49 CFR 228.311 - Minimum space requirements, beds, storage, and sanitary facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... each occupant's clothing and personal articles must be provided in every room used for sleeping... provided by a collective bargaining agreement, clean linens must be provided to each occupant. (d) In a...

49 CFR 228.311 - Minimum space requirements, beds, storage, and sanitary facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... each occupant's clothing and personal articles must be provided in every room used for sleeping... provided by a collective bargaining agreement, clean linens must be provided to each occupant. (d) In a...

49 CFR 228.311 - Minimum space requirements, beds, storage, and sanitary facilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... each occupant's clothing and personal articles must be provided in every room used for sleeping... provided by a collective bargaining agreement, clean linens must be provided to each occupant. (d) In a...

[Groups of female workers with lowered adaptation to the working conditions in footwear industry].

PubMed

Datsenko, M F; Poguda, A A; Nuromskaia, O A

1991-01-01

The Republican Centre for Occupational Diseases was set in Estonia in 1971. The Centre performs administrative and methodological guidance for the republican clinical institutions in diagnostics, prevention and treatment of occupational diseases. The Centre also runs an out-patient department and a 40-bed in-patient stationary. In the occupational diseases structure, communicable diseases are prevalent (particularly, erysipeloid), followed by occupational hypoacusis, vibration related and allergic diseases.

Scheduling admissions and reducing variability in bed demand.

PubMed

Bekker, René; Koeleman, Paulien M

2011-09-01

Variability in admissions and lengths of stay inherently leads to variability in bed occupancy. The aim of this paper is to analyse the impact of these sources of variability on the required amount of capacity and to determine admission quota for scheduled admissions to regulate the occupancy pattern. For the impact of variability on the required number of beds, we use a heavy-traffic limit theorem for the G/G/∞ queue yielding an intuitively appealing approximation in case the arrival process is not Poisson. Also, given a structural weekly admission pattern, we apply a time-dependent analysis to determine the mean offered load per day. This time-dependent analysis is combined with a Quadratic Programming model to determine the optimal number of elective admissions per day, such that an average desired daily occupancy is achieved. From the mathematical results, practical scenarios and guidelines are derived that can be used by hospital managers and support the method of quota scheduling. In practice, the results can be implemented by providing admission quota prescribing the target number of admissions for each patient group.

Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs.

PubMed

Halpern, Neil A; Pastores, Stephen M

2010-01-01

To analyze the evolving role, patterns of use, and costs of critical care medicine in the United States from 2000 to 2005. Retrospective study of data from the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, Maryland). Nonfederal, acute care hospitals with critical care medicine beds in the United States. None. None. We analyzed hospital and critical care medicine beds, bed types, days, occupancy rates, payer mix (Medicare and Medicaid), and costs. Critical care medicine costs were compared with national cost indexes. Between 2000 and 2005, the total number of U.S. hospitals with critical care medicine beds decreased by 12.2% (from 3,586 to 3,150). Although the number of hospital beds decreased by 4.2% (from 655,785 to 628,409), both hospital days and occupancy rates increased by 5.1% (from 145.1 to 152.5 million) and 13.7% (from 59% to 67%), respectively. Critical care medicine beds increased by 6.5% (from 88,252 to 93,955), days by 10.6% (from 21.0 to 23.2 million), and occupancy rates by 4.5% (from 65% to 68%). The majority (90%) of critical care medicine beds were classified as intensive care, premature/neonatal, and coronary care unit beds. The percentage of critical care medicine days used by Medicare decreased by 3.8% (from 37.9% to 36.5%) compared with an increase of 15.5% (from 14.5% to 16.8%) by Medicaid. From 2000 to 2005, critical care medicine costs per day increased by 30.4% (from $2698 to $3518). Although annual critical care medicine costs increased by 44.2% (from $56.6 to $81.7 billion), the proportion of hospital costs and national health expenditures allocated to critical care medicine decreased by 1.6% and 1.8%, respectively. However, the proportion of the gross domestic product used by critical care medicine increased by 13.7%. In 2005, critical care medicine costs represented 13.4% of hospital costs, 4.1% of national health expenditures, and 0.66% of the gross domestic product. Critical care medicine continues to grow in a shrinking U.S. hospital system. The critical care medicine payer mix is evolving, with Medicaid increasing in its percentage of critical care medicine use. Critical care medicine is more cost controlled than other healthcare indexes, but is still using an increasing percentage of the gross domestic product. Our updated and comprehensive critical care medicine use and cost analysis provides a contemporary benchmark for the strategic planning of critical care medicine services within the U.S. healthcare system.

Association of unit size, resource utilization and occupancy with outcomes of preterm infants.

PubMed

Shah, P S; Mirea, L; Ng, E; Solimano, A; Lee, S K

2015-07-01

Assess association of NICU size, and occupancy rate and resource utilization at admission with neonatal outcome. Retrospective cohort study of 9978 infants born at 23-32 weeks gestation and admitted to 23 tertiary-level Canadian NICUs during 2010-2012. Adjusted odds ratios (AOR) were estimated for a composite outcome of mortality/any major morbidity with respect to NICU size, occupancy rate and intensity of resource utilization at admission. A total of 2889 (29%) infants developed the composite outcome, the odds of which were higher for 16-29, 30-36 and >36-bed NICUs compared with <16-bed NICUs (AOR (95% CI): 1.47 (1.25-1.73); 1.49 (1.25-1.78); 1.55 (1.29-1.87), respectively) and for NICUs with higher resource utilization at admission (AOR: 1.30 (1.08-1.56), Q4 vs Q1) but not different according to NICU occupancy. Larger NICUs and more intense resource utilization at admission are associated with higher odds of a composite adverse outcome in very preterm infants.

The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting.

PubMed

Triplett, Patrick; Dearholt, Sandra; Cooper, Mary; Herzke, John; Johnson, Erin; Parks, Joyce; Sullivan, Patricia; Taylor, Karin F; Rohde, Judith

Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.

Efforts to reduce exposure at Japanese PWRs: CVCS improvement

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

Terada, Ryosuke

1995-03-01

Many reports have been focused on the reduction of radiation sources and related occupational exposures. The radiation sources mainly consist of corrosion products. Radiation dose rate is determined by the amount of the activated corrosion products on the surface of the primary loop components of Pressurized Water Reactor (PWR) plants. Therefore, reducing the amount of the corrosion product will contribute to the reduction of occupational exposures. In order to reduce the corrosion products, Chemical and Volume Control System (CVCS) has been improved in Japanese PWRs as follows: (a) Cation Bed Demineralizer Flowrate Control; (b) Hydrogen Peroxide Injection System; (c) Purificationmore » Flowrate During Plant Shutdown; (d) Fine Mesh Filters Upstream of Mixed Bed Demineralizers.« less

Trends in Critical Care Beds and Use Among Population Groups and Medicare and Medicaid Beneficiaries in the United States: 2000-2010.

PubMed

Halpern, Neil A; Goldman, Debra A; Tan, Kay See; Pastores, Stephen M

2016-08-01

To analyze patterns of critical care medicine beds, use, and costs in acute care hospitals in the United States and relate critical care medicine beds and use to population shifts, age groups, and Medicare and Medicaid beneficiaries from 2000 to 2010. Retrospective study of data from the federal Healthcare Cost Report Information System, American Hospital Association, and U.S. Census Bureau. None. None. Acute care U.S. hospitals with critical care medicine beds. From 2000 to 2010, U.S. hospitals with critical care medicine beds decreased by 17% (3,586-2,977), whereas the U.S. population increased by 9.6% (282.2-309.3M). Although hospital beds decreased by 2.2% (655,785-641,395), critical care medicine beds increased by 17.8% (88,235-103,900), a 20.4% increase in the critical care medicine-to-hospital bed ratio (13.5-16.2%). There was a greater percentage increase in premature/neonatal (29%; 14,391-18,567) than in adult (15.9%; 71,978-83,417) or pediatric (2.7%; 1,866-1,916) critical care medicine beds. Hospital occupancy rates increased by 10.4% (58.6-64.6%), whereas critical care medicine occupancy rates were stable (range, 65-68%). Critical care medicine beds per 100,000 total population increased by 7.4% (31.3-33.6). The proportional use of critical care medicine services by Medicare beneficiaries decreased by 17.3% (37.9-31.4%), whereas that by Medicaid rose by 18.3% (14.5-17.2%). Between 2000 and 2010, annual critical care medicine costs nearly doubled (92.2%; $56-108 billion). In the same period, the proportion of critical care medicine cost to the gross domestic product increased by 32.1% (0.54-0.72%). Critical care medicine beds, use, and costs in the United States continue to rise. The increasing use of critical care medicine by the premature/neonatal and Medicaid populations should be considered by healthcare policy makers, state agencies, and hospitals as they wrestle with critical care bed growth and the associated costs.

A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: a cluster randomized trial in intensive care.

PubMed

de Vos, Maartje L G; van der Veer, Sabine N; Wouterse, Bram; Graafmans, Wilco C; Peek, Niels; de Keizer, Nicolette F; Jager, Kitty J; Westert, Gert P; van der Voort, Peter H J

2015-07-08

Organizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards. In a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs. We analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62-1.27) or compared to control group (OR 0.67; 95 % CI 0.39-1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41-1.26 compared to baseline and OR 0.65; 95 % CI 0.35-1.19 compared to control group). A multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up. ISRCTN50542146.

Health Occupations Curriculum. Skills for Nursing Assistant. Volume 3, Unit 8.

ERIC Educational Resources Information Center

Arizona State Dept. of Education, Phoenix.

Part of a health occupations program, this instructional unit contains 13 learning modules for use in training nursing assistants. Covered in the modules are (1) making beds, bathing patients, and measuring intake and output; (2) body mechanics, moving and lifting patients, range of motion exercises, and caring for patients in casts or traction;…

Monitoring environmental cleanliness on two surgical wards.

PubMed

Dancer, Stephanie J; White, Liza; Robertson, Chris

2008-10-01

Ten hand-touch sites were screened weekly on two surgical wards over two consecutive six-month periods. The results were analysed using hygiene standards, which specify (i) an aerobic colony count (ACC) > 2.5 cfu/cm(2), and (ii) presence of coagulase-positive staphylococci, as hygiene failures. Sites most often failing the standards were beds and hoist (64%: 33 of 52 weeks), bedside lockers (62%: 32 of 52) and overbed tables (44%: 23 of 52). Methicillin-susceptible/resistant Staphylococcus aureus (MSSA/MRSA) were more often recovered from lockers, overbed tables and beds. Recovery of MSSA/MRSA at any site was significantly associated with an ACC > 2.5 cfu/cm(2) from that site (p = 0.001; OR: 3.35 [95% CI 1.79, 6.28]). In addition, total ACC's > 2.5 cfu/cm(2) each week were significantly associated with weekly bed occupancies > 95% (p = 0.0004; OR: 2.94 [95% CI 1.44, 6.02]). Higher microbial growth levels from hand-touch sites reflect weekly bed occupancies and indicate a risk for both resistant and susceptible S. aureus. These organisms are more likely to be recovered from near-patient sites on the ward.

Determinants of nursing home costs in Florida: policy implications and support in national research findings.

PubMed Central

Traxler, H G

1982-01-01

Descriptive and econometric analysis of the major nonquality determinants of nursing home costs for Florida shows that mean costs, size, and occupancy rate increased between 1971 and 1976, that per diem costs and occupancy rate were inversely related, and that the per diem cost was lower in rural than in urban areas. Regression of the data shows that--next to inflation, as expressed by the Consumer Price Index--the occupancy rate accounts for most of the variation in per diem costs, followed by size, urban-rural location, and by type of control. The hypothetical "optimal," defined as lowest cost-size range, was calculated to be more than 350 beds. Recent research substantiates most of these findings. Medicaid Cost Reports from Florida's nursing homes were the source of the information analyzed; by 1976, the sixth year of the study, the data base covered nearly 9 of 10 licensed beds in the State. Some policy implications can be drawn from the analysis. Reductions in per diem costs could be achieved by higher occupancy rates, especially in the larger nursing homes, and a reduction in the rate of inflation would reduce the rate of increase in nursing home costs. PMID:6815706

Performance evaluation of hospitals that provide care in the public health system, Brazil.

PubMed

Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

2015-01-01

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

Performance evaluation of hospitals that provide care in the public health system, Brazil

PubMed Central

Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

2015-01-01

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimento s de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals. PMID:26247385

Using autoregressive integrated moving average (ARIMA) models to predict and monitor the number of beds occupied during a SARS outbreak in a tertiary hospital in Singapore.

PubMed

Earnest, Arul; Chen, Mark I; Ng, Donald; Sin, Leo Yee

2005-05-11

The main objective of this study is to apply autoregressive integrated moving average (ARIMA) models to make real-time predictions on the number of beds occupied in Tan Tock Seng Hospital, during the recent SARS outbreak. This is a retrospective study design. Hospital admission and occupancy data for isolation beds was collected from Tan Tock Seng hospital for the period 14th March 2003 to 31st May 2003. The main outcome measure was daily number of isolation beds occupied by SARS patients. Among the covariates considered were daily number of people screened, daily number of people admitted (including observation, suspect and probable cases) and days from the most recent significant event discovery. We utilized the following strategy for the analysis. Firstly, we split the outbreak data into two. Data from 14th March to 21st April 2003 was used for model development. We used structural ARIMA models in an attempt to model the number of beds occupied. Estimation is via the maximum likelihood method using the Kalman filter. For the ARIMA model parameters, we considered the simplest parsimonious lowest order model. We found that the ARIMA (1,0,3) model was able to describe and predict the number of beds occupied during the SARS outbreak well. The mean absolute percentage error (MAPE) for the training set and validation set were 5.7% and 8.6% respectively, which we found was reasonable for use in the hospital setting. Furthermore, the model also provided three-day forecasts of the number of beds required. Total number of admissions and probable cases admitted on the previous day were also found to be independent prognostic factors of bed occupancy. ARIMA models provide useful tools for administrators and clinicians in planning for real-time bed capacity during an outbreak of an infectious disease such as SARS. The model could well be used in planning for bed-capacity during outbreaks of other infectious diseases as well.

Occupational Survey Report. AFSC 4A2X1 Biomedical Equipment

DTIC Science & Technology

2004-05-01

Electrocardiograms 70 Hospital Beds, Electric 67 Surgical Lamps 67 Hospital Beds, Manual 66 Audiometers 64 Dental Curing Units 63 Dental Handpieces 63...Pumps 78 Pulse Oximeters 78 Dental Chairs 76 Blood Pressure Monitors, Automatic 74 Examination Lamps 72 Examination Tables 72 Blood Pressure Cuffs 71...Exercise Bicycles 63 Dental Amalgamators 62 Scales or Balances, other than Pediatric 62 Scales or Balances, Pediatric 61 First-Enlistment Personnel

Hospital Nursing Workforce Costs, Wages, Occupational Mix,and Resource Utilization.

PubMed

Welton, John M

2015-10-01

The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare &Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P G .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

Hospital nursing workforce costs, wages, occupational mix, and resource utilization.

PubMed

Welton, John M

2011-01-01

: The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. : This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare & Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. : RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P < .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. : The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

Occupational class differences in later life hospital use by women who survived to age 80: the Renfrew and Paisley prospective cohort study.

PubMed

Hart, Carole L; McCartney, Gerry; Watt, Graham C M

2015-05-01

population ageing challenges the sustainability of healthcare provision. to investigate occupational class differences in hospital use in women aged 80+ years. a total of 8,353 female residents, aged 45-64, took part in the Renfrew and Paisley prospective cohort study in 1972-76. Information on general and mental health hospital discharges was provided from computerised linkage with the Scottish Morbidity Records data to 31 December 2012. Numbers of admissions and bed-days after the 80th birthday were calculated for all and specific causes. Rate ratios by occupational class were calculated using negative binomial regression analysis, adjusting for age and a range of risk factors. four thousand and four hundred and seven (56%) women survived to age 80 and had 17,563 general admissions thereafter, with a mean stay of 19.4 days. There were no apparent relationships with occupational class for all general admissions, but lower occupational class was associated with higher rate ratios for coronary heart disease and stroke and lower rate ratios for cancer. Adjustment for risk factors could not fully explain the raised rate ratios. Bed-day use was higher in lower occupational classes, especially for stroke. There were strong associations with mental health admissions, especially dementia. Compared with the highest occupational class, admission rate ratios for dementia were higher for the lowest occupational class (adjusted rate ratio = 2.60, 95% confidence interval 1.79-3.77). in this population, there were no socio-economic gradients seen in hospital utilisation for general admissions in old age. However, occupational class was associated with mental health admissions, coronary heart disease, stroke and cancer. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A modelling tool for capacity planning in acute and community stroke services.

PubMed

Monks, Thomas; Worthington, David; Allen, Michael; Pitt, Martin; Stein, Ken; James, Martin A

2016-09-29

Mathematical capacity planning methods that can take account of variations in patient complexity, admission rates and delayed discharges have long been available, but their implementation in complex pathways such as stroke care remains limited. Instead simple average based estimates are commonplace. These methods often substantially underestimate capacity requirements. We analyse the capacity requirements for acute and community stroke services in a pathway with over 630 admissions per year. We sought to identify current capacity bottlenecks affecting patient flow, future capacity requirements in the presence of increased admissions, the impact of co-location and pooling of the acute and rehabilitation units and the impact of patient subgroups on capacity requirements. We contrast these results to the often used method of planning by average occupancy, often with arbitrary uplifts to cater for variability. We developed a discrete-event simulation model using aggregate parameter values derived from routine administrative data on over 2000 anonymised admission and discharge timestamps. The model mimicked the flow of stroke, high risk TIA and complex neurological patients from admission to an acute ward through to community rehab and early supported discharge, and predicted the probability of admission delays. An increase from 10 to 14 acute beds reduces the number of patients experiencing a delay to the acute stroke unit from 1 in every 7 to 1 in 50. Co-location of the acute and rehabilitation units and pooling eight beds out of a total bed stock of 26 reduce the number of delayed acute admissions to 1 in every 29 and the number of delayed rehabilitation admissions to 1 in every 20. Planning by average occupancy would resulted in delays for one in every five patients in the acute stroke unit. Planning by average occupancy fails to provide appropriate reserve capacity to manage the variations seen in stroke pathways to desired service levels. An appropriate uplift from the average cannot be based simply on occupancy figures. Our method draws on long available, intuitive, but underused mathematical techniques for capacity planning. Implementation via simulation at our study hospital provided valuable decision support for planners to assess future bed numbers and organisation of the acute and rehabilitation services.

A premerger profile of Columbia and HCA hospitals.

PubMed

McCue, M J

1996-01-01

This article profiles the premerger marketing, management, and mission characteristics of the combined Columbia and Hospital Corporation of America (HCA) entity relative to local market hospitals. The findings show that the Columbia/HCA hospitals had fewer Medicaid patients, lower proportion of outpatient revenues, higher operating cash flow per bed, lower occupancy rates, lower salary expense per discharge, higher debt to total assets, fewer beds, and a higher case-mix index relative to local competitors.

Cancellation of scheduled procedures as a mechanism to generate hospital bed surge capacity-a pilot study.

PubMed

Soremekun, Olan A; Zane, Richard D; Walls, Andrew; Allen, Matthew B; Seefeld, Kimberly J; Pallin, Daniel J

2011-06-01

The ability to generate hospital beds in response to a mass-casualty incident is an essential component of public health preparedness. Although many acute care hospitals' emergency response plans include some provision for delaying or cancelling elective procedures in the event of an inpatient surge, no standardized method for implementing and quantifying the impact of this strategy exists in the literature. The aim of this study was to develop a methodology to prospectively emergency plan for implementing a strategy of delaying procedures and quantifying the potential impact of this strategy on creating hospital bed capacity. This is a pilot study. A categorization methodology was devised and applied retrospectively to all scheduled procedures during four one-week periods chosen by convenience. The categorization scheme grouped procedures into four categories: (A) procedures with no impact on inpatient capacity; (B) procedures that could be delayed indefinitely; (C) procedures that could be delayed by one week; and (D) procedures that could not be delayed. The categorization scheme was applied by two research assistants and an emergency medicine resident. All three raters categorized the first 100 cases to allow for calculation of inter-rater reliability. Maximal hospital bed capacity was defined as the 95th percentile weekday occupancy, as this is more representative of functional bed capacity than is the number of licensed beds. The main outcome was the number of hospital beds that could be created by postponing procedures in categories B and C. Maximal hospital bed capacity was 816 beds. Mean occupancy during weekdays was 759 versus 694 on weekends. By postponing Group B and C procedures, a mean of 60 beds (51 general medical/surgical and nine intensive care unit (ICU)) could be created on weekdays, and four beds (three general medical/surgical and one ICU) on weekends. This represents 7.3% and 0.49% of maximal hospital bed capacity and ICU capacity, respectively. In the event that sustained surge is needed, delaying all category B and C procedures for one week would lead to the generation of 1,235 hospital-bed days. Inter-rater reliability was high (kappa = 0.74) indicating good agreement between all three raters. For the institution studied, the strategy of delaying scheduled procedures could generate inpatient capacity with maximal impact during weekdays and little impact on weekends. Future research is needed to validate the categorization scheme and increase the ability to predict inpatient surge capacity across various hospital types and sizes.

Implications of bed reduction in an acute psychiatric service.

PubMed

Bastiampillai, Tarun J; Bidargaddi, Niranjan P; Dhillon, Rohan S; Schrader, Geoffrey D; Strobel, Jörg E; Galley, Philip J

2010-10-04

To evaluate the impact of psychiatric inpatient bed closures, accompanied by a training program aimed at enhancing team effectiveness and incorporating data-driven practices, in a mental health service. Retrospective comparison of the changes in services within three consecutive financial years: baseline period - before bed reduction (2006-07); observation period - after bed reduction (2007-08); and intervention period - second year after bed reduction (2008-09). The study was conducted at Cramond Clinic, Queen Elizabeth Hospital, Adelaide. Length of stay, 28-day readmission rates, discharges, bed occupancy rates, emergency department (ED) presentations, ED waiting time, seclusions, locality of treatment, and follow-up in the community within 7days. Reduced bed numbers were associated with reduced length of stay, fewer referrals from the community and subsequently shorter waiting times in the ED, without significant change in readmission rates. A higher proportion of patients was treated in the local catchment area, with improved community follow-up and a significant reduction in inpatient seclusions. Our findings should reassure clinicians concerned about psychiatric bed numbers that service redesign with planned bed reductions will not necessarily affect clinical care, provided data literacy and team training programs are in place to ensure smooth transition of patients across ED, inpatient and community services.

Characteristics of the divested HCA and AMI hospitals.

PubMed

McCue, M J; Clement, J P

1992-04-01

The primary aim of this study was to compare and contrast the predivestiture managerial and market characteristics of the following: Divested and nondivested hospitals of Hospital Corporation of America (HCA) and American Medical International (AMI). The findings indicated that HCA hospitals with 1) lower occupancy rates, 2) less growth in revenues, 3) higher debt to total asset position, 4) fewer beds, 5) less growth in their elderly populations, and 6) less growth in their markets' per capita incomes had a higher probability of being divested into HealthTrust. The results for the AMI model were similar to those for the HCA model. AMI hospitals with 1) fewer beds, 2) less growth in their markets' per capita incomes, 3) lower salary expenses per discharge, 4) lower occupancy rates, and 5) increased growth in populations had a higher probability of being divested into EPIC.

Bed bug aggregation on dirty laundry: a mechanism for passive dispersal.

PubMed

Hentley, William T; Webster, Ben; Evison, Sophie E F; Siva-Jothy, Michael T

2017-09-28

Bed bugs have shown a recent and rapid global expansion that has been suggested to be caused by cheap air travel. How a small, flightless and anachoretic insect that hides within its host's sleeping area manages to travel long distances is not yet clear. Bed bugs are attracted to the odour of sleeping humans and we suggest that soiled clothing may present a similarly attractive cue, allowing bed bugs to 'hitch-hike' around the world after aggregating in the laundry bags of travellers. We show that (1) soiled clothing is significantly more attractive than clean clothing to active bed bugs moving within a bedroom sized arena and (2) elevation of CO 2 to a level that simulates human occupancy in the same arena appears to initiate search behaviour rather than direct it. Our results show, for the first time, how leaving worn clothing exposed in sleeping areas when travelling can be exploited by bed bugs to facilitate passive dispersal.

The impact of severe acute respiratory syndrome on otorhinolaryngological services at the Prince of Wales Hospital in Hong Kong.

PubMed

Vlantis, Alexander C; Tsang, Raymond K Y; Wong, Duncan K K; Woo, John K S; van Hasselt, C Andrew

2004-01-01

The objective was to describe the impact of severe acute respiratory syndrome (SARS) on the services of the division of otorhinolaryngology-head and neck surgery at an academic tertiary referral hospital in Hong Kong. Descriptive. Records of general and subspecialty outpatient attendance, ward admissions, ward bed occupancy, and elective and emergency surgery were obtained for the period since the SARS outbreak and for an equivalent period before the outbreak. The changes in these parameters were determined against the background of new SARS cases. Since the outbreak of SARS in March 2003, the weekly outpatient clinic attendance has declined by 59%, the number of operations performed by 79%, the average ward bed occupancy rate by 79% and the daily admission rate by 84%. A dramatic increase of 300% in the number of patients defaulting on their outpatient appointments was recorded. The substantial decrease in otorhinolaryngological services at an academic tertiary referral hospital in Hong Kong has been multifaceted. The decrease in attendance at the outpatient clinics reflects the increased number of patients defaulting on their appointments. Nonessential elective surgery was suspended soon after the outbreak, accounting for the decrease in the number of surgical procedures performed and partially for the decrease in ward bed occupancy and ward admissions. The temporary closure of the accident and emergency department contributed to the decrease in ward admissions and emergency surgical procedures. The reduced service offered by the hospital is having an impact on the quality of care available to patients with non-life-threatening otorhinolaryngological conditions.

Hospitalization due to drug use did not change after a decade of the Psychiatric Reform

PubMed Central

Balbinot, Alexandre Dido; Horta, Rogério Lessa; da Costa, Juvenal Soares Dias; Araújo, Renata Brasil; Poletto, Simone; Teixeira, Marina Bressaneli

2016-01-01

ABSTRACT OBJECTIVE To investigate whether the psychiatric hospitalization rates due to use of psychoactive substances and average time of hospitalization suffered any changes after the first decade of effective implementation of the psychiatric reform in Brazil. METHODS This article examines the evolution of hospitalizations due to disorders arising from the use of alcohol or other substances in the state of Santa Catarina, Southern Brazil, from 2000 to 2012. This is an ecological, time-series study, which uses data from admissions obtained by the Informatics Service of the Brazilian Unified Health System. Hospitalization rates by 100,000 inhabitants and average time of occupancy of beds were estimated. Coefficients of variation of these rates were estimated by Poisson Regression. RESULTS The total and male hospitalization rates did not vary (p = 0.056 and p = 0.244, respectively). We observed an increase of 3.0% for the female sex (p = 0.049). We did not observe any significant variation for occupancy time of beds. CONCLUSIONS The deployment of services triggered by the Brazilian psychiatric reform was not accompanied by a reduction of hospitalization rates or mean occupancy time of hospitalized patients during this first decade of implementation of the reform. PMID:27253902

Reviewing emergency care systems I: insights from system dynamics modelling

PubMed Central

Lattimer, V; Brailsford, S; Turnbull, J; Tarnaras, P; Smith, H; George, S; Gerard, K; Maslin-Prothero, S

2004-01-01

Objectives: To describe the components of an emergency and urgent care system within one health authority and to investigate ways in which patient flows and system capacity could be improved. Methods: Using a qualitative system dynamics (SD) approach, data from interviews were used to build a conceptual map of the system illustrating patient pathways from entry to discharge. The map was used to construct a quantitative SD model populated with demographic and activity data to simulate patterns of demand, activity, contingencies, and system bottlenecks. Using simulation experiments, a range of scenarios were tested to determine their likely effectiveness in meeting future objectives and targets. Results: Emergency hospital admissions grew at a faster annual rate than the national average for 1998–2001. Without intervention, and assuming this trend continued, acute hospitals were likely to have difficulty sustaining levels of elective work, in reaching elective admission targets and in achieving bed occupancy targets. General practice admissions exerted the greatest influence on occupancy rates. Prevention of emergency admissions for older people (3%–6% each year) reduced bed occupancy in both hospitals by 1% per annum over five years. Prevention of emergency admissions for patients with chronic respiratory disease affected occupancy less noticeably, but because of the seasonal pattern of admissions, had an effect on peak winter occupancy. Conclusions: Modelling showed the potential consequences of continued growth in demand for emergency care, but also considerable scope to intervene to ameliorate the worst case scenarios, in particular by increasing the care management options available in the community. PMID:15496694

Factors Associated With the Increasing Rates of Discharges Directly Home From Intensive Care Units-A Direct From ICU Sent Home Study.

PubMed

Lau, Vincent I; Priestap, Fran A; Lam, Joyce N H; Ball, Ian M

2018-02-01

To evaluate the relationship between rates of discharge directly to home (DDH) from the intensive care unit (ICU) and bed availability (ward and ICU). Also to identify patient characteristics that make them candidates for safe DDH and describe transfer delay impact on length of stay (LOS). Retrospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma ICU between April 2003 and March 2015. Median age was 49 years (interquartile range [IQR]: 33.5-60.4), and the majority of the patients were males (54.8%). Median number of preexisting comorbidities was 5 (IQR: 2-7) diagnoses. Discharge directly to home increased from 28 (3.1% of all survivors) patients in 2003 to 120 (12.5%) patients in 2014. The mean annual rate of DDH was between 11% and 12% over the last 6 years. Approximately 62% (n = 397) of patients waited longer than 4 hours for a ward bed, with a median delay of 2.0 days (IQR: 0.5-4.7) before being DDH. There was an inverse correlation between ICU occupancy and DDH rates ( r P = -.55, P < .0001, 95% confidence interval [CI] = -0.36 to -0.69, R 2 = .29). There was no correlation with ward occupancy and DDH rates ( r s = -.055, P = .64, 95% CI = -0.25 to 0.21). The DDH rates have been increasing over time at our institution and were inversely correlated with ICU bed occupancy but were not associated with ward occupancy. The DDH patients are young, have few comorbidities on admission, and few discharge diagnoses, which are usually reversible single system problems with low disease burden. Transfers to the ward are delayed in a majority of cases, leading to increased ICU LOS and likely increased overall hospital LOS as well.

Impact of Patient and Procedure Mix on Finances of Perinatal Centres – Theoretical Models for Economic Strategies in Perinatal Centres

PubMed Central

Hildebrandt, T.; Kraml, F.; Wagner, S.; Hack, C. C.; Thiel, F. C.; Kehl, S.; Winkler, M.; Frobenius, W.; Faschingbauer, F.; Beckmann, M. W.; Lux, M. P.

2013-01-01

Introduction: In Germany, cost and revenue structures of hospitals with defined treatment priorities are currently being discussed to identify uneconomic services. This discussion has also affected perinatal centres (PNCs) and represents a new economic challenge for PNCs. In addition to optimising the time spent in hospital, the hospital management needs to define the “best” patient mix based on costs and revenues. Method: Different theoretical models were proposed based on the cost and revenue structures of the University Perinatal Centre for Franconia (UPF). Multi-step marginal costing was then used to show the impact on operating profits of changes in services and bed occupancy rates. The current contribution margin accounting used by the UPF served as the basis for the calculations. The models demonstrated the impact of changes in services on costs and revenues of a level 1 PNC. Results: Contribution margin analysis was used to calculate profitable and unprofitable DRGs based on average inpatient cost per day. Nineteen theoretical models were created. The current direct costing used by the UPF and a theoretical model with a 100 % bed occupancy rate were used as reference models. Significantly higher operating profits could be achieved by doubling the number of profitable DRGs and halving the number of less profitable DRGs. Operating profits could be increased even more by changing the rates of profitable DRGs per bed occupancy. The exclusive specialisation on pathological and high-risk pregnancies resulted in operating losses. All models which increased the numbers of caesarean sections or focused exclusively on c-sections resulted in operating losses. Conclusion: These theoretical models offer a basis for economic planning. They illustrate the enormous impact potential changes can have on the operating profits of PNCs. Level 1 PNCs require high bed occupancy rates and a profitable patient mix to cover the extremely high costs incurred due to the services they are legally required to offer. Based on our theoretical models it must be stated that spontaneous vaginal births (not caesarean sections) were the most profitable procedures in the current DRG system. Overall, it currently makes economic sense for level I PNCs to treat as many low-risk pregnancies and neonates as possible to cover costs. PMID:24771932

The bedding of laboratory animals as a source of airborne contaminants.

PubMed

Kaliste, E; Linnainmaa, M; Meklin, T; Torvinen, E; Nevalainen, A

2004-01-01

In work environments with laboratory animals, the bedding of animals binds the excreta as well as other compounds originating from the animals and their environment. These may be generated into the ambient air when the personnel handle bedding in different procedures. This study compares the dustiness of different types of six clean and four soiled beddings from rat or mouse cages. The dust generation of clean bedding varied from <1 to 25 mg/m(3). When used in the cages of rats or mice for 4 days, the dust concentration of the beddings decreased, increased or stayed the same, depending on the type of bedding and animal species. A decrease in dustiness was, however, more common. The levels in the soiled beddings varied from <1 to 8.6 mg/m(3). In the case of the aspen chip bedding, the contents of bedding used in mouse, rat or rabbit cages were analysed for mesophilic bacteria and fungi, mycobacteria and endotoxins. All of these contaminants were variably found in the bedding samples, the maximal concentrations for bacteria were >6 500 000 colony-forming units (cfu)/g, for fungi 212 000 cfu/g, and for endotoxins 6500 ng/g (81 000 EU/g). The results showed that the bedding of laboratory animals may contain biologically effective compounds, and that these may be distributed into the ambient air depending on the characteristics of the bedding material. The dustiness of different bedding types is an important factor affecting the amount and quality of the occupational exposure of the personnel to airborne contaminants.

Efficacy of an Essential Oil-Based Pesticide for Controlling Bed Bug (Cimex lectularius) Infestations in Apartment Buildings.

PubMed

Wang, Changlu; Singh, Narinderpal; Cooper, Richard

2014-11-05

Bed bugs (Cimex lectularius L. and Cimex hemipterus F.) are among the most difficult urban pests to manage. Many essential oil-based bed bug control products that are considered reduced risk to mammals compared to synthetic insect neurotoxins have become commercially available, but their effectiveness as a stand-alone control method is unknown. This study assessed the field efficacy of an essential oil-based bed bug control product (EcoRaider; a.i. 1% geraniol + 1% cedar oil + 2% sodium lauryl sulfate) compared to a pyrethroid and neonicotinoid mixture spray (0.075% Temprid SC; a.i. beta-cyfluthrin + imidacloprid). After 12 weeks, the three treatments-EcoRaider, Temprid SC, and EcoRaider + Temprid SC caused 92.5 ± 2.7, 92.9 ± 3.0, and 91.7% ± 2.7% bed bug count reduction, respectively. No significant differences existed in the bed bug reduction among the treatments. Bed bugs were eliminated from only 22% of the treated apartments. Among those still with bed bugs, 76% of the residents did not know bed bugs were present. We documented the residents' self-control practices and discussed the potential of using essential oil-based insecticides in bed bug management programs to minimize the health risks to building occupants and pets and to slow down the development of insecticide resistance.

Efficacy of an Essential Oil-Based Pesticide for Controlling Bed Bug (Cimex lectularius) Infestations in Apartment Buildings

PubMed Central

Wang, Changlu; Singh, Narinderpal; Cooper, Richard

2014-01-01

Bed bugs (Cimex lectularius L. and Cimex hemipterus F.) are among the most difficult urban pests to manage. Many essential oil-based bed bug control products that are considered reduced risk to mammals compared to synthetic insect neurotoxins have become commercially available, but their effectiveness as a stand-alone control method is unknown. This study assessed the field efficacy of an essential oil-based bed bug control product (EcoRaider; a.i. 1% geraniol + 1% cedar oil + 2% sodium lauryl sulfate) compared to a pyrethroid and neonicotinoid mixture spray (0.075% Temprid SC; a.i. beta-cyfluthrin + imidacloprid). After 12 weeks, the three treatments—EcoRaider, Temprid SC, and EcoRaider + Temprid SC caused 92.5 ± 2.7, 92.9 ± 3.0, and 91.7% ± 2.7% bed bug count reduction, respectively. No significant differences existed in the bed bug reduction among the treatments. Bed bugs were eliminated from only 22% of the treated apartments. Among those still with bed bugs, 76% of the residents did not know bed bugs were present. We documented the residents’ self-control practices and discussed the potential of using essential oil-based insecticides in bed bug management programs to minimize the health risks to building occupants and pets and to slow down the development of insecticide resistance. PMID:26462944

The prevalence and characteristics associated with mother-infant bed-sharing in Klang district, Malaysia.

PubMed

Tan, K L; Ghani, S N; Moy, F M

2009-12-01

This was a cross-sectional study to determine the prevalence and characteristics of mother-infant bed-sharing practice in Klang district, Malaysia. Data was collected by face-to-face interview using a structured questionnaire for a four month period in 2006. A total of 682 mother-infant pairs attending government health clinics were included in the study. Data regarding socio-demographic characteristics of the mothers, information on the infants, bed-sharing and breastfeeding practices were collected. The mean maternal age was 28.4 +/- 5.1 years while the mean infant gestational age was 38.8 +/- 1.8 weeks. The study showed the prevalence of bed-sharing was 73.5% (95% CI: 70.0, 76.7). In multivariate analysis; area of interview, maternal occupation, family income, breastfeeding and infant birth weight were associated with bed-sharing after adjusted for maternal ethnicity, age, marital status, educational level, parity, infant gender and infant gestational age. In conclusion, bed-sharing is a common practice in Klang district, Malaysia, not specific to ethnicity, but strongly associated with low family income and breastfeeding.

Ratios and nurse staffing: the vexed case of emergency departments.

PubMed

Wise, Sarah; Fry, Margaret; Duffield, Christine; Roche, Michael; Buchanan, John

2015-02-01

Within Australia nursing unions are pursuing mandated nurse-patient ratios to safeguard patient outcomes and protect their members in healthcare systems where demand perpetually exceeds supply. Establishing ratios for an emergency department is more contentious than for hospital wards. The study's aim was to estimate average staffing levels, skill mix and patient presentations in all New South Wales (NSW) Emergency Departments (EDs). The design was a retrospective historical census audit. Nurse rosters and patient presentation data were collected for three randomly selected census days in May 2010. Twenty-six valid responses out of 44 were returned. A ratio of the number of beds per nurse was calculated as well as skill mix and bed occupancy. The average beds per nurse ratios found were 3.8 (morning shift), 3.6 (evening), and 5.1 (night). However, ratios as high as 8.4 (morning), 7.3 (evening) and 16.0 (night) were identified on particular shifts. Overall a rich skill mix was found with an average of 90% of nursing hours being provided by Registered Nurses. The average daily bed occupancy of 4 patients per bed was similar across ED levels. The study adds to the limited literature on ED staffing and demonstrates the utility in the simplicity of ratios in flagging potential staffing problems. The audit revealed wide variation in staffing levels which was not always linked to patient activity. Of particular concern were the regional EDs (Level 5) which have the capacity to deal with all types of emergencies but where ratios as high as 7 beds per nurse were found during the day. Ratios cannot be used to determine the optimal staffing levels in every clinical situation; their purpose is to force an increase in nursing supply and to prevent individual units from becoming understaffed. Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

[Public health in Orhei County--realities and opportunities].

PubMed

Cărăuşu, Elena Mihaela; Stirbate, P; Indrei, L L

2011-01-01

Orhei District Hospital has 420 beds located in 17 wards. Providing beds in 2010 is 39.2 to 10 000 people compared with 47.7 in 2008, but it is still more than the regional average for the country- 32.6. Rotation bed, the lethality rate of hospitalization of people have not changed in the previous year. The average duration of treatment and average bed occupancy rose in 2010 compared with 2009, but the bed occupancy rate is still small--about 60%. Share divergence diagnostic is lower than the previous year--this is a good indicator of quality. Enough old equipment is still an issue for the District Hospital Orhei. Making an analysis of the distinctive features of health care evaluations, where resources are expressed by the cost and the results are expressed as effects on health, we conclude that it is necessary to change the conceptual aspects regarding health care financing. For redress the economic and financial situation, is proposed following strategy: 1. Reduced costs for hotel accommodation, by introducing "a day hospital". This system implies investigation and medical advice, and writing medication without the patient to remain hospitalized for a long time (for cases that do not require prolonged hospitalization) 2. Reducing costs the necessary material resources with, the introduction of electronic auction. 3. Introducing the concept of health management, need for hospital management, better management the four types of resources available (human resources, material resources, financial resources, time). 4. Increasing managerial capacity, through a competitive selection manager, will be combine short-term planning and the long-term strategy (more flexible) to raise the efficiency of medical care. In this respect spaces allocated section of Pulmonology, will be reassembled in geriatric beds, and the space available, will be outsourced of other persons (individuals or corporate person), under the law where they will earn additional income. It is noted that the actual development costs are increasing.

Improving hospital bed occupancy and resource utilization through queuing modeling and evolutionary computation.

PubMed

Belciug, Smaranda; Gorunescu, Florin

2015-02-01

Scarce healthcare resources require carefully made policies ensuring optimal bed allocation, quality healthcare service, and adequate financial support. This paper proposes a complex analysis of the resource allocation in a hospital department by integrating in the same framework a queuing system, a compartmental model, and an evolutionary-based optimization. The queuing system shapes the flow of patients through the hospital, the compartmental model offers a feasible structure of the hospital department in accordance to the queuing characteristics, and the evolutionary paradigm provides the means to optimize the bed-occupancy management and the resource utilization using a genetic algorithm approach. The paper also focuses on a "What-if analysis" providing a flexible tool to explore the effects on the outcomes of the queuing system and resource utilization through systematic changes in the input parameters. The methodology was illustrated using a simulation based on real data collected from a geriatric department of a hospital from London, UK. In addition, the paper explores the possibility of adapting the methodology to different medical departments (surgery, stroke, and mental illness). Moreover, the paper also focuses on the practical use of the model from the healthcare point of view, by presenting a simulated application. Copyright © 2014 Elsevier Inc. All rights reserved.

The Implementation and Evaluation of the Patient Admission Prediction Tool: Assessing Its Impact on Decision-Making Strategies and Patient Flow Outcomes in 2 Australian Hospitals.

PubMed

Crilly, Julia L; Boyle, Justin; Jessup, Melanie; Wallis, Marianne; Lind, James; Green, David; FitzGerald, Gerry

2015-01-01

To evaluate the implementation of a Patient Admission Prediction Tool (PAPT) in terms of patient flow outcomes and decision-making strategies. The PAPT was implemented in 2 Australian public teaching hospitals during October-December 2010 (hospital A) and October-December 2011 (hospital B). A multisite prospective, comparative (before and after) design was used. Patient flow outcomes measured included access block and hospital occupancy. Daily and weekly data were collected from patient flow reports and routinely collected emergency department information by the site champion and researchers. Daily decision-making strategies ranged from business as usual to use of overcensus beds. Weekly strategies included advanced approval to use of overcensus beds and prebooking nursing staff. These strategies resulted in improved weekend discharges to manage incoming demand for the following week. Following the introduction of the PAPT and workflow guidelines, patient access and hospital occupancy levels could be maintained despite increases in patient presentations (hospital A). The use of a PAPT, embedded in patient flow management processes and championed by a manager, can benefit bed and staff management. Further research that incorporates wider evaluation of the use of the tool at other sites is warranted.

Mark-Release-Recapture Reveals Extensive Movement of Bed Bugs (Cimex lectularius L.) within and between Apartments

PubMed Central

Cooper, Richard; Wang, Changlu; Singh, Narinderpal

2015-01-01

Understanding movement and dispersal of the common bed bug (Cimex lectularius L.) under field conditions is important in the control of infestations and for managing the spread of bed bugs to new locations. We investigated bed bug movement within and between apartments using mark-release-recapture (m-r-r) technique combined with apartment-wide monitoring using pitfall-style interceptors. Bed bugs were collected, marked, and released in six apartments. The distribution of marked and unmarked bed bugs in these apartments and their 24 neighboring units were monitored over 32 days. Extensive movement of marked bed bugs within and between apartments occurred regardless of the number of bed bugs released or presence/absence of a host. Comparison of marked and unmarked bed bug distributions confirms that the extensive bed bug activity observed was not an artifact of the m-r-r technique used. Marked bed bugs were recovered in apartments neighboring five of six m-r-r apartments. Their dispersal rates at 14 or 15 d were 0.0–5.0%. The estimated number of bed bugs per apartment in the six m-r-r apartments was 2,433–14,291 at 4–7 d after release. Longevity of bed bugs in the absence of a host was recorded in a vacant apartment. Marked large nymphs (3rd– 5th instar), adult females, and adult males continued to be recovered up to 57, 113, and 134 d after host absence, respectively. Among the naturally existing unmarked bed bugs, unfed small nymphs (1st– 2nd instar) were recovered up to 134 d; large nymphs and adults were still found at 155 d when the study ended. Our findings provide important insight into the behavioral ecology of bed bugs in infested apartments and have significant implications in regards to eradication programs and managing the spread of bed bugs within multi-occupancy dwellings. PMID:26352145

Special Feature: Epistemological Paradigms in Evaluation: Implications for Practice. Section 1: "Paradigm Contrast" Case Studies.

ERIC Educational Resources Information Center

Rose, Tom; And Others

1991-01-01

This section presents two pragmatic studies focusing on a real-life situation and specific applications in managerial decision making. One study deals with improving occupational safety in a bedding manufacturing plant, whereas the other concentrates on managing a state mental health program. (SLD)

Soil analyses and evaluations at the impact dynamics research facility for two full-scale aircraft crash tests

NASA Technical Reports Server (NTRS)

Cheng, R. Y. K.

1977-01-01

The aircraft structural crash behavior and occupant survivability for aircraft crashes on a soil surface was studied. The results of placement, compaction, and maintenance of two soil test beds are presented. The crators formed by the aircraft after each test are described.

Effects of Known Determinants on Methylene Bisphenyl Isocyanate (MDI) Concentration During Spray-On Truck Bed-Lining Processes.

PubMed

Schaal, Nicholas C; Brazile, William J; Finnie, Katie L; Tiger, James P

2017-08-01

Occupational exposure to methylene bisphenyl isocyanate (MDI) presents serious worker health concerns as it may lead to short- and long-term health effects such as asthma, airway irritation, hypersensitivity pneumonitis, and irritation of skin and mucous membranes. While studies of worker isocyanate exposures during vehicle painting activities are widespread, few studies have investigated the spray-on truck bed-liner (STBL) industry. The purpose of this study was to determine the effectiveness of several ventilation system variables and process characteristics in controlling MDI concentrations in the STBL industry. A total of 47 personal air samples were collected for MDI during 18 site visits at nine STBL companies in Colorado and Wyoming. Ventilation system and process characteristics that were assessed included: ventilation system face velocity, airflow, air changes per minute (AC/M), capture velocity, percent of MDI in bed-liner product, application temperature, application pressure, paint booth temperature, paint booth relative humidity, paint booth volume, and quantity of bed-liner product applied. Pearson correlation revealed percentage of MDI in bed-liner product (r = 0.557, n = 14, P < 0.05) and process temperature (r = 0.677, n = 14, P < 0.05) had high positive correlation with MDI concentration. Ventilation system face velocity (r = -0.578, n = 14, P < 0.05) and AC/M (r = -0.657, n = 14, P < 0.05) had high negative correlation with MDI concentration while airflow (r = -0.475, n = 14, P < 0.05) and capture velocity (r = -0.415, n = 14, P = 0.07) had moderate negative correlation with MDI concentration. Multiple linear regression revealed process temperature and capture velocity made a statistically significant and unique contribution in estimating MDI concentration (F (2, 11) = 10.99, P < 0.05) with an adjusted R2 of 0.61, explaining 61% of the variability in MDI concentration. This investigation contributed to an understudied STBL industry by targeting determinants germane to MDI exposures during STBL application processes. Increasing ventilation performance for AC/M, airflow, face velocity, and capture velocity while also decreasing bed-liner application temperature and bed-liner product MDI content may have the greatest effect on reducing worker MDI exposures during STBL activities. Published by Oxford University Press on behalf of the British Occupational Hygiene Society 2017.

Breakthrough curves for toluene adsorption on different types of activated carbon fibers: application in respiratory protection.

PubMed

Balanay, Jo Anne G; Floyd, Evan L; Lungu, Claudiu T

2015-05-01

Activated carbon fibers (ACF) are considered viable alternative adsorbent materials in respirators because of their larger surface area, lighter weight, and fabric form. The purpose of this study was to characterize the breakthrough curves of toluene for different types of commercially available ACFs to understand their potential service lives in respirators. Two forms of ACF, cloth (AC) and felt (AF), with three surface areas each were tested. ACFs were challenged with six toluene concentrations (50-500 p.p.m.) at constant air temperature (23°C), relative humidity (50%), and air flow (16 l min-1) at different bed depths. Breakthrough data were obtained using continuous monitoring by gas chromatography using a gas sampling valve. The ACF specific surface areas were measured by an automatic physisorption analyzer. Results showed unique shapes of breakthrough curves for each ACF form: AC demonstrated a gradual increase in breakthrough concentration, whereas AF showed abrupt increase in concentration from the breakpoint, which was attributed to the difference in fiber density between the forms. AF has steeper breakthrough curves compared with AC with similar specific surface area. AC exhibits higher 10% breakthrough times for a given bed depth due to higher mass per bed depth compared with AF, indicating more adsorption per bed depth with AC. ACF in respirators may be appropriate for use as protection in environments with toluene concentration at the Occupational Safety and Health Administration Permissible Exposure Limit, or during emergency escape for higher toluene concentrations. ACF has shown great potential for application in respiratory protection against toluene and in the development of thinner, lighter, and more efficient respirators. © The Author 2014. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Feasibility of Using Rice Hulls as Bedding for Laboratory Mice.

PubMed

Carbone, Elizabeth T; Kass, Philip H; Evans, Kristin D

2016-01-01

Factors that are considered when selecting laboratory mouse bedding include animal health and comfort, cost, effects on personnel, and bioactive properties. Corncob is economical and facilitates low intracage ammonia but has undesirable influences on some endocrine studies. Rice hulls are an economical material that has not been well characterized as a bedding substrate. In this pilot study, we compared various aspects of bedding performance of rice hulls and other materials. On a per-volume basis, rice hulls were less absorbent than was corncob bedding. Rice hulls had higher odds than did corncob or reclaimed wood pulp of having moisture present at the bedding surface. The results of the absorbency tests coupled with the results of preliminary monitoring of intracage ammonia raised concern about the ability of rice hulls to control ammonia levels sufficiently in cages with high occupancy. However, ammonia was negligible when cages contained 5 young adult female mice. The relative expression of 3 cytochrome p450 genes was compared among mice housed on rice hulls, corncob, reclaimed wood pulp, or pine shavings. The expression of Cyp1a2 was 1.7 times higher in the livers of mice housed on rice hulls than on pine shavings, but other differences were not statistically significant. This study provides information on the merits of rice hulls as laboratory mouse bedding. Their relatively poor moisture control is a major disadvantage that might preclude their widespread use.

Feasibility of Using Rice Hulls as Bedding for Laboratory Mice

PubMed Central

Carbone, Elizabeth T; Kass, Philip H; Evans, Kristin D

2016-01-01

Factors that are considered when selecting laboratory mouse bedding include animal health and comfort, cost, effects on personnel, and bioactive properties. Corncob is economical and facilitates low intracage ammonia but has undesirable influences on some endocrine studies. Rice hulls are an economical material that has not been well characterized as a bedding substrate. In this pilot study, we compared various aspects of bedding performance of rice hulls and other materials. On a per-volume basis, rice hulls were less absorbent than was corncob bedding. Rice hulls had higher odds than did corncob or reclaimed wood pulp of having moisture present at the bedding surface. The results of the absorbency tests coupled with the results of preliminary monitoring of intracage ammonia raised concern about the ability of rice hulls to control ammonia levels sufficiently in cages with high occupancy. However, ammonia was negligible when cages contained 5 young adult female mice. The relative expression of 3 cytochrome p450 genes was compared among mice housed on rice hulls, corncob, reclaimed wood pulp, or pine shavings. The expression of Cyp1a2 was 1.7 times higher in the livers of mice housed on rice hulls than on pine shavings, but other differences were not statistically significant. This study provides information on the merits of rice hulls as laboratory mouse bedding. Their relatively poor moisture control is a major disadvantage that might preclude their widespread use. PMID:27177559

42 CFR 409.20 - Coverage of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... with the furnishing of that nursing care. (3) Physical, occupational, or speech therapy. (4) Medical... are considered as posthospital SNF care. For example, a type of medical or surgical procedure that is...) Terminology. In § 409.21 through § 409.36—. (1) The terms SNF and swing-bed hospital are used when the context...

Single-room usage patterns and allocation decision-making in an Australian public hospital: a sequential exploratory study.

PubMed

Bloomer, Melissa J; Lee, Susan F; Lewis, David P; Biro, Mary Anne; Moss, Cheryle

2016-08-01

The aims are to (1) measure occupancy rates of single and shared rooms; (2) compare single room usage patterns and (3) explore the practice, rationale and decision-making processes associated with single rooms; across one Australian public health service. There is a tendency in Australia and internationally to increase the proportion of single patient rooms in hospitals. To date there have been no Australian studies that investigate the use of single rooms in clinical practice. This study used a sequential exploratory design with data collected in 2014. A descriptive survey was used to measure the use of single rooms across a two-week time frame. Semi-structured interviews were undertaken with occupancy decision-makers to explore the practices, rationale decision-making process associated with single-room allocation. Total bed occupancy did not fall below 99·4% during the period of data collection. Infection control was the primary reason for patients to be allocated to a single room, however, the patterns varied according to ward type and single-room availability. For occupancy decision-makers, decisions about patient allocation was a complex and challenging process, influenced and complicated by numerous factors including occupancy rates, the infection status of the patient/s, funding and patient/family preference. Bed moves were common resulting from frequent re-evaluation of need. Apart from infection control mandates, there was little tangible evidence to guide decision-making about single-room allocation. Further work is necessary to assist nurses in their decision-making. There is a trend towards increasing the proportion of single rooms in new hospital builds. Coupled with the competing clinical demands for single room care, this study highlights the complexity of nursing decision-making about patient allocation to single rooms, an issue urgently requiring further attention. © 2016 John Wiley & Sons Ltd.

A Novel Mental Health Crisis Service - Outcomes of Inpatient Data.

PubMed

Morrow, R; McGlennon, D; McDonnell, C

2016-01-01

Northern Ireland has high mental health needs and a rising suicide rate. Our area has suffered a 32% reduction of inpatient beds consistent with the national drive towards community based treatment. Taking these factors into account, a new Mental Health Crisis Service was developed incorporating a high fidelity Crisis Response Home Treatment Team (CRHTT), Acute Day Care facility and two inpatient wards. The aim was to provide alternatives to inpatient admission. The new service would facilitate transition between inpatient and community care while decreasing bed occupancy and increasing treatment in the community. All services and processes were reviewed to assess deficiencies in current care. There was extensive consultation with internal and external stakeholders and process mapping using the COBRAs framework as a basis for the service improvement model. The project team set the service criteria and reviewed progress. In the original service model, the average inpatient occupancy rate was 106.6%, admission rate was 48 patients per month and total length of stay was 23.4 days. After introducing the inpatient consultant hospital model, the average occupancy rate decreased to 90%, admissions to 43 per month and total length of stay to 22 days. The results further decreased to 83% occupancy, 32 admissions per month and total length of stay 12 days after CRHTT initiation. The Crisis Service is still being evaluated but currently the model has provided safe alternatives to inpatient care. Involvement with patients, carers and all multidisciplinary teams is maximised to improve the quality and safety of care. Innovative ideas including structured weekly timetable and regular interface meetings have improved communication and allowed additional time for patient care.

A Novel Mental Health Crisis Service – Outcomes of Inpatient Data

PubMed Central

McGlennon, D; McDonnell, C

2016-01-01

Introduction Northern Ireland has high mental health needs and a rising suicide rate. Our area has suffered a 32% reduction of inpatient beds consistent with the national drive towards community based treatment. Taking these factors into account, a new Mental Health Crisis Service was developed incorporating a high fidelity Crisis Response Home Treatment Team (CRHTT), Acute Day Care facility and two inpatient wards. The aim was to provide alternatives to inpatient admission. The new service would facilitate transition between inpatient and community care while decreasing bed occupancy and increasing treatment in the community. Methods All services and processes were reviewed to assess deficiencies in current care. There was extensive consultation with internal and external stakeholders and process mapping using the COBRAs framework as a basis for the service improvement model. The project team set the service criteria and reviewed progress. Results In the original service model, the average inpatient occupancy rate was 106.6%, admission rate was 48 patients per month and total length of stay was 23.4 days. After introducing the inpatient consultant hospital model, the average occupancy rate decreased to 90%, admissions to 43 per month and total length of stay to 22 days. The results further decreased to 83% occupancy, 32 admissions per month and total length of stay 12 days after CRHTT initiation. Discussion The Crisis Service is still being evaluated but currently the model has provided safe alternatives to inpatient care. Involvement with patients, carers and all multidisciplinary teams is maximised to improve the quality and safety of care. Innovative ideas including structured weekly timetable and regular interface meetings have improved communication and allowed additional time for patient care. PMID:27158159

Environmental Cues in Double-Occupancy Rooms to Support Patients With Dementia.

PubMed

Motzek, Tom; Bueter, Kathrin; Marquardt, Gesine

2016-04-01

The purpose of this study was to evaluate the effectiveness of different environmental cues in double-occupancy rooms of an acute care hospital to support patients' abilities to identify their bed and wardrobe. The quasi-experiment was conducted on a geriatric ward of an acute care hospital. Patients with dementia were included (n = 42). To test the effectiveness of environmental cues, two rooms were enhanced with the environmental cue "color," two rooms with the cue "number," and two rooms with the cue "patient's name". Four rooms were not redesigned and were used as control rooms. For analysis, we pooled the intervention groups color and number (n = 14) and compared it with the control group (n = 22). The environmental cues color and number were significantly effective to improve the identification of the wardrobe from the third to the fifth day after admission. However, for the 10th-12th day after admission, we found no difference in results. Furthermore, results indicate improvements in the ability to identify the bed by using the environmental cues color and number. As this study indicated, the environmental cues color and number are helpful for these patients to identify their bed and wardrobe. However, these cues were most effective from the third to the fifth day after admission. To sustain their effectiveness on patients' identification abilities during their hospital stay, we discuss, whether verbal prompting and an ongoing mentioning of such cues, embedded in the daily work of nurses, could be beneficial. © The Author(s) 2015.

StratBAM: A Discrete-Event Simulation Model to Support Strategic Hospital Bed Capacity Decisions.

PubMed

Devapriya, Priyantha; Strömblad, Christopher T B; Bailey, Matthew D; Frazier, Seth; Bulger, John; Kemberling, Sharon T; Wood, Kenneth E

2015-10-01

The ability to accurately measure and assess current and potential health care system capacities is an issue of local and national significance. Recent joint statements by the Institute of Medicine and the Agency for Healthcare Research and Quality have emphasized the need to apply industrial and systems engineering principles to improving health care quality and patient safety outcomes. To address this need, a decision support tool was developed for planning and budgeting of current and future bed capacity, and evaluating potential process improvement efforts. The Strategic Bed Analysis Model (StratBAM) is a discrete-event simulation model created after a thorough analysis of patient flow and data from Geisinger Health System's (GHS) electronic health records. Key inputs include: timing, quantity and category of patient arrivals and discharges; unit-level length of care; patient paths; and projected patient volume and length of stay. Key outputs include: admission wait time by arrival source and receiving unit, and occupancy rates. Electronic health records were used to estimate parameters for probability distributions and to build empirical distributions for unit-level length of care and for patient paths. Validation of the simulation model against GHS operational data confirmed its ability to model real-world data consistently and accurately. StratBAM was successfully used to evaluate the system impact of forecasted patient volumes and length of stay in terms of patient wait times, occupancy rates, and cost. The model is generalizable and can be appropriately scaled for larger and smaller health care settings.

Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data.

PubMed

Blay, Nicole; Roche, Michael; Duffield, Christine; Xu, Xiaoyue

2017-12-01

To determine whether there was an association between intra-hospital transfers and adverse outcomes. Transfers between clinical units and between beds on the same unit are routine aspects of an episode of care in acute hospitals. The rate of these transfers per episode has increased in response to high occupancy levels, a decline in bed numbers, and increased demand for hospital services. The impact of the number of transfers between both wards and beds on patient outcomes is not widely explored. Retrospective cross sectional design using hospital administrative data. Data were extracted from existing hospital administrative datasets for one large metropolitan hospital for the financial year 2008-09 in Australia (n = 14,133). Descriptive analyses and logistic regression models were developed for each of 3 selected patient outcomes. Nearly one-tenth of patients (9.2%) experienced a fall with injury, 3.8% of surgical patients a wound infection and 0.1% a complication from medication errors. For each bed or ward transfer, the odds of falls and wound infections increased. Medication errors were not associated with either bed or ward moves. Hospitals should minimise the number of bed and ward transfers per episode of care in order to reduce the likelihood of adverse patient outcomes. Current bed management policies and practices should be evaluated and further refined to address this need. Additional strategies include improving coordination and communication during and after transfer. Nurses must consider the potential cost of intrahospital transfers on patients, length of stay and bed availability. © 2017 John Wiley & Sons Ltd.

Short-term forecasting of emergency inpatient flow.

PubMed

Abraham, Gad; Byrnes, Graham B; Bain, Christopher A

2009-05-01

Hospital managers have to manage resources effectively, while maintaining a high quality of care. For hospitals where admissions from the emergency department to the wards represent a large proportion of admissions, the ability to forecast these admissions and the resultant ward occupancy is especially useful for resource planning purposes. Since emergency admissions often compete with planned elective admissions, modeling emergency demand may result in improved elective planning as well. We compare several models for forecasting daily emergency inpatient admissions and occupancy. The models are applied to three years of daily data. By measuring their mean square error in a cross-validation framework, we find that emergency admissions are largely random, and hence, unpredictable, whereas emergency occupancy can be forecasted using a model combining regression and autoregressive integrated moving average (ARIMA) model, or a seasonal ARIMA model, for up to one week ahead. Faced with variable admissions and occupancy, hospitals must prepare a reserve capacity of beds and staff. Our approach allows estimation of the required reserve capacity.

Healthy Buildings Keep Employees out of Bed and Employers out of Court.

ERIC Educational Resources Information Center

Dunklee, Dennis R.; Silberman, Richard M.

1991-01-01

Sick building syndrome (SBS) is a situation in which at lease 15-20 percent of a building's occupants exhibit physical symptoms in a pattern that is linked to the building in which they work. Describes health effect, factors and causes of SBS, implications for risk management, and precautions school officials should take. (MLF)

The underlying reasons for very high levels of bed net use, and higher malaria infection prevalence among bed net users than non-users in the Tanzanian city of Dar es Salaam: a qualitative study.

PubMed

Msellemu, Daniel; Shemdoe, Aloysia; Makungu, Christina; Mlacha, Yeromini; Kannady, Khadija; Dongus, Stefan; Killeen, Gerry F; Dillip, Angel

2017-10-23

Bed nets reduce malaria-related illness and deaths, by forming a protective barrier around people sleeping under them. When impregnated with long-lasting insecticide formulations they also repel or kill mosquitoes attempting to feed upon sleeping humans, and can even suppress entire populations of malaria vectors that feed predominantly upon humans. Nevertheless, an epidemiological study in 2012 demonstrated higher malaria prevalence among bed net users than non-users in urban Dar es Salaam, Tanzania. Focus group discussions were conducted with women from four selected wards of Dar es Salaam city, focusing on four major themes relating to bed net use behaviours: (1) reasons for bed net use, (2) reasons for not using bed nets, (3) stimuli or reminders for people to use a bed net (4) perceived reasons for catching malaria while using a bed net. An analytical method by framework grouping of relevant themes was used address key issues of relevance to the study objectives. Codes were reviewed and grouped into categories and themes. All groups said the main reason for bed net use was protection against malaria. Houses with well-screened windows, with doors that shut properly, and that use insecticidal sprays against mosquitoes, were said not to use bed nets, while frequent attacks from malaria was the main stimulus for people to use bed nets. Various reasons were mentioned as potential reasons that compromise bed net efficacy, the most common of which were: (1) bed net sharing by two or more people, especially if one occupant tends to come to bed late at night, and does not tuck in the net 71%; (2) one person shares the bed but does not use the net, moving it away from the side on which s/he sleeps 68%; (3) ineffective usage habits, called ulalavi, in which a sprawling sleeper either touches the net while sleeping up against it or leaves a limb hanging outside of it 68%. Less common reasons mentioned included: (1) Small bed nets which become un-tucked at night (31%); (2) Bed nets with holes large enough to allow mosquitoes to pass (28%); and (3) Going to bed late after already being bitten outdoors (24%). Behaviours associated with bed net use like; bed sharing, bed net non compliant-bedfellow, sleeping pattern like ulalavi and some physical bed net attributes compromise its effectiveness and supposedly increase of malaria infection to bed net users. While some well-screened houses looked to instigate low malaria prevalence to non-bed net users.

Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003-2012: Results of the French National Network Survey, AES-RAISIN.

PubMed

Floret, N; Ali-Brandmeyer, O; L'Hériteau, F; Bervas, C; Barquins-Guichard, S; Pelissier, G; Abiteboul, D; Parneix, P; Bouvet, E; Rabaud, C

2015-08-01

To assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities. Retrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008-12). Reported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012. Of the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.

Tanning bed exposure increases the risk of malignant melanoma.

PubMed

Ting, William; Schultz, Kara; Cac, Natalie N; Peterson, Michael; Walling, Hobart W

2007-12-01

Epidemiologic studies have associated tanning bed exposure and cutaneous melanoma. The relationship between the extent of tanning bed exposure and the risk of melanoma has not been elucidated in detail. Surveys assessing the extent of tanning bed exposure and the history of skin cancer, including malignant melanoma, were collected from academic dermatology clinic patients (n = 1518). Of these, 551 (36.3%) completed all components of the survey. The available medical records, including pathology reports (n = 501; 33%), were reviewed to confirm cases of skin cancer. Data on potential confounding factors, including indoor vs. outdoor occupation and leisure activities, Fitzpatrick skin type, history of blistering sunburn, use of sunscreen and sun protective clothing, history of phototherapy, and level of education, were assessed and compared. Of the patients surveyed, 487 (32.1%) reported tanning bed exposure. Women aged 45 years or younger accounted for about 60% of all tanning bed users. Seventy-nine cases of malignant melanoma were reported, 22 in women aged 45 years or younger. In the entire cohort, the "ever-use" of tanning beds was found to be a significant risk factor for the development of melanoma [P < 0.05; odds ratio (OR), 1.64; 95% confidence interval (95% CI), 1.01-2.67]. The risk was greater in women aged 45 years or younger (P < 0.05; OR, 3.22; 95% CI, 1.01-11.46). Patients with a history of melanoma were significantly more likely to report tanning bed sessions exceeding 20 min (P < 0.01; OR, 3.18; 95% CI, 1.48-6.82); this association was even stronger for women aged 45 years or younger (OR, 4.12; 95% CI, 1.41-12.02). The study was subject to recall bias, included only patients at a midwestern academic practice, and had a relatively low response rate. Exposure to tanning beds increases the risk of malignant melanoma, especially in women aged 45 years or younger. These findings reinforce the hazards of tanning bed exposure.

Dr. Hall and the work cure.

PubMed

Reed, Kathlyn L

2005-01-01

Herbert James Hall, MD (1870-1923), was a pioneer in the systematic and organized study of occupation as therapy for persons with nervous and mental disorders that he called the "work cure." He began his work in 1904 during the early years of the Arts and Crafts Movement in the United States. His primary interest was the disorder neurasthenia, a condition with many symptoms including chronic fatigue, stress, and inability to work or perform everyday tasks. The prevailing treatment of the day was absolute bed rest known as the "rest cure." Hall believed that neurasthenia was not caused by overwork but by faulty living habits that could be corrected through an ordered life schedule and selected occupations. He identified several principles of therapy that are still used today including graded activity and energy conservation. Dr. Adolph Meyer credits Hall for organizing the ideas on the therapeutic use of occupation (Meyer, 1922). Hall also provided the name American Occupational Therapy Association for the professional organization and served as the fourth president. For his many contributions to the profession Hall deserves to be recognized as a major contributor to the development and organization of occupational therapy.

Individual and hospital-related determinants of potentially inappropriate admissions emerging from administrative records.

PubMed

Fusco, Marco; Buja, Alessandra; Piergentili, Paolo; Golfetto, Maria Teresa; Serafin, Gianni; Gallo, Silvia; Dalla Barba, Livio; Baldo, Vincenzo

2016-11-01

The appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. Medical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients' medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. Inappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards' specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients' higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. Some individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate inexpensive real-time data for identifying what determines potentially inappropriate hospital resource usage, and thus orient auditing activities and health care policy-making. Copyright © 2016. Published by Elsevier Ireland Ltd.

Implementing a sharps injury reduction program at a charity hospital in India.

PubMed

Gramling, Joshua J; Nachreiner, Nancy

2013-08-01

Health care workers in India are at high risk of developing bloodborne infections from needlestick injuries. Indian hospitals often do not have the resources to invest in safety devices and protective equipment to decrease this risk. In collaboration with hospital staff, the primary author implemented a sharps injury prevention and biomedical waste program at an urban 60-bed charity hospital in northern India. The program aligned with hospital organizational objectives and was designed to be low-cost and sustainable. Occupational health nurses working in international settings or with international workers should be aware of employee and employer knowledge and commitment to occupational health and safety. Copyright 2013, SLACK Incorporated.

Behavioural responses of females of two anopheline mosquito species to human-occupied, insecticide-treated and untreated bed nets

PubMed Central

2014-01-01

Background Insecticide-treated bed nets (ITNs), used extensively to reduce human exposure to malaria, work through physical and chemical means to block or deter host-seeking mosquitoes. Despite the importance of ITNs, very little is known about how host-seeking mosquitoes behave around occupied bed nets. As a result, evidence-based evaluations of the effects of physical damage on bed net effectiveness are not possible and there is a dearth of knowledge on which to base ITN design. Methods The dispersion of colony-raised female Anopheles gambiae and Anopheles albimanus was observed in 2-hr laboratory experiments in which up to 200 mosquitoes were released inside a mosquito-proof 3 m × 3 m tent housing a bed net arrayed with 18 30 cm × 30 cm sticky screen squares on the sides, ends and roof. Numbers of mosquitoes caught on the sticky squares were interpreted as the ‘mosquito pressure’ on that part of the net. Results Presence of a human subject in the bed net significantly increased total mosquito pressure on the net for both species and significantly re-oriented An. gambiae to the roof of the net. Anopheles albimanus pressure was greatest on the bed net roof in both host-present and no-host conditions. The effects of different human subjects in the bed net, of different ambient conditions (dry, cool conditions vs warm, humid conditions) and of bed net treatment (deltamethrin-treated or no insecticide) on mosquito pressure patterns were tested for both species. Species-specific pressure patterns did not vary greatly as a result of any of these factors though some differences were noted that may be due the size of the different human subjects. Conclusions As a result of the interaction between host-seeking responses and the convective plume from the net occupant, species-specific mosquito pressure patterns manifest more or less predictably on the bed net. This has implications for bed net design and suggests that current methods of assessing damaged bed nets, which do not take damage location into account, should be modified. PMID:25080389

Vehicle-related injuries in and around a medium sized Swedish City - bicyclist injuries caused the heaviest burden on the medical sector.

PubMed

Björnstig, Johanna; Bylund, Per-Olof; Björnstig, Ulf

2017-12-01

A data acquisition from the medical sector may give one important view of the burden on the society caused by vehicle related injuries. The official police-reported statistics may only reflect a part of all vehicle-related injured seeking medical attention. The aim is to provide a comprehensive picture of the burden of vehicle related injuries on the medical sector (2013), and to compare with official police-reported statistics and the development year 2000-2013. The data set includes 1085 injured from the Injury Data Base at Umeå University Hospital's catchment area with 148,500 inhabitants in 2013. Bicyclists were the most frequently injured (54%). One-third had non-minor (MAIS2+) injuries, and bicyclists accounted for 58% of the 1071 hospital bed days for all vehicle-related injuries. Car occupants represented 23% of all injured, and only 9% had MAIS2+ injuries. They accounted for 17% of the hospital bed days. Motorized two wheel vehicle riders represented 11% of the injured and 39% had MAIS2+ injuries and they occupied 11% of the hospital bed days. Of the 1085 medically treated persons, 767 were injured in public traffic areas, and, therefore, should be included in the official police statistics; however, only a third (232) of them were reported by the police. The annual injury rate had not changed during 2000-2013 for bicyclists, motor-cycle riders, pedestrians or snowmobile riders. However, for passenger car occupants a decrease was observed after 2008, and for mopedists the injury rate was halved after 2009 when a licensing regulation was introduced. The Swedish traffic injury reducing strategy Vision Zero, may have contributed to the reduction of injured car occupants and moped riders. The official police-reported statistics was a biased data source for vehicle related injuries and the total number medically treated was in total five times higher. Bicyclists caused the heaviest burden on the medical sector; consequently, they need to be prioritized in future safety work, as recently declared in the Government plan Vision Zero 2.0.

