Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial

PubMed Central

2014-01-01

Background In Sub-Saharan Africa over one million newborns die annually. We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practices and survival. Here we report the effect on newborn care practices one year after full implementation. Methods All 132 wards in the 6-district study area were randomised to intervention or comparison groups. Starting in 2010, in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practices including hygiene, breastfeeding and identification and extra care for low birth weight babies. In 2011, in a representative sample of 5,240 households, we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practices. Results Four of 14 newborn care practices were more commonly reported in intervention than comparison areas: delaying the baby’s first bath by at least six hours (81% versus 68%, OR 2.0 (95% CI 1.2-3.4)), exclusive breastfeeding in the three days after birth (83% versus 71%, OR 1.9 (95% CI 1.3-2.9)), putting nothing on the cord (87% versus 70%, OR 2.8 (95% CI 1.7-4.6)), and, for home births, tying the cord with a clean thread (69% versus 39%, OR 3.4 (95% CI 1.5-7.5)). For other behaviours there was little evidence of differences in reported practices between intervention and comparison areas including childbirth in a health facility or with a skilled attendant, thermal care practices, breastfeeding within an hour of birth and, for home births, the birth attendant having clean hands, cutting the cord with a clean blade and birth preparedness activities. Conclusions A home-based counselling strategy using volunteers and designed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania. Further research is needed to evaluate if, and at what cost, these gains will lead to improved newborn survival. Trial registration Trial Registration Number NCT01022788 (http://www.clinicaltrials.gov, 2009) PMID:25052850

46 CFR 160.151-43 - Conditions at servicing facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... liferaft, can be easily cleaned, and is kept clean and free from oil, grease, and abrasive material; (6) Is... areas or rooms for storage of liferafts awaiting servicing, repair, or delivery; for repair and painting...

46 CFR 160.151-43 - Conditions at servicing facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... liferaft, can be easily cleaned, and is kept clean and free from oil, grease, and abrasive material; (6) Is... areas or rooms for storage of liferafts awaiting servicing, repair, or delivery; for repair and painting...

46 CFR 160.151-43 - Conditions at servicing facilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... liferaft, can be easily cleaned, and is kept clean and free from oil, grease, and abrasive material; (6) Is... areas or rooms for storage of liferafts awaiting servicing, repair, or delivery; for repair and painting...

46 CFR 160.151-43 - Conditions at servicing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... liferaft, can be easily cleaned, and is kept clean and free from oil, grease, and abrasive material; (6) Is... areas or rooms for storage of liferafts awaiting servicing, repair, or delivery; for repair and painting...

CleanFleet final report. Volume 1, summary

DOT National Transportation Integrated Search

1995-12-01

The South Coast Alternative Fuels Demonstration, called CleanFleet, was conducted in the Los Angeles area from April 1992 through September 1994. The demonstration consisted of 111 package delivery vans operating on five alternative fuels and the con...

CleanFleet final report. Volume 4, fuel economy

DOT National Transportation Integrated Search

1995-12-01

The South Coast Alternative Fuels Demonstration, called CleanFleet, was conducted in the Los Angeles area from April 1992 through September 1994. The demonstration consisted of 111 package delivery vans operating on five alternative fuels and the con...

CleanFleet final report. Volume 6, occupational hygiene

DOT National Transportation Integrated Search

1995-12-01

The South Coast Alternative Fuels Demonstration, called CleanFleet, was conducted in the Los Angeles area from April 1992 through September 1994. The demonstration consisted of 111 package delivery vans operating on five alternative fuels and the con...

CleanFleet final report. Volume 5, employee attitude assessment

DOT National Transportation Integrated Search

1995-12-01

The South Coast Alternative Fuels Demonstration, called CleanFleet, was conducted in the Los Angeles area from April 1992 through September 1994. The demonstration consisted of 111 package delivery vans operating on five alternative fuels and the con...

