campbell; Christopher Small; Nancy F. Sonti; Dana R. Fisher; Jacqueline W.T. Lu

2014-01-01

This study explores the connections between vegetation cover change, environmental stewardship, and building footprint change in New York City neighborhoods from the years 2000 to 2010. We use a mixed-methods multidisciplinary approach to analyze spatially explicit social and ecological data. Most neighborhoods lost vegetation during the study period. Neighborhoods...

Online virtual cases to teach resource stewardship.

PubMed

Zhou, Linghong Linda; Tait, Gordon; Sandhu, Sharron; Steiman, Amanda; Lake, Shirley

2018-06-11

As health care costs rise, medical education must focus on high-value clinical decision making. To teach and assess efficient resource use in rheumatology, online virtual interactive cases (VICs) were developed to simulate real patient encounters to increase price transparency and reinforce cost consciousness. To teach and assess efficient resource use in rheumatology, online virtual interactive cases (VICs) were developed METHODS: The VIC modules were distributed to a sample of medical students and internal medicine residents, who were required to assess patients, order appropriate investigations, develop differential diagnoses and formulate management plans. Each action was associated with a time and price, with the totals compared against ideals. Trainees were evaluated not only on their diagnosis and patient management, but also on the total time, cost and value of their selected workup. Trainee responses were tracked anonymously, with opportunity to provide feedback at the end of each case. Seventeen medical trainees completed a total of 48 VIC modules. On average, trainees spent CAN $227.52 and 68 virtual minutes on each case, which was lower than expected. This may have been the result of a low management score of 52.4%, although on average 92.0% of participants in each case achieved the correct diagnosis. In addition, 85.7% felt more comfortable working up similar cases, and 57.1% believed that the modules increased their ability to appropriately order cost-conscious rheumatology investigations. Our initial assessment of the VIC rheumatology modules was positive, supporting their role as an effective tool in teaching an approach to rheumatology patients, with an emphasis on resource stewardship. Future directions include the expansion of cases, based on feedback, wider dissemination and an evaluation of learning retention. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

The pharmaceuticalisation of security: Molecular biomedicine, antiviral stockpiles, and global health security.

PubMed

Elbe, Stefan

2014-12-01

Pharmaceuticals are now critical to the security of populations. Antivirals, antibiotics, next-generation vaccines, and antitoxins are just some of the new 'medical countermeasures' that governments are stockpiling in order to defend their populations against the threat of pandemics and bioterrorism. How has security policy come to be so deeply imbricated with pharmaceutical logics and solutions? This article captures, maps, and analyses the 'pharmaceuticalisation' of security. Through an in-depth analysis of the prominent antiviral medication Tamiflu , it shows that this pharmaceutical turn in security policy is intimately bound up with the rise of a molecular vision of life promulgated by the biomedical sciences. Caught in the crosshairs of powerful commercial, political, and regulatory pressures, governments are embracing a molecular biomedicine promising to secure populations pharmaceutically in the twenty-first century. If that is true, then the established disciplinary view of health as a predominantly secondary matter of 'low' international politics is mistaken. On the contrary, the social forces of health and biomedicine are powerful enough to influence the core practices of international politics - even those of security. For a discipline long accustomed to studying macrolevel processes and systemic structures, it is in the end also our knowledge of the minute morass of molecules that shapes international relations.

Alternative methods of flexible base compaction acceptance.

DOT National Transportation Integrated Search

2012-05-01

In the Texas Department of Transportation, flexible base construction is governed by a series of stockpile : and field tests. A series of concerns with these existing methods, along with some premature failures in the : field, led to this project inv...

A Survey of U.S. Army Public Affairs Officers’ Views on Environmental Stewardship Training

DTIC Science & Technology

1993-10-01

Department of Environmental Studies, 3 Victoria College, and Bruce Crawshaw , lecturer at the Universiti Pertanian Malaysia, caution about the problems of...side a series of 3 subjects which the ’teachers’ know to be useful subjects such as ecology, economics, law, management, etc. (Stokes & Crawshaw 36...8217environment’" (Stokes & Crawshaw 36). The Army has apparently taken this approach to its new I environmental stewardship training for public affairs 3

Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.