Effects of emergency department expansion on emergency department patient flow.

PubMed

Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F

2014-05-01

Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does not appear to be an adequate solution to ED crowding. © 2014 by the Society for Academic Emergency Medicine.

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study.

PubMed

Dunnigan, Matthew G; Pollock, Allyson M

2003-04-26

To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1.

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital.

PubMed

Smith, Thomas J

2012-01-01

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.

Is medical perspective on clinical governance practices associated with clinical units' performance and mortality? A cross-sectional study through a record-linkage procedure.

PubMed

Sarchielli, Guido; De Plato, Giovanni; Cavalli, Mario; Albertini, Stefano; Nonni, Ilaria; Bencivenni, Lucia; Montali, Arianna; Ventura, Antonio; Montali, Francesca

2016-01-01

Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units' performance measured through mortality rates and efficiency indicators. This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors' knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units' performance indicators which include patients' mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators. The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units' efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units' mortality rates (odds ratio, -8.677; 95% confidence interval, -16.654, -0.700). The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical governance tools application on its own clinical practice.

The current cost of angina pectoris to the National Health Service in the UK

PubMed Central

Stewart, S; Murphy, N; Walker, A; McGuire, A; McMurray, J J V

2003-01-01

Objective: To calculate the cost of angina pectoris to the UK National Health Service (NHS) in the year 2000. Methods: Calculation of the cost of hospital admissions, revascularisation procedures, hospital outpatient consultations, general practice (GP) consultations, and prescribed drug treatment. Results: 634 000 individuals (1.1% of the UK population) consulted GPs 2.35 million times, costing £60.5 million. They required 16.0 million prescriptions (cost £80.7 million) and 254 000 hospital outpatient referrals (cost £30.4 million). There were 149 000 hospital admissions, 117 000 coronary angiograms, 21 400 coronary artery bypass operations, 17 700 percutaneous coronary interventions, and 516 000 outpatient visits, at a cost of £208.4 million, £69.9 million, £106.2 million, £60.7 million, and £52.2 million, respectively. The direct cost of angina was therefore £669 million (1.3% of total NHS expenditure), with hospital bed occupancy and procedures accounting for 32% and 35% of this total, respectively. Conclusions: Angina is a common and costly public health problem. It consumed over 1% of all NHS expenditure in the year 2000, mainly because of hospital bed occupancy and revascularisation procedures. This is likely to be a conservative estimate of its true cost. PMID:12860855

[Structure of nurse labor market and determinants of hospital nurse staffing levels].

PubMed

Park, Bohyun; Seo, Sukyung; Lee, Taejin

2013-02-01

To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

The n-by-T Target Discharge Strategy for Inpatient Units.

PubMed

Parikh, Pratik J; Ballester, Nicholas; Ramsey, Kylie; Kong, Nan; Pook, Nancy

2017-07-01

Ineffective inpatient discharge planning often causes discharge delays and upstream boarding. While an optimal discharge strategy that works across all units at a hospital is likely difficult to identify and implement, a strategy that provides a reasonable target to the discharge team appears feasible. We used observational and retrospective data from an inpatient trauma unit at a Level 2 trauma center in the Midwest US. Our proposed novel n-by-T strategy-discharge n patients by the Tth hour-was evaluated using a validated simulation model. Outcome measures included 2 measures: time-based (mean discharge completion and upstream boarding times) and capacity-based (increase in annual inpatient and upstream bed hours). Data from the pilot implementation of a 2-by-12 strategy at the unit was obtained and analyzed. The model suggested that the 1-by-T and 2-by-T strategies could advance the mean completion times by over 1.38 and 2.72 h, respectively (for 10 AM ≤ T ≤ noon, occupancy rate = 85%); the corresponding mean boarding time reductions were nearly 11% and 15%. These strategies could increase the availability of annual inpatient and upstream bed hours by at least 2,469 and 500, respectively. At 100% occupancy rate, the hospital-favored 2-by-12 strategy reduced the mean boarding time by 26.1%. A pilot implementation of the 2-by-12 strategy at the unit corroborated with the model findings: a 1.98-h advancement in completion times (P<0.0001) and a 14.5% reduction in boarding times (P = 0.027). Target discharge strategies, such as the n-by-T, can help substantially reduce discharge lateness and upstream boarding, especially during high unit occupancy. To sustain implementation, necessary commitment from the unit staff and physicians is vital, and may require some training.

[Palliative care pathways of older patients].

PubMed

Zubieta, Lourdes; Hébert, Réjean; Raîche, Michel

To determine the palliative care pathways of older patients in Sherbrooke, Qc by examining their transfers to other facilities. This analysis was conducted by linking 3 databases: emergency department, hospitalizations and nursing homes. The study period ranged from January 2011 to December 2015. SPSS was used for statistical analysis. The study only included palliative care patients. 25% of patients waited less than 7 days for transfer, and 74% waited less than 3 weeks. 64.9% of patients were transferred to a long-term facility for dependent adults (LTF), 15.2% returned home or were transferred to private accommodation, and 15.9% were transferred to an intermediate care facility. One-half of patients subsequently changed facility, mainly those in homes or intermediate care. Palliative care patient bed occupation rates represented 1% of available bed-days and less than 2% of total beds for 86.4% of days. Only 12% of patients returned to hospital within 90 days after discharge. The number of beds occupied by palliative care patients does not seem to disrupt the hospital capacity. The majority of the palliative care patients were well managed, as reflected by the low readmission rate. Our results indicate good management of transfers and an adequate supply of long-term care facilities and home services.

[Hospital efficiency measured by bed space use in a secondary care hospital].

PubMed

Moreno-Martínez, Roberto; Martínez-Cruz, Rocío Alejandra

2015-01-01

In recognition that the availability of resources in the medical facility forms part of the factors that influence the quality of healthcare, it is of vital importance to measure their outcome. The aim of this study was determine the efficiency of the medical facility through the use of beds in a secondary level hospital. Through the Health Information Management System (HIMS), we examined statistical reports from July 2012 to June 2013 including variables such as expenses, patient days, occupancy rate, average length of stay by specialty and medical division, results were obtained for each strategic indicator, and these results were related assumptions proposing to assess hospital efficiency. Overall, we identified optimal efficiency of the medical facility without analysis of services, leads to deteriorating and low efficiency. The overall outcome of the five indicators applied overlooked saturation of services within the medical unit. However, the overall analysis shows the problem, noting the advantage of evaluating the same scenario from different perspectives. The include indicators measuring hospital efficiency resource based bed, allows considering deficiencies identified, so that decision making is strengthened the decision making health.

Analysis of the Internal Bed Regulation Committees from hospitals of a Southern Brazilian city

PubMed Central

Soares, Vinícius Sabedot

2017-01-01

ABSTRACT Objective To evaluate the composition of the Internal Regulation Committees created in hospitals of a capital city. Methods A cross-sectional descriptive study assessing the structure, processes and results of each Committee. Results The main reasons for implementing the committees were legal issues and overcrowding in the emergency department. The most monitored indicators were the occupancy rate and the mean length of stay, and the most observed results were reductions in the latter. Institutional protocols were developed in 70% of cases, and the degree of support that the Internal Regulation Committee received from the hospital managers was high, despite being only average the support received from the medical teams. Promoting the efficient use of beds seemed to be the main goal. To achieve it, the Internal Regulation Committee had to control hospital capacity at levels that allowed proper and safe bed turnover for patients. The strategies for this were varied and needed to integrate administrative and care issues. Conclusion The Internal Regulation Committees were a management tool with great potential and promising results in the experiences evaluated. PMID:29091157

[Intensive care services resources in Spain].

PubMed

Martín, M C; León, C; Cuñat, J; del Nogal, F

2013-10-01

To identify the resources related to the care of critically ill patients in Spain, which are available in the units dependent of the Services of Intensive Care Medicine (ICM) or other services/specialties, analyzing their distribution according to characteristics of the hospitals and by autonomous communities. Prospective observational study. Spanish hospitals. Heads of the Services of ICM. Number of units and beds for critically ill patients and functional dependence. The total number of registries obtained with at least one Service of ICM was 237, with a total of 100,198 hospital beds. Level iii (43.5%) and level ii (35%) hospitals predominated. A total of 73% were public hospitals and 55.3% were non-university centers. The total number of beds for adult critically ill patients, was 4,738 (10.3/100,000 inhabitants). The services of ICM registered had available 258 intensive are units (ICUs), with 3,363 beds, mainly polyvalent ICUs (81%) and 43 intermediate care units. The number of patients attended in the Services of ICM in 2008 was 174,904, with a percentage of occupation of 79.5% A total of 228 units attending critically ill patients, which are dependent of other services with 2,233 beds, 772 for pediatric patients or neonates, were registered. When these last specialized units are excluded, there was a marked predominance of postsurgical units followed by coronary and cardiac units. Seventy one per cent of beds available in the Critical Care Units in Spain are characterized by attending severe adult patients, are dependent of the services of ICM, and most of them are polyvalent. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Vegetation during UMBI and deposition of Tuff IF at Olduvai Gorge, Tanzania (ca. 1.8 Ma) based on phytoliths and plant remains.

PubMed

Albert, Rosa Maria; Bamford, Marion K

2012-08-01

As part of ongoing research at Olduvai Gorge, Tanzania, to determine the detailed paleoenvironmental setting during Bed I and Bed II times and occupation of the basin by early hominins, we present the results of phytolith analyses of Tuff IF which is the uppermost unit of Bed I. Phytoliths were identified in most of the levels and localities on the eastern paleolake margin, but there are not always sufficient numbers of identifiable morphologies to infer the specific type of vegetation due to dissolution. Some surge surfaces and reworked tuff surfaces were vegetated between successive ash falls, as indicated by root-markings and the presence of a variety of phytolith morphotypes. Dicotyledonous wood/bark types were dominant except at the FLK N site just above Tuff IF when monocots are dominant and for the palm-dominated sample from the reworked channel cutting down into Tuff IF at FLK N. The area between the two fault scarps bounding the HWK Compartment, approximately 1 km wide, was vegetated at various time intervals between some of the surges and during the reworking of the Tuff. By lowermost Bed II times the eastern margin was fully vegetated again. Climate and tectonic activity probably controlled the fluctuating lake levels but locally the paleorelief and drainage were probably the controlling factors for the vegetation changes. These data support a scenario of small groups of hominins making brief visits to the paleolake during uppermost Bed I times, followed by a more desirable vegetative environment during lowermost Bed II times. Copyright © 2011 Elsevier Ltd. All rights reserved.

Reducing the length of postnatal hospital stay: implications for cost and quality of care.

PubMed

Bowers, John; Cheyne, Helen

2016-01-15

UK health services are under pressure to make cost savings while maintaining quality of care. Typically reducing the length of time patients stay in hospital and increasing bed occupancy are advocated to achieve service efficiency. Around 800,000 women give birth in the UK each year making maternity care a high volume, high cost service. Although average length of stay on the postnatal ward has fallen substantially over the years there is pressure to make still further reductions. This paper explores and discusses the possible cost savings of further reductions in length of stay, the consequences for postnatal services in the community, and the impact on quality of care. We draw on a range of pre-existing data sources including, national level routinely collected data, workforce planning data and data from national surveys of women's experience. Simulation and a financial model were used to estimate excess demand, work intensity and bed occupancy to explore the quantitative, organisational consequences of reducing the length of stay. These data are discussed in relation to findings of national surveys to draw inferences about potential impacts on cost and quality of care. Reducing the length of time women spend in hospital after birth implies that staff and bed numbers can be reduced. However, the cost savings may be reduced if quality and access to services are maintained. Admission and discharge procedures are relatively fixed and involve high cost, trained staff time. Furthermore, it is important to retain a sufficient bed contingency capacity to ensure a reasonable level of service. If quality of care is maintained, staffing and bed capacity cannot be simply reduced proportionately: reducing average length of stay on a typical postnatal ward by six hours or 17% would reduce costs by just 8%. This might still be a significant saving over a high volume service however, earlier discharge results in more women and babies with significant care needs at home. Quality and safety of care would also require corresponding increases in community based postnatal care. Simply reducing staffing in proportion to the length of stay increases the workload for each staff member resulting in poorer quality of care and increased staff stress. Many policy debates, such as that about the length of postnatal hospital-stay, demand consideration of multiple dimensions. This paper demonstrates how diverse data sources and techniques can be integrated to provide a more holistic analysis. Our study suggests that while earlier discharge from the postnatal ward may achievable, it may not generate all of the anticipated cost savings. Some useful savings may be realised but if staff and bed capacity are simply reduced in proportion to the length of stay, care quality may be compromised.

A Comparison of Nurse Staffing Methods Used by the United States Air Force and Selected Civilian Hospitals

DTIC Science & Technology

1989-09-01

X1 = average days of bed occupancy by medical and surgical patients/month lexcluding pediatric, nursery, neonatal intensive care, psychiatric and...one for a neonatal intensive nursery. The residency teaching program additive is identical to the one used in AFMS 5206. The neonatal intensive nursery...additive is quite straightforward: if the facility nas a Neonatal Level Ii nursery, a constant requirement for twelve additional personnel is added to

Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections

PubMed Central

Reed, John L; Lyne, Maggi

2000-01-01

Objective To investigate the facilities for inpatient care of mentally disordered people in prison. Design Semistructured inspections conducted by doctor and nurse. Expected standards were based on healthcare quality standards published by the Prison Service or the NHS. Setting 13 prisons with inpatient beds in England and Wales subject to the prison inspectorate's routine inspection programme during 1997-8. Main outcomes measures Appraisals of quality of care against published standards. Results The 13 prisons had 348 beds, 20% of all beds in prisons. Inpatient units had between 3 and 75 beds. No doctor in charge of inpatients had completed specialist psychiatric training. 24% of nursing staff had mental health training; 32% were non-nursing trained healthcare officers. Only one prison had occupational therapy input; two had input from a clinical psychologist. Most patients were unlocked for about 3.5 hours a day and none for more than nine hours a day. Four prisons provided statistics on the use of seclusion. The average length of an episode of seclusion was 50 hours. Conclusion The quality of services for mentally ill prisoners fell far below the standards in the NHS. Patients' lives were unacceptably restricted and therapy limited. The present policy dividing inpatient care of mentally disordered prisoners between the prison service and the NHS needs reconsideration. PMID:10764360

Control of accidental releases of hydrogen selenide in vented storage cabinets

NASA Astrophysics Data System (ADS)

Fthenakis, V. M.; Moskowitz, P. D.; Sproull, R. D.

1988-07-01

Highly toxic hydrogen selenide and hydrogen sulfide gases are used in the production of copper-indium-diselenide photovoltaic cells by reactive sputtering. In the event of an accident, these gases may be released to the atmosphere and pose hazards to public and occupational safety and health. This paper outlines an approach for designing systems for the control of these releases given the uncertainty in release conditions and lack of data on the chemical systems involved. Accidental releases of these gases in storage cabinets can be controlled by either a venturi and packed-bed scrubber and carbon adsorption bed, or containment scrubbing equipment followed by carbon adsorption. These systems can effectively reduce toxic gas emissions to levels needed to protect public health. The costs of these controls (˜0.012/Wp) are samll in comparison with current (˜6/Wp) and projected (˜I/Wp) production costs.

[Job stress and well-being of care providers: development of a standardized survey instrument].

PubMed

Kivimäki, M; Lindström, K

1992-01-01

The main aim was to develop a standardized survey instrument for measuring job stress and well-being in hospital settings. The actual study group consisted of 349 workers from medical bed wards, first aid unit wards and bed wards for gynecology and obstetrics in a middle-sized hospital in the Helsinki region. Based on the factor analysis of separate questions, the following content areas were chosen for the job stressor scales: haste at work, problems in interpersonal relations at work, problems in occupational collaboration with others, too much responsibility, safety and health risks, lack of appreciation, troublesome patients, and lack of equipment and resources. Content areas for well-being scales and items were general job satisfaction, strain symptoms, perceived mental and physical work load. The reference values of the questionnaire and reliabilities for the scales were calculated. The application and further development of the questionnaire was discussed.

Finding savings in laundry operations.

PubMed

Giancola, D

1993-07-01

A 450-bed hospital, operating at 75 percent occupancy, which has a cash outlay of $10.00 per patient day for linen service, will spend $1,231,875 on linen service per year. If the cash outlay for linen service can be reduced to $7.00 per patient day, the hospital will save $369,562 per year. This article details the factors that affect linen service operations expenses, suggests ways such operations may be improved, and provides a method of measuring the potential savings.

Indirect costs of teaching in Canadian hospitals.

PubMed Central

MacKenzie, T A; Willan, A R; Cox, M A; Green, A

1991-01-01

We sought to determine whether there are indirect costs of teaching in Canadian hospitals. To examine cost differences between teaching and nonteaching hospitals we estimated two cost functions: cost per case and cost per patient-day (dependent variables). The independent variables were number of beds, occupancy rate, teaching ratio (number of residents and interns per 100 beds), province, urbanicity (the population density of the county in which the hospital was situated) and wage index. Within each hospital we categorized a random sample of patient discharges according to case mix and severity of illness using age and standard diagnosis and procedure codes. Teaching ratio and case severity were each highly correlated positively with the dependent variables. The other variables that led to higher costs in teaching hospitals were wage rates and number of beds. Our regression model could serve as the basis of a reimbursement system, adjusted for severity and teaching status, particularly in provinces moving toward introducing case-weighting mechanisms into their payment model. Even if teaching hospitals were paid more than nonteaching hospitals because of the difference in the severity of illness there should be an additional allowance to cover the indirect costs of teaching. PMID:1898870

Morbidity and mortality amongst Indian Hajj pilgrims: A 3-year experience of Indian Hajj medical mission in mass-gathering medicine.

PubMed

Khan, Inam D; Khan, Shahbaz A; Asima, Bushra; Hussaini, Syed B; Zakiuddin, M; Faisal, F A

The Hajj, a mass-gathering of over 3.5-million pilgrims, faces challenges to global health-security, housing, food, water, transportation, communication, sanitation, crowd-control and security. The Indian Medical Mission extended health-security to approximately 140,000 pilgrims, through outreach medical teams, primary-care clinics, tent-clinics, secondary-care hospitals and evacuation capabilities. Data on medical attendance, bed-occupancy, investigations, referrals, medication usage and deaths was compared. Outpatient attendance was 374,475 in static-clinics, 5135 in tent-clinics and 13,473 through task-forces. 585 (62.90%) in-patients were hospitalized amongst 930 secondary-care referrals. Secondary-care bed-days were 2106 with average bed-occupancy being 77.78%. 495 patients were institutionalized in tertiary-care Saudi-Arabian hospitals. Infectious diseases were most commonly (53.26%) encountered due to overwhelming respiratory-infections, followed by trauma (24.40%). Analgesics (66.38/100 patients) and antibacterials (48.34/100 patients) were frequently prescribed. Crude mortality amongst Indian pilgrims was 11.99/10,000. Risk-factors associated with high morbidity were old-age and pre-existing comorbidities. Overwhelming surge of patients facilitates transmission of communicable infections and leads to stress induced physical, mental and compassion fatigue amongst healthcare personnel. Respiratory infections are highly prevalent and easily transmissible during Hajj leading to significant morbidity, increased burden to existing health facilities, overwhelming costs on health systems and globalization of multiresistant pathogens. Diabetic patients should avoid heat exposure and use protective footwear during Hajj rituals. Mass-gathering medicine at Hajj can be optimized by improving patient knowledge on performing Hajj at a younger age, medicine compliance, avoiding self-medication, self-monitoring of hypertension, blood glucose, and preventive health measures; screening of pre-existing comorbidities; and resource augmentation with telemedicine networks and decision-support systems. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Association of emergency department and hospital characteristics with elopements and length of stay.

PubMed

Handel, Daniel A; Fu, Rongwei; Vu, Eugene; Augustine, James J; Hsia, Renee Y; Shufflebarger, Charles M; Sun, Benjamin

2014-06-01

As the Centers for Medicare & Medicaid Services (CMS) core measures in 2013 compare Emergency Department (ED) treatment time intervals, it is important to identify ED and hospital characteristics associated with these metrics to facilitate accurate comparisons. The objective of this study is to assess differences in operational metrics by ED and hospital characteristics. ED-level characteristics included annual ED volume, percentage of patients admitted, percentage of patients presenting by ambulance, and percentage of pediatric patients. Hospital-level characteristics included teaching hospital status, trauma center status, hospital ownership (nonprofit or for-profit), inpatient bed capacity, critical access status, inpatient bed occupancy, and rural vs. urban location area. Data from the ED Benchmarking Alliance from 2004 to 2009 were merged with the American Hospital Association's Annual Survey Database to include hospital characteristics that may impact ED throughput. Overall median length of stay (LOS) and left before treatment is complete (LBTC) were the primary outcome variables, and a linear mixed model was used to assess the association between outcome variables and ED and hospital characteristics, while accounting for correlations among multiple observations within each hospital. All data were at the hospital level on a yearly basis. There were 445 EDs included in the analysis, from 2004 to 2009, with 850 observations over 6 years. Higher-volume EDs were associated with higher rates of LBTC and LOS. For-profit hospitals had lower LBTC and LOS. Higher inpatient bed occupancies were associated with a higher LOS. Increasing admission percentages were positively associated with overall LOS for EDs, but not with rates of LBTC. Higher-volume EDs are associated with higher LBTC and LOS, and for-profit hospitals appear more favorably in these metrics compared with their nonprofit counterparts. It is important to appreciate that hospitals have different baselines for performance that may be more tied to volume and capacity, and less to quality of care. Copyright © 2014 Elsevier Inc. All rights reserved.

The provision of patient personal hygiene in the intensive care unit: a descriptive exploratory study of bed-bathing practice.

PubMed

Coyer, Fiona M; O'Sullivan, Judy; Cadman, Nicola

2011-08-01

The provision of the patient bed-bath is a fundamental nursing care activity yet few quantitative data and no qualitative data are available on registered nurses' (RNs) clinical practice in this domain in the intensive care unit (ICU). The aim of this study was to describe ICU RNs current practice with respect to the timing, frequency and duration of the patient bed-bath and the cleansing and emollient agents used. The study utilised a two-phase sequential explanatory mixed method design. Phase one used a questionnaire to survey RNs and phase two employed semi-structured focus group (FG) interviews with RNs. Data was collected over 28 days across four Australian metropolitan ICUs. Ethical approval was granted from the relevant hospital and university human research ethics committees. RNs were asked to complete a questionnaire following each episode of care (i.e. bed-bath) and then to attend one of three FG interviews: RNs with less than 2 years ICU experience; RNs with 2-5 years ICU experience; and RNs with greater than 5 years ICU experience. During the 28-day study period the four ICUs had 77.25 beds open. In phase one a total of 539 questionnaires were returned, representing 30.5% of episodes of patient bed-baths (based on 1767 bed occupancy and one bed-bath per patient per day). In 349 bed-bath episodes 54.7% patients were mechanically ventilated. The bed-bath was given between 02.00 and 06.00h in 161 episodes (30%), took 15-30min to complete (n=195, 36.2%) and was completed within the last 8h in 304 episodes (56.8%). Cleansing agents used were predominantly pH balanced soap or liquid soap and water (n=379, 71%) in comparison to chlorhexidine impregnated sponges/cloths (n=86, 16.1%) or other agents such as pre-packaged washcloths (n=65, 12.2%). In 347 episodes (64.4%) emollients were not applied after the bed-bath. In phase two 12 FGs were conducted (three FGs at each ICU) with a total of 42 RN participants. Thematic analysis of FG transcripts across the three levels of RN ICU experience highlighted a transition of patient hygiene practice philosophy from shades of grey - falling in line for inexperienced clinicians to experienced clinicians concrete beliefs about patient bed-bath needs. This study identified variation in process and products used in patient hygiene practices in four ICUs. Further study to improve patient outcomes is required to determine the appropriate timing of patient hygiene activities and cleansing agents used to improve skin integrity. Copyright © 2010 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Estimating the Hospital Burden of Norovirus-Associated Gastroenteritis in England and its Opportunity Costs for Non-Admitted Patients.

PubMed

Sandmann, Frank G; Shallcross, Laura; Adams, Natalie; Allen, David J; Coen, Pietro G; Jeanes, Annette; Kozlakidis, Zisis; Larkin, Lesley; Wurie, Fatima; Robotham, Julie V; Jit, Mark; Deeny, Sarah R

2018-02-26

Norovirus places a substantial burden on healthcare systems, arising from infected patients, disease outbreaks, beds kept unoccupied for infection control, and staff absences due to infection. In settings with high rates of bed occupancy, opportunity costs arise from patients who cannot be admitted due to beds being unavailable. With several treatments and vaccines against norovirus in development, quantifying the expected economic burden is timely. The number of inpatients with norovirus-associated gastroenteritis in England were modelled using infectious and non-infectious gastrointestinal Hospital Episode Statistics codes and laboratory reports of gastrointestinal pathogens collected at Public Health England. The excess length of stay from norovirus was estimated with a multi-state model and local outbreak data. Unoccupied bed-days and staff absences were estimated from national outbreak surveillance. The burden was valued conventionally using accounting expenditures and wages, which we contrasted to the opportunity costs from forgone patients using a novel methodology. Between July 2013 and June 2016, 17.7% (95%-confidence interval: 15.6%‒21.6%) of primary and 23.8% (20.6%‒29.9%) of secondary gastrointestinal diagnoses were norovirus-attributable. Annually, the estimated median 290,000 (interquartile range: 282,000‒297,000) occupied and unoccupied bed-days used for norovirus displaced 57,800 patients. Conventional costs for the National Health Service reached £107.6 million; the economic burden approximated to £297.7 million and a loss of 6,300 quality-adjusted life years annually. In England, norovirus is now the second-largest contributor of the gastrointestinal hospital burden. With the projected impact being greater than previously estimated, improved capture of relevant opportunity costs seems imperative for diseases like norovirus.

Emergency Department Overcrowding and Ambulance Turnaround Time

PubMed Central

Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul

2015-01-01

Objective The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. Methods This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Results Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). Conclusions In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance. PMID:26115183

[Comparison of occupational and home accidents as a cause of severe burns. The experience of a large burn center in an industrial city].

PubMed

Romano, C; Arturi, L; Rubino, G F; Magliacani, G

1989-01-01

Among acute "traumatisms", occupational and domestic accidents chiefly share burn. To compare these two causes of severe burns, we examined clinical records of patients hospitalized from January 1986 to February 1989 in the "Grand Burns Center" at the C.T.O. hospital in Turin. Data exclusively refer to patients over 12 years old. 61 out of 313 cases (19%) were due to occupational burns, 221 (71%) to domestic ones (left cases including burns occurred in different surroundings). Males predominance was very high (95%) in the occupational settings, lower though still relevant (60%) in the domestic ones. The topographic distribution of the burns did not show any relevant difference. Similarly, the two groups did not differ as the affected percent of the body surface area (BSA) is concerned: in both cases burns extended cases. Decreased patients were fairly more numerous among the domestic burns (33%) as compared to the occupational ones (18%). The overwhelming majority (90.5%) of domestic burns were caused by fire; such a predominance, though present, was lower (68.8%) among occupational accidents. More in detail, domestic burns were caused as follows: alcohol spraying to stir a fire (26%), gas burst (25%), flammable substances exposed to heat sources (18%), hot water or different liquid (8%), fall over heating devices (6%), fires from cigarettes in bed (5%), kitchen stoves (with or without clothing fire) (5%), brushwood burning (4%), other (3%). It is worth noting that in as many as 40% of the cases of domestic burns patients were affected by a pre-existing neuro-psychic disorder, namely: personality disorders (15%), psychiatric disorders (%), epilepsy (9%), mental debility (7%).

Thoron Mitigation System based on charcoal bed for applications in thorium fuel cycle facilities (part 2): Development, characterization, and performance evaluation.

PubMed

Sudeep Kumara, K; Sahoo, B K; Gaware, J J; Sapra, B K; Mayya, Y S; Karunakara, N

2017-06-01

Exposure due to thoron ( 220 Rn) gas and its decay products in a thorium fuel cycle facility handling thorium or 232 U/ 233 U mixture compounds is an important issue of radiological concern requiring control and mitigation. Adsorption in a flow-through charcoal bed offers an excellent method of alleviating the release of 220 Rn into occupational and public domain. In this paper, we present the design, development, and characterization of a Thoron Mitigation System (TMS) for industrial application. Systematic experiments were conducted in the TMS for examining the 220 Rn mitigation characteristics with respect to a host of parameters such as flow rate, pressure drop, charcoal grain size, charcoal mass and bed depth, water content, and heat of the carrier gas. An analysis of the experimental data shows that 220 Rn attenuation in a flow through charcoal bed is not exponential with respect to the residence time, L/U a (L: bed depth; U a : superficial velocity), but follows a power law behaviour, which can be attributed to the occurrence of large voids due to wall channeling in a flow through bed. The study demonstrates the regeneration of charcoal adsorption capacity degraded due to moisture adsorption, by hot air blowing technique. It is found that the mitigation factor (MF), which is the ratio of the inlet 220 Rn concentration (C in ) to the outlet 220 Rn concentration (C out ), of more than 10 4 for the TMS is easily achievable during continuous operation (>1000 h) at a flow rate of 40 L min -1 with negligible (<1 cm of water column) pressure drop. The Thoron Mitigation System based on adsorption on charcoal bed offers a compact and effective device to remove 220 Rn from affluent air streams in a space constrained domain. The prototype system has been installed in a thorium fuel cycle facility where it is being evaluated for its long-term performance and overall effectiveness in mitigating 220 Rn levels in the workplace. Copyright © 2017 Elsevier Ltd. All rights reserved.

Twenty years of a multidisciplinary paediatric diabetes home care unit

PubMed Central

McEvilly, A; Kirk, J

2005-01-01

As only a minority of patients with type 1 diabetes are unwell at diagnosis, these patients could be managed at home if appropriate facilities were available. A multidisciplinary diabetes home care service was established over 20 years ago at Birmingham Children's Hospital, to support children with diabetes mellitus within the home environment from diagnosis, reducing emotional upset and separation. Despite increase in the size and distribution of the unit over this time (from 230 to 400 patients (now spread over two hospitals)), the proportion of newly diagnosed children managed wholly at home (median 43%; range 31–67%), and the reduction in number and duration of admissions has been sustained (readmission rate with diabetic ketoacidosis 4.1 bed-days per 100 patients/year; range 2.9–7.1), with no deterioration in overall blood glucose control. In this way the savings achieved by reductions in expensive hospital bed occupancy have more than offset the costs of maintaining the unit. PMID:15781919

Innovative Information Systems in the Intensive Care Unit, King Saud Medical City in Saudi Arabia.

PubMed

Al Saleem, Nouf; Al Harthy, Abdulrahman

2015-01-01

The purpose of this paper is to discuss the experience of implementing innovative information technology to improve the quality of services in one of the largest Intensive Care Units in Saudi Arabia. The Intensive Care Units in King Saud Medical City (ICU-KSMC) is the main ICU in the kingdom that represents the Ministry of Health. KSMC's ICU is also considered one of the largest ICU in the world as it consists of six units with 129 beds. Leaders in KSMC's ICU have introduced and integrated three information technologies to produce powerful, accurate, and timely information systems to overcome the challenges of the ICU nature and improve the quality of service to ensure patients' safety. By 2015, ICU in KSMC has noticed a remarkable improvement in: beds' occupation and utilization, staff communication, reduced medical errors, and improved departmental work flow, which created a healthy professional work environment. Yet, ICU in KSMC has ongoing improvement projects that include future plans for more innovative information technologies' implementation in the department.

Initial excavation and dating of Ngalue Cave: a Middle Stone Age site along the Niassa Rift, Mozambique.

PubMed

Mercader, Julio; Asmerom, Yemane; Bennett, Tim; Raja, Mussa; Skinner, Anne

2009-07-01

Direct evidence for a systematic occupation of the African tropics during the early late Pleistocene is lacking. Here, we report a record of human occupation between 105-42ka, based on results from a radiometrically-dated cave section from the Mozambican segment of the Niassa (Malawi/Nyasa) Rift called Ngalue. The sedimentary sequence from bottom to top has five units. We concentrate on the so-called "Middle Beds," which contain a Middle Stone Age industry characterized by the use of the discoidal reduction technique. A significant typological feature is the presence of formal types such as points, scrapers, awls, and microliths. Special objects consist of grinders/core-axes covered by ochre. Ngalue is one of the few directly-dated Pleistocene sites located along the biogeographical corridor for modern human dispersals that links east, central, and southern Africa, and, with further study, may shed new light on hominin cave habitats during the late Pleistocene.

[Implementation of safety devices: biological accident prevention].

PubMed

Catalán Gómez, M Teresa; Sol Vidiella, Josep; Castellà Castellà, Manel; Castells Bo, Carolina; Losada Pla, Nuria; Espuny, Javier Lluís

2010-04-01

Accidental exposures to blood and biological material were the most frequent and potentially serious accidents in healthcare workers, reported in the Prevention of Occupational Risks Unit within 2002. Evaluate the biological percutaneous accidents decrease after a progressive introduction of safety devices. Biological accidents produced between 2.002 and 2.006 were analyzed and reported by the injured healthcare workers to the Level 2b Hospital Prevention of Occupational Risk Unit with 238 beds and 750 employees. The key of the study was the safety devices (peripheral i.v. catheter, needleless i.v. access device and capillary blood collection lancet). Within 2002, 54 percutaneous biological accidents were registered and 19 in 2006, that represents a 64.8% decreased. There has been no safety devices accident reported involving these material. Accidents registered during the implantation period occurred because safety devices were not used at that time. Safety devices have proven to be effective in reducing needle stick percutaneous accidents, so that they are a good choice in the primary prevention of biological accidents contact.

Blast resistant vehicle seat

DOEpatents

Ripley, Edward B

2013-02-12

Disclosed are various seats for vehicles particularly military vehicles that are susceptible to attack by road-bed explosive devices such as land mines or improvised explosive devices. The seats often have rigid seat shells and may include rigid bracing for rigidly securing the seat to the chassis of the vehicle. Typically embodiments include channels and particulate media such as sand disposed in the channels. A gas distribution system is generally employed to pump a gas through the channels and in some embodiments the gas is provided at a pressure sufficient to fluidize the particulate media when an occupant is sitting on the seat.

Land factors affecting soil erosion during snow melting: a case study from Lebanon

NASA Astrophysics Data System (ADS)

Darwich, Talal

2014-05-01

Soil erosion is one of the major problems facing the mountainous agricultural lands in Lebanon. In order to assess the land factors acting on soil erosion; a study was conducted in the upper watershed of Ibrahim River in the spring months of April, May and June. Water and bed load sediments from six locations alimented by six sub-basins were sampled. Four sub-basins (1, 2, 3 and 6) were dominated by agricultural lands while lands in sub-basins 4 and 7 were occupied by grassland and bare soils. The highest quantities of suspended sediments were found in waters originating from watersheds dominated by agricultural lands, such as Location 2 (713.72 mg L-1 in April 2012). Low clay content and the combination of land occupation (orchards = 71%) and slope (20.7 degrees) caused this ecosystem disturbance. Locations 1, 2, 3 and 6 were alimented by runoff water due to the melting of the snow. For this, the concentrations of sediments decreased by 4 fold between April and May in sub-basin 1 and by 11-14 fold in sub-basins 2, 3 and 6. Globally, some 1669.4 tons of sediments were delivered in the upper river during April. Bed load sediments were separated into 4 classes according to their size. The size of the particles found in the bed load reflected to a large extent the type of soils surrounding the watershed. The range of sand in the regions surrounding locations 6 and 7 was 64% and 82%, while the average in the bed load was 80.9% and 78.25% respectively. The silt content in locations 2, 3 and 5 was well reflected in the concentrations of silt in the bed load. In bed load samples, the exchangeable potassium ranged from 70-250 mg kg-1 in sub-basins dominated by agricultural lands against 20-50 mg kg-1 in sub-basins dominated by grassland and bare rocks. Further quantitative studies need to be conducted especially during the first rains to fully estimate the water load sediments after a prolonged dry season, characterizing the east Mediterranean. Action must be taken for land conservation by improving the farmer's practices, modifying the frequency of plowing and introducing no tillage beside the maintenance of terraces. Keywords: Mountains, erosion, sediments, East Mediterranean, river, bed load quality.

Technical efficiency and productivity of Chinese county hospitals: an exploratory study in Henan province, China.

PubMed

Cheng, Zhaohui; Tao, Hongbing; Cai, Miao; Lin, Haifeng; Lin, Xiaojun; Shu, Qin; Zhang, Ru-Ning

2015-09-09

Chinese county hospitals have been excessively enlarging their scale during the healthcare reform since 2009. The purpose of this paper is to examine the technical efficiency and productivity of county hospitals during the reform process, and to determine whether, and how, efficiency is affected by various factors. 114 sample county hospitals were selected from Henan province, China, from 2010 to 2012. Data envelopment analysis was employed to estimate the technical and scale efficiency of sample hospitals. The Malmquist index was used to calculate productivity changes over time. Tobit regression was used to regress against 4 environmental factors and 5 institutional factors that affected the technical efficiency. (1) 112 (98.2%), 112 (98.2%) and 104 (91.2%) of the 114 sample hospitals ran inefficiently in 2010, 2011 and 2012, with average technical efficiency of 0.697, 0.748 and 0.790, respectively. (2) On average, during 2010-2012, productivity of sample county hospitals increased by 7.8%, which was produced by the progress in technical efficiency changes and technological changes of 0.9% and 6.8%, respectively. (3) Tobit regression analysis indicated that government subsidy, hospital size with above 618 beds and average length of stay assumed a negative sign with technical efficiency; bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency. There was considerable space for technical efficiency improvement in Henan county hospitals. During 2010-2012, sample hospitals experienced productivity progress; however, the adverse change in pure technical efficiency should be emphasised. Moreover, according to the Tobit results, policy interventions that strictly supervise hospital bed scale, shorten the average length of stay and coordinate the proportion among physicians, nurses and beds, would benefit hospital efficiency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Technical efficiency and productivity of Chinese county hospitals: an exploratory study in Henan province, China

PubMed Central

Cheng, Zhaohui; Tao, Hongbing; Cai, Miao; Lin, Haifeng; Lin, Xiaojun; Shu, Qin; Zhang, Ru-ning

2015-01-01

Objectives Chinese county hospitals have been excessively enlarging their scale during the healthcare reform since 2009. The purpose of this paper is to examine the technical efficiency and productivity of county hospitals during the reform process, and to determine whether, and how, efficiency is affected by various factors. Setting and participants 114 sample county hospitals were selected from Henan province, China, from 2010 to 2012. Outcome measures Data envelopment analysis was employed to estimate the technical and scale efficiency of sample hospitals. The Malmquist index was used to calculate productivity changes over time. Tobit regression was used to regress against 4 environmental factors and 5 institutional factors that affected the technical efficiency. Results (1) 112 (98.2%), 112 (98.2%) and 104 (91.2%) of the 114 sample hospitals ran inefficiently in 2010, 2011 and 2012, with average technical efficiency of 0.697, 0.748 and 0.790, respectively. (2) On average, during 2010–2012, productivity of sample county hospitals increased by 7.8%, which was produced by the progress in technical efficiency changes and technological changes of 0.9% and 6.8%, respectively. (3) Tobit regression analysis indicated that government subsidy, hospital size with above 618 beds and average length of stay assumed a negative sign with technical efficiency; bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency. Conclusions There was considerable space for technical efficiency improvement in Henan county hospitals. During 2010–2012, sample hospitals experienced productivity progress; however, the adverse change in pure technical efficiency should be emphasised. Moreover, according to the Tobit results, policy interventions that strictly supervise hospital bed scale, shorten the average length of stay and coordinate the proportion among physicians, nurses and beds, would benefit hospital efficiency. PMID:26353864

Distribution of a climate-sensitive species at an interior range margin

USGS Publications Warehouse

Ray, Chris; Beever, Erik; Rodhouse, Thomas J.

2016-01-01

Advances in understanding the factors that limit a species’ range, particularly in the context of climate change, have come disproportionately through investigations at range edges or margins. The margins of a species’ range might often correspond with anomalous microclimates that confer habitat suitability where the species would otherwise fail to persist. We addressed this hypothesis using data from an interior, climatic range margin of the American pika (Ochotona princeps), an indicator of relatively cool, mesic climates in rocky habitats of western North America. Pikas in Lava Beds National Monument, northeastern California, USA, occur at elevations much lower than predicted by latitude and longitude. We hypothesized that pika occurrence within Lava Beds would be associated primarily with features such as “ice caves” in which sub-surface ice persists outside the winter months. We used data loggers to monitor sub-surface temperatures at cave entrances and at non-cave sites, confirming that temperatures were cooler and more stable at cave entrances. We surveyed habitat characteristics and evidence of pika occupancy across a random sample of cave and non-cave sites over a 2-yr period. Pika detection probability was high (~0.97), and the combined occupancy of cave and non-cave sites varied across the 2 yr from 27% to 69%. Contrary to our hypothesis, occupancy was not higher at cave sites. Vegetation metrics were the best predictors of site use by pikas, followed by an edge effect and elevation. The importance of vegetation as a predictor of pika distribution at this interior range margin is congruent with recent studies from other portions of the species’ range. However, we caution that vegetation composition depends on microclimate, which might be the proximal driver of pika distribution. The microclimates available in non-cave crevices accessible to small animals have not been characterized adequately for lava landscapes. We advocate innovation in the acquisition and use of microclimatic data for understanding the distributions of many taxa. Appropriately scaled microclimatic data are increasingly available but rarely used in studies of range dynamics.

Direct determination and speciation of mercury compounds in environmental and biological samples by carbon bed atomic absorption spectroscopy

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

Skelly, E.M.

A method was developed for the direct determination of mercury in water and biological samples using a unique carbon bed atomizer for atomic absorption spectroscopy. The method avoided sources of error such as loss of volatile mercury during sample digestion and contamination of samples through added reagents by eliminating sample pretreatment steps. The design of the atomizer allowed use of the 184.9 nm mercury resonance line in the vacuum ultraviolet region, which increased sensitivity over the commonly used spin-forbidden 253.7 nm line. The carbon bed atomizer method was applied to a study of mercury concentrations in water, hair, sweat, urine,more » blood, breath and saliva samples from a non-occupationally exposed population. Data were collected on the average concentration, the range and distribution of mercury in the samples. Data were also collected illustrating individual variations in mercury concentrations with time. Concentrations of mercury found were significantly higher than values reported in the literature for a ''normal'' population. This is attributed to the increased accuracy gained by eliminating pretreatment steps and increasing atomization efficiency. Absorption traces were obtained for various solutions of pure and complexed mercury compounds. Absorption traces of biological fluids were also obtained. Differences were observed in the absorption-temperatures traces of various compounds. The utility of this technique for studying complexation was demonstrated.« less

Reserve Drug Indent Form and Its Impact on Antimicrobial Consumption and Sensitivity Pattern in the Medical Intensive Care Unit of a Tertiary Care Hospital

PubMed Central

Anitha, K.B.; Rai, Mohandas; Fernandes, Anisha

2015-01-01

Objectives: A world without effective antibiotics is a terrifying but a real prospect. Overuse or misuse especially of newer and higher antimicrobials (AM) is of particular concern, as this contributes to development of resistance among microorganisms. To check this trend, the Reserve Drug Indent Form (RDIF) was introduced in our hospital and its impact on AM consumption, cost of therapy and the sensitivity pattern was studied in the medical intensive care unit (MICU). Materials and Methods: A retrospective descriptive study in the medical ICU of a tertiary care hospital from July 2012 to August 2013. From March 2013, RDIF was made mandatory to be filled up prior to prescribing reserve antimicrobials. AM consumption (expressed as DDD/100 bed days) and sensitivity pattern (expressed in percentage) six months prior to and six months after implementation of the form were analysed. Results: The total Reserve AM consumption was 125.79 per 100 bed days during the study period. Average occupancy index was 0.50 and length of ICU stay was 6 days. The total consumption reduced from 85.55/100 to 40.24/100 bed days after the introduction of the RDIF. However, Imipenem usage increased from 11.35/100 to 23.94/100 bed days, which can be attributed to sensitivity profile to Imipenem (82.1%) compared to Meropenem (65.7%). Cost of therapy reduced from Rs 6,27,951 to 4,20,469. Conclusion: Reserve AM consumption showed a declining trend after introduction of the RDIF. Hence, the RDIF served as an important tool to combat inappropriate use, reducing the cost burden and also helped to improve the sensitivity to reserve drugs. PMID:25859466

[Acute Care Rehabilitation is the First Link in a Chain of Rehabilitation Interventions].

PubMed

Beyer, Joachim; Seidel, Egbert J

2017-08-01

An early, intensive rehabilitative therapy accelerates the recovery of the functions of patients. It contributes to a reduction in the complication rate as well as an improvement in physical and social functioning/participation in the long-term follow-up. Early rehabilitation must be strengthened on the basis of the existing structures: the creation and maintenance of adequately qualified early-stage rehabilitation facilities, at least in hospitals with priority and maximum supply contracts. Patients with long-term intensive care and polytrauma must be rehabilitated as soon as possible (intensive medical rehabilitation).Specialists in physical and rehabilitative medicine, rehabilitative geriatrists, neurologists, orthopaedists and accident surgeons and other regional physicians must cooperate in a targeted manner. Exclusion criteria using corresponding OPS codes must be canceled. Additional specialist physician groups (anesthetists and intensive care physicians, general practitioners, accident and thoracic surgeons, internists) must be sensitized to the importance of early rehabilitation.In the case of more than 500,000 hospital beds, 25,000 beds should be identified as age- and diagnosis-independent early-care beds in the country-specific bed-care plans. A cost-covering financing of the different, personal and cost-intensive early rehabilitation must be ensured. A phase model similar to the BAR guidelines for neurological-neurosurgical early rehabilitation is to be considered for other disease entities.In order to make the rehabilitation process as successful as possible, medical (acute) treatment, medical rehabilitation, occupational integration and social integration have to be understood as a holistic event and are effectively interrelated, as a continuous process which accompanies the entire disease phase-wise. For this purpose, a continuous case management or a rehabilitation guidance has to be established. © Georg Thieme Verlag KG Stuttgart · New York.

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital

PubMed Central

Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

2016-01-01

Background: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. Objective: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. Methods: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. Results: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. Conclusion: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department. PMID:26234974

Assessing archetypes of organizational culture based on the Competing Values Framework: the experimental use of the framework in Japanese neonatal intensive care units

PubMed Central

Sasaki, Hatoko; Yonemoto, Naohiro; Mori, Rintaro; Nishida, Toshihiko; Kusuda, Satoshi; Nakayama, Takeo

2017-01-01

Abstract Objective To assess organizational culture in neonatal intensive care units (NICUs) in Japan. Design Cross-sectional survey of organizational culture. Setting Forty NICUs across Japan. Participants Physicians and nurses who worked in NICUs (n = 2006). Main Outcome Measures The Competing Values Framework (CVF) was used to assess the organizational culture of the study population. The 20-item CVF was divided into four culture archetypes: Group, Developmental, Hierarchical and Rational. We calculated geometric means (gmean) and 95% bootstrap confidence intervals of the individual dimensions by unit and occupation. The median number of staff, beds, physicians’ work hours and work engagement were also calculated to examine the differences by culture archetypes. Results Group (gmean = 34.6) and Hierarchical (gmean = 31.7) culture archetypes were higher than Developmental (gmean = 16.3) and Rational (gmean = 17.4) among physicians as a whole. Hierarchical (gmean = 36.3) was the highest followed by Group (gmean = 25.8), Developmental (gmean = 16.3) and Rational (gmean = 21.7) among nurses as a whole. Units with dominant Hierarchical culture had a slightly higher number of physicians (median = 7) than dominant Group culture (median = 6). Units with dominant Group culture had a higher number of beds (median = 12) than dominant Hierarchical culture (median = 9) among physicians. Nurses from units with a dominant Group culture (median = 2.8) had slightly higher work engagement compared with those in units with a dominant Hierarchical culture (median = 2.6). Conclusions Our findings revealed that organizational culture in NICUs varies depending on occupation and group size. Group and Hierarchical cultures predominated in Japanese NICUs. Assessing organizational culture will provide insights into the perceptions of unit values to improve quality of care. PMID:28371865

Assessing archetypes of organizational culture based on the Competing Values Framework: the experimental use of the framework in Japanese neonatal intensive care units.

PubMed

Sasaki, Hatoko; Yonemoto, Naohiro; Mori, Rintaro; Nishida, Toshihiko; Kusuda, Satoshi; Nakayama, Takeo

2017-06-01

To assess organizational culture in neonatal intensive care units (NICUs) in Japan. Cross-sectional survey of organizational culture. Forty NICUs across Japan. Physicians and nurses who worked in NICUs (n = 2006). The Competing Values Framework (CVF) was used to assess the organizational culture of the study population. The 20-item CVF was divided into four culture archetypes: Group, Developmental, Hierarchical and Rational. We calculated geometric means (gmean) and 95% bootstrap confidence intervals of the individual dimensions by unit and occupation. The median number of staff, beds, physicians' work hours and work engagement were also calculated to examine the differences by culture archetypes. Group (gmean = 34.6) and Hierarchical (gmean = 31.7) culture archetypes were higher than Developmental (gmean = 16.3) and Rational (gmean = 17.4) among physicians as a whole. Hierarchical (gmean = 36.3) was the highest followed by Group (gmean = 25.8), Developmental (gmean = 16.3) and Rational (gmean = 21.7) among nurses as a whole. Units with dominant Hierarchical culture had a slightly higher number of physicians (median = 7) than dominant Group culture (median = 6). Units with dominant Group culture had a higher number of beds (median = 12) than dominant Hierarchical culture (median = 9) among physicians. Nurses from units with a dominant Group culture (median = 2.8) had slightly higher work engagement compared with those in units with a dominant Hierarchical culture (median = 2.6). Our findings revealed that organizational culture in NICUs varies depending on occupation and group size. Group and Hierarchical cultures predominated in Japanese NICUs. Assessing organizational culture will provide insights into the perceptions of unit values to improve quality of care. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care

Interest of a simple on-line screening registry for measuring ICU burden related to an influenza pandemic.

PubMed

Richard, Jean-Christophe Marie; Pham, Tài; Brun-Buisson, Christian; Reignier, Jean; Mercat, Alain; Beduneau, Gaëtan; Régnier, Bernard; Mourvillier, Bruno; Guitton, Christophe; Castanier, Matthias; Combes, Alain; Le Tulzo, Yves; Brochard, Laurent

2012-07-09

The specific burden imposed on Intensive Care Units (ICUs) during the A/H1N1 influenza 2009 pandemic has been poorly explored. An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs. We conducted a prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden. Among the 108 centers participating to the French H1N1 research network on mechanical ventilation (REVA) - French Society of Intensive Care (SRLF) registry, 69 ICUs belonging to seven large geographical areas voluntarily participated in a website screening-registry. The aim was to daily assess the ICU beds occupancy rate by influenza-infected and non-infected patients for at least three weeks. Three hundred ninety-one critically ill infected patients were enrolled in the cohort, representing a subset of 35% of the whole French 2009 pandemic cohort; 73% were mechanically ventilated, 13% required extra corporal membrane oxygenation (ECMO) and 22% died. The global Flu-OR in these ICUs was only 7.6%, but it exceeded a predefined 15% critical threshold in 32 ICUs for a total of 103 weeks. Flu-ORs were significantly higher in University than in non-University hospitals. The peak ICU burden was poorly predicted by observations obtained at the level of large geographical areas. The peak Flu-OR during the pandemic significantly exceeded a 15% critical threshold in almost half of the ICUs, with an uneven distribution with time, geographical areas and between University and non-University hospitals. An on-line assessment of Flu-OR via a simple dedicated registry may contribute to better match resources and needs.

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

PubMed

Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

2015-05-17

Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.‎ This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.‎ The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

Junior doctor strike model of care: Reduced access block and predominant Fellow of the Australasian College for Emergency Medicine staffing improve emergency department performance.

PubMed

Thornton, Vanessa; Hazell, Wayne

2008-10-01

To describe the response and analyse ED performance during a 5-day junior doctor strike. Data were collected via the patient information management computer system. Key performance indicators included percentage seen within maximum waiting times per triage category (TC), ED length of stay, emergency medicine patients who did not wait to be seen, hospital bed occupancy and access block percentage. Comparisons were made for the same 5 days before the strike (BS), during the strike (S) and after the strike. Total doctor's shifts BS were 78.66 with 25% of these shifts being Fellow of the Australasian College for Emergency Medicine (FACEM) shifts. FACEM shifts were more common during the S period at 75% (P < 0.001). Total attendances (BS 631 vs S 596, P = 0.22) and TC percentages (P-values for TC 1, 2, 3, 4, 5, respectively, 1.0, 0.55, 0.88, 0.97, 0.46) in the BS, S and after-the-strike periods were not significantly different. Despite fewer total doctor shifts, the FACEM predominant model of care during the strike resulted in better percentages seen within the maximum waiting times for TC3 (66%), TC4 (78%) and TC5 (86%) (all P < 0.001). There was a reduction in patients who did not wait to be seen (28 BS vs 5 S, P < 0.001), ED length of stay (admissions: BS 451 min vs S 258 min, P < 0.001; discharges: BS 233 min vs S 144 min, P < 0.02) and referrals to inpatient services (P = 0.02). This occurred with reduced bed point occupancy of 66% and a consequent reduction in access block. FACEM staffing and reduced access block were significant factors in improved ED performance.

Determinants of disinfectant use among nurses in U.S. healthcare facilities

PubMed Central

Dumas, Orianne; Wiley, Aleta S; Henneberger, Paul K; Speizer, Frank E; Zock, Jan-Paul; Varraso, Raphaëlle; Le Moual, Nicole; Boggs, Krislyn M; Camargo, Carlos A

2016-01-01

Background Disinfectant use among healthcare workers has been associated with respiratory disorders, especially asthma. We aimed to describe disinfectants used by U.S. nurses, and to investigate qualitative and quantitative differences according to workplace characteristics and region. Methods Disinfectant use was assessed by questionnaire in 8,851 nurses. Hospital characteristics were obtained from the American Hospital Association database. Results Working in a hospital was associated with higher disinfectant use (OR: 2.06 [95%CI: 1.89-2.24]), but lower spray use (0.74 [0.66-0.82]). Nurses working in smaller hospitals (<50 beds vs. ≥200 beds) were more likely to use disinfectants (1.69 [1.23-2.32]) and sprays (1.69 [1.20-2.38]). Spray use was lower in the West than in the Northeast (0.75 [0.58-0.97]). Conclusion Disinfectant use was more common among nurses working in smaller hospitals, possibly because they perform more diverse tasks. Variations in spray use by hospital size and region suggest additional targets for future efforts to prevent occupational asthma. PMID:27862135

An innovative national health care waste management system in Kyrgyzstan.

PubMed

Toktobaev, Nurjan; Emmanuel, Jorge; Djumalieva, Gulmira; Kravtsov, Alexei; Schüth, Tobias

2015-02-01

A novel low-cost health care waste management system was implemented in all rural hospitals in Kyrgyzstan. The components of the Kyrgyz model include mechanical needle removers, segregation using autoclavable containers, safe transport and storage, autoclave treatment, documentation, recycling of sterilized plastic and metal parts, cement pits for anatomical waste, composting of garden wastes, training, equipment maintenance, and management by safety and quality committees. The gravity-displacement autoclaves were fitted with filters to remove pathogens from the air exhaust. Operating parameters for the autoclaves were determined by thermal and biological tests. A hospital survey showed an average 33% annual cost savings compared to previous costs for waste management. All general hospitals with >25 beds except in the capital Bishkek use the new system, corresponding to 67.3% of all hospital beds. The investment amounted to US$0.61 per capita covered. Acceptance of the new system by the staff, cost savings, revenues from recycled materials, documented improvements in occupational safety, capacity building, and institutionalization enhance the sustainability of the Kyrgyz health care waste management system. © The Author(s) 2015.

Association of Nursing Overtime, Nurse Staffing, and Unit Occupancy with Health Care-Associated Infections in the NICU.

PubMed

Beltempo, Marc; Blais, Régis; Lacroix, Guy; Cabot, Michèle; Piedboeuf, Bruno

2017-08-01

Objective  This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections (HCAIs) in the neonatal intensive care unit (NICU). Study Design  A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database "Logibec" and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio, and the unit occupancy rate over 3-day periods before HCAI were compared with days that did not precede infections. Adjusted odds ratios (aOR) that control for the latter factors and unit risk factors were also computed. Results  A total of 122 (5%) infants developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (aOR, 1.70; 95% confidence interval [95% CI], 1.05-2.75, quartile [Q]4 vs. Q1). High unit occupancy rates were not associated with increased odds of infection (aOR, 0.85; 95% CI, 0.47-1.51, Q4 vs. Q1) nor were higher available/recommended nurse ratios (aOR, 1.16; 95% CI, 0.67-1.99, Q4 vs. Q1). Conclusion  Nursing overtime is associated with higher odds of HCAI in the NICU. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A study of leakage rates through mine seals in underground coal mines

PubMed Central

Schatzel, Steven J.; Krog, Robert B.; Mazzella, Andrew; Hollerich, Cynthia; Rubinstein, Elaine

2015-01-01

The National Institute for Occupational Safety and Health conducted a study on leakage rates through underground coal mine seals. Leakage rates of coal bed gas into active workings have not been well established. New seal construction standards have exacerbated the knowledge gap in our understanding of how well these seals isolate active workings near a seal line. At a western US underground coal mine, we determined seal leakage rates ranged from about 0 to 0.036 m3/s for seven 340 kPa seals. The seal leakage rate varied in essentially a linear manner with variations in head pressure at the mine seals. PMID:26322119

KSC-07pd0851

NASA Image and Video Library

2007-04-10

KENNEDY SPACE CENTER, FLA. -- Two trucks (one air-ride, one flat-bed) deliver the Dawn spacecraft, as well as additional electrical and ground support equipment and xenon ground support equipment, to Astrotech. Dawn will be moved from the truck and the shipping container removed. The spacecraft will then be moved into the high bay of the Payload Processing Facility. Dawn's mission is to explore two of the asteroid belt's most intriguing and dissimilar occupants: asteroid Vesta and the dwarf planet Ceres. The Dawn mission is managed by JPL, a division of the California Institute of Technology in Pasadena, for NASA's Science Mission Directorate in Washington, D.C. Photo credit: NASA/Jim Grossmann

A comparison between tracer gas and aerosol particles distribution indoors: The impact of ventilation rate, interaction of airflows, and presence of objects.

PubMed

Bivolarova, M; Ondráček, J; Melikov, A; Ždímal, V

2017-11-01

The study investigated the separate and combined effects of ventilation rate, free convection flow produced by a thermal manikin, and the presence of objects on the distribution of tracer gas and particles in indoor air. The concentration of aerosol particles and tracer gas was measured in a test room with mixing ventilation. Three layouts were arranged: an empty room, an office room with an occupant sitting in front of a table, and a single-bed hospital room. The room occupant was simulated by a thermal manikin. Monodisperse particles of three sizes (0.07, 0.7, and 3.5 μm) and nitrous oxide tracer gas were generated simultaneously at the same location in the room. The particles and gas concentrations were measured in the bulk room air, in the breathing zone of the manikin, and in the exhaust air. Within the breathing zone of the sitting occupant, the tracer gas emerged as reliable predictor for the exposure to all different-sized test particles. A change in the ventilation rate did not affect the difference in concentration distribution between tracer gas and larger particle sizes. Increasing the room surface area did not influence the similarity in the dispersion of the aerosol particles and the tracer gas. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Palliative rehabilitation of two patients with terminal stage cancer: a visit to patient's home and the provision of advice by a nurse and rehabilitation staff members before discharge--from physical therapist's perspective].

PubMed

Kuhara, Satoshi; Kakou, Hiroaki; Tokuo, Mika; Nogami, Michiko; Takemura, Jin; Hachisuka, Kenji

2009-12-01

We report two patients with terminal stage cancer who spent some days at their home after a physical therapist, occupational therapist, nurse, and medical social worker all visited the patients' homes and advised the patients' family in regard to the appropriate care before the patients were discharged as a strategy for palliative rehabilitation. Case 1: A patient suffering from terminal stage cancer was bed-ridden because of a pathological fracture of the femur. After palliative rehabilitation, the patient was able to get out of the bed and improved her daily living activity level through physical therapy. She spent some days at home according to the results of the pre-discharge home visit guidance to her family. Case 2: A patient suffering from terminal stage cancer manifested symptoms of fatigue and generalized muscular weakness. After palliative rehabilitation, her muscle strength and physical endurance were improved by physical therapy and adjustment of the bed height. Because she was eager to go home, we took her to her home before being discharged, and she was able to spend a few hours at home. Pre-discharge home visit guidance by a nurse and rehabilitation staff members to the patient' s family in regard to appropriate home care may therefore be a good means of satisfying such patients' desire to see their home once more and thereby improve their quality of life.

Variability of indoor fungal microbiome of green and non-green low-income homes in Cincinnati, Ohio.

PubMed

Coombs, Kanistha; Taft, Diana; Ward, Doyle V; Green, Brett J; Chew, Ginger L; Shamsaei, Behrouz; Meller, Jaroslaw; Indugula, Reshmi; Reponen, Tiina

2018-01-01

"Green" housing is designed to use low-impact materials, increase energy efficiency and improve occupant health. However, little is known about the indoor mycobiome of green homes. The current study is a subset of a multicenter study that aims to investigate the indoor environment of green homes and the respiratory health of asthmatic children. In the current study, the mycobiome in air, bed dust and floor dust was compared between green (study site) and non-green (control site), low-income homes in Cincinnati, Ohio. The samples were collected at baseline (within four months following renovation), and 12months after the baseline at the study site. Parallel sample collection was conducted in non-green control homes. Air samples were collected by PM2.5 samplers over 5-days. Bed and floor dust samples were vacuumed after the air sampling was completed. The DNA sample extracts were analyzed using ITS amplicon sequencing. Analysis indicated that there was no clear trend in the fungal communities between green and non-green homes. Instead, fungal community differences were greatest between sample types - air, bed, and floor. Microbial communities also changed substantially between sampling intervals in both green and non-green homes for all sample types, potentially indicating that there was very little stability in the mycobiomes. Research gaps remain regarding how indoor mycobiome fluctuates over time. Longer follow-up periods might elucidate the effect of green renovation on microbial load in buildings. Copyright © 2017 Elsevier B.V. All rights reserved.

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study

PubMed Central

Dunnigan, Matthew G; Pollock, Allyson M

2003-01-01

Objectives To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Design Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Main outcome measures Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. Results By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). Conclusion The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1. What is already known on this topicThe full business cases for the 15 first wave private finance initiative (PFI) hospitals in England and Scotland projected reductions in acute beds of about 30% in the five years before the opening of the new replacement hospitalsThe new PFI Royal Infirmary of Edinburgh, which will fully open in 2003, is the cornerstone of Lothian Health Board's healthcare plan for its acute hospitalsWhat this study addsCompared with other Scottish NHS hospitals, service delivery has been reduced across Lothian associated with PFI developmentThe planning targets and increase in clinical activity in acute specialties in Lothian hospitals had not been achieved by 2000-1There is evidence of an independent “PFI effect” on hospital downsizing and bed reductions, which in Lothian has resulted in severe capacity constraints across all acute specialties with a need for immediate expansion in acute and community provisionFurther hospital and community service downsizing may be required to meet the financial deficit, which is principally due to the high costs of PFI PMID:12714469

Novel Analog For Muscle Deconditioning

NASA Technical Reports Server (NTRS)

Ploutz-Snyder, Lori; Ryder, Jeff; Buxton, Roxanne; Redd. Elizabeth; Scott-Pandorf, Melissa; Hackney, Kyle; Fiedler, James; Ploutz-Snyder, Robert; Bloomberg, Jacob

2011-01-01

Existing models (such as bed rest) of muscle deconditioning are cumbersome and expensive. We propose a new model utilizing a weighted suit to manipulate strength, power, or endurance (function) relative to body weight (BW). Methods: 20 subjects performed 7 occupational astronaut tasks while wearing a suit weighted with 0-120% of BW. Models of the full relationship between muscle function/BW and task completion time were developed using fractional polynomial regression and verified by the addition of pre-and postflightastronaut performance data for the same tasks. Splineregression was used to identify muscle function thresholds below which task performance was impaired. Results: Thresholds of performance decline were identified for each task. Seated egress & walk (most difficult task) showed thresholds of leg press (LP) isometric peak force/BW of 18 N/kg, LP power/BW of 18 W/kg, LP work/BW of 79 J/kg, isokineticknee extension (KE)/BW of 6 Nm/kg, and KE torque/BW of 1.9 Nm/kg.Conclusions: Laboratory manipulation of relative strength has promise as an appropriate analog for spaceflight-induced loss of muscle function, for predicting occupational task performance and establishing operationally relevant strength thresholds.

Association of nursing overtime, nurse staffing and unit occupancy with medical incidents and outcomes of very preterm infants.

PubMed

Beltempo, M; Lacroix, G; Cabot, M; Blais, R; Piedboeuf, B

2018-02-01

To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants. Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight <1000 g admitted at a 56 bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity). Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.

Landscapes, depositional environments and human occupation at Middle Paleolithic open-air sites in the southern Levant, with new insights from Nesher Ramla, Israel

NASA Astrophysics Data System (ADS)

Zaidner, Yossi; Frumkin, Amos; Friesem, David; Tsatskin, Alexander; Shahack-Gross, Ruth

2016-04-01

Middle Paleolithic human occupation in the Levant (250-50 ka ago) has been recorded in roofed (cave and rockshelter) and open-air sites. Research at these different types of sites yielded different perspectives on the Middle Paleolithic human behavior and evolution. Until recently, open-air Middle Paleolithic sites in the Levant were found in three major sedimentary environments: fluvial, lake-margin and spring. Here we describe a unique depositional environment and formation processes at the recently discovered open-air site of Nesher Ramla (Israel) and discuss their contribution to understanding site formation processes in open-air sites in the Levant. The site is 8-m-thick Middle Paleolithic sequence (OSL dated to 170-80 ka) that is located in a karst sinkhole formed by gravitational deformation and sagging into underground voids. The sedimentary sequence was shaped by gravitational collapse, cyclic colluviation of soil and gravel into the depression, waterlogging, in situ pedogenesis and human occupation. Original bedding and combustion features are well-preserved in the Lower archaeological sequence, a rare occurrence in comparison to other open-air archaeological sites. This phenomenon coincides with episodes of fast sedimentation/burial, which also allowed better preservation of microscopic remains such as ash. The Upper archaeological sequence does not exhibit bedding or preservation of ash, despite presence of heat-affected lithic artifacts, which makes it similar to other open-air sites in the Levant. We suggest that rate of burial is the major factor that caused the difference between the Upper and Lower sequences. The differences in the burial rate may be connected to environmental and vegetation changes at the end of MIS 6. We also identified an interplay between sediment in-wash and density of human activity remains, i.e. during episodes of low natural sediment input the density of artifacts is higher relative to episodes with high rate of sediment in-wash. The detailed analysis of natural and anthropogenic processes at Nesher Ramla suggests a much wider spectrum of processes than previously reported for southern Levantine Paleolithic sites. Nesher Ramla shares certain depositional and post-depositional characteristics with both cave and open-air sites and provides a better insight into processes which control both types of sites.

Adaptive vibration control of structures under earthquakes

NASA Astrophysics Data System (ADS)

Lew, Jiann-Shiun; Juang, Jer-Nan; Loh, Chin-Hsiung

2017-04-01

techniques, for structural vibration suppression under earthquakes. Various control strategies have been developed to protect structures from natural hazards and improve the comfort of occupants in buildings. However, there has been little development of adaptive building control with the integration of real-time system identification and control design. Generalized predictive control, which combines the process of real-time system identification and the process of predictive control design, has received widespread acceptance and has been successfully applied to various test-beds. This paper presents a formulation of the predictive control scheme for adaptive vibration control of structures under earthquakes. Comprehensive simulations are performed to demonstrate and validate the proposed adaptive control technique for earthquake-induced vibration of a building.

Metabolism during hypodynamia

NASA Technical Reports Server (NTRS)

Federov, I. V.

1980-01-01

Physical immobilization, inaction due to space travel, a sedentary occupation, or bed confinement due to a chronic illness elicit similar alternations in the metabolism of man and animals (rat, rabbit, dog, mouse). After a preliminary period of weight loss, there is eventually weight gain due to increased lipid storage. Protein catabolism is enhanced and anabolism depressed, with elevated urinary excretion of amino acids, creatine, and ammonia. Glycogen stores are depleted and glyconeogenesis is accelerated. Polyuria develops with subsequent redistribution of body fluids in which the blood volume of the systemic circulation is decreased and that of pulmonary circulation increased. This results in depressed production of vasopressin by the posterior pituitary which further enhances urinary water and salt loss.

Small rural hospitals: an example of market segmentation analysis.

PubMed

Mainous, A G; Shelby, R L

1991-01-01

In recent years, market segmentation analysis has shown increased popularity among health care marketers, although marketers tend to focus upon hospitals as sellers. The present analysis suggests that there is merit to viewing hospitals as a market of consumers. Employing a random sample of 741 small rural hospitals, the present investigation sought to determine, through the use of segmentation analysis, the variables associated with hospital success (occupancy). The results of a discriminant analysis yielded a model which classifies hospitals with a high degree of predictive accuracy. Successful hospitals have more beds and employees, and are generally larger and have more resources. However, there was no significant relationship between organizational success and number of services offered by the institution.

MRSA acquisition in an intensive care unit.

PubMed

Dancer, Stephanie J; Coyne, Michael; Speekenbrink, A; Samavedam, Sam; Kennedy, Julie; Wallace, Peter G M

2006-02-01

This paper describes a retrospective investigation of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in an 8-bed intensive care unit (ICU) over a 5-month period. Clinical and microbiologic data were collected from the ICU, including MRSA detection dates, patient dependency scores, standardized environmental screening data, weekly bed occupancies, number of admissions, and nurse staffing levels. MRSA acquisition weeks were defined as weeks during which initial delivery of MRSA occurred before sampling and laboratory confirmation. Weekly workloads were plotted against staffing levels and modelled against MRSA acquisition weeks and hygiene failures. Of 174 patients admitted into the ICU, 28 (16%) were found to have MRSA; 12 of these (7%) acquired MRSA on the ICU within 7 of the 23 weeks studied. Six of these 7 weeks were associated with a deficit of trained nurses during the day and 5 with hygiene failures (data unavailable for 2). Pulsed-field gel electrophoresis (PFGE) profiles demonstrated relationships between staphylococci from staff hands, hand-touch sites, and patients' blood. MRSA acquisition in the ICU was temporally associated with reduced numbers of trained nurses and hygiene failures predominantly involving hand-touch sites. Epidemiologic analysis suggested that patient acquisitions were 7 times more likely to occur during periods of nurse understaffing.

Dump truck-related deaths in construction, 1992-2007.

PubMed

McCann, Michael; Cheng, Mei-Tai

2012-05-01

Dump trucks are universally used in construction and other industries to haul materials to the location and to remove waste materials. The source for dump truck-related fatality data was the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI) Research File. From 1992 to 2007, 829 construction workers were killed in dump truck-related incidents nationwide. Of those, 336 were dump truck operators with 215 deaths occurring in street and highway incidents. Another 343 deaths involved workers on foot, three-quarters struck by dump trucks. Sixty-four of the construction workers killed were maintaining dump trucks, 22 when caught between the truck frame and a falling dump truck bed. Of the 86 other deaths, 55 involved streets and highways. Recommendations include: (i) improving the reporting of seat belt usage in fatality reports; (ii) requiring use of seat belts; (iii) requiring the use of backup alarms, spotters, or other methods to alert dump truck operators to workers in their blind spots; (iv) prohibiting direct dumping at river banks and embankments; (v) using cameras or radar to enforce stopping at railway crossings; and (xi) enforcing worker safety practices (e.g., lockout/tagout procedures on elevated dump truck beds). Copyright © 2011 Wiley Periodicals, Inc.

Healthcare Provider Perceptions of Causes and Consequences of ICU Capacity Strain in a Large Publicly Funded Integrated Health Region: A Qualitative Study.