7 CFR 51.2956 - Practically clean.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Standards for Grades of Walnuts in the Shell Definitions § 51.2956 Practically clean. Practically clean... dirt or other foreign matter, and that individual walnuts are not damaged by such means. A slightly... or foreign matter. ...

7 CFR 51.2956 - Practically clean.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Standards for Grades of Walnuts in the Shell Definitions § 51.2956 Practically clean. Practically clean... dirt or other foreign matter, and that individual walnuts are not damaged by such means. A slightly... or foreign matter. ...

A survey of UK practice patterns in the delivery of intravitreal injections.

PubMed

Samia-Aly, Emma; Cassels-Brown, Andrew; Morris, Daniel S; Stancliffe, Rachel; Somner, John E A

2015-07-01

To assess UK practice patterns related to the prescription of antibiotics before, during and after intravitreal injections, the location where injections are carried out and the qualifications of those administering the injections. Every ophthalmology unit featured in the Royal College of Ophthalmologists (UK) training directory was contacted. A healthcare professional involved in giving intravitreal injections at each institution completed a questionnaire regarding local practice patterns. A response rate of 85% (115/136) was achieved. Seventy four percent of hospitals (85/115) gave take home antibiotics post intravitreal injection. Twenty three percent (26/115) of hospitals employed non-medical healthcare professionals to administer injections and 83% (96/115) administered intravitreal injections in a dedicated clean room as opposed to an operating theatre. Practice patterns for intravitreal injection vary considerably. Guidelines alone do not appear to be effective in reducing practices which are considered wasteful and other approaches need to be developed. © 2015 The Authors Ophthalmic & Physiological Optics © 2015 The College of Optometrists.

29 CFR 551.8 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... as picking up and returning the delivery vehicle at the beginning and end of the workday, cleaning... in loading or unloading the goods, and picking up empty containers or other goods from customers for... local deliveries. (f) A plan of compensation on the basis of trip rates or other delivery payment plan...

CleanFleet final report. Volume 3, vehicle maintenance and durability

DOT National Transportation Integrated Search

1995-12-01

The South Coast Alternative Fuels Demonstration, called CleanFleet, was conducted in the Los Angeles area from April 1992 through September 1994. The demonstration consisted of 111 package delivery vans operating on five alternative fuels and the con...

30 CFR 57.6802 - Bulk delivery vehicles.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-Surface and Underground § 57.6802 Bulk delivery vehicles. No welding or cutting shall be performed on a... removed. Before welding or cutting on a hollow shaft, the shaft shall be thoroughly cleaned inside and out...

Estimating the health consequences of replacing cigarettes with nicotine inhalers

PubMed Central

Sumner, W

2003-01-01

Background: A fast acting, clean nicotine delivery system might substantially displace cigarettes. Public health consequences would depend on the subsequent prevalence of nicotine use, hazards of delivery systems, and intrinsic hazards of nicotine. Methods: A spreadsheet program, DEMANDS, estimates differences in expected mortality, adjusted for nicotine delivery system features and prevalence of nicotine use, by extending the data and methods of the SAMMEC 3 software from the US Centers for Disease Control and Prevention. The user estimates disease risks attributable to nicotine, other smoke components, and risk factors that coexist with smoking. The public health consequences of a widely used clean nicotine inhaler replacing cigarettes were compared to historical observations and public health goals, using four different risk attribution scenarios and nicotine use prevalence from 0–100%. Main outcome measures: Changes in years of potential life before age 85 (YPL85). Results: If nicotine accounts for less than a third of smokers' excess risk of SAMMEC diseases, as it most likely does, then even with very widespread use of clean nicotine DEMANDS predicts public health gains, relative to current tobacco use. Public health benefits accruing from a widely used clean nicotine inhaler probably equal or exceed the benefits of achieving Healthy People 2010 goals. Conclusions: Clean nicotine inhalers might improve public health as much as any feasible tobacco control effort. Although the relevant risk estimates are somewhat uncertain, partial nicotine deregulation deserves consideration as part of a broad tobacco control policy. PMID:12773720