PubMed

Perez, Katherine K; Olsen, Randall J; Musick, William L; Cernoch, Patricia L; Davis, James R; Peterson, Leif E; Musser, James M

2014-09-01

An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria. A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures. Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P < 0.001) and effective antibiotic therapy (89.7 h versus 32 h, P < 0.001). Patients in the pre-intervention period had increased duration of hospitalization compared to those in the intervention period (23.3 days versus 15.3 days, P = 0.0001) and longer intensive care unit length of stay (16 days versus 10.7 days, P = 0.008). Mortality among patients during the intervention period was lower (21% versus 8.9%, P = 0.01) and our study intervention remained a significant predictor of survival (OR, 0.3; 95% confidence interval [CI], 0.12-0.79) after multivariate logistic regression. Mean hospital costs for each inpatient survivor were reduced $26,298 in the intervention cohort resulting in an estimated annual cost savings of $2.4 million (P = 0.002). Integration of rapid identification and susceptibility techniques with antimicrobial stewardship resulted in significant improvements in clinical and financial outcomes

Developing a mixture design specification for flexible base construction.

DOT National Transportation Integrated Search

2012-06-01

In the Texas Department of Transportation (TxDOT), flexible base producers typically generate large stockpiles of material exclusively for TxDOT projects. This large state-only inventory often maintained by producers, along with time requiremen...

Implementing an intensified antibiotic stewardship programme targeting daptomycin use in orthopaedic surgery: a cost-benefit analysis from the hospital perspective.

PubMed

Borde, Johannes P; Nussbaum, Sarah; Hauser, Stefanie; Hehn, Philip; Hübner, Johannes; Sitaru, Gabriela; Köller, Sebastian; Schweigert, Bruno; deWith, Katja; Kern, Winfried V; Kaier, Klaus

2016-06-01

Hospital antibiotic stewardship (ABS) programmes offer several evidence-based tools to control prescription rates of antibiotics in different settings, influence the incidence of nosocomial infections and to contain the development of multi-drug-resistant bacteria. In the context of endoprosthetic surgery, however, knowledge of core antibiotic stewardship strategies, comparisons of costs and benefits of hospital ABS programmes are still lacking. We identified a high daptomycin use for the treatment of methicillin-sensitive staphylococcal infections as a potential target for our ABS intervention. In addition, we endorsed periprosthetic tissue cultures for the diagnosis of PJI. Monthly antibiotic use data were obtained from the hospital pharmacy and were expressed as WHO-ATC defined daily doses (DDD) and dose definitions adapted to local guidelines (recommended daily doses, RDD), normalized per 1000 patient days. The pre-intervention period was defined from February 2012 through January 2014 (24 months). The post-intervention period included monthly time points from February 2014 to April 2015 (15 months). For a basic cost-benefit analysis from the hospital perspective, three cost drivers were taken into account: (1) the cost savings due to changes in antimicrobial prescribing; (2) costs associated with the increase in the number of cultured tissue samples, and (3) the appointment of an infectious disease consultant. Interrupted time-series analysis (ITS) was applied. Descriptive analysis of the usage data showed a decline in overall use of anti-infective substances in the post-intervention period (334.9 vs. 221.4 RDDs/1000 patient days). The drug use density of daptomycin dropped by -75 % (51.7 vs. 12.9 RDD/1000 patient days), whereas the utilization of narrow-spectrum penicillins, in particular flucloxacillin, increased from 13.8 to 33.6 RDDs/1000 patient days. ITS analysis of the consumption dataset showed significant level changes for overall prescriptions, as

Use of computer decision support in an antimicrobial stewardship program (ASP).