PubMed

Bagshaw, Sean M; Opgenorth, Dawn; Potestio, Melissa; Hastings, Stephanie E; Hepp, Shelanne L; Gilfoyle, Elaine; McKinlay, David; Boucher, Paul; Meier, Michael; Parsons-Leigh, Jeanna; Gibney, R T Noel; Zygun, David A; Stelfox, Henry T

2017-04-01

Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain. Qualitative study using a conventional thematic analysis. Nine ICUs across Alberta, Canada. Nineteen focus groups (n = 122 participants). None. Participants' perspectives on strain on ICU capacity and its perceived impact on providers, families, and patient care were explored. Participants defined "capacity strain" as a discrepancy between the availability of ICU beds, providers, and ICU resources (supply) and the need to admit and provide care for critically ill patients (demand). Four interrelated themes of contributors to strain were characterized (each with subthemes): patient/family related, provider related, resource related, and health system related. Patient/family-related subthemes were "increasing patient complexity/acuity," along with patient-provider communication issues ("paucity of advance care planning and goals-of-care designation," "mismatches between patient/family and provider expectations," and "timeliness of end-of-life care planning"). Provider-related factor subthemes were nursing workforce related ("nurse attrition," "inexperienced workforce," "limited mentoring opportunities," and "high patient-to-nurse ratios") and physician related ("frequent turnover/handover" and "variations in care plan"). Resource-related subthemes were "reduced service capability after hours" and "physical bed shortages." Health system-related subthemes were "variable ICU utilization," "preferential "bed" priority for other services," and "high ward bed occupancy." Participants perceived that strain had negative implications for patients ("reduced quality and safety of care" and "disrupted opportunities for patient- and family-centered care"), providers ("increased workload," "moral distress," and "burnout"), and the health system ("unnecessary, excessive, and inefficient resource utilization"). Engagement with frontline critical care providers is essential for understanding their experiences and perspectives regarding strained capacity and for the development of sustainable strategies for improvement.

Evaluation of radon adsorption characteristics of a coconut shell-based activated charcoal system for radon and thoron removal applications.

PubMed

Karunakara, N; Sudeep Kumara, K; Yashodhara, I; Sahoo, B K; Gaware, J J; Sapra, B K; Mayya, Y S

2015-04-01

Radon ((222)Rn), thoron ((220)Rn), and their decay products contribute a major fraction (more than 50%) of doses received from ionisation radiation in public domain indoor environments and occupation environments such as uranium mines, thorium plants, and underground facilities, and are recognised as important radiological hazardous materials, which need to be controlled. This paper presents studies on the removal of (222)Rn and (220)Rn from air using coconut shell-based granular activated charcoal cylindrical adsorber beds. Experiments were conducted to evaluate the (222)Rn and (220)Rn adsorption characteristics, and the mitigation efficiency of coconut-based activated charcoal available in India. The performance parameters evaluated include breakthrough time (τ) and adsorption coefficient (K), and degassing characteristics of the charcoal bed of varying dimensions at different flow rates. While the breakthrough for (222)Rn occurred depending on the dimension of the adsorber bed and flow rates, for (220)Rn, the breakthrough did not occur. The breakthrough curve exhibited a stretched S-shape response, instead of the theoretically predicted sharp step function. The experiments confirm that the breakthrough time individually satisfies the quadratic relationship with respect to the diameter of the bed, and the linear relationship with respect to the length, as predicted in the theory. The K value varied in the range of 2.3-4.12 m(3) kg(-1) with a mean value of 2.99 m(3) kg(-1). The K value was found to increase with the increase in flow rate. Heating the charcoal to ∼ 100 °C resulted in degassing of the adsorbed (222)Rn, and the K of the degassed charcoal and virgin charcoal were found to be similar with no deterioration in performance indicating the re-usability of the charcoal. Copyright © 2015 Elsevier Ltd. All rights reserved.

Overcrowding of accident & emergency units: is it a growing concern in Nigeria?

PubMed

Makama, Jerry G; Iribhogbe, Pius; Ameh, Emmanuel A

2015-06-01

The inability of the Nigeria's Accident and Emergency Departments (AED) to meet current demands is growing among the public and health care professionals. The data supporting perceptions of insufficient capacity are limited. Therefore, this study was intended to determine the prevalence, causes, and effects of overcrowding AEDs in Nigeria. This was a cross sectional, descriptive study carried out among AED staff of 3 referral teaching hospitals in Nigeria, using a pre-tested and validated structured questionnaire. The analysis of the 267 AED staff revealed 20-56 years (36.40+5.1 mean) age range. One hundred and twenty eight (47.9%) were males, 139 (52.1%) females. Two hundred and fifty nine (97%) agreed that an AED should have a bed capacity of 21-30. Agreement to AED overcrowding in Nigeria was quite considerable. The frequency of AED overcrowding per week was 4-7 times. The average bed occupancy level was 3.25. Agreed common causes of prolonged AED admissions were to be a high volume of critically ill patients, Delayed transfer of patients to the wards, delay in theatre operation, delay in radiological investigations and exceptionally high proportion of patients requiring admission in AED. Also, long pre-review waiting time and haematological delays were more causes. The average waiting time for victims to be seen was 29.7 minutes. There are many causes of AED overcrowding in this environment. However, improving AED bed management, better organized and diligent discharge planning, and reducing access block should be a priority to reduce AED overcrowding.

Occupational exposure to organic solvents as a cause of sleep apnoea.

PubMed Central

Edling, C; Lindberg, A; Ulfberg, J

1993-01-01

A high prevalence of sleep apnoea was found in a group of men occupationally exposed to organic solvents. Workers with long term exposure to organic solvents often report symptoms such as fatigue, forgetfulness, and concentration difficulties. These symptoms are strikingly similar to those reported by patients with obstructive sleep apnoea syndrome (OSAS). This is a frequently diagnosed disorder characterised by disturbed sleep causing psychic or somatic complications and daytime sleepiness. A study was undertaken to evaluate whether people with long term occupational exposure to organic solvents have a higher prevalence of sleep apnoea than the general population. Patients exposed to solvents (66 men) were invited to participate in a screening for sleep apnoea. A static charge sensitive bed was used for the monitoring of respiration movements and pulse oximetry during one night. A classical sleep apnoea was diagnosed if periodic respiration movement exceeded 45% of estimated sleep time and the oxygen desaturation index exceeded 6. The prevalence of sleep apnoea among the men exposed to solvents was compared with the prevalence in the general population (1.4%). The prevalence among the participating exposed men was 19.7% which gave a conservative relative risk estimate of 14.1 (95% confidence interval (95% CI) 7.5-24.2). The results indicate that exposure to organic solvents causes sleep apnoea. An alternative possibility is that people with sleep apnoea are misdiagnosed as cases of solvent induced toxic encephalopathy. The interpretation has importance for the caring of the patient. PMID:8457496

Hospital Patient Room Design: The Issues Facing 23 Occupational Groups Who Work in Medical/Surgical Patient Rooms.

PubMed

Lavender, Steven A; Sommerich, Carolyn M; Patterson, Emily S; Sanders, Elizabeth B-N; Evans, Kevin D; Park, Sanghyun; Umar, Radin Zaid Radin; Li, Jing

2015-01-01

The aim of this study was to learn from a wide range of hospital staff members about how the design of the patient room in which they work adversely affects their ergonomics or hinders their job performance. In addition to providing a healing space for patients, hospital patient rooms need to serve as functional workplaces for the people who provide clinical care, to clean, or to maintain room functions. Therefore, from a design perspective, it is important to understand the needs of all the users of hospital patient rooms with regard to room design. One hundred forty-seven people, representing 23 different occupational stakeholder groups, participated in either focus groups or interviews in which they were asked to identify room design issues that affect the performance of their work tasks. Key issues shared across multiple stakeholder groups included an inability to have eye contact with the patient when entering the room, inadequate space around the bed for the equipment used by stakeholders, the physical demands experienced as stakeholders move furnishings to accomplish their activities or access equipment, and a lack of available horizontal surfaces. Unique issues were also identified for a number of stakeholder groups. There are a number of issues that should be addressed in the next generation of hospital patient rooms, or when refurbishing existing facilities, so that all occupational stakeholder groups can work effectively, efficiently, and without undue physical stress. © The Author(s) 2015.

Does adoption of electronic health records improve organizational performances of hospital surgical units? Results from the French e-SI (PREPS-SIPS) study.

PubMed

Plantier, Morgane; Havet, Nathalie; Durand, Thierry; Caquot, Nicolas; Amaz, Camille; Philip, Irène; Biron, Pierre; Perrier, Lionel

2017-02-01

Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances. The aim of this study was to evaluate the impact of EHR use on the organizational performances of acute care hospital surgical units throughout France. This retrospective study was based on data derived from three national databases for year the 2012: IPAQSS (Indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. National data and methodological support were provided by the French Ministry of Health (DGOS) and the French National Authority for Health (HAS). Multivariate linear models were used to assess four organizational performance indicators: the occupancy rate of surgical inpatient beds, operating room utilization, the activity per surgeon, and the activity per both nurse anesthetist and anesthesiologist which were dependent variables. Several independent variables were taken into account, including the degree of EHR use. The models revealed a significant positive impact of EHR use on operating room utilization and bed occupancy rates for surgical inpatient units. No significant association was found between the activity per surgeon or the activity per nurse anesthetist and anesthesiologist with EHR use. All four organizational performance indicators were impacted by the type of hospital, the geographical region, and the severity of the pathologies. We were able to verify the purported potential benefits of EHR use on the organizational performances of surgical units in French hospitals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Geographical coverage of the Mexican Healthcare System and a spatial analysis of utilization of its General Hospitals in 1998].

PubMed

Hernández-Avila, Juan E; Rodríguez, Mario H; Rodríguez, Norma E; Santos, René; Morales, Evangelina; Cruz, Carlos; Sepúlveda-Amor, Jaime

2002-01-01

To describe the geographical coverage of the Mexican Healthcare System (MHS) services and to assess the utilization of its General Hospitals. A Geographic Information System (GIS) was used to include sociodemographic data by locality, the geographical location of all MHS healthcare services, and data on hospital discharge records. A maximum likelihood estimation model was developed to assess the utilization levels of 217 MHS General Hospitals. The model included data on human resources, additional infrastructure, and the population within a 25 km radius. In 1998, 10,806 localities with 72 million inhabitants had at least one public healthcare unit, and 97.2% of the population lived within 50 km of a healthcare unit; however, over 18 million people lived in rural localities without a healthcare unit. The mean annual hospital occupation rate was 48.5 +/- 28.5 per 100 bed/years, with high variability within and between states. Hospital occupation was significantly associated with the number of physicians in the unit, and in the Mexican Institute of Social Security units utilization was associated with additional health infrastructure, and with the population's poverty index. GIS analysis allows improved estimation of the coverage and utilization of MHS hospitals.

The resilience of postglacial hunter-gatherers to abrupt climate change.

PubMed

Blockley, Simon; Candy, Ian; Matthews, Ian; Langdon, Pete; Langdon, Cath; Palmer, Adrian; Lincoln, Paul; Abrook, Ashley; Taylor, Barry; Conneller, Chantal; Bayliss, Alex; MacLeod, Alison; Deeprose, Laura; Darvill, Chris; Kearney, Rebecca; Beavan, Nancy; Staff, Richard; Bamforth, Michael; Taylor, Maisie; Milner, Nicky

2018-05-01

Understanding the resilience of early societies to climate change is an essential part of exploring the environmental sensitivity of human populations. There is significant interest in the role of abrupt climate events as a driver of early Holocene human activity, but there are very few well-dated records directly compared with local climate archives. Here, we present evidence from the internationally important Mesolithic site of Star Carr showing occupation during the early Holocene, which is directly compared with a high-resolution palaeoclimate record from neighbouring lake beds. We show that-once established-there was intensive human activity at the site for several hundred years when the community was subject to multiple, severe, abrupt climate events that impacted air temperatures, the landscape and the ecosystem of the region. However, these results show that occupation and activity at the site persisted regardless of the environmental stresses experienced by this society. The Star Carr population displayed a high level of resilience to climate change, suggesting that postglacial populations were not necessarily held hostage to the flickering switch of climate change. Instead, we show that local, intrinsic changes in the wetland environment were more significant in determining human activity than the large-scale abrupt early Holocene climate events.

Hospital discharge queues in Massachusetts.

PubMed

Gruenberg, L W; Willemain, T R

1982-02-01

There is growing concern over the inappropriate utilization of health care facilities. The high cost of hospital care and the apparent shortage of nursing home beds have focused attention on one aspect of this problem: the clinically unnecessary days (sometimes called "administrative days" or "ADs") spent in hospitals by patients who are awaiting placement in long-term care facilities. In this study, data from a 1976 Massachusetts Department of Public Health survey of patients backed up in hospitals were analyzed to determine the magnitude of the problem and to examine the influence of several major factors that had been hypothesized in previous studies to contribute to the backup. We demonstrate that the average delay of a patient found waiting in a "snapshot" survey (which is often used to estimate the magnitude of the problem) is significantly greater than the average delay experienced by a typical discharged patient. We show that there are at least two major factors that influence the delay time: nursing home preferences in accepting certain types of patients and nursing home occupancy rates in the hospital service area. Neither medical-surgical occupancy rate nor the number of AD patients waiting in the hospital was significantly correlated with the delay time.

Spatial resonance in a small artery excited by vibration input as a possible mechanism to cause hand-arm vascular disorders

NASA Astrophysics Data System (ADS)

Pattnaik, Shrikant; Banerjee, Rupak; Kim, Jay

2012-04-01

Hand-arm vibration syndrome (HAVS) is collectively a vasospastic and neurodegenerative occupational disease. One of the major symptoms of HAVS is vibration white finger (VWF) caused by exaggerated vasoconstriction of the arteries and skin arterioles. While VWF is a very painful and costly occupational illness, its pathology has not been well understood. In this study a small artery is modeled as a fluid filled elastic tube whose diameter changes along the axial direction. Equations of motion are developed by considering interactions between the fluid, artery wall and soft-tissue bed. It is shown that the resulting wave equation is the same as that of the basilar membrane in the cochlea of mammals. Therefore, the artery system shows a spatial resonance as in the basilar membrane, which responds with the highest amplitude at the location determined by the vibration frequency. This implies that a long-term use of one type of tool will induce high-level stresses at a few identical locations of the artery that correspond to the major frequency components of the tool. Hardening and deterioration of the artery at these locations may be a possible cause of VWF.

Forecasting future needs and optimal allocation of medical residency positions: the Emilia-Romagna Region case study.

PubMed

Senese, Francesca; Tubertini, Paolo; Mazzocchetti, Angelina; Lodi, Andrea; Ruozi, Corrado; Grilli, Roberto

2015-01-30

Italian regional health authorities annually negotiate the number of residency grants to be financed by the National government and the number and mix of supplementary grants to be funded by the regional budget. This study provides regional decision-makers with a requirement model to forecast the future demand of specialists at the regional level. We have developed a system dynamics (SD) model that projects the evolution of the supply of medical specialists and three demand scenarios across the planning horizon (2030). Demand scenarios account for different drivers: demography, service utilization rates (ambulatory care and hospital discharges) and hospital beds. Based on the SD outputs (occupational and training gaps), a mixed integer programming (MIP) model computes potentially effective assignments of medical specialization grants for each year of the projection. To simulate the allocation of grants, we have compared how regional and national grants can be managed in order to reduce future gaps with respect to current training patterns. The allocation of 25 supplementary grants per year does not appear as effective in reducing expected occupational gaps as the re-modulation of all regional training vacancies.

A 29-Year-Old Man With Nonproductive Cough, Exertional Dyspnea, and Chest Discomfort.

PubMed

Halpenny, Darragh; Suh, James; Garofano, Suzette; Alpert, Jeffrey

2015-09-01

A 29-year-old man presented with a 5-month history of worsening dry cough, exertional dyspnea, chest tightness, and palpitations. He had been treated by his primary care physician with trials of guaifenesin/codeine, azithromycin, albuterol, and omeprazole without improvement. He denied wheezing, fever, sweats, anorexia, joint pain, swelling, or rash. He had no past medical history. He denied a history of tobacco smoking or IV drug use. He kept no pets, worked as a manager in an office environment, and had no history of occupational inhalational exposure. He reported using aerosolized insect spray to eradicate bed bugs in his house shortly before the cough began but did not report any acute symptoms when using the spray.

APSIC Guidelines for environmental cleaning and decontamination.

PubMed

Ling, Moi Lin; Apisarnthanarak, Anucha; Thu, Le Thi Anh; Villanueva, Victoria; Pandjaitan, Costy; Yusof, Mohamad Yasim

2015-01-01

This document is an executive summary of APSIC Guidelines for Environmental Cleaning and Decontamination. It describes best practices in routine cleaning and decontamination in healthcare facilities as well as in specific settings e.g. management of patients with isolation precautions, food preparation areas, construction and renovation, and following a flood. It recommends the implementation of environmental hygiene program to keep the environment safe for patients, staff and visitors visiting a healthcare facility. Objective assessment of cleanliness and quality is an essential component of this program as a method for identifying quality improvement opportunities. Recommendations for safe handling of linen and bedding; as well as occupational health and safety issues are included in the guidelines. A training program is vital to ensure consistent adherence to best practices.

Low back injuries related to nursing professionals working conditions: a systematic review.

PubMed

Schlossmacher, Roberta; Amaral, Fernando Gonçalves

2012-01-01

Identify the prevalence of low back disorders and associated risks, as well as the characteristics and ergonomic factors present in the work of nursing professionals. Systematic review based on the search of terms such as low back pain, professionals, hospital ergonomics, work organization, nursing found in national and international databases. The prevalence of low back pain symptoms was between 14.7% and 72% and the main cause, that is, the transference of the patient from bed to chair, leaded to the profession abandonment as a main consequence. it was possible to conclude that the prevalence of low back injury is high among nursing professionals and its causes are related to occupational factors - physical or psychological, which are in many cases permanent and disabling.

The decision process used for hospital bond rating--and its implications.

PubMed Central

Cleverley, W O; Nutt, P C

1984-01-01

Investigation of the process of hospital bond rating related the ratings assigned by Moody's and Standard and Poors to indicators of hospital financial condition (such as debt per bed and peak debt coverage), institutional factors (including size, occupancy, and local market competition), indenture provisions (such as reserves), and contextual factors. The criteria used by Moody's and Standard and Poors to rate hospital bonds were revealed to be similar, but not identical. Criteria used in the bond rating process have several important implications: the rating approach provides strong financial incentives for increases in hospital size and complexity, for example, and hospitals that rely on extensive amounts of public financing appear to be penalized in the rating process. PMID:6500959

Uranium-series dating of the Mousterian occupation at Abric Romani, Spain

USGS Publications Warehouse

Bischoff, J.L.; Julia, R.; Mora, R.

1988-01-01

The precise evolutionary position of the Neanderthal people continues to be a major uncertainty in human evolution. Their origin and their relationship to anatomically modern people are unclear and are clouded by poor chronology. Lithic artefacts of' the Mousterian type, found throughout Europe and the Mediterranean Basin, are believed to be the tool kit of the Neanderthals, but dates within Mousterian-bearing deposits are extremely rare. We report here on 20 high-quality uranium-series dates from Mousterian beds at Abric Romani, a rock shelter near Barcelona, Spain. The dates range from 39 to 60 kyr before present (BP) in an orderly stratigraphic succession and provide precise chronological control on an important Mousterian archaeological site. ?? 1988 Nature Publishing Group.

Comment on: Geoarchaeological and chronometrical evidence of early human occupation on Lanzarote (Canary Islands), by Zöller et al.

NASA Astrophysics Data System (ADS)

Carracedo, Juan-Carlos; Meco, Joaquín.; Lomoschitz, Alejandro; Antonia Perera, María.; Ballester, Javier; Betancort, Juan-Francisco

2004-10-01

In a recent paper Zöller et al. (2003) present their results of the stratigraphic, sedimentologic, soil mineralogy and IRSL dating of several soil beds filling a basin located near the village of Guatiza, at the eastern flank of the Famara shield, in the island of Lanzarote (Canary Islands). According to these authors, the soils correspond to a desert loess-palaeosol sequence with many coarse alluvial fan deposits, accumulated as scoria cones encircled the open ancient valley extending from SW to NE near Guatiza and their lava flowed to form the Vega de Guatiza endoreic basin. According to these authors, this depression served as a sediment trap from its formation.

Sexuality and physical intimacy in long-term care.

PubMed

Lichtenberg, Peter A

2014-01-01

Sexuality and sexual needs in older adults remains a neglected area of clinical intervention, particularly so in long-term care settings. Because older adults in medical rehabilitation and long-term care beds present with significant frailties, and often significant neurocognitive disorders, it makes it difficult for occupational therapists and other staff to evaluate the capacity of an older adult resident to participate in sexual relationships. The current paper reviews the current literature on sexuality and aging, examines some of the clinical practices and guidelines regarding sexual expression in long-term care, and presents two case examples. A semistructured interview and decision tree is presented to assist therapists in making careful and informed decisions and thereby balancing the needs for protection with the needs for autonomy.

Modeling of replenishment of sediments on a water-worked gravel bed channel

NASA Astrophysics Data System (ADS)

Juez, Carmelo; Battisacco, Elena; Schleiss, Anton J.; Franca, Mário J.

2016-04-01

The presence of dams causes a sediment deficit downstream. Hence, the surface structure of the riverbeds is altered by this interruption in the sediment continuity and The presence of dams causes a sediment deficit downstream. The surface structure of the riverbed is altered by this interruption in the sediment continuity and becoming water-worked. The main morphological effects verified in these cases are thus the generation of armored layers, bank instability, riverbed incision, changes in the channel width and coarsening of the bed particles. These results impact on the riverbed topographic variability and structure of the bedforms. Surface complexity is thus reduced with further ecological implications. The lack of fine material and surface complexity leads to the loss of aquatic and riparian habitats, limiting the possibilities for fish spawning. Nowadays, the revitalization of disturbed river reaches forms an integral part of river management. Sediment transport and associated channel morphology are understood as key processes for recreating and maintaining aquatic ecosystems. For this purpose several replenishment techniques have been considered in order to supply sediments lacking in the downstream reaches. The replenishment techniques can be seen as a pulse-like addition of sedimentary material that initially disturbs the channel. In this work, the response of the flow to the complementary material which is added in the channel is studied by means of the 2D shallow water equations in combination with the Exner equation. The numerical scheme is built by means of a weakly-coupled treatment between the hydrodynamic and morphodynamic equations leading to an efficient and robust solution. Computational outcomes are compared with experimental data obtained from several replenishment configurations studied in the laboratory. The results are analyzed by means of: (i) temporal evolution of the material spreading, (ii) occupational ratio along the channel which is the area percentage that is covered by the replenishment material, (iii) travel distance of the center of the pulse mass and (iv) effect of the bed fining in the bed shear stress. The results of these experiments assist in further evaluating how water-worked gravel bed channels evolve with artificial replenishment of sediments. This work was funded by the ITN-Programme (Marie Curie Actions) of the European Union's Seventh Framework Programme FP7-PEOPLE-2013-ITN under REA grant agreement n_607394-SEDITRANS. The sediment replenishment experiments were funded by FOEN (Federal Office for the Environment, Switzerland).

Environmental challenges of identifying a patient zone and the healthcare zone in a crowded Vietnamese hospital.

PubMed

Salmon, S; McLaws, M L

2015-09-01

The application of the World Health Organization (WHO) 'My five moments for hand hygiene' was designed for a healthcare environment with levels of bed spacing and occupancy normally present in developed countries. However, overcrowded healthcare facilities in Vietnam and other challenged settings require strategies to adapt 'My five moments for hand hygiene' in order to meet their situational needs. To identify the environmental challenges to compliance with the 'My five moments' indications. Overt observation using the WHO hand hygiene audit tool was conducted in two clinical departments at a large teaching hospital in Vietnam. Clinical practice movements and the 'My five moments' indications were detailed diagrammatically. Sharing a bed is widely practised outside the intensive care unit in this country, which makes visualizing a patient zone according to the WHO instructions difficult. In addition, decreased spacing between shared beds in overcrowded conditions results in the close proximity of patients to the shared healthcare zone. These two barriers prevent attempts to apply the 'My five moments' correctly. Undertaking hand hygiene and conducting audits in accordance with the 'My five moments for hand hygiene' assumes a separation of patients and individual healthcare zones. The barriers to applying 'My five moments' include the lack of distinct zones between patients and their shared healthcare zone, and amelioration requires resources beyond current chronic resource challenges. Until environmental resources can meet the western standards required for application of the 'Five moments' principle, healthcare workers urgently need detailed clarification of modifications that would empower them to comply. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings.

PubMed

Drolet, Anne; DeJuilio, Patti; Harkless, Sherri; Henricks, Sherry; Kamin, Elizabeth; Leddy, Elizabeth A; Lloyd, Joanna M; Waters, Carissa; Williams, Sarah

2013-02-01

Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility, and the potential for longer hospital stays. The purpose of this study was to determine the effectiveness of a nurse-driven mobility protocol to increase the percentage of patients ambulating during the first 72 hours of their hospital stay. A quasi-experimental design was used before and after intervention in a 16-bed adult medical/surgical intensive care unit (ICU) and a 26-bed adult intermediate care unit (IMCU) at a large community hospital. A multidisciplinary team developed and implemented a mobility order set with an embedded algorithm to guide nursing assessment of mobility potential. Based on the assessments, the protocol empowers the nurse to consult physical therapists or occupational therapists when appropriate. Daily ambulation status reports were reviewed each morning to determine each patient's activity level. Retrospective and prospective chart reviews were performed to evaluate the effectiveness of the protocol for patients 18 years of age and older who were hospitalized 72 hours or longer. In the 3 months prior to implementation of the Move to Improve project, 6.2% (12 of 193) of the ICU patients and 15.5% (54 of 349) of the IMCU patients ambulated during the first 72 hours of their hospitalization. During the 6 months following implementation, those rates rose to 20.2% (86 of 426) and 71.8% (257 of 358), respectively. The study was carried out at only one center. The initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.

Striving towards efficiency in the Greek hospitals by reviewing case mix classifications.

PubMed

Polyzos, Nicholas M

2002-09-01

In order to verify the efficiency level of Greek public hospitals, this paper evaluates the most recent indicators. Relevant data were collected from the two following databases: (a) hospitals' utilisation data generally and per clinical speciality [Ministry of Health, Athens, (Data based) 1995]; (b) Patients' and hospitals' characteristics per diagnosis [National Statistical Office, Athens, (Data based) 1993]. As explanatory variables, the study examines supply and demand factors following case mix classifications. Firstly, average length of stay (ALOS) and secondly, cost per case were regressed as dependent variables. The study highlights the extent of variability across hospitals for different groups of patients with the same condition. The results specify the most important factors that affect ALOS and cost pertaining to efficiency. Per speciality analysis shows occupancy, size-type of the hospital, beds and doctors per speciality, access and use of outpatient services, and surgical operations, etc. as the most significant factors. Per disease-diagnosis analysis shows age of over 65 years, gender, residence, marital status, surgical operation and insurance as the most important factors. General cost analysis in all National Health Systems (NHS) hospitals shows that economies of scale appear in: (a) district and/or specialised hospitals of 250-400 beds; (b) regional and/or teaching hospitals of over but near to 400 beds. Consequently, the author determines the 'Greek' Diagnostic Related Groups (DRGs), based on the cost per clinical speciality in the nine basic specialities and on the cost per diagnosis of the top 15 diagnoses. Further to the scientific results, such studies will enhance much necessary discussions on the organisation of service delivery and financing, by following case mix classification. Copyright 2002 Elsevier Science Ireland Ltd.

Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain.

PubMed

Harris, Steve; Singer, Mervyn; Sanderson, Colin; Grieve, Richard; Harrison, David; Rowan, Kathryn

2018-05-07

To estimate the effect of prompt admission to critical care on mortality for deteriorating ward patients. We performed a prospective cohort study of consecutive ward patients assessed for critical care. Prompt admissions (within 4 h of assessment) were compared to a 'watchful waiting' cohort. We used critical care strain (bed occupancy) as a natural randomisation event that would predict prompt transfer to critical care. Strain was classified as low, medium or high (2+, 1 or 0 empty beds). This instrumental variable (IV) analysis was repeated for the subgroup of referrals with a recommendation for critical care once assessed. Risk-adjusted 90-day survival models were also constructed. A total of 12,380 patients from 48 hospitals were available for analysis. There were 2411 (19%) prompt admissions (median delay 1 h, IQR 1-2) and 9969 (81%) controls; 1990 (20%) controls were admitted later (median delay 11 h, IQR 6-26). Prompt admissions were less frequent (p < 0.0001) as strain increased from low (22%), to medium (15%) to high (9%); the median delay to admission was 3, 4 and 5 h respectively. In the IV analysis, prompt admission reduced 90-day mortality by 7.4% (95% CI 1.7-18.5%, p = 0.117) overall, and 16.2% (95% CI 1.1-31.3%, p = 0.036) for those recommended for critical care. In the risk-adjust survival model, 90-day mortality was similar. After allowing for unobserved prognostic differences between the groups, we find that prompt admission to critical care leads to lower 90-day mortality for patients assessed and recommended to critical care.

Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

PubMed Central

2013-01-01

Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25) of the day in some form of physical activity and received 58 (SD 34) minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32) hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care. PMID:24024192

Rethinking health care commercialization: evidence from Malaysia.

PubMed

Nwagbara, Vitalis Chukwudi; Rasiah, Rajah

2015-11-19

Against the backdrop of systemic inefficiency in the public health care system and the theoretical claims that markets result in performance and efficiency improvement, developing countries' governments have been rapidly commercializing health care delivery. This paper seeks to determine whether commercialization through an expansion in private hospitals has led to performance improvements in public hospitals. Inpatient utilization records of all public hospitals in Peninsular Malaysia over the period 2006-2010 were used in this study. These records were obtained from the Ministry of Health. The study relied on utilization ratios, bed occupancy rates (BOR), bed turnover rates (BTR) and average length of stay (ALOS). The data were analyzed using SPSS 22 Statistical Software and the Pabon Lasso technique. Over 60 % of public hospitals in Malaysia are inefficient and perform sub-optimally. Average BOR among the public hospitals was 56 % in 2006 and 61 % in 2010. There was excessive BTR of 65 and 73 times within the period. Overall, the ALOS was low, falling from 3.4 days in 2006 to 3.1 days in 2010. This study demonstrates that commercialization has not led to performance improvements in the public health care sector in Malaysia. The evidence suggests that efforts to improve performance will require a focus directly on public hospitals.

[A proposal to improve nursing fee differentiation policy for general hospitals using profitability-analysis in the national health insurance].

PubMed

Kim, Sungjae; Kim, Jinhyun

2012-06-01

The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

Cumulative total effective whole-body radiation dose in critically ill patients.

PubMed

Rohner, Deborah J; Bennett, Suzanne; Samaratunga, Chandrasiri; Jewell, Elizabeth S; Smith, Jeffrey P; Gaskill-Shipley, Mary; Lisco, Steven J

2013-11-01

Uncertainty exists about a safe dose limit to minimize radiation-induced cancer. Maximum occupational exposure is 20 mSv/y averaged over 5 years with no more than 50 mSv in any single year. Radiation exposure to the general population is less, but the average dose in the United States has doubled in the past 30 years, largely from medical radiation exposure. We hypothesized that patients in a mixed-use surgical ICU (SICU) approach or exceed this limit and that trauma patients were more likely to exceed 50 mSv because of frequent diagnostic imaging. Patients admitted into 15 predesignated SICU beds in a level I trauma center during a 30-day consecutive period were prospectively observed. Effective dose was determined using Huda's method for all radiography, CT imaging, and fluoroscopic examinations. Univariate and multivariable linear regressions were used to analyze the relationships between observed values and outcomes. Five of 74 patients (6.8%) exceeded exposures of 50 mSv. Univariate analysis showed trauma designation, length of stay, number of CT scans, fluoroscopy minutes, and number of general radiographs were all associated with increased doses, leading to exceeding occupational exposure limits. In a multivariable analysis, only the number of CT scans and fluoroscopy minutes remained significantly associated with increased whole-body radiation dose. Radiation levels frequently exceeded occupational exposure standards. CT imaging contributed the most exposure. Health-care providers must practice efficient stewardship of radiologic imaging in all critically ill and injured patients. Diagnostic benefit must always be weighed against the risk of cumulative radiation dose.

Facility and market factors affecting transitions from nursing home to community.

PubMed

Arling, Greg; Abrahamson, Kathleen A; Cooke, Valerie; Kane, Robert L; Lewis, Teresa

2011-09-01

Research into nursing home transitions has given limited attention to the facility or community contexts. To identify facility and market factors affecting transitions of nursing home residents back to the community. Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional conditions. Facility discharge rates were adjusted using Empirical Bayes estimation. Annual cohort of first-time admissions (N=24,648) to 378 Minnesota nursing facilities in 75 nursing home markets from July 2005 to June 2006. Community discharge within 90 days of admission; facility occupancy, payer mix, ownership, case-mix acuity, size, admissions from hospitals, nurse staffing level, and proportion of admissions preferring or having support to return to the community; and nursing market population size, average occupancy, market concentration, and availability of home and community-based services. Rates of community discharge (Empirical Bayes residual) were highest in facilities with more residents preferring community discharge, more Medicare days, higher nurse staffing levels, and higher occupancy. In addition, facilities had higher community discharge rates if they were located in markets with a greater ratio of home and community-based services recipients to nursing home residents and with larger populations. State Medicaid programs should undertake system-level interventions that encourage nursing facilities to reduce unused bed capacity, balance the mix of payers, invest in nurse staffing, and take other steps to promote community discharges. In addition, states should increase home and community-based services, particularly in markets with low community discharge rates.

[Intensive care in Africa: a report of the first two years of activity of the intensive care unit of Ouagadougou national hospital (Burkina Faso)].

PubMed

Ouédraogo, Nazinigouba; Niakara, Ali; Simpore, André; Barro, Svetlana; Ouédraogo, Hamadé; Sanou, Joachim

2002-01-01

Intensive care units (ICUs) are very expensive and their role and effectiveness in developing countries are discussed; yet, their performance in these countries was infrequently reported. We report the experience over the first two years of activity of the multidisciplinary intensive care unit of the Ouagadougou national hospital. The analysis of such experience raises the issues related to intensive care in a developing country in terms of technical and social efficiency. Retrospective study of medical records. Multidisciplinary ICUs of a national teaching hospital. The eleven million inhabitants of Burkina Faso are one the poorest nations in the world (3rd in UNDP classification). The Yalgado Ouedraogo national hospital is the largest in the country and the only one in the capital city, Ouagadougou; this national referral and teaching hospital has 724 beds. The ICU was created in December 1996; it has 8 beds, equipped with ventilators, monitors and various instruments. The staff consists of two full-time anesthesiologists and three others who contribute to the duty system, one senior nurse, two nurses specialized in anesthesia and fourteen other nurses. The unit is open to medical students and student nurses for hospital-based training. All patients admitted in 1997 and 1998. Data was collected from medical records and related to length of stay (LOS), morbidity, mortality, therapy and patients' socio-demographic background. No severity score was given. Three hundred and thirty-eight patients, mainly males (73%), were admitted; the average bed occupancy rate was 25%. The average age of patients was 39.05 +/- 1.21; there was no sex-specific age difference. Distribution as per socio-professional category showed a high proportion of civil servants (38.0%); farmers (23.7%) and housewives (17.6%) were relatively few. Admission diagnoses included 146 traumas (43.2%) of which 105 cranial traumas, 121 post operative (35.8%) and 71 medical pathologies (21.0%). Forty-nine patients (14.5%) were mechanically ventilated. The average LOS was 4.69 0.42 days; half of the patients stayed under 48 hours. The overall mortality rate was 63.6%. The rate was 79% for medical pathologies, 70.5% for traumas and 48.5% for post operative patients. The LOS was significantly longer in survivors (7.24 +/- 1.02) than in deceased (3.54 +/- 0.38). The cumulative survival curve showed a high death probability density which decreased in time: 0.74 on the first day, 0.58 on the second, 0.36 on the sixth. The mortality rate was higher in ventilated patients than in non-ventilated ones. The highest mortality rate was observed among senior civil servants and farmers, and the lowest among craftsmen. The analysis of the first two years of operation of the ICUs of Ouagadougou national hospital reveals a low bed occupancy and a high mortality rate, particularly in the first days and for farmers. These results provide an opportunity to suggest the need for reorganization, with special emphasis on personnel availability and training, and for improved affordability of intensive care services.

Trends in the supply of inpatient rehabilitation facilities services: 1996 to 2004.

PubMed

Mallinson, Trudy R; Manheim, Larry M; Almagor, Orit; Demark, Holly M; Heinemann, Allen W

2008-11-01

Describe the supply of inpatient rehabilitation facilities (IRFs) services in 1996 and examine changes between 1996 and 2004, including the impact of the IRF prospective payment system (PPS) in 2002 on organizational trends. Retrospective pre-post design. Freestanding and subprovider (distinct-part units) IRFs. IRFs (N=1424), including 257 freestanding IRFs and 1167 IRF units reported in the Healthcare Cost Report Information System database, from years 1996 to 2004. Not applicable. Number of IRF openings, IRF closures, beds, and inpatient days. The number of IRFs grew from 1037 to 1183 between 1996 and 2001 and grew to 1235 between 2001 and 2004. The likelihood of IRF closures trended lower after PPS, and there was a significant increase in the likelihood of openings when PPS was introduced. For-profit, rural, and small IRFs were more likely to open over the entire period. There was a 12.9% increase in the number of total inpatient days, somewhat less than the 15.7% growth in IRF beds over the period. There was no impact of PPS on beds available but a significant decline in total inpatient days after PPS. Inpatient days rose under the Tax Equity and Fiscal Responsibility Act and declined after 2002. Yet the likelihood of openings and closures did not appear to respond to these changes, perhaps because they were modest compared with changes in local IRF markets. The IRF PPS did little to affect service distribution in less well-served areas, although we did find growth in rural areas. Occupancy rates in 2004 were close to rates at the start of the period (70%). This observation implies that IRFs were implementing strategies to recruit a sufficient number of patients, even though bed numbers were increasing and length of stay was declining. Consequently, policy that limits the potential of IRFs to increase patient admissions, such as the limits on admissions to IRFs of patients with conditions other than those included in the 75% rule, is likely to produce substantial decreases in total inpatient days.

[Predictors of Turnover among New Nurses using Multilevel Survival Analysis].

PubMed

Kim, Suhee; Lee, Kyongeun

2016-10-01

The purpose of this study was to examine factors influencing new graduate nurse turnover. This study was carried out as a secondary analysis of data from the 2010 Graduates Occupational Mobility Survey (GOMS). A total of 323 nurses were selected for analysis concerning reasons for turnover. Data were analyzed using descriptive statistics and multilevel survival analysis. About 24.5% of new nurses left their first job within 1 year of starting their jobs. Significant predictors of turnover among new nurse were job status, monthly income, job satisfaction, the number of hospitals in region, and the number of nurses per 100 beds. New graduate nurses are vulnerable to turnover. In order to achieve the best health of the nation, policy approaches and further studies regarding reducing new graduate nurse turnover are needed.

Early human occupation of Western Europe: Paleomagnetic dates for two paleolithic sites in Spain

PubMed Central

Oms, O.; Parés, J. M.; Martínez-Navarro, B.; Agustí, J.; Toro, I.; Martínez-Fernández, G.; Turq, A.

2000-01-01

The lacustrine deposits infilling the intramontane Guadix-Baza Basin, in the Betic Range of Southern Spain, have yielded abundant well-preserved lithic artifacts. In addition, the lake beds contain a wide range of micromammals including Mimomys savini and Allophaiomys burgondiae and large mammals such as Mammuthus and Hippopotamus together with the African saber-toothed felid Megantereon. The association of the lithic artifacts along with the fossil assemblages, themselves of prime significance in the Eurasian mammal biochronology, is providing new insight into the controversy of the human settlement in Southern Europe. Despite the importance of the artifacts and fossil assemblage, estimates of the geological age of the site are still in conflict. Some attempts at dating the sediments have included biochronology, uranium series, amino acid racemization, and stratigraphic correlation with other well-dated sections in the basin, but so far have failed to yield unambiguous ages. Here we present paleomagnetic age dating at the relevant localities and thus provide useful age constraints for this critical paleoanthropological and mammal site. Our data provide firm evidence for human occupation in Southern Europe in the Lower Pleistocene, around 1 mega-annum ago. The current view of when and how hominids first dispersed into Europe needs to be reevaluated. PMID:10973485

Geology of the dry creek site; a stratified early man site in Interior Alaska

USGS Publications Warehouse

Thorson, R.M.; Hamilton, T.D.

1977-01-01

The Dry Creek archeologic site contains a stratified record of late Pleistocene human occupation in central Alaska. Four archeologic components occur within a sequence of multiple loess and sand layers which together form a 2-m cap above weathered glacial outwash. The two oldest components appear to be of late Pleistocene age and occur with the bones of extinct game animals. Geologic mapping, stratigraphic correlations, radiocarbon dating, and sediment analyses indicate that the basal loess units formed part of a widespread blanket that was associated with an arctic steppe environment and with stream aggradation during waning phases of the last major glaciation of the Alaska Range. These basal loess beds contain artifacts for which radiocarbon dates and typologic correlations suggest a time range of perhaps 12,000-9000 yr ago. A long subsequent episode of cultural sterility was associated with waning loess deposition and development of a cryoturbated tundra soil above shallow permafrost. Sand deposition from local source areas predominated during the middle and late Holocene, and buried Subarctic Brown Soils indicate that a forest fringe developed on bluff-edge sand sheets along Dry Creek. The youngest archeologic component, which is associated with the deepest forest soil, indicates intermittent human occupation of the site between about 4700 and 3400 14C yr BP. ?? 1977.

Regulation of human feto-placental endothelial barrier integrity by vascular endothelial growth factors: competitive interplay between VEGF-A165a, VEGF-A165b, PIGF and VE-cadherin.

PubMed

Pang, Vincent; Bates, David O; Leach, Lopa

2017-12-01

The human placenta nourishes and protects the developing foetus whilst influencing maternal physiology for fetal advantage. It expresses several members of the vascular endothelial growth factor (VEGF) family including the pro-angiogenic/pro-permeability VEGF-A 165 a isoform, the anti-angiogenic VEGF-A 165 b, placental growth factor (PIGF) and their receptors, VEGFR1 and VEGFR2. Alterations in the ratio of these factors during gestation and in complicated pregnancies have been reported; however, the impact of this on feto-placental endothelial barrier integrity is unknown. The present study investigated the interplay of these factors on junctional occupancy of VE-cadherin and macromolecular leakage in human endothelial monolayers and the perfused placental microvascular bed. Whilst VEGF-A 165 a (50 ng/ml) increased endothelial monolayer albumin permeability ( P <0.0001), equimolar concentrations of VEGF-A 165 b ( P >0.05) or PlGF ( P >0.05) did not. Moreover, VEGF-A 165 b (100 ng/ml; P <0.001) but not PlGF (100 ng/ml; P >0.05) inhibited VEGF-A 165 a-induced permeability when added singly. PlGF abolished the VEGF-A 165 b-induced reduction in VEGF-A 165 a-mediated permeability ( P >0.05); PlGF was found to compete with VEGF-A 165 b for binding to Flt-1 at equimolar affinity. Junctional occupancy of VE-cadherin matched alterations in permeability. In the perfused microvascular bed, VEGF-A 165 b did not induce microvascular leakage but inhibited and reversed VEGF-A 165 a-induced loss of junctional VE-cadherin and tracer leakage. These results indicate that the anti-angiogenic VEGF-A 165 b isoform does not increase permeability in human placental microvessels or HUVEC primary cells and can interrupt VEGF-A 165 a-induced permeability. Moreover, the interplay of these isoforms with PIGF (and s-flt1) suggests that the ratio of these three factors may be important in determining the placental and endothelial barrier in normal and complicated pregnancies. © 2017 The Author(s).

Human effects on estuarine shoreline decadal evolution

NASA Astrophysics Data System (ADS)

Rilo, A.; Freire, P.; Ceia, R.; Mendes, R. N.; Catalão, J.; Taborda, R.

2012-04-01

Due to their sheltered conditions and natural resources, estuaries were always attractive to human activities (industrial, agriculture, residential and recreation). Consequently, the complex interactions between anthropogenic and natural drivers increase estuarine shoreline vulnerability to climate changes impacts. The environmental sustainability of these systems depends on a fragile balance between societal development and natural values that can be further disturbed by climate change effects. This challenging task for scientific community, managers and stakeholders can only be accomplished with interdisplinary approaches. In this context, it seems clear that estuarine management plans should incorporate the concept of change into the planning of policy decisions since these natural dynamic areas are often under human pressure and are recognized as sensitive to climate change effects. Therefore, the knowledge about historical evolution of estuarine shoreline is important to provide new insights on the spatial and temporal dimensions of estuarine change. This paper aims to present and discuss shoreline changes due to human intervention in Tagus estuary, located on the west coast of Portugal. Detailed margins cartography, in a 550m fringe (drawn inland from the highest astronomical tide line), was performed based on 2007 orthophotos (spatial resolution of 0.5 m) analysis. Several classification categories were considered, as urbanized areas, industrial, port and airport facilities, agriculture spaces, green areas and natural zones. The estuarine bed (area bellow the highest astronomical tide line) was also mapped (including human occupation, natural habitats, morpho-sedimentary units) based on the geographic information above and LANSAT 7 TM+ images using image processing techniques. Aerial photographs dated from 1944, 1946, 1948, 1955 and 1958 were analyzed for a set of pilot zones in order to fully understand the decadal shoreline change. Estuarine bed presents an extensive intertidal area (146 km2), that includes 13% of salt marshes and 1% of beaches. Anthropogenic structures such as salt pans, old tide mills or aquaculture installations cover 15% of the intertidal zone. Margins cartography indicates that natural areas (i.e regions that still preserve their natural characteristics) correspond to 1% of margins total area (130 km2), indicating that Tagus estuary has undergone great anthropogenic change. The most important occupation types are the agriculture parcel (35%) and the urban area (34%). Industrial zones, ports and airports facilities cover 24% and green spaces (areas with vegetation in urban and non-urban zones, gardens, and leisure facilities) extend for 6%. Preliminary results confirm that estuarine shoreline changes during the last 60 years are mainly related with the direct effect of human activities in the intertidal zone, which promoted the loss of natural areas such as beaches and salt marshes. Nevertheless, few examples of natural recovery of abandoned areas by salt marshes can occur within the studied period. This paper brings to light the knowledge about the anthropogenic role in Tagus estuarine shoreline decadal evolution, providing valuable information in future climate change effects since it indicates that human occupation can be a barrier to the estuarine system natural response. Furthermore it points out the relevance of planning occupation strategies in these areas.

Carbapenem-Resistant Acinetobacter baumannii: Concomitant Contamination of Air and Environmental Surfaces.

PubMed

Shimose, Luis A; Masuda, Eriko; Sfeir, Maroun; Berbel Caban, Ana; Bueno, Maria X; dePascale, Dennise; Spychala, Caressa N; Cleary, Timothy; Namias, Nicholas; Kett, Daniel H; Doi, Yohei; Munoz-Price, L Silvia

2016-07-01

OBJECTIVE To concomitantly determine the differential degrees of air and environmental contamination by Acinetobacter baumannii based on anatomic source of colonization and type of ICU layout (single-occupancy vs open layout). DESIGN Longitudinal prospective surveillance study of air and environmental surfaces in patient rooms. SETTING A 1,500-bed public teaching hospital in Miami, Florida. PATIENTS Consecutive A. baumannii-colonized patients admitted to our ICUs between October 2013 and February 2014. METHODS Air and environmental surfaces of the rooms of A. baumannii-colonized patients were sampled daily for up to 10 days. Pulsed-field gel electrophoresis (PFGE) was used to type and match the matching air, environmental, and clinical A. baumannii isolates. RESULTS A total of 25 A. baumannii-colonized patients were identified during the study period; 17 were colonized in the respiratory tract and 8 were colonized in the rectum. In rooms with rectally colonized patients, 38.3% of air samples were positive for A. baumannii; in rooms of patients with respiratory colonization, 13.1% of air samples were positive (P=.0001). In rooms with rectally colonized patients, 15.5% of environmental samples were positive for A. baumannii; in rooms of patients with respiratory colonization, 9.5% of environmental samples were positive (P=.02). The rates of air contamination in the open-layout and single-occupancy ICUs were 17.9% and 21.8%, respectively (P=.5). Environmental surfaces were positive in 9.5% of instances in open-layout ICUs versus 13.4% in single-occupancy ICUs (P=.09). CONCLUSIONS Air and environmental surface contaminations were significantly greater among rectally colonized patients; however, ICU layout did not influence the rate of contamination. Infect Control Hosp Epidemiol 2016;37:777-781.

The health sector reforms and the efficiency of public hospitals in Turkey: provincial markets.

PubMed

Sulku, Seher Nur

2012-10-01

Turkey initiated the 'Health Transformation Programme' (HTP) in 2003 to align its health care system with the European Union and OECD countries. This study investigates the impact of these reforms on the efficiency of public hospitals. Our study would contribute to the existing literature with a comprehensive analysis of the health system in a developing country. We employ the data envelopment approach and the Malmquist index to comparatively examine before and after the reform years. Our analyses compare the performances of public hospitals served in provincial markets. Inputs of number of beds, number of primary care physician, and number of specialists, and how they are used to produce outputs of inpatient discharges, outpatient visits and surgical operations are investigated. Indeed, as the performance indicators dead rate, hospital bed occupation rate and average length of stay are considered. The HTP was generally successful in boosting productivity due to advancements in technology and technical efficiency but in the socio-economically disadvantaged provinces productivity gains have not been achieved. The average technical efficiency gains took place because of the significantly improved scale efficiencies, as the average pure technical efficiency slightly improved. Lastly, the hospital performance indicators have not improved in the short run. It appears that the expected benefits from the health reforms in Turkey have been partially achieved in the short run.

Designing ecological flows to gravely braided rivers in alpine environments

NASA Astrophysics Data System (ADS)

Egozi, R.; Ashmore, P.

2009-04-01

Designing ecological flows in gravelly braided streams requires estimating the channel forming discharge in order to maintain the braided reach physical (allocation of flow and bed load) and ecological (maintaining the habitat diversity) functions. At present, compared to single meander streams, there are fewer guiding principles for river practitioners that can be used to manage braided streams. Insight into braiding morphodynamics using braiding intensity indices allows estimation of channel forming discharge. We assess variation in braiding intensity by mapping the total number of channels (BIT) and the number of active (transporting bed load) channels (BIA) at different stages of typical diurnal melt-water hydrographs in a pro-glacial braided river, Sunwapta River, Canada. Results show that both BIA and BIT vary with flow stage but over a limited range of values. Furthermore, maximum BIT occurs below peak discharge. At this stage there is a balance between channel merging from inundation and occupation of new channels as the stage rises. This stage is the channel forming discharge because above this stage the existing braided pattern cannot discharge the volume of water without causing morphological changes (e.g., destruction of bifurcations, channel avulsion). Estimation of the channel forming discharge requires a set of braiding intensity measurements over a range of flow stages. The design of ecological flows must take into consideration flow regime characteristics rather than just the channel forming discharge magnitude.

[Medico-economic analysis of a neurosurgery department at a university hospital].

PubMed

Lemaire, J-J; Delom, C; Coste, A; Khalil, T; Jourdy, J-C; Pontier, B; Gabrillargues, J; Sinardet, D; Chabanne, A; Achim, V; Sakka, L; Coste, J; Chazal, J; Salagnac, A; Coll, G; Irthum, B

2015-02-01

Economic and societal constraints require to take into account the economic dimension and medical performance of hospital departments. We carried out a self-assessment study, which we thought could be useful to share with the neurosurgical community. Care and research activities were assessed from 2009 to 2013. We used institutional and assessment-body parameters in order to describe activities and perform a financial evaluation. It was a retrospective descriptive study based on the guidelines of the DHOS/O4 circular No. 2007/390 of October 29, 2007. The average annual, analytic income statement was +1.39 millions euros, for 63 beds with a 92% occupancy rate, including 6.7 full-time equivalent neurosurgeons (and assistants), for 2553 patients and 1975 surgeries. The average mortality rate was 2.74%. The annual mean length of stay was 6.82 days. Per year, on average 15.6% of patients were admitted in emergency and 76.9% returned home. The annual, act-related-pricing and publication-related incomes represented 77% and 0.6%, respectively of the total funding. Difficulties to find downstream beds for the most severe patients induced 1401 "waiting days" in 2012. Medico-economic analysis of a neurosurgery department at a university hospital was useful in order to take into account the care, teaching and research activities, as well as its related financial value. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

A virtual laboratory for the simulation of sustainable energy systems in a low energy building: A case study

NASA Astrophysics Data System (ADS)

Breen, M.; O'Donovan, A.; Murphy, M. D.; Delaney, F.; Hill, M.; Sullivan, P. D. O.

2016-03-01

The aim of this paper was to develop a virtual laboratory simulation platform of the National Building Retrofit Test-bed at the Cork Institute of Technology, Ireland. The building in question is a low-energy retrofit which is provided with electricity by renewable systems including photovoltaics and wind. It can be thought of as a living laboratory, as a number of internal and external building factors are recorded at regular intervals during human occupation. The analysis carried out in this paper demonstrated that, for the period from April to September 2015, the electricity provided by the renewable systems did not consistently match the building’s electricity requirements due to differing load profiles. It was concluded that the use of load shifting techniques may help to increase the percentage of renewable energy utilisation.

[Investigation of burn rehabilitation development of China in 2014].

PubMed

Ao, M; Wu, J; Chen, J

2017-05-20

Objective: To further study the development of burn rehabilitation in China, so as to promote the development of burn rehabilitation in China. Methods: The questionnaire about the development of burn rehabilitation treatment was started by Specialized Committee of Burn Treatment and Rehabilitation Science of Chinese Association of Rehabilitation Medicine (hereinafter referred to as Specialized Committee) in the end of 2014, and 65 affiliations of Specialized Committee members participated in. There was a total of 26 questions, mainly focusing on problems as below: (1) General information of the burn department of the units, including the number of authorized beds, annual admitted burn patients, annual admitted patients with extremely severe burn, doctors, nurses, rehabilitation therapists, and the condition of rehabilitation area and rehabilitation beds, etc. (2) Development of burn rehabilitation treatment, including the development of rehabilitation treatment, the intervention time of rehabilitation treatment, the rehabilitation treatment carried out in intensive care unit (ICU), the composition of rehabilitation treating personnel, and the professional title and background, educational background, and division of responsibilities of rehabilitation therapists, etc. (3) Major problems affecting the development of burn rehabilitation treatment of the units. The burn treatment units were grouped according to the number of annual admitted patients. The units' situation of authorized beds, admitted patients, allocation of medical personnel and rehabilitation, and the ratio of beds to doctors, beds to nurses, beds to full-time burn rehabilitation treating personnel were recorded. Data were processed with t test, one-way analysis of variance, and chi-square test. Results: (1) A total of 65 questionnaires were sent, and 45 questionnaires (69.2%) were retrieved. Among the 45 units that replied the questionnaires, 35 units were burn treatment units. (2) The 35 burn treatment units were divided into less than 500 cases group ( n =8), 501-1 000 cases group ( n =11), 1 001-1 500 cases group ( n =10), and more than 1 500 cases group ( n =6) according to the number of annual admitted patients. The number of authorized beds of units in 1 001-1 500 cases group was significantly more than that in less than 500 cases group ( t =4.563, P <0.05). The number of authorized beds of units in more than 1 500 cases group was significantly more than that in the other 3 groups, respectively (with t values from 1.859 to 3.743, P values below 0.05). The number of annual admitted patients of units in 501-1 000 cases group, 1 001-1 500 cases group, and more than 1 500 cases group was dramatically more than that in less than 500 cases group (with t values from 6.027 to 12.684, P values below 0.05). The number of annual admitted patients of units in 1 001-1 500 cases group and more than 1 500 cases group was significantly more than that in 501-1 000 cases group (with t values respectively 7.408 and 6.980, P values below 0.05). The number of annual admitted patients of units in more than 1 500 cases group was significantly more than that in 1 001-1 500 cases group ( t =4.239, P <0.05). The number of annual admitted patients with extremely severe burn and the condition of rehabilitation area and rehabilitation beds of units in the 4 groups was similar ( F =0.820, with χ (2) values respectively 5.266 and 2.848, P values above 0.05). The number of doctors of units in more than 1 500 cases group was significantly more than that in less than 500 cases group ( t =2.836, P <0.05). The number of nurses of units in 1 001-1 500 cases group was significantly more than that in less than 500 cases group ( t =2.837, P <0.05). The number of nurses and that of rehabilitation therapists of units in more than 1 500 cases group were significantly more than those in the other 3 groups (with t values from 1.762 to 4.789, P values below 0.05). (3) The 35 burn treatment units were able to provide at least one rehabilitation treatment for patients, among which body positioning, motion of joint exercise, infrared ray irradiation, hydrotherapy, function training, activities of daily life training, scar massage, and drug injection in scar were carried out well, while psychological therapy, music therapy, occupational rehabilitation, and social rehabilitation were mostly not carried out. (4) Only 9 (25.7%) burn treatment units started rehabilitation treatment for patients within 3 days after injury. (5) Twenty-seven (77.1%) burn treatment units could carry out body positioning in ICU. (6) Twenty-three burn treatment units had full-time rehabilitation treating personnel, and the units were divided into less than 500 cases group ( n =1), 501-1 000 cases group ( n =8), 1 001-1 500 cases group ( n =9), and more than 1 500 cases group ( n =5) according to the number of annual admitted patients. The ratio of beds to doctors of units in more than 1 500 cases group was significantly higher than that in 501-1 000 cases group ( t =2.810, P <0.05) and the ratios of beds to doctors of units in 501-1 000 cases group and 1 001-1 500 cases group were similar ( t =1.506, P >0.05). The ratios of beds to nurses and beds to full-time burn rehabilitation treating personnel in 4 groups were similar (with F values respectively 0.783 and 0.434, P values above 0.05). (7) Twenty burn treatment units had rehabilitation therapists with rehabilitation treatment related professional background (a total of 73 person, account for 76.0%), 80.8% (59/73) rehabilitation therapists with rehabilitation and therapeutic professions, 60.3% (44/73) with bachelor degree or above, and 87.7% (64/73) with primary and intermediate titles. Besides, 39.7% (29/73) rehabilitation therapists did physical therapy; 12.3% (9/73) rehabilitation therapists did occupational therapy; 38.4% (28/73) rehabilitation therapists did not have specific duties. (8) During the development of burn rehabilitation treatment of 35 burn treatment units, the common problems were reflected in the authorized strength and professional technology level of rehabilitation treatment relating personnel, and the area and equipment for rehabilitation. There were also many problems in cooperation between burn surgeons and rehabilitation therapists and fund. The supports from hospital and department leaders were good. Conclusions: Through the development of several years, the general condition and the development of rehabilitation treatment of burn treatment units in China are improved; the beginning time of burn rehabilitation treatment is advanced; the number of rehabilitation treatment personnel is increased with their speciality improved; the burn rehabilitation work get great support from hospitals and departments.

Antibiotic consumption in non-teaching Lebanese hospitals: A cross-sectional study.

PubMed

Iskandar, Katia; Hanna, Pierre A; Salameh, Pascale; Raad, Etwal B

2016-01-01

The rising threat of antibiotic resistance is linked to patterns of antibiotic use in hospital settings where global efforts are undertaken to encourage reporting and benchmarking antibiotic consumption in an attempt to improve prescription regimens. In Lebanon, where data concerning the level of antibiotic consumption in hospitals is scarce, the aim of our paper is to track the intensity of antibiotic consumption in order to identify potential evidence of antibiotic misuse or abuse. The study is conducted in 2012 for a period of 12-month using data from pharmacy records in 27 non-teaching Lebanese hospitals according to the Anatomical, Therapeutic and chemical classification system and Defined Daily Dose (ATC/DDD) recommended by the World Health Organization and compiling data on ABC Calc software version 3.1. Results show that the average antibiotic consumption excluding pediatric cases is 72.56 Defined Daily Dose per 100 Bed-Days (DDD/100BD). Total broad spectrum antibiotic consumption is 12.14 DDD/100BD with no significant difference found between public and private hospitals (p>0.05 for all). The most commonly used antibiotics were Amoxycillin/Clavulanic acid, Ceftriaxone, Amoxycillin and Cefuroxime for parenteral use. Consumption of beta-lactams, Cephalosporins, Carbapenems, Monobactams and quinolones did not vary significantly by region, occupancy rate, number of beds including the number of intensive care unit beds. Our data findings provides baseline information on patterns of antibiotic consumption in Lebanon and the issue calls for concerted efforts to encourage data reporting on national basis and to correlate future findings with results of antibiotic susceptibility testing which can provide insights and tools needed to assess the public health consequences of antimicrobial misuse and to evaluate the impact of antibiotic resistance containment interventions. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Data envelopment analysis for estimating efficiency of intensive care units: a case study in Iran.

PubMed

Bahrami, Mohammad Amin; Rafiei, Sima; Abedi, Mahdieh; Askari, Roohollah

2018-05-14

Purpose As hospitals are the most costly service providers in every healthcare systems, special attention should be given to their performance in terms of resource allocation and consumption. The purpose of this paper is to evaluate technical, allocative and economic efficiency in intensive care units (ICUs) of hospitals affiliated by Yazd University of Medical Sciences (YUMS) in 2015. Design/methodology/approach This was a descriptive, analytical study conducted in ICUs of seven training hospitals affiliated by YUMS using data envelopment analysis (DEA) in 2015. The number of physicians, nurses, active beds and equipment were regarded as input variables and bed occupancy rate, the number of discharged patients, economic information such as bed price and physicians' fees were mentioned as output variables of the study. Available data from study variables were retrospectively gathered and analyzed through the Deap 2.1 software using the variable returns to scale methodology. Findings The study findings revealed the average scores of allocative, economic, technical, managerial and scale efficiency to be relatively 0.956, 0.866, 0.883, 0.89 and 0.913. Regarding to latter three types of efficiency, five hospitals had desirable performance. Practical implications Given that additional costs due to an extra number of manpower or unnecessary capital resources impose economic pressure on hospitals also the fact that reduction of surplus production plays a major role in reducing such expenditures in hospitals, it is suggested that departments with low efficiency reduce their input surpluses to achieve the optimal level of performance. Originality/value The authors applied a DEA approach to measure allocative, economic, technical, managerial and scale efficiency of under-study hospitals. This is a helpful linear programming method which acts as a powerful and understandable approach for comparative performance assessment in healthcare settings and a guidance for healthcare managers to improve their departments' performance.

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial.

PubMed

Sackley, Catherine M; Walker, Marion F; Burton, Christopher R; Watkins, Caroline L; Mant, Jonathan; Roalfe, Andrea K; Wheatley, Keith; Sheehan, Bart; Sharp, Leslie; Stant, Katie E; Fletcher-Smith, Joanna; Steel, Kerry; Wilde, Kate; Irvine, Lisa; Peryer, Guy

2015-02-05

To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Pragmatic, parallel group, cluster randomised controlled trial. 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval -0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies.Trial registration Current Controlled Trials ISRCTN00757750. © Sackley et al 2015.

An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial

PubMed Central

Sackley, Catherine M; Walker, Marion F; Burton, Christopher R; Watkins, Caroline L; Mant, Jonathan; Roalfe, Andrea K; Wheatley, Keith; Sheehan, Bart; Sharp, Leslie; Stant, Katie E; Fletcher-Smith, Joanna; Steel, Kerry; Wilde, Kate; Irvine, Lisa

2015-01-01

Objective To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae. Design Pragmatic, parallel group, cluster randomised controlled trial. Setting 228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012. Intervention Targeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment. Main outcome measures Primary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points. Results 64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points. Conclusions This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies. Trial registration Current Controlled Trials ISRCTN00757750. PMID:25657106

De-institutionalisation and trans-institutionalisation - changing trends of inpatient care in Norwegian mental health institutions 1950-2007

PubMed Central

2009-01-01

Background Over the last decades mental health services in most industrialised countries have been characterised by de-institutionalisation and different kinds of redistribution of patients. This article will examine the historical trends in Norway over the period 1950-2007, identify the patterns of change in service settings and discuss why the mental health services have been dramatically transformed in less than sixty years. Methods The presentation of the trends in the Norwegian mental health services and the outline of the major changes in the patterns of inpatient care over the period 1950-2007 is founded on five indicators: The average inpatient population, the number of discharges during a year, the average length of stay, the number of beds or places, and the occupancy rate (average inpatient population/beds). Data are reported by institutional setting. Multiple sources of data are used. In some cases it has been necessary to interpolate data due to missing data. Results New categories of institutions were established and closed during the 57 years period. De-hospitalisation started in Norway in the early 1970s, de-institutionalisation in general 15 years later. Six distinct periods are identified: The asylum period (-1955), institutionalisation and trans-institutionalisation (1955-65), stabilisation and onset of de-hospitalisation (1965-75), de-hospitalisation (1975-87), from nursing homes to community-based services (1988-98), and the national mental health program (1999-2007). There has been a significant reduction in the number of beds and in the average in-patient population. The average length of stay in institutions has been continuously reduced since 1955. The number of patients actually treated in psychiatric institutions has increased significantly. Accessibility, quality of care and treatment for most patients has improved during the period. The mental health system in Norway has recently been evaluated as better than the systems in USA, England and Canada. Conclusions De-institutionalisation means fewer beds but not fewer patients treated, neither in institutions in general nor in psychiatric hospitals. The periods represent different kinds of de-, trans-, and even re-institutionalisation. Expansion of the welfare state, increased professional focus on active treatment and increased focus on patients' preferences are the factors that best explain de-institutionalisation in Norway. PMID:20035623

Investigation of Vehicle Rear Under Run Protection Device (RUPD) Using Aluminium Foam

NASA Astrophysics Data System (ADS)

Nagaraj Goud, B.; pachori, Avinash

2017-08-01

Whenever the passenger cars meet with accidents with the heavy duty truck from rear, it will tend to penetrate under the truck bed called truck trailer under-ride crash. This is responsible for the thousands of accidents, causing severe injuries and spot death. This is mostly due to the lack of effective guarding system. The Present paper gives an importance on energy absorption mechanism of a Rear under Run Protection Device (RUPD) under crash effect of the truck. The aim of the study is to replace Steel RUPD with aluminum foam, which promises an improvement of vehicle crashworthiness as well as to reduce weight of the vehicle. The aluminum foam is selected due to the high specific strength and specific stiffness. This inborn character makes it a promising candidate in the modern lightweight structures in the automotive engineering which can contribute to the improvement of mileage in addition to safety of the occupants.

[Management practices in medium-sized private hospitals in São Paulo, Brazil].

PubMed

Brito, Luiz Artur Ledur; Malik, Ana Maria; Brito, Eliane; Bulgacov, Sergio; Andreassi, Tales

2017-04-03

Traditional management practices are sometimes considered merely a necessary condition for superior performance. Other resources and competencies with higher barriers to imitation are assumed to be potential sources of competitive advantage. This study describes and analyzes the effect of traditional management practices on the performance of medium-sized hospitals. Medium-sized companies frequently display the greatest differences in management practices, and only recently did the hospital sector seek ways to develop its competitiveness in the administrative arena. The results generally indicate that basic management practices can make differences in performance, offering support for the new practice-based view (PBV). Hospitals with the highest rate of adoption of practices had the highest occupancy rate, hospital-bed admissions, and accreditation. Lack of adoption of management practices by medium-sized hospitals limits their competitive capacity and can be viewed as a component of the so-called Brazil cost, but in this case an internal component.

Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus.

PubMed

Zingg, Walter; Holmes, Alison; Dettenkofer, Markus; Goetting, Tim; Secci, Federica; Clack, Lauren; Allegranzi, Benedetta; Magiorakos, Anna-Pelagia; Pittet, Didier

2015-02-01

Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around 37,000 deaths each year. We did a systematic review to identify crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring. 92 studies published from 1996 to 2012 were assessed and ten key components identified: organisation of infection control at the hospital level; bed occupancy, staffing, workload, and employment of pool or agency nurses; availability of and ease of access to materials and equipment and optimum ergonomics; appropriate use of guidelines; education and training; auditing; surveillance and feedback; multimodal and multidisciplinary prevention programmes that include behavioural change; engagement of champions; and positive organisational culture. These components comprise manageable and widely applicable ways to reduce health-care-associated infections and improve patients' safety. Copyright © 2015 Elsevier Ltd. All rights reserved.

The impact of non-IPA HMOs on the number of hospitals and hospital capacity.

PubMed

Chernew, M

1995-01-01

Concentration in the hospital market could limit the success of health care reform strategies that rely on managed care to constrain costs. Hospital market capacity also is important because capacity affects both costs and the degree of price competition. Because managed care plans, particularly non-individual practice association (non-IPA) model HMOs, practice a less hospital-intensive style of care, consolidation and downsizing in the hospital market potentially will accompany managed care growth, influencing the long-run effectiveness of managed care cost-containment strategies. Using Standard Metropolitan Statistical Area (SMSA) data from 1982 and 1987, a 10-percentage point increase in non-IPA HMO market share is estimated to reduce the number of hospitals by about 4%, causing an approximate 5% reduction in the number of hospital beds. No statistically significant relationship is found between non-IPA HMO penetration rates and hospital occupancy rates.

[Impact of interventions in the pressure ulcer rate].

PubMed

Araya Farías, I; Febré, N

To evaluate the impact of a risk management program for prevention of pressure ulcers (PUs) in an adult Intensive Care Unit (ICU). A quantitative, prospective study performed with a «before and after» evaluation, and designed in three stages: 1) PU incidence study; 2) Intervention by implementing a risk management program, and 3) Assessment of the impact. Adherence to the preventive measures showed a significant increase (11.7%) between the first month of the program and the final month (58.5%) of the assessment. Initial PU rate was 20.9, with a decrease in the rate to 14.0 per 1000 bed occupancy days (P<.05) after the risk management program. The data show that the risk management program, using prevention measures, was effective in reducing the rate of PU in the period under study by more than 33%. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Organizational characteristics influencing nursing home social service directors' qualifications: a national study.

PubMed

Simons, Kelsey V

2006-11-01

This research sought to identify organizational characteristics associated with the amount of professional qualifications among a nationally representative sample of nursing home social service directors. A self-administered survey was sent to directors in 675 facilities randomly sampled from a federal database, excluding facilities with fewer than 120 beds that are not required to staff a full-time social worker. The response rate was 45 percent (N = 299). Univariate results showed that most respondents possessed a social work degree, most lacked licensure, and few were clinically supervised. A multiple regression analysis found that nonprofit, independently owned facilities in rural areas staffed social service directors who were significantly more qualified than directors in for-profit, chain-affiliated facilities in urban and suburban areas. Facilities with fewer psychosocial deficiencies and higher occupancy rates employed social service directors with greater qualifications. The implications of these findings for social work education, practice, policy, and research are discussed.

Dating of the Basal Aurignacian Sandwich at Abric Romanı́ (Catalunya, Spain) by Radiocarbon and Uranium-Series

USGS Publications Warehouse

Bischoff, James L.; Ludwig, Kenneth R.; Garcia, Jose Francisco; Carbonell, E.; Vaquero, Manola; Stafford, Thomas W.; Jull, A.J.T.

1994-01-01

Abric Romani{dotless}??, a rock shelter located near Barcelona, Spain, contains a charcoal-bearing basal Aurignacian occupation level sandwiched between beds of moss-generated carbonate. The Aurignacian culture is the oldest artefact industry in Europe with which anatomically modern human remains have been associated. Radiocarbon analysis of charcoal fragments by accelerator mass spectrometry (AMS) dates the basal Aurignacian to about 37 ?? 2 ka bp. U-series analyses by alpha spectrometry (AS) and mass spectrometry (MS) date the enclosing carbonate to 43 ?? 1 ka bp. These results confirm the great antiquity of the Aurignacian in northern Spain and support the similar AMS dates from El Castillo and l'Arbreda caves. They also show that radiocarbon dates are significantly younger than U-series at 40 ka bp, as predicted by theory. ?? 1994 Academic Press. All rights reserved.

A portable magnetic induction measurement system (PIMS).

PubMed

Cordes, Axel; Foussier, Jérôme; Pollig, Daniel; Leonhardt, Steffen

2012-02-22

For contactless monitoring of ventilation and heart activity, magnetic induction measurements are applicable. As the technique is harmless for the human body, it is well suited for long-term monitoring solutions, e.g., bedside monitoring, monitoring of home care patients, and the monitoring of persons in critical occupations. For such settings, a two-channel portable magnetic induction system has been developed, which is small and light enough to be fitted in a chair or bed. Because demodulation, control, and filtering are implemented on a front-end digital signal processor, a PC is not required (except for visualization/data storage during research and development). The system can be connected to a local area network (LAN) or wireless network (WiFi), allowing to connect several devices to a large monitoring system, e.g., for a residential home for the elderly or a hospital with low-risk patients not requiring standard ECG monitoring. To visualize data streams, a Qt-based (Qt-framework by Nokia, Espoo, Finland) monitoring application has been developed, which runs on Netbook computers, laptops, or standard PCs. To induce and measure the magnetic fields, external coils and amplifiers are required. This article describes the system and presents results for monitoring respiration and heart activity in a (divan) bed and for respiration monitoring in a chair. Planar configurations and orthogonal coil setups were examined during the measurement procedures. The measurement data were streamed over a LAN to a monitoring PC running Matlab (The MathWorks Inc, Natick, MA, USA).