Nondestructive Evaluation (NDE) Exploratory Development for Air Force Systems. Delivery Order 0001: Quick Reaction NDE and Characterization--Effects of Chemical Effects of Chemical Etching after Pre-Inspection Mechanical Cleaning on Fluorescent Penetrant Indications of Fatigue Cracks

DTIC Science & Technology

2011-08-01

Specimen 625 -58 Cleaned with 50-ksi Water Jet ....................... 18 Figure 12. SEM Images of Inconel Specimen 626-63 Cleaned with 50-ksi Water...SEM Images of Inconel Specimen 626-22 Cleaned with Wet Glass Bead.......................... 21 Figure 15. SEM Images of Titanium Specimen 625 -02...Figure 18. SEM Images of Titanium Specimen 625 -40 Cleaned with Dry Al2O3 (240 grit) ............... 24 Figure 19. SEM Images of Inconel Specimen

Scaling up interventions to eliminate neonatal tetanus: factors associated with the coverage of tetanus toxoid and clean deliveries among women in Vientiane, Lao PDR.

PubMed

Masuno, Kanako; Xaysomphoo, Duangpachan; Phengsavanh, Alongkone; Douangmala, Somthana; Kuroiwa, Chushi

2009-07-09

The Lao People's Democratic Republic (PDR) is one of seven countries that have not eliminated maternal and neonatal tetanus in more than 50% of districts. We conducted a community-based household survey to assess the achievements of strategies towards maternal and neonatal tetanus elimination in the capital province. The coverage of tetanus toxoid (TT) was 79.7% by the protection-at-birth (PAB) method. The percentages of deliveries attended by skilled personnel and of deliveries at a health facility were 68.4% and 63.7%, respectively. The progress towards eliminating neonatal tetanus in Lao PDR is not sufficient despite the study sites being placed in the capital province. The lack of continuum of care for mothers and newborns is the major obstacle to scale up the tetanus toxoid coverage and PAB as well as clean deliveries.

Quality Partners

ERIC Educational Resources Information Center

Clark, Bob

2006-01-01

Green cleaning is gaining momentum. It is a method of cleaning and maintaining facilities that is friendly to the environment and healthful for students and staff. The process uses environmentally friendly and nontoxic cleaning products and practices that must be third-party-certified. Using green cleaning practices and products can result in…

Healthier Cleaning & Maintenance: Practices and Products for Schools.

ERIC Educational Resources Information Center

New York State Association for Superintendents of School Buildings and Grounds, Albany.

This paper helps all those concerned with keeping schools clean and properly maintained in adopting healthier cleaning and maintenance practices and promoting the purchase and use of environmentally preferable products which perform well and are cost effective. It explains how children are exposed to toxic chemicals in school cleaning and…

Knowledge, attitudes, and practices regarding environmental cleaning among environmental service workers in Chinese hospitals.

PubMed

Ni, Kaiwen; Chen, Bingbing; Jin, Hui; Kong, Qingxin; Ni, Xiaoping; Xu, Hong

2017-09-01

We conducted a study using a face-to-face survey to assess knowledge, attitudes, and practices of environmental service workers (ESWs) concerning routine cleaning and disinfection at 3 tertiary hospitals in China. There were 115 (89.1%) respondents who agreed that environmental cleaning can contribute to keep patients safe, whereas 63 (48.8%) reported they were very willing to make cleaning practices better. Only 15 (11.6%) ESWs agreed they were in risk of nosocomial infections during daily cleaning. Our findings suggest that the level of ESWs' knowledge regarding cleaning practices was passable, but the awareness of occupational safety and health was weak. There is a need to introduce sustained education and training aimed at ESWs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

40 CFR 63.5755 - How do I demonstrate compliance with the aluminum recreational boat surface coating spray gun...

Code of Federal Regulations, 2013 CFR

2013-07-01

... the aluminum recreational boat surface coating spray gun cleaning work practice standards? 63.5755... recreational boat surface coating spray gun cleaning work practice standards? You must demonstrate compliance with the aluminum coating spray gun cleaning work practice standards by meeting the requirements of...