PubMed

Evans, R S; Olson, J A; Stenehjem, E; Buckel, W R; Thorell, E A; Howe, S; Wu, X; Jones, P S; Lloyd, J F

2015-01-01

Document information needs, gaps within the current electronic applications and reports, and workflow interruptions requiring manual information searches that decreased the ability of our antimicrobial stewardship program (ASP) at Intermountain Healthcare (IH) to prospectively audit and provide feedback to clinicians to improve antimicrobial use. A framework was used to provide access to patient information contained in the electronic medical record, the enterprise-wide data warehouse, the data-driven alert file and the enterprise-wide encounter file to generate alerts and reports via pagers, emails and through the Centers for Diseases and Control's National Healthcare Surveillance Network. Four new applications were developed and used by ASPs at Intermountain Medical Center (IMC) and Primary Children's Hospital (PCH) based on the design and input from the pharmacists and infectious diseases physicians and the new Center for Diseases Control and Prevention/National Healthcare Safety Network (NHSN) antibiotic utilization specifications. Data from IMC and PCH now show a general decrease in the use of drugs initially targeted by the ASP at both facilities. To be effective, ASPs need an enormous amount of "timely" information. Members of the ASP at IH report these new applications help them improve antibiotic use by allowing efficient, timely review and effective prioritization of patients receiving antimicrobials in order to optimize patient care.

Tracking progress: Applying the Forest Service 10 Year Wilderness Stewardship Challenge as a model of performance management

Treesearch

Liese C. Dean

2007-01-01

The USDA Forest Service applied a performance management/ accountability system to the 407 wildernesses it oversees by defining and tracking critical work. Work elements were consolidated and packaged into the “10 Year Wilderness Stewardship Challenge.” The goal of the Challenge is to have 100 percent of wildernesses administered by the Forest Service managed to a...

Application of the “4R” nutrient stewardship concept to horticultural crops: getting nutrients in the “right” place

USDA-ARS?s Scientific Manuscript database

The 4R nutrient stewardship concept was introduced in 2009 by International Plant Nutrition Institute to define the right source, rate, time, and place to apply fertilizers to produce not only the most economical outcome in any given crop but to also to provide desirable social and environmental ben...

Networked governance and the management of ecosystem services: The case of urban environmental stewardship in New York City

Treesearch

James J.T. Connolly; Erika S. Svendsen; Dana R. Fisher; Lindsay K. Campbell

2014-01-01

Urban environmental stewardship groups have become an essential component of the governance structure that regulates ecosystem services in cities. New York City is one example where these groups have grown rapidly in number, size, and visibility since the 1970s. In this article, we combine quantitative survey data with qualitative interview data to examine the...

Transformative leadership: an ethical stewardship model for healthcare.

PubMed

Caldwell, Cam; Voelker, Carolyn; Dixon, Rolf D; LeJeune, Adena

2008-01-01

The need for effective leadership is a compelling priority for those who would choose to govern in public, private, and nonprofit organizations, and applies as much to the healthcare profession as it does to other sectors of the economy (Moody, Horton-Deutsch, & Pesut, 2007). Transformative Leadership, an approach to leadership and governance that incorporates the best characteristics of six other highly respected leadership models, is an integrative theory of ethical stewardship that can help healthcare professionals to more effectively achieve organizational efficiencies, build stakeholder commitment and trust, and create valuable synergies to transform and enrich today's healthcare systems (cf. Caldwell, LeJeune, & Dixon, 2007). The purpose of this article is to introduce the concept of Transformative Leadership and to explain how this model applies within a healthcare context. We define Transformative Leadership and identify its relationship to Transformational, Charismatic, Level 5, Principle-Centered, Servant, and Covenantal Leadership--providing examples of each of these elements of Transformative Leadership within a healthcare leadership context. We conclude by identifying contributions of this article to the healthcare leadership literature.

Veterinary Students' Knowledge and Perceptions About Antimicrobial Stewardship and Biosecurity-A National Survey.

PubMed

Hardefeldt, Laura; Nielsen, Torben; Crabb, Helen; Gilkerson, James; Squires, Richard; Heller, Jane; Sharp, Claire; Cobbold, Rowland; Norris, Jacqueline; Browning, Glenn