Sustaining critical care: using evidence-based simulation to evaluate ICU management policies.

PubMed

Mahmoudian-Dehkordi, Amin; Sadat, Somayeh

2017-12-01

Intensive Care Units (ICU) are costly yet critical hospital departments that should be available to care for patients needing highly specialized critical care. Shortage of ICU beds in many regions of the world and the constant fire-fighting to make these beds available through various ICU management policies motivated this study. The paper discusses the application of a generic system dynamics model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to explore the dynamics of intended and unintended consequences of such ICU management policies under a natural disaster crisis scenario. ICU management policies that can be implemented by a single hospital on short notice, namely premature transfer from ICU, boarding in ward, and general ward admission control, along with their possible combinations, are modeled and their impact on managerial and health outcome measures are investigated. The main insight out of the study is that the general ward admission control policy outperforms the rest of ICU management policies under such crisis scenarios with regards to reducing total mortality, which is counter intuitive for hospital administrators as this policy is not very effective at alleviating the symptoms of the problem, namely high ED and ICU occupancy rates that are closely monitored by hospital management particularly in times of crisis. A multivariate sensitivity analysis on parameters with diverse range of values in the literature found the superiority of the general ward admission control to hold true in every scenario.

Cost of curative pediatric services in a public sector setting.

PubMed

Krishnan, Anand; Arora, Narendra K; Pandav, Chandrakant S; Kapoor, Suresh K

2005-08-01

To estimate the cost of ambulatory (out-patient) and in-patient pediatric health services for the year 1999 provided by All India Institute of Medical Sciences (AIIMS) at all the three levels-primary, secondary and tertiary level. The costing module developed by Children's Vaccines Initiative (CVI) was used. This rapid assessment tool focuses on collection of data at macro level by using key informants like doctors, nursing staff, accountant, store keeper, engineer etc. Cost per beneficiary was estimated separately for in-patients and out-patients and was calculated by dividing the total cost of the services by the number of beneficiaries for the year 1999. For the out-patient, the beneficiaries were the total out-patient attendees and for the in-patient, it was the total pediatric admissions multiplied by mean duration of stay in days. The cost per out-patient visit was INR.20.2 (US0.44 dollars@1US dollars=INR.46) at primary level, higher than INR14.5 (US0.31 dollars) at the secondary level, while at tertiary level it was INR 33.8 (US 0.73 dollars). At the primary and secondary level, non-physician cost was more than the physician cost, and for tertiary level, physician cost was much higher than the other costs. There were no in-patient services at primary level. The cost of in-patient services at secondary level was estimated as INR 419.30 (US 9.1 dollars) per patient per day with a bed occupancy rate of 60%. Two-fifths of the cost was due to nursing and other supportive staff and one fifth due to the doctor costs and overhead costs. The unit cost of INR 928 (US 20.2 dollars) per patient per day incurred at AIIMS with a bed occupancy rate of 100% was almost twice that of secondary level. In contrast to the secondary level, almost half the total costs at tertiary level was due to the doctors costs. Effective use of resources at lower level of care especially ambulatory care at primary level and inpatient care at secondary level can result in much higher savings for the system and also, the society. These would need to be appropriately strengthened.

Expanded Occupational Safety and Health Administration 300 log as metric for bariatric patient-handling staff injuries.

PubMed

Randall, Stephen B; Pories, Walter J; Pearson, Amy; Drake, Daniel J

2009-01-01

Mobilization of morbidly obese patients poses significant physical challenges to healthcare providers. The purpose of this study was to examine the staff injuries associated with the patient handling of the obese, to describe a process for identifying injuries associated with their mobilization, and to report on the need for safer bariatric patient handling. We performed our study at a 761-bed, level 1 trauma center affiliated with a U.S. medical school. The hospital's Occupational Safety and Health Administration (OSHA) 300 log was expanded to the "E-OSHA 300 log" to specifically identify injuries the staff attributed to bariatric patient handling. The 2007 E-OSHA 300 log was analyzed to identify and describe the frequency, severity, and nature of bariatric versus nonbariatric patient handling injuries. The analyses revealed that during 2007, although patients with a body mass index of > or =35 kg/m(2) constituted <10% of our patient population, 29.8% of staff injuries related to patient handling were linked to working with a bariatric patient. Bariatric patient handling accounted for 27.9% of all lost workdays and 37.2% of all restricted workdays associated with patient handling. Registered nurses and nursing assistants accounted for 80% of the injuries related to bariatric patient handling. Turning and repositioning the patient in bed accounted for 31% of the injuries incurred. The E-OSHA 300 log narratives revealed that staff injuries associated with obese and nonobese patient handling were usually performed using biomechanics and not equipment. Manual mobilization of morbidly obese patients increases the risk of caregiver injury. A tracking indicator on the OSHA 300 logs for staff injury linked to a bariatric patient would provide the ability to compare obese and nonobese patient handling injuries. The E-OSHA 300 log provides a method to identify the frequency, severity, and nature of caregiver injury during mobilization of the obese. Understanding the heightened risk of injury associated with manual bariatric patient handling should help healthcare institutions identify deficiencies in their current injury prevention program and focus resources more precisely for safer, systems-based bariatric patient-handling solutions. Effective patient handling systems should also reduce the aura of fear that might be present in some caregivers when mobilizing a bariatric patient.

Decision support for hospital bed management using adaptable individual length of stay estimations and shared resources

PubMed Central

2013-01-01

Background Elective patient admission and assignment planning is an important task of the strategic and operational management of a hospital and early on became a central topic of clinical operations research. The management of hospital beds is an important subtask. Various approaches have been proposed, involving the computation of efficient assignments with regard to the patients’ condition, the necessity of the treatment, and the patients’ preferences. However, these approaches are mostly based on static, unadaptable estimates of the length of stay and, thus, do not take into account the uncertainty of the patient’s recovery. Furthermore, the effect of aggregated bed capacities have not been investigated in this context. Computer supported bed management, combining an adaptable length of stay estimation with the treatment of shared resources (aggregated bed capacities) has not yet been sufficiently investigated. The aim of our work is: 1) to define a cost function for patient admission taking into account adaptable length of stay estimations and aggregated resources, 2) to define a mathematical program formally modeling the assignment problem and an architecture for decision support, 3) to investigate four algorithmic methodologies addressing the assignment problem and one base-line approach, and 4) to evaluate these methodologies w.r.t. cost outcome, performance, and dismissal ratio. Methods The expected free ward capacity is calculated based on individual length of stay estimates, introducing Bernoulli distributed random variables for the ward occupation states and approximating the probability densities. The assignment problem is represented as a binary integer program. Four strategies for solving the problem are applied and compared: an exact approach, using the mixed integer programming solver SCIP; and three heuristic strategies, namely the longest expected processing time, the shortest expected processing time, and random choice. A baseline approach serves to compare these optimization strategies with a simple model of the status quo. All the approaches are evaluated by a realistic discrete event simulation: the outcomes are the ratio of successful assignments and dismissals, the computation time, and the model’s cost factors. Results A discrete event simulation of 226,000 cases shows a reduction of the dismissal rate compared to the baseline by more than 30 percentage points (from a mean dismissal ratio of 74.7% to 40.06% comparing the status quo with the optimization strategies). Each of the optimization strategies leads to an improved assignment. The exact approach has only a marginal advantage over the heuristic strategies in the model’s cost factors (≤3%). Moreover,this marginal advantage was only achieved at the price of a computational time fifty times that of the heuristic models (an average computing time of 141 s using the exact method, vs. 2.6 s for the heuristic strategy). Conclusions In terms of its performance and the quality of its solution, the heuristic strategy RAND is the preferred method for bed assignment in the case of shared resources. Future research is needed to investigate whether an equally marked improvement can be achieved in a large scale clinical application study, ideally one comprising all the departments involved in admission and assignment planning. PMID:23289448

Decision support for hospital bed management using adaptable individual length of stay estimations and shared resources.

PubMed

Schmidt, Robert; Geisler, Sandra; Spreckelsen, Cord

2013-01-07

Elective patient admission and assignment planning is an important task of the strategic and operational management of a hospital and early on became a central topic of clinical operations research. The management of hospital beds is an important subtask. Various approaches have been proposed, involving the computation of efficient assignments with regard to the patients' condition, the necessity of the treatment, and the patients' preferences. However, these approaches are mostly based on static, unadaptable estimates of the length of stay and, thus, do not take into account the uncertainty of the patient's recovery. Furthermore, the effect of aggregated bed capacities have not been investigated in this context. Computer supported bed management, combining an adaptable length of stay estimation with the treatment of shared resources (aggregated bed capacities) has not yet been sufficiently investigated. The aim of our work is: 1) to define a cost function for patient admission taking into account adaptable length of stay estimations and aggregated resources, 2) to define a mathematical program formally modeling the assignment problem and an architecture for decision support, 3) to investigate four algorithmic methodologies addressing the assignment problem and one base-line approach, and 4) to evaluate these methodologies w.r.t. cost outcome, performance, and dismissal ratio. The expected free ward capacity is calculated based on individual length of stay estimates, introducing Bernoulli distributed random variables for the ward occupation states and approximating the probability densities. The assignment problem is represented as a binary integer program. Four strategies for solving the problem are applied and compared: an exact approach, using the mixed integer programming solver SCIP; and three heuristic strategies, namely the longest expected processing time, the shortest expected processing time, and random choice. A baseline approach serves to compare these optimization strategies with a simple model of the status quo. All the approaches are evaluated by a realistic discrete event simulation: the outcomes are the ratio of successful assignments and dismissals, the computation time, and the model's cost factors. A discrete event simulation of 226,000 cases shows a reduction of the dismissal rate compared to the baseline by more than 30 percentage points (from a mean dismissal ratio of 74.7% to 40.06% comparing the status quo with the optimization strategies). Each of the optimization strategies leads to an improved assignment. The exact approach has only a marginal advantage over the heuristic strategies in the model's cost factors (≤3%). Moreover,this marginal advantage was only achieved at the price of a computational time fifty times that of the heuristic models (an average computing time of 141 s using the exact method, vs. 2.6 s for the heuristic strategy). In terms of its performance and the quality of its solution, the heuristic strategy RAND is the preferred method for bed assignment in the case of shared resources. Future research is needed to investigate whether an equally marked improvement can be achieved in a large scale clinical application study, ideally one comprising all the departments involved in admission and assignment planning.

Using multiple bed load measurements: Toward the identification of bed dilation and contraction in gravel-bed rivers

NASA Astrophysics Data System (ADS)

Marquis, G. A.; Roy, A. G.

2012-02-01

This study examines bed load transport processes in a small gravel-bed river (Béard Creek, Québec) using three complementary methods: bed elevation changes between successive floods, bed activity surveys using tags inserted into the bed, and bed load transport rates from bed load traps. The analysis of 20 flood events capable of mobilizing bed material led to the identification of divergent results among the methods. In particular, bed elevation changes were not consistent with the bed activity surveys. In many cases, bed elevation changes were significant (1 to 2 times the D50) even if the bed surface had not been activated during the flood, leading to the identification of processes of bed dilation and contraction that occurred over 10% to 40% of the bed surface. These dynamics of the river bed prevent accurate derivation of bed load transport rates from topographic changes, especially for low magnitude floods. This paper discusses the mechanisms that could explain the dilation and contraction of particles within the bed and their implications in fluvial dynamics. Bed contraction seems to be the result of the winnowing of the fine sediments under very low gravel transport. Bed dilation seems to occur on patches of the bed at the threshold of motion where various processes such as fine sediment infiltration lead to the maintenance of a larger sediment framework volume. Both processes are also influenced by flood history and the initial local bed state and in turn may have a significant impact on sediment transport and morphological changes in gravel-bed rivers.

Forecasting Emergency Department Crowding: An External, Multi-Center Evaluation

PubMed Central

Hoot, Nathan R.; Epstein, Stephen K.; Allen, Todd L.; Jones, Spencer S.; Baumlin, Kevin M.; Chawla, Neal; Lee, Anna T.; Pines, Jesse M.; Klair, Amandeep K.; Gordon, Bradley D.; Flottemesch, Thomas J.; LeBlanc, Larry J.; Jones, Ian; Levin, Scott R.; Zhou, Chuan; Gadd, Cynthia S.; Aronsky, Dominik

2009-01-01

Objective To apply a previously described tool to forecast ED crowding at multiple institutions, and to assess its generalizability for predicting the near-future waiting count, occupancy level, and boarding count. Methods The ForecastED tool was validated using historical data from five institutions external to the development site. A sliding-window design separated the data for parameter estimation and forecast validation. Observations were sampled at consecutive 10-minute intervals during 12 months (n = 52,560) at four sites and 10 months (n = 44,064) at the fifth. Three outcome measures – the waiting count, occupancy level, and boarding count – were forecast 2, 4, 6, and 8 hours beyond each observation, and forecasts were compared to observed data at corresponding times. The reliability and calibration were measured following previously described methods. After linear calibration, the forecasting accuracy was measured using the median absolute error (MAE). Results The tool was successfully used for five different sites. Its forecasts were more reliable, better calibrated, and more accurate at 2 hours than at 8 hours. The reliability and calibration of the tool were similar between the original development site and external sites; the boarding count was an exception, which was less reliable at four out of five sites. Some variability in accuracy existed among institutions; when forecasting 4 hours into the future, the MAE of the waiting count ranged between 0.6 and 3.1 patients, the MAE of the occupancy level ranged between 9.0 and 14.5% of beds, and the MAE of the boarding count ranged between 0.9 and 2.7 patients. Conclusion The ForecastED tool generated potentially useful forecasts of input and throughput measures of ED crowding at five external sites, without modifying the underlying assumptions. Noting the limitation that this was not a real-time validation, ongoing research will focus on integrating the tool with ED information systems. PMID:19716629

Ability of bed bug-detecting canines to locate live bed bugs and viable bed bug eggs.

PubMed

Pfiester, Margie; Koehler, Philip G; Pereira, Roberto M

2008-08-01

The bed bug, Cimex lectularius L., like other bed bug species, is difficult to visually locate because it is cryptic. Detector dogs are useful for locating bed bugs because they use olfaction rather than vision. Dogs were trained to detect the bed bug (as few as one adult male or female) and viable bed bug eggs (five, collected 5-6 d after feeding) by using a modified food and verbal reward system. Their efficacy was tested with bed bugs and viable bed bug eggs placed in vented polyvinyl chloride containers. Dogs were able to discriminate bed bugs from Camponotus floridanus Buckley, Blattella germanica (L.), and Reticulitermes flavipes (Kollar), with a 97.5% positive indication rate (correct indication of bed bugs when present) and 0% false positives (incorrect indication of bed bugs when not present). Dogs also were able to discriminate live bed bugs and viable bed bug eggs from dead bed bugs, cast skins, and feces, with a 95% positive indication rate and a 3% false positive rate on bed bug feces. In a controlled experiment in hotel rooms, dogs were 98% accurate in locating live bed bugs. A pseudoscent prepared from pentane extraction of bed bugs was recognized by trained dogs as bed bug scent (100% indication). The pseudoscent could be used to facilitate detector dog training and quality assurance programs. If trained properly, dogs can be used effectively to locate live bed bugs and viable bed bug eggs.

How many fish? Comparison of two underwater visual sampling methods for monitoring fish communities

PubMed Central

Sini, Maria; Vatikiotis, Konstantinos; Katsoupis, Christos

2018-01-01

Background Underwater visual surveys (UVSs) for monitoring fish communities are preferred over fishing surveys in certain habitats, such as rocky or coral reefs and seagrass beds and are the standard monitoring tool in many cases, especially in protected areas. However, despite their wide application there are potential biases, mainly due to imperfect detectability and the behavioral responses of fish to the observers. Methods The performance of two methods of UVSs were compared to test whether they give similar results in terms of fish population density, occupancy, species richness, and community composition. Distance sampling (line transects) and plot sampling (strip transects) were conducted at 31 rocky reef sites in the Aegean Sea (Greece) using SCUBA diving. Results Line transects generated significantly higher values of occupancy, species richness, and total fish density compared to strip transects. For most species, density estimates differed significantly between the two sampling methods. For secretive species and species avoiding the observers, the line transect method yielded higher estimates, as it accounted for imperfect detectability and utilized a larger survey area compared to the strip transect method. On the other hand, large-scale spatial patterns of species composition were similar for both methods. Discussion Overall, both methods presented a number of advantages and limitations, which should be considered in survey design. Line transects appear to be more suitable for surveying secretive species, while strip transects should be preferred at high fish densities and for species of high mobility. PMID:29942703

Institutional Variation in Traumatic Brain Injury Acute Rehabilitation Practice.

PubMed

Seel, Ronald T; Barrett, Ryan S; Beaulieu, Cynthia L; Ryser, David K; Hammond, Flora M; Cullen, Nora; Garmoe, William; Sommerfeld, Teri; Corrigan, John D; Horn, Susan D

2015-08-01

To describe institutional variation in traumatic brain injury (TBI) inpatient rehabilitation program characteristics and evaluate to what extent patient factors and center effects explain how TBI inpatient rehabilitation services are delivered. Secondary analysis of a prospective, multicenter, cohort database. TBI inpatient rehabilitation programs. Patients with complicated mild, moderate, or severe TBI (N=2130). Not applicable. Mean minutes; number of treatment activities; use of groups in occupational therapy, physical therapy, speech therapy, therapeutic recreation, and psychology inpatient rehabilitation sessions; and weekly hours of treatment. A wide variation was observed between the 10 TBI programs, including census size, referral flow, payer mix, number of dedicated beds, clinician experience, and patient characteristics. At the centers with the longest weekday therapy sessions, the average session durations were 41.5 to 52.2 minutes. At centers with the shortest weekday sessions, the average session durations were approximately 30 minutes. The centers with the highest mean total weekday hours of occupational, physical, and speech therapies delivered twice as much therapy as the lowest center. Ordinary least-squares regression modeling found that center effects explained substantially more variance than patient factors for duration of therapy sessions, number of activities administered per session, use of group therapy, and amount of psychological services provided. This study provides preliminary evidence that there is significant institutional variation in rehabilitation practice and that center effects play a stronger role than patient factors in determining how TBI inpatient rehabilitation is delivered. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Acoustic bed velocity and bed load dynamics in a large sand bed river

USGS Publications Warehouse

Gaeuman, D.; Jacobson, R.B.

2006-01-01

Development of a practical technology for rapid quantification of bed load transport in large rivers would represent a revolutionary advance for sediment monitoring and the investigation of fluvial dynamics. Measurement of bed load motion with acoustic Doppler current profiles (ADCPs) has emerged as a promising approach for evaluating bed load transport. However, a better understanding of how ADCP data relate to conditions near the stream bed is necessary to make the method practical for quantitative applications. In this paper, we discuss the response of ADCP bed velocity measurements, defined as the near-bed sediment velocity detected by the instrument's bottom-tracking feature, to changing sediment-transporting conditions in the lower Missouri River. Bed velocity represents a weighted average of backscatter from moving bed load particles and spectral reflections from the immobile bed. The ratio of bed velocity to mean bed load particle velocity depends on the concentration of the particles moving in the bed load layer, the bed load layer thickness, and the backscatter strength from a unit area of moving particles relative to the echo strength from a unit area of unobstructed bed. A model based on existing bed load transport theory predicted measured bed velocities from hydraulic and grain size measurements with reasonable success. Bed velocities become more variable and increase more rapidly with shear stress when the transport stage, defined as the ratio of skin friction to the critical shear stress for particle entrainment, exceeds a threshold of about 17. This transition in bed velocity response appears to be associated with the appearance of longer, flatter bed forms at high transport stages.

Endotoxin, coliform, and dust levels in various types of rodent bedding.

PubMed

Whiteside, Tanya E; Thigpen, Julius E; Kissling, Grace E; Grant, Mary G; Forsythe, Diane

2010-03-01

Endotoxins in grain dust, household dust, and animal bedding may induce respiratory symptoms in rodents and humans. We assayed the endotoxin, coliform, and dust levels in 20 types of rodent bedding. Endotoxin concentrations were measured by using a commercial test kit, coliform counts were determined by using conventional microbiologic procedures, and dust content was evaluated by using a rotating-tapping shaker. Paper bedding types contained significantly less endotoxin than did other bedding types; the highest levels of endotoxin were detected in hardwood and corncob beddings. The range of endotoxin content for each bedding type was: corncob bedding, 1913 to 4504 endotoxin units per gram (EU/g); hardwood bedding, 3121 to 5401 EU/g; corncob-paper mixed bedding, 1586 to 2416 EU/g; and paper bedding, less than 5 to 105 EU/g. Coliform counts varied from less than 10 to 7591 cfu/g in corncob beddings, 90 to 4010 cfu/g in corncob-paper mixed beddings, less than 10 to 137 cfu/g in hardwood beddings, and less than 10 cfu/g in paper beddings. Average dust content was less than 0.15% in all commercial bedding types. We conclude that paper bedding is the optimal bedding type for conducting LPS inhalation studies and that rodent bedding containing high levels of endotoxin may alter the results of respiratory and immunologic studies in rodents.

Endotoxin, Coliform, and Dust Levels in Various Types of Rodent Bedding

PubMed Central

Whiteside, Tanya E; Thigpen, Julius E; Kissling, Grace E; Grant, Mary G; Forsythe, Diane B

2010-01-01

Endotoxins in grain dust, household dust, and animal bedding may induce respiratory symptoms in rodents and humans. We assayed the endotoxin, coliform, and dust levels in 20 types of rodent bedding. Endotoxin concentrations were measured by using a commercial test kit, coliform counts were determined by using conventional microbiologic procedures, and dust content was evaluated by using a rotating–tapping shaker. Paper bedding types contained significantly less endotoxin than did other bedding types; the highest levels of endotoxin were detected in hardwood and corncob beddings. The range of endotoxin content for each bedding type was: corncob bedding, 1913 to 4504 endotoxin units per gram (EU/g); hardwood bedding, 3121 to 5401 EU/g; corncob–paper mixed bedding, 1586 to 2416 EU/g; and paper bedding, less than 5 to 105 EU/g. Coliform counts varied from less than 10 to 7591 cfu/g in corncob beddings, 90 to 4010 cfu/g in corncob–paper mixed beddings, less than 10 to 137 cfu/g in hardwood beddings, and less than 10 cfu/g in paper beddings. Average dust content was less than 0.15% in all commercial bedding types. We conclude that paper bedding is the optimal bedding type for conducting LPS inhalation studies and that rodent bedding containing high levels of endotoxin may alter the results of respiratory and immunologic studies in rodents. PMID:20353693

Field assessment of alternative bed-load transport estimators

USGS Publications Warehouse

Gaeuman, G.; Jacobson, R.B.

2007-01-01

Measurement of near-bed sediment velocities with acoustic Doppler current profilers (ADCPs) is an emerging approach for quantifying bed-load sediment fluxes in rivers. Previous investigations of the technique have relied on conventional physical bed-load sampling to provide reference transport information with which to validate the ADCP measurements. However, physical samples are subject to substantial errors, especially under field conditions in which surrogate methods are most needed. Comparisons between ADCP bed velocity measurements with bed-load transport rates estimated from bed-form migration rates in the lower Missouri River show a strong correlation between the two surrogate measures over a wide range of mild to moderately intense sediment transporting conditions. The correlation between the ADCP measurements and physical bed-load samples is comparatively poor, suggesting that physical bed-load sampling is ineffective for ground-truthing alternative techniques in large sand-bed rivers. Bed velocities measured in this study became more variable with increasing bed-form wavelength at higher shear stresses. Under these conditions, bed-form dimensions greatly exceed the region of the bed ensonified by the ADCP, and the magnitude of the acoustic measurements depends on instrument location with respect to bed-form crests and troughs. Alternative algorithms for estimating bed-load transport from paired longitudinal profiles of bed topography were evaluated. An algorithm based on the routing of local erosion and deposition volumes that eliminates the need to identify individual bed forms was found to give results similar to those of more conventional dune-tracking methods. This method is particularly useful in cases where complex bed-form morphology makes delineation of individual bed forms difficult. ?? 2007 ASCE.

Design of a model to predict surge capacity bottlenecks for burn mass casualties at a large academic medical center.

PubMed

Abir, Mahshid; Davis, Matthew M; Sankar, Pratap; Wong, Andrew C; Wang, Stewart C

2013-02-01

To design and test a model to predict surge capacity bottlenecks at a large academic medical center in response to a mass-casualty incident (MCI) involving multiple burn victims. Using the simulation software ProModel, a model of patient flow and anticipated resource use, according to principles of disaster management, was developed based upon historical data from the University Hospital of the University of Michigan Health System. Model inputs included: (a) age and weight distribution for casualties, and distribution of size and depth of burns; (b) rate of arrival of casualties to the hospital, and triage to ward or critical care settings; (c) eligibility for early discharge of non-MCI inpatients at time of MCI; (d) baseline occupancy of intensive care unit (ICU), surgical step-down, and ward; (e) staff availability-number of physicians, nurses, and respiratory therapists, and the expected ratio of each group to patients; (f) floor and operating room resources-anticipating the need for mechanical ventilators, burn care and surgical resources, blood products, and intravenous fluids; (g) average hospital length of stay and mortality rate for patients with inhalation injury and different size burns; and (h) average number of times that different size burns undergo surgery. Key model outputs include time to bottleneck for each limiting resource and average waiting time to hospital bed availability. Given base-case model assumptions (including 100 mass casualties with an inter-arrival rate to the hospital of one patient every three minutes), hospital utilization is constrained within the first 120 minutes to 21 casualties, due to the limited number of beds. The first bottleneck is attributable to exhausting critical care beds, followed by floor beds. Given this limitation in number of patients, the temporal order of the ensuing bottlenecks is as follows: Lactated Ringer's solution (4 h), silver sulfadiazine/Silvadene (6 h), albumin (48 h), thrombin topical (72 h), type AB packed red blood cells (76 h), silver dressing/Acticoat (100 h), bismuth tribromophenate/Xeroform (102 h), and gauze bandage rolls/Kerlix (168 h). The following items do not precipitate a bottleneck: ventilators, topical epinephrine, staplers, foams, antimicrobial non-adherent dressing/Telfa types A, B, or O blood. Nurse, respiratory therapist, and physician staffing does not induce bottlenecks. This model, and similar models for non-burn-related MCIs, can serve as a real-time estimation and management tool for hospital capacity in the setting of MCIs, and can inform supply decision support for disaster management.

The optimal design of the bed structure of bedstand based on ABAQUS

NASA Astrophysics Data System (ADS)

Yang, Xudong; Dong, Yu; Ge, Qingkuan; Wang, Song

2017-12-01

Hydraulic transmission bedstand is one kind of the most commonly used in engineering machinery companies, and the bed structure is the most important part. Based on the original hydraulic transmission bedstand bed structure and the CAE technology, the original bed structure is improved. The optimized bed greatly saves the material of the production bed and improves the seismic performance of the bed. In the end, the performance of the optimized bed was compared with the original bed.

Particle size variations between bed load and bed material in natural gravel bed channels

Treesearch

Thomas E. Lisle

1995-01-01

Abstract - Particle sizes of bed load and bed material that represent materials transported and stored over a period of years are used to investigate selective transport in 13 previously sampled, natural gravel bed channels. The ratio (D*) of median particle size of bed material to the transport- and frequency-weighted mean of median bed load size decreases to unity...

Resources for controlling tuberculosis in Malawi.

PubMed Central

Harries, A. D.; Kwanjana, J. H.; Hargreaves, N. J.; Van Gorkom, J.; Salaniponi, F. M.

2001-01-01

OBJECTIVE: To document resources for controlling tuberculosis (TB) in Malawi. METHODS: We performed a countrywide study of all 43 hospitals (3 central, 22 district and 18 mission) which register and treat patients with TB. To collect data for 1998 on the TB-related workload, diagnostic facilities, programme staff and treatment facilities, we used laboratory, radiographic and TB registers, conducted interviews and visited hospital facilities. FINDINGS: The data show that in 1998, 88,257 TB suspects/patients contributed approximately 230,000 sputum specimens for smear microscopy, 55,667 chest X-rays were performed and 23,285 patients were registered for TB treatment. There were 86 trained laboratory personnel, 44 radiographers and 83 TB programme staff. Of these, about 40% had periods of illness during 1998. Approximately 20% of the microscopes and X-ray machines were broken. Some 16% of the hospital beds were designated for TB patients in special wards, but even so, the occupancy of beds in TB wards exceeded 100%. Although stocks of anti-TB drugs were good, there was a shortage of full-time TB ward nurses and 50% of district hospitals conducted no TB ward rounds. In general, there was a shortage of facilities for managing associated HIV-related disease; central hospitals, in particular, were underresourced. CONCLUSION: Malawi needs better planning to utilize its manpower and should consider cross-training hospital personnel. The equipment needs regular maintenance, and more attention should be paid to HIV-related illness. The policies of decentralizing resources to the periphery and increasing diagnostic and case-holding resources for central hospitals should be continued. PMID:11357212

Practical aspects of change management at the Obstetrics and Gynecology Clinic at the University Hospital of Medical Sciences in Poznań, Poland.

PubMed

Sobkowski, Maciej; Opala, Tomasz

2014-01-01

Recent changes to the Polish healthcare system have forced healthcare managers and administrators to implement modern instruments for strategic and operations management. The main aim of the study was to analyze the effect of managerial decisions in the area of human resources, resulting from the adopted restructuring program, on the economic situation of the OGCH, PUMS. The research material comprised of secondary sources on finance, accounting and human resources data: financial statements, analysis of costs incurred by individual hospital departments, reports on the implementation of NHF contracts for providing health services and on hospital workforce at the time of the study, as well as the results of patient satisfaction survey at the OGCH, PUMS. After implementation of the restructuring program all clinics apart from one - Surgical Gynecology Clinic - reached better beds occupancy rates in 2012 as compared to 2009, as well as significantly improved profit/per hospital bed. Over the course of three years, since the launch of the hospital restructuring program, a significant (20%) increase in the revenues from selling healthcare services and a simultaneous decrease (2%) of the operating cost was observed. Inclusion of department heads into the decision making processes of managerial accounting seems to be necessary to improve the overall financial condition of a hospital. However, it requires a more flexible hospital structure, what can be achieved by implementing a divisional organizational structure, which grants individual organizational units a certain autonomy in the process of making medical-financial decisions.

Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster.

PubMed

Sprung, Charles L; Zimmerman, Janice L; Christian, Michael D; Joynt, Gavin M; Hick, John L; Taylor, Bruce; Richards, Guy A; Sandrock, Christian; Cohen, Robert; Adini, Bruria

2010-03-01

To provide recommendations and standard operating procedures for intensive care units and hospital preparedness for an influenza pandemic. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics. Key recommendations include: Hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas. Hospitals should have appropriate beds and monitors for these expansion areas. Establish a management system with control groups at facility, local, regional and/or national levels to exercise authority over resources. Establish a system of communication, coordination and collaboration between the ICU and key interface departments. A plan to access, coordinate and increase labor resources is required with a central inventory of all clinical and non-clinical staff. Delegate duties not within the usual scope of workers' practice. Ensure that adequate essential medical equipment, pharmaceuticals and supplies are available. Protect patients and staff with infection control practices and supporting occupational health policies. Maintain staff confidence with reassurance plans for legal protection and assistance. Have objective, ethical, transparent triage criteria that are applied equitably and publically disclosed. ICU triage of patients should be based on the likelihood for patients to benefit most or a 'first come, first served' basis. Develop protocols for safe performance of high-risk procedures. Train and educate staff. Mortality, although inevitable during a severe influenza outbreak or disaster, can be reduced by adequate preparation.

Solving the negative impact of congestion in the postanesthesia care unit: a cost of opportunity analysis.

PubMed

Ruiz-Patiño, Alejandro; Acosta-Ospina, Laura Elena; Rueda, Juan-David

2017-04-01

Congestion in the postanesthesia care unit (PACU) leads to the formation of waiting queues for patients being transferred after surgery, negatively affecting hospital resources. As patients recover in the operating room, incoming surgeries are delayed. The purpose of this study was to establish the impact of this phenomenon in multiple settings. An operational mathematical study based on the queuing theory was performed. Average queue length, average queue waiting time, and daily queue waiting time were evaluated. Calculations were based on the mean patient daily flow, PACU length of stay, occupation, and current number of beds. Data was prospectively collected during a period of 2 months, and the entry and exit time was recorded for each patient taken to the PACU. Data was imputed in a computational model made with MS Excel. To account for data uncertainty, deterministic and probabilistic sensitivity analyses for all dependent variables were performed. With a mean patient daily flow of 40.3 and an average PACU length of stay of 4 hours, average total lost surgical opportunity time was estimated at 2.36 hours (95% CI: 0.36-4.74 hours). Cost of opportunity was calculated at $1592 per lost hour. Sensitivity analysis showed that an increase of two beds is required to solve the queue formation. When congestion has a negative impact on cost of opportunity in the surgical setting, queuing analysis grants definitive actions to solve the problem, improving quality of service and resource utilization. Copyright © 2016 Elsevier Inc. All rights reserved.

The cost of ignoring acute cholecystectomy.

PubMed

Garner, J P; Sood, S K; Robinson, J; Barber, W; Ravi, K

2009-01-01

Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over 40,000 pounds. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.

Determinants of Allergen Concentrations in Apartments of Asthmatic Children Living in Public Housing

PubMed Central

Levy, Jonathan I.; Rogers, Christine A.; Burge, Harriet A.; Spengler, John D.

2007-01-01

There is growing evidence linking poor housing conditions and respiratory diseases, including asthma. The association between housing conditions and asthma in the inner city has been attributed in part to cockroach and mouse infestation and the resulting allergen exposures. Multiple social and behavioral factors can influence environmental exposures and health conditions, necessitating a thorough examination of such factors. As part of the Healthy Public Housing Initiative, we evaluated the association between physical and household characteristics and pest-related allergen levels in three public housing developments in Boston, MA. We detected cockroach allergens (Bla g 1 and Bla g 2) in bedroom air, bed, and especially high concentrations in kitchen samples. In multivariate Tobit regressions controlling for development and season, clutter and lack of cleanliness in the apartment were associated with a tenfold increase in Bla g 1 concentration in the air, a sevenfold increase in Bla g 1 and an eightfold increase in Bla g 2 concentrations in the bed, and an 11-fold increase in Bla g 2 in the kitchen (p<0.05 for all). Holes in the wall/ceiling were associated with a six- to 11-fold increase in kitchen cockroach allergen concentrations (p<0.05). Occupancy in an apartment unit of 2 years or more was also associated with increased cockroach allergen concentrations. In contrast, there were low concentrations of mouse urinary protein in this population. In conclusion, these results suggest that interventions in these homes should focus on reducing cockroach allergen concentrations and that building-wide interventions should be supplemented with targeted efforts focused on high-risk units. PMID:17216349

Cost-Analysis of Seven Nosocomial Outbreaks in an Academic Hospital.

PubMed

Dik, Jan-Willem H; Dinkelacker, Ariane G; Vemer, Pepijn; Lo-Ten-Foe, Jerome R; Lokate, Mariëtte; Sinha, Bhanu; Friedrich, Alex W; Postma, Maarten J

2016-01-01

Nosocomial outbreaks, especially with (multi-)resistant microorganisms, are a major problem for health care institutions. They can cause morbidity and mortality for patients and controlling these costs substantial amounts of funds and resources. However, how much is unclear. This study sets out to provide a comparable overview of the costs of multiple outbreaks in a single academic hospital in the Netherlands. Based on interviews with the involved staff, multiple databases and stored records from the Infection Prevention Division all actions undertaken, extra staff employment, use of resources, bed-occupancy rates, and other miscellaneous cost drivers during different outbreaks were scored and quantified into Euros. This led to total costs per outbreak and an estimated average cost per positive patient per outbreak day. Seven outbreaks that occurred between 2012 and 2014 in the hospital were evaluated. Total costs for the hospital ranged between €10,778 and €356,754. Costs per positive patient per outbreak day, ranged between €10 and €1,369 (95% CI: €49-€1,042), with a mean of €546 and a median of €519. Majority of the costs (50%) were made because of closed beds. This analysis is the first to give a comparable overview of various outbreaks, caused by different microorganisms, in the same hospital and all analyzed with the same method. It shows a large variation within the average costs due to different factors (e.g. closure of wards, type of ward). All outbreaks however cost considerable amounts of efforts and money (up to €356,754), including missed revenue and control measures.

Assessing the management of healthcare waste in Hawassa city, Ethiopia.

PubMed

Israel Deneke Haylamicheal; Mohamed Aqiel Dalvie; Biruck Desalegn Yirsaw; Hanibale Atsbeha Zegeye

2011-08-01

Inadequate management of healthcare waste is a serious concern in many developing countries due to the risks posed to human health and the environment. This study aimed to evaluate healthcare waste management in Hawassa city, Ethiopia. The study was conducted in nine healthcare facilities (HCFs) including hospitals (four), health centres (two) and higher clinics (three) in two phases, first to assess the waste management aspect and second to determine daily waste generation rate. The result showed that the median quantity of waste generated at the facilities was 3.46 kg bed(-1) day(-1) (range: 1.48-8.19 kg bed(-1) day(-1)). The quantity of waste per day generated at a HCF increased as occupancy increased (p < 0.001). The percentage hazardous waste generated at government HCFs was more than at private HCFs (p < 0.05). The proportion of hazardous waste (20-63.1%) generated at the different HCFs was much higher than the WHO recommendation (10-25%). There was no waste segregation in most HCFs and only one used a complete color coding system. Solid waste and wastewater were stored, transported, treated and disposed inappropriately at all HCFs. Needle-stick injuries were prevalent in 25-100% of waste handlers employed at these HCFs. Additionally, low levels of training and awareness of waste legislation was prevalent amongst staff. The study showed that management of healthcare waste at HCFs to be poor. Waste management practices need to be improved through improved legislation and enforcement, and training of staff in the healthcare facilities in Hawassa.

Marginal bed load transport in a gravel bed stream, Sagehen Creek, California

USGS Publications Warehouse

Andrews, E.D.

1994-01-01

Marginal bed load transport describes the condition when relatively few bed particles are moving at any time. Bed particles resting in the shallowest bed pockets will move when the dimensionless shear stress т* exceeds a value of about 0.020. As т* increases, the number of bed particles moving increases. Significant motion of bed particles, i.e., when a substantial fraction of the bed particles are moving, occurs when т* exceeds a value of about 0.060. Thus marginal bed load transport occurs over the domain 0.020 < т* < 0.060. Marginal bed load transport rates and associated hydraulic characteristics of Sagehen Creek, a small mountain gravel bed stream, were measured on 55 days at discharges ranging from slightly less than one half of the bank-full discharge to more than 4 times the bank-full discharge. Dimensionless shear stress varied from 0.032 to 0.042, and bed particles as large as the 80th percentile of the bed surface were transported. The relation between reference dimensionless shear stress and relative particle protrusion for Sagehen Creek was determined by varying т*ri to obtain the best fit of the Parker bed load function to the measured transport rates. During the period of record (water years 1954–1991), the mean annual quantity of bed load transported past the Sagehen Creek gage was 24.7 tons. Forty-seven percent of all bed load transported during the 38 years of record occurred in just 6 years. During 10 of the 38 years of record, essentially no bed load was transported. The median diameter of bed load was 26 mm, compared to 58 mm in the surface bed material.

Effect of regional trauma centralization on volume, injury severity and outcomes of injured patients admitted to trauma centres.

PubMed

Metcalfe, D; Bouamra, O; Parsons, N R; Aletrari, M O; Lecky, F E; Costa, M L

2014-07-01

Centralization of complex healthcare services into specialist high-volume centres is believed to improve outcomes. For injured patients, few studies have evaluated the centralization of major trauma services. The aim of this study was to evaluate how a regional trauma network affected trends in admissions, case mix, and outcomes of injured patients. A retrospective before-after study was undertaken of severely injured patients attending four hospitals that became major trauma centres (MTCs) in March 2012. Consecutive patients with major trauma were identified from a national registry and divided into two groups according to injury before or after the launch of a new trauma network. The two cohorts were compared for differences in case mix, demand on hospital resources, and outcomes. Patient volume increased from 442 to 1326 (200 per cent), operations from 349 to 1231 (253 per cent), critical care bed-days from 1100 to 3704 (237 per cent), and total hospital bed-days from 7910 to 22,772 (188 per cent). Patient age increased on MTC designation from 45.0  years before March 2012 to 48.2 years afterwards (P = 0.021), as did the proportion of penetrating injuries (1.8 versus 4.1 per cent; P = 0.025). Injury severity fell as measured by median Injury Severity Score (16 versus 14) and Revised Trauma Score (4.1 versus 7.8). Fewer patients required secondary transfer to a MTC from peripheral hospitals (19.9 versus 16.1 per cent; P = 0.100). There were no significant differences in total duration of hospital stay, critical care requirements or mortality. However, there was a significant increase, from 55.5 to 62.3 per cent (P < 0.001), in the proportion of patients coded as having a 'good recovery' at discharge after institution of the trauma network. MTC designation leads to an increased case volume with considerable implications for operating theatre capacity and bed occupancy. Although no mortality benefit was demonstrated within 6 months of establishing this trauma network, early detectable advantages included improved functional outcome at discharge. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Channel Patterns as the Result of Self-Organization Within the Flow-Sediment-Vegetation System

NASA Astrophysics Data System (ADS)

Tal, M.; Paola, C.

2003-12-01

The familiar patterns of braided and meandering rivers can be thought of as the result of self-organization within a "three-phase" system comprising fluid, sediment, and vegetation. Interactions between these three components are also largely responsible for the organization of river systems into separate and distinguishable channels and floodplains. Key elements of the self organization include the space and time characteristics of seed dispersal and plant growth as well as the statistics of occupation, abandonment, and reworking of the bed by the flow. Seeds are transported and dispersed readily by wind and water and opportunistically colonize areas of the channel that are abandoned or exposed at low flows. Vegetation increases bank stability through root reinforcement of the sediment and increases the threshold shear stress needed for erosion. In addition, vegetation offers resistance to the flow by increasing the drag and reducing the velocity, thus decreasing the stream power available for erosion and transport. Vegetation that is not removed while young will become stronger and increasingly resistant to erosion and removal by the flow. Thus a key organizing parameter in the flow-sediment-vegetation system is the time scale for establishment of the vegetation relative to a characteristic channel or bed mobility time. Experiments at the St. Anthony Falls Laboratory demonstrate how repeated cycling of vegetation seeding and water discharge changes an unvegetated braided channel morphology: the flow is gradually corralled into a single sinuous channel that largely tracks the thread of maximum velocity in the original braided network. The experiments are carried out in a large unconsolidated sand bed flume in which alfalfa sprouts are used to simulate riparian vegetation and offer the only form of cohesion in the system. An initial braided pattern is allowed to evolve freely in conjunction with alternating high and low discharges and repeated seedings. As the vegetation density and age increase with time, smaller and weaker channels are choked off leaving a single relatively narrow channel with a sinuous thalweg. This channel develops its own internal bar forms with smaller length scales than the original braid bars.

A Comparison of Inpatient Adult Psychiatric Services in Italy and Canada.

PubMed

Guaiana, Giuseppe; O'Reilly, Richard; Grassi, Luigi

2018-05-03

We examine the possibility the Organisation for Economic Co-operation and Development (OECD) bed count for Italy may be an underestimation of the actual beds available. We compared bedded services for mental disorders in two regions in Italy and Canada respectively. We found out that if we consider acute psychiatric beds only, the district of Ferrara has 30 beds (8.5 per 100,000) and the Middlesex and Elgin Counties have 89 beds (16.3 beds for 100,000). However, if we include the rehabilitation beds (that are located within a hospital setting in Ontario and in a residential community setting in Ferrara), we find that the district of Ferrara has 95 beds (27.0 per 100,000) and the Middlesex and Elgin Counties have 176 beds (32.3 per 100,000). As a result, the 10/100,000 beds rate for Italy reported by the OECD is an underestimate compared to figures reported for most other countries, as the beds included are hospital beds only.

Detection of patient's bed statuses in 3D using a Microsoft Kinect.

PubMed

Li, Yun; Berkowitz, Lyle; Noskin, Gary; Mehrotra, Sanjay

2014-01-01

Patients spend the vast majority of their hospital stay in an unmonitored bed where various mobility factors can impact patient safety and quality. Specifically, bed positioning and a patient's related mobility in that bed can have a profound impact on risks such as pneumonias, blood clots, bed ulcers and falls. This issue has been exacerbated as the nurse-per-bed (NPB) ratio has decreased in recent years. To help assess these risks, it is critical to monitor a hospital bed's positional status (BPS). Two bed positional statuses, bed height (BH) and bed chair angle (BCA), are of critical interests for bed monitoring. In this paper, we develop a bed positional status detection system using a single Microsoft Kinect. Experimental results show that we are able to achieve 94.5% and 93.0% overall accuracy of the estimated BCA and BH in a simulated patient's room environment.

Effects of a physiotherapy and occupational therapy intervention on mobility and activity in care home residents: a cluster randomised controlled trial.

PubMed

Sackley, Catherine M; van den Berg, Maayken E; Lett, Karen; Patel, Smitaa; Hollands, Kristen; Wright, Christine C; Hoppitt, Thomas J

2009-09-01

To compare the clinical effectiveness of a programme of physiotherapy and occupational therapy with standard care in care home residents who have mobility limitations and are dependent in performing activities of daily living. Cluster randomised controlled trial, with random allocation at the level of care home. Care homes within the NHS South Birmingham primary care trust and the NHS Birmingham East and North primary care trust that had more than five beds and provided for people in the care categories "physical disability" and "older people." Care home residents with mobility limitations, limitations in activities of daily living (as screened by the Barthel index), and not receiving end of life care were eligible to take part in the study. A targeted three month occupational therapy and physiotherapy programme. Scores on the Barthel index and the Rivermead mobility index. 24 of 77 nursing and residential homes that catered for residents with mobility limitations and dependency for activities of daily living were selected for study: 12 were randomly allocated to the intervention arm (128 residents, mean age 86 years) and 12 to the control arm (121 residents, mean age 84 years). Participants were evaluated by independent assessors blind to study arm allocation before randomisation (0 months), three months after randomisation (at the end of the treatment period for patients who received the intervention), and again at six months after randomisation. After adjusting for home effect and baseline characteristics, no significant differences were found in mean Barthel index scores at six months post-randomisation between treatment arms (mean effect 0.08, 95% confidence interval -1.14 to 1.30; P=0.90), across assessments (-0.01, -0.63 to 0.60; P=0.96), or in the interaction between assessment and intervention (0.42, -0.48 to 1.32; P=0.36). Similarly, no significant differences were found in the mean Rivermead mobility index scores between treatment arms (0.62, -0.51 to 1.76; P=0.28), across assessments (-0.15, -0.65 to 0.35; P=0.55), or interaction (0.71, -0.02 to 1.44; P=0.06). The three month occupational therapy and physiotherapy programme had no significant effect on mobility and independence. On the other hand, the variation in residents' functional ability, the prevalence of cognitive impairment, and the prevalence of depression were considerably higher in this sample than expected on the basis of previous work. Further research to clarify the efficacy of occupational therapy and physiotherapy is required if access to therapy services is to be recommended in this population. ISRCTN79859980.

Utility of Recycled Bedding for Laboratory Rodents

PubMed Central

Miyamoto, Toru; Li, Zhixia; Kibushi, Tomomi; Okano, Shinya; Yamasaki, Nakamichi; Kasai, Noriyuki

2009-01-01

Animal facilities generate a large amount of used bedding containing excrement as medical waste. We developed a recycling system for used bedding that involves soft hydrothermal processing. In this study, we examined the effects of bedding type on growth, hematologic and serum biochemical values, and organ weights of female and male mice reared on either recycled or fresh bedding from 3 to 33 wk of age. Neither growth nor physiology differed between mice housed on recycled bedding compared with fresh bedding. When 14-wk-old mice were bred, litter size and total number of weaned pups showed no significant differences between animals raised on recycled or fresh bedding. Because bedding type influences the environment within cages and animal rooms, we evaluated particulate and ammonia data from cages and animal rooms. Values were significantly lower from cages and rooms that used recycled bedding than from those using fresh bedding, thus indicating that recycled bedding has the potential to improve the environment within both cages and animal rooms. Overall, this study revealed that recycled bedding is an excellent material for use in housing laboratory rodents. Specifically, recycled bedding may reduce medical waste and maintain healthy environments within cages and animal rooms. PMID:19653951

Tetrapod tracks in Permo-Triassic eolian beds of southern Brazil (Paraná Basin).

PubMed

Francischini, Heitor; Dentzien-Dias, Paula; Lucas, Spencer G; Schultz, Cesar L

2018-01-01

Tetrapod tracks in eolianites are widespread in the fossil record since the late Paleozoic. Among these ichnofaunas, the ichnogenus Chelichnus is the most representative of the Permian tetrapod ichnological record of eolian deposits of Europe, North America and South America, where the Chelichnus Ichnofacies often occurs. In this contribution, we describe five sets of tracks (one of which is preserved in cross-section), representing the first occurrence of Dicynodontipus and Chelichnus in the "Pirambóia Formation" of southern Brazil. This unit represents a humid desert in southwestern Pangea and its lower and upper contacts lead us to consider its age as Lopingian-Induan. The five sets of tracks studied were compared with several ichnotaxa and body fossils with appendicular elements preserved, allowing us to attribute these tracks to dicynodonts and other indeterminate therapsids. Even though the "Pirambóia Formation" track record is sparse and sub-optimally preserved, it is an important key to better understand the occupation of arid environments by tetrapods across the Permo-Triassic boundary.

Managing resource capacity using hybrid simulation

NASA Astrophysics Data System (ADS)

Ahmad, Norazura; Ghani, Noraida Abdul; Kamil, Anton Abdulbasah; Tahar, Razman Mat

2014-12-01

Due to the diversity of patient flows and interdependency of the emergency department (ED) with other units in hospital, the use of analytical models seems not practical for ED modeling. One effective approach to study the dynamic complexity of ED problems is by developing a computer simulation model that could be used to understand the structure and behavior of the system. Attempts to build a holistic model using DES only will be too complex while if only using SD will lack the detailed characteristics of the system. This paper discusses the combination of DES and SD in order to get a better representation of the actual system than using either modeling paradigm solely. The model is developed using AnyLogic software that will enable us to study patient flows and the complex interactions among hospital resources for ED operations. Results from the model show that patients' length of stay is influenced by laboratories turnaround time, bed occupancy rate and ward admission rate.

Point-of-care: being a pilot site. Interview by Bill W. Childs.

PubMed

Bills, J

1988-11-01

Scripps Memorial Hospital in Chula Vista, CA, a 159-bed acute care facility, opened in 1964. The facility was acquired in 1986 by the Scripps Memorial Hospitals family which has acute care facilities in La Jolla, Encinitas and Chula Vista, CA. Prior to 1986, the hospital was in severe financial difficulty and was very near to closing its doors. With the help of an excellent group of employees and medical staff, Scripps Memorial Hospital--Chula Vista has made significant changes in all aspects of the operation. The CliniCom pilot program is only one of many changes the hospital has introduced in its effort to continue its role as a major healthcare provider in the South Bay area of San Diego. Scripps Memorial Hospital--Chula Vista is a very active facility with 85 percent occupancy, 32,000 emergency visits and 4,200 deliveries a year. The hospital is planning an expansion program to meet the current and future needs of the community.

The Balanced Budget Act (1997) and the supplyof nursing home subacute care.

PubMed

Qaseem, Amir; Weech-Maldonado, Robert; Mkanta, William

2007-01-01

This article examines the impact of the Medicare prospective payment system (PPS) on the supply of subacute care services by nursing homes. A quasi-experimental interrupted time-series design using Heckman's two-stage regression model is employed to test for changes before and after the implementation of Medicare PPS. Our findings suggest that the change in Medicare reimbursement from cost-based to PPS under the Balanced Budget Act of 1997 resulted in a decrease of 1.7 percent in the supply of subacute care beds by nursing homes. However, this was a one-time, short-term negative effect. The supply of nursing home subacute care remained stable in the long-term. Other environmental factors, such as Medicare hospital discharges, hospital-based subacute care, Medicare managed care penetration, availability of home health, and per capita income were associated with nursing home subacute care supply. Organizational-level factors, such as occupancy rate, RN staff mix, and Medicare payer mix were also predictors of nursing home subacute care supply.

Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

PubMed

Bonaiuti, Donatella; Sioli, Paolo; Fumagalli, Lorenzo; Beghi, Ettore; Agostoni, Elio

2011-08-01

Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.

Using a Radiofrequency Identification System for Improving the Patient Discharge Process: A Simulation Study.

PubMed

Shim, Sung J; Kumar, Arun; Jiao, Roger

2016-01-01

A hospital is considering deploying a radiofrequency identification (RFID) system and setting up a new "discharge lounge" to improve the patient discharge process. This study uses computer simulation to model and compare the current process and the new process, and it assesses the impact of the RFID system and the discharge lounge on the process in terms of resource utilization and time taken in the process. The simulation results regarding resource utilization suggest that the RFID system can slightly relieve the burden on all resources, whereas the RFID system and the discharge lounge together can significantly mitigate the nurses' tasks. The simulation results in terms of the time taken demonstrate that the RFID system can shorten patient wait times, staff busy times, and bed occupation times. The results of the study could prove helpful to others who are considering the use of an RFID system in the patient discharge process in hospitals or similar processes.

A general power equation for predicting bed load transport rates in gravel bed rivers

Treesearch

Jeffrey J. Barry; John M. Buffington; John G. King

2004-01-01

A variety of formulae has been developed to predict bed load transport in gravel bed rivers, ranging from simple regressions to complex multiparameter formulations. The ability to test these formulae across numerous field sites has, until recently, been hampered by a paucity of bed load transport data for gravel bed rivers. We use 2104 bed load transport observations...

Method and apparatus for enhancing the desulfurization of hot coal gas in a fluid-bed coal gasifier

DOEpatents

Grindley, T.

1988-04-05

A process and apparatus for providing additional desulfurization of the hot gas produced in a fluid-bed coal gasifier, within the gasifier is described. A fluid-bed of iron oxide is located inside the gasifier above the gasification bed in a fluid-bed coal gasifier in which in-bed desulfurization by lime/limestone takes place. The product gases leave the gasification bed typically at 1600 to 1800 F and are partially quenched with water to 1000 to 1200 F before entering the iron oxide bed. The iron oxide bed provides additional desulfurization beyond that provided by the lime /limestone. 1 fig.

Method for enhancing the desulfurization of hot coal gas in a fluid-bed coal gasifier

DOEpatents

Grindley, Thomas

1989-01-01

A process and apparatus for providing additional desulfurization of the hot gas produced in a fluid-bed coal gasifier, within the gasifier. A fluid-bed of iron oxide is located inside the gasifier above the gasification bed in a fluid-bed coal gasifier in which in-bed desulfurization by lime/limestone takes place. The product gases leave the gasification bed typically at 1600.degree. to 1800.degree. F. and are partially quenched with water to 1000.degree. to 1200.degree. F. before entering the iron oxide bed. The iron oxide bed provides additional desulfurization beyond that provided by the lime/limestone.

DNA profiling of trace DNA recovered from bedding.

PubMed

Petricevic, Susan F; Bright, Jo-Anne; Cockerton, Sarah L

2006-05-25

Trace DNA is often detected on handled items and worn clothing examined in forensic laboratories. In this study, the potential transfer of trace DNA to bedding by normal contact, when an individual sleeps in a bed, is examined. Volunteers slept one night on a new, lower bed sheet in their own bed and one night in a bed foreign to them. Samples from the sheets were collected and analysed by DNA profiling. The results indicate that the DNA profile of an individual can be obtained from bedding after one night of sleeping in a bed. The DNA profile of the owner of the bed could also be detected in the foreign bed experiments. Since mixed DNA profiles can be obtained from trace DNA on bedding, caution should be exercised when drawing conclusions from DNA profiling results obtained from such samples. This transfer may have important repercussions in sexual assault investigations.

Rapid ignition of fluidized bed boiler

DOEpatents

Osborn, Liman D.

1976-12-14

A fluidized bed boiler is started up by directing into the static bed of inert and carbonaceous granules a downwardly angled burner so that the hot gases cause spouting. Air is introduced into the bed at a rate insufficient to fluidize the entire bed. Three regions are now formed in the bed, a region of lowest gas resistance, a fluidized region and a static region with a mobile region at the interface of the fluidized and static regions. Particles are transferred by the spouting action to form a conical heap with the carbonaceous granules concentrated at the top. The hot burner gases ignite the carbonaceous matter on the top of the bed which becomes distributed in the bed by the spouting action and bed movement. Thereafter the rate of air introduction is increased to fluidize the entire bed, the spouter/burner is shut off, and the entire fluidized bed is ignited.

AIR PASSIVATION OF METAL HYDRIDE BEDS FOR WASTE DISPOSAL

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

Klein, J; R. H. Hsu, R

2007-07-02

Metal hydride beds offer compact, safe storage of tritium. After metal hydride beds have reached the end of their useful life, the beds will replaced with new beds and the old beds prepared for disposal. One acceptance criteria for hydride bed waste disposal is that the material inside the bed not be pyrophoric. To determine the pyrophoric nature of spent metal hydride beds, controlled air ingress tests were performed. A simple gas handling manifold fitted with pressure transducers and a calibrated volume were used to introduce controlled quantities of air into a metal hydride bed and the bed temperature risemore » monitored for reactivity with the air. A desorbed, 4.4 kg titanium prototype hydride storage vessel (HSV) produced a 4.4 C internal temperature rise upon the first air exposure cycle and a 0.1 C temperature rise upon a second air exposure. A total of 346 scc air was consumed by the bed (0.08 scc per gram Ti). A desorbed, 9.66 kg LaNi{sub 4.25}Al{sub 0.75} prototype storage bed experienced larger temperature rises over successive cycles of air ingress and evacuation. The cycles were performed over a period of days with the bed effectively passivated after the 12th cycle. Nine to ten STP-L of air reacted with the bed producing both oxidized metal and water.« less

7 CFR 3201.15 - Bedding, bed linens, and towels.

Code of Federal Regulations, 2014 CFR

2014-01-01

... group of woven cloth products used as coverings on a bed. Bedding includes products such as blankets, bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding. (3) Towels are woven cloth products used primarily for drying and wiping. (b) Minimum biobased content. The...

7 CFR 2902.15 - Bedding, bed linens, and towels.

Code of Federal Regulations, 2011 CFR

2011-01-01

... group of woven cloth products used as coverings on a bed. Bedding includes products such as blankets, bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding. (3) Towels are woven cloth products used primarily for drying and wiping. (b) Minimum biobased content. The...

7 CFR 3201.15 - Bedding, bed linens, and towels.

Code of Federal Regulations, 2012 CFR

2012-01-01

... group of woven cloth products used as coverings on a bed. Bedding includes products such as blankets, bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding. (3) Towels are woven cloth products used primarily for drying and wiping. (b) Minimum biobased content. The...

7 CFR 3201.15 - Bedding, bed linens, and towels.

Code of Federal Regulations, 2013 CFR

2013-01-01

... group of woven cloth products used as coverings on a bed. Bedding includes products such as blankets, bedspreads, comforters, and quilts. (2) Bed linens are woven cloth sheets and pillowcases used in bedding. (3) Towels are woven cloth products used primarily for drying and wiping. (b) Minimum biobased content. The...

Odorous Volatile Organic Compounds, Escherichia coli, and Nutrient Concentrations when Kiln-Dried Pine Chips and Corn Stover Bedding Are Used in Beef Bedded Manure Packs.

PubMed

Spiehs, Mindy J; Berry, Elaine D; Wells, James E; Parker, David B; Brown-Brandl, Tami M

2017-07-01

Pine ( spp.) bedding has been shown to lower the concentration of odorous volatile organic compounds (VOCs) and pathogenic bacteria compared with corn ( L.) stover bedding, but availability and cost limit the use of pine bedding in cattle confinement facilities. The objectives of this study were to determine if the addition of pine wood chips to laboratory-scaled bedded packs containing corn stover (i) reduced odorous VOC emissions; (ii) reduced total ; and (iii) changed the nutrient composition of the resulting manure-bedded packs. Bedding treatments included 0, 10, 20, 30, 40, 60, 80, and 100% pine chips, with the balance being corn stover. Four bedded packs for each mixture were maintained for 42 d ( = 4 observations per bedding material). The production of total sulfur compounds increased significantly when 100% pine chips were used (44.72 ng L) compared with bedding mixture containing corn stover (18.0-24.56 ng L). The carbon-to-nitrogen ratio exceeded the ideal ratio of 24:1 for the optimum activity of soil microorganisms when ≥60% pine chips (25.3-27.5 ng L) were included in the mixture. The use of 100% pine chips as bedding increased sulfide concentration in the facility 1.8 to 2.4 times over the use of corn stover bedding. was not influenced by the addition of pine chips to the corn stover bedding material but did decrease as the bedded pack aged. Bedding material mixtures containing 30 to 60% pine and 40 to 70% corn stover may be the ideal combination to mitigate odors from livestock facilities using deep bedded systems. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Development of the 7-Item Binge-Eating Disorder Screener (BEDS-7)

PubMed Central

Deal, Linda S.; DiBenedetti, Dana B.; Nelson, Lauren; Fehnel, Sheri E.; Brown, T. Michelle

2016-01-01

Objective Develop a brief, patient-reported screening tool designed to identify individuals with probable binge-eating disorder (BED) for further evaluation or referral to specialists. Methods Items were developed on the basis of the DSM-5 diagnostic criteria, existing tools, and input from 3 clinical experts (January 2014). Items were then refined in cognitive debriefing interviews with participants self-reporting BED characteristics (March 2014) and piloted in a multisite, cross-sectional, prospective, noninterventional study consisting of a semistructured diagnostic interview (to diagnose BED) and administration of the pilot Binge-Eating Disorder Screener (BEDS), Binge Eating Scale (BES), and RAND 36-Item Short-Form Health Survey (RAND-36) (June 2014–July 2014). The sensitivity and specificity of classification algorithms (formed from the pilot BEDS item-level responses) in predicting BED diagnosis were evaluated. The final algorithm was selected to minimize false negatives and false positives, while utilizing the fewest number of BEDS items. Results Starting with the initial BEDS item pool (20 items), the 13-item pilot BEDS resulted from the cognitive debriefing interviews (n = 13). Of the 97 participants in the noninterventional study, 16 were diagnosed with BED (10/62 female, 16%; 6/35 male, 17%). Seven BEDS items (BEDS-7) yielded 100% sensitivity and 38.7% specificity. Participants correctly identified (true positives) had poorer BES scores and RAND-36 scores than participants identified as true negatives. Conclusions Implementation of the brief, patient-reported BEDS-7 in real-world clinical practice is expected to promote better understanding of BED characteristics and help physicians identify patients who may have BED. PMID:27486542

Development of the 7-Item Binge-Eating Disorder Screener (BEDS-7).

PubMed

Herman, Barry K; Deal, Linda S; DiBenedetti, Dana B; Nelson, Lauren; Fehnel, Sheri E; Brown, T Michelle

2016-01-01

Develop a brief, patient-reported screening tool designed to identify individuals with probable binge-eating disorder (BED) for further evaluation or referral to specialists. Items were developed on the basis of the DSM-5 diagnostic criteria, existing tools, and input from 3 clinical experts (January 2014). Items were then refined in cognitive debriefing interviews with participants self-reporting BED characteristics (March 2014) and piloted in a multisite, cross-sectional, prospective, noninterventional study consisting of a semistructured diagnostic interview (to diagnose BED) and administration of the pilot Binge-Eating Disorder Screener (BEDS), Binge Eating Scale (BES), and RAND 36-Item Short-Form Health Survey (RAND-36) (June 2014-July 2014). The sensitivity and specificity of classification algorithms (formed from the pilot BEDS item-level responses) in predicting BED diagnosis were evaluated. The final algorithm was selected to minimize false negatives and false positives, while utilizing the fewest number of BEDS items. Starting with the initial BEDS item pool (20 items), the 13-item pilot BEDS resulted from the cognitive debriefing interviews (n = 13). Of the 97 participants in the noninterventional study, 16 were diagnosed with BED (10/62 female, 16%; 6/35 male, 17%). Seven BEDS items (BEDS-7) yielded 100% sensitivity and 38.7% specificity. Participants correctly identified (true positives) had poorer BES scores and RAND-36 scores than participants identified as true negatives. Implementation of the brief, patient-reported BEDS-7 in real-world clinical practice is expected to promote better understanding of BED characteristics and help physicians identify patients who may have BED.

Deposition of Suspended Clay to Open and Sand-Filled Framework Gravel Beds in a Laboratory Flume

NASA Astrophysics Data System (ADS)

Mooneyham, Christian; Strom, Kyle

2018-01-01

Pulses of fine sediment composed of sand, silt, and clay can be introduced to gravel bed rivers through runoff from burn-impacted hillslopes, landslides, bank failure, or the introduction of reservoir sediment as a result of sluicing or dam decommissioning. Here we present a study aimed at quantifying exchange between suspensions of clay and gravel beds. The questions that motivate the work are: how do bed roughness and pore space characteristics, shear velocity (u∗), and initial concentration (C0) affect clay deposition on or within gravel beds? Where does deposition within these beds occur, and can deposited clay be resuspended while the gravel is immobile? We examine these questions in a laboratory flume using acrylic, open-framework gravel, and armored sand-gravel beds under conditions of varying u∗ and C0. Deposition of clay occurred to all beds (even with Rouse numbers ˜ 0.01). We attribute deposition under full suspension conditions to be an outcome of localized protected zones where clay can settle and available pore space in the bed. For smooth wall cases, protection came from the viscous wall region and the development of bed forms; for the rough beds, protection came from separation zones and low-velocity pore spaces. Bed porosity was the strongest influencer of nondimensional deposition rate; deposition increased with porosity. Deposition was inversely related to u∗ for the acrylic bed runs; no influence of u∗ was found for the porous bed runs. Increases in discharge resulted in resuspension of clay from acrylic beds; no resuspension was observed in the porous bed runs.

Bacillus cereus in free-stall bedding.

PubMed

Magnusson, M; Svensson, B; Kolstrup, C; Christiansson, A

2007-12-01

To increase the understanding of how different factors affect the bacterial growth in deep sawdust beds for dairy cattle, the microbiological status of Bacillus cereus and coliforms in deep sawdust-bedded free stalls was investigated over two 14-d periods on one farm. High counts of B. cereus and coliforms were found in the entire beds. On average, 4.1 log(10) B. cereus spores, 5.5 log(10) B. cereus, and 6.7 log(10) coliforms per gram of bedding could be found in the upper layers of the sawdust likely to be in contact with the cows' udders. The highest counts of B. cereus spores, B. cereus, and coliforms were found in the bedding before fresh bedding was added, and the lowest immediately afterwards. Different factors of importance for the growth of B. cereus in the bedding material were explored in laboratory tests. These were found to be the type of bedding, pH, and the type and availability of nutrients. Alternative bedding material such as peat and mixtures of peat and sawdust inhibited the bacterial growth of B. cereus. The extent of growth of B. cereus in the sawdust was increased in a dose-dependent manner by the availability of feces. Urine added to different bedding material raised the pH and also led to bacterial growth of B. cereus in the peat. In sawdust, a dry matter content greater than 70% was needed to lower the water activity to 0.95, which is needed to inhibit the growth of B. cereus. In an attempt to reduce the bacterial growth of B. cereus and coliforms in deep sawdust beds on the farm, the effect of giving bedding daily or a full replacement of the beds was studied. The spore count of B. cereus in the back part of the free stalls before fresh bedding was added was 0.9 log units lower in stalls given daily bedding than in stalls given bedding twice weekly. No effect on coliform counts was found. Replacement of the entire sawdust bedding had an effect for a short period, but by 1 to 2 mo after replacement, the counts of B. cereus spores in the beds had increased about 2 log units and were as high as they were before bed replacement. Therefore, free-stall management could, to a limited extent, reduce the content of B. cereus spores in the beds by daily bedding and entire bed replacement.

Bed Bugs FAQs

MedlinePlus

... Consultations, and General Public. Contact Us Parasites Home Bed Bugs FAQs Recommend on Facebook Tweet Share Compartir On ... are bed bugs treated and prevented? What are bed bugs? Bed bugs ( Cimex lectularius ) are small, flat, parasitic ...

The financial impact of heparin-induced thrombocytopenia.

PubMed

Smythe, Maureen A; Koerber, John M; Fitzgerald, Maureen; Mattson, Joan C

2008-09-01

Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that increases patient morbidity and mortality. The financial impact of HIT to an institution is thought to be significant. The objective of this study was to evaluate the financial impact of HIT. A case-control study was employed. Case patients were identified as newly diagnosed HIT patients. Control subjects were matched by diagnosis-related group, primary diagnosis code, primary procedure code, and hospital admission date. The financial/decision support database of the hospital was queried to identify the matched control subjects, total cost, and reimbursement. The determination of financial impact included the total profit or (total loss) and the backfill effect (ie, the lost operating margin resulting from increased length of stay). Length of stay and mortality were compared. Data from 22 case patients and 255 control subjects were analyzed. On average, HIT case patients incurred a financial loss of $14,387 per patient and an increase in length of stay of 14.5 days. When confining the analysis to only Medicare case patients (n = 17) and Medicare control subjects, case patients incurred a financial loss of $20,170 per case and an increase in length of stay of 15.8 days. Depending on the occupancy rate of the institution, additional financial loss could result from the backfill effect. Mortality was not significantly affected. For an institution that sees 50 new cases of HIT per year, the projected annual financial impact ranges from approximately $700,000 to $1 million. Institutions with high bed occupancy rates may see an additional loss from the backfill effect.

Staged fluidized-bed combustion and filter system

DOEpatents

Mei, Joseph S.; Halow, John S.

1994-01-01

A staged fluidized-bed combustion and filter system for substantially reducing the quantity of waste through the complete combustion into ash-type solids and gaseous products. The device has two fluidized-bed portions, the first primarily as a combustor/pyrolyzer bed, and the second as a combustor/filter bed. The two portions each have internal baffles to define stages so that material moving therein as fluidized beds travel in an extended route through those stages. Fluidization and movement is achieved by the introduction of gases into each stage through a directional nozzle. Gases produced in the combustor/pyrolyzer bed are permitted to travel into corresponding stages of the combustor/filter bed through screen filters that permit gas flow but inhibit solids flow. Any catalyst used in the combustor/filter bed is recycled. The two beds share a common wall to minimize total volume of the system. A slightly modified embodiment can be used for hot gas desulfurization and sorbent regeneration. Either side-by-side rectangular beds or concentric beds can be used. The system is particularly suited to the processing of radioactive and chemically hazardous waste.

EPA-Registered Bed Bug Products

MedlinePlus

... Bugs EPA Registered Bed Bug Products EPA-Registered Bed Bug Products Resources Bed Bug Main Page Top Ten ... Where you can use the pesticide Pesticide type Bed Bug Search Tool Enter the information as described in ...

Health Information in Oromo (Afan Oromoo)

MedlinePlus

... Section Bed Bugs Bed Bug Control in Residences - English PDF Bed Bug Control in Residences - Afan Oromoo ( ... Department of Agriculture Vacuuming to Capture Bed Bugs - English PDF Vacuuming to Capture Bed Bugs - Afan Oromoo ( ...

General and food-specific inhibitory deficits in binge eating disorder.

PubMed

Svaldi, Jennifer; Naumann, Eva; Trentowska, Monika; Schmitz, Florian

2014-07-01

To investigate behavioral inhibition in individuals with binge eating disorder (BED) compared with overweight and obese individuals without BED (No-BED). Participants with BED (n = 31) and the weight-matched No-BED group (n = 29) completed an inhibitory control task (stop-signal task, SST) with food and neutral stimuli. The BED group needed more time to stop an ongoing response, as indicated by increased stop signal reaction time (SSRT) relative to the No-BED group. Additionally, compared with the No-BED group, the BED group displayed more difficulty inhibiting responses elicited by food stimuli. The deficits in behavioral response inhibition were also found to be related to the severity of reported symptoms. There is a general deficit in late stage behavioral inhibition in BED, and this may be particularly pronounced in the context of food stimuli. © 2014 Wiley Periodicals, Inc.

Thermal enhancement cartridge heater modified (TECH Mod) tritium hydride bed development, Part 1 - Design and fabrication

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

Klein, J.E.; Estochen, E.G.