40 CFR 63.5755 - How do I demonstrate compliance with the aluminum recreational boat surface coating spray gun...

Code of Federal Regulations, 2012 CFR

2012-07-01

... the aluminum recreational boat surface coating spray gun cleaning work practice standards? 63.5755... recreational boat surface coating spray gun cleaning work practice standards? You must demonstrate compliance with the aluminum coating spray gun cleaning work practice standards by meeting the requirements of...

40 CFR 63.5755 - How do I demonstrate compliance with the aluminum recreational boat surface coating spray gun...

Code of Federal Regulations, 2014 CFR

2014-07-01

... the aluminum recreational boat surface coating spray gun cleaning work practice standards? 63.5755... recreational boat surface coating spray gun cleaning work practice standards? You must demonstrate compliance with the aluminum coating spray gun cleaning work practice standards by meeting the requirements of...

40 CFR 63.5755 - How do I demonstrate compliance with the aluminum recreational boat surface coating spray gun...

Code of Federal Regulations, 2011 CFR

2011-07-01

... the aluminum recreational boat surface coating spray gun cleaning work practice standards? 63.5755... surface coating spray gun cleaning work practice standards? You must demonstrate compliance with the aluminum coating spray gun cleaning work practice standards by meeting the requirements of paragraph (a) or...

40 CFR 63.5755 - How do I demonstrate compliance with the aluminum recreational boat surface coating spray gun...

Code of Federal Regulations, 2010 CFR

2010-07-01

... the aluminum recreational boat surface coating spray gun cleaning work practice standards? 63.5755... surface coating spray gun cleaning work practice standards? You must demonstrate compliance with the aluminum coating spray gun cleaning work practice standards by meeting the requirements of paragraph (a) or...

Practical Approaches for Assessment of Daily and Post-discharge Room Disinfection in Healthcare Facilities.

PubMed

Deshpande, Abhishek; Donskey, Curtis J

2017-09-01

Cleaning and disinfection in healthcare facilities is essential to ensure patient safety. This review examines practical strategies used to assess and improve the effectiveness of daily and post-discharge manual cleaning in healthcare facilities. Effective implementation of cleaning interventions requires objective monitoring of staff performance with regular feedback on performance. Use of fluorescent markers to assess thoroughness of cleaning and measurement of residual ATP can provide rapid and objective feedback to personnel and have been associated with improved cleaning. Direct observation of cleaning and interviews with front-line staff are useful to identify variations and deficiencies in practice that may not be detected by other methods. Although not recommended for routine monitoring, cultures can be helpful for outbreak investigations. Monitoring and feedback can be effective in improving cleaning and disinfection in healthcare facilities. Ongoing commitment within institutions is needed to sustain successful cleaning and disinfection programs.

Interventions to reduce neonatal mortality from neonatal tetanus in low and middle income countries--a systematic review.