2018-04-18

A better understanding of veterinary students’ perceptions, attitudes, and knowledge about antimicrobial stewardship and biosecurity could facilitate more effective education of future veterinarians about these important issues. A multicenter cross-sectional study was performed by administering a questionnaire to veterinary students expected to graduate in 2017 or 2018 in all Australian veterinary schools. Four hundred and seventy-six of 1246 students (38%) completed the survey. Many students were unaware of the high importance of some veterinary drugs to human medicine, specifically enrofloxacin and cefovecin (59% and 47% of responses, respectively). Fewer than 10% of students would use appropriate personal protective equipment in scenarios suggestive of Q fever or psittacosis. Students expected to graduate in 2018 were more likely to select culture and susceptibility testing in companion animal cases (OR 1.89, 95% CI 1.33–2.69, p < 0.001), and were more likely to appropriately avoid antimicrobials in large animal cases (OR 1.75, 95% CI 1.26–2.44, p = 0.001) than those expected to graduate in 2017. However, 2018 graduates were less likely to correctly identify the importance rating of veterinary antimicrobials for human health (OR 0.48, 95% CI 0.34–0.67, p < 0.001) than 2017 graduates. Students reported having a good knowledge of antimicrobial resistance, and combating resistance, but only 34% thought pharmacology teaching was adequate and only 20% said that teaching in lectures matched clinical teaching. Efforts need to be made to harmonize preclinical and clinical teaching, and greater emphasis is needed on appropriate biosecurity and antimicrobial stewardship.

Data Stewardship throughout the Ocean Research Data Life Cycle

NASA Astrophysics Data System (ADS)

Chandler, Cynthia; Groman, Robert; Allison, Molly; Wiebe, Peter; Glover, David

2013-04-01

The Biological and Chemical Oceanography Data Management Office (BCO-DMO) works in partnership with ocean science investigators to publish data from research projects funded by the Biological and Chemical Oceanography Sections and the Office of Polar Programs Antarctic Organisms & Ecosystems Program (OPP ANT) at the U.S. National Science Foundation. Since 2006, researchers have been contributing data to the BCO-DMO data system, and it has developed into a rich repository of data from ocean, coastal and Great Lakes research programs. The end goals of the BCO-DMO are to ensure preservation of NSF funded project data and to provide open access to those data; achievement of those goals is attained through successful completion of a series of related phases. BCO-DMO has developed an end-to-end data stewardship process that includes all phases of the data life cycle: (1) providing data management advice to investigators during the proposal writing stage; (2) registering their funded project at BCO-DMO; (3) adding data and supporting documentation to the BCO-DMO data repository; (4) providing geospatial and text-based data access systems that support data discovery, access, display, assessment, integration, and export of data resources; (5) exploring mechanisms for exchange of data with complementary repositories; (6) publication of data sets to provide publishers of the peer-reviewed literature with citable references (Digital Object Identifiers) and to encourage proper citation and attribution of data sets in the future and (7) submission of final data sets for preservation in the appropriate long-term data archive. Strategic development of collaborative partnerships with complementary data management organizations is essential to sustainable coverage of the full data life cycle from research proposal through preservation of the final data products. Development and incorporation of controlled vocabularies, domain-specific ontologies and globally unique, persistent

Building a national Infection Intelligence Platform to improve antimicrobial stewardship and drive better patient outcomes: the Scottish experience.

PubMed

Bennie, Marion; Malcolm, William; Marwick, Charis A; Kavanagh, Kimberley; Sneddon, Jean; Nathwani, Dilip

2017-10-01

The better use of new and emerging data streams to understand the epidemiology of infectious disease and to inform and evaluate antimicrobial stewardship improvement programmes is paramount in the global fight against antimicrobial resistance. To create a national informatics platform that synergizes the wealth of disjointed, infection-related health data, building an intelligence capability that allows rapid enquiry, generation of new knowledge and feedback to clinicians and policy makers. A multi-stakeholder community, led by the Scottish Antimicrobial Prescribing Group, secured government funding to deliver a national programme of work centred on three key aspects: (i) technical platform development with record linkage capability across multiple datasets; (ii) a proportionate governance approach to enhance responsiveness; and (iii) generation of new evidence to guide clinical practice. The National Health Service Scotland Infection Intelligence Platform (IIP) is now hosted within the national health data repository to assure resilience and sustainability. New technical solutions include simplified 'data views' of complex, linked datasets and embedded statistical programs to enhance capability. These developments have enabled responsiveness, flexibility and robustness in conducting population-based studies including a focus on intended and unintended effects of antimicrobial stewardship interventions and quantification of infection risk factors and clinical outcomes. We have completed the build and test phase of IIP, overcoming the technical and governance challenges, and produced new capability in infection informatics, generating new evidence for improved clinical practice. This provides a foundation for expansion and opportunity for global collaborations. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Accurate 238U(n , 2 n )237U reaction cross-section measurements from 6.5 to 14.8 MeV

NASA Astrophysics Data System (ADS)

Krishichayan, Bhike, M.; Tornow, W.; Tonchev, A. P.; Kawano, T.