The Savannah River Site (SRS) tritium facilities have used first generation (Gen1) LaNi{sub 4.25}Al{sub 0.75} (LANA0.75) metal hydride storage beds for tritium absorption, storage, and desorption. The Gen1 design utilizes hot and cold nitrogen supplies to thermally cycle these beds. Second and third generation (Gen2 and Gen3) storage bed designs include heat conducting foam and divider plates to spatially fix the hydride within the bed. For thermal cycling, the Gen2 and Gen3 beds utilize internal electric heaters and glovebox atmosphere flow over the bed inside the bed external jacket for cooling. The currently installed Gen1 beds require replacement due tomore » tritium aging effects on the LANA0.75 material, and cannot be replaced with Gen2 or Gen3 beds due to different designs of these beds. At the end of service life, Gen1 bed desorption efficiencies are limited by the upper temperature of hot nitrogen supply. To increase end-of-life desorption efficiency, the Gen1 bed design was modified, and a Thermal Enhancement Cartridge Heater Modified (TECH Mod) bed was developed. Internal electric cartridge heaters in the new design to improve end-of-life desorption, and also permit in-bed tritium accountability (IBA) calibration measurements to be made without the use of process tritium. Additional enhancements implemented into the TECH Mod design are also discussed. (authors)« less

THERMAL ENHANCEMENT CARTRIDGE HEATER MODIFIED TECH MOD TRITIUM HYDRIDE BED DEVELOPMENT PART I DESIGN AND FABRICATION

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

Klein, J.; Estochen, E.

The Savannah River Site (SRS) tritium facilities have used 1{sup st} generation (Gen1) LaNi{sub 4.25}Al{sub 0.75} (LANA0.75) metal hydride storage beds for tritium absorption, storage, and desorption. The Gen1 design utilizes hot and cold nitrogen supplies to thermally cycle these beds. Second and 3{sup rd} generation (Gen2 and Gen3) storage bed designs include heat conducting foam and divider plates to spatially fix the hydride within the bed. For thermal cycling, the Gen2 and Gen 3 beds utilize internal electric heaters and glovebox atmosphere flow over the bed inside the bed external jacket for cooling. The currently installed Gen1 beds requiremore » replacement due to tritium aging effects on the LANA0.75 material, and cannot be replaced with Gen2 or Gen3 beds due to different designs of these beds. At the end of service life, Gen1 bed desorption efficiencies are limited by the upper temperature of hot nitrogen supply. To increase end-of-life desorption efficiency, the Gen1 bed design was modified, and a Thermal Enhancement Cartridge Heater Modified (TECH Mod) bed was developed. Internal electric cartridge heaters in the new design to improve end-of-life desorption, and also permit in-bed tritium accountability (IBA) calibration measurements to be made without the use of process tritium. Additional enhancements implemented into the TECH Mod design are also discussed.« less

Petrology and geochemistry of samples from bed-contact zones in Tunnel Bed 5, U12g-Tunnel, Nevada Test Site

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

Connolly, J.R.; Keil, K.; Mansker, W.L.

1984-10-01

This report summarizes the detailed geologic characterization of samples of bed-contact zones and surrounding nonwelded bedded tuffs, both within Tunnel Bed 5, that are exposed in the G-Tunnel complex beneath Rainier Mesa on the Nevada Test Site (NTS). Original planning studies treated the bed-contact zones in Tunnel Bed 5 as simple planar surfaces of relatively high permeability. Detailed characterization, however, indicates that these zones have a finite thickness, are depositional in origin, vary considerably over short vertical and horizontal distances, and are internally complex. Fluid flow in a sequence of nonwelded zeolitized ash-flow or bedded tuffs and thin intervening reworkedmore » zones appears to be a porous-medium phenomenon, regardless of the presence of layering. There are no consistent differences in either bulk composition or detailed mineralogy between bedded tuffs and bed-contact zones in Tunnel Bed 5. Although the original bulk composition of Tunnel Bed 5 was probably peralkaline, extensive zeolitization has resulted in a present peraluminous bulk composition of both bedded tuffs and bed-contact zones. The major zeolite present, clinoptilolite, is intermediate (Ca:K:Na = 26:35:39) and effectively uniform in composition. This composition is similar to that of clinoptilolite from the tuffaceous beds of Calico Hills above the static water level in hole USW G-1, but somewhat different from that reported for zeolites from below the static water level in USW G-2. Tunnel Bed 5 also contains abundant hydrous manganese oxides. The similarity in composition of the clinoptilolites from Tunnel Bed 5 and those above the static water level at Yucca Mountain indicates that many of the results of nuclide-migration experiments in Tunnel Bed 5 would be transferrable to zeolitized nonwelded tuffs above the static water level at Yucca Mountain.« less

CFD-DEM study of effect of bed thickness for bubbling fluidized beds

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

Tingwen, Li; Gopalakrishnan, Pradeep; Garg, Rahul

2011-10-01

The effect of bed thickness in rectangular fluidized beds is investigated through the CFD–DEM simulations of small-scale systems. Numerical results are compared for bubbling fluidized beds of various bed thicknesses with respect to particle packing, bed expansion, bubble behavior, solids velocities, and particle kinetic energy. Good two-dimensional (2D) flow behavior is observed in the bed having a thickness of up to 20 particle diameters. However, a strong three-dimensional (3D) flow behavior is observed in beds with a thickness of 40 particle diameters, indicating the transition from 2D flow to 3D flow within the range of 20–40 particle diameters. Comparison ofmore » velocity profiles near the walls and at the center of the bed shows significant impact of the front and back walls on the flow hydrodynamics of pseudo-2D fluidized beds. Hence, for quantitative comparison with experiments in pseudo-2D columns, the effect of walls has to be accounted for in numerical simulations.« less

Method and apparatus for a combination moving bed thermal treatment reactor and moving bed filter

DOEpatents

Badger, Phillip C.; Dunn, Jr., Kenneth J.

2015-09-01

A moving bed gasification/thermal treatment reactor includes a geometry in which moving bed reactor particles serve as both a moving bed filter and a heat carrier to provide thermal energy for thermal treatment reactions, such that the moving bed filter and the heat carrier are one and the same to remove solid particulates or droplets generated by thermal treatment processes or injected into the moving bed filter from other sources.

Control of bed height in a fluidized bed gasification system

DOEpatents

Mehta, Gautam I.; Rogers, Lynn M.

1983-12-20

In a fluidized bed apparatus a method for controlling the height of the fdized bed, taking into account variations in the density of the bed. The method comprises taking simultaneous differential pressure measurements at different vertical elevations within the vessel, averaging the differential pressures, determining an average fluidized bed density, then periodically calculating a weighting factor. The weighting factor is used in the determination of the actual bed height which is used in controlling the fluidizing means.

Evaluation of a clay-based acidic bedding conditioner for dairy cattle bedding.

PubMed

Proietto, R L; Hinckley, L S; Fox, L K; Andrew, S M

2013-02-01

This study investigated the effects of a clay-based acidic bedding conditioner on sawdust bedding pH, dry matter (DM), environmental pathogen counts, and environmental bacterial counts on teat ends of lactating dairy cows. Sixteen lactating Holstein cows were paired based on parity, days in milk, milk yield, and milk somatic cell count, and were negative for the presence of an intramammary pathogen. Within each pair, cows were randomly assigned to 1 of 2 treatments with 3-wk periods in a crossover design. Treatment groups consisted of 9 freestalls per group bedded with either untreated sawdust or sawdust with a clay-based acidic bedding conditioner, added at 3- to 4-d intervals over each 21-d period. Bedding and teat ends were aseptically sampled on d 0, 1, 2, 7, 14, and 21 for determination of environmental bacterial counts. At the same time points, bedding was sampled for DM and pH determination. The bacteria identified in the bedding material were total gram-negative bacteria, Streptococcus spp., and coliform bacteria. The bacteria identified on the teat ends were Streptococcus spp., coliform bacteria, and Klebsiella spp. Teat end score, milk somatic cell count, and intramammary pathogen presence were measured weekly. Bedding and teat cleanliness, environmental high and low temperatures, and dew point data were collected daily. The bedding conditioner reduced the pH, but not the DM, of the sawdust bedding compared with untreated sawdust. Overall environmental bacterial counts in bedding were lower for treated sawdust. Total bacterial counts in bedding and on teat ends increased with time over both periods. Compared with untreated sawdust, the treated bedding had lower counts of total gram-negative bacteria and streptococci, but not coliform counts. Teat end bacterial counts were lower for cows bedded on treated sawdust for streptococci, coliforms, and Klebsiella spp. compared with cows bedded on untreated sawdust. The clay-based acidic bedding conditioner reduced environmental pathogens in sawdust bedding and teat ends without affecting teat end integrity. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Trends in the supply of California’s emergency departments and inpatient services, 2005–2014: a retrospective analysis

PubMed Central

Chow, Jessica L; Niedzwiecki, Matthew J; Hsia, Renee Y

2017-01-01

Objectives Given increasing demand for emergency care, there is growing concern over the availability of emergency department (ED) and inpatient resources. Existing studies of ED bed supply are dated and often overlook hospital capacity beyond ED settings. We described recent statewide trends in the capacity of ED and inpatient hospital services from 2005 to 2014. Design Retrospective analysis. Setting Using California hospital data, we examined the absolute and per admission changes in ED beds and inpatient beds in all hospitals from 2005 to 2014. Participants Our sample consisted of all patients inpatient and outpatient) from 501 hospital facilities over 10-year period. Outcome measures We analysed linear trends in the total annual ED visits, ED beds, licensed and staffed inpatient hospital beds and bed types, ED beds per ED visit, and inpatient beds per admission (ED and non-ED). Results Between 2005 and 2014, ED visits increased from 9.8 million to 13.2 million (an increase of 35.0%, p<0.001). ED beds also increased (by 29.8%, p<0.001), with an average annual increase of 195.4 beds. Despite this growth, ED beds per visit decreased by 3.9%, from 6.0 ED beds per 10 000 ED visits in 2005 to 5.8 beds in 2014 (p=0.01). While overall admission numbers declined by 4.9% (p=0.06), inpatient medical/surgical beds per visit grew by 11.3%, from 11.6 medical/surgical beds per 1000 admissions in 2005 to 12.9 beds in 2014 (p<0.001). However, there were reductions in psychiatric and chemical dependency beds per admission, by −15.3% (p<0.001) and −22.4% (p=0.05), respectively. Conclusions These trends suggest that, in its current state, inadequate supply of ED and specific inpatient beds cannot keep pace with growing patient demand for acute care. Analysis of ED and inpatient supply should capture dynamic variations in patient demand. Our novel ‘beds pervisit’ metric offers improvements over traditional supply measures. PMID:28495813

Use of soft hydrothermal processing to improve and recycle bedding for laboratory animals.

PubMed

Miyamoto, T; Li, Z; Kibushi, T; Yamasaki, N; Kasai, N

2008-10-01

Cage bedding for laboratory rodents can influence animal wellbeing and thus the experimental data. In addition, a large amount of used bedding containing excrement is discharged as medical waste from life science institutes and breeding companies. We developed a ground-breaking system to improve fresh bedding and recycle used bedding by applying a soft hydrothermal process with high-temperature and high-pressure dry steam. The system removes both harmful organic components and aromatic hydrocarbons that can affect animals' metabolism. The purpose of the present study was to evaluate the chemical and physical properties of the improved fresh bedding and the recycled used bedding treated by the system. The results showed that 68-99% of the predominant aromatic hydrocarbons were removed from fresh bedding treated at 0.35 MPa and 140 degrees C for 120 min ('improved bedding'). In addition, 59.4-99.0% of predominant harmful organic compounds derived from excrement were removed from used bedding treated at 0.45 MPa and 150 degrees C for 60 min ('recycled bedding'). The soft hydrothermal treatment increased the number of acidic functional groups on the bedding surface and gave it the high adsorptive efficiency of ammonia gas. Harmful substances such as microorganisms, heavy metals and pesticides decreased below the detection limit. The results clearly showed that the improved and recycled bedding is safer for laboratory rodents and has the potential to ameliorate conditions in primary and secondary enclosures (e.g. cages and animal rooms) used for maintaining laboratory animals. This process may be one of the most advanced techniques in providing an alternative to softwood and other bedding, economizing through the recycling of used bedding and reducing bedding waste from animal facilities.

Diagnosing binge eating disorder in a primary care setting.

PubMed

Montano, C Brendan; Rasgon, Natalie L; Herman, Barry K

2016-01-01

Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment-seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that it is not merely a subtype of obesity.

Collaborative Strategy on Bed Bugs

EPA Pesticide Factsheets

The Collaborative Strategy on Bed Bugs was developed by the Federal Bed Bug Workgroup to clarify the federal role in bed bug control and highlight ways that government, community, academia and private industry can work together on bed bug issues.

'My friends love to tan': examining sensation seeking and the mediating role of association with friends who use tanning beds on tanning bed use intentions.

PubMed

Banerjee, Smita C; Greene, Kathryn; Bagdasarov, Zhanna; Campo, Shelly

2009-12-01

This paper explored how sensation seeking contributes to the likelihood of tanning bed use intentions both directly and indirectly through the way it shapes interaction with peers who use tanning beds and attitudes toward tanning bed. Eight hundred and ninety six (n = 896) male and female college students were recruited for the study. Measured variables included sensation seeking, association with friends who use tanning beds, attitudes toward tanning and tanning bed use intentions. Structural equation modeling was performed to test the hypotheses. In general, results supported the proposed hypotheses and documented that sensation seeking is indirectly associated with tanning bed use intentions through the mediation of association with peers who use tanning beds and attitudes toward tanning. The article discusses theoretical and methodological implications of the findings demonstrating the pathways of influence of sensation seeking on tanning bed use intentions.

The Safety of Hospital Beds

PubMed Central

Gervais, Pierre; Pooler, Charlotte; Merryweather, Andrew; Doig, Alexa K.; Bloswick, Donald

2015-01-01

To explore the safety of the standard and the low hospital bed, we report on a microanalysis of 15 patients’ ability to ingress, move about the bed, and egress. The 15 participants were purposefully selected with various disabilities. Bed conditions were randomized with side rails up or down and one low bed with side rails down. We explored the patients’ use of the side rails, bed height, ability to lift their legs onto the mattress, and ability to turn, egress, and walk back to the chair. The standard bed was too high for some participants, both for ingress and egress. Side rails were used by most participants when entering, turning in bed, and exiting. We recommend that side rails be reconsidered as a means to facilitate in-bed movement, ingress, and egress. Furthermore, single deck height settings for all patients are not optimal. Low beds as a safety measure must be re-evaluated. PMID:28462302

Exploring the Early Structure of a Rapidly Decompressed Particle Bed

NASA Astrophysics Data System (ADS)

Zunino, Heather; Adrian, R. J.; Clarke, Amanda; Johnson, Blair; Arizona State University Collaboration

2017-11-01

Rapid expansion of dense, pressurized beds of fine particles subjected to rapid reduction of the external pressure is studied in a vertical shock tube. A near-sonic expansion wave impinges on the particle bed-gas interface and rapidly unloads the particle bed. A high-speed video camera captures events occurring during bed expansion. The particle bed does not expand homogeneously, but breaks down into horizontal slabs and then transforms into a cellular-type structure. There are several key parameters that affect the particle bed evolution, including particle size and initial bed height. Analyses of this bed structure evolution from experiments with varying particle sizes and initial bed heights is presented. This work is supported by the U.S. Department of Energy, National Nuclear Security Administration, Advanced Simulation and Computing Program, as a Cooperative Agreement under the Predictive Science and Academic Alliance Program, under Contract No. DE-NA0002378.

Method of shielding a liquid-metal-cooled reactor

DOEpatents

Sayre, Robert K.

1978-01-01

The primary heat transport system of a nuclear reactor -- particularly for a liquid-metal-cooled fast-breeder reactor -- is shielded and protected from leakage by establishing and maintaining a bed of a powdered oxide closely and completely surrounding all components thereof by passing a gas upwardly therethrough at such a rate as to slightly expand the bed to the extent that the components of the system are able to expand without damage and yet the particles of the bed remain close enough so that the bed acts as a guard vessel for the system. Preferably the gas contains 1 to 10% oxygen and the gas is passed upwardly through the bed at such a rate that the lower portion of the bed is a fixed bed while the upper portion is a fluidized bed, the line of demarcation therebetween being high enough that the fixed bed portion of the bed serves as guard vessel for the system.

Hybrid fluidized bed combuster

DOEpatents

Kantesaria, Prabhudas P.; Matthews, Francis T.

1982-01-01

A first atmospheric bubbling fluidized bed furnace is combined with a second turbulent, circulating fluidized bed furnace to produce heat efficiently from crushed solid fuel. The bed of the second furnace receives the smaller sizes of crushed solid fuel, unreacted limestone from the first bed, and elutriated solids extracted from the flu gases of the first bed. The two-stage combustion of crushed solid fuel provides a system with an efficiency greater than available with use of a single furnace of a fluidized bed.

Solid fuel feed system for a fluidized bed

DOEpatents

Jones, Brian C.

1982-01-01

A fluidized bed for the combustion of coal, with limestone, is replenished with crushed coal from a system discharging the coal laterally from a station below the surface level of the bed. A compartment, or feed box, is mounted at one side of the bed and its interior separated from the bed by a weir plate beneath which the coal flows laterally into the bed while bed material is received into the compartment above the plate to maintain a predetermined minimum level of material in the compartment.

Fluid bed material transfer method

DOEpatents

Pinske, Jr., Edward E.

1994-01-01

A fluidized bed apparatus comprising a pair of separated fluid bed enclosures, each enclosing a fluid bed carried on an air distributor plate supplied with fluidizing air from below the plate. At least one equalizing duct extending through sidewalls of both fluid bed enclosures and flexibly engaged therewith to communicate the fluid beds with each other. The equalizing duct being surrounded by insulation which is in turn encased by an outer duct having expansion means and being fixed between the sidewalls of the fluid bed enclosures.

Apparatus and process for controlling fluidized beds

DOEpatents

Rehmat, Amirali G.; Patel, Jitendra G.

1985-10-01

An apparatus and process for control and maintenance of fluidized beds under non-steady state conditions. An ash removal conduit is provided for removing solid particulates from a fluidized bed separate from an ash discharge conduit in the lower portion of the grate supporting such a bed. The apparatus and process of this invention is particularly suitable for use in ash agglomerating fluidized beds and provides control of the fluidized bed before ash agglomeration is initiated and during upset conditions resulting in stable, sinter-free fluidized bed maintenance.

Apparatus for controlling fluidized beds

DOEpatents

Rehmat, Amirali G.; Patel, Jitendra G.

1987-05-12

An apparatus and process for control and maintenance of fluidized beds under non-steady state conditions. An ash removal conduit is provided for removing solid particulates from a fluidized bed separate from an ash discharge conduit in the lower portion of the grate supporting such a bed. The apparatus and process of this invention is particularly suitable for use in ash agglomerating fluidized beds and provides control of the fluidized bed before ash agglomeration is initiated and during upset conditions resulting in stable, sinter-free fluidized bed maintenance.

Implications of lessons learned from tobacco control for tanning bed reform.

PubMed

Sinclair, Craig; Makin, Jennifer K

2013-01-01

Tanning beds used according to the manufacturer's instructions expose the user to health risks, including melanoma and other skin cancers. Applying the MPOWER model (monitor, protect, offer alternatives, warn, enforce, and raise taxes), which has been used in tobacco control, to tanning bed reform could reduce the number of people at risk of diseases associated with tanning bed use. Among the tactics available to government are restricting the use of tanning beds by people under age 18 and those with fair skin, increasing the price of tanning bed services through taxation, licensing tanning bed operators, and banning unsupervised tanning bed operations.

Implications of Lessons Learned From Tobacco Control for Tanning Bed Reform

PubMed Central

Sinclair, Craig

2013-01-01

Tanning beds used according to the manufacturer’s instructions expose the user to health risks, including melanoma and other skin cancers. Applying the MPOWER model (monitor, protect, offer alternatives, warn, enforce, and raise taxes), which has been used in tobacco control, to tanning bed reform could reduce the number of people at risk of diseases associated with tanning bed use. Among the tactics available to government are restricting the use of tanning beds by people under age 18 and those with fair skin, increasing the price of tanning bed services through taxation, licensing tanning bed operators, and banning unsupervised tanning bed operations. PMID:23449282

Method of burning sulfur-containing fuels in a fluidized bed boiler

DOEpatents

Jones, Brian C.

1982-01-01

A method of burning a sulfur-containing fuel in a fluidized bed of sulfur oxide sorbent wherein the overall utilization of sulfur oxide sorbent is increased by comminuting the bed drain solids to a smaller average particle size, preferably on the order of 50 microns, and reinjecting the comminuted bed drain solids into the bed. In comminuting the bed drain solids, particles of spent sulfur sorbent contained therein are fractured thereby exposing unreacted sorbent surface. Upon reinjecting the comminuted bed drain solids into the bed, the newly-exposed unreacted sorbent surface is available for sulfur oxide sorption, thereby increasing overall sorbent utilization.

Testing a Threshold-Based Bed Bug Management Approach in Apartment Buildings.

PubMed

Singh, Narinderpal; Wang, Changlu; Zha, Chen; Cooper, Richard; Robson, Mark

2017-07-26

We tested a threshold-based bed bug ( Cimex lectularius L.) management approach with the goal of achieving elimination with minimal or no insecticide application. Thirty-two bed bug infested apartments were identified. These apartments were divided into four treatment groups based on apartment size and initial bed bug count, obtained through a combination of visual inspection and bed bug monitors: I- Non-chemical only in apartments with 1-12 bed bug count, II- Chemical control only in apartments with 1-12 bed bug count, III- Non-chemical and chemical control in apartments with >12 bed bug count, and IV- Chemical control only in apartments with ≥11 bed bug count. All apartments were monitored or treated once every two weeks for a maximum of 28 wk. Treatment I eliminated bed bugs in a similar amount of time to treatment II. Time to eliminate bed bugs was similar between treatment III and IV but required significantly less insecticide spray in treatment III than that in treatment IV. A threshold-based management approach (non-chemical only or non-chemical and chemical) can eliminate bed bugs in a similar amount of time, using little to no pesticide compared to a chemical only approach.

Mechanical stratigraphic controls on natural fracture spacing and penetration

NASA Astrophysics Data System (ADS)

McGinnis, Ronald N.; Ferrill, David A.; Morris, Alan P.; Smart, Kevin J.; Lehrmann, Daniel

2017-02-01

Fine-grained low permeability sedimentary rocks, such as shale and mudrock, have drawn attention as unconventional hydrocarbon reservoirs. Fracturing - both natural and induced - is extremely important for increasing permeability in otherwise low-permeability rock. We analyze natural extension fracture networks within a complete measured outcrop section of the Ernst Member of the Boquillas Formation in Big Bend National Park, west Texas. Results of bed-center, dip-parallel scanline surveys demonstrate nearly identical fracture strikes and slight variation in dip between mudrock, chalk, and limestone beds. Fracture spacing tends to increase proportional to bed thickness in limestone and chalk beds; however, dramatic differences in fracture spacing are observed in mudrock. A direct relationship is observed between fracture spacing/thickness ratio and rock competence. Vertical fracture penetrations measured from the middle of chalk and limestone beds generally extend to and often beyond bed boundaries into the vertically adjacent mudrock beds. In contrast, fractures in the mudrock beds rarely penetrate beyond the bed boundaries into the adjacent carbonate beds. Consequently, natural bed-perpendicular fracture connectivity through the mechanically layered sequence generally is poor. Fracture connectivity strongly influences permeability architecture, and fracture prediction should consider thin bed-scale control on fracture heights and the strong lithologic control on fracture spacing.

Efficacy of three different steamers for control of bed bugs (Cimex lectularius L.).

PubMed

Wang, Desen; Wang, Changlu; Wang, Guohong; Zha, Chen; Eiden, Amanda L; Cooper, Richard

2018-04-15

Bed bugs, Cimex lectularius L., have become one of the most difficult urban pests to control. Steam treatment is reported to be an effective method to kill bed bugs and is considered to be an important component of bed bug integrated pest management (IPM). We evaluated and compared the efficacy of two affordable consumer-grade commercial steamers to a commonly used professional-grade steamer for killing bed bugs. In laboratory experiments, the consumer-grade steamer at an affordable price achieved the same high control efficacy as the professional-grade steamer for treating bed bugs exposed on mattresses (100% bed bug mortality), located beneath a fabric cover (>89% bed bug mortality), or hiding in cracks (100% bed bug mortality). Bed bugs located behind a leather cover did not suffer significant mortality from steam treatment regardless of the type of steamers used and treatment duration. Proper use of steamers can kill all life stages of bed bugs. Affordable consumer-grade steamers are as effective as professional-grade steam machines for eliminating bed bugs resting on mattresses, hiding behind fabric materials, or in cracks. This article is protected by copyright. All rights reserved.

Tanning beds: A call to action for further educational and legislative efforts.

PubMed

Farley, Clara; Alimi, Yewande; Espinosa, Lauren R; Perez, Sebastian; Knechtle, William; Hestley, Andrea; Carlson, Grant W; Russell, Maria C; Delman, Keith A; Rizzo, Monica

2015-08-01

Melanoma is steadily increasing over the past decade. Recent studies confirmed a link between tanning bed use and melanoma. We sought to determine the prevalence and frequency of tanning bed among young patients with melanoma. We retrospectively analyzed tanning bed use among young melanoma patients compared to controls selected from the hospital medical records. A telephone survey investigated family history of melanoma or skin cancer, hair color, eye color, skin type, tanning bed use, and patient awareness of dangers of tanning bed use. A total of 601 melanoma cases were identified; 265 (44%) completed the telephone survey as did 195 (31%) controls. Of these 460 subjects, 260 were female. Females were 3.0 times more likely to have used a tanning bed. Melanoma patients had natural light color hair, blue-green eyes, and 2.0 times more likely to use a tanning bed than controls. Among the tanning bed users, 90% were aware of danger of tanning bed. Our study found that tanning beds were more likely to be used by young women, the majority of whom are aware of the associated risks. Eliminating the use of tanning beds should be considered to decrease the incidence of melanoma. © 2015 Wiley Periodicals, Inc.

Testing a Threshold-Based Bed Bug Management Approach in Apartment Buildings

PubMed Central

Singh, Narinderpal; Zha, Chen; Cooper, Richard; Robson, Mark

2017-01-01

We tested a threshold-based bed bug (Cimex lectularius L.) management approach with the goal of achieving elimination with minimal or no insecticide application. Thirty-two bed bug infested apartments were identified. These apartments were divided into four treatment groups based on apartment size and initial bed bug count, obtained through a combination of visual inspection and bed bug monitors: I- Non-chemical only in apartments with 1–12 bed bug count, II- Chemical control only in apartments with 1–12 bed bug count, III- Non-chemical and chemical control in apartments with >12 bed bug count, and IV- Chemical control only in apartments with ≥11 bed bug count. All apartments were monitored or treated once every two weeks for a maximum of 28 wk. Treatment I eliminated bed bugs in a similar amount of time to treatment II. Time to eliminate bed bugs was similar between treatment III and IV but required significantly less insecticide spray in treatment III than that in treatment IV. A threshold-based management approach (non-chemical only or non-chemical and chemical) can eliminate bed bugs in a similar amount of time, using little to no pesticide compared to a chemical only approach. PMID:28933720

Dosimetric quality endpoints for low-dose-rate prostate brachytherapy using biological effective dose (bed) vs. conventional dose

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

Singh, Rachana; Al-Hallaq, Hania; Pelizzari, Charles A.

2003-12-31

The purpose of this study was to compare conventional low-dose-rate prostate brachytherapy dosimetric quality parameters with their biological effective dose (BED) counterparts. To validate a model for transformation from conventional dose to BED, the postimplant plans of 31 prostate brachytherapy patients were evaluated using conventional dose-volume histogram (DVH) quality endpoints and analogous BED-DVH endpoints. Based on CT scans obtained 4 weeks after implantation, DVHs were computed and standard dosimetric endpoints V100 (volume receiving 100% of the prescribed dose), V150, V200, HI (1-[V150/V100]), and D90 (dose that 90% of the target volume received) were obtained for quality analysis. Using known andmore » reported transformations, dose grids were transformed to BED-early ({alpha}/{beta} = 10 Gy) and BED-late ({alpha}/{beta} = 3 Gy) grids, and the same dosimetric endpoints were analyzed. For conventional, BED-early and BED-late DVHs, no differences in V100 were seen (0.896, 0.893, and 0.894, respectively). However, V150 and V200 were significantly higher for both BED-early (0.582 and 0.316) and BED-late (0.595 and 0.337), compared with the conventional (0.539 and 0.255) DVHs. D90 was significantly lower for the BED-early (103.1 Gy) and BED-late transformations (106.9 Gy) as compared with the conventional (119.5 Gy) DVHs. The conventional prescription parameter V100 is the same for the corresponding BED-early and BED-late transformed DVHs. The toxicity parameters V150 and V200 are slightly higher using the BED transformations, suggesting that the BED doses are somewhat higher than predicted using conventional DVHs. The prescription/quality parameter D90 is slightly lower, implying that target coverage is lower than predicted using conventional DVHs. This methodology can be applied to analyze BED dosimetric endpoints to improve clinical outcome and reduce complications of prostate brachytherapy.« less

Discrete Element Modeling of the Mobilization of Coarse Gravel Beds by Finer Gravel Particles

NASA Astrophysics Data System (ADS)

Hill, K. M.; Tan, D.

2012-12-01

Recent research has shown that the addition of fine gravel particles to a coarse bed will mobilize the coarser bed, and that the effect is sufficiently strong that a pulse of fine gravel particles can mobilize an impacted coarser bed. Recent flume experiments have demonstrated that the degree of bed mobilization by finer particles is primarily dependent on the particle size ratio of the coarse and fine particles, rather than absolute size of either particle, provided both particles are sufficiently large. However, the mechanism behind the mobilization is not understood. It has previously been proposed that the mechanism is driven by a combination of geometric effects and hydraulic effects. For example, it has been argued that smaller particles fill in gaps along the bed, resulting in a smoother bed over which the larger particles are less likely to be disentrained and a reduced near-bed flow velocity and subsequent increased drag on protruding particles. Altered near-bed turbulence has also been cited as playing an important role. We perform simulations using the discrete element method with one-way fluid-solid coupling to conduct simulations of mobilization of a gravel bed by fine gravel particles. By independently and artificially controlling average and fluctuating velocity profiles, we systematically investigate the relative role that may be played by particle-particle interactions, average near-bed velocity profiles, and near-bed turbulence statistics. The simulations indicate that the relative importance of these mechanisms changes with the degree of mobilization of the bed. For higher bed mobility similar to bed sheets, particle-particle interactions, plays a significant role in an apparent rheology in the bed sheets, not unlike that observed in a dense granular flow of particles of different sizes. For conditions closer to a critical shear stress for bedload transport, the near-bed velocity profiles and turbulence statistics become increasingly important.

Cognitive Rationalizations for Tanning-Bed Use: A Preliminary Exploration

PubMed Central

Banerjee, Smita C.; Hay, Jennifer L.; Greene, Kathryn

2016-01-01

Objectives To examine construct and predictive utility of an adapted cognitive rationalization scale for tanning-bed use. Methods Current/former tanning-bed-using undergraduate students (N = 216; 87.6% females; 78.4% white) at a large northeastern university participated in a survey. A cognitive rationalization for tanning-bed use scale was adapted. Standardized self-report measures of past tanning-bed use, advantages of tanning, perceived vulnerability to photoaging, tanning-bed use dependence, and tanning- bed use intention were also administered. Results The cognitive rationalization scale exhibited strong construct and predictive validity. Current tanners and tanning-bed-use-dependent participants endorsed rationalizations more strongly than did former tanners and not-tanning-bed-use-dependent participants respectively. Conclusions Findings indicate that cognitive rationalizations help explain discrepancy between inconsistent cognitions. PMID:23985280

Updated Performance Evaluation of the ISS Water Processor Multifiltration Beds

NASA Technical Reports Server (NTRS)

Bowman, Elizabeth M.; Carter, Layne; Carpenter, Joyce; Orozco, Nicole; Weir, Natalee; Wilson, Mark

2014-01-01

The ISS Water Processor Assembly (WPA) produces potable water from a waste stream containing humidity condensate and urine distillate. The primary treatment process is achieved in the Multifiltration Beds, which include adsorbent media and ion exchange resin for the removal of dissolved organic and inorganic contaminants. Two Multifiltration Beds (MF Beds) were replaced on ISS in July 2010 after initial indication of inorganic breakthrough of the first bed and an increasing Total Organic Carbon (TOC) trend in the product water. The first bed was sampled and analyzed Sept 2011 through March 2012. The second MF Bed was sampled and analyzed June 2012 through August 2012. The water resident in the both beds was analyzed for various parameters to evaluate adsorbent loading, performance of the ion exchange resin, microbial activity, and generation of leachates from the ion exchange resin. Portions of the adsorbent media and ion exchange resin were sampled and subsequently desorbed to identify the primary contaminants removed at various points in the bed in addition to microbial analysis. Analysis of the second bed will be compared to results from the first bed to provide a comprehensive overview of how the Multifiltration Beds function on orbit. New data from the second bed supplements the analysis of the first bed (previously reported) and gives a more complete picture of breakthrough compounds, resin breakdown products, microbial activity, and difficult to remove compounds. The results of these investigations and implications to the operation of the WPA on ISS are documented in this paper.

77 FR 12182 - Safety Standard for Portable Bed Rails: Final Rule

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-29

... of ASTM F2085- 10a, comply with the following: (i) 1.4.1 Foam and inflatable bed rails need meet only...--portable bed rail constructed primarily of nonrigid materials such as fabric or foam. 3.1.11 inflatable bed..., inflatable bed rail, are terms that are now incorporated as non-rigid bed rail under new section 3.1.12 in...

Surveillance Monitoring Management for General Care Units: Strategy, Design, and Implementation.

PubMed

McGrath, Susan P; Taenzer, Andreas H; Karon, Nancy; Blike, George

2016-07-01

The growing number of monitoring devices, combined with suboptimal patient monitoring and alarm management strategies, has increased "alarm fatigue," which have led to serious consequences. Most reported alarm man- agement approaches have focused on the critical care setting. Since 2007 Dartmouth-Hitchcock (Lebanon, New Hamp- shire) has developed a generalizable and effective design, implementation, and performance evaluation approach to alarm systems for continuous monitoring in general care settings (that is, patient surveillance monitoring). In late 2007, a patient surveillance monitoring system was piloted on the basis of a structured design and implementation approach in a 36-bed orthopedics unit. Beginning in early 2009, it was expanded to cover more than 200 inpatient beds in all medicine and surgical units, except for psychiatry and labor and delivery. Improvements in clinical outcomes (reduction of unplanned transfers by 50% and reduction of rescue events by more than 60% in 2008) and approximately two alarms per patient per 12-hour nursing shift in the original pilot unit have been sustained across most D-H general care units in spite of increasing patient acuity and unit occupancy. Sample analysis of pager notifications indicates that more than 85% of all alarm conditions are resolved within 30 seconds and that more than 99% are resolved before escalation is triggered. The D-H surveillance monitoring system employs several important, generalizable features to manage alarms in a general care setting: alarm delays, static thresholds set appropriately for the prevalence of events in this setting, directed alarm annunciation, and policy-driven customization of thresholds to allow clinicians to respond to needs of individual patients. The systematic approach to design, implementation, and performance management has been key to the success of the system.

Time course of sleep inertia dissipation in human performance and alertness

NASA Technical Reports Server (NTRS)

Jewett, M. E.; Wyatt, J. K.; Ritz-De Cecco, A.; Khalsa, S. B.; Dijk, D. J.; Czeisler, C. A.

1999-01-01

Alertness and performance on a wide variety of tasks are impaired immediately upon waking from sleep due to sleep inertia, which has been found to dissipate in an asymptotic manner following waketime. It has been suggested that behavioural or environmental factors, as well as sleep stage at awakening, may affect the severity of sleep inertia. In order to determine the time course of sleep inertia dissipation under normal entrained conditions, subjective alertness and cognitive throughput were measured during the first 4 h after habitual waketime from a full 8-h sleep episode on 3 consecutive days. We investigated whether this time course was affected by either sleep stage at awakening or behavioural/environmental factors. Sleep inertia dissipated in an asymptotic manner and took 2-4 h to near the asymptote. Saturating exponential functions fitted the sleep inertia data well, with time constants of 0.67 h for subjective alertness and 1.17 h for cognitive performance. Most awakenings occurred out of stage rapid eye movement (REM), 2 or 1 sleep, and no effect of sleep stage at awakening on either the severity of sleep inertia or the time course of its dissipation could be detected. Subjective alertness and cognitive throughput were significantly impaired upon awakening regardless of whether subjects got out of bed, ate breakfast, showered and were exposed to ordinary indoor room light (approximately 150 lux) or whether subjects participated in a constant routine (CR) protocol in which they remained in bed, ate small hourly snacks and were exposed to very dim light (10-15 lux). These findings allow for the refinement of models of alertness and performance, and have important implications for the scheduling of work immediately upon awakening in many occupational settings.

Estonia: health system review.

PubMed

Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout

2013-01-01

This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Information needs assessment of medical equipment offices based on Critical Success Factors (CSF) and Business System Planning (BSP) methods.

PubMed

Khorrami, F; Ahmadi, M; Alizadeh, A; Roozbeh, N; Mohseni, S

2015-01-01

Introduction: Given the ever-increasing importance and value of information, providing the management with a reliable information system, which can facilitate decision-making regarding planning, organization and control, is vitally important. This study aimed to analyze and evaluate the information needs of medical equipment offices. Methods: This descriptive applied cross-sectional study was carried out in 2010. The population of the study included the managers of statistic and medical records at the offices of vice-chancellor for treatment in 39 medical universities in Iran. Data were collected by using structured questioners. With regard to different kinds of designing information systems, sampling was done by two methods, BSP (based on processes of job description) and CSF method (based on critical success factors). The data were analyzed by SPSS-16. Results: Our study showed that 41% of information needs were found to be critical success factors of managers of office. The first priority of managers was "the number of bed and bed occupancy in hospitals". Of 29 identified information needs, 62% were initial information needs of managers (from the viewpoints of managers). Of all, 4% of the information needs were obtained through the form, 14% through both the form and database, 11% through the web site, and 71% had no sources (forms, databases, web site). Conclusion: Since 71% of the information needs of medical equipment offices managers had no information sources, the development of information system in these offices seems to be necessary. Despite the important role of users in designing the information systems (identifying 62% of information needs), other scientific methods is also needed to be utilized in designing the information systems.

Compensation of chief executive officers at nonprofit US hospitals.

PubMed

Joynt, Karen E; Le, Sidney T; Orav, E John; Jha, Ashish K

2014-01-01

Hospital chief executive officers (CEOs) can shape the priorities and performance of their organizations. The degree to which their compensation is based on their hospitals' quality performance is not well known. To characterize CEO compensation and examine its relation with quality metrics. Retrospective observational study. Participants included 1877 CEOs at 2681 private, nonprofit US hospitals. We used linear regression to identify hospital structural characteristics associated with CEO pay. We then determined the degree to which a hospital's performance on financial metrics, technologic metrics, quality metrics, and community benefit in 2008 was associated with CEO pay in 2009. The CEOs in our sample had a mean compensation of $595,781 (median, $404,938) in 2009. In multivariate analyses, CEO pay was associated with the number of hospital beds overseen ($550 for each additional bed; 95% CI, 429-671; P < .001), teaching status ($425,078 more at major teaching vs nonteaching hospitals; 95% CI, 315,238-534,918; P < .001), and urban location. Hospitals with high levels of advanced technologic capabilities compensated their CEOs $135,862 more (95% CI, 80,744-190,990; P < .001) than did hospitals with low levels of technology. Hospitals with high performance on patient satisfaction compensated their CEOs $51,706 more than did those with low performance on patient satisfaction (95% CI, 15,166-88,247; P = .006). We found no association between CEO pay and hospitals' margins, liquidity, capitalization, occupancy rates, process quality performance, mortality rates, readmission rates, or measures of community benefit. Compensation of CEOs at nonprofit hospitals was highly variable across the country. Compensation was associated with technology and patient satisfaction but not with processes of care, patient outcomes, or community benefit.

The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study.

PubMed

Erdem, H; Stahl, J P; Inan, A; Kilic, S; Akova, M; Rioux, C; Pierre, I; Canestri, A; Haustraete, E; Engin, D O; Parlak, E; Argemi, X; Bruley, D; Alp, E; Greffe, S; Hosoglu, S; Patrat-Delon, S; Heper, Y; Tasbakan, M; Corbin, V; Hopoglu, M; Balkan, I I; Mutlu, B; Demonchy, E; Yilmaz, H; Fourcade, C; Toko-Tchuindzie, L; Kaya, S; Engin, A; Yalci, A; Bernigaud, C; Vahaboglu, H; Curlier, E; Akduman, D; Barrelet, A; Oncu, S; Korten, V; Usluer, G; Turgut, H; Sener, A; Evirgen, O; Elaldi, N; Gorenek, L

2014-09-01

The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

Information needs assessment of medical equipment offices based on Critical Success Factors (CSF) and Business System Planning (BSP) methods

PubMed Central

Khorrami, F; Ahmadi, M; Alizadeh, A; Roozbeh, N; Mohseni, S

2015-01-01

Introduction: Given the ever-increasing importance and value of information, providing the management with a reliable information system, which can facilitate decision-making regarding planning, organization and control, is vitally important. This study aimed to analyze and evaluate the information needs of medical equipment offices. Methods: This descriptive applied cross-sectional study was carried out in 2010. The population of the study included the managers of statistic and medical records at the offices of vice-chancellor for treatment in 39 medical universities in Iran. Data were collected by using structured questioners. With regard to different kinds of designing information systems, sampling was done by two methods, BSP (based on processes of job description) and CSF method (based on critical success factors). The data were analyzed by SPSS-16. Results: Our study showed that 41% of information needs were found to be critical success factors of managers of office. The first priority of managers was “the number of bed and bed occupancy in hospitals”. Of 29 identified information needs, 62% were initial information needs of managers (from the viewpoints of managers). Of all, 4% of the information needs were obtained through the form, 14% through both the form and database, 11% through the web site, and 71% had no sources (forms, databases, web site). Conclusion: Since 71% of the information needs of medical equipment offices managers had no information sources, the development of information system in these offices seems to be necessary. Despite the important role of users in designing the information systems (identifying 62% of information needs), other scientific methods is also needed to be utilized in designing the information systems. PMID:28255389

Role of Vision and Mechanoreception in Bed Bug, Cimex lectularius L. Behavior

PubMed Central

Singh, Narinderpal; Wang, Changlu; Cooper, Richard

2015-01-01

The role of olfactory cues such as carbon dioxide, pheromones, and kairomones in bed bug, Cimex lectularius L. behavior has been demonstrated. However, the role of vision and mechanoreception in bed bug behavior is poorly understood. We investigated bed bug vision by determining their responses to different colors, vertical objects, and their ability to detect colors and vertical objects under low and complete dark conditions. Results show black and red paper harborages are preferred compared to yellow, green, blue, and white harborages. A bed bug trapping device with a black or red exterior surface was significantly more attractive to bed bugs than that with a white exterior surface. Bed bugs exhibited strong orientation behavior toward vertical objects. The height (15 vs. 30 cm tall) and color (brown vs. black) of the vertical object had no significant effect on orientation behavior of bed bugs. Bed bugs could differentiate color and detect vertical objects at very low background light conditions, but not in complete darkness. Bed bug preference to different substrate textures (mechanoreception) was also explored. Bed bugs preferred dyed tape compared to painted tape, textured painted plastic, and felt. These results revealed that substrate color, presence of vertical objects, and substrate texture affect host-seeking and harborage-searching behavior of bed bugs. Bed bugs may use a combination of vision, mechanoreception, and chemoreception to locate hosts and seek harborages. PMID:25748041

Coevolution of bed surface patchiness and channel morphology: 2. Numerical experiments

USGS Publications Warehouse

Nelson, Peter A.; McDonald, Richard R.; Nelson, Jonathan M.; Dietrich, William E.

2015-01-01

In gravel bed rivers, bed topography and the bed surface grain size distribution evolve simultaneously, but it is not clear how feedbacks between topography and grain sorting affect channel morphology. In this, the second of a pair of papers examining interactions between bed topography and bed surface sorting in gravel bed rivers, we use a two-dimensional morphodynamic model to perform numerical experiments designed to explore the coevolution of both free and forced bars and bed surface patches. Model runs were carried out on a computational grid simulating a 200 m long, 2.75 m wide, straight, rectangular channel, with an initially flat bed at a slope of 0.0137. Over five numerical experiments, we varied (a) whether an obstruction was present, (b) whether the sediment was a gravel mixture or a single size, and (c) whether the bed surface grain size feeds back on the hydraulic roughness field. Experiments with channel obstructions developed a train of alternate bars that became stationary and were connected to the obstruction. Freely migrating alternate bars formed in the experiments without channel obstructions. Simulations incorporating roughness feedbacks between the bed surface and flow field produced flatter, broader, and longer bars than simulations using constant roughness or uniform sediment. Our findings suggest that patches are not simply a by-product of bed topography, but they interact with the evolving bed and influence morphologic evolution.

Binge eating disorder and obesity: preliminary evidence for distinct cardiovascular and psychological phenotypes.

PubMed

Klatzkin, Rebecca R; Gaffney, Sierra; Cyrus, Kathryn; Bigus, Elizabeth; Brownley, Kimberly A

2015-04-01

This study investigated cardiovascular functioning, mood, and eating-related psychological factors at rest and in response to mental stress in three groups of women: 1) Obese women with binge eating disorder (BED; n=9); 2) obese non-BED women (n=15); and 3) normal weight (NW) non-BED women (n=15). Compared to both obese and NW non-BED women, obese women with BED showed heightened overall blood pressure and reported greater depression symptoms, perceived stress, and eating-related psychopathology. Additionally, obese women with BED reported greater overall negative affect and state anxiety compared to obese non-BED women. The heart rate response to stress was blunted in the obese BED group compared to the other groups, but this effect was no longer significant after controlling for baseline differences in depression. Correlational analyses revealed a positive association between stress-induced changes in hunger and cardiovascular measures only in obese women with BED. Longitudinal studies are needed to determine if stress dysregulation and stress-induced increases in hunger contribute to the onset and/or maintenance of BED. In particular, studies utilizing an additional NW BED control group are warranted in order to further examine the impact of BED above and beyond the impact of obesity on psychophysiological functioning and to inform the growing literature regarding stress-related factors that distinguish the BED and obesity phenotypes. Copyright © 2015 Elsevier Inc. All rights reserved.

Role of vision and mechanoreception in bed bug, Cimex lectularius L. behavior.

PubMed

Singh, Narinderpal; Wang, Changlu; Cooper, Richard

2015-01-01

The role of olfactory cues such as carbon dioxide, pheromones, and kairomones in bed bug, Cimex lectularius L. behavior has been demonstrated. However, the role of vision and mechanoreception in bed bug behavior is poorly understood. We investigated bed bug vision by determining their responses to different colors, vertical objects, and their ability to detect colors and vertical objects under low and complete dark conditions. Results show black and red paper harborages are preferred compared to yellow, green, blue, and white harborages. A bed bug trapping device with a black or red exterior surface was significantly more attractive to bed bugs than that with a white exterior surface. Bed bugs exhibited strong orientation behavior toward vertical objects. The height (15 vs. 30 cm tall) and color (brown vs. black) of the vertical object had no significant effect on orientation behavior of bed bugs. Bed bugs could differentiate color and detect vertical objects at very low background light conditions, but not in complete darkness. Bed bug preference to different substrate textures (mechanoreception) was also explored. Bed bugs preferred dyed tape compared to painted tape, textured painted plastic, and felt. These results revealed that substrate color, presence of vertical objects, and substrate texture affect host-seeking and harborage-searching behavior of bed bugs. Bed bugs may use a combination of vision, mechanoreception, and chemoreception to locate hosts and seek harborages.

Apparatus for controlling fluidized beds

DOEpatents

Rehmat, A.G.; Patel, J.G.

1987-05-12

An apparatus and process are disclosed for control and maintenance of fluidized beds under non-steady state conditions. An ash removal conduit is provided for removing solid particulates from a fluidized bed separate from an ash discharge conduit in the lower portion of the grate supporting such a bed. The apparatus and process of this invention is particularly suitable for use in ash agglomerating fluidized beds and provides control of the fluidized bed before ash agglomeration is initiated and during upset conditions resulting in stable, sinter-free fluidized bed maintenance. 2 figs.

Cross-bedding Related Anisotropy and its Role in the Orientation of Joints in an Aeolian Sandstone

NASA Astrophysics Data System (ADS)

Deng, S.; Cilona, A.; Mapeli, C.; Panfilau, A.; Aydin, A.; Prasad, M.

2014-12-01

Previous research revealed that the cross-bedding related anisotropy in aeolian sandstones affects the orientation of compaction bands, also known as anticracks. We hypothesize that cross-bedding should a have similar influence on the orientation of the joints within the same rock at the same location. To test this hypothesis, we investigated the relationship between the cross-beds and the cross-bed package confined joints in the Jurassic aeolian Aztec Sandstone cropping out in the Valley of Fire State Park, Nevada. The field data demonstrates that the cross-bed package confined joints occur at high-angle to bedding and trend roughly parallel to the dip direction of the cross-beds. This shows that the cross-bed orientation and the associated anisotropy also exert a strong control on the formation and orientation of the joints. In order to characterize the anisotropy due to cross-bedding in the Aztec Sandstone, we measured the P-wave velocities parallel and perpendicular to bedding from 11 samples in the laboratory using a bench-top ultrasonic assembly. The measured P-wave anisotropy is about 13% on average. Based on these results, a numerical model based on the generalized Hooke's law for anisotropic materials is analyzed assuming the cross-bedded sandstone to be transversely isotropic. Using this model, we tested various cross-bed orientations as well as different strain boundary conditions (uniaxial, axisymmetric and triaxial). It is possible to define a boundary condition under which the modeled results roughly match with the observed relationship between cross-bed package confined joints and cross-beds. These results have important implications for fluid flow through aeolian sandstones in reservoirs and aquifers.

Mineral resources of the Devil's Garden Lava Bed, Squaw Ridge Lava Bed, and Four Craters Lava Bed Wilderness Study Areas, Lake County, Oregon

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

Keith, W.J.; King, H.D.; Gettings, M.E.

1988-01-01

The Devel's Garden lava Bed, Squaw Ridge Lava Bed, and Four Craters Lava Bed Wilderness Study Areas include approximately 70,940 acres and are underlain entirely by Pleistocene or Holocene lava flows and associated sediments. There is no evidence of hydrothermal alteration in the study areas. No resources were identified in the study areas, but there is low potential for perlite resources in the southern part of the Devil's Garden Lava Bed and the northern half of the Squaw Ridge Lava Bed areas. All three study areas have low potential for geothermal resources and for oil and gas resources.

High-Flux, High Performance H2O2 Catalyst Bed for ISTAR

NASA Technical Reports Server (NTRS)

Ponzo, J.

2005-01-01

On NASA's ISTAR RBCC program packaging and performance requirements exceeded traditional H2O2 catalyst bed capabilities. Aerojet refined a high performance, monolithic 90% H202 catalyst bed previously developed and demonstrated. This approach to catalyst bed design and fabrication was an enabling technology to the ISTAR tri-fluid engine. The catalyst bed demonstrated 55 starts at throughputs greater than 0.60 lbm/s/sq in for a duration of over 900 seconds in a physical envelope approximately 114 of traditional designs. The catalyst bed uses photoetched plates of metal bonded into a single piece monolithic structure. The precise control of the geometry and complete mixing results in repeatable, quick starting, high performing catalyst bed. Three different beds were designed and tested, with the best performing bed used for tri-fluid engine testing.

77 FR 18793 - Spectrum Sharing Innovation Test-Bed Pilot Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

.... 120322212-2212-01] Spectrum Sharing Innovation Test-Bed Pilot Program AGENCY: National Telecommunications... Innovation Test-Bed pilot program to assess whether devices employing Dynamic Spectrum Access techniques can... Spectrum Sharing Innovation Test-Bed (Test-Bed) pilot program to examine the feasibility of increased...

The effect of bedding system selected by manual muscle testing on sleep-related cardiovascular functions.

PubMed

Kuo, Terry B J; Li, Jia-Yi; Lai, Chun-Ting; Huang, Yu-Chun; Hsu, Ya-Chuan; Yang, Cheryl C H

2013-01-01

Different types of mattresses affect sleep quality and waking muscle power. Whether manual muscle testing (MMT) predicts the cardiovascular effects of the bedding system was explored using ten healthy young men. For each participant, two bedding systems, one inducing the strongest limb muscle force (strong bedding system) and the other inducing the weakest limb force (weak bedding system), were identified using MMT. Each bedding system, in total five mattresses and eight pillows of different firmness, was used for two continuous weeks at the participant's home in a random and double-blind sequence. A sleep log, a questionnaire, and a polysomnography were used to differentiate the two bedding systems. Heart rate variability and arterial pressure variability analyses showed that the strong bedding system resulted in decreased cardiovascular sympathetic modulation, increased cardiac vagal activity, and increased baroreceptor reflex sensitivity during sleep as compared to the weak bedding system. Different bedding systems have distinct cardiovascular effects during sleep that can be predicted by MMT.

The Effect of Bedding System Selected by Manual Muscle Testing on Sleep-Related Cardiovascular Functions

PubMed Central

Kuo, Terry B. J.; Li, Jia-Yi; Lai, Chun-Ting; Huang, Yu-Chun; Hsu, Ya-Chuan; Yang, Cheryl C. H.

2013-01-01

Background. Different types of mattresses affect sleep quality and waking muscle power. Whether manual muscle testing (MMT) predicts the cardiovascular effects of the bedding system was explored using ten healthy young men. Methods. For each participant, two bedding systems, one inducing the strongest limb muscle force (strong bedding system) and the other inducing the weakest limb force (weak bedding system), were identified using MMT. Each bedding system, in total five mattresses and eight pillows of different firmness, was used for two continuous weeks at the participant's home in a random and double-blind sequence. A sleep log, a questionnaire, and a polysomnography were used to differentiate the two bedding systems. Results and Conclusion. Heart rate variability and arterial pressure variability analyses showed that the strong bedding system resulted in decreased cardiovascular sympathetic modulation, increased cardiac vagal activity, and increased baroreceptor reflex sensitivity during sleep as compared to the weak bedding system. Different bedding systems have distinct cardiovascular effects during sleep that can be predicted by MMT. PMID:24371836

Reduction of FeO contents in sinter under high bed operation

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

Fujii, K.; Hazama, K.; Hoshikuma, Y.

1996-12-31

High-bed operation (bed height more than 700 mm) is currently being carried out at the Kure No. 1 sintering plant. Before initiating this high-bed operation, the authors conducted sinter pot tests at various bed heights to investigate the effect of bed height on sintering. The following results were obtained from these pot tests: Heightening of the sinter bed increased yield at the upper layer, but at the lower layer, the yield reached a maximum value at a certain bed height. From observation of the sinter cakes, the reduction in yield is attributed to uneven burn caused by surplus heat atmore » the lower layers. Therefore, when high-bed operation is carried out, reduction of the burning energy (reduction of the FeO content in the sinter) is required. This high-bed operation with lower FeO content has enabled the company to reduce fuel consumption and SiO{sub 2} content, while maintaining high yield and high sinter quality.« less

Stress-induced laboratory eating behavior in obese women with binge eating disorder.

PubMed

Laessle, Reinhold G; Schulz, Simone

2009-09-01

To compare the microstructural eating behavior of obese patients with and without binge eating disorder (BED) after stress induction in laboratory. Forty-eight obese women were investigated. Seventeen were assigned to the group of BED. Group (BED vs. non-BED) by condition (stress vs. no stress) interaction effect on feeding variables, measured by a universal eating monitor, was tested. Stress was induced by the trier social stress test (TSST) and chocolate pudding served as laboratory food. From the nonstress to the stress condition, patients with BED, when compared with non-BED had a greater increase in average eating rate (p < .01) and a corresponding greater increase in the frequency of spoonfuls (p < .02). The BED group also showed a different change in acceleration/deceleration from the nonstress to the stress condition compared to the non-BED group (p < .04). Obese individuals with BED appear to exhibit a different response to stress than obese non-BED individuals and individuals with bulimia nervosa.

Response of bed mobility to sediment supply in natural gravel bed channels: A detailed examination and evaluation of mobility parameters

Treesearch

T. E. Lisle; J. M. Nelson; B. L. Barkett; J. Pitlick; M. A. Madej

1998-01-01

Recent laboratory experiments have shown that bed mobility in gravel bed channels responds to changes in sediment supply, but detailed examinations of this adjustment in natural channels have been lacking, and practical methodologies to measure bed mobility have not been tested. We examined six gravel-bed, alternate-bar channels which have a wide range in annual...

Separation of particulate from flue gas of fossil fuel combustion and gasification

DOEpatents

Yang, W.C.; Newby, R.A.; Lippert, T.E.

1997-08-05

The gas from combustion or gasification of fossil fuel contains fly ash and other particulates. The fly ash is separated from the gas in a plurality of standleg moving granular-bed filter modules. Each module includes a dipleg through which the bed media flows into the standleg. The bed media forms a first filter bed having an upper mass having a first frusto-conical surface in a frusto-conical member at the entrance to the standleg and a lower mass having a second frusto-conical surface of substantially greater area than the first surface after it passes through the standleg. A second filter media bed may be formed above the first filter media bed. The gas is fed tangentially into the module above the first surface. The fly ash is captured on the first frusto-conical surface and within the bed mass. The processed gas flows out through the second frusto-conical surface and then through the second filter bed, if present. The bed media is cleaned of the captured fly ash and recirculated to the moving granular bed filter. Alternatively, the bed media may be composed of the ash from the combustion which is pelletized to form agglomerates. The ash flows through the bed only once; it is not recycled. 11 figs.

Separation of particulate from flue gas of fossil fuel combustion and gasification

DOEpatents

Yang, Wen-Ching; Newby, Richard A.; Lippert, Thomas E.

1997-01-01

The gas from combustion or gasification of fossil fuel contains flyash and other particulate. The flyash is separated from the gas in a plurality of standleg moving granular-bed filter modules. Each module includes a dipleg through which the bed media flows into the standleg. The bed media forms a first filter bed having an upper mass having a first frusto-conical surface in a frusto-conical member at the entrance to the standleg and a lower mass having a second frusto-conical surface of substantially greater area than the first surface after it passes through the standleg. A second filter media bed may be formed above the first filter media bed. The gas is fed tangentially into the module above the first surface. The flyash is captured on the first frusto-conical surface and within the bed mass. The processed gas flows out through the second frusto-conical surface and then through the second filter bed, if present. The bed media is cleaned of the captured flyash and recirculated to the moving granular bed filter. Alternatively, the bed media may be composed of the ash from the combustion which is pelletized to form agglomerates. The ash flows through the bed only once; it is not recycled.

Variability of Bed Load Transport During Six Summers of Continuous Measurements in Two Austrian Mountain Streams (Fischbach and Ruetz)

NASA Astrophysics Data System (ADS)

Rickenmann, Dieter

2018-01-01

Previous measurements of bed load transport in gravel bed streams revealed a large temporal and spatial variability of bed load transport rates. Using an impact plate geophone system, continuous bed load transport measurements were made during 6 years in two mountain streams in Austria. The two streams have a snow-melt and glacier-melt dominated hydrologic regime resulting in frequent transport activity during the summer half year. Periods of days to weeks were identified which are associated with approximately constant Shields values that indicate quasi-stable bed conditions. Between these stable periods, the position of the bed load transport function varied while its steepness remained approximately constant. For integration time scales of several hours to 1 day, the fluctuations in bed load transport decreased and the correlation between bed load transport and water discharge increased. For integration times of about 70-100 days, bed load transport is determined by discharge or shear stress to within a factor of about 2, relative to the 6 year mean level. Bed load texture increased with increasing mean flow strength and mean transport intensity. Weak and predominantly clockwise daily hysteresis of bed load transport was found for the first half of the summer period.

[Fire behavior of Mongolian oak leaves fuel-bed under no-wind and zero-slope conditions. I. Factors affecting fire spread rate and modeling].

PubMed

Jin, Sen; Liu, Bo-Fei; Di, Xue-Ying; Chu, Teng-Fei; Zhang, Ji-Li

2012-01-01

Aimed to understand the fire behavior of Mongolian oak leaves fuel-bed under field condition, the leaves of a secondary Mongolian oak forest in Northeast Forestry University experimental forest farm were collected and brought into laboratory to construct fuel-beds with varied loading, height, and moisture content, and a total of 100 experimental fires were burned under no-wind and zero-slope conditions. It was observed that the fire spread rate of the fuel-beds was less than 0.5 m x min(-1). Fuel-bed loading, height, and moisture contents all had significant effects on the fire spread rate. The effect of fuel-bed moisture content on the fire spread had no significant correlations with fuel-bed loading and height, but the effect of fuel-bed height was related to the fuel-bed loading. The packing ratio of fuel-beds had less effect on the fire spread rate. Taking the fuel-bed loading, height, and moisture content as predictive variables, a prediction model for the fire spread rate of Mongolian oak leaves fuel-bed was established, which could explain 83% of the variance of the fire spread rate, with a mean absolute error 0.04 m x min(-1) and a mean relative error less than 17%.

Trends in infant bedding use: National Infant Sleep Position study, 1993-2010.

PubMed

Shapiro-Mendoza, Carrie K; Colson, Eve R; Willinger, Marian; Rybin, Denis V; Camperlengo, Lena; Corwin, Michael J

2015-01-01

Use of potentially hazardous bedding, as defined by the American Academy of Pediatrics (eg, pillows, quilts, comforters, loose bedding), is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation. The proportion of US infants sleeping with these types of bedding is unknown. To investigate the US prevalence of and trends in bedding use, we analyzed 1993-2010 data from the National Infant Sleep Position study. Infants reported as being usually placed to sleep with blankets, quilts, pillows, and other similar materials under or covering them in the last 2 weeks were classified as bedding users. Logistic regression was used to describe characteristics associated with bedding use. From 1993 to 2010, bedding use declined but remained a widespread practice (moving average of 85.9% in 1993-1995 to 54.7% in 2008-2010). Prevalence was highest for infants of teen-aged mothers (83.5%) and lowest for infants born at term (55.6%). Bedding use was also frequently reported among infants sleeping in adult beds, on their sides, and on a shared surface. The rate of decline in bedding use was markedly less from 2001-2010 compared with 1993-2000. For 2007 to 2010, the strongest predictors (adjusted odds ratio: ≥1.5) of bedding use were young maternal age, non-white race and ethnicity, and not being college educated. Bedding use for infant sleep remains common despite recommendations against this practice. Understanding trends in bedding use is important for tailoring safe sleep interventions. Copyright © 2015 by the American Academy of Pediatrics.

Trends in Infant Bedding Use: National Infant Sleep Position Study, 1993–2010

PubMed Central

Colson, Eve R.; Willinger, Marian; Rybin, Denis V.; Camperlengo, Lena; Corwin, Michael J.

2015-01-01

BACKGROUND: Use of potentially hazardous bedding, as defined by the American Academy of Pediatrics (eg, pillows, quilts, comforters, loose bedding), is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation. The proportion of US infants sleeping with these types of bedding is unknown. METHODS: To investigate the US prevalence of and trends in bedding use, we analyzed 1993–2010 data from the National Infant Sleep Position study. Infants reported as being usually placed to sleep with blankets, quilts, pillows, and other similar materials under or covering them in the last 2 weeks were classified as bedding users. Logistic regression was used to describe characteristics associated with bedding use. RESULTS: From 1993 to 2010, bedding use declined but remained a widespread practice (moving average of 85.9% in 1993–1995 to 54.7% in 2008–2010). Prevalence was highest for infants of teen-aged mothers (83.5%) and lowest for infants born at term (55.6%). Bedding use was also frequently reported among infants sleeping in adult beds, on their sides, and on a shared surface. The rate of decline in bedding use was markedly less from 2001–2010 compared with 1993–2000. For 2007 to 2010, the strongest predictors (adjusted odds ratio: ≥1.5) of bedding use were young maternal age, non-white race and ethnicity, and not being college educated. CONCLUSIONS: Bedding use for infant sleep remains common despite recommendations against this practice. Understanding trends in bedding use is important for tailoring safe sleep interventions. PMID:25452654

Unusual seismogenic soft-sediment deformation structures in Cambrian epicratonic carbonate deposits, western Colorado, U.S.A

NASA Astrophysics Data System (ADS)

Myrow, P.; Chen, J.

2013-12-01

A wide variety of unusual penecontemporaneous deformation structures exist in grainstone and flat-pebble conglomerate beds of the Upper Cambrian strata, western Colorado, including slide scarps, thrusted beds, irregular blocks and internally deformed beds. Slide scarps are characterized by concave-up, sharp surfaces that truncate one or more underlying beds. Thrusted beds record movement of a part of a bed onto itself along a moderate to steeply inclined (generally 25°-40°) ramp. The hanging wall lenses in cases show fault-bend geometries, with either intact or mildly deformed bedding. Irregular bedded to internally deformed blocks isolated on generally flat upper bedding surfaces are similar in composition to the underlying beds. These features represent parts of beds that were detached, moved up onto, and some distances across, the laterally adjacent undisturbed bed surfaces. The blocks moved either at the sediment-water interface or intrastratally at shallow depths within overlying muddy deposits. Finally, internally deformed beds have large blocks, fitted fabrics of highly irregular fragments, and contorted lamination, which represent heterogeneous deformation, such as brecciation and liquefaction. The various deformation structures were most probably triggered by earthquakes, considering the nature of deformation (regional distribution of liquefaction structures, and the brittle segmentation and subsequent transportation of semi-consolidated beds) and the reactivation of Mesoproterozoic, crustal-scale shear zones in the central Rockies during the Late Cambrian. Features produced by initial brittle deformation are unusual relative to most reported seismites, and may represent poorly recognized to unrecognized seismogenic structures in the rock record.

Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study

PubMed Central

Fuller, Christopher; Savage, Joan; Cookson, Barry; Hayward, Andrew; Cooper, Ben; Duckworth, Georgia; Michie, Susan; Murray, Miranda; Jeanes, Annette; Roberts, J; Teare, Louise; Charlett, Andre

2012-01-01

Objective To evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement. Design Prospective, ecological, interrupted time series study from 1 July 2004 to 30 June 2008. Setting 187 acute trusts in England and Wales. Intervention Installation of bedside alcohol hand rub, materials promoting hand hygiene and institutional engagement, regular hand hygiene audits, rolled out nationally from 1 December 2004. Main outcome measures Quarterly (that is, every three months) rates for each trust of hospital procurement of alcohol hand rub and liquid soap; Staphylococcus aureus bacteraemia (meticillin resistant (MRSA) and meticillin sensitive (MSSA)) and Clostridium difficile infection for each trust. Associations between procurement and infection rates assessed by mixed effect Poisson regression model (which also accounted for effect of bed occupancy, hospital type, and timing of other national interventions targeting these infections). Results Combined procurement of soap and alcohol hand rub tripled from 21.8 to 59.8 mL per patient bed day; procurement rose in association with each phase of the campaign. Rates fell for MRSA bacteraemia (1.88 to 0.91 cases per 10 000 bed days) and C difficile infection (16.75 to 9.49 cases). MSSA bacteraemia rates did not fall. Increased procurement of soap was independently associated with reduced C difficile infection throughout the study (adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993, 95% confidence interval 0.990 to 0.996; P<0.0001). Increased procurement of alcohol hand rub was independently associated with reduced MRSA bacteraemia, but only in the last four quarters of the study (0.990, 0.985 to 0.995; P<0.0001). Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia (0.86, 0.75 to 0.98; P=0.02) and C difficile infection (0.75, 0.67 to 0.84; P<0.0001). Trust visits by Department of Health improvement teams were also associated with reduced MRSA bacteraemia (0.91, 0.83 to 0.99; P=0.03) and C difficile infection (0.80, 0.71 to 0.90; P=0.01), for at least two quarters after each visit. Conclusions The Cleanyourhands campaign was associated with sustained increases in hospital procurement of alcohol rub and soap, which the results suggest has an important role in reducing rates of some healthcare associated infections. National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections. PMID:22556101

Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.

PubMed

Stone, Sheldon Paul; Fuller, Christopher; Savage, Joan; Cookson, Barry; Hayward, Andrew; Cooper, Ben; Duckworth, Georgia; Michie, Susan; Murray, Miranda; Jeanes, Annette; Roberts, J; Teare, Louise; Charlett, Andre

2012-05-03

To evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement. Prospective, ecological, interrupted time series study from 1 July 2004 to 30 June 2008. 187 acute trusts in England and Wales. Installation of bedside alcohol hand rub, materials promoting hand hygiene and institutional engagement, regular hand hygiene audits, rolled out nationally from 1 December 2004. Quarterly (that is, every three months) rates for each trust of hospital procurement of alcohol hand rub and liquid soap; Staphylococcus aureus bacteraemia (meticillin resistant (MRSA) and meticillin sensitive (MSSA)) and Clostridium difficile infection for each trust. Associations between procurement and infection rates assessed by mixed effect Poisson regression model (which also accounted for effect of bed occupancy, hospital type, and timing of other national interventions targeting these infections). Combined procurement of soap and alcohol hand rub tripled from 21.8 to 59.8 mL per patient bed day; procurement rose in association with each phase of the campaign. Rates fell for MRSA bacteraemia (1.88 to 0.91 cases per 10,000 bed days) and C difficile infection (16.75 to 9.49 cases). MSSA bacteraemia rates did not fall. Increased procurement of soap was independently associated with reduced C difficile infection throughout the study (adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993, 95% confidence interval 0.990 to 0.996; P < 0.0001). Increased procurement of alcohol hand rub was independently associated with reduced MRSA bacteraemia, but only in the last four quarters of the study (0.990, 0.985 to 0.995; P < 0.0001). Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia (0.86, 0.75 to 0.98; P = 0.02) and C difficile infection (0.75, 0.67 to 0.84; P < 0.0001). Trust visits by Department of Health improvement teams were also associated with reduced MRSA bacteraemia (0.91, 0.83 to 0.99; P=0.03) and C difficile infection (0.80, 0.71 to 0.90; P=0.01), for at least two quarters after each visit. The Cleanyourhands campaign was associated with sustained increases in hospital procurement of alcohol rub and soap, which the results suggest has an important role in reducing rates of some healthcare associated infections. National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections.

75 FR 24572 - Foreign-Trade Zone 29 - Louisville, Kentucky, Application for Subzone, Louisville Bedding Company...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... - Louisville, Kentucky, Application for Subzone, Louisville Bedding Company (Household Bedding Products...-purpose subzone status for the bedding products manufacturing facilities of Louisville Bedding Company..., Louisville; Site 2 - warehouse (4.3 acres) located at 100 Quality Street, Munfordville; and, Site 3...

75 FR 28554 - Foreign-Trade Zone 50 Long Beach, California, Application for Subzone, Louisville Bedding Company...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-21

..., California, Application for Subzone, Louisville Bedding Company (Household Bedding Products), Ontario... Avenue in Ontario, California. The facility is used to manufacture household bedding products, including... shipments for the domestic market, the finished household bedding products would be entered for consumption...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

3-D capacitance density imaging of fluidized bed

DOEpatents

Fasching, George E.

1990-01-01

A three-dimensional capacitance density imaging of a gasified bed or the like in a containment vessel is achieved using a plurality of electrodes provided circumferentially about the bed in levels and along the bed in channels. The electrodes are individually and selectively excited electrically at each level to produce a plurality of current flux field patterns generated in the bed at each level. The current flux field patterns are suitably sensed and a density pattern of the bed at each level determined. By combining the determined density patterns at each level, a three-dimensional density image of the bed is achieved.

Correlation of Paleocene Harmon and Hansen lignite beds, Adams, Billings, Bowman, Golden Valley, Hettinger, and Slope Counties, Williston Basin, North Dakota

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

Keighin, C.W.; Flores, R.M.; Ochs, A.

In southwestern North Dakota, minable lignite beds in the Paleocene Fort Union Formation include the Harmon and Hansen beds in the Bowman-Gascoyne area. Data from more than 700 drill holes penetrating these beds was used to construct stratigraphic cross sections. The Harmon and Hansen beds are the thickest and most laterally persistent lignites found under < 150 ft of overburden. The Harmon coal bed is as much as 34 ft thick, and is often split by claystone interbeds of variable thickness. The Hansen coal bed typically occurs 10--100 ft below the Harmon coal bed; it rarely attains a thickness ofmore » 15 ft, and averages 4 ft in thickness.« less

Effect of bed characters on the direct synthesis of dimethyldichlorosilane in fluidized bed reactor.

PubMed

Zhang, Pan; Duan, Ji H; Chen, Guang H; Wang, Wei W

2015-03-06

This paper presents the numerical investigation of the effects of the general bed characteristics such as superficial gas velocities, bed temperature, bed heights and particle size, on the direct synthesis in a 3D fluidized bed reactor. A 3D model for the gas flow, heat transfer, and mass transfer was coupled to the direct synthesis reaction mechanism verified in the literature. The model was verified by comparing the simulated reaction rate and dimethyldichlorosilane (M2) selectivity with the experimental data in the open literature and real production data. Computed results indicate that superficial gas velocities, bed temperature, bed heights, and particle size have vital effect on the reaction rates and/or M2 selectivity.