PubMed

Khan, Adeel Ahmed; Zahidie, Aysha; Rabbani, Fauziah

2013-04-09

In 1988, WHO estimated around 787,000 newborns deaths due to neonatal tetanus. Despite few success stories majority of the Low and Middle Income Countries (LMICs) are still struggling to reduce neonatal mortality due to neonatal tetanus. We conducted a systematic review to understand the interventions that have had a substantial effect on reducing neonatal mortality rate due to neonatal tetanus in LMICs and come up with feasible recommendations for decreasing neonatal tetanus in the Pakistani setting. We systemically reviewed the published literature (Pubmed and Pubget databases) to identify appropriate interventions for reducing tetanus related neonatal mortality. A total of 26 out of 30 studies were shortlisted for preliminary screening after removing overlapping information. Key words used were "neonatal tetanus, neonatal mortality, tetanus toxoid women". Of these twenty-six studies, 20 were excluded. The pre-defined exclusion criteria was (i) strategies and interventions to reduce mortality among neonates not described (ii) no abstract/author (4 studies) (iii) not freely accessible online (1 study) (iv) conducted in high income countries (2 studies) and (v) not directly related to neonatal tetanus mortality and tetanus toxoid immunization (5). Finally six studies which met the eligibility criteria were entered in the pre-designed data extraction form and five were selected for commentary as they were directly linked with neonatal tetanus reduction. Interventions that were identified to reduce neonatal mortality in LMICs were: a) vaccination of women of child bearing age (married and unmarried both) with tetanus toxoid b) community based interventions i.e. tetanus toxoid immunization for all mothers; clean and skilled care at delivery; newborn resuscitation; exclusive breastfeeding; umbilical cord care and management of infections in newborns c) supplementary immunization (in addition to regular EPI program) d) safer delivery practices. The key intervention to reduce neonatal mortality from neonatal tetanus was found to be vaccination of pregnant women with tetanus toxoid. In the resource poor countries like Pakistan, this single intervention coupled with regular effective antenatal checkups, clean delivery practices and compliance with the "high- risk" approach can be effective in reducing neonatal tetanus.

Interventions to reduce neonatal mortality from neonatal tetanus in low and middle income countries - a systematic review

PubMed Central

2013-01-01

Background In 1988, WHO estimated around 787,000 newborns deaths due to neonatal tetanus. Despite few success stories majority of the Low and Middle Income Countries (LMICs) are still struggling to reduce neonatal mortality due to neonatal tetanus. We conducted a systematic review to understand the interventions that have had a substantial effect on reducing neonatal mortality rate due to neonatal tetanus in LMICs and come up with feasible recommendations for decreasing neonatal tetanus in the Pakistani setting. Methods We systemically reviewed the published literature (Pubmed and Pubget databases) to identify appropriate interventions for reducing tetanus related neonatal mortality. A total of 26 out of 30 studies were shortlisted for preliminary screening after removing overlapping information. Key words used were “neonatal tetanus, neonatal mortality, tetanus toxoid women”. Of these twenty-six studies, 20 were excluded. The pre-defined exclusion criteria was (i) strategies and interventions to reduce mortality among neonates not described (ii) no abstract/author (4 studies) (iii) not freely accessible online (1 study) (iv) conducted in high income countries (2 studies) and (v) not directly related to neonatal tetanus mortality and tetanus toxoid immunization (5). Finally six studies which met the eligibility criteria were entered in the pre-designed data extraction form and five were selected for commentary as they were directly linked with neonatal tetanus reduction. Results Interventions that were identified to reduce neonatal mortality in LMICs were: a) vaccination of women of child bearing age (married and unmarried both) with tetanus toxoid b) community based interventions i.e. tetanus toxoid immunization for all mothers; clean and skilled care at delivery; newborn resuscitation; exclusive breastfeeding; umbilical cord care and management of infections in newborns c) supplementary immunization (in addition to regular EPI program) d) safer delivery practices. Conclusion The key intervention to reduce neonatal mortality from neonatal tetanus was found to be vaccination of pregnant women with tetanus toxoid. In the resource poor countries like Pakistan, this single intervention coupled with regular effective antenatal checkups, clean delivery practices and compliance with the “high- risk” approach can be effective in reducing neonatal tetanus. PMID:23570611

Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use

PubMed Central

O'Connor, Katherine; Kim, Sunkyung; Kelley, Maureen; Odhiambo, Aloyce; Faith, Sitnah; Otieno, Ronald; Nygren, Benjamin; Kamb, Mary; Quick, Robert