2017-10-01

The cross section for the 238U(n ,2 n )237U reaction has been measured in the incident neutron energy range from 6.5 to 14.8 MeV in small energy steps using an activation technique. Monoenergetic neutron beams were produced via the 2H(d ,n )3He and 3H(d ,n )4He reactions. 238U targets were activated along with Au and Al monitor foils to determine the incident neutron flux. The activity of the reaction products was measured in TUNL's low-background counting facility using high-resolution γ -ray spectroscopy. The results are compared with previous measurements and latest data evaluations. Statistical-model calculations, based on the Hauser-Feshbach formalism, have been carried out using the CoH3 code and are compared with the experimental results. The present self-consistent and high-quality data are important for stockpile stewardship and nuclear forensic purposes as well as for the design and operation of fast reactors.

Breaking the Supermassive Black Hole Speed Limit

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smidt, Joseph

A new computer simulation helps explain the existence of puzzling supermassive black holes observed in the early universe. The simulation is based on a computer code used to understand the coupling of radiation and certain materials. “Supermassive black holes have a speed limit that governs how fast and how large they can grow,” said Joseph Smidt of the Theoretical Design Division at Los Alamos National Laboratory. “The relatively recent discovery of supermassive black holes in the early development of the universe raised a fundamental question, how did they get so big so fast?” Using computer codes developed at Los Alamosmore » for modeling the interaction of matter and radiation related to the Lab’s stockpile stewardship mission, Smidt and colleagues created a simulation of collapsing stars that resulted in supermassive black holes forming in less time than expected, cosmologically speaking, in the first billion years of the universe.« less

Framework for Springs Stewardship Program and proposed action development: Spring Mountains National Recreation Area, Humboldt-Toiyabe National Forest

Treesearch

Marc Coles-Ritchie; Stephen J. Solem; Abraham E. Springer; Burton Pendleton

2014-01-01

In the desert Southwest, springs are an important ecological feature and serve as a focal point for both biological and human interactions on the landscape. As a result, attention has been placed on the stewardship and protection of these important resources. Management has traditionally focused on the more accessible and heavily used eastern canyons within the Spring...

[The interplay of diagnostic and antimicrobial stewardship for the management of septic patients: the Tuscan model.

PubMed

Forni, Silvia; Toccafondi, Giulio; Viaggi, Bruno; Grazzini, Maddalena; D'Arienzo, Sara; Gemmi, Fabrizio; Vannucci, Andrea; Tulli, Giorgio

2018-02-01

Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorganisms. Antimicrobial stewardship (AS) is a coordinated intervention designed to improve the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen, dose, duration of therapy and route of administration. AS programs have proved effective in reducing antimicrobial resistance, inappropriate antimicrobial use and in improving patient outcomes. Recently developed rapid diagnostic technologies in microbiology (RDTM) allows a faster and etiological diagnosis of infection and a reduction in the use of unnecessary empirical therapies. This may result in important advancement in time-critical care pathways for septic patients. Nevertheless, RDTM are costly and if not rationally positioned may consume resources and hinder the efficacy of AS programs. In this regard, Tuscany Region is engaged in designing, through a systemic approach, an effective high-quality clinical microbiological service grid. In order to develop a sustainable and equitable model for integrating diagnostic and antimicrobial stewardship we conducted a survey in the regional network of 14 microbiological laboratories. The results shows that in order to develop a sustainable service we need to improve the communication at the interface between laboratories and care unit, harmonize the time windows for processing samples and to devise a robust score for stratifying patient with suspected sepsis.