Effect of Bed Characters on the Direct Synthesis of Dimethyldichlorosilane in Fluidized Bed Reactor

PubMed Central

Zhang, Pan; Duan, Ji H.; Chen, Guang H.; Wang, Wei W.

2015-01-01

This paper presents the numerical investigation of the effects of the general bed characteristics such as superficial gas velocities, bed temperature, bed heights and particle size, on the direct synthesis in a 3D fluidized bed reactor. A 3D model for the gas flow, heat transfer, and mass transfer was coupled to the direct synthesis reaction mechanism verified in the literature. The model was verified by comparing the simulated reaction rate and dimethyldichlorosilane (M2) selectivity with the experimental data in the open literature and real production data. Computed results indicate that superficial gas velocities, bed temperature, bed heights, and particle size have vital effect on the reaction rates and/or M2 selectivity. PMID:25742729

Bed Bugs (Cimex lectularius) as Vectors of Trypanosoma cruzi

PubMed Central

Salazar, Renzo; Castillo-Neyra, Ricardo; Tustin, Aaron W.; Borrini-Mayorí, Katty; Náquira, César; Levy, Michael Z.

2015-01-01

Populations of the common bed bug, Cimex lectularius, have recently undergone explosive growth. Bed bugs share many important traits with triatomine insects, but it remains unclear whether these similarities include the ability to transmit Trypanosoma cruzi, the etiologic agent of Chagas disease. Here, we show efficient and bidirectional transmission of T. cruzi between hosts and bed bugs in a laboratory environment. Most bed bugs that fed on experimentally infected mice acquired the parasite. A majority of previously uninfected mice became infected after a period of cohabitation with exposed bed bugs. T. cruzi was also transmitted to mice after the feces of infected bed bugs were applied directly to broken host skin. Quantitative bed bug defecation measures were similar to those of important triatomine vectors. Our findings suggest that the common bed bug may be a competent vector of T. cruzi and could pose a risk for vector-borne transmission of Chagas disease. PMID:25404068

Bed bugs, public health, and social justice: Part 2, An opinion survey.

PubMed

Eddy, Christopher; Jones, Susan C

2011-04-01

Bed bug infestations have resurged globally, nationally, and locally, yet the public health community in the U.S. has yet to mount a coordinated response to the escalating bed bug problem. Surveys of attendees at the 2009 National Environmental Health Association Annual Educational Conference & Exhibition, 2009 Ohio Association of Health Commissioners Fall Conference, 2009 Central Ohio Bed Bug Summit, and 2010 Hamilton County Council on Aging Annual Conference were conducted to gauge opinions about bed bugs. Survey results revealed that 90% of all respondents considered bed bugs to be a public health concern, and 73% indicated that bed bugs pose an environmental justice concern. These findings, which indicate that bed bugs are an inescapable public health mandate with environmental justice undertones, should rally public health agencies at federal, state, and local levels to respond with authority of agency to the escalating bed bug problem.

Relationship between fluid bed aerosol generator operation and the aerosol produced

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

Carpenter, R.L.; Yerkes, K.

1980-12-01

The relationships between bed operation in a fluid bed aerosol generator and aerosol output were studied. A two-inch diameter fluid bed aerosol generator (FBG) was constructed using stainless steel powder as a fluidizing medium. Fly ash from coal combustion was aerosolized and the influence of FBG operating parameters on aerosol mass median aerodynamic diameter (MMAD), geometric standard deviation (sigma/sub g/) and concentration was examined. In an effort to extend observations on large fluid beds to small beds using fine bed particles, minimum fluidizing velocities and elutriation constant were computed. Although FBG minimum fluidizing velocity agreed well with calculations, FBG elutriationmore » constant did not. The results of this study show that the properties of aerosols produced by a FBG depend on fluid bed height and air flow through the bed after the minimum fluidizing velocity is exceeded.« less

Differences in sleep complaints in adults with varying levels of bed days residing in extended care facilities for chronic disease management.

PubMed

Fox, Mary T; Sidani, Souraya; Brooks, Dina

2010-05-01

This cohort study examined differences in perceived insomnia and daytime sleepiness in 67 adults residing in extended care facilities for chronic disease management who had varying levels of bed days. One bed day was defined as spending 24 hours in bed. Planned pairwise comparisons, using Bonferroni adjustment, were made between participants who spent 0 (n = 21), 2 to 4 (n = 23), and 5 to 7 (n = 23) days in bed during 1 week of monitoring. Participants who spent 5 to 7 days in bed had significantly greater insomnia than those who spent 2 to 4 days in bed. No group differences were found in daytime sleepiness. Based on the findings, nurses may assess subjective insomnia and explore sleep hygiene strategies, such as increasing time out of bed with patients who have high levels of 5 to 7 bed days.

Ethnic differences in prevalence and determinants of mother-child bed-sharing in early childhood.

PubMed

Luijk, Maartje P C M; Mileva-Seitz, Viara R; Jansen, Pauline W; van IJzendoorn, Marinus H; Jaddoe, Vincent W V; Raat, Hein; Hofman, Albert; Verhulst, Frank C; Tiemeier, Henning

2013-11-01

To date few studies have examined how multiple layers of influences shape the emergence of bed-sharing practices in the first 2 years postpartum. In our report, we examined bed-sharing in a large multiethnic sample, exploring the influences of three broad classes of influence on bed-sharing at single time points and across time: (1) sociodemographic and (2) contextual factors such as breastfeeding, maternal mental health and stress, and (3) child temperament and sleep habits. Frequencies of bed-sharing were assessed at two time points, 2 and 24 months, in a population-based multiethnic (Dutch, Turkish or Moroccan, and Caribbean) sample of 6309 children born in the Netherlands. In Dutch mothers, the majority of mothers did not share their beds with their child, and bed-sharing rates decreased from 2 to 24 months. Other ethnic groups showed higher bed-sharing rates, typified by both increases in bed-sharing (the Turkish and Moroccan group) and persistence of bed-sharing over time (the Caribbean group). There were few family and child characteristics associated with bed-sharing in the non-Dutch ethnic groups. In contrast, bed-sharing in Dutch mothers was associated with child temperament and sleeping problems, maternal depression, and sociodemographic variables like crowding and maternal education. Our results suggest that mothers with a Turkish and Moroccan or Caribbean background were more influenced by cultural values, whereas bed-sharing practices were more reactive in the Dutch group. Copyright © 2013 Elsevier B.V. All rights reserved.

Clinical phenotype of bipolar disorder with comorbid binge eating disorder

PubMed Central

McElroy, Susan L.; Crow, Scott; Biernacka, Joanna M.; Winham, Stacey; Geske, Jennifer; Cuellar Barboza, Alfredo B.; Prieto, Miguel L.; Chauhan, Mohit; Seymour, Lisa R.; Mori, Nicole; Frye, Mark A.

2017-01-01

Background To explore the relationship between binge eating disorder (BED) and obesity in patients with bipolar disorder (BP). Methods 717 patients participating in the Mayo Clinic Bipolar Biobank completed structured diagnostic interviews and questionnaires for demographic and illness-related variables. They also had weight and height measured to determine body mass index (BMI). The effects of BED and obesity (BMI≥30 kg/m2), as well as their interaction, were assessed on one measure of general medical burden and six proxies of psychiatric illness burden. Results 9.5% of patients received a clinical diagnosis of BED and 42.8% were obese. BED was associated with a significantly elevated BMI. Both BED and obesity were associated with greater psychiatric and general illness burden, but illness burden profiles differed. After controlling for obesity, BED was associated with suicidality, psychosis, mood instability, anxiety disorder comorbidity, and substance abuse comorbidity. After controlling for BED status, obesity was associated with greater general medical comorbidity, but lower substance abuse comorbidity. There were no significant interaction effects between obesity and BED, or BMI and BED, on any illness burden outcome. Limitations There may have been insufficient power to detect interactions between BED and obesity. Conclusions: Among patients with BP, BED and obesity are highly prevalent and correlated, but associated with different profiles of enhanced illness burden. As the association of BED with greater psychiatric illness burden remained significant even after accounting for the effect of obesity, BP with BED may represent a clinically important sub-phenotype. PMID:23742827

Debris-bed friction of hard-bedded glaciers

USGS Publications Warehouse

Cohen, D.; Iverson, N.R.; Hooyer, T.S.; Fischer, U.H.; Jackson, M.; Moore, P.L.

2005-01-01

[1] Field measurements of debris-bed friction on a smooth rock tablet at the bed of Engabreen, a hard-bedded, temperate glacier in northern Norway, indicated that basal ice containing 10% debris by volume exerted local shear traction of up to 500 kPa. The corresponding bulk friction coefficient between the dirty basal ice and the tablet was between 0.05 and 0.08. A model of friction in which nonrotating spherical rock particles are held in frictional contact with the bed by bed-normal ice flow can account for these measurements if the power law exponent for ice flowing past large clasts is 1. A small exponent (n < 2) is likely because stresses in ice are small and flow is transient. Numerical calculations of the bed-normal drag force on a sphere in contact with a flat bed using n = 1 show that this force can reach values several hundred times that on a sphere isolated from the bed, thus drastically increasing frictional resistance. Various estimates of basal friction are obtained from this model. For example, the shear traction at the bed of a glacier sliding at 20 m a-1 with a geothermally induced melt rate of 0.006 m a-1 and an effective pressure of 300 kPa can exceed 100 kPa. Debris-bed friction can therefore be a major component of sliding resistance, contradicting the common assumption that debris-bed friction is negligible. Copyright 2005 by the American Geophysical Union.

Relationship Between Faults Oriented Parallel and Oblique to Bedding in Neogene Massive Siliceous Mudstones at The Horonobe Underground Research Laboratory, Japan

NASA Astrophysics Data System (ADS)

Hayano, Akira; Ishii, Eiichi

2016-10-01

This study investigates the mechanical relationship between bedding-parallel and bedding-oblique faults in a Neogene massive siliceous mudstone at the site of the Horonobe Underground Research Laboratory (URL) in Hokkaido, Japan, on the basis of observations of drill-core recovered from pilot boreholes and fracture mapping on shaft and gallery walls. Four bedding-parallel faults with visible fault gouge, named respectively the MM Fault, the Last MM Fault, the S1 Fault, and the S2 Fault (stratigraphically, from the highest to the lowest), were observed in two pilot boreholes (PB-V01 and SAB-1). The distribution of the bedding-parallel faults at 350 m depth in the Horonobe URL indicates that these faults are spread over at least several tens of meters in parallel along a bedding plane. The observation that the bedding-oblique fault displaces the Last MM fault is consistent with the previous interpretation that the bedding- oblique faults formed after the bedding-parallel faults. In addition, the bedding-parallel faults terminate near the MM and S1 faults, indicating that the bedding-parallel faults with visible fault gouge act to terminate the propagation of younger bedding-oblique faults. In particular, the MM and S1 faults, which have a relatively thick fault gouge, appear to have had a stronger control on the propagation of bedding-oblique faults than did the Last MM fault, which has a relatively thin fault gouge.

Reported bed net ownership and use in social contacts is associated with uptake of bed nets for malaria prevention in pregnant women in Ghana.

PubMed

Ernst, Kacey C; Erly, Steven; Adusei, Charity; Bell, Melanie L; Kessie, David Komla; Biritwum-Nyarko, Alberta; Ehiri, John

2017-01-04

Despite progress made in the last decades, malaria persists as a pressing health issue in sub-Saharan Africa. Pregnant women are particularly vulnerable to infection and serious health outcomes for themselves and their unborn child. Risk can be mitigated through appropriate use of control measures such as insecticide-treated bed nets. Although social networks can influence uptake of preventive strategies, the role of social influence on bed net ownership has not been explored. During an evaluation of a bed net distribution programme, the influence of non-health care advisors on ownership and use of bed nets by pregnant women in Kumasi, Ghana was examined. Data were collected through in-person interviews with 300 pregnant women seeking antenatal care in an urban hospital in Kumasi, Ghana. Participants were asked about their bed net ownership, bed net use, and information about three personal contacts that they go to for pregnancy advice. Information about these advisors was combined into an influence score. Logistic regression models were used to determine the association between the score and bed net ownership. Those who owned a bed net were further assessed to determine if interpersonal influence was associated with self-reported sleeping under the bed net the previous night. Of the 294 women in the analysis, 229 (78%) reported owning bed nets. Of these bed net owners, 139 (61%) reported using a bed net the previous night. A dose response relationship was observed between the interpersonal influence score and bed net ownership and use. Compared to the lowest influence score, those with the highest influence score (>1 SD above the mean) were marginally more likely to own a bed net [OR = 2.37, 95% CI (0.87, 6.39)] and much more likely to use their bed net [5.38, 95% CI (1.89, 15.25)] after adjusting for other factors. Interpersonal influence appears to have modest impact on ownership and use of bed nets by pregnant women in an urban area of Ghana. Further investigations would need to be conducted to determine if the relationship is causal or if individuals who associate are simply more likely to have similar practices.

Infant's bed climate and bedding in the Japanese home.

PubMed

Nakamura Ikeda, Rie; Fukai, Kiyoko; Okamoto Mizuno, Kazue

2012-06-01

to assess the bed climate of infants in their homes in Japan. descriptive, exploratory, non-experimental research design. the data were collected at the participants' homes under normal circumstances. nineteen healthy infants between the ages of two and five months. Their mothers, who joined a parenting class organised by a maternity clinic in Okayama, Japan, consented to participate in this study. we visited the infants' homes and interviewed their mothers concerning the types and use of bedding. The temperature and relative humidity of the bed climate at the back and foot of the bedding, and in the room were measured every minute for four consecutive days. Differences among the bed climates measured during three seasons (spring, summer, and autumn) were assessed by one-way analysis of variance. The bed temperature was higher for infants than for adults. No significant difference in temperature was noted among the three seasons. The bed temperature was about 36.0°C when waterproof sheets and futon mattresses for children or adult were used. The average relative humidity of the bed climate at the back was highest in summer, followed by that in spring and autumn; the differences were significant. The use of waterproof sheets and futon mattresses for children in summer increased the relative humidity to 80% or more. The use of infant beds, sunoko drainboards, and cotton futon mattresses in summer was effective in reducing the bed humidity. these results suggest that nurse-midwives should advise the parents on comfortable bed climates for their infants, as well as how to select and use bedding for them. Copyright © 2010 Elsevier Ltd. All rights reserved.

Repellency of selected chemicals against the bed bug (Hemiptera: Cimicidae).

PubMed

Wang, Changlu; Lü, Lihua; Zhang, Aijun; Liu, Chaofeng

2013-12-01

In recent years, the common bed bug, Cimex lectularius L. (Hemiptera: Cimicidae), became a major public health concern in urban communities. Bed bugs are notoriously difficult to control, and their bites are not tolerated by most people. The public has an urgent need for materials and methods to reduce bed bug introduction and bites during work, travel, or sleep. A repellent product will help achieve these goals by discouraging and preventing bed bugs from moving to a protected area. We evaluated the repellency of three commercially available insect repellent or control materials and five nonregistered materials with the goal of identifying safe and effective bed bug repellents. The two commercial repellent products that contained 7% picaridin or 0.5% permethrin had little repellency against bed bugs. N,N-diethyl-m-toluamide (DEET), the most commonly used insect repellent, provided a high level of repellency against bed bugs. When a host cue (carbon dioxide) was present, the minimum DEET concentration to repel > or = 94% of the bed bugs for a9-h period was 10%. The longevity of repellency of DEET was concentration dependent. At 25% concentration, DEET-treated fabric surface remained highly repellent to bed bugs for a 14-d period. However, DEET has a strong smell and dissolves certain plastic materials. Therefore, we evaluated several odorless, noncorrosive, and potentially effective repellents. Isolongifolenone and isolongifolanone, two natural products and recently reported insect repellents, exhibited strong repellent property against bed bugs but at significantly lower levels than DEET. Three novel potential repellent compounds discovered by Bedoukian Research Inc. (Danbury, CT) exhibited similar level of repellency and longevity as DEET for repelling bed bugs. These nonirritant and odorless compounds are promising candidates as alternatives to DEET for reducing the spread of bed bugs and bed bug bites.

The Effects of Long Duration Bed Rest on Functional Mobility and Balance: Relationship to Resting State Motor Cortex Connectivity

NASA Technical Reports Server (NTRS)

Erdeniz, B.; Koppelmans, V.; Bloomberg, J. J.; Kofman, I. S.; DeDios, Y. E.; Riascos-Castaneda, R. F.; Wood, S. J.; Mulavara, A. P.; Seidler, R. D.

2014-01-01

NASA offers researchers from a variety of backgrounds the opportunity to study bed rest as an experimental analog for space flight. Extended exposure to a head-down tilt position during long duration bed rest can resemble many of the effects of a low-gravity environment such as reduced sensory inputs, body unloading and increased cephalic fluid distribution. The aim of our study is to a) identify changes in brain function that occur with prolonged bed rest and characterize their recovery time course; b) assess whether and how these changes impact behavioral and neurocognitive performance. Thus far, we completed data collection from six participants that include task based and resting state fMRI. The data have been acquired through the bed rest facility located at the University of Texas Medical Branch (Galveston, TX). Subjects remained in bed with their heads tilted down 6 degrees below their feet for 70 consecutive days. Behavioral measures and neuroimaging assessments were obtained at seven time points: a) 7 and 12 days before bed rest; b) 7, 30, and 65 days during bed rest; and c) 7 and 12 days after bed rest. Functional connectivity magnetic resonance imaging (FcMRI) analysis was performed to assess the connectivity of motor cortex in and out of bed rest. We found a decrease in motor cortex connectivity with vestibular cortex and the cerebellum from pre bed rest to in bed rest. We also used a battery of behavioral measures including the functional mobility test and computerized dynamic posturography collected before and after bed rest. We will report the preliminary results of analyses relating brain and behavior changes. Furthermore, we will also report the preliminary results of a spatial working memory task and vestibular stimulation during in and out of bed rest.

Characterization of Binge-Eating Behavior in Individuals With Binge-Eating Disorder in an Adult Population in the United States.

PubMed

Pawaskar, Manjiri; Solo, Kirk; Valant, Jason; Schmitt, Emily; Nwankwo, Millicent; Herman, Barry K

2016-10-27

Characterize the frequency, duration, and severity of binge-eating behaviors in adults meeting DSM-5 criteria for binge-eating disorder (BED) in a large US community sample. A representative sample of US adults from the National Health and Wellness Survey was recruited from an online panel and asked to respond to an Internet survey (conducted in October 2013) that included questions designed to assess binge-eating behaviors in relation to DSM-5 BED diagnostic criteria. Of 22,397 respondents, 344 self-reported meeting DSM-5 BED criteria (BED respondents). Most BED respondents reported that binge-eating episodes had occurred for the past 7-12 months (61.0%), and 93.6% reported ≥ 2-3 binge-eating episodes/wk. All BED respondents reported that "extreme" (52.6%) or "great" (47.4%) distress levels were associated with binge-eating episodes. Among BED respondents who agreed to provide detailed binge-eating behavior data after being invited to respond to additional survey questions, 40.6% reported binge eating on average > 1 time/d, and 59.2% reported binge eating 2-3 times/d. For 44.5% of BED respondents, binge-eating duration was 31-60 minutes. BED respondents reported that they "very often" (36.6%) or "often" (34.0%) had urges to binge eat between 7-10 pm. "Feeling disgusted with oneself, depressed, or guilty afterward" was the most bothersome symptom of binge eating for BED respondents (extremely bothersome: 41.9%). Binge-eating frequency among BED respondents averaged once daily. Most BED respondents exhibited binge-eating behavior for 7-12 months, often with severe symptoms. These findings highlight the disease burden of BED and have potential implications for diagnosing and treating BED. © Copyright 2016 Physicians Postgraduate Press, Inc.

Ammonia, Total Reduced Sulfides, and Greenhouse Gases of Pine Chip and Corn Stover Bedding Packs.

PubMed

Spiehs, Mindy J; Brown-Brandl, Tami M; Parker, David B; Miller, Daniel N; Berry, Elaine D; Wells, James E

2016-03-01

Bedding materials may affect air quality in livestock facilities. Our objective in this study was to compare headspace concentrations of ammonia (NH), total reduced sulfides (TRS), carbon dioxide (CO), methane (CH), and nitrous oxide (NO) when pine wood chips ( spp.) and corn stover ( L.) were mixed in various ratios (0, 10, 20, 30, 40, 60, 80, and 100% pine chips) and used as bedding with manure. Air samples were collected from the headspace of laboratory-scaled bedded manure packs weekly for 42 d. Ammonia concentrations were highest for bedded packs containing 0, 10, and 20% pine chips (equivalent to 501.7, 502.3, and 502.3 mg m, respectively) in the bedding mixture and were lowest when at least 80% pine chips were used as bedding (447.3 and 431.0 mg m, respectively for 80 and 100% pine chip bedding). The highest NH concentrations were observed at Day 28. The highest concentration of TRS was observed when 100% pine chips were used as bedding (11.4 µg m), with high concentrations occurring between Days 7 and 14, and again at Day 35. Greenhouse gases were largely unaffected by bedding material but CH and CO concentrations increased as the bedded packs aged and NO concentrations were highly variable throughout the incubation. We conclude that a mixture of bedding material that contains 30 to 40% pine chips may be the ideal combination to reduce both NH and TRS emissions. All gas concentrations increased as the bedded packs aged, suggesting that frequent cleaning of facilities would improve air quality in the barn, regardless of bedding materials used. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Material exchange and food web of seagrass beds in the Sylt-Rømø Bight: how significant are community changes at the ecosystem level?

NASA Astrophysics Data System (ADS)

Asmus, H.; Asmus, R.

2000-07-01

Material exchange, biodiversity and trophic transfer within the food web were investigated in two different types of intertidal seagrass beds: a sheltered, dense Zostera marina bed and a more exposed, sparse Z. noltii bed, in the Northern Wadden Sea. Both types of Zostera beds show a seasonal development of above-ground biomass, and therefore measurements were carried out during the vegetation period in summer. The exchange of particles and nutrients between seagrass beds and the overlying water was measured directly using an in situ flume. Particle sedimentation [carbon (C), nitrogen (N) and phosphorus (P) constituents] from the water column prevailed in dense seagrass beds. In the sheltered, dense seagrass bed, a net particle uptake was found even on windy days (7-8 Beaufort). Dissolved inorganic N and orthophosphate were mainly taken up by the dense seagrass bed. At times of strong winds, nutrients were released from the benthic community to tidal waters. In a budget calculation of total N and total P, the dense seagrass beds were characterised as a material sink. The seagrass beds with sparse Z. noltii were a source of particles even during calm weather. The uptake of dissolved inorganic N in the sparse seagrass bed was low but significant, while the uptake of inorganic phosphate and silicate by seagrasses and their epiphytes was exceeded by release processes from the sediment into the overlying water. Estimates at the ecosystem level showed that material fluxes of seagrass beds in the Sylt-Rømø Bight are dominated by the dense type of Zostera beds. Therefore, seagrass beds act as a sink for particles and for dissolved inorganic nutrients. During storms, seagrass beds are distinct sources for inorganic nutrients. The total intertidal area of the Sylt-Rømø Bight could be described as a sink for particles and a source for dissolved nutrients. This balance of the material budget was estimated by either including or excluding seagrass beds. Including the subtidal part, the function of the ecosystem as a source for particles increased, supposing that all seagrass beds were lost from the area. During the vegetation period, seagrass beds act as a storage compartment for material accumulated in the living biomass of the community. There was great biodiversity among the plant and animal groups found in intertidal seagrass beds of the Sylt-Rømø Bay, representing 50-86% of the total number of species investigated, depending on the particular group. Since most species are not exclusively seagrass residents, the loss of intertidal seagrass beds would be of minor importance for biodiversity at the ecosystem level. Food web structure in seagrass beds is different from other intertidal communities. Primary production and detritus input is high, but secondary production is similar to that of unvegetated areas, although the relative importance of the trophic guilds is different. The loss of seagrass beds leads to profound alterations in the food web of the total ecosystem. Historical as well as recent changes in material fluxes and energy flow due to man-made alterations to the ecosystem are discussed.

7 CFR 2902.15 - Bedding, bed linens, and towels.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROCUREMENT Designated Items § 2902.15 Bedding, bed linens, and towels. (a) Definition. (1) Bedding is that... minimum biobased content is 12 percent and shall be based on the amount of qualifying biobased carbon in..., and silk are not qualifying biobased feedstocks for the purpose of determining the biobased content of...

Health Information in Amharic (Amarɨñña / አማርኛ )

MedlinePlus

... Section Bed Bugs Bed Bug Control in Residences - English PDF Bed Bug Control in Residences - Amarɨñña / አማርኛ ( ... Department of Agriculture Vacuuming to Capture Bed Bugs - English PDF Vacuuming to Capture Bed Bugs - Amarɨñña / አማርኛ ( ...

Thermal Analysis of Fluidized Bed and Fixed Bed Latent Heat Thermal Storage System

NASA Astrophysics Data System (ADS)

Beemkumar, N.; Karthikeyan, A.; Shiva Keshava Reddy, Kota; Rajesh, Kona; Anderson, A.

2017-05-01

Thermal energy storage technology is essential because its stores available energy at low cost. Objective of the work is to store the thermal energy in a most efficient method. This work is deal with thermal analysis of fluidized bed and fixed bed latent heat thermal storage (LHTS) system with different encapsulation materials (aluminium, brass and copper). D-Mannitol has been used as phase change material (PCM). Encapsulation material which is in orbicular shape with 4 inch diameter and 2 mm thickness orbicular shaped product is used. Therminol-66 is used as a heat transfer fluid (HTF). Arrangement of encapsulation material is done in two ways namely fluidized bed and fixed bed thermal storage system. Comparison was made between the performance of fixed bed and fluidized bed with different encapsulation material. It is observed that from the economical point of view aluminium in fluidized bed LHTS System has highest efficiency than copper and brass. The thermal energy storage system can be analyzed with fixed bed by varying mass flow rate of oil paves a way to find effective heat energy transfer.

Flow resistance and suspended load in sand-bed rivers: Simplified stratification model

USGS Publications Warehouse

Wright, S.; Parker, G.

2004-01-01

New methods are presented for the prediction of the flow depth, grain-size specific near-bed concentration, and bed-material suspended sediment transport rate in sand-bed rivers. The salient improvements delineated here all relate to the need to modify existing formulations in order to encompass the full range of sand-bed rivers, and in particular large, low-slope sand-bed rivers. They can be summarized as follows: (1) the inclusion of density stratification effects in a simplified manner, which have been shown in the companion paper to be particularly relevant for large, low-slope, sand-bed rivers; (2) a new predictor for near-bed entrainment rate into suspension which extends a previous relation to the range of large, low-slope sand-bed rivers; and (3) a new predictor for form drag which again extends a previous relation to include large, low-slope sand-bed rivers. Finally, every attempt has been made to cast the relations in the simplest form possible, including the development of software, so that practicing engineers may easily use the methods. ?? ASCE.

Survival and Transstadial Persistence of Trypanosoma cruzi in the bed bug (Hemiptera: Cimicidae).

PubMed

Blakely, Brittny N; Hanson, Stephen F; Romero, Alvaro

2018-05-04

Bed bug populations are increasing around the world at an alarming rate and have become a major public health concern. The appearance of bed bug populations in areas where Chagas disease is endemic raises questions about the role of these insects in the transmission of Trypanosoma cruzi, the etiological agent of the disease. In a series of laboratory evaluations, bed bug adults and nymphs were experimentally fed with T. cruzi-infected blood to assess the ability of T. cruzi to survive inside the bed bug and throughout the insect's molting process. Live T. cruzi were observed in gut contents of experimentally infected bed bug adults via light microscopy and the identity of the parasite was confirmed via polymerase chain reaction analysis. T. cruzi persisted at least 97-d postinfection in adult bed bugs. Nymphal stage bed bugs that were infected with T. cruzi maintained the parasite after molting, indicating that transstadial passage of T. cruzi in bed bugs took place. This report provides further evidence of acquisition, maintenance, and for the first time, transstadial persistence of T. cruzi in bed bugs.

Reducing Respiratory Health Risks to Horses and Workers: A Comparison of Two Stall Bedding Materials

PubMed Central

Saastamoinen, Markku; Särkijärvi, Susanna; Hyyppä, Seppo

2015-01-01

Simple Summary In this study, the effect of wood shavings and peat was examined on stable air quality and health of horses and stable workers. The ammonia level in the boxes in which peat was used as bedding was non-existent or very low. The respiratory symptoms in horses increased regardless of the bedding material at the beginning of the study. The health status of the horses on peat bedding returned to the initial level in the end of the trial but horses in stalls bedded with wood shavings continued to be symptomatic. The hooves of the horses in stalls with peat bedding had a better moisture content. The results suggest that peat is a better bedding material for horses and people working or visiting horse stables than wood shavings. Abstract Stable air quality and the choice of bedding material are an important health issue both in horses and people working or visiting horse stables. Risks of impaired respiratory health are those that can especially be avoided by improving air quality in the stable. The choice of bedding material is particularly important in cold climate conditions; where horses are kept most of the day and year indoors throughout their life. This study examined the effect of two bedding materials; wood shavings and peat; on stable air quality and health of horses. Ammonia and dust levels were also measured to assess conditions in the stable. Ammonia was not detected or was at very low levels (<0.25 ppm) in the boxes in which peat was used as bedding; but its concentration was clearly higher (1.5–7.0 ppm) in stalls with wood shavings as bedding. Personal measurements of workers revealed quite high ammonia exposure (5.9 ppm8h) in the boxes in which wood shavings were used; but no exposure was observed in stalls bedded with peat. The respiratory symptoms in horses increased regardless of the bedding material at the beginning of the study. The health status of the horses in the peat bedding group returned to the initial level in the end of the trial but horses bedded with wood shavings continued to be symptomatic. The hooves of the horses with peat bedding had a better moisture content than those of the horses bedded with wood shavings. The results suggest that peat is a better bedding material for horses than wood shavings regarding the health of both horses and stable workers. PMID:26479479

Bed Bug Infestations in an Urban Environment

PubMed Central

Svoboda, Tomislav J.; De Jong, Iain J.; Kabasele, Karl J.; Gogosis, Evie

2005-01-01

Until recently, bed bugs have been considered uncommon in the industrialized world. This study determined the extent of reemerging bed bug infestations in homeless shelters and other locations in Toronto, Canada. Toronto Public Health documented complaints of bed bug infestations from 46 locations in 2003, most commonly apartments (63%), shelters (15%), and rooming houses (11%). Pest control operators in Toronto (N = 34) reported treating bed bug infestations at 847 locations in 2003, most commonly single-family dwellings (70%), apartments (18%), and shelters (8%). Bed bug infestations were reported at 20 (31%) of 65 homeless shelters. At 1 affected shelter, 4% of residents reported having bed bug bites. Bed bug infestations can have an adverse effect on health and quality of life in the general population, particularly among homeless persons living in shelters. PMID:15829190

The Influence of Relative Submergence on the Near-bed Flow Field: Implications for Bed-load Transport

NASA Astrophysics Data System (ADS)

Cooper, J.; Tait, S.; Marion, A.

2005-12-01

Bed-load is governed by interdependent mechanisms, the most significant being the interaction between bed roughness, surface layer composition and near-bed flow. Despite this, practically all transport rate equations are described as a function of average bed shear stress. Some workers have examined the role of turbulence in sediment transport (Nelson et al. 1995) but have not explored the potential significance of spatial variations in the near-bed flow field. This is unfortunate considering evidence showing that transport is spatially heterogeneous and could be linked to the spatial nature of the near-bed flow (Drake et al., 1988). An understanding is needed of both the temporal and spatial variability in the near-bed flow field. This paper presents detailed spatial velocity measurements of the near-bed flow field over a gravel-bed, obtained using Particle Image Velocimetry. These data have been collected in a laboratory flume under two regimes: (i) tests with one bed slope and different flow depths; and (ii) tests with a combination of flow depths and slopes at the same average bed shear stress. Results indicate spatial variation in the streamwise velocities of up to 45 per cent from the double-averaged velocity (averaged in both time and space). Under both regimes, as the depth increased, spatial variability in the flow field increased. The probability distributions of near-bed streamwise velocities became progressively more skewed towards the higher velocities. This change was more noticeable under regime (i). This has been combined with data from earlier tests in which the near-bed velocity close to an entraining grain was measured using a PIV/image analysis system (Chegini et al, 2002). This along with data on the shape of the probability density function of velocities capable of entraining individual grains derived from a discrete-particle model (Heald et al., 2004) has been used to estimate the distribution of local velocities required for grain motion in the above tests. The overlap between this distribution and the measured velocities are used to estimate entrainment rates. Predicted entrainment rates increase with relative submergence, even for similar bed shear stress. Assuming bed-load rate is the product of entrainment rate and hop length, and that hop lengths are sensibly stable, suggests that transport rate has a dependence on relative submergence. This demonstrates that transport rate is not a direct function of average bed shear stress. The results describe a mechanism that will cause river channels with contrasting morphologies (and different relative submergence) but similar levels of average bed stress to experience different levels of sediment mobility. Chegini A. Tait S. Heald J. McEwan I. 2002 The development of an automated system for the measurement of near bed turbulence and grain motion. Proc. ASCE Conf. on Hydraulic Measurements and Experimental Methods, ISBN 0-7844-0655-3. Drake T.G. Shreve R.L. Dietrich W.E. Whiting P.J. Leopold L.B. 1988 Bedload transport of fine gravel observed by motion-picture photography, J. Fluid Mech., 192, 193-217. Heald J. McEwan I. Tait, S. 2004 Sediment transport over a flat bed in a unidirectional flow: simulations and validation, Phil. Trans. Roy. Soc. of London A, 362, 1973-1986. Nelson J.M. Shreve R.L. McLean S.R. Drake T.G. 1995 Role of near-bed turbulence structure in bed-load transport and bed form mechanics, Water. Res. Res., 31, 8, 2071-2086.

Temporal and spatial variability in thalweg profiles of a gravel-bed river

USGS Publications Warehouse

Madej, Mary Ann

1999-01-01

This study used successive longitudinal thalweg profiles in gravel-bed rivers to monitor changes in bed topography following floods and associated large sediment inputs. Variations in channel bed elevations, distributions of residual water depths, percentage of channel length occupied by riffles, and a spatial autocorrelation coefficient (Moran's I) were used to quantify changes in morphological diversity and spatial structure in Redwood Creek basin, northwestern California. Bed topography in Redwood Creek and its major tributaries consists primarily of a series of pools and riffles. The size, frequency and spatial distribution of the pools and riffles have changed significantly during the past 20 years. Following large floods and high sediment input in Redwood Creek and its tributaries in 1975, variation in channel bed elevations was low and the percentage of the channel length occupied by riffles was high. Over the next 20 years, variation in bed elevations increased while the length of channel occupied by riffles decreased. An index [(standard deviation of residual water depth/bankfull depth) × 100] was developed to compare variations in bed elevation over a range of stream sizes, with a higher index being indicative of greater morphological diversity. Spatial autocorrelation in the bed elevation data was apparent at both fine and coarse scales in many of the thalweg profiles and the observed spatial pattern of bed elevations was found to be related to the dominant channel material and the time since disturbance. River reaches in which forced pools dominated, and in which large woody debris and bed particles could not be easily mobilized, exhibited a random distribution of bed elevations. In contrast, in reaches where alternate bars dominated, and both wood and gravel were readily transported, regularly spaced bed topography developed at a spacing that increased with time since disturbance. This pattern of regularly spaced bed features was reversed following a 12-year flood when bed elevations became more randomly arranged.

Evaluation of two least toxic integrated pest management programs for managing bed bugs (Heteroptera: Cimicidae) with discussion of a bed bug intercepting device.

PubMed

Wang, Changlu; Gibb, Timothy; Bennett, Gary W

2009-05-01

The cost and effectiveness of two bed bug (Cimex lectularius L.) integrated pest management (IPM) programs were evaluated for 10 wk. Sixteen bed bug-infested apartments were chosen from a high-rise low-income apartment building. The apartments were randomly divided into two treatment groups: diatomaceous earth dust-based IPM (D-IPM) and chlorfenapyr spray-based IPM (S-IPM). The initial median (minimum, maximum) bed bug counts (by visual inspection) of the two treatment groups were 73.5 (10, 352) and 77 (18, 3025), respectively. A seminar and an educational brochure were delivered to residents and staff. It was followed by installing encasements on mattresses and box springs and applying hot steam to bed bug-infested areas in all 16 apartments. Diatomaceous earth dust (Mother Earth-D) was applied in the D-IPM group 2 d after steaming. In addition, bed bug-intercepting devices were installed under legs of infested beds or sofas or chairs to intercept bed bugs. The S-IPM group only received 0.5% chlorfenapyr spray (Phantom) after the nonchemical treatments. All apartments were monitored bi-weekly and retreated when necessary. After 10 wk, bed bugs were eradicated from 50% of the apartments in each group. Bed bug count reduction (mean +/- SEM) was 97.6 +/- 1.6 and 89.7 +/- 7.3% in the D-IPM and S-IPM groups, respectively. Mean treatment costs in the 10-wk period were $463 and $482 per apartment in the D-IPM and S-IPM groups, respectively. Bed bug interceptors trapped an average of 219 +/- 135 bed bugs per apartment in 10 wk. The interceptors contributed to the IPM program efficacy and were much more effective than visual inspections in estimating bed bug numbers and determining the existence of bed bug infestations.

Mother-child bed-sharing trajectories and psychiatric disorders at the age of 6 years.

PubMed

Santos, Iná S; Barros, Aluísio Jd; Barros, Fernando C; Munhoz, Tiago N; Da Silva, Bianca Del Ponte; Matijasevich, Alicia

2017-01-15

Little is known about the effect of bed-sharing with the mother over the child mental health. Population-based birth cohort conducted in Pelotas, Brazil. Children were enrolled at birth (n=4231) and followed-up at 3 months and at 1, 2, 4, and 6 years of age. Bed-sharing was defined as "habitual sharing of the bed between the child and the mother, for sleeping, for part of the night or the whole night". Trajectories of bed sharing between 3 months and 6 years of age were calculated. Mental health was assessed at the age of 6 years using the Development and Well-Being Assessment instrument that generates psychiatric diagnosis according to ICD-10 and DSM-IV criteria. Odds ratios (OR) with 95% confidence intervals were obtained by multivariate logistic regression. 3583 children were analyzed. Four trajectories were identified: non bed-sharers (44.4%), early-only (36.2%), late-onset (12.0%), and persistent bed-sharers (7.4%). In the adjusted analyses persistent bed-sharers were at increased odds of presenting any psychiatric disorder (OR=1.7; 1.2-2.5) and internalizing problems (OR=2.1; 1.4-3.1), as compared to non bed-sharers. Among the early-only bed-sharers OR for any psychiatric disorder was 1.4 (1.1-1.8) and for internalizing problems 1.6 (1.2-2.1). Although the effect of bed-sharing was adjusted for several covariates including the family socio-economic status, maternal mental health and excessive crying, there was no information on maternal personal reasons for bed-sharing. Mothers that bed-share intentionally and those that bed-share in reaction to a child sleep problem may have a different interpretation of their children behavior that may bias the study results. Bed-sharing is a common practice in our setting and is associated with impaired child mental health at the age of six years. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

In-Bed Accountability Development for a Passively Cooled, Electrically Heated Hydride (PACE) Bed

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

Klein, J.E.

A nominal 1500 STP-L PAssively Cooled, Electrically heated hydride (PACE) Bed has been developed for implementation into a new Savannah River Site tritium project. The 1.2 meter (four-foot) long process vessel contains on internal 'U-tube' for tritium In-Bed Accountability (IBA) measurements. IBA will be performed on six, 12.6 kg production metal hydride storage beds.IBA tests were done on a prototype bed using electric heaters to simulate the radiolytic decay of tritium. Tests had gas flows from 10 to 100 SLPM through the U-tube or 100 SLPM through the bed's vacuum jacket. IBA inventory measurement errors at the 95% confidence levelmore » were calculated using the correlation of IBA gas temperature rise, or (hydride) bed temperature rise above ambient temperature, versus simulated tritium inventory.Prototype bed IBA inventory errors at 100 SLPM were the largest for gas flows through the vacuum jacket: 15.2 grams for the bed temperature rise and 11.5 grams for the gas temperature rise. For a 100 SLPM U-tube flow, the inventory error was 2.5 grams using bed temperature rise and 1.6 grams using gas temperature rise. For 50 to 100 SLPM U-tube flows, the IBA gas temperature rise inventory errors were nominally one to two grams that increased above four grams for flows less than 50 SLPM. For 50 to 100 SLPM U-tube flows, the IBA bed temperature rise inventory errors were greater than the gas temperature rise errors, but similar errors were found for both methods at gas flows of 20, 30, and 40 SLPM.Electric heater IBA tests were done for six production hydride beds using a 45 SLPM U-tube gas flow. Of the duplicate runs performed on these beds, five of the six beds produced IBA inventory errors of approximately three grams: consistent with results obtained in the laboratory prototype tests.« less

In-Bed Accountability Development for a Passively Cooled, Electrically Heated Hydride (PACE) Bed

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

KLEIN, JAMES

A nominal 1500 STP-L PAssively Cooled, Electrically heated hydride (PACE) Bed has been developed for implementation into a new Savannah River Site tritium project. The 1.2 meter (four-foot) long process vessel contains an internal ''U-tube'' for tritium In-Bed Accountability (IBA) measurements. IBA will be performed on six, 12.6 kg production metal hydride storage beds. IBA tests were done on a prototype bed using electric heaters to simulate the radiolytic decay of tritium. Tests had gas flows from 10 to 100 SLPM through the U-tube or 100 SLPM through the bed's vacuum jacket. IBA inventory measurement errors at the 95 percentmore » confidence level were calculated using the correlation of IBA gas temperature rise, or (hydride) bed temperature rise above ambient temperature, versus simulated tritium inventory. Prototype bed IBA inventory errors at 100 SLPM were the largest for gas flows through the vacuum jacket: 15.2 grams for the bed temperature rise and 11.5 grams for the gas temperature rise. For a 100 SLPM U-tube flow, the inventory error was 2.5 grams using bed temperature rise and 1.6 grams using gas temperature rise. For 50 to 100 SLPM U-tube flows, the IBA gas temperature rise inventory errors were nominally one to two grams that increased above four grams for flows less than 50 SLPM. For 50 to 100 SLPM U-tube flows, the IBA bed temperature rise inventory errors were greater than the gas temperature rise errors, but similar errors were found for both methods at gas flows of 20, 30, and 40 SLPM. Electric heater IBA tests were done for six production hydride beds using a 45 SLPM U-tube gas flow. Of the duplicate runs performed on these beds, five of the six beds produced IBA inventory errors of approximately three grams: consistent with results obtained in the laboratory prototype tests.« less

Complex channel responses to changes in stream flow and sediment supply on the lower Duchesne River, Utah

USGS Publications Warehouse

Gaeuman, D.; Schmidt, J.C.; Wilcock, P.R.

2005-01-01

Channel responses to flow depletions in the lower Duchesne River over the past 100 years have been highly complex and variable in space and time. In general, sand-bed reaches adjusted to all perturbations with bed-level changes, whereas the gravel-bed reaches adjusted primarily through width changes. Gravel-bed reaches aggraded only when gravel was supplied to the channel through local bank erosion and degraded only during extreme flood events. A 50% reduction in stream flow and an increase in fine sediment supply to the study area occurred in the first third of the 20th century. The gravel-bed reach responded primarily with channel narrowing, whereas bed aggradation and four large-scale avulsions occurred in the sand-bed reaches. These avulsions almost completely replaced a section of sinuous channel about 14 km long with a straighter section about 7 km long. The most upstream avulsion, located near a break in valley slope and the transition from a gravel bed upstream and a sand bed downstream, transformed a sinuous sand-bed reach into a braided gravel-bed reach and eventually into a meandering gravel-bed reach over a 30-year period. Later, an increase in flood magnitudes and durations caused widening and secondary bed aggradation in the gravel-bed reaches, whereas the sand-bed reaches incised and narrowed. Water diversions since the 1950s have progressively eliminated moderate flood events, whereas larger floods have been less affected. The loss of frequent flooding has increased the duration and severity of drought periods during which riparian vegetation can establish along the channel margins. As a result, the channel has gradually narrowed throughout the study area since the late 1960s, despite the occasional occurrence of large floods. No tributaries enter the Duchesne River within the study area, so all reaches have experienced identical changes in stream flow and upstream sediment supply. ?? 2004 Elsevier B.V. All rights reserved.

Volatile organic compound adsorption in a gas-solid fluidized bed.

PubMed

Ng, Y L; Yan, R; Tsen, L T S; Yong, L C; Liu, M; Liang, D T

2004-01-01

Fluidization finds many process applications in the areas of catalytic reactions, drying, coating, combustion, gasification and microbial culturing. This work aims to compare the dynamic adsorption characteristics and adsorption rates in a bubbling fluidized bed and a fixed bed at the same gas flow-rate, gas residence time and bed height. Adsorption with 520 ppm methanol and 489 ppm isobutane by the ZSM-5 zeolite of different particle size in the two beds enabled the differentiation of the adsorption characteristics and rates due to bed type, intraparticle mass transfer and adsorbate-adsorbent interaction. Adsorption of isobutane by the more commonly used activated carbon provided the comparison of adsorption between the two adsorbent types. With the same gas residence time of 0.79 seconds in both the bubbling bed and fixed bed of the same bed size of 40 mm diameter and 48 mm height, the experimental results showed a higher rate of adsorption in the bubbling bed as compared to the fixed bed. Intraparticle mass transfer and adsorbent-adsorbate interaction played significant roles in affecting the rate of adsorption, with intraparticle mass transfer being more dominant. The bubbling bed was observed to have a steeper decline in adsorption rate with respect to increasing outlet concentration compared to the fixed bed. The adsorption capacities of zeolite for the adsorbates studied were comparatively similar in both beds; fluidizing, and using smaller particles in the bubbling bed did not increase the adsorption capacity of the ZSM-5 zeolite. The adsorption capacity of activated carbon for isobutane was much higher than the ZSM-5 zeolite for isobutane, although at a lower adsorption rate. Fourier transform infra-red (FTIR) spectroscopy was used as an analytical tool for the quantification of gas concentration. Calibration was done using a series of standards prepared by in situ dilution with nitrogen gas, based on the ideal gas law and relating partial pressure to gas concentration. Concentrations up to 220 ppm for methanol and 75 ppm for isobutane were prepared using this method.

Seaweed beds support more juvenile reef fish than seagrass beds in a south-western Atlantic tropical seascape

NASA Astrophysics Data System (ADS)

Eggertsen, L.; Ferreira, C. E. L.; Fontoura, L.; Kautsky, N.; Gullström, M.; Berkström, C.

2017-09-01

Seascape connectivity is regarded essential for healthy reef fish communities in tropical shallow systems. A number of reef fish species use separate adult and nursery habitats, and hence contribute to nutrient and energy transfer between habitats. Seagrass beds and mangroves often constitute important nursery habitats, with high structural complexity and protection from predation. Here, we investigated if reef fish assemblages in the tropical south-western Atlantic demonstrate ontogenetic habitat connectivity and identify possible nurseries on three reef systems along the eastern Brazilian coast. Fish were surveyed in fore reef, back reef, Halodule wrightii seagrass beds and seaweed beds. Seagrass beds contained lower abundances and species richness of fish than expected, while Sargassum-dominated seaweed beds contained significantly more juveniles than all other habitats (average juvenile fish densities: 32.6 per 40 m2 in Sargassum beds, 11.2 per 40 m2 in back reef, 10.1 per 40 m2 in fore reef, and 5.04 per 40 m2 in seagrass beds), including several species that are found in the reef habitats as adults. Species that in other regions worldwide (e.g. the Caribbean) utilise seagrass beds as nursery habitats were here instead observed in Sargassum beds or back reef habitats. Coral cover was not correlated to adult fish distribution patterns; instead, type of turf was an important variable. Connectivity, and thus pathways of nutrient transfer, seems to function differently in east Brazil compared to many tropical regions. Sargassum-dominated beds might be more important as nurseries for a larger number of fish species than seagrass beds. Due to the low abundance of structurally complex seagrass beds we suggest that seaweed beds might influence adult reef fish abundances, being essential for several keystone species of reef fish in the tropical south-western Atlantic.

Preferences for paper bedding material of the laboratory mice.

PubMed

Ago, Akio; Gonda, Tatuo; Takechi, Mayumi; Takeuchi, Takashi; Kawakami, Kohei

2002-04-01

In order to identify indicators of the preferences for bedding materials, the paper bedding material preferences of laboratory mice were investigated in the present study. Four cages, each containing a different structure of paper bedding material were connected to allow free access to each cage. The preferences for paper bedding materials of laboratory mice were judged by the differences in the length of stay and sleep in each cage. The mice preferred the bedding material that allowed them to easily hide and build nests and was soft. We conclude that the comfort and well-being of laboratory mice can be increased through the appropriate selection of bedding material.

Fluidized bed heat exchanger utilizing angularly extending heat exchange tubes

DOEpatents

Talmud, Fred M.; Garcia-Mallol, Juan-Antonio

1980-01-01

A fluidized bed heat exchanger in which air is passed through a bed of particulate material containing fuel disposed in a housing. A steam/water natural circulation system is provided and includes a steam drum disposed adjacent the fluidized bed and a series of tubes connected at one end to the steam drum. A portion of the tubes are connected to a water drum and in the path of the air and the gaseous products of combustion exiting from the bed. Another portion of the tubes pass through the bed and extend at an angle to the upper surface of the bed.

25. Typical valves used to control flow into and out ...

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

25. Typical valves used to control flow into and out of filtration bed. Left valve (painted red) drains the bed, and center valve (painted green) admits water into the bed. The right valve is a cross over valve which is used to admit water into a dry bed from the bottom. This bottom fill excludes entrapped air as the bed is filled. When the water reached to top of the bed, filling is continued from the top of the bed. - Lake Whitney Water Filtration Plant, Filtration Plant, South side of Armory Street between Edgehill Road & Whitney Avenue, Hamden, New Haven County, CT

Internal dust recirculation system for a fluidized bed heat exchanger

DOEpatents

Gamble, Robert L.; Garcia-Mallol, Juan A.

1981-01-01

A fluidized bed heat exchanger in which air is passed through a bed of particulate material containing fuel disposed in a housing. A steam/water natural circulation system is provided in a heat exchange relation to the bed and includes a steam drum disposed adjacent the bed and a tube bank extending between the steam drum and a water drum. The tube bank is located in the path of the effluent gases exiting from the bed and a baffle system is provided to separate the solid particulate matter from the effluent gases. The particulate matter is collected and injected back into the fluidized bed.

A preliminary evaluation of the potential of Beauveria bassiana for bed bug control.

PubMed

Barbarin, Alexis M; Jenkins, Nina E; Rajotte, Edwin G; Thomas, Matthew B

2012-09-15

Residual biopesticide treatments of Beauveria bassiana were tested against the bed bug Cimex lectularius. An oil formulation of conidia was applied to different substrates. Bed bugs were exposed for 1 h, transferred to an unsprayed environment and monitored for mortality. Separate bioassays evaluated the effect of bed bug strain, sex, life stage, and exposure substrate on mortality. Rapid mortality was observed in all bioassays, with bed bugs exposed to treated jersey knit cotton dying most rapidly. A further assay demonstrated efficient autodissemination of conidia from exposed bed bugs to unexposed bed bugs within artificial harborages. Copyright © 2012 Elsevier Inc. All rights reserved.

Bed Bugs

EPA Pesticide Factsheets

Prevent, identify, and treat bed bug infestations using EPA’s step-by-step guides, based on IPM principles. Find pesticides approved for bed bug control, check out the information clearinghouse, and dispel bed bug myths.

Change in attachment states of mind of women with binge-eating disorder.

PubMed

Maxwell, Hilary; Tasca, Giorgio A; Grenon, Renee; Ritchie, Kerri; Bissada, Hany; Balfour, Louise

2017-11-01

Insecure and unresolved/disorganized attachment states of mind may impact affect regulation and interpersonal functioning that contribute to binge eating in women with binge-eating disorder (BED). Group psychological treatment may facilitate changes from insecure to secure and from unresolved-disorganized to non-unresolved/disorganized attachment states of mind. This study used attachment theory to understand better the psychopathology of BED and co-morbid overweight status and to understand better the treatment response of patients with BED who receive group psychotherapy. Women with BED attended group psychodynamic interpersonal psychotherapy and completed the Adult Attachment Interview pretreatment and 6 months posttreatment. Matched samples of overweight women without BED and normal-weight women without BED completed the Adult Attachment Interview at 1 time point. Women with BED had significantly higher rates of preoccupied and unresolved/disorganized attachment states of mind compared to normal-weight women without BED and had similar rates of insecure and unresolved/disorganized attachment states of mind compared to overweight women without BED. Of the women with BED who had an insecure and/or unresolved/disorganized attachment states of mind at pretreatment, about 60% demonstrated clinically relevant changes to secure and to non-unresolved/disorganized states of mind at 6 months post group psychodynamic interpersonal psychotherapy. Results indicated that some women with BED may benefit from interventions that help them regulate hyperactivated affect and create coherent narratives. Both women with BED and overweight women without BED may benefit from treatments that help them develop more adaptive affect regulation strategies related to unresolved/disorganized attachment states of mind. Copyright © 2017 John Wiley & Sons, Ltd.

Thermal insulation and SIDS-an investigation of selected 'Eastern' and 'Western' infant bedding combinations.

PubMed

Wilson, C A; Chu, M S

2005-08-01

Differences in the incidence of SIDS between 'Western' and 'Eastern' countries has been attributed to cultural practices, which may affect the infants care and thermal environment. The purpose of this work was to estimate for selected 'commonly' used bedding, sleep positions and practices in Japan, Korea and New Zealand, the intrinsic 'dry' thermal resistance of bedding. Insulation levels are also discussed in the context of published information about the thermal environment in which the bedding is likely to be used. Selected Japanese, Korean and New Zealand bedding was loosely tucked over an infant manikin in the lateral, prone and supine sleep positions. Thickness in use was measured, and intrinsic 'dry' thermal resistance estimated using the Wilson Laing model which accommodates the effect on insulation of the three-dimensional arrangement of bedding combinations during use. Thickness of under- and upper-bedding varied among countries with thickness and estimated 'dry' thermal resistance of the upper-bedding affected by the type/combination of bedding and the infants sleep position. Insulation levels are discussed in relation to environmental conditions within and among countries and between seasons. Further information on thermal environments, bedding combinations used and care practices within both Asian and Western countries is needed. 'Eastern' infants appear likely to be generally covered in bedding combinations of greater insulation than those used to cover 'Western' infants in comparable seasons. Differences existed between insulation of the Japanese and Korean bedding combinations investigated. Lower rates of SIDS apparent in 'Asian' populations do not appear attributable to use of lower levels of bedding insulation only.

A bioassay for studying behavioural responses of the common bed bug, Cimex lectularius (Hemiptera: Cimicidae) to bed bug-derived volatiles.

PubMed

Weeks, E N I; Logan, J G; Gezan, S A; Woodcock, C M; Birkett, M A; Pickett, J A; Cameron, M M

2011-02-01

The common bed bug, Cimex lectularius (Hemiptera: Cimicidae), has recently re-emerged in increasing numbers, distribution and intensity of infestation in many countries. Current control relies on the application of residual pesticides; but, due to the development of insecticide resistance, there is a need for new tools and techniques. Semiochemicals (behaviour and physiology modifying chemicals) could be exploited for management of bed bugs. However, in order to identify semiochemicals that can be utilised in monitoring or control, a suitable olfactometer is needed that enables the study of the responses of bed bugs to volatile chemicals. Previous studies have used olfactometers that do not separate olfactory responses from responses to physical contact. In this study, a still-air olfactometer was used to measure behavioural responses to different bed bug-derived volatiles presented in an odour pot. Bed bugs were significantly more likely to visit the area above the odour pot first, and more frequently, in the presence of volatiles from bed bug-exposed paper but not in the presence of volatiles from conspecific bed bugs. Bed bug activity was found to be dependent on the presence of the volatiles from bed bug-exposed paper, the time during the scotophase and the sex of the insect being tested. The still-air olfactometer could be used to test putative semiochemicals, which would allow an understanding of their behavioural role in bed bug ecology. Ultimately, this could lead to the identification of new semiochemical tools for bed bug monitoring and control.

Bed Surface Adjustments to Spatially Variable Flow in Low Relative Submergence Regimes

NASA Astrophysics Data System (ADS)

Monsalve, A.; Yager, E. M.

2017-11-01

In mountainous rivers, large relatively immobile grains partly control the local and reach-averaged flow hydraulics and sediment fluxes. When the flow depth is similar to the size of these grains (low relative submergence), heterogeneous flow structures and plunging flow cause spatial distributions of bed surface elevations, textures, and sedimentation rates. To explore how the bed surface responds to these flow variations we conducted a set of experiments in which we varied the relative submergence of staggered hemispheres (simulated large boulders) between runs. All experiments had the same average sediment transport capacity, upstream sediment supply, and initial bed thickness and grain size distribution. We combined our laboratory measurements with a 3-D flow model to obtain the detailed flow structure around the hemispheres. The local bed shear stress field displayed substantial variability and controlled the bed load transport rates and direction in which sediment moved. The divergence in bed shear stress caused by the hemispheres promoted size-selective bed load deposition, which formed patches of coarse sediment upstream of the hemisphere. Sediment deposition caused a decrease in local bed shear stress, which combined with the coarser grain size, enhanced the stability of this patch. The region downstream of the hemispheres was largely controlled by a recirculation zone and had little to no change in grain size, bed elevation, and bed shear stress. The formation, development, and stability of sediment patches in mountain streams is controlled by the bed shear stress divergence and magnitude and direction of the local bed shear stress field.

Experimental System of Solar Adsorption Refrigeration with Concentrated Collector.

PubMed

Yuan, Z X; Li, Y X; Du, C X

2017-10-18

To improve the performance of solar adsorption refrigeration, an experimental system with a solar concentration collector was set up and investigated. The main components of the system were the adsorbent bed, the condenser, the evaporator, the cooling sub-system, and the solar collector. In the first step of the experiment, the vapor-saturated bed was heated by the solar radiation under closed conditions, which caused the bed temperature and pressure to increase. When the bed pressure became high enough, the bed was switched to connect to the condenser, thus water vapor flowed continually from the bed to the condenser to be liquefied. Next, the bed needed to cool down after the desorption. In the solar-shielded condition, achieved by aluminum foil, the circulating water loop was opened to the bed. With the water continually circulating in the bed, the stored heat in the bed was took out and the bed pressure decreased accordingly. When the bed pressure dropped below the saturation pressure at the evaporation temperature, the valve to the evaporator was opened. A mass of water vapor rushed into the bed and was adsorbed by the zeolite material. With the massive vaporization of the water in the evaporator, the refrigeration effect was generated finally. The experimental result has revealed that both the COP (coefficient of the performance of the system) and the SCP (specific cooling power of the system) of the SAPO-34 zeolite was greater than that of the ZSM-5 zeolite, no matter whether the adsorption time was longer or shorter. The system of the SAPO-34 zeolite generated a maximum COP of 0.169.

Scaling relationships between bed load volumes, transport distances, and stream power in steep mountain channels

NASA Astrophysics Data System (ADS)

Schneider, Johannes M.; Turowski, Jens M.; Rickenmann, Dieter; Hegglin, Ramon; Arrigo, Sabrina; Mao, Luca; Kirchner, James W.

2014-03-01

Bed load transport during storm events is both an agent of geomorphic change and a significant natural hazard in mountain regions. Thus, predicting bed load transport is a central challenge in fluvial geomorphology and natural hazard risk assessment. Bed load transport during storm events depends on the width and depth of bed scour, as well as the transport distances of individual sediment grains. We traced individual gravels in two steep mountain streams, the Erlenbach (Switzerland) and Rio Cordon (Italy), using magnetic and radio frequency identification tags, and measured their bed load transport rates using calibrated geophone bed load sensors in the Erlenbach and a bed load trap in the Rio Cordon. Tracer transport distances and bed load volumes exhibited approximate power law scaling with both the peak stream power and the cumulative stream energy of individual hydrologic events. Bed load volumes scaled much more steeply with peak stream power and cumulative stream energy than tracer transport distances did, and bed load volumes scaled as roughly the third power of transport distances. These observations imply that large bed load transport events become large primarily by scouring the bed deeper and wider, and only secondarily by transporting the mobilized sediment farther. Using the sediment continuity equation, we can estimate the mean effective thickness of the actively transported layer, averaged over the entire channel width and the duration of individual flow events. This active layer thickness also followed approximate power law scaling with peak stream power and cumulative stream energy and ranged up to 0.57 m in the Erlenbach, broadly consistent with independent measurements.

The variability of critical care bed numbers in Europe.

PubMed

Rhodes, A; Ferdinande, P; Flaatten, H; Guidet, B; Metnitz, P G; Moreno, R P

2012-10-01

To quantify the numbers of critical care beds in Europe and to understand the differences in these numbers between countries when corrected for population size and gross domestic product. Prospective data collection of critical care bed numbers for each country in Europe from July 2010 to July 2011. Sources were identified in each country that could provide data on numbers of critical care beds (intensive care and intermediate care). These data were then cross-referenced with data from international databases describing population size and age, gross domestic product (GDP), expenditure on healthcare and numbers of acute care beds. We identified 2,068,892 acute care beds and 73,585 (2.8 %) critical care beds. Due to the heterogeneous descriptions of these beds in the individual countries it was not possible to discriminate between intensive care and intermediate care in most cases. On average there were 11.5 critical care beds per 100,000 head of population, with marked differences between countries (Germany 29.2, Portugal 4.2). The numbers of critical care beds per country corrected for population size were positively correlated with GDP (r(2) = 0.16, p = 0.05), numbers of acute care beds corrected for population (r(2) = 0.12, p = 0.05) and the percentage of acute care beds designated as critical care (r(2) = 0.59, p < 0.0001). They were not correlated with the proportion of GDP expended on healthcare. Critical care bed numbers vary considerably between countries in Europe. Better understanding of these numbers should facilitate improved planning for critical care capacity and utilization in the future.

Impulsivity in binge eating disorder: food cues elicit increased reward responses and disinhibition.

PubMed

Schag, Kathrin; Teufel, Martin; Junne, Florian; Preissl, Hubert; Hautzinger, Martin; Zipfel, Stephan; Giel, Katrin Elisabeth

2013-01-01

Binge eating disorder (BED) represents a distinct eating disorder diagnosis. Current approaches assume increased impulsivity to be one factor leading to binge eating and weight gain. We used eye tracking to investigate both components of impulsivity, namely reward sensitivity and rash-spontaneous behaviour towards food in BED for the first time. Overweight and obese people with BED (BED+; n = 25), without BED (BED-; n = 26) and healthy normal-weight controls (NWC; n = 25) performed a free exploration paradigm measuring reward sensitivity (experiment 1) and a modified antisaccade paradigm measuring disinhibited, rash-spontaneous behaviour (experiment 2) using food and nonfood stimuli. Additionally, trait impulsivity was assessed. In experiment 1, all participants located their initial fixations more often on food stimuli and BED+ participants gazed longer on food stimuli in comparison with BED- and NWC participants. In experiment 2, BED+ participants had more difficulties inhibiting saccades towards food and nonfood stimuli compared with both other groups in first saccades, and especially towards food stimuli in second saccades and concerning sequences of first and second saccades. BED- participants did not differ significantly from NWC participants in both experiments. Additionally, eye tracking performance was associated with self-reported reward responsiveness and self-control. According to these results, food-related reward sensitivity and rash-spontaneous behaviour, as the two components of impulsivity, are increased in BED in comparison with weight-matched and normal-weight controls. This indicates that BED represents a neurobehavioural phenotype of obesity that is characterised by increased impulsivity. Interventions for BED should target these special needs of affected patients.

Vision in the common bed bug Cimex lectularius L. (Hemiptera: Cimicidae): eye morphology and spectral sensitivity.

PubMed

McNeill, C A; Allan, S A; Koehler, P G; Pereira, R M; Weeks, E N I

2016-12-01

Bed bugs as pests of public health importance recently experienced a resurgence in populations throughout the U.S. and other countries. Consequently, recent research efforts have focused on improving understanding of bed bug physiology and behaviour to improve management. While few studies have investigated the visual capabilities of bed bugs, the present study focused specifically on eye morphology and spectral sensitivity. A 3-D imaging technique was used to document bed bug eye morphology from the first instar through adult and revealed morphological characteristics that differentiate the common bed bug from the tropical bed bug as well as sex-specific differences. Electrophysiological measurements were used to evaluate the spectral sensitivity of adult bed bugs. Male bed bugs were more responsive than females at some wavelengths. Electrophysiological studies provided evidence for at least one photoreceptor with a spectral sensitivity curve peak in the green (λ max 520 nm) region of the spectrum. The broadened long wavelength portion of the spectral sensitivity curve may potentially indicate another photoreceptor in the yellow-green (λ max 550 nm) portion of the spectrum or screening pigments. Understanding more about bed bug visual biology is vital for designing traps, which are an important component of integrated bed bug management. © 2016 The Royal Entomological Society.

The ecosystem service value of living versus dead biogenic reef

NASA Astrophysics Data System (ADS)

Sheehan, E. V.; Bridger, D.; Attrill, M. J.

2015-03-01

Mixed maerl beds (corralline red algae) comprise dead thalli with varying amounts of live maerl fragments, but previously it was not known whether the presence of the live maerl increases the ecosystem service 'habitat provision' of the dead maerl for the associated epibenthos. A 'flying array' towed sled with high definition video was used to film transects of the epibenthos in dead maerl and mixed maerl beds in two locations to the north and south of the English Channel (Falmouth and Jersey). Mixed maerl beds supported greater number of taxa and abundance than dead beds in Falmouth, while in Jersey, mixed and dead beds supported similar number of taxa and dead beds had a greater abundance of epifauna. Scallops tended to be more abundant on mixed beds than dead beds. Tube worms were more abundant on mixed beds in Falmouth and dead beds in Jersey. An increasing percentage occurrence of live maerl thalli correlated with increasing number of taxa in Falmouth but not Jersey. It was concluded that while live thalli can increase the functional role of dead maerl beds for the epibenthos, this is dependent on location and response variable. As a result of this work, maerl habitat in SE Jersey has been protected from towed demersal fishing gear.

Early processing variations in selective attention to the color and direction of moving stimuli during 30 days head-down bed rest

NASA Astrophysics Data System (ADS)

Wang, Lin-Jie; He, Si-Yang; Niu, Dong-Bin; Guo, Jian-Ping; Xu, Yun-Long; Wang, De-Sheng; Cao, Yi; Zhao, Qi; Tan, Cheng; Li, Zhi-Li; Tang, Guo-Hua; Li, Yin-Hui; Bai, Yan-Qiang

2013-11-01

Dynamic variations in early selective attention to the color and direction of moving stimuli were explored during a 30 days period of head-down bed rest. Event-related potentials (ERPs) were recorded at F5, F6, P5, P6 scalp locations in seven male subjects who attended to pairs of bicolored light emitting diodes that flashed sequentially to produce a perception of movement. Subjects were required to attend selectively to a critical feature of the moving target, e.g., color or direction. The tasks included: a no response task, a color selective response task, a moving direction selective response task, and a combined color-direction selective response task. Subjects were asked to perform these four tasks on: the 3rd day before bed rest; the 3rd, 15th and 30th day during the bed rest; and the 5th day after bed rest. Subjects responded quickly to the color than moving direction and combined color-direction response. And they had a longer reaction time during bed rest on the 15th and 30th day during bed rest after a relatively quicker response on the 3rd day. Using brain event-related potentials technique, we found that in the color selective response task, the mean amplitudes of P1 and N1 for target ERPs decreased in the 3rd day during bed rest and 5th day after bed rest in comparison with pre-bed rest, 15th day and 30th day during bed rest. In the combined color-direction selective response task, the P1 latencies for target ERPs on the 3rd and 30th day during bed rest were longer than on the 15th day during bed rest. As 3rd day during bed rest was in the acute adaptation period and 30th day during bed rest was in the relatively adaptation stage of head-down bed rest, the results help to clarify the effects of bed rest on different task loads and patterns of attention. It was suggested that subjects expended more time to give correct decision in the head-down tilt bed rest state. A difficulty in the recruitment of brain resources was found in feature selection task, but no variations were detected in the no response and direction selective response tasks. It is suggested that the negative shift in color selective response task on the 3rd day of bed rest are a result of fluid redistribution. And feature selection was more affected than motion selection in the head down bed rest. The variations in cognitive processing speed observed for the combined color-direction selective response task are suggested to reflect the interaction between top-down mechanisms and hierarchical physiological characteristics during 30 days head-down bed rest.

The dominance of dispersion in the evolution of bed material waves in gravel-bed rivers

Treesearch

Thomas E. Lisle; Yantao Cui; Gary Parker; James E. Pizzuto; Annjanette M. Dodd

2001-01-01

Abstract - Bed material waves are temporary zones of sediment accumulation created by large sediment inputs. Recent theoretical, experimental and field studies examine factors in fluencing dispersion and translation of bed material waves in quasi-uniform, gravel-bed channels. Exchanges of sediment between a channel and its floodplain are...

Bed load transport in gravel-bed rivers

Treesearch

Jeffrey J. Barry

2007-01-01

Bed load transport is a fundamental physical process in alluvial rivers, building and maintaining a channel geometry that reflects both the quantity and timing of water and the volume and caliber of sediment delivered from the watershed. A variety of formulae have been developed to predict bed load transport in gravel-bed rivers, but testing of the equations in natural...

The Relationship between Parent-Infant Bed Sharing and Marital Satisfaction for Mothers of Infants

ERIC Educational Resources Information Center

Messmer, Rosemary; Miller, Lynn D.; Yu, Christine M.

2012-01-01

This study investigated the relationship between marital satisfaction and time spent bed sharing with infants in a community sample of 81 bed sharing mothers. Time spent bed sharing did not significantly predict variance in marital satisfaction when considering bed sharers as a whole. Moderation analysis, however, showed the interaction between…

A low tritium hydride bed inventory estimation technique

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

Klein, J.E.; Shanahan, K.L.; Baker, R.A.

2015-03-15

Low tritium hydride beds were developed and deployed into tritium service in Savannah River Site. Process beds to be used for low concentration tritium gas were not fitted with instrumentation to perform the steady-state, flowing gas calorimetric inventory measurement method. Low tritium beds contain less than the detection limit of the IBA (In-Bed Accountability) technique used for tritium inventory. This paper describes two techniques for estimating tritium content and uncertainty for low tritium content beds to be used in the facility's physical inventory (PI). PI are performed periodically to assess the quantity of nuclear material used in a facility. Themore » first approach (Mid-point approximation method - MPA) assumes the bed is half-full and uses a gas composition measurement to estimate the tritium inventory and uncertainty. The second approach utilizes the bed's hydride material pressure-composition-temperature (PCT) properties and a gas composition measurement to reduce the uncertainty in the calculated bed inventory.« less

Cognitive Functioning in Long Duration Head-down Bed Rest

NASA Technical Reports Server (NTRS)

Seaton, Kimberly A.; Slack, Kelley J.; Sipes, Walter A.; Bowie, Kendra

2008-01-01

The Space Flight Cognitive Assessment Tool for Windows (WinSCAT) is a self-administered battery of tests used on the International Space Station for evaluating cognitive functioning. Here, WinSCAT was used to assess cognitive functioning during extended head-down bed rest. Thirteen subjects who participated in 60 or 90 days of 6 deg head-down bed rest took WinSCAT during the pre-bed rest phase, the in-bed rest phase, and the post-bed rest (reconditioning) phase of study participation. After adjusting for individual baseline performance, 12 off-nominal scores were observed out of 351 total observations during bed rest and 7 of 180 during reconditioning. No evidence was found for systematic changes in off-nominal incidence as time in bed rest progressed, or during the reconditioning period. Cognitive functioning does not appear to be adversely affected by long duration head-down bed rest. Individual differences in underlying cognitive ability and motivation level are likely explanations for the current findings.

Tanning bed burns reported on Twitter: over 15,000 in 2013.

PubMed

Seidenberg, Andrew B; Pagoto, Sherry L; Vickey, Theodore A; Linos, Eleni; Wehner, Mackenzie R; Costa, Renata Dalla; Geller, Alan C

2016-06-01

Few surveillance tools exist for monitoring tanning bed injuries. Twitter data were examined to identify and describe reports of tanning bed-caused burns. Tweets sent in 2013 containing keywords for tanning bed use and burning were content analyzed to determine whether a burn caused by a tanning bed was described, and additional data on tanning behavior and burn characteristics were extracted. After content assessment, 15,178 (64 %) tweets were found to describe a tanning bed-caused burn. Sites most reportedly burnt were buttocks (n = 3117), face/head (n = 1020), and chest/breast (n = 546). Alarmingly, 200 burns to the eyes/eyelids were mentioned. A total of 456 tweets described burning >1 time from a tanning bed. A total of 211 tweets mentioned falling asleep inside the tanning bed. In 2013, over 15,000 tweets reported tanning bed-caused burns. Twitter data provides unique insight into tanning behaviors and injuries not captured through traditional public health surveillance.