2017-01-01

Reducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ≥ 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9–4.5), health facility delivery (OR = 5.3, 95% CI = 3.4–8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9–4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1–2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5–7.1) than women with less education. For women who lived ≤ 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5–4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0–2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing (P = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women. PMID:28193744

Bio-Inspired Self-Cleaning Surfaces

NASA Astrophysics Data System (ADS)

Liu, Kesong; Jiang, Lei

2012-08-01

Self-cleaning surfaces have drawn a lot of interest for both fundamental research and practical applications. This review focuses on the recent progress in mechanism, preparation, and application of self-cleaning surfaces. To date, self-cleaning has been demonstrated by the following four conceptual approaches: (a) TiO2-based superhydrophilic self-cleaning, (b) lotus effect self-cleaning (superhydrophobicity with a small sliding angle), (c) gecko setae-inspired self-cleaning, and (d) underwater organisms-inspired antifouling self-cleaning. Although a number of self-cleaning products have been commercialized, the remaining challenges and future outlook of self-cleaning surfaces are also briefly addressed. Through evolution, nature, which has long been a source of inspiration for scientists and engineers, has arrived at what is optimal. We hope this review will stimulate interdisciplinary collaboration among material science, chemistry, biology, physics, nanoscience, engineering, etc., which is essential for the rational design and reproducible construction of bio-inspired multifunctional self-cleaning surfaces in practical applications.

INFECTION CONTROL IN ALTERNATIVE HEALTHCARE SETTINGS

PubMed Central

Flanagan, Elaine; Chopra, Teena; Mody, Lona

2011-01-01

SYNOPSIS With the changing healthcare delivery, patients receive care at various settings including acute care hospitals, skilled nursing facilities, outpatient primary care and specialty clinics, as well as at home, exposing them to pathogens in various settings. Various healthcare settings face unique challenges requiring individualized infection control programs. Infection control programs in skilled nursing facilities should address: surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. Infection control programs in ambulatory clinics should address: Triage and standard – transmission based precautions, cleaning, disinfection and sterilization principles, surveillance in surgical clinics, safe injection practices, and bioterrorism and disaster planning for ambulatory clinics. PMID:21316005

Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect

PubMed Central

2011-01-01

Background Annually over 520,000 newborns die from neonatal sepsis, and 60,000 more from tetanus. Estimates of the effect of clean birth and postnatal care practices are required for evidence-based program planning. Objective To review the evidence for clean birth and postnatal care practices and estimate the effect on neonatal mortality from sepsis and tetanus for the Lives Saved Tool (LiST). Methods We conducted a systematic review of multiple databases. Data were abstracted into standard tables and assessed by GRADE criteria. Where appropriate, meta-analyses were undertaken. For interventions with low quality evidence but a strong GRADE recommendation, a Delphi process was conducted. Results Low quality evidence supports a reduction in all-cause neonatal mortality (19% (95% c.i. 1–34%)), cord infection (30% (95% c.i. 20–39%)) and neonatal tetanus (49% (95% c.i. 35–62%)) with birth attendant handwashing. Very low quality evidence supports a reduction in neonatal tetanus mortality with a clean birth surface (93% (95% c.i. 77-100%)) and no relationship between a clean perineum and tetanus. Low quality evidence supports a reduction of neonatal tetanus with facility birth (68% (95% c.i. 47-88%). No relationship was found between birth place and cord infections or sepsis mortality. For postnatal clean practices, all-cause mortality is reduced with chlorhexidine cord applications in the first 24 hours of life (34% (95% c.i. 5–54%, moderate quality evidence) and antimicrobial cord applications (63% (95% c.i. 41–86%, low quality evidence). One study of postnatal maternal handwashing reported reductions in all-cause mortality (44% (95% c.i. 18–62%)) and cord infection ((24% (95% c.i. 5-40%)). Given the low quality of evidence, a Delphi expert opinion process was undertaken. Thirty experts reached consensus regarding reduction of neonatal sepsis deaths by clean birth practices at home (15% (IQR 10–20)) or in a facility (27% IQR 24–36)), and by clean postnatal care practices (40% (IQR 25–50)). The panel estimated that neonatal tetanus mortality was reduced by clean birth practices at home (30% (IQR(20–30)), or in a facility (38% (IQR 34–40)), and by clean postnatal care practices (40% (IQR 30–50)). Conclusion According to expert opinion, clean birth and particularly postnatal care practices are effective in reducing neonatal mortality from sepsis and tetanus. Further research is required regarding optimal implementation strategies. PMID:21501428