Temporal variation in bed configuration and one-dimensional bottom roughness at the mid-shelf STRESS site

NASA Astrophysics Data System (ADS)

Wheatcroft, Robert A.

1994-08-01

Time-lapse stereophotographs were taken over a 90-day period from mid-November 1990 to late-February 1991 at a 90-m silt-bottom site on the central California shelf as part of the STRESS (Sediment Transport Events on Shelves and Slopes) project. Five distinct bed configurations were observed, in order of decreasing abundance, these are: (1) bioturbated bed; (2) smoothed bed; (3) current-rippled bed; (4) scour-pitted bed; and (5) wave-rippled bed. Concurrent measurements of the flow field implicate along-shelf currents, rather than waves, as the primary agent forming the physical bed configurations. The presence of a wave-induced cross-shelf gradient in near-bottom suspended sediment during storm events and the redistribution of this sediment by upwelling or downwelling currents is postulated to control the appearance of depositional current-ripples (northwest poleward flow, downwelling) and erosional scour-pits (southeast equatorward flow, upwelling). All physical bed forms are destroyed by bioturbation processes in periods of hours to days. Analytical photogrammetric techniques were used to extract high-resolution sea floor height data from the stereophotographs. Results indicate maximal relief over a 0.25-m 2 area at this site never exceeded 5 cm. Root-mean-square (rms) height varied by a factor of 3 (3.2-9.2 mm) and is a weak function of bed configuration. Current ripples have the largest rms-height, smoothed and scour-pitted beds the smallest. Rms-heights of bioturbated beds are variable and appear to depend on the previously produced physical bed configuration. Changes in rms-height can be abrupt with factor of 2 changes observed over a 12-h period. Horizontal descriptors of roughness such as peak spacing or peak width cannot separate bed configurations. Results from surface slope distributions are broadly coherent with the rms-height data, in that surfaces with large rms-heights have broad slope distributions and vice versa. Slope distribution data also indicate that all bed configurations except the current-rippled bed are isotropic. These preliminary data suggest that time series information is needed to adequately resolve both the micro-scale roughness of the sea floor on continental shelves and the presence of short lived, but potentially flow-diagnostic bed configurations.

Using research and education to implement practical bed bug control programs in multifamily housing.

PubMed

Bennett, Gary W; Gondhalekar, Ameya D; Wang, Changlu; Buczkowski, Grzegorz; Gibb, Timothy J

2016-01-01

Multifamily housing facilities serving low-income populations have been at the forefront of bed bug outbreaks. Research conducted in the past 8 years has consistently proven that integrated pest management (IPM) is the best approach for successful suppression of bed bug infestations. Bed bug IPM in multifamily settings is especially dependent upon a collaborative community or building-wide effort involving residents, building staff and pest control technicians. Other components of a bed bug IPM program include regular monitoring to detect early-stage bed bug infestations and combined use of non-chemical and chemical interventions. Lastly, to reduce reinfestation rates and costs associated with bed bug control, it is critical to continue periodic monitoring and implement preventive control measures even after successful elimination of bed bugs has been achieved. © 2015 Society of Chemical Industry.

Four Bed Molecular Sieve - Exploration (4BMS-X) Virtual Heater Design and Optimization

NASA Technical Reports Server (NTRS)

Schunk, R. Gregory; Peters, Warren T.; Thomas, John T., Jr.

2017-01-01

A 4BMS-X (Four Bed Molecular Sieve - Exploration) design and heater optimization study for CO2 sorbent beds in proposed exploration system architectures is presented. The primary objectives of the study are to reduce heater power and thermal gradients within the CO2 sorbent beds while minimizing channeling effects. Some of the notable changes from the ISS (International Space Station) CDRA (Carbon Dioxide Removal Assembly) to the proposed exploration system architecture include cylindrical beds, alternate sorbents and an improved heater core. Results from both 2D and 3D sorbent bed thermal models with integrated heaters are presented. The 2D sorbent bed models are used to optimize heater power and fin geometry while the 3D models address end effects in the beds for more realistic thermal gradient and heater power predictions.

Potential of Essential Oil-Based Pesticides and Detergents for Bed Bug Control.

PubMed

Singh, Narinderpal; Wang, Changlu; Cooper, Richard

2014-12-01

The bed bug, (Cimex lectularius L.), is a difficult pest to control. Prevalence of insecticide resistance among bed bug populations and concerns over human-insecticide exposure has stimulated the development of alternative bed bug control materials. Many essential oil-based pesticides and detergent insecticides targeting bed bugs have been developed in recent years. We evaluated the efficacy of nine essential oil-based products and two detergents using direct spray and residual contact bioassays in the laboratory. Two conventional insecticides, Temprid SC (imidacloprid and β-cyfluthrin) and Demand CS (λ-cyhalothrin), were used for comparison. Among the 11 nonsynthetic insecticides tested, only EcoRaider (1% geraniol, 1% cedar extract, and 2% sodium lauryl sulfate) and Bed Bug Patrol (0.003% clove oil, 1% peppermint oil, and 1.3% sodium lauryl sulfate) caused >90% mortality of nymphs in direct spray and forced exposure residual assays. However, the efficacy of EcoRaider and Bed Bug Patrol was significantly lower than that of Temprid SC and Demand CS in choice exposure residual bioassay. Direct spray of EcoRaider caused 87% egg mortality, whereas the other nonsynthetic insecticides had little effect on bed bug eggs. EcoRaider and Bed Bug Patrol did not exhibit detectable repellency against bed bugs in the presence of a carbon dioxide source. These findings suggest that EcoRaider and Bed Bug Patrol are potentially useful pesticides for controlling bed bug infestations, but further testing in naturally infested environments is needed. © 2014 Entomological Society of America.

Bugging forecast: unknown, disliked, occasionally intimate. Bed bugs in Germany meet unprepared people.

PubMed

Seidel, Conrad; Reinhardt, Klaus

2013-01-01

Bed bugs appear to be feared more than vector insects and other household pests. The reasons for this exaggerated fear are not fully understood. One hypothesis is that the folk knowledge on recognising and controlling bed bugs decreased as bed bugs became rarer in the 1960s and led to irrational perceptions. Here, we examine people's ability to recognise a bed bug and their response what to do in case of an infestation. We found that 13% of a sample of 391 people in four large German cities recognised a bed bug; 15% of all respondents would call a pest controller in case of bed bug infestation. This results in the pessimistic estimate that 97% of all early-stage infestations could go untreated. We discuss additional scenarios. The effectiveness of efforts to educate people about the presence of bed bugs has never been tested, but our sample is useful to guide future studies. We found three sources of information were associated with increased recognition rates of bed bugs: a) previous contacts with bed bugs (60% recognition), b) knowledge from friends or relatives (25%) and school or education courses (15%). By contrast, people who heard of bed bugs from television, print media or the Internet showed reduced recognition rates. We propose that the former factors be tested for educational interventions. In Germany, the bed bug is an estranged creature to many people, a fact that seems to hinder rational approaches to their control.

Cardiovascular Adaptations to Long Duration Head-Down Tilt Bed Rest

NASA Technical Reports Server (NTRS)

Platts, Steven H.; Martin, David S.; Perez, Sondar A.; Ribeiro, Christine; Stenger, Michael B.; Summers, Richard; Meck, Janice V.

2008-01-01

INTRODUCTION: Orthostatic hypotension is a serious risk for crewmembers returning from spaceflight. Numerous cardiovascular mechanisms have been proposed to account for this problem, including vascular and cardiac dysfunction, which we studied during bed rest. METHODS: Thirteen subjects were studied before and during bed rest. Statistical analysis was limited to the first 49-60 days of bed rest, and compared to pre-bed rest data. Ultrasound data were collected on vascular and cardiac structure and function. Tilt testing was conducted for 30 minutes or until presyncopal symptoms intervened. RESULTS: Plasma volume was significantly reduced by day 7 of bed rest. Flow-mediated dilation in the leg was significantly increased at bed rest day 49. Arterial responses to nitroglycerin differed in the arm and leg, but did not change as a result of bed rest. Intimal-medial thickness markedly decreased at bed rest days 21, 35 and 49. Several cardiac functional parameters including isovolumic relaxation time, ejection time and myocardial performance index were significantly increased (indicating a decrease in cardiac function) during bed rest. There was a trend for decreased orthostatic tolerance following 60 days of bed rest. DISCUSSION: These data suggest that 6 head-down tilt bed rest alters cardiovascular structure and function in a pattern similar to short duration spaceflight. Additionally, the vascular alterations are primarily seen in the lower body, while vessels of the upper body are unaffected. KEY WORDS: spaceflight, orthostatic intolerance, hypotension, fluid-shift, plasma volume

Bugging Forecast: Unknown, Disliked, Occasionally Intimate. Bed Bugs in Germany Meet Unprepared People

PubMed Central

Seidel, Conrad; Reinhardt, Klaus

2013-01-01

Bed bugs appear to be feared more than vector insects and other household pests. The reasons for this exaggerated fear are not fully understood. One hypothesis is that the folk knowledge on recognising and controlling bed bugs decreased as bed bugs became rarer in the 1960s and led to irrational perceptions. Here, we examine people’s ability to recognise a bed bug and their response what to do in case of an infestation. We found that 13% of a sample of 391 people in four large German cities recognised a bed bug; 15% of all respondents would call a pest controller in case of bed bug infestation. This results in the pessimistic estimate that 97% of all early-stage infestations could go untreated. We discuss additional scenarios. The effectiveness of efforts to educate people about the presence of bed bugs has never been tested, but our sample is useful to guide future studies. We found three sources of information were associated with increased recognition rates of bed bugs: a) previous contacts with bed bugs (60% recognition), b) knowledge from friends or relatives (25%) and school or education courses (15%). By contrast, people who heard of bed bugs from television, print media or the Internet showed reduced recognition rates. We propose that the former factors be tested for educational interventions. In Germany, the bed bug is an estranged creature to many people, a fact that seems to hinder rational approaches to their control. PMID:23300947

Comparing ownership and use of bed nets at two sites with differential malaria transmission in western Kenya.

PubMed

Ernst, Kacey C; Hayden, Mary H; Olsen, Heather; Cavanaugh, Jamie L; Ruberto, Irene; Agawo, Maurice; Munga, Stephen

2016-04-14

Challenges persist in ensuring access to and optimal use of long-lasting, insecticidal bed nets (LLINs). Factors associated with ownership and use may differ depending on the history of malaria and prevention control efforts in a specific region. Understanding how the cultural and social-environmental context of bed net use may differ between high- and low-risk regions is important when identifying solutions to improve uptake and appropriate use. Community forums and a household, cross-sectional survey were used to collect information on factors related to bed net ownership and use in western Kenya. Sites with disparate levels of transmission were selected, including an endemic lowland area, Miwani, and a highland epidemic-prone area, Kapkangani. Analysis of ownership was stratified by site. A combined site analysis was conducted to examine factors associated with use of all available bed nets. Logistic regression modelling was used to determine factors associated with ownership and use of owned bed nets. Access to bed nets as the leading barrier to their use was identified in community forums and cross-sectional surveys. While disuse of available bed nets was discussed in the forums, it was a relatively rare occurrence in both sites. Factors associated with ownership varied by site. Education, perceived risk of malaria and knowledge of individuals who had died of malaria were associated with higher bed net ownership in the highlands, while in the lowlands individuals reporting it was easy to get a bed net were more likely to own one. A combined site analysis indicated that not using an available bed net was associated with the attitudes that taking malaria drugs is easier than using a bed net and that use of a bed net will not prevent malaria. In addition, individuals with an unused bed net in the household were more likely to indicate that bed nets are difficult to use, that purchased bed nets are better than freely distributed ones, and that bed nets should only be used during the rainy season. Variations in factors associated with ownership should be acknowledged when constructing messaging and distribution campaigns. Despite reports of bed nets being used for other purposes, those in the home were rarely unused in these communities. Disuse seemed to be related to beliefs that can be addressed through education programmes. As mass distributions continue to take place, additional research is needed to determine if factors associated with LLIN ownership and use change with increasing availability of LLIN.

Indoor tanning and problem behavior.

PubMed

Bagdasarov, Zhanna; Banerjee, Smita; Greene, Kathryn; Campo, Shelly

2008-01-01

The authors examined factors predicting college students' use of tanning beds. Undergraduate students (N = 745) at a large Northeastern university participated in the study by answering a survey measuring tanning behavior and other psychosocial variables, including sensation seeking, self-esteem, tanning image beliefs, and friends' tanning bed use. All 3 systems from problem behavior theory predicted past tanning bed use and intention to use tanning beds. The authors observed a positive association between sensation seeking and intention to use tanning beds. Tanning image beliefs were positively associated with both past tanning behavior and intention to use tanning beds. Interventions focusing on friend and acquaintance social network influences may be more effective than health-risk campaigns in reducing tanning bed use.

Fine bed material in pools of natural gravel bed channels

Treesearch

Thomas E. Lisle; Sue Hilton

1999-01-01

Abstract - Natural gravel bed channels commonly contain a fine mode of sand and fine gravel that fills voids of the bed framework of coarser gravel. If the supply of fine bed material exceeds the storage capacity of framework voids, excess fine material forms surficial patches, which can be voluminous in pools during low flow. Data collected in 34 natural channels in...

76 FR 550 - Second National Bed Bug Summit; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-05

... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OPP-2009-0190; FRL-8858-4] Second National Bed Bug Summit... planning the second National Bed Bug Summit to be held February 1 and 2, 2011, on the topic of the bed bug resurgence in the United States. The goal of this meeting is to review the current bed bug problem and...

Manual for computing bed load transport using BAGS (Bedload Assessment for Gravel-bed Streams) Software

Treesearch

John Pitlick; Yantao Cui; Peter Wilcock

2009-01-01

This manual provides background information and instructions on the use of a spreadsheet-based program for Bedload Assessment in Gravel-bed Streams (BAGS). The program implements six bed load transport equations developed specifically for gravel-bed rivers. Transport capacities are calculated on the basis of field measurements of channel geometry, reach-average slope,...

Regenerable biocide delivery unit

NASA Technical Reports Server (NTRS)

Sauer, Richard L. (Inventor); Colombo, Gerald V. (Inventor); Jolly, Clifford D. (Inventor)

1993-01-01

A method and apparatus are disclosed for maintaining continuous, long-term microbial control in the water supply for potable, hygiene, and experimental water for space activities, as well as treatment of water supplies on Earth. The water purification is accomplished by introduction of molecular iodine into the water supply to impart a desired iodine residual. The water is passed through an iodinated anion exchange resin bed. The iodine is bound as I-(sub n) at the anion exchange sites and releases I(sub 2) into the water stream flowing through the bed. The concentration of I(sub 2) in the flowing water gradually decreases and, in the prior art, the ion-exchange bed has had to be replaced. In a preferred embodiment, a bed of iodine crystals is provided with connections for flowing water therethrough to produce a concentrated (substantially saturated) aqueous iodine solution which is passed through the iodinated resin bed to recharge the bed with bound iodine. The bed of iodine crystals is connected in parallel with the iodinated resin bed and is activated periodically (e.g., by timer, by measured flow of water, or by iodine residual level) to recharge the bed. Novelty resides in the capability of inexpensively and repeatedly regenerating the ion-exchange bed in situ.

Histamine as an emergent indoor contaminant: Accumulation and persistence in bed bug infested homes.

PubMed

DeVries, Zachary C; Santangelo, Richard G; Barbarin, Alexis M; Schal, Coby

2018-01-01

Histamine is used in bronchial and dermal provocation, but it is rarely considered an environmental risk factor in allergic disease. Because bed bugs defecate large amounts of histamine as a component of their aggregation pheromone, we sought to determine if histamine accumulates in household dust in bed bug infested homes, and the effects of bed bug eradication with spatial heat on histamine levels in dust. We collected dust in homes and analyzed for histamine before, and up to three months after bed bug eradication. Histamine levels in bed bug infested homes were remarkably high (mean = 54.6±18.9 μg/100 mg of sieved household dust) and significantly higher than in control homes not infested with bed bugs (mean < 2.5±1.9 μg/100 mg of sieved household dust). Heat treatments that eradicated the bed bug infestations failed to reduce histamine levels, even three months after treatment. We report a clear association between histamine levels in household dust and bed bug infestations. The high concentrations, persistence, and proximity to humans during sleep suggest that bed bug-produced histamine may represent an emergent contaminant and pose a serious health risk in the indoor environment.

Histamine as an emergent indoor contaminant: Accumulation and persistence in bed bug infested homes

PubMed Central

Santangelo, Richard G.; Barbarin, Alexis M.; Schal, Coby

2018-01-01

Histamine is used in bronchial and dermal provocation, but it is rarely considered an environmental risk factor in allergic disease. Because bed bugs defecate large amounts of histamine as a component of their aggregation pheromone, we sought to determine if histamine accumulates in household dust in bed bug infested homes, and the effects of bed bug eradication with spatial heat on histamine levels in dust. We collected dust in homes and analyzed for histamine before, and up to three months after bed bug eradication. Histamine levels in bed bug infested homes were remarkably high (mean = 54.6±18.9 μg/100 mg of sieved household dust) and significantly higher than in control homes not infested with bed bugs (mean < 2.5±1.9 μg/100 mg of sieved household dust). Heat treatments that eradicated the bed bug infestations failed to reduce histamine levels, even three months after treatment. We report a clear association between histamine levels in household dust and bed bug infestations. The high concentrations, persistence, and proximity to humans during sleep suggest that bed bug-produced histamine may represent an emergent contaminant and pose a serious health risk in the indoor environment. PMID:29432483

Flow resistance under conditions of intense gravel transport

USGS Publications Warehouse

Pitlick, John

1992-01-01

A study of flow resistance was undertaken in a channelized reach of the North Fork Toutle River, downstream of Mount St. Helens, Washington. Hydraulic and sediment transport data were collected in flows with velocities up to 3 m/s and shear stresses up to 7 times the critical value needed for bed load transport. Details of the flow structure as revealed in vertical velocity profiles indicate that weak bed load transport over a plane gravel bed has little effect on flow resistance. The plane gravel bed persists up to stresses ∼3 times critical, at which point, irregular bed forms appear. Bed forms greatly increase flow resistance and cause velocity profiles to become distorted. The latter arises as an effect of flows becoming depth-limited as bed form amplitude increases. At very high rates of bed load transport, an upper stage plane bed appeared. Velocity profiles measured in these flows match the law of the wall closely, with the equivalent roughness being well represented by ks = 3D84 of the bed load. The effects noted here will be important in very large floods or in rivers that are not free to widen, such as those cut into bedrock.

Does Deinstitutionalization Increase Suicide?

PubMed Central

Yoon, Jangho; Bruckner, Tim A

2009-01-01

Objectives (1) To test whether public psychiatric bed reduction may increase suicide rates; (2) to investigate whether the supply of private hospital psychiatric beds—separately for not-for-profit and for-profit—can substitute for public bed reduction without increasing suicides; and (3) to examine whether the level of community mental health resources moderates the relationship between public bed reduction and suicide rates. Methods We examined state-level variation in suicide rates in relation to psychiatric beds and community mental health spending in the United States for the years 1982–1998. We categorize psychiatric beds separately for public, not-for-profit, and for-profit hospitals. Principal Findings Reduced public psychiatric bed supply was found to increase suicide rates. We found no evidence that not-for-profit or for-profit bed supply compensates for public bed reductions. However, greater community mental health spending buffers the adverse effect of public bed reductions on suicide. We estimate that in 2008, an additional decline in public psychiatric hospital beds would raise suicide rates for almost all states. Conclusions Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising. PMID:19500164

Plasma vasopressin and renin activity in women exposed to bed rest and +G/z/ acceleration

NASA Technical Reports Server (NTRS)

Keil, L. C.; Ellis, S.

1976-01-01

To study the effect of prolonged recumbency on plasma vasopressin and renin activity, eight women were subjected to 17 days of absolute bed rest. The tolerance to +3G vertical acceleration of the subjects was tested before and after 14 days of bed rest. From day 2 and through day 17 of bed rest, plasma arginine vasopressin (AVP) levels were reduced 33%. Plasma renin activity (PRA) increased 91% above ambulatory control values from days 10 through 15 of bed rest. When compared to precentrifuge values, exposure to vertical acceleration prior to bed rest provoked a 20-fold rise in mean plasma AVP but resulted in only a slight increase in PRA. After bed rest, acceleration increased plasma AVP 7-fold; however, the magnitude of this increase was less than the post +3G acceleration value obtained prior to bed rest. After bed rest, no significant rise was noted in PRA following +3G acceleration. This study demonstrates that prolonged bed rest leads to a significant rise in the PRA of female subjects, while exposure to positive vertical acceleration provokes a marked rise in plasma AVP.

Predicting fractional bed load transport rates: Application of the Wilcock‐Crowe equations to a regulated gravel bed river

USGS Publications Warehouse

Gaeuman, David; Andrews, E.D.; Krause, Andreas; Smith, Wes

2009-01-01

Bed load samples from four locations in the Trinity River of northern California are analyzed to evaluate the performance of the Wilcock‐Crowe bed load transport equations for predicting fractional bed load transport rates. Bed surface particles become smaller and the fraction of sand on the bed increases with distance downstream from Lewiston Dam. The dimensionless reference shear stress for the mean bed particle size (τ*rm) is largest near the dam, but varies relatively little between the more downstream locations. The relation between τ*rm and the reference shear stresses for other size fractions is constant across all locations. Total bed load transport rates predicted with the Wilcock‐Crowe equations are within a factor of 2 of sampled transport rates for 68% of all samples. The Wilcock‐Crowe equations nonetheless consistently under‐predict the transport of particles larger than 128 mm, frequently by more than an order of magnitude. Accurate prediction of the transport rates of the largest particles is important for models in which the evolution of the surface grain size distribution determines subsequent bed load transport rates. Values of τ*rm estimated from bed load samples are up to 50% larger than those predicted with the Wilcock‐Crowe equations, and sampled bed load transport approximates equal mobility across a wider range of grain sizes than is implied by the equations. Modifications to the Wilcock‐Crowe equation for determining τ*rm and the hiding function used to scale τ*rm to other grain size fractions are proposed to achieve the best fit to observed bed load transport in the Trinity River.

Bed rest attenuates sympathetic and pressor responses to isometric exercise in antigravity leg muscles in humans.

PubMed

Kamiya, Atsunori; Michikami, Daisaku; Shiozawa, Tomoki; Iwase, Satoshi; Hayano, Junichiro; Kawada, Toru; Sunagawa, Kenji; Mano, Tadaaki

2004-05-01

Although spaceflight and bed rest are known to cause muscular atrophy in the antigravity muscles of the legs, the changes in sympathetic and cardiovascular responses to exercises using the atrophied muscles remain unknown. We hypothesized that bed rest would augment sympathetic responses to isometric exercise using antigravity leg muscles in humans. Ten healthy male volunteers were subjected to 14-day 6 degrees head-down bed rest. Before and after bed rest, they performed isometric exercises using leg (plantar flexion) and forearm (handgrip) muscles, followed by 2-min postexercise muscle ischemia (PEMI) that continues to stimulate the muscle metaboreflex. These exercises were sustained to fatigue. We measured muscle sympathetic nerve activity (MSNA) in the contralateral resting leg by microneurography. In both pre- and post-bed-rest exercise tests, exercise intensities were set at 30 and 70% of the maximum voluntary force measured before bed rest. Bed rest attenuated the increase in MSNA in response to fatiguing plantar flexion by approximately 70% at both exercise intensities (both P < 0.05 vs. before bed rest) and reduced the maximal voluntary force of plantar flexion by 15%. In contrast, bed rest did not alter the increase in MSNA response to fatiguing handgrip and had no effects on the maximal voluntary force of handgrip. Although PEMI sustained MSNA activation before bed rest in all trials, bed rest entirely eliminated the PEMI-induced increase in MSNA in leg exercises but partially attenuated it in forearm exercises. These results do not support our hypothesis but indicate that bed rest causes a reduction in isometric exercise-induced sympathetic activation in (probably atrophied) antigravity leg muscles.

[Comparison of PAHs distribution in stabilized sludge by sludge drying bed and reed bed].

PubMed

Cui, Yu-Bo; Sun, Hong-Jie; Ran, Chun-Qiu; Li, Jin-Feng; Xie, Yao

2013-03-01

The difference in the removal efficiencies of polycyclic aromatic hydrocarbons (PAHs) in planted and unplanted sludge drying bed was investigated. Pilot-scale sludge drying bed and reed bed had the same size of 3.0 m x 1.0 m x 1.3 m (L x W x H), and the bed height consisted of a 65 cm media layer and a 65 cm super height. Both beds had a ventilation pipe which was mounted on the drainage pipes. The experiment lasted for three years, and the first two years was the sludge loading period, and the third year was the natural stabilization period. In the first two years, a total thickness of 8.4 m of sludge was loaded and the average sludge loading rate was 41.3 kg x (m2 x a)(-1). After the three-year stabilization, the contents of the sixteen PAHs decreased with time in both the sludge drying bed and the reed bed. The total PAHs contents in the surface, middle and bottom sludge layers in the sludge drying bed were 4.161, 3.543 and 3.118 mg x kg(-1) (DW), corresponding to 26.91%, 37.77% and 45.23% of removal; and the values in the reed bed were 2.722, 1.648 and 1.218 mg x kg(-1) (DW), corresponding to 52.18%, 71.05% and 78.60% of removal. The average PAHs removal in the reed bed was 29.86% higher than that in the sludge drying bed. In the stabilized sludge, the removal of low-molecular-weight PAHs predominated. The results suggested that reed played a positive role in the removal of PAHs.

A computational investigation of the interstitial flow induced by a variably thick blanket of very fine sand covering a coarse sand bed

NASA Astrophysics Data System (ADS)

Bartzke, Gerhard; Huhn, Katrin; Bryan, Karin R.

2017-10-01

Blanketed sediment beds can have different bed mobility characteristics relative to those of beds composed of uniform grain-size distribution. Most of the processes that affect bed mobility act in the direct vicinity of the bed or even within the bed itself. To simulate the general conditions of analogue experiments, a high-resolution three-dimensional numerical `flume tank' model was developed using a coupled finite difference method flow model and a discrete element method particle model. The method was applied to investigate the physical processes within blanketed sediment beds under the influence of varying flow velocities. Four suites of simulations, in which a matrix of uniform large grains (600 μm) was blanketed by variably thick layers of small particles (80 μm; blanket layer thickness approx. 80, 350, 500 and 700 μm), were carried out. All beds were subjected to five predefined flow velocities ( U 1-5=10-30 cm/s). The fluid profiles, relative particle distances and porosity changes within the bed were determined for each configuration. The data show that, as the thickness of the blanket layer increases, increasingly more small particles accumulate in the indentations between the larger particles closest to the surface. This results in decreased porosity and reduced flow into the bed. In addition, with increasing blanket layer thickness, an increasingly larger number of smaller particles are forced into the pore spaces between the larger particles, causing further reduction in porosity. This ultimately causes the interstitial flow, which would normally allow entrainment of particles in the deeper parts of the bed, to decrease to such an extent that the bed is stabilized.

Changes in markers of bone formation and resorption in a bed rest model of weightlessness

NASA Technical Reports Server (NTRS)

Lueken, S. A.; Arnaud, S. B.; Taylor, A. K.; Baylink, D. J.

1993-01-01

To study the mechanism of bone loss in physical unloading, we examined indices of bone formation and bone resorption in the serum and urine of eight healthy men during a 7 day -6 degrees head-down tilt bed rest. Prompt increases in markers of resorption--pyridinoline (PD), deoxypyridinoline (DPD), and hydroxyproline (Hyp)/g creatinine--during the first few days of inactivity were paralleled by tartrate-resistant acid phosphatase (TRAP) with significant increases in all these markers by day 4 of bed rest. An index of formation, skeletal alkaline phosphatase (SALP), did not change during bed rest and showed a moderate 15% increase 1 week after reambulation. In contrast to SALP, serum osteocalcin (OC) began increasing the day preceding the increase in Hyp, remained elevated for the duration of the bed rest, and returned to pre-bed rest values within 5 days of reambulation. Similarly, DPD increased significantly at the onset of bed rest, remained elevated for the duration of bed rest, and returned to pre-bed rest levels upon reambulation. On the other hand, the other three indices of resorption, Hyp, PD, and TRAP, remained elevated for 2 weeks after reambulation. The most sensitive indices of the levels of physical activity proved to be the noncollagenous protein, OC, and the collagen crosslinker, DPD. The bed rest values of both these markers were significantly elevated compared to both the pre-bed rest values and the post-bed rest values. The sequence of changes in the circulating markers of bone metabolism indicated that increases in serum OC are the earliest responses of bone to head-down tilt bed rest.

Using an extreme bony prominence anatomical model to examine the influence of bed sheet materials and bed making methods on the distribution of pressure on the support surface.

PubMed

Iuchi, Terumi; Nakajima, Yukari; Fukuda, Moriyoshi; Matsuo, Junko; Okamoto, Hiroyuki; Sanada, Hiromi; Sugama, Junko

2014-05-01

Bed sheets generate high surface tension across the support surface and increase pressure to the body through a process known as the hammock effect. Using an anatomical model and a loading device characterized by extreme bony prominences, the present study compared pressure distributions on support surfaces across different bed making methods and bed sheet materials to determine the factors that influence pressure distribution. The model was placed on a pressure mapping system (CONFORMat; NITTA Corp., Osaka, Japan), and interface pressure was measured. Bed sheet elasticity and friction between the support surface and the bed sheets were also measured. For maximum interface pressure, the relative values of the following methods were higher than those of the control method, which did not use any bed sheets: cotton sheets with hospital corners (1.28, p = 0.02), polyester with no corners (1.29, p = 0.01), cotton with no corners (1.31, p = 0.003), and fitted polyester sheets (1.35, p = 0.002). Stepwise multiple regression analysis indicated that maximum interface pressure was negatively correlated with bed sheet elasticity (R(2) = 0.74). A statistically significant negative correlation was observed between maximum interface pressure and immersion depth, which was measured using the loading device (r = -0.40 and p = 0.04). We found that several combinations of bed making methods and bed sheet materials induced maximum interface pressures greater than those observed for the control method. Bed sheet materials influenced maximum interface pressure, and bed sheet elasticity was particularly important in reducing maximum interface pressure. Copyright © 2014 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

"To sleep, perchance to tweet": in-bed electronic social media use and its associations with insomnia, daytime sleepiness, mood, and sleep duration in adults.

PubMed

Bhat, Sushanth; Pinto-Zipp, Genevieve; Upadhyay, Hinesh; Polos, Peter G

2018-04-01

The use of mobile device-based electronic social media (ESM) in bed is rapidly becoming commonplace, with potentially adverse impacts on sleep and daytime functioning. The purpose of this study was to determine the extent to which in-bed ESM use is associated with insomnia, daytime sleepiness, mood, and sleep duration in adults. This was a cross-sectional observational study conducted among 855 hospital employees and university students (mean age, 43.6years; 85% female) via an online questionnaire. Nearly 70% of participants indulged in in-bed ESM use, with nearly 15% spending an hour or more a night doing so. The degree of in-bed ESM use did not vary by gender, but higher levels of in-bed ESM use were seen in younger and middle-aged than elderly participants. Compared with participants with no in-bed ESM use and controlling for age, gender, and ethnicity, participants with high in-bed ESM use were more likely to have insomnia, anxiety, and short sleep duration on weeknights, but not depression or daytime sleepiness; low in-bed ESM use only increased the likelihood of short sleep duration on weeknights. In-bed ESM use by a bed partner did not have an adverse association with sleep or mood. In-bed ESM use is associated with sleep and mood dysfunction in adults. These findings are of relevance to clinicians, therapists, and the public at large, as they suggest that limitation of in-bed ESM use is a potential interventional strategy in the overall management of sleep hygiene and mental health. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

A population-based study of the epidemiology of acute adult burns in Ecuador from 2005 to 2014.

PubMed

Ortiz-Prado, Esteban; Armijos, Luciana; Iturralde, Ana Lucia

2015-05-01

To describe the demographic, risk factor, occupational, and morbidity and mortality characteristics of burns in adults in Ecuador using national data. These data are from the only specialized public hospital in Ecuador that has a 12-bed burn unit. The National Institute of Statistics and Census provided data from the burn unit of the Hospital Eugenio Espejo, in Quito. Three different datasets pertaining to burn deaths, burn unit inpatient admissions, and hospital discharge were analyzed. Patients who died or were discharged before entering the burn unit were not included in this analysis. During the 10-year period, 1106 patients were admitted to the burn unit, men represent 69.37% with 768 cases and women represent 30.62% with 337 patients; the number of patients per year was on average 123 cases; the average age was 33-34 years old, with a range between 16 and 96 years old. Heat (thermal) burns represent 65.78% followed by electrical with 30.53%, friction burns with 2.06%, and chemical burns with 1.62%. Domestic methane gas was the most frequent agent causing thermal burns and the most affected occupational groups are construction workers and people who stay at home. The overall mortality is 10.2% and the average length of stay was 23 days. Thermal burns are more frequent than any other cause of burns. Electrical burns are more frequent in Ecuador than anywhere else according to our research, meaning that control and prevention of workplace safety, urban planning, and home safety are scarce. The most affected groups are those dedicated to labor work. Finally, mortality in hospitalized patient is higher when compared with developed countries. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Living actively in the face of impending death: constantly adjusting to bodily decline at the end-of-life.

PubMed

Morgan, Deidre D; Currow, David C; Denehy, Linda; Aranda, Sanchia A

2017-06-01

People with advanced cancer experience bodily change resulting in debilitating functional decline. Although inability to participate in everyday activities (occupation) contributes to profound suffering, limited research has examined the relationship between altered bodily experience (embodiment) and functional ability. The purpose of this study was to better understand the lived experience of functional decline for people with advanced cancer living at home. Indepth interviews were conducted with 10 community dwelling people with advanced cancer about their bodily experiences of functional decline. This study employed a pragmatic qualitative approach, informed by hermeneutic phenomenology. People described living with rapidly disintegrating bodies and how this affected their ability to participate in everyday activities. Analysis identified themes which were evaluated against conceptual frameworks of 'occupation' and 'embodiment'. People experienced a shifting sense of self. They had to continuously reinterpret changing bodies. Previously automatic movements became disjointed and effortful. Simple actions like standing or getting out of bed required increasing concentration. Relentless bodily breakdown disrupted peoples' relationship with time, hindering their ability, but not their desire, to participate in everyday activities. Contending with this deterioration is the work of adaptation to functional decline at the end-of-life. This study highlights the role active participation in everyday activities plays in mediating adjustment to functional decline. These findings challenge us to look beyond palliation of physical symptoms and psychospiritual care as ends in themselves. Symptom control and palliation should be viewed as mechanisms to optimise active participation in essential and valued activities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Malaria Hotspots Drive Hypoendemic Transmission in the Chittagong Hill Districts of Bangladesh

PubMed Central

Ahmed, Sabeena; Galagan, Sean; Scobie, Heather; Khyang, Jacob; Prue, Chai Shwai; Khan, Wasif Ali; Ram, Malathi; Alam, Mohammad Shafiul; Haq, M. Zahirul; Akter, Jasmin; Glass, Gregory; Norris, Douglas E.; Nyunt, Myaing Myaing; Shields, Timothy; Sullivan, David J.; Sack, David A.

2013-01-01

Background Malaria is endemic in 13 of 64 districts of Bangladesh, representing a population at risk of about 27 million people. The highest rates of malaria in Bangladesh occur in the Chittagong Hill Districts, and Plasmodium falciparum (predominately chloroquine resistant) is the most prevalent species. Methods The objective of this research was to describe the epidemiology of symptomatic P. falciparum malaria in an area of Bangladesh following the introduction of a national malaria control program. We carried out surveillance for symptomatic malaria due to P. falciparum in two demographically defined unions of the Chittagong Hill Districts in Bangladesh, bordering western Myanmar, between October 2009 and May 2012. The association between sociodemographics and temporal and climate factors with symptomatic P. falciparum infection over two years of surveillance data was assessed. Risk factors for infection were determined using a multivariate regression model. Results 472 cases of symptomatic P. falciparum malaria cases were identified among 23,372 residents during the study period. Greater than 85% of cases occurred during the rainy season from May to October, and cases were highly clustered geographically within these two unions with more than 80% of infections occurring in areas that contain approximately one-third of the total population. Risk factors statistically associated with infection in a multivariate logistic regression model were living in the areas of high incidence, young age, and having an occupation including jhum cultivation and/or daily labor. Use of long lasting insecticide-treated bed nets was high (89.3%), but its use was not associated with decreased incidence of infection. Conclusion Here we show that P. falciparum malaria continues to be hypoendemic in the Chittagong Hill Districts of Bangladesh, is highly seasonal, and is much more common in certain geographically limited hot spots and among certain occupations. PMID:23936345

Factors determining the exposure of dairy farmers to thoracic organic dust.

PubMed

Pfister, Hugo; Madec, Laurent; Cann, Pierre Le; Costet, Nathalie; Chouvet, Martine; Jouneau, Stéphane; Vernhet, Laurent

2018-08-01

Bronchial respiratory diseases are more common in dairy farmers than in the general population, perhaps because the repeated inhalation of organic dust contributes to the development of these disorders. However, the factors determining the exposure of farmers to particles that can enter the lower bronchial tract and interact with it, i.e. the thoracic fraction of the inhalable dust, remain to be identified. We therefore measured the exposure of dairy farmers to thoracic organic dust and identified the farm features and tasks that increased exposure. We measured thoracic particles (n = 110) and farm characteristics and occupational tasks in 29 Brittany dairy farms. The mean (GM) (geometric standard deviation, GSD) concentration of thoracic dust in air inhaled by farmers was 0.24 mg/m 3 (2.8) and the concentrations of endotoxins, Gram-positive bacteria and fungi in the thoracic fraction were 128 EU/m 3 (4.0), 960 CFU/m 3 (6.3) and 690 CFU/m 3 (5.4), respectively. Model-based estimates of the association between exposure, farm features and tasks indicated that manual grain and feed handling and mechanical bedding spreading significantly increased exposure to thoracic dust, endotoxins, bacteria and fungi. Exposure to bacteria and fungi was reduced by cowsheds divided into cubicles, whereas using automatic muck scrappers in alleyway and automatic milking tended to increase exposure to bacteria and endotoxins. Finally, exposure to endotoxin and fungi were reduced by warmer farm buildings and well-ventilated buildings having walls with large openings. In conclusions, major occupational tasks and specific farm features determine the exposure of Breton dairy farmers to thoracic organic dust. Copyright © 2018 Elsevier Inc. All rights reserved.

Bed Bug Infestations and Control Practices in China: Implications for Fighting the Global Bed Bug Resurgence.

PubMed

Wang, Changlu; Wen, Xiujun

2011-04-11

The bed bug resurgence in North America, Europe, and Australia has elicited interest in investigating the causes of the widespread and increasing infestations and in developing more effective control strategies. In order to extend global perspectives on bed bug management, we reviewed bed bug literature in China by searching five Chinese language electronic databases. We conducted telephone interviews of staff from 77 Health and Epidemic Prevention Stations in six Chinese cities in November 2010. We also conducted telephone interviews of 68 pest control firms in two cities during March 2011. Two species of bed bugs (Cimex lectularius L. and Cimex hemipterus (F.)) are known to occur in China. These were common urban pests before the early1980s. Nationwide "Four-Pest Elimination" campaigns (bed bugs being one of the targeted pests) were implemented in China from 1960 to the early 1980s. These campaigns succeeded in the elimination of bed bug infestations in most communities. Commonly used bed bug control methods included applications of hot water, sealing of bed bug harborages, physical removal, and applications of residual insecticides (mainly organophosphate sprays or dusts). Although international and domestic travel has increased rapidly in China over the past decade (2000-2010), there have only been sporadic new infestations reported in recent years. During 1999-2009, all documented bed bug infestations were found in group living facilities (military dormitories, worker dormitories, and prisons), hotels, or trains. One city (Shenzhen city near Hong Kong) experienced significantly higher number of bed bug infestations. This city is characterized by a high concentration of migratory factory workers. Current bed bug control practices include educating residents, washing, reducing clutter, putting items under the hot sun in summer, and applying insecticides (pyrethroids or organophosphates). There have not been any studies or reports on bed bug insecticide resistance. Difficulties of control were noted in our surveys of dormitories in which crowded living, seasonal worker migration, and financial constraints contributed to control failures. This study supports the following conclusions: (1) the bed bug infestation in China dramatically decreased following the campaigns from 1960 to the early 1980s; (2) In our survey of Health and Epidemics Prevention Stations, no bed bug cases were reported in Beijing and Shanghai for the past 12 months, but complaints were reported in Guangzhou, Lanzhou, Urumqi, and Shenzhen; (3) Current bed bug infestations primarily are reported in crowded living environments or transient environments such as worker dormitories and military dormitories. These findings suggest that community-wide bed bug monitoring and control campaigns are necessary for effective control of bed bug infestations as a societal response.

Bed Bug Infestations and Control Practices in China: Implications for Fighting the Global Bed Bug Resurgence

PubMed Central

Wang, Changlu; Wen, Xiujun

2011-01-01

The bed bug resurgence in North America, Europe, and Australia has elicited interest in investigating the causes of the widespread and increasing infestations and in developing more effective control strategies. In order to extend global perspectives on bed bug management, we reviewed bed bug literature in China by searching five Chinese language electronic databases. We conducted telephone interviews of staff from 77 Health and Epidemic Prevention Stations in six Chinese cities in November 2010. We also conducted telephone interviews of 68 pest control firms in two cities during March 2011. Two species of bed bugs (Cimex lectularius L. and Cimex hemipterus (F.)) are known to occur in China. These were common urban pests before the early1980s. Nationwide “Four-Pest Elimination” campaigns (bed bugs being one of the targeted pests) were implemented in China from 1960 to the early 1980s. These campaigns succeeded in the elimination of bed bug infestations in most communities. Commonly used bed bug control methods included applications of hot water, sealing of bed bug harborages, physical removal, and applications of residual insecticides (mainly organophosphate sprays or dusts). Although international and domestic travel has increased rapidly in China over the past decade (2000–2010), there have only been sporadic new infestations reported in recent years. During 1999–2009, all documented bed bug infestations were found in group living facilities (military dormitories, worker dormitories, and prisons), hotels, or trains. One city (Shenzhen city near Hong Kong) experienced significantly higher number of bed bug infestations. This city is characterized by a high concentration of migratory factory workers. Current bed bug control practices include educating residents, washing, reducing clutter, putting items under the hot sun in summer, and applying insecticides (pyrethroids or organophosphates). There have not been any studies or reports on bed bug insecticide resistance. Difficulties of control were noted in our surveys of dormitories in which crowded living, seasonal worker migration, and financial constraints contributed to control failures. This study supports the following conclusions: (1) the bed bug infestation in China dramatically decreased following the campaigns from 1960 to the early 1980s; (2) In our survey of Health and Epidemics Prevention Stations, no bed bug cases were reported in Beijing and Shanghai for the past 12 months, but complaints were reported in Guangzhou, Lanzhou, Urumqi, and Shenzhen; (3) Current bed bug infestations primarily are reported in crowded living environments or transient environments such as worker dormitories and military dormitories. These findings suggest that community-wide bed bug monitoring and control campaigns are necessary for effective control of bed bug infestations as a societal response. PMID:26467615

Method for in situ gasification of a subterranean coal bed

DOEpatents

Shuck, Lowell Z.

1977-05-31

The method of the present invention relates to providing controlled directional bores in subterranean earth formations, especially coal beds for facilitating in situ gasification operations. Boreholes penetrating the coal beds are interconnected by laser-drilled bores disposed in various arrays at selected angles to the major permeability direction in the coal bed. These laser-drilled bores are enlarged by fracturing prior to the gasification of the coal bed to facilitate the establishing of combustion zones of selected configurations in the coal bed for maximizing the efficiency of the gasification operation.

Phase holdups in three-phase fluidized beds in the presence of disc promoter

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

Murty, M.S.N.; Ramesh, K.V.; Venkateswarlu, P.

2011-02-15

Three-phase fluidized beds are found to have wide applications in process industries. The present investigation essentially comprises of the studies on gas holdup, liquid holdup and bed porosity in three-phase fluidized beds with coaxially placed disc promoter. Holdup data were obtained from bed expansion and pressure drop measurements. Analysis of the data was done to elucidate the effects of dynamic and geometric parameters on gas holdup, liquid holdup and bed porosity. Data were correlated and useful equations were obtained from empirical modeling. (author)

WTP Pretreatment Facility Potential Design Deficiencies--Sliding Bed and Sliding Bed Erosion Assessment

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

Hansen, E. K.

2015-05-06

This assessment is based on readily available literature and discusses both Newtonian and non-Newtonian slurries with respect to sliding beds and erosion due to sliding beds. This report does not quantify the size of the sliding beds or erosion rates due to sliding beds, but only assesses if they could be present. This assessment addresses process pipelines in the Pretreatment (PT) facility and the high level waste (HLW) transfer lines leaving the PT facility to the HLW vitrification facility concentrate receipt vessel.

Mass and heat transfer in crushed oil shale

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

Carley, J.F.; Ott, L.L.; Swecker, J.L.

1995-03-01

Studies of heat and mass transfer in packed beds, which disagree substantially in their findings, have nearly all been done with beds of regular particles of uniform size, whereas oil-shale retorting involves particles of diverse irregular shapes and sizes. The authors, in 349 runs, measured mass-transfer rates front naphthalene particles buried in packed beds by passing through air at room temperature. An exact catalog between convection of heat and mass makes it possible to infer heat-transfer coefficients from measured mass-transfer coefficients and fluid properties. Some beds consisted of spheres, naphthalene and inert, of the same, contrasting or distributed sizes. Inmore » some runs, naphthalene spheres were buried in beds of crushed shale, some in narrow screen ranges and others with a wide size range. In others, naphthalene lozenges of different shapes were buried in beds of crushed shale in various bed axis orientations. This technique permits calculation of the mass-transfer coefficient for each active particle in the bed rather than, as in most past studies, for the bed as a whole. The data are analyzed by the traditional correlation of Colburn j{sub D} vs. Reynolds number and by multiple regression of the mass-transfer coefficient on air rate, sizes of active and inert particles, void fraction, and temperature. Principal findings are: local Reynolds number should be based on the active-particle size, not the average for the whole bed; differences between shallow and deep beds are not appreciable; mass transfer is 26% faster for spheres and lozenges buried in shale than in all-sphere beds; orientation of lozenges in shale beds has little or no effect on mass-transfer rate; and for mass or heat transfer in shale beds, log(j{center_dot}{epsilon}) = {minus}0.0747 - 0.6344 log N{sub Re} + 0. 0592 log {sup 2} N{sub Re}.« less

Bed site selection by a subordinate predator: an example with the cougar (Puma concolor) in the Greater Yellowstone Ecosystem.

PubMed

Kusler, Anna; Elbroch, L Mark; Quigley, Howard; Grigione, Melissa

2017-01-01

As technology has improved, our ability to study cryptic animal behavior has increased. Bed site selection is one such example. Among prey species, bed site selection provides thermoregulatory benefits and mitigates predation risk, and may directly influence survival. We conducted research to test whether a subordinate carnivore also selected beds with similar characteristics in an ecosystem supporting a multi-species guild of competing predators. We employed a model comparison approach in which we tested whether cougar ( Puma concolor ) bed site attributes supported the thermoregulatory versus the predator avoidance hypotheses, or exhibited characteristics supporting both hypotheses. Between 2012-2016, we investigated 599 cougar bed sites in the Greater Yellowstone Ecosystem and examined attributes at two scales: the landscape (second-order, n  = 599) and the microsite (fourth order, n  = 140). At the landscape scale, cougars selected bed sites in winter that supported both the thermoregulatory and predator avoidance hypotheses: bed sites were on steeper slopes but at lower elevations, closer to the forest edge, away from sagebrush and meadow habitat types, and on southern, eastern, and western-facing slopes. In the summer, bed attributes supported the predator avoidance hypothesis over the thermoregulation hypothesis: beds were closer to forest edges, away from sagebrush and meadow habitat classes, and on steeper slopes. At the microsite scale, cougar bed attributes in both the winter and summer supported both the predator avoidance and thermoregulatory hypotheses: they selected bed sites with high canopy cover, high vegetative concealment, and in a rugged habitat class characterized by cliff bands and talus fields. We found that just like prey species, a subordinate predator selected bed sites that facilitated both thermoregulatory and anti-predator functions. In conclusion, we believe that measuring bed site attributes may provide a novel means of measuring the use of refugia by subordinate predators, and ultimately provide new insights into the habitat requirements and energetics of subordinate carnivores.

Practical aspects and uncertainty analysis of biological effective dose (BED) regarding its three-dimensional calculation in multiphase radiotherapy treatment plans

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

Kauweloa, Kevin I., E-mail: Kauweloa@livemail.uthscsa.edu; Gutierrez, Alonso N.; Bergamo, Angelo

2014-07-15

Purpose: There is a growing interest in the radiation oncology community to use the biological effective dose (BED) rather than the physical dose (PD) in treatment plan evaluation and optimization due to its stronger correlation with radiobiological effects. Radiotherapy patients may receive treatments involving a single only phase or multiple phases (e.g., primary and boost). Since most treatment planning systems cannot calculate the analytical BED distribution in multiphase treatments, an approximate multiphase BED expression, which is based on the total physical dose distribution, has been used. The purpose of this paper is to reveal the mathematical properties of the approximatemore » BED formulation, relative to the true BED. Methods: The mathematical properties of the approximate multiphase BED equation are analyzed and evaluated. In order to better understand the accuracy of the approximate multiphase BED equation, the true multiphase BED equation was derived and the mathematical differences between the true and approximate multiphase BED equations were determined. The magnitude of its inaccuracies under common clinical circumstances was also studied. All calculations were performed on a voxel-by-voxel basis using the three-dimensional dose matrices. Results: Results showed that the approximate multiphase BED equation is accurate only when the dose-per-fractions (DPFs) in both the first and second phases are equal, which occur when the dose distribution does not significantly change between the phases. In the case of heterogeneous dose distributions, which significantly vary between the phases, there are fewer occurrences of equal DPFs and hence the inaccuracy of the approximate multiphase BED is greater. These characteristics are usually seen in the dose distributions being delivered to organs at risk rather than to targets. Conclusions: The finding of this study indicates that the true multiphase BED equation should be implemented in the treatment planning systems due to the inconsistent accuracy of the approximate multiphase BED equation in most of the clinical situations.« less

Potential population growth and harmful effects on humans from bed bug populations exposed to different feeding regimes.

PubMed

Pereira, R M; Taylor, A S; Lehnert, M P; Koehler, P G

2013-06-01

Effects of host availability and feeding period on bed bugs, Cimex lectularius (L.) (Hemiptera: Cimicidae), were measured. Population growth and the potential harmful effect of bed bug populations on human hosts were modelled. Bloodmeal sizes were affected by both feeding length and frequency, with >2-fold difference between insects fed daily or weekly. Blood consumption increased >2-fold between bed bugs fed occasionally and often, and 1.5-fold between occasional and daily feeding. Bed bugs fed more often than once a week, potentially every 2-4 days. Egg production was associated with nutrition, being strongly correlated with blood consumption in the previous week. Bed bug populations can grow under different feeding regimes and are hard to control with <80% mortality. Bed bugs can survive and grow even in locations with a limited blood supply, where bed bug persistence may be important for the continual spread of populations. Persistence in non-traditional locations and a potential association with human pathogens increase the health risks of bed bugs. Potential blood loss as a result of a bed bug can have serious consequences because uncontrolled populations can reach harmful levels in 3-8 months. The reproduction potential of bed bug populations suggests serious consequences to human health and the need for efficacious control measures. © 2012 The Royal Entomological Society.

Body dissatisfaction and socio-cultural factors in women with and without BED: their relation with eating psychopathology.

PubMed

Bautista-Díaz, M L; Franco-Paredes, K; Mancilla-Díaz, J M; Alvarez-Rayón, G; López-Aguilar, X; Ocampo Téllez-Girón, T; Soto-González, Y

2012-06-01

The goal of the present study was to assess the role of body dissatisfaction and socio-cultural factors on eating psychopathology in women with Binge Eating Disorder (BED) and women without BED. Seventy obese women consecutively evaluated participated: 35 with BED and 35 without BED who attended for the first time in a weight loss program. All participants completed a battery of questionnaires, including: Body Shape Questionnaire, Questionnaire of Influences on the Aesthetic Body Shape Model, Questionnaire on Eating and Weight Patterns, Three Factor Eating Questionnaire, and they were interviewed with the Interview for the Diagnosis of Eating Disorder-IV. The Body Mass Index, Waist-to-Hip Ratio and Body Fat were calculated. The results showed that 21% of obese women who participated in a weight reduction program met BED criteria. The scores of body dissatisfaction, influences of socio-cultural factors and eating psychopathology were higher in women with BED compared with women without BED. In the same way, significantly stronger correlations were found among influences of socio-cultural factors, specifically, influence of advertisement, social relations and eating psychopathology in women with BED than women without BED. It is concluded that the high body dissatisfaction as well as stronger associations among influence of socio-cultural factors and eating psychopathology could play an important role in women with BED.

Development and Evaluation of a Wide-Bed Former for Vegetable Cultivation in Controlled Tractor Traffic

NASA Astrophysics Data System (ADS)

Dixit, Anoop; Khurana, Rohinish; Verma, Aseem; Singh, Arshdeep; Manes, G. S.

2018-05-01

India is the second largest producer of vegetables in the world. For vegetable cultivation, a good seed bed preparation is an important task which involves 6-10 different operations. To tackle the issue of multiple operations, a prototype of tractor operated wide bed former was developed and evaluated. The machine comprises of a rotary tiller and a bed forming setup. It forms bed of 1000 mm top width which is suitable as per the track width of an average sized tractor in India. The height of the beds formed is 130 mm whereas the top and bottom width of channel formed on both sides of the bed is 330 and 40 mm respectively at soil moisture content of 12.5-16% (db). The forward speed of 2.75 km/h was observed to be suitable for proper bed formation. The average fuel consumption of the machine was 5.9 l/h. The average bulk density of soil before and after the bed formation was 1.46 and 1.63 g/cc respectively. Field capacity of the machine was found to be 0.31 ha/h. The machine resulted in 93.8% labour saving and 80.4% saving in cost of bed preparation as compared to conventional farmer practice. Overall performance of wide-bed former was found to be satisfactory.

Experimental study on the bed shear stress under breaking waves

NASA Astrophysics Data System (ADS)

Hao, Si-yu; Xia, Yun-feng; Xu, Hua

2017-06-01

The object of present study is to investigate the bed shear stress on a slope under regular breaking waves by a novel instrument named Micro-Electro-Mechanical System (MEMS) flexible hot-film shear stress sensor. The sensors were calibrated before application, and then a wave flume experiment was conducted to study the bed shear stress for the case of regular waves spilling and plunging on a 1:15 smooth PVC slope. The experiment shows that the sensor is feasible for the measurement of the bed shear stress under breaking waves. For regular incident waves, the bed shear stress is mainly periodic in both outside and inside the breaking point. The fluctuations of the bed shear stress increase significantly after waves breaking due to the turbulence and vortexes generated by breaking waves. For plunging breaker, the extreme value of the mean maximum bed shear stress appears after the plunging point, and the more violent the wave breaks, the more dramatic increase of the maximum bed shear stress will occur. For spilling breaker, the increase of the maximum bed shear stress along the slope is gradual compared with the plunging breaker. At last, an empirical equation about the relationship between the maximum bed shear stress and the surf similarity parameter is given, which can be used to estimate the maximum bed shear stress under breaking waves in practice.

Pulse enhanced fluidized bed combustion

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

Mueller, B.

1996-12-31

Information is outlined on pulse enhanced fluidized bed combustion. The following topics are discussed: what is pulse enhanced fluidized bed combustion?; pulse combustors; pulsed atmospheric fluidized bed combustor (PAFBC); advantages of PAFBC; performance advantages; PAFBC facts; and PAFBC contact points.

Bed bug aggregation pheromone finally identified.

PubMed

Gries, Regine; Britton, Robert; Holmes, Michael; Zhai, Huimin; Draper, Jason; Gries, Gerhard

2015-01-19

Bed bugs have become a global epidemic and current detection tools are poorly suited for routine surveillance. Despite intense research on bed bug aggregation behavior and the aggregation pheromone, which could be used as a chemical lure, the complete composition of this pheromone has thus far proven elusive. Here, we report that the bed bug aggregation pheromone comprises five volatile components (dimethyl disulfide, dimethyl trisulfide, (E)-2-hexenal, (E)-2-octenal, 2-hexanone), which attract bed bugs to safe shelters, and one less-volatile component (histamine), which causes their arrestment upon contact. In infested premises, a blend of all six components is highly effective at luring bed bugs into traps. The trapping of juvenile and adult bed bugs, with or without recent blood meals, provides strong evidence that this unique pheromone bait could become an effective and inexpensive tool for bed bug detection and potentially their control. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Effect of bed rest and exercise on body balance

NASA Technical Reports Server (NTRS)

Haines, R. F.

1974-01-01

A battery of 11 body balance tests was administered to 7 men before and after 14 days of bedrest. Seven men who had not undergone bed rest served as controls. During bed rest, each subject underwent daily either isotonic, isometric, or no leg exercise. The results showed that, for the bed-rested no exercise, isotonic exercise, and isometric exercise groups, 2 weeks of bed rest produces significant body balance decrements on 3, 4, and 5 of the 11 tests, respectively. Daily leg exercise did not prevent the debilitating effects of bed rest on body balance. After bed rest, balance skill was relearned rapidly so that in most tests, performance had reached prebed-rest levels by the third recovery day. These data suggest that balance impairment is not due to loss of muscular strength in the legs but, perhaps, to a bed-rest-related change in the neurally coded information to postural control centers.

The role of coherence of mind and reflective functioning in understanding binge-eating disorder and co-morbid overweight.

PubMed

Maxwell, Hilary; Tasca, Giorgio A; Grenon, Renee; Faye, Megan; Ritchie, Kerri; Bissada, Hany; Balfour, Louise

2017-08-01

Coherence of mind and reflective functioning may impact negative affect and interpersonal functioning over and above the effects of symptoms of depression and interpersonal problems that contribute to symptoms of binge-eating disorder (BED) and overweight/obesity. Matched samples of overweight women with BED and overweight and normal weight women without BED completed the Adult Attachment Interview, a measure of depressive symptoms, and a measure of interpersonal problems. Greater symptoms of depression distinguished women with BED from the matched comparison samples. Greater interpersonal problems differentiated women with BED from overweight women without BED. Coherence of Mind scores did not differentiate the samples. However, lower Reflective Functioning scores did distinguish both women with BED and overweight women without BED from normal weight women. Lower reflective functioning may lead to binge eating independent of depressive symptoms and interpersonal problems.

Virtual Design of a 4-Bed Molecular Sieve for Exploration

NASA Technical Reports Server (NTRS)

Giesy, Timothy J.; Coker, Robert F.; O'Connor, Brian F.; Knox, James C.

2017-01-01

Simulations of six new 4-Bed Molecular Sieve configurations have been performed using a COMSOL (COMSOL Multiphysics - commercial software) model. The preliminary results show that reductions in desiccant bed size and sorbent bed size when compared to the International Space Station configuration are feasible while still yielding a process that handles at least 4.0 kilograms a day CO2. The results also show that changes to the CO2 sorbent are likewise feasible. Decreasing the bed sizes was found to have very little negative effect on the adsorption process; breakthrough of CO2 in the sorbent bed was observed for two of the configurations, but a small degree of CO2 breakthrough is acceptable, and water breakthrough in the desiccant beds was not observed. Both configurations for which CO2 breakthrough was observed still yield relatively high CO2 efficiency, and future investigations will focus on bed size in order to find the optimum configuration.

Virtual Design of a 4-Bed Molecular Sieve for Exploration

NASA Technical Reports Server (NTRS)

Giesy, Timothy J.; Coker, Robert F.; O'Connor, Brian F.; Knox, James C.

2017-01-01

Simulations of six new 4-Bed Molecular Sieve configurations have been performed using a COMSOL model. The preliminary results show that reductions in desiccant bed size and sorbent bed size when compared to the International Space Station configuration are feasible while still yielding a process that handles at least 4.0 kg/day CO2. The results also show that changes to the CO2 sorbent are likewise feasible. Decreasing the bed sizes was found to have very little negative effect on the adsorption process; breakthrough of CO2 in the sorbent bed was observed for two of the configurations, but water breakthrough in the desiccant beds was not observed. Nevertheless, both configurations for which CO2 breakthrough was observed still yield relatively high CO2 efficiency, and future investigations will focus on bed size in order to find the optimum configuration.

Loneliness mediates the relationship between emotion dysregulation and bulimia nervosa/binge eating disorder psychopathology in a clinical sample

PubMed Central

Christensen, Kara A.; Fettich, Karla C.; Weissman, Jessica; Berona, Johnny; Chen, Eunice Y.

2017-01-01

Emotion dysregulation has been linked to binge eating disorder (BED) and bulimia nervosa (BN) although the mechanisms by which it affects BN/BED psychopathology are unclear. This study tested loneliness as a mediator between emotion dysregulation and BN/BED psychopathology. A treatment-seeking sample of 107 women with BN or BED was assessed for loneliness (UCLA Loneliness Scale), emotion dysregulation (Difficulties in Emotion Regulation Scale), and BN/BED psychopathology (Eating Disorder Examination) before treatment. Hierarchical linear regressions and bootstrapping mediation models were run. Greater overall emotion dysregulation was associated with greater BN/BED psychopathology, mediated by loneliness (95 % CI 0.03, 0.09). Emotion dysregulation, however, did not mediate between loneliness and BN/BED psychopathology (95 % CI −0.01, 0.01). Targeting loneliness may effectively treat emotional aspects of BN/BED in women. PMID:24235091

Variability of bed mobility in natural, gravel-bed channels and adjustments to sediment load at local and reach scales

Treesearch

Thomas E. Lisle; Jonathan M. Nelson; John Pitlick; Mary Ann Madej; Brent L. Barkett

2000-01-01

Abstract - Local variations in boundary shear stress acting on bed-surface particles control patterns of bed load transport and channel evolution during varying stream discharges. At the reach scale a channel adjusts to imposed water and sediment supply through mutual interactions among channel form, local grain size, and local flow dynamics that govern bed mobility...

Odorous volatile organic compounds, Escherichia coli, and nutrient concentrations when kiln-dried pine chips and corn stover bedding are used in beef bedded manure packs

USDA-ARS?s Scientific Manuscript database

Pine (Pinus spp.) bedding has been shown to lower the concentration of odorous volatile organic compounds (VOCs) and pathogenic bacteria compared with corn (Zea mays L.) stover bedding, but availability and cost limit the use of pine bedding in cattle confinement facilities. The objectives of this s...

[The structural functional analysis of beds stock of curative preventive organizations of the state public health system of the Russian Federation].

PubMed

Schepin, V O

2014-01-01

The article presents the results of comprehensive scientific analysis of size and structure of beds stock of medical curative preventive organizations of state and municipal health care systems of the Russian Federation. The issues of beds support of population on national, federal okrugs and federation subjects' levels including differentiation on different medical specialties are considered. The main indicators of functioning of hospitals, per capita consumption of hospital medical care and territorial characteristics and differences of these indicators are analyzed In conditions of on-going decrease of size of beds stock and amount of medical care in hospitals and against the background of stability of main indicators of beds use the expressed but not always objectively conditioned differences continue to be present concerning both population support with beds stock and indicators of consumption of medical care in hospitals. All these occurrences undoubtedly impact accessibility of this type of medical care to population and its resource capacity for the government. In 2012, beds support of population decreased from 85.7 to 84.1 beds per 10 000 of population. The value of indicator in federal subjects differs up to 2.9 times. In the structure of beds stock are prevailing specialized beds or groups of beds on such medical specialties as psychiatry, surgery, obstetrics and gynecology and therapy. The per capita use of medical care in hospitals decreased up to 2.609 beds-per-day that is 6.2% lower than standard value from the program of state guarantees of free-of-charge medical care support of citizen. The end values of indicator in federal subjects differ in 2.7 times. In federal subjects indicators of mean number of work of bed per year differ up to 1.2 times, of mean duration of treatment--up to 1.6 times, turn-over of bed--up to 1.6 times, hospital lethality--up to 5.9 times. The results of study confirm necessity of structural functional optimization of national beds stock and development of interaction between hospitals and out-patient services.

A qualitative study on caretakers' perceived need of bed-nets after reduced malaria transmission in Zanzibar, Tanzania

PubMed Central

2012-01-01

Background The elimination of malaria in Zanzibar is highly dependent on sustained effective coverage of bed-nets to avoid malaria resurgence. The Health Belief Model (HBM) framework was used to explore the perceptions of malaria and bed-net use after a noticeable reduction in malaria incidence. Methods Nineteen in-depth interviews were conducted with female and male caretakers of children under five in North A district, Zanzibar. Deductive content analysis was used to identify meaning units that were condensed, coded and assigned to pre-determined elements of the HBM. Results Awareness of malaria among caretakers was high but the illness was now seen as easily curable and uncommon. In addition to the perceived advantage of providing protection against malaria, bed-nets were also thought to be useful for avoiding mosquito nuisance, especially during the rainy season when the malaria and mosquito burden is high. The discomfort of sleeping under a net during the hot season was the main barrier that interrupted consistent bed-net usage. The main cue to using a bed-net was high mosquito density, and children were prioritized when it came to bed-net usage. Caretakers had high perceived self-efficacy and did not find it difficult to use bed-nets. Indoor Residual Spraying (IRS), which was recognized as an additional means of mosquito prevention, was not identified as an alternative for bed-nets. A barrier to net ownership was the increasingly high cost of bed-nets. Conclusions Despite the reduction in malaria incidence and the resulting low malaria risk perceptions among caretakers, the benefit of bed-nets as the most proficient protection against mosquito bites upholds their use. This, in combination with the perceived high self-efficacy of caretakers, supports bed-net usage, while seasonality interrupts consistent use. High effective coverage of bed-nets could be further improved by reinforcing the benefits of bed-nets, addressing the seasonal heat barrier by using nets with larger mesh sizes and ensuring high bed-net ownership rates through sustainable and affordable delivery mechanisms. PMID:22863188

An adjusted bed net coverage indicator with estimations for 23 African countries

PubMed Central

2013-01-01

Background Many studies have assessed the level of bed net coverage in populations at risk of malaria infection. These revealed large variations in bed net use across countries, regions and social strata. Such studies are often aimed at identifying populations with low access to bed nets that should be prioritized in future interventions. However, often spatial differences in malaria endemicity are not taken into account. By ignoring variability in malaria endemicity, these studies prioritize populations with little access to bed nets, even if these happen to live in low endemicity areas. Conversely, populations living in regions with high malaria endemicity will receive a lower priority once a seizable proportion is protected by bed nets. Adequately assigning priorities requires accounting for both the current level of bed net coverage and the local malaria endemicity. Indeed, as shown here for 23 African countries, there is no correlation between the level of bed net coverage and the level of malaria endemicity in a region. Therefore, the need for future interventions can not be assessed based on current bed net coverage alone. This paper proposes the Adjusted Bed net Coverage (ABC) statistic as a measure taking into account both local malaria endemicity and the level of bed net coverage. The measure allows setting priorities for future interventions taking into account both local malaria endemicity and bed net coverage. Methods A mathematical formulation of the ABC as a weighted difference of bed net coverage and malaria endemicity is presented. The formulation is parameterized based on a model of malaria epidemiology (Smith et al. Trends Parasitol 25:511-516, 2009). By parameterizing the ABC based on this model, the ABC as used in this paper is proxy for the steady-state malaria burden given the current level of bed net coverage. Data on the bed net coverage in under five year olds and malaria endemicity in 23 Sub-Saharan countries is used to show that the ABC prioritizes different populations than the level of bed net coverage by itself. Data from the following countries was used: Angola, Burkina Faso, Burundi, Cameroon, Congo Democratic Republic, Ethiopia, Ghana, Guinea, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Nigeria, Rwanda, Senegal, Sierra Leone, Tanzania, Uganda, Zambia and Zimbabwe. The priority order given by the ABC and the bed net coverage are compared at the countries’ level, the first level administrative divisions and for five different wealth quintiles. Results Both at national level and at the level of the administrative divisions the ABC suggests a different priority order for selecting countries and divisions for future interventions. When taking into account malaria endemicity, measures assessing equality in access to bed nets across wealth quintiles, such as slopes of inequality, are prone to change. This suggests that when assessing inequality in access to bed nets one should take into account the local malaria endemicity for populations from different wealth quintiles. Conclusion Accounting for malaria endemicity highlights different countries, regions and socio-economic strata for future intervention than the bed net coverage by itself. Therefore, care should be taken to factor out any effects of local malaria endemicity in assessing bed net coverage and in prioritizing populations for further scale-up of bed net coverage. The ABC is proposed as a simple means to do this that is derived from an existing model of malaria epidemiology. PMID:24359227

Comparison of Three Bed Bug Management Strategies in a Low-Income Apartment Building.

PubMed

Wang, Changlu; Saltzmann, Kurt; Bennett, Gary; Gibb, Timothy

2012-04-02

Bed bug (Cimex lectularius L.) infestations are currently controlled by a variety of non-chemical and chemical methods. There have been few studies on the comparative effectiveness of these control techniques. We evaluated three bed bug management strategies in an apartment building: (1) non-chemical methods only (n = 9); (2) insecticides only (n = 6); and (3) integrated pest management including both non-chemical methods and insecticides (n = 9). The apartments were one-bedroom units occupied by seniors or people with disabilities. Bed bug numbers in each apartment were determined by visual inspection and/or installing intercepting devices under bed and sofa legs. The median (min, max) bed bug counts in the non-chemical methods only, insecticides only, and integrated pest management (IPM) treatment were: 4 (1, 57), 19 (1, 250), and 14 (1, 219), respectively prior to the treatments. The apartments were retreated if found necessary during biweekly to monthly inspections. After 10 weeks, bed bugs were found to be eliminated from 67, 33, and 44% of the apartments in the three treatment groups, respectively. The final (after 10 weeks) median (min, max) bed bug counts in the non-chemical methods only, insecticides only, and IPM treatment were: 0 (0, 134), 11.5 (0, 58), and 1 (0, 38), respectively. There were no significant differences in the speed of bed bug count reduction or the final bed bug counts. Lack of resident cooperation partially contributed to the failure in eliminating bed bugs from some of the apartments. Results of this study suggest that non-chemical methods can effectively eliminate bed bugs in lightly infested apartments.

Tracking bed bugs (Cimex lectularius): a study of the effect of physiological and extrinsic factors on the response to bed bug-derived volatiles.

PubMed

Weeks, E N I; Logan, J G; Birkett, M A; Pickett, J A; Cameron, M M

2013-02-01

The common bed bug, Cimex lectularius, feeds on the blood of mammal and bird hosts, and is a pest of global importance. Semiochemicals are chemicals involved in animal communication that may affect behaviour and/or physiology. Attractive semiochemicals that play a role in mediating bed bug behaviour could be exploited for the development of a highly effective novel monitoring device. Tracking software was used to record the response of bed bugs to volatiles from paper previously exposed to conspecific bugs in a still-air olfactometer illuminated by infrared lights, through a variety of activity variables. The effect of time of day as an extrinsic factor, and sex, stage, mating status and nutritional status as physiological factors on the response of bed bugs to the volatiles was examined. Bed bugs of both sexes and all stages responded to the volatiles from bed bug-exposed papers, showing significant attraction and orientation towards the volatile source whether they were starved or engorged. Confirmation that the physiological factors examined do not affect the response of bed bugs to the volatiles from bed bug-exposed papers provides evidence that these bed bug-derived volatiles contain aggregation cues, as semiochemicals that promote aggregation should by definition be detected by both sexes and all life stages. A device baited with such semiochemicals could play a major role in limiting the impact of the current bed bug resurgence by enabling timely detection of infestations, along with quantitative evaluation of control and effective surveillance of the geographical distribution of the pest species.

Channel widening due to urbanization and a major flood can alter bed particle organization and bed stability in an urban boulder-bed channel

NASA Astrophysics Data System (ADS)

Prestegaard, K. L.; Behrns, K.; Blanchet, Z.; Hankin, E.