A Review of the CDC Recommendations for Prevention of HAIs in Outpatient Settings.

PubMed

Garrett, J Hudson

2015-05-01

According to the Centers for Disease Control and Prevention (CDC), most health care-associated infections (HAIs) are caused by contamination from the hands of health care providers or patients, contamination from the environment, and contamination from the patient's own skin. To mitigate common sources of infection transmission, frontline health care providers must be compliant with basic infection-prevention interventions, including hand hygiene, environmental cleaning and disinfection, safe injection practices, and designation of a trained health care professional to be responsible for the infection prevention and control program. Integration of CDC recommendations should incorporate a bundled approach to these interventions and should be part of a comprehensive approach to infection prevention and control. Effective infection-prevention practices in outpatient settings are critical for reducing the risk of infection transmission, improving patient safety and patient outcomes, and reducing costs associated with health care delivery. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Farming for Ecosystem Services: An Ecological Approach to Production Agriculture

PubMed Central

Philip Robertson, G.; Gross, Katherine L.; Hamilton, Stephen K.; Landis, Douglas A.; Schmidt, Thomas M.; Snapp, Sieglinde S.; Swinton, Scott M.

2014-01-01

A balanced assessment of ecosystem services provided by agriculture requires a systems-level socioecological understanding of related management practices at local to landscape scales. The results from 25 years of observation and experimentation at the Kellogg Biological Station long-term ecological research site reveal services that could be provided by intensive row-crop ecosystems. In addition to high yields, farms could be readily managed to contribute clean water, biocontrol and other biodiversity benefits, climate stabilization, and long-term soil fertility, thereby helping meet society's need for agriculture that is economically and environmentally sustainable. Midwest farmers—especially those with large farms—appear willing to adopt practices that deliver these services in exchange for payments scaled to management complexity and farmstead benefit. Surveyed citizens appear willing to pay farmers for the delivery of specific services, such as cleaner lakes. A new farming for services paradigm in US agriculture seems feasible and could be environmentally significant. PMID:26955069

Farming for Ecosystem Services: An Ecological Approach to Production Agriculture.

PubMed

Philip Robertson, G; Gross, Katherine L; Hamilton, Stephen K; Landis, Douglas A; Schmidt, Thomas M; Snapp, Sieglinde S; Swinton, Scott M

2014-05-01

A balanced assessment of ecosystem services provided by agriculture requires a systems-level socioecological understanding of related management practices at local to landscape scales. The results from 25 years of observation and experimentation at the Kellogg Biological Station long-term ecological research site reveal services that could be provided by intensive row-crop ecosystems. In addition to high yields, farms could be readily managed to contribute clean water, biocontrol and other biodiversity benefits, climate stabilization, and long-term soil fertility, thereby helping meet society's need for agriculture that is economically and environmentally sustainable. Midwest farmers-especially those with large farms-appear willing to adopt practices that deliver these services in exchange for payments scaled to management complexity and farmstead benefit. Surveyed citizens appear willing to pay farmers for the delivery of specific services, such as cleaner lakes. A new farming for services paradigm in US agriculture seems feasible and could be environmentally significant.

Evaluation of Bacterial Contamination of Clipper Blades in Small Animal Private Practice.