2007-12-01

The Anacostia River is a tributary of the Potomac River north of Washington D.C. that has become progressively more urbanized in the past 50 years. Bankfull discharge and bankfull width in the Anacostia have increased by 3- 4x in the past 50 years. Nearby watersheds of similar size and geology, but without significant urbanization, contain threshold gravel-bed streams. The Anacostia, however, is not a threshold channel; it exhibits break-up of boulder-bed channels in upstream reaches and significant gravel bar formation in downstream reaches. These gravel bars have grown and migrated considerably in the past 10-15 years, contributing significantly to local channel widening that can be twice that of adjacent reaches. The purpose of this study is to determine bedload transport rates and grain size distributions and their relationship to discharge, bed organization and sediment supply. Bed mobility data come from both bedload transport measurements and measurements of channel bed changes. Channel bed changes were obtained from a) repeated channel cross section surveys, b) surface and subsurface size distributions, and c) bed particle organization measurements (measurements of location of particles within reaches). These measurements were made prior to and after the floods of 2006, which equalled the largest floods on record for most parts of the Anacostia River. In some boulder bed reaches, boulders were removed from the center of the channel and deposited along and on the channel banks. The mid-channel boulders were replaced by sheets of gravel and cobbles, significantly altering the bed mobility of the channels.

A Controlled Evaluation of the Distress Criterion for Binge Eating Disorder

PubMed Central

Grilo, Carlos M.; White, Marney A.

2012-01-01

Objective Research has examined various aspects of the validity of the research criteria for binge eating disorder (BED) but has yet to evaluate the utility of criterion C “marked distress about binge eating.” This study examined the significance of the marked distress criterion for BED using two complementary comparisons groups. Method A total of 1075 community volunteers completed a battery of self-report instruments as part of an internet study. Analyses compared body mass index (BMI), eating-disorder psychopathology, and depressive levels in four groups: 97 participants with BED except for the distress criterion (BED-ND), 221 participants with BED including the distress criterion (BED), 79 participants with bulimia nervosa (BN), and 489 obese participants without binge-eating or purging (NBPO). Parallel analyses compared these study groups using the broadened frequency criterion (i.e., once-weekly for binge/purge behaviors) proposed for DSM-5 and the DSM-IV twice-weekly frequency criterion. Results The BED group had significantly greater eating-disorder psychopathology and depressive levels than the BED-ND group. The BED group, but not the BED-ND group, had significantly greater eating-disorder psychopathology than the NBPO comparison group. The BN group had significantly greater eating-disorder psychopathology and depressive levels than all three other groups. The group differences existed even after controlling for depression levels, BMI, and demographic variables, although some differences between the BN and BED groups were attenuated when controlling for depression levels. Conclusions These findings provide support for the validity of the “marked distress” criterion for the diagnosis of BED. PMID:21707133

Experimental study of the effect of grain sizes in a bimodal mixture on bed slope, bed texture, and the transition to washload

NASA Astrophysics Data System (ADS)

Hill, Kimberly M.; Gaffney, John; Baumgardner, Sarah; Wilcock, Peter; Paola, Chris

2017-01-01

When fine sediment is added to a coarse-grained system, the mobility and composition of the bed can change dramatically. We conducted a series of flume experiments to determine how the size of fine particles introduced to an active gravel bed influences the mobility and composition of the bed. We initiated our experiments using a constant water discharge and feed rate of gravel. After the system reached steady state, we doubled the feed rate by supplying a second sediment of equal or lesser size, creating size ratios from 1:1 to 1:150. As we decreased the relative size of the fine particles, the system transitioned among three regimes: (1) For particle size ratios close to one, the bed slope increased to transport the additional load of similar-sized particles. The bed surface remained planar and unchanged. (2) For intermediate particle size ratios, the bed slope decreased with the additional fines. The bed surface became patchy with regions of fine and coarse grains. (3) For the largest particle size ratios (the smallest fines), the bed slope remained relatively unchanged. The subsurface became clogged with fine sediment, but fine particles were not present in the surface layer. This third regime constitutes washload, defined by those fractions that do not affect bed-material transport conditions. Our results indicate washload should be defined in terms of three conditions: small grain size relative to that of the bed material, full suspension based on the Rouse number, and a small rate of fine sediment supply relative to transport capacity.

Pilot study of the prevalence of binge eating disorder in non-alcoholic fatty liver disease patients.

PubMed

Zhang, Jinyu; Abbasi, Omair; Malevanchik, Lev; Mohan, Neena; Denicola, Richard; Tarangelo, Nicholas; Marzio, Dina Halegoua-De

2017-01-01

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States. Binge eating disorder (BED) is the most common form of eating disorder. NAFLD and BED have similar risk factors, including obesity, insulin resistance, and metabolic syndrome. The aim of our study was to examine prevalence of BED in NAFLD patients. We administered the Binge Eating Scale (BES), a questionnaire validated to screen for BED, to NAFLD patients at our Fatty Liver Center. Demographics were retrieved retrospectively from our electronic medical record. Of the total 95 NAFLD patients screened, 22 (23.1%) had binge eating tendencies; 6 of the 22 (6.3%) scored 27 or more points, suggestive of severe binge eating. Patient demographics included 59 females and 36 males (14 females and 8 males positive for BED). Liver disease severity and of metabolic syndrome presence were similar in both groups: 45 patients had steatosis, 25 steatohepatitis, and 24 cirrhosis, of which 10 steatosis, 5 steatohepatitis, and 7 cirrhosis patients screened positive for BED. Of the NAFLD patients with BED, 50.0% had insulin resistance, 68.2% hypertension, and 50.0% hyperlipidemia, whereas among non-BED NAFLD patients 58.9% had insulin resistance, 63.0% hypertension, and 67.1% hyperlipidemia. This pilot study suggests that BED may have a higher prevalence among NAFLD patients than in the general population. Based on these preliminary results, further study into the prevalence of BED is recommended. More data is need to identify effects of BED on the progression of NAFLD and role of BED treatment.

Bed material transport in the Virgin River, Utah

USGS Publications Warehouse

Andrews, E.D.

2000-01-01

Detailed information concerning the rate and particle size distribution of bed material transport by streamflows can be very difficult and expensive to obtain, especially where peak streamflows are brief and bed material is poorly sorted, including some very large boulders. Such streams, however, are common in steep, arid watersheds. Any computational approach must consider that (1) only the smaller particle sizes present on the streambed move even during large floods and (2) the largest bed particles exert a significant form drag on the flow. Conventional methods that rely on a single particle size to estimate the skin friction shear stress acting on the mobile fraction of the bed material perform poorly. Instead, for this study, the skin friction shear stress was calculated for the observed range of streamflows by calculating the form drag exerted on the reach‐averaged flow field by all particle sizes. Suspended and bed load transported rates computed from reach‐averaged skin friction shear stress are in excellent agreement with measured transport rates. The computed mean annual bed material load, including both bed load and suspended load, of the East Fork Virgin River for the water years 1992‐1996 was approximately 1.3×10 5 t. A large portion of the bed material load consists of sand‐sized particles, 0.062–1.0 mm in diameter, that are transported in suspension. Such particles, however, constituted only 10% of the surface bed material and less than 25% of the subsurface bed material. The mean annual quantity of bed load transported was 1060 t/yr with a median size of 15 mm.

Tidal asymmetry and variability of bed shear stress and sediment bed flux at a site in San Francisco Bay, USA

USGS Publications Warehouse

Brennan, Matthew L.; Schoellhamer, David H.; Burau, Jon R.; Monismith, Stephen G.; Winterwerp, J.C.; Kranenburg, C.

2002-01-01

The relationship between sediment bed flux and bed shear stress during a pair of field experiments in a partially stratified estuary is examined in this paper. Time series of flow velocity, vertical density profiles, and suspended sediment concentration were measured continuously throughout the water column and intensely within 1 meter of the bed. These time series were analyzed to determine bed shear stress, vertical turbulent sediment flux, and mass of sediment suspended in the water column. Resuspension, as inferred from near-bed measurements of vertical turbulent sediment flux, was flood dominant, in accordance with the flood-dominant bed shear stress. Bathymetry-induced residual flow, gravitational circulation, and ebb tide salinity stratification contributed to the flood dominance. In addition to this flow-induced asymmetry, the erodibility of the sediment appears to increase during the first 2 hours of flood tide. Tidal asymmetry in bed shear stress and erodibility help explain an estuarine turbidity maximum that is present during flood tide but absent during ebb tide. Because horizontal advection was insignificant during most of the observation periods, the change in bed mass can be estimated from changes in the total suspended sediment mass. The square wave shape of the bed mass time series indicates that suspended sediment rapidly deposited in an unconsolidated or concentrated benthic suspension layer at slack tides and instantly resuspended when the shear stress became sufficiently large during a subsequent tide. The variability of bed mass associated with the spring/neap cycle (about 60 mg/cm2) is similar to that associated with the semidiurnal tidal cycle.

Hospital output forecasts and the cost of empty hospital beds.

PubMed Central

Pauly, M V; Wilson, P

1986-01-01

This article investigates the cost incurred when hospitals have different levels of beds to treat a given number of patients. The cost of hospital care is affected by both the forecasted level of admissions and the actual number of admissions. When the relationship between forecasted and actual admissions is held constant, it is found that an empty hospital bed at a typical hospital in Michigan has a relatively low cost, about 13 percent or less of the cost of an occupied bed. However, empty beds in large hospitals do add significantly to cost. If hospital beds are closed, whether by closing beds at hospitals which remain in business or by closing entire hospitals, cost savings are estimated to be small. PMID:3759473

76 FR 19914 - Safety Standard for Portable Bed Rails: Notice of Proposed Rulemaking

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

... constructed primarily of nonrigid materials, such as fabric or foam. An ``inflatable bed rail'' is defined as..., such as fabric or foam; Inflatable bed rail is a portable bed rail constructed primarily of nonrigid...

Introduction to Bed Bugs

EPA Pesticide Factsheets

The common bed bug (Cimex lectularius) is a pest – feeding on blood, causing itchy bites and generally irritating their human hosts. EPA and other agencies all consider bed bugs a public health pest, but bed bugs are not known to transmit disease.

Peering inside the granular bed: illuminating feedbacks between bed-load transport and bed-structure evolution

NASA Astrophysics Data System (ADS)

Houssais, M.; Jerolmack, D. J.; Martin, R. L.

2013-12-01

The threshold of motion is perhaps the most important quantity to determine for understanding rates of bed load transport, however it is a moving target. Decades of research show that it changes in space and in time within a river, and is highly variable among different systems; however, these differences are not mechanistically understood. Recent researchers have proposed that the critical Shields stress is strongly dependent on the local configuration of the sediment bed [Frey and Church, 2011]. Critical Shields stress has been observed to change following sediment-transporting flood events in natural rivers [e.g., Turowski et al., 2011], while small-scale laboratory experiments have produced declining bed load transport rates associated with slow bed compaction [Charru et al., 2004]. However, no direct measurements have been made of the evolving bed structure under bed load transport, so the connection between granular controls and the threshold of motion remains uncertain. A perspective we adopt is that granular effects determine the critical Shields stress, while the fluid supplies a distribution of driving stresses. In order to isolate the granular effect, we undertake laminar bed load transport experiments using plastic beads sheared by a viscous oil in a small, annular flume. The fluid and beads are refractive index matched, and the fluid impregnated with a fluorescing powder. When illuminated with a planar laser sheet, we are able to image slices of the granular bed while also tracking the overlying sediment transport. We present the first results showing how bed load transport influences granular packing, and how changes in packing influence the threshold of motion to feed back on bed load transport rates. This effect may account for much of the variability observed in the threshold of motion in natural streams, and by extension offers a plausible explanation for hysteresis in bed load transport rates observed during floods. Charru, F., H. Mouilleron, and O. Eiff, Erosion and deposition of particles on a bed sheared by a viscous flow, Journal of Fluid Mech., 519, 55-80, 2004 Frey, P. and Church, M. (2011), Bedload: a granular phenomenon. Earth Surf. Process. Landforms, 36: 58-69. doi: 10.1002/esp.2103 Turowski, J. M., A. Badoux, and D. Rickenmann (2011), Start and end of bedload transport in gravel-bed streams, Geophys. Res. Lett., 38, L04401, doi:10.1029/2010GL046558.

Tetrapod tracks in Permo–Triassic eolian beds of southern Brazil (Paraná Basin)

PubMed Central

Dentzien-Dias, Paula; Lucas, Spencer G.; Schultz, Cesar L.

2018-01-01

Tetrapod tracks in eolianites are widespread in the fossil record since the late Paleozoic. Among these ichnofaunas, the ichnogenus Chelichnus is the most representative of the Permian tetrapod ichnological record of eolian deposits of Europe, North America and South America, where the Chelichnus Ichnofacies often occurs. In this contribution, we describe five sets of tracks (one of which is preserved in cross-section), representing the first occurrence of Dicynodontipus and Chelichnus in the “Pirambóia Formation” of southern Brazil. This unit represents a humid desert in southwestern Pangea and its lower and upper contacts lead us to consider its age as Lopingian–Induan. The five sets of tracks studied were compared with several ichnotaxa and body fossils with appendicular elements preserved, allowing us to attribute these tracks to dicynodonts and other indeterminate therapsids. Even though the “Pirambóia Formation” track record is sparse and sub-optimally preserved, it is an important key to better understand the occupation of arid environments by tetrapods across the Permo–Triassic boundary. PMID:29796341

Psychiatric hospitalizations in the Rio Grande do Sul State (Brazil) from 2000 to 2011.

PubMed

Horta, Rogério Lessa; da Costa, Juvenal Soares Dias; Balbinot, Alexandre Didó; Watte, Guilherme; Teixeira, Vanesa Andina; Poletto, Simone

2015-01-01

To examine the variation in the rates of psychiatric hospitalization and the mean hospital stay time in the public health system in the state of Rio Grande do Sul, in the south of Brazil, from 2000 to 2011. This was an ecological study. Data were collected from DATASUS. The rates were obtained from diagnosis of admissions due to psychoactive substance use and to other causes, stratified by the gender of the patients. The data were analyzed using Poisson regression and Spearman correlation coefficient. Increasing hospitalization rates were observed for women with disorders due to substance use (p < 0.001) and other causes (p < 0.001), and among men with disorders due to the use of alcohol or other drugs (p < 0.001). This elevation of the rates remained statistically significant and inversely correlated to the length of hospital stay (p < 0.001). In a period of expansion of the local care networks for mental health, an increase in the occupancy of psychiatric beds in the state was noticed, with shorter length of stay and greater diversity of gender and causes of hospitalization.

Mid-term NEAT review: analysing the improvements in hospital ED performance.

PubMed

Khanna, Sankalp; Boyle, Justin; Good, Norm; Lind, James

2014-01-01

Introduced with a promise to reduce overcrowding in the Emergency Department (ED) and the associated morbidity and mortality linked to bed access difficulties, the National Emergency Access Target (NEAT) is now over halfway through transitionary arrangements towards a target of 90% of patients that visit a hospital ED being admitted or discharged within 4 hours. Facilitation and reward funding has ensured hospitals around the country are remodelling workflows to ensure compliance. Recent reports however show that the majority of hospitals are still far from being able to meet this target. We investigate the NEAT journey of 30 Queensland hospitals over the past two years and compare this performance to a previous study that investigated the 4 hour ED discharge performance of these hospitals at various times of day and under varying occupancy conditions. Our findings reveal that, while most hospitals have made significant improvements to their 4 hour discharge performance in 2013, the underlying flow patterns and periods of poor NEAT compliance remain largely unchanged. The work identifies areas for targeted improvement to inform system redesign and workflow planning.

Workload and awkward posture problems among small-scale strawberry farmers in Japan.

PubMed

Kumudini, Ganga; Hasegawa, Tetsuya

2009-12-01

Farmers handle heavy workloads, often in awkward postures and experiencing some work related problems. Farmers perceive them as no more than inevitable consequences of farming activities. Although many problems can be prevented or reduced by simple and inexpensive modifications to work, these problems are increasing among farmers. The main focus of the paper was to investigate workload and awkward postures among strawberry farmers and suggest possible solutions to overcome the identified problems. Questionnaires, direct observations and intertwining methods were used to collect the data. Low-level strawberry beds and long working hours were recognized as critical factors that led to farmers' health problems including suffering from low back pain, heavy fatigue, unsteady feeling after work, etc. There was a substantial increase in fatigue in busy seasons compared with slack seasons. When compared with the other workers such as office, technical, sales and blue-collar workers, female farmers' general fatigue level was considerably high. Findings indicated that strawberry farming was a stressful occupation and farmers were strained under heavy workload, monotonous and repetitive work and poor working conditions with frequent fatigue symptoms and severe influence on health.

Fabrication Capabilities Utilizing In Situ Materials

NASA Technical Reports Server (NTRS)

McLemore, Carole A.; Fikes, John C.; Darby, Charles A.; Good, James E.; Gilley, Scott D.

2008-01-01

The National Aeronautics and Space Administration (NASA) has a Space Exploration Policy that lays out a plan that far exceeds the earlier Apollo goals where landing on the moon and taking those first historic steps fulfilled the mission. The policy states that we will set roots on the moon by establishing an outpost. This outpost will be used as a test bed for residing in more distant locales, such as Mars. In order to become self-sufficient, the occupants must have the capability to fabricate component parts in situ. Additionally, in situ materials must be used to minimize valuable mission upmass and to be as efficient as possible. In situ materials can be found from various sources such as raw lunar regolith whereby specific constituents can be extracted from the regolith (such as aluminum, titanium, or iron), and existing hardware already residing on the moon from past Apollo missions. The Electron Beam Melting (EBM) process lends itself well to fabricating parts, tools, and other necessary items using in situ materials and will be discussed further in this paper.

The public hospital of the future.

PubMed

Zajac, Jeffrey D

2003-09-01

Public hospitals designed for the past are not changing rapidly enough to meet the needs of the future. Changing work practices, increased pressure on bed occupancy, and greater numbers of patients with complex diseases and comorbidities will determine the functions of future hospitals. To maximise the use of resources, hospital "down times" on weekends and public holidays will be a distant memory. Elective surgery will increase in the traditionally "quiet times", such as summer, and decrease in the busy winter period. The patient will be the focus of an efficient information flow, streamlining patient care in hospital and enhancing communication between hospitals and community-based health providers. General and specialty units will need to work more efficiently together, as general physicians take on the role of patient case managers for an increasing proportion of patients. Funding needs to be adequate, and system management should involve clinicians. Safety will be enshrined in hospital systems and procedures, as well as in the minds of hospital staff. If these changes are not implemented successfully, public hospitals will not survive in the future.

Effects of bedding systems selected by manual muscle testing on sleep and sleep-related respiratory disturbances.

PubMed

Tsai, Ling-Ling; Liu, Hau-Min

2008-03-01

In this study, we investigated the feasibility of applying manual muscle testing (MMT) for bedding selection and examined the bedding effect on sleep. Four lay testers with limited training in MMT performed muscle tests for the selection of the bedding systems from five different mattresses and eight different pillows for 14 participants with mild sleep-related respiratory disturbances. For each participant individually, two bedding systems-one inducing stronger muscle forces and the other inducing weaker forces-were selected. The tester-participant pairs showed 85% and 100% agreement, respectively, for the selection of mattresses and pillows that induced the strongest muscle forces. The firmness of the mattress and the height of the pillow were significantly correlated with the body weight and body mass index of the participants for the selected strong bedding system but not for the weak bedding system. Finally, differences were observed between the strong and the weak bedding systems with regard to sleep-related respiratory disturbances and the percentage of slow-wave sleep. It was concluded that MMT can be performed by inexperienced testers for the selection of bedding systems.

Grouped comparisons of sleep quality for new and personal bedding systems.

PubMed

Jacobson, Bert H; Wallace, Tia J; Smith, Doug B; Kolb, Tanner

2008-03-01

The purpose of this study was to compare sleep comfort and quality between personal and new bedding systems. A convenience sample (women, n=33; men, n=29) with no clinical history of disturbed sleep participated in the study. Subjects recorded back and shoulder pain, sleep quality, comfort, and efficiency for 28 days each in their personal beds (pre) and in new medium-firm bedding systems (post). Repeated measures ANOVAs revealed significant improvement between pre- and post-test means for all dependent variables. Furthermore, reduction of pain and stiffness and improvement of sleep comfort and quality became more prominent over time. No significant differences were found for the groupings of age, weight, height, or body mass index. It was found that for the cheapest category of beds, lower back pain was significantly (p<0.01) more prominent than for the medium and higher priced beds. Average bed age was 9.5yrs. It was concluded that new bedding systems can significantly improve selected sleep variables and that continuous sleep quality may be dependent on timely replacement of bedding systems.

Water column and bed-sediment core samples collected from Brownlee Reservoir near Oxbow, Oregon, 2012

USGS Publications Warehouse

Fosness, Ryan L.; Naymik, Jesse; Hopkins, Candice B.; DeWild, John F.

2013-01-01

The U.S. Geological Survey, in cooperation with Idaho Power Company, collected water-column and bed-sediment core samples from eight sites in Brownlee Reservoir near Oxbow, Oregon, during May 5–7, 2012. Water-column and bed-sediment core samples were collected at each of the eight sites and analyzed for total mercury and methylmercury. Additional bed-sediment core samples, collected from three of the eight sites, were analyzed for pesticides and other organic compounds, trace metals, and physical characteristics, such as particle size. Total mercury and methylmercury were detected in each of the water column and bed-sediment core samples. Only 17 of the 417 unique pesticide and organic compounds were detected in bed-sediment core samples. Concentrations of most organic wastewater compounds detected in bed sediment were less than the reporting level. Trace metals detected were greater than the reporting level in all the bed-sediment core samples submitted for analysis. The particle size distribution of bed-sediment core samples was predominantly clay mixed with silt.

The development of test beds to support the definition and evolution of the Space Station Freedom power system

NASA Technical Reports Server (NTRS)

Soeder, James F.; Frye, Robert J.; Phillips, Rudy L.

1991-01-01

Since the beginning of the Space Station Freedom Program (SSFP), the Lewis Research Center (LeRC) and the Rocketdyne Division of Rockwell International have had extensive efforts underway to develop test beds to support the definition of the detailed electrical power system design. Because of the extensive redirections that have taken place in the Space Station Freedom Program in the past several years, the test bed effort was forced to accommodate a large number of changes. A short history of these program changes and their impact on the LeRC test beds is presented to understand how the current test bed configuration has evolved. The current test objectives and the development approach for the current DC Test Bed are discussed. A description of the test bed configuration, along with its power and controller hardware and its software components, is presented. Next, the uses of the test bed during the mature design and verification phase of SSFP are examined. Finally, the uses of the test bed in operation and evolution of the SSF are addressed.

Atropine unmasks bed-rest effect - A spectral analysis of cardiac interbeat intervals

NASA Technical Reports Server (NTRS)

Goldberger, Ary L.; Goldwater, Danielle; Bhargava, Valmik

1986-01-01

Heart rate spectral data obtained for 10 male subjects between 35-49 years following orthostatic tolerance testing with lower body negative pressure prebed rest and after 7-10 days of bed rest, while on placebo and after intravenous atropine are analyzed. Comparison of the spectral atropine rms for subjects prebed rest and after bed rest reveal a decrease from 63 + or - 24 ms to 40 + or - 23 ms. It is observed that heart rate interval variability for subjects after bed rest and with atropine is reduced; the heart rate at bed rest with atropine is increased from 70.4 + or - 12.4 beats/min prebed rest to 83.7 + or - 18.9 beats/min; and the exercise tolerance time for subjects in the atropine prebed-rest phase (658 + or - 352 s) is higher than the bed-rest phase (505 + or - 252 s). It is noted that bed rest impairs the cardiovascular capacity to adaptively modulate physiological responses, atropine exposes bed-rest deconditioning effects, and spectral analysis is useful for studying the effects of bed-rest deconditioning on cardiac dynamics.

Development of channel organization and roughness following sediment pulses in single‐thread, gravel bed rivers

USGS Publications Warehouse

Madej, Mary Ann

2001-01-01

Large, episodic inputs of coarse sediment (sediment pulses) in forested, mountain streams may result in changes in the size and arrangement of bed forms and in channel roughness. A conceptual model of channel organization delineates trajectories of response to sediment pulses for many types of gravel bed channels. Channels exhibited self‐organizing behavior to various degrees based on channel gradient, presence of large in‐channel wood or other forcing elements, the size of the sediment pulse, and the number of bed‐mobilizing flows since disturbance. Typical channel changes following a sediment pulse were initial decreases in water depth, in variability of bed elevations, and in the regularity of bed form spacing. Trajectories of change subsequently showed increased average water depth, more variable and complex bed topography, and increased uniformity of bed form spacing. Bed form spacing in streams with abundant forcing elements developed at a shorter spatial scale (two to five channel widths) than in streams without such forcing mechanisms (five to 10 channel widths). Channel roughness increased as bed forms developed.

Neonatal and pediatric intensive care in Rio de Janeiro State, Brazil: an analysis of bed distribution, 1997 and 2007.

PubMed

Barbosa, Arnaldo Prata; Cunha, Antônio José Ledo Alves da

2011-01-01

The objective of this study was to describe the characteristics of neonatal and pediatric intensive care units (ICU) and beds in Rio de Janeiro, correlating with population demands in 1997 and 2007. All neonatal and pediatric ICUs were visited, identifying the availability and type of beds. Comparisons were made between: supply and demand using projected need for beds for the population; public and private ICUs; and geographical regions. In 2007, 95 units were included totaling 1,094 beds (74 units and 1,080 beds in 1997): 51% public and 48% private (47% and 52% in 1997); 47% neonatal, 18% pediatric and 35% mixed units. Most units were located in the metropolitan area. The distribution of public and private beds was similar in the metropolitan area in both periods; in the interior, public beds tripled. Access has improved, mainly in the interior, but there is still no equity in the distribution of and accessibility to the available beds, with a shortage in the public sector, an excess in the private sector, and a great concentration in the metropolitan area.

Heat and mass transfer within partially wetted packed fractured granular beds

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

Khalil, E.B.; Karim, G.A.

1996-10-01

Fractured granular beds heated by hot gaseous streams have been the subject of numerous investigations in recent years due to their importance in many applications such as in in-situ and enhanced oil recovery. In a previous paper (Khalil and Karim, 1995) the results of an investigation of some aspects of the transport processes that occur within dry granular beds were reported. The present contribution examines similar beds when partially wetted. The granular beds were cylindrical in shape containing an axial central small diameter circular channel representing a fracture which can have different permeability from that of the main bed. Itmore » is shown that the mass flow rate of the hot gases, the relative permeability of the bed and the central channel as well as the initial liquid content of the bed control the drying rate. The results of an analytical model formulated to simulate the drying process in unobstructed channel beds showed good agreement with experimental results at low temperatures, however deviations occurred as the drying proceeds at higher temperatures.« less

Timing of chopper herbicide site preparation relative to bedding in the establishment of lower coastal plain pine plantations

Treesearch

Dwight K. Lauer; Harold E. Quicke

2006-01-01

The timing of Chopper® (BASF Corporation, Research Triangle Park, NC) herbicide applications before and after bedding was examined at four Lower Coastal Plain locations. Two bedding regimes, mid-season and late-season, were included at each location. Mid-season bedding occurred between May and July and late-season bedding between September and November. No post-plant...

Are tanning beds "safe"? Human studies of melanoma.

PubMed

Berwick, Marianne

2008-10-01

Controversy continues over the carcinogenic properties of tanning beds. The tanning industry "sells" tanning beds as a safe alternative to UV exposure for both tanning as well as vitamin D biosynthesis. But, how safe are tanning beds? Epidemiologic data - incomplete and unsatisfactory - suggests that tanning beds are not safer than solar ultraviolet radiation and that they may have independent effects from solar exposure that increase risk for melanoma.

Binge Eating Disorder.

PubMed

Guerdjikova, Anna I; Mori, Nicole; Casuto, Leah S; McElroy, Susan L

2017-06-01

Binge eating disorder (BED) is the most common eating disorder and an important public health problem. Lifetime prevalence of BED in the United States is 2.6%. In contrast to other eating disorders, the female to male ratio in BED is more balanced. BED co-occurs with a plethora of psychiatric disorders, most commonly mood and anxiety disorders. BED is also associated with obesity and its numerous complications. Although BED is similar in men and women in presentation and treatment outcomes, there are some key neurobiological differences that should be taken in consideration when personalizing treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

3-D capacitance density imaging system

DOEpatents

Fasching, G.E.

1988-03-18

A three-dimensional capacitance density imaging of a gasified bed or the like in a containment vessel is achieved using a plurality of electrodes provided circumferentially about the bed in levels and along the bed in channels. The electrodes are individually and selectively excited electrically at each level to produce a plurality of current flux field patterns generated in the bed at each level. The current flux field patterns are suitably sensed and a density pattern of the bed at each level determined. By combining the determined density patterns at each level, a three-dimensional density image of the bed is achieved. 7 figs.

A Comparison of Tandem Walk Performance Between Bed Rest Subjects and Astronauts

NASA Technical Reports Server (NTRS)

Miller, Chris; Peters, Brian; Kofman, Igor; Philips, Tiffany; Batson, Crystal; Cerisano, Jody; Fisher, Elizabeth; Mulavara, Ajitkumar; Feiveson, Alan; Reschke, Millard;

Virulence of entomopathogenic bacteria in the bed bug, Cimex lectularius.

PubMed

Pietri, Jose E; Liang, Dangsheng

2018-01-01

Due in part to the development of insecticide resistance, the common bed bug, Cimex lectularius, has overcome human intervention efforts to make a global resurgence. The failure of chemical pesticides has created a need for novel strategies to combat bed bugs. While a number of insect pests are susceptible to the use of entomopathogenic microbes or microbial-derived toxins, biological control methods have not been thoroughly explored in bed bugs. Here, we tested the virulence of three entomopathogenic bacterial species in C. lectularius to determine their potential for bed bug control. We examined bed bug survival after inoculation with live or heat-killed Serratia marcescens, Pseudomonas fluorescens, and Bacillus thuringiensis israelensis at varying temperatures. We also analyzed the viability and growth of the same bacteria in infected bed bugs. All three bacterial species were pathogenic to bed bugs. However, the effects of S. marcescens and P. fluorescens were temperature-dependent while the lethality of B. thuringiensis israelensis was not. In addition, bacterial virulence was partly dependent on the route of infection but was not strongly associated with proliferation. Thus, our results suggest multiple possible mechanisms of microbial pathogenicity in the bed bug and indicate that entomopathogenic bacteria, or products derived from them, may have useful applications for bed bug control. Copyright © 2017 Elsevier Inc. All rights reserved.

Wave Driven Fluid-Sediment Interactions over Rippled Beds

NASA Astrophysics Data System (ADS)

Foster, Diane; Nichols, Claire

2008-11-01

Empirical investigations relating vortex shedding over rippled beds to oscillatory flows date back to Darwin in 1883. Observations of the shedding induced by oscillating forcing over fixed beds have shown vortical structures to reach maximum strength at 90 degrees when the horizontal velocity is largest. The objective of this effort is to examine the vortex generation and ejection over movable rippled beds in a full-scale, free surface wave environment. Observations of the two-dimensional time-varying velocity field over a movable sediment bed were obtained with a submersible Particle Image Velocimetry (PIV) system in two wave flumes. One wave flume was full scale and had a natural sand bed and the other flume had an artificial sediment bed with a specific gravity of 1.6. Full scale observations over an irregularly rippled bed show that the vortices generated during offshore directed flow over the steeper bed form slope were regularly ejected into the water column and were consistent with conceptual models of the oscillatory flow over a backward facing step. The results also show that vortices remain coherent during ejection when the background flow stalls (i.e. both the velocity and acceleration temporarily approach zero). These results offer new insight into fluid sediment interaction over rippled beds.

Reasons for tanning bed use: a survey of community college students in North Carolina.

PubMed

Neenan, Ashley; Lea, C Suzanne; Lesesky, Erin B

2012-01-01

Tanning bed use is classified as carcinogenic and is associated with an increased risk of skin cancer. The aim of this cross-sectional survey was to identify the most commonly stated reasons for tanning bed use among a sample of male and female community college students in eastern North Carolina. A brief, self-administered survey was distributed to students during English, Art, or Psychology class periods in 5 eastern North Carolina community colleges during the 2010 fall semester. The 95% response rate consisted of 487 returned surveys. Of the 487 respondents, 12.7% (N = 62) were current users, 24.5% (N = 119) were past users, and 62.2% (N = 303) reported never using tanning beds. Women (79%) were more likely than men (18%) to be current or former tanning bed users. Three African Americans reported current tanning bed use (4.8%). Reasons for tanning bed use were similar among men and women, with "I think I look better when I am tan" being the most commonly cited reason (70.2%) for tanning bed use. A convenience sample limits generalizability to all North Carolina students attending community college. Current tanning bed use was not widely reported. However, educational strategies for preventing tanning bed initiation or recurrence among male and female community college students should include appearance-driven factors.

Binge Eating among Women Veterans in Primary Care: Comorbidities and Treatment Priorities.

PubMed

Rosenbaum, Diane L; Kimerling, Rachel; Pomernacki, Alyssa; Goldstein, Karen M; Yano, Elizabeth M; Sadler, Anne G; Carney, Diane; Bastian, Lori A; Bean-Mayberry, Bevanne A; Frayne, Susan M

2016-01-01

Little is known about the clinical profile and treatment priorities of women with binge eating disorder (BED), a diagnosis new to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. We identified comorbidities and patients' treatment priorities, because these may inform implementation of clinical services. Data were collected from women veteran primary care patients. Analyses compared those who screened positive for BED (BED+), and those without any binge eating symptoms (BED-). Frequencies of comorbid medical and psychological disorders were high in the BED+ group. The BED+ group's self-identified most common treatment priorities were mood concerns (72.2%), weight loss (66.7%), and body image/food issues (50%). Among those with obesity, a greater proportion of the BED+ group indicated body image/food issues was their top treatment priority (12.9% vs. 2.8%; p < .01), suggesting that these patients may be more apt to seek treatment beyond weight management for their problematic eating patterns. Women primary care patients with BED demonstrate high medical and psychological complexity; their subjective treatment priorities often match objective needs. These findings may inform the development of targeted BED screening practices for women with obesity in primary care settings, and the eventual adoption of patient-centered BED treatment resources. Published by Elsevier Inc.

Effect of bed height and use of hands on trunk angular velocity during the sit-to-stand transfer.

PubMed

Lindemann, Ulrich; van Oosten, Leon; Evers, Jordi; Becker, Clemens; van Dieen, Jaap H; van Lummel, Rob C

2014-01-01

The ability to rise from a chair or bed is critical to an individual's quality of life because it determines functional independence. This study was to investigate the effect of bed height and use of hands on trunk angular velocity and trunk angles during the sit-to-stand (STS) performance. Twenty-four older persons (median age 74 years) were equipped with a body-fixed gyroscopic sensor and stood up from a bed adjusted to different heights, with and without the use of hands at each height. Peak angular velocity and trunk range of motion decreased with increasing bed height (all p ≤ 0.038) and were lower using hands during STS transfer indicating less effort. In conclusion, gyroscopic sensor data of the STS transfer of older persons show differences as an effect of bed height and use of hands. These results provide the rationale for recommending a relatively high bed height for most of the older persons. To minimise the effort during sit-to-stand transfer performance from bed, it is necessary to understand the effect of bed height and use of hands. It is concluded that a relatively high bed height and the use of hands is helpful for most of the older persons during sit-to-stand transfer.

Assessment of executive functioning in binge-eating disorder independent of weight status.

PubMed

Eneva, Kalina T; Arlt, Jean M; Yiu, Angelina; Murray, Susan M; Chen, Eunice Y

2017-08-01

Executive functioning (EF) problems may serve as vulnerability or maintenance factors for Binge-Eating Disorder (BED). However, it is unclear if EF problems observed in BED are related to overweight status or BED status. The current study extends this literature by examining EF in overweight and normal-weight BED compared to weight-matched controls. Participants were normal-weight women with BED (n = 23), overweight BED (n = 32), overweight healthy controls (n = 48), and normal-weight healthy controls (n = 29). The EF battery utilized tests from the National Institutes of Health (NIH) Toolbox and Delis-Kaplan Executive Function System (D-KEFS). After controlling for years of education and minority status, overweight individuals performed more poorly than normal-weight individuals on a task of cognitive flexibility requiring generativity (p < .01), and speed on psychomotor performance tasks (p = .01). Normal-weight and overweight BED performed worse on working memory tasks compared to controls (p = .04). Unexpectedly, normal-weight BED individuals out-performed all other groups on an inhibitory control task (p < .01). No significant differences were found between the four groups on tasks of planning. Regardless of weight status, BED is associated with working memory problems. Replication of the finding that normal-weight BED is associated with enhanced inhibitory control is needed. © 2017 Wiley Periodicals, Inc.

Application of CaO-Based Bed Material for Dual Fluidized Bed Steam Biomass Gasification

NASA Astrophysics Data System (ADS)

Koppatz, S.; Pfeifer, C.; Kreuzeder, A.; Soukup, G.; Hofbauer, H.

Gasification of biomass is a suitable option for decentralized energy supply based on renewable sources in the range of up to 50 MW fuel input. The paper presents the dual fluidized bed (DFB) steam gasification process, which is applied to generate high quality and nitrogen-free product gas. Essential part of the DFB process is the bed material used in the fluidized reactors, which has significant impact on the product gas quality. By the use of catalytically active bed materials the performance of the overall process is increased, since the bed material favors reactions of the steam gasification. In particular, tar reforming reactions are favored. Within the paper, the pilot plant based on the DFB process with 100kW fuel input at Vienna University of Technology, Austria is presented. Actual investigations with focus on CaO-based bed materials (limestone) as well as with natural olivine as bed material were carried out at the pilot plant. The application of CaO-based bed material shows mainly decreased tar content in the product gas in contrast to experiments with olivine as bed material. The paper presents the results of steam gasification experiments with limestone and olivine, whereby the product gas composition as well as the tar content and the tar composition are outlined.

Management and characteristics of recycled manure solids used for bedding in Midwest freestall dairy herds.

PubMed

Husfeldt, A W; Endres, M I; Salfer, J A; Janni, K A

2012-04-01

Interest in using recycled manure solids (RMS) as a bedding material for dairy cows has grown in the US Midwest. Cost of common bedding materials has increased in recent years and availability has decreased. Information regarding the composition of RMS and its use as a bedding material for dairy cows in the Midwest is very limited. The objectives of this study were to characterize RMS as a bedding material, observe bedding management practices, document methods of obtaining RMS, and describe housing facilities. We visited 38 Midwest dairy operations bedding freestalls with RMS to collect data. Methods of obtaining RMS for bedding included separation of anaerobic digested manure, separation of raw manure, and separation of raw manure followed by mechanical drum-composting for 18 to 24 h. Average bedding moisture of unused RMS was 72.4% with a pH of 9.16. Unused samples contained (on a dry basis) 1.4% N, 44.9% C, 32.7C:N ratio, 0.44% P, 0.70% K, 76.5% neutral detergent fiber, 9.4% ash, 4.4% nonfiber carbohydrates, and 1.1% fat. Moisture was lowest for drum-composted solids before and after use as freestall bedding. After use in the stalls, digested solids had lower neutral detergent fiber content (70.5%) than drum-composted (75.0%) and separated raw (73.1%) solids. Total N content was greater in digested solids (2.0%) than in separated raw (1.7%) solids. Total bacterial populations in unused bedding were greatest in separated raw manure solids but were similar between digested and drum-composted manure solids. Drum-composted manure solids had no coliform bacteria before use as freestall bedding. After use as bedding, digested manure solids had lower total bacteria counts compared with drum-composted and separated raw manure solids, which had similar counts. Used bedding samples of digested solids contained fewer environmental streptococci than drum-composted and separated raw solids and had reduced Bacillus counts compared with separated raw solids. Coliform counts were similar for all 3 bedding sources. Addition of a mechanical blower post-separation and use of a shelter for storage were associated with reduced fresh-bedding moisture but not associated with bacterial counts. This was the first survey of herds using RMS for bedding in the Midwest. We learned that RMS was being used successfully as a source of bedding for dairy cows. For most farms in the study, somatic cell count was comparable to the average in the region and not excessively high. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Orlistat with behavioral weight loss for obesity with versus without binge eating disorder: randomized placebo-controlled trial at a community mental health center serving educationally and economically disadvantaged Latino/as.

PubMed

Grilo, Carlos M; White, Marney A

2013-03-01

This study was a randomized placebo-controlled trial testing the addition of orlistat to behavioral weight loss for obesity in Spanish-speaking-only Latino/as with versus without binge eating disorder (BED) performed at a community mental health center serving educationally- and economically-disadvantaged patients. Latino/as have high rates of obesity but are under-represented in obesity treatment studies and despite comparable-to-or-higher rates of BED than Whites, Latino/as are under-represented in BED treatment studies. BED is associated with obesity but whether it predicts/moderates treatment outcomes remains uncertain. Thus, this study also tested whether BED prospectively predicts/moderates outcomes. Seventy-nine obese Spanish-speaking-only Latino/as with BED (N=40) versus without BED (N=39) at a community mental health center were randomly assigned to four-months of orlistat-plus-BWL or placebo-plus-BWL. BWL was culturally-enhanced modification of Diabetes-Prevention-Program delivered in weekly sessions in Spanish. Orlistat (120 mg tid) and matching-placebo delivered with standard clinical-management. Participants were assessed independently throughout treatment, post-treatment, and six-month follow-up. 78% completed treatments; completion rates did not differ significantly by medication or BED. Intent-to-treat mixed-models analyses revealed significant improvements in binge eating, eating-psychopathology, and depression, and significant--albeit modest--weight-loss. Overall, the addition of orlistat to BWL was not associated with greater improvements; however, BED moderated weight-loss: orlistat-plus-BWL produced significantly greater weight-loss in non-BED group but not in BED. Improvements were maintained through 6-month follow-up; BED significantly predicted/moderated increases in eating concerns and depression following treatment. Within BED-group, binge-eating remission rates were 65% (post-treatment) and 50% (follow-up). In this controlled trial performed at community mental health center serving educationally- and economically-disadvantaged Spanish-speaking-only Latino/as with co-morbid psychiatric needs, we observed outcomes for the BWL plus orlistat/placebo medication that approximate or are slightly dampened relative to the literature for efficacy trials with much more restrictive obese and BED samples. In this complex patient group, adding orlistat to BWL produced greater weight-loss than adding placebo among obese patients without BED but not among those with BED. Although 50% of BED patients maintained abstinence from binge-eating following these specific obesity treatments (BWL plus orlistat/placebo), BED was a negative prognostic indicator for some outcome variables. clinicaltrials.gov Identifier: NCT00516919. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparison of Ocular Outcomes in Two 14-Day Bed Rest Studies

NASA Technical Reports Server (NTRS)

Cromwell, R. L.; Zanello, S. B.; Yarbough, P. O.; Taibbi, G.; Vizzeri, G.

2011-01-01

Reports of astronauts visual changes raised concern about ocular health during long-duration spaceflight. Some of these findings included hyperopic shifts, choroidal folds, optic disc edema, retinal nerve fiber layer (RNFL) thickening, and cotton wool spots. While the etiology remains unknown, hypotheses speculate that hypertension in the brain caused by cephalad fluid shifts during spaceflight is a possible mechanism for these ocular changes. Head-down tilt (HDT) bed rest is a spaceflight analog that induces cephalad fluid shifts. In addition, previous studies of the HDT position demonstrated body fluid shifts associated with changes in intraocular pressure (IOP). For these reasons, vision monitoring of HDT bed rest subjects was implemented for NASA bed rest studies. Subjects selected for these studies were healthy adults (14 males and 5 females). Average age was 37.5 plus or minus 9.1 years, weight was 77.4 plus or minus 11.3 Kg, and height was 173.4 plus or minus 7.2 14 cm. Controlled conditions followed for all NASA bed rest studies were implemented. These conditions included factors such as eating a standardized diet, maintaining a strict sleep wake cycle, and remaining in bed for 24 hours each day. In one study, subjects maintained a horizontal (0 degree) position while in bed and were exercised six days per week with an integrated resistance and aerobic training (iRAT) program. In the other study, subjects were placed at 6 degrees HDT while in bed and did not engage in exercise. All subjects underwent pre- and post bed rest vision testing. While the battery of vision tests for each study was not identical, measures common to both studies will be presented. These measures included IOP and measures that provided an indication of optic disc swelling as derived from optical coherence tomography (OCT) testing: average retinal nerve fiber layer (RNFL) thickness (millimeters), disc area (square millimeters), rim area (square millimters), and average cup to disc (C/D) ratio. For all measures, there was no significant difference between subject groups for pre-bed rest testing. Post bed rest values also remained similar between groups. Comparison of pre- to post bed rest testing within each group did not demonstrate any statistical differences. These preliminary results from 14-day bed rest studies suggest that the combination of exercise and horizontal bed rest as compared to 6 degrees HDT bed rest did not produce differences in the ocular response with regard to IOP and optic disc parameters. The ocular measures reported here only included pre- and post bed rest time points. Further investigation is needed to examine both the acute response and long term adaptation of structural and functional ocular parameters in the bed rest platform and determine its usefulness for studying spaceflight phenomena. From a clinical perspective, the ability to study ocular responses in the controlled environment of the bed rest platform can provide valuable information for the care of patients restricted to bed rest.

A method for improving predictions of bed-load discharges to reservoirs

USGS Publications Warehouse

Lopes, V.L.; Osterkamp, W.R.; Bravo-Espinosa, M.

2007-01-01

Effective management options for mitigating the loss of reservoir water storage capacity to sedimentation depend on improved predictions of bed-load discharges into the reservoirs. Most predictions of bed-load discharges, however, are based on the assumption that the rates of bed-load sediment availability equal the transport capacity of the flow, ignoring the spatio-temporal variability of the sediment supply. This paper develops a semiquantitative method to characterize bed-load sediment transport in alluvial channels, assuming a channel reach is non-supply limited when the bed-load discharge of a given sediment particle-size class is functionally related to the energy that is available to transport that fraction of the total bed-load. The method was applied to 22 alluvial stream channels in the USA to determine whether a channel reach had a supply-limited or non-supply-limited bed-load transport regime. The non-supply-limited transport regime was further subdivided into two groups on the basis of statistical tests. The results indicated the pattern of bed-load sediment transport in alluvial channels depends on the complete spectrum of sediment particle sizes available for transport rather than individual particle-size fractions represented by one characteristic particle size. The application of the method developed in this paper should assist reservoir managers in selecting bed-load sediment transport equations to improve predictions of bed-load discharge in alluvial streams, thereby significantly increasing the efficiency of management options for maintaining the storage capacity of waterbodies. ?? 2007 Blackwell Publishing Asia Pty Ltd.

Numerical simulation of dune-flat bed transition and stage‐discharge relationship with hysteresis effect

USGS Publications Warehouse

Shimizu, Yasuyuki; Giri, Sanjay; Yamaguchi, Satomi; Nelson, Jonathan M.

2009-01-01

This work presents recent advances on morphodynamic modeling of bed forms under unsteady discharge. This paper includes further development of a morphodynamic model proposed earlier by Giri and Shimizu (2006a). This model reproduces the temporal development of river dunes and accurately replicates the physical properties associated with bed form evolution. Model results appear to provide accurate predictions of bed form geometry and form drag over bed forms for arbitrary steady flows. However, accurate predictions of temporal changes of form drag are key to the prediction of stage‐discharge relation during flood events. Herein, the model capability is extended to replicate the dune–flat bed transition, and in turn, the variation of form drag produced by the temporal growth or decay of bed forms under unsteady flow conditions. Some numerical experiments are performed to analyze hysteresis of the stage‐discharge relationship caused by the transition between dune and flat bed regimes during rising and falling stages of varying flows. The numerical model successfully simulates dune–flat bed transition and the associated hysteresis of the stage‐discharge relationship; this is in good agreement with physical observations but has been treated in the past only using empirical methods. A hypothetical relationship for a sediment parameter (the mean step length) is proposed to a first level of approximation that enables reproduction of the dune–flat bed transition. The proposed numerical model demonstrates its ability to address an important practical problem associated with bed form evolution and flow resistance in varying flows.

Packing microstructure and local density variations of experimental and computational pebble beds

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

Auwerda, G. J.; Kloosterman, J. L.; Lathouwers, D.

2012-07-01

In pebble bed type nuclear reactors the fuel is contained in graphite pebbles, which form a randomly stacked bed with a non-uniform packing density. These variations can influence local coolant flow and power density and are a possible cause of hotspots. To analyse local density variations computational methods are needed that can generate randomly stacked pebble beds with a realistic packing structure on a pebble-to-pebble level. We first compare various properties of the local packing structure of a computed bed with those of an image made using computer aided X-ray tomography, looking at properties in the bulk of the bedmore » and near the wall separately. Especially for the bulk of the bed, properties of the computed bed show good comparison with the scanned bed and with literature, giving confidence our method generates beds with realistic packing microstructure. Results also show the packing structure is different near the wall than in the bulk of the bed, with pebbles near the wall forming ordered layers similar to hexagonal close packing. Next, variations in the local packing density are investigated by comparing probability density functions of the packing fraction of small clusters of pebbles throughout the bed. Especially near the wall large variations in local packing fractions exists, with a higher probability for both clusters of pebbles with low (<0.6) and high (>0.65) packing fraction, which could significantly affect flow rates and, together with higher power densities, could result in hotspots. (authors)« less

Suicidality in adolescents and adults with binge-eating disorder: Results from the national comorbidity survey replication and adolescent supplement.

PubMed

Forrest, Lauren N; Zuromski, Kelly L; Dodd, Dorian R; Smith, April R

2017-01-01

The relation between binge-eating disorder (BED) and suicidality (i.e., suicide ideation, plan, and/or attempt) has not been studied extensively, and it is unknown whether BED is uniquely associated with suicidality when adjusting for comorbid psychopathology. Moreover, the course of suicidality in BED has not been determined and it is unknown whether BED precedes suicidality or vice versa. A total of 10,123 adolescents and 2,980 adults from two nationally representative surveys were administered diagnostic interviews assessing psychopathology and suicidality, as well the retrospectively reported ages of onset. Among adults and adolescents, BED was associated with elevated odds of suicide ideation, plan, and attempt at a univariate level, but BED was not associated with elevated odds of suicidality when adjusting for comorbid psychopathology. Kaplan-Meier estimates of temporal patterns displayed that most adolescents experienced suicidality onset following BED onset, whereas most adults experienced suicidality onset prior to BED onset. BED, comorbid disorders, and suicidality share common factors and interrelations, and individuals with BED and comorbid disorders may be at particularly high risk for suicidal outcomes. The presence of BED in adolescence may serve as a marker for more severe symptomatology that precedes the occurrence of suicidality. Research is needed to understand how eating disorder symptoms, comorbid symptoms, and suicidality affect one another over time. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:40-49). © 2016 Wiley Periodicals, Inc.

Key Spatial Factors Influencing the Perceived Privacy in Nursing Units: An Exploration Study With Eight Nursing Units in Hong Kong.

PubMed

Lu, Yi; Cai, Hui; Bosch, Sheila J

2017-07-01

This study examined how the spatial characteristics of patient beds, which are influenced by patient room design and nursing unit configuration, affect patients' perceptions about privacy. In the hospital setting, most patients expect a certain degree of privacy but also understand that their caregivers need appropriate access to them in order to provide high-quality care. Even veteran healthcare designers may struggle to create just the right balance between privacy and accessibility. A paper-based survey was conducted with 159 participants in Hong Kong-72 (45.3%) participants had been hospitalized and 87 (54.7%) participants had not-to document their selection of high-privacy beds, given simplified plans of eight nursing units. Two types of information, comprised of six variables, were examined for each bed. These include (1) room-level variables, specifically the number of beds per room and area per bed and (2) relational variables, including walking distance, directional change, integration, and control. The results demonstrate that when asked to identify high-privacy beds, participants selected beds in patient rooms with fewer beds per room, a larger area per bed, and a longer walking distance to the care team workstation. Interestingly, the participants having been hospitalized also chose beds with a visual connection to the care team workstation as being high in privacy. The participants with hospitalization experience may be willing to accept a bed with reduced visual privacy, perhaps out of a concern for safety.

Coastal geomorphic conditions and styles of storm surge washover deposits from Southern Thailand

NASA Astrophysics Data System (ADS)

Phantuwongraj, Sumet; Choowong, Montri; Nanayama, Futoshi; Hisada, Ken-Ichiro; Charusiri, Punya; Chutakositkanon, Vichai; Pailoplee, Santi; Chabangbon, Akkaneewut

2013-06-01

The characteristics of tropical storm washover deposits laid down during the years 2007 to 2011 along the southern peninsular coast of the Gulf of Thailand (GOT) were described in relation to their different geomorphic conditions, including perched fan, washover terrace and sheetwash lineations preserved behind the beach zone within 100 m of the shoreline. As a result, washover terrace and sheetwash lineations were found where the beach configuration was uniform and promoted an unconfined flow. Non-uniform beach configurations that promoted a confined flow resulted in a perched fan deposit. Washover sediments were differentiated into two types based on sedimentary characteristics, including (i) a thick-bedded sand of multiple reverse grading layers and (ii) a medium-bedded sand of multiple normal grading layers. In the case of thick-bedded washover deposits, the internal sedimentary structures were characterized by the presence of sub-horizontal bedding, reverse grading, lamination, foreset bedding and wavy bedding, whereas, horizontal bedding, normal grading, and dunes were the dominant structures in the medium-bedded washover sand. Rip-up clasts were rare and recognized only in the washover deposits in the bottom unit, which reflects the condition when a mud supply was available. All washover successions were found in the landward inclined-bedding with a basal sharp contact. A high elevated beach ridge associated with a large swale at the backshore proved suitable for a thick-bedded washover type, whereas a small beach ridge with uniformly flat backshore topography promoted a medium-bedded washover sediment.

Active magnetic regenerator method and apparatus

DOEpatents

DeGregoria, Anthony J.; Zimm, Carl B.; Janda, Dennis J.; Lubasz, Richard A.; Jastrab, Alexander G.; Johnson, Joseph W.; Ludeman, Evan M.

1993-01-01

In an active magnetic regenerator apparatus having a regenerator bed of material exhibiting the magnetocaloric effect, flow of heat transfer fluid through the bed is unbalanced, so that more fluid flows through the bed from the hot side of the bed to the cold side than from the cold side to the hot side. The excess heat transfer fluid is diverted back to the hot side of the bed. The diverted fluid may be passed through a heat exchanger to draw heat from a fluid to be cooled. The apparatus may be operated at cryogenic temperatures, and the heat transfer fluid may be helium gas and the fluid to be cooled may be hydrogen gas, which is liquified by the device. The apparatus can be formed in multiple stages to allow a greater span of cooling temperatures than a single stage, and each stage may be comprised of two bed parts. Where two bed parts are employed in each stage, a portion of the fluid passing from the hot side to the cold side of a first bed part which does not have a magnetic field applied thereto is diverted back to the cold side of the other bed part in the stage, where it is passed through to the hot side. The remainder of the fluid from the cold side of the bed part of the first stage is passed to the hot side of the bed part of the second stage.

Effects of 21 days of bed rest, with or without artificial gravity, on nutritional status of humans

PubMed Central

Zwart, S. R.; Crawford, G. E.; Gillman, P. L.; Kala, G.; Rodgers, A. S.; Rogers, A.; Inniss, A. M.; Rice, B. L.; Ericson, K.; Coburn, S.; Bourbeau, Y.; Hudson, E.; Mathew, G.; DeKerlegand, D. E.; Sams, C. F.; Heer, M. A.; Paloski, W. H.; Smith, S. M.

2009-01-01

Spaceflight and bed rest models of microgravity have profound effects on physiological systems, including the cardiovascular, musculoskeletal, and immune systems. These effects can be exacerbated by suboptimal nutrient status, and therefore it is critical to monitor nutritional status when evaluating countermeasures to mitigate negative effects of spaceflight. As part of a larger study to investigate the usefulness of artificial gravity as a countermeasure for musculoskeletal and cardiovascular deficits during bed rest, we tested the hypothesis that artificial gravity would have an effect on some aspects of nutritional status. Dietary intake was recorded daily before, during, and after 21 days of bed rest with artificial gravity (n = 8) or bed rest alone (n = 7). We examined body composition, hematology, general blood chemistry, markers of oxidative damage, and blood levels of selected vitamins and minerals before, during, and after the bed rest period. Several indicators of vitamin status changed in response to diet changes: serum α- and γ-tocopherol and urinary 4-pyridoxic acid decreased (P < 0.001) and plasma β-carotene increased (P < 0.001) in both groups during bed rest compared with before bed rest. A decrease in hematocrit (P < 0.001) after bed rest was accompanied by a decrease in transferrin (P < 0.001), but transferrin receptors were not changed. These data provide evidence that artificial gravity itself does not negatively affect nutritional status during bed rest. Likewise, artificial gravity has no protective effect on nutritional status during bed rest. PMID:19074571

Fluidized bed operations survey summary

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

Lombardi, C.

1996-12-31

A fluidized bed operations survey summary is presented. The survey contains information on: forced outage causes; forced outage concerns ranked numerically; 1996 boiler operation and maintenance (O&M) concerns; 1997 boiler O&M concerns; fluidized bed capacity factor results; and fluidized bed total outage time.

Electric versus hydraulic hospital beds: differences in use during basic nursing tasks.

PubMed

Capodaglio, Edda Maria

2013-01-01

Biomechanical, postural and ergonomic aspects during real patient-assisting tasks performed by nurses using an electric versus a hydraulic hospital bed were observed. While there were no differences in the flexed postures the nurses adopted, longer performance times were recorded when electric beds were used. Subjective effort, force exertion and lumbar shear forces exceeding safety limits proved electric beds were superior. Patients' dependency level seemed to influence the type of nurses' intervention (duration and force actions), irrespective of the bed used. The nurses greatly appreciated the electric bed. Its use seemed to reduce the level of effort perceived during care giving and the postural load during critical subtasks. Ergonomics and organizational problems related to adopting electric beds in hospital wards should be addressed further to make their use more efficient.

Pharmacologic counter measures minimizing post-space flight orthostatic intolerance. [bed rest, drug disposition, and physiological function

NASA Technical Reports Server (NTRS)

Harrison, D. C.; Kates, R.

1982-01-01

The effect of bed rest on drug disposition and physiological function was investigated as part of a project to determine the cardiovascular effects of space flight. One group of subjects was given doses of lidocane, penicillin-G, and ICG during a control period and following seven days of bed rest. Cardiac function was evaluated by echo-cardiography. Renal function was evaluated in a second group before and after several days of bed rest. Inulin, para-aminohippurate, and dextran clearances were studied. In the first group, the post-bed rest parameters were not statistically different from the pre-bed rest valves. In the second study, renal function did not change significantly after seven days of bed rest. Plans for future research are reviewed.

Fast fluidized bed steam generator

DOEpatents

Bryers, Richard W.; Taylor, Thomas E.

1980-01-01

A steam generator in which a high-velocity, combustion-supporting gas is passed through a bed of particulate material to provide a fluidized bed having a dense-phase portion and an entrained-phase portion for the combustion of fuel material. A first set of heat transfer elements connected to a steam drum is vertically disposed above the dense-phase fluidized bed to form a first flow circuit for heat transfer fluid which is heated primarily by the entrained-phase fluidized bed. A second set of heat transfer elements connected to the steam drum and forming the wall structure of the furnace provides a second flow circuit for the heat transfer fluid, the lower portion of which is heated by the dense-phase fluidized bed and the upper portion by the entrained-phase fluidized bed.

Multi-scale fracture networks within layered shallow water tight carbonates

NASA Astrophysics Data System (ADS)

Panza, Elisa; Agosta, Fabrizio; Rustichelli, Andrea; Vinciguerra, Sergio; Zambrano, Miller; Prosser, Giacomo; Tondi, Emanuele

2015-04-01

The work is aimed at deciphering the contribution of background deformation and persistent fracture zones on the fluid flow properties of tight platform carbonates. Taking advantage of 3D exposures present in the Murge area of southern Italy, the fracture networks crosscutting at different scales the layered Cretaceous limestone of the Altamura Fm. were analyzed. The rock multi-layer is characterized by 10's of cm-thick, sub-horizontal, laterally continuous carbonate beds. Each bed commonly represents a shallowing-upward peritidal cycle made up of homogeneous micritic limestones grading upward to cm-thick stromatolitic limestones and/or fenestral limestones. The bed interfaces are formed by sharp maximum flooding surfaces. Porosity measurements carried out on 40 limestone samples collected from a single carbonate bed show values ranging between 0,5% and 5,5%. Background deformation includes both stratabound and non-stratabound fractures. The former elements consist of bed-perpendicular joints and sheared joints, which are confined within a single bed and often displace small, bed-parallel stylolites. Non-stratabound fractures consist of incipient, cm offset, sub-vertical strike-slip faults, which crosscut the bed interfaces. The aforementioned elements are often confined within individual bed-packages, which are identified by presence of pronounced surfaces locally marked by veneers of reddish clayey paleosoils. Persistent fracture zones consist of 10's of m-high, 10's of cm-offset strike-slip faults that offset the bed-package interfaces and are confined within individual bed-packages association. Laterally discontinuous, cm- to a few m-thick paleokarstic breccia levels separate the different bed-packages associations. Persistent fracture zones include asymmetric fractured damage zones and mm-thick veneers of discontinuous fault rocks. The fracture networks that pervasively crosscut the study limestone multi-layer are investigated by mean of scanline and scanarea methodologies. The dimensional, spatial and scaling properties of both stratabound and non-stratabound fractures are documented along single beds and bed-packages, respectively. Persistent fracture zones are studied from individual bed-package associations. By computing the intensity, height distribution, aspect ratio, aperture of each fracture/fault set, DFN (Discrete Fracture Network) models are built for the aforementioned different scales of observation. DFN models of single beds and bed-packages include stratabound and non-stratabound fractures. Differently, the DFN model of a bed-packages association also includes persistent fracture zones and related damage zones. To check the results of our computations, we also build up a smaller scale, 1m3 geocellular volume in which fractures are inserted one at time in the model. All DFN models do not include the matrix porosity. Porosity and 3D permeability (Kx, Ky, Kz) values are obtained as outputs of the DFN models. The results are consistent with the most prominet set of non-stratabound fractures being the major control on the petrophysical properties of both single beds and bed-packages. As expected, the persistent fractures zones strongly affect both porosity and permeability of the bed-packages association. The results of ongoing laboratory analyses on representative limestone samples not only will provide a quantitative assessment of the physical properties of the matrix in terms of porosity and permeability, but also will shed new light on the geometry, density and anisotropy of microfractures and their role on fluid flow properties.

Ability of organic and inorganic bedding materials to promote growth of environmental bacteria.

PubMed

Godden, S; Bey, R; Lorch, K; Farnsworth, R; Rapnicki, P

2008-01-01

The major objective of this study was to contrast the ability of 4 commonly utilized bedding materials to promote growth of environmental bacteria under controlled conditions. A second objective was to describe the relationship between bacterial growth and specific biochemical or nutritional properties of these bedding materials. Unused samples of clean sand (CS; n = 20), recycled sand (RS; n = 21), digested manure solids (DS; n = 15), and shavings (SH; n = 15) were collected from bedding storage areas on 49 commercial Minnesota and Wisconsin dairy farms. Sterilized bedding samples were inoculated with Klebsiella pneumoniae and Enterococcus faecium then incubated, in triplicate, for 72 h at 37 degrees C. Subsamples were collected after 0, 24, 48, and 72 h of incubation for culture and enumeration of bacteria. Subsamples of bedding were also tested for pH, total C content (%), and total N content (%). If bacterial growth occurred, peak levels were typically achieved within 24 h. Digested manure solids promoted the greatest amounts of growth of K. pneumoniae, followed by RS and then SH, whereas CS promoted the least. There would seem to be a tradeoff in selecting SH as a bedding material, because it supported moderate growth of K. pneumoniae but caused a rapid decline in the numbers of E. faecium. However, RS, CS, and DS each only supported relatively small amounts of growth of E. faecium, so the benefit of SH relative to other bedding materials is limited. High bedding pH may partially explain why some bedding materials supported growth of E. faecium (e.g., DS and RS). Both high bedding pH (e.g., as for DS or RS) and high total C (%) content (e.g., as for DS and SH) may partially explain why some bedding materials supported growth of K. pneumoniae.

Bone metabolism and nutritional status during 30-day head-down-tilt bed rest

PubMed Central

Morgan, Jennifer L. L.; Zwart, Sara R.; Heer, Martina; Ploutz-Snyder, Robert; Ericson, Karen

2012-01-01

Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25–49 yr) who participated in a 30-day −6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ∼20% (P < 0.001), and serum parathyroid hormone decreased ∼25% (P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ∼20% during bed rest (P < 0.001) and correlated inversely with urinary calcium (R = −0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration. PMID:22995395

Molecular Basis of N,N-Diethyl-3-Methylbenzamide (DEET) in Repelling the Common Bed Bug, Cimex lectularius.

PubMed

Liu, Feng; Xia, Xiaoming; Liu, Nannan

2017-01-01

As the most extensively used chemical repellent, N,N-diethyl-3-methylbenzamide (DEET) displayed repellency to a wide range of insects, including the common bed bug, Cimex lectularius . While the neuronal or molecular basis involved in DEET's repellency have been majorly focused on mosquitos and fruit flies, DEET's repellency to the common bed bug is largely unreached. To gain new insights into the cellular and molecular mechanisms in DEET's repellency to the common bed bug, we characterized the neuronal response of bed bugs to DEET, identified the olfactory receptors targeted by DEET and demonstrated the interfering effect of DEET on bed bug's responses to human odorants. High doses of DEET were required for activating the olfactory receptor neurons in the sensilla of bed bugs and at least three DEET-sensitive receptors were functionally deciphered. These DEET-sensitive receptors presented even more sensitive to certain botanical terpenes/terpenoids which also displayed repellency at varying levels for bed bugs. In addition, DEET produced a blocking effect on the neuronal responses of bed bugs to specific human odors and showed inhibitory effect on the function of odorant receptors in responding to certain human odors. Taken together, our results indicate that DEET may function as a stimulus that triggers avoidance behaviors and a molecular "confusant" for interrupting the host odor recognition in the odorant receptors of bed bugs. The receptors that coincidently responded to both synthetic DEET and botanical terpenes/terpenoids suggested that DEET probably target on receptors that originally responded to terpenes/terpenoids. This study gave novel insight into the mechanisms of DEET's repellency to bed bugs and also provided valuable information for developing new reagents for bed bug control.

Coupling Solute and Fine Particle Transport with Sand Bed Morphodynamics within a Field Experiment

NASA Astrophysics Data System (ADS)

Phillips, C. B.; Ortiz, C. P.; Schumer, R.; Jerolmack, D. J.; Packman, A. I.

2017-12-01

Fine suspended particles are typically considered to pass through streams and rivers as wash load without interacting with the bed, however experiments have demonstrated that hyporheic flow causes advective exchange of fine particles with the stream bed, yielding accumulation of fine particle deposits within the bed. Ultimately, understanding river morphodynamics and ecosystem dynamics requires coupling both fine particle and solute transport with bed morphodynamics. To better understand the coupling between these processes we analyze a novel dataset from a controlled field experiment conducted on Clear Run, a 2nd order sand bed stream located within the North Carolina coastal plain. Data include concentrations of continuously injected conservative solutes and fine particulate tracers measured at various depths within the stream bed, overhead time lapse images of bed forms, stream discharge, and geomorphological surveys of the stream. We use image analysis of bed morphodynamics to assess exchange, retention, and remobilization of solutes and fine particles during constant discharge and a short duration experimental flood. From the images, we extract a time series of bedform elevations and scour depths for the duration of the experiment. The high-resolution timeseries of bed elevation enables us to assess coupling of bed morphodynamics with both the solute and fine particle flux during steady state mobile bedforms prior to the flood and to changing bedforms during the flood. These data allow the application of a stochastic modeling framework relating bed elevation fluctuations to fine particle residence times. This combined experimental and modeling approach ultimately informs our ability to predict not only the fate of fine particulate matter but also associated nutrient and carbon dynamics within streams and rivers.

The association between number of doctors per bed and readmission of elderly patients with pneumonia in South Korea.

PubMed

Lee, Joo Eun; Kim, Tae Hyun; Cho, Kyoung Hee; Han, Kyu-Tae; Park, Eun-Cheol

2017-06-08

There is an urgent need to reduce readmission of patients with pneumonia and improve quality of care. To assess the association between hospital resources and quality of care, we examined the effect of number of doctors per bed on 30-day readmission and investigated the combined effect of number of doctors per bed and number of beds. We used nationwide cohort sample data of health insurance claims by the National Health Insurance Service (NHIS) from 2002 to 2013. Pneumonia admissions to acute care hospitals among 7446 inpatients older than 65 were examined. We conducted a multivariate Cox proportional hazard model to analyze the association between the number of doctors per bed and 30-day readmission, as well as that of pneumonia-specific 30-day readmission with the combined effects of number of doctors per bed and number of beds. Overall, 1421 (19.1%) patients were readmitted within 30 days and 756 (11.2%) patients were readmitted for pneumonia within 30 days. Patients with pneumonia treated by very low or low number of doctors per bed showed higher readmission (pneumonia-specific readmission: hazard ratio [HR] = 1. 406, 95% confidence interval [CI] = 1.072-1.843 for low number of doctors per bed; all-cause readmissions: HR = 1.276, 95% CI = 1.026-1.587 for very low number of doctors per bed, and HR = 1.280, 95% CI = 1.064-1.540 for low number of doctors per bed). This empirical study showed that patients with pneumonia cared for in hospitals with more doctors were less likely to be readmitted. Pneumonia-specific 30-day readmission was also significantly associated with the combined effect of the number of doctors and the number of hospital beds.

Cacao bean husk: an applicable bedding material in dairy free-stall barns.

PubMed

Yajima, Akira; Owada, Hisashi; Kobayashi, Suguru; Komatsu, Natsumi; Takehara, Kazuaki; Ito, Maria; Matsuda, Kazuhide; Sato, Kan; Itabashi, Hisao; Sugimura, Satoshi; Kanda, Shuhei

2017-07-01

The objectives of the study were to assess the effect of cacao bean husk as bedding material in free-stall barn on the behavior, productivity, and udder health of dairy cattle, and on the ammonia concentrations in the barn. Four different stall surfaces (no bedding, cacao bean husk, sawdust, and chopped wheat straw) were each continuously tested for a period of 1 week to determine their effects on nine lactating Holstein cows housed in the free-stall barn with rubber matting. The lying time and the milk yield were measured between d 4 and d 7. Blood samples for plasma cortisol concentration and teat swabs for bacterial counts were obtained prior to morning milking on d 7. The time-averaged gas-phase ammonia concentrations in the barn were measured between d 2 and d 7. The cows spent approximately 2 h more per day lying in the stalls when bedding was available than without bedding. The milk yield increased in the experimental periods when cows had access to bedding materials as compared to the period without bedding. The lying time was positively correlated with the milk yield. Bacterial counts on the teat ends recorded for cows housed on cacao bean husk were significantly lower than those recorded for cows housed without bedding. Ammonia concentration under cacao bean husk bedding decreased by 6%, 15%, and 21% as compared to no bedding, sawdust, and chopped wheat straw, respectively. The cortisol concentration was lowest in the period when cacao bean husk bedding was used. We observed a positive correlation between the ammonia concentrations in the barn and the plasma cortisol concentrations. Cacao bean husk is a potential alternative of conventional bedding material, such as sawdust or chopped wheat straw, with beneficial effects on udder health and ammonia concentrations in the barns.

Breakup and reestablishment of the armour layer in a large gravel-bed river below dams: The lower Ebro

NASA Astrophysics Data System (ADS)

Vericat, Damia; Batalla, Ramon J.; Garcia, Celso

2006-06-01

Changes in armour layer during floods under supply limited conditions are little known. This paper describes the breakup and the reestablishment of the bed armour layer in the regulated gravel-bed Ebro River during a flooding period. The study was conducted over a 28-km study reach from 2002 to 2004. The surface, subsurface and bed load grain size distribution constitute the bases for the analysis of bed-armouring dynamics. The results indicate that the magnitude of floods controlled the degree of armouring of the river bed. The initial mean armouring ratio was 2.3, with maximum values reaching 4.4. Floods in the winter of 2002-2003 ( Q8) caused the breakup of the armour layer in several sections. This resulted in the erratic bed load pattern observed during the December 2002 flushing flow and in the increase in bed load transport during successive events. Most grain size classes were entrained and transported, causing river bed incision. The mean armouring ratio decreased to 1.9. In contrast, during low magnitude floods in 2003-2004 ( Q2), the coarsest fractions (64 mm) did not take part in the bed load while finer particles were winnowed, thus surface deposits coarsened. As a result, the armour layer was reestablished (i.e., the mean armouring ratio increased to 2.3), and the supply of subsurface sediment decreased. The supply and transport of bed material appear to be in balance in the river reach immediately below the dam. In contrast, the transport of medium and finer size classes in the downstream reaches was higher than their supply from upstream, a phenomenon that progressively reduced their availability in the river bed surface, hence the armour layer reworking.