PubMed

Mount, Rebecca; Schick, Anthea E; Lewis, Thomas P; Newton, Heide M

2016-01-01

Nosocomial infections are a growing concern in veterinary hospitals, and identifying fomites is imperative to reducing the risk of pathogen transmission. In veterinary medicine, shaving of hair is necessary prior to many procedures. Contaminated clipper blades have been cited as potential fomites involved in the transmission of pathogens in veterinary and human medicine. The primary goal of this study was to evaluate bacterial contamination of clipper blades in veterinary practices. A secondary goal was to assess whether there was an association between bacterial contamination of clipper blades and clipper blade cleaning solutions, clipper blade cleaning protocols, clipper blade storage, and type of practice. Sixty clipper blades from 60 different practices were cultured. Information regarding blade cleaning solutions, protocols, and storage was collected from each practice. Fifty-one percent (31/60) of clipper blades sampled were contaminated with bacteria. Category of cleaning solutions had a significant association with bacterial contamination (P < 0.02). Cleaning frequency (P = 0.55), storage location (P = 0.26), and practice type (P = 0.06) had no significant association with bacterial contamination. This study documented bacterial contamination of clipper blades in veterinary practices, and clipper blades should be considered potential fomites.

A study of blood contamination of Siqveland matrix bands.

PubMed

Lowe, A H; Bagg, J; Burke, F J T; MacKenzie, D; McHugh, S

2002-01-12

AIMS To use a sensitive forensic test to measure blood contamination of used Siqveland matrix bands following routine cleaning and sterilisation procedures in general dental practice. Sixteen general dental practices in the West of Scotland participated. Details of instrument cleaning procedures were recorded for each practice. A total of 133 Siqveland matrix bands were recovered following cleaning and sterilisation and were examined for residual blood contamination by the Kastle-Meyer test, a well-recognised forensic technique. Ultrasonic baths were used for the cleaning of 62 (47%) bands and retainers and the remainder (53%) were hand scrubbed prior to autoclaving. Overall, 21% of the matrix bands and 19% of the retainers gave a positive Kastle-Meyer test, indicative of residual blood contamination, following cleaning and sterilisation. In relation to cleaning method, 34% of hand-scrubbed bands and 32% of hand-scrubbed retainers were positive for residual blood by the Kastle-Meyer test compared with 6% and 3% respectively of ultrasonically cleaned bands and retainers (P < 0.001). If Siqveland matrix bands are re-processed in the assembled state, then adequate pre-sterilisation cleaning cannot be achieved reliably. Ultrasonic baths are significantly more effective than hand cleaning for these items of equipment.

Hygienic measures during animal transport to abattoirs - a status quo analysis of the current cleaning and disinfection of animal transporters in Germany.

PubMed

Weber, Luisa; Meemken, Diana

2018-01-01

The process of cleaning and disinfection of animal transport vehicles after unloading animals at the abattoir is a critical control point regarding proper hygiene. It is an important step regarding the biosecurity. In the present study, a status quo analysis of the currently performed cleaning and disinfection measures of animal transport vehicles was carried out at the vehicle washing facilities of five different industrial abattoirs in Germany. For this purpose, a checklist was developed and validated to assess the washing procedure of transport vehicles in a standardised way. The evaluated phases of cleaning included the evaluation criteria "length of time per used floor", "visual cleaning success" and the "hygienic awareness of the driver". During disinfection, attention was paid to the internal and external surfaces of the transporter and to the methods used to disinfect them. In addition, the technical and structural equipment of the five different washing facilities were recorded using a questionnaire and compared to the legal regulations, respectively. At each location, approximately 150 vehicles of all delivery types (transport vehicles owned by the abattoir, external delivery companies and vehicles owned by the supplying farmers) were inspected so that in total a number of more than 750 vehicles were included in this study. The aim was to develop abattoir specific, as well as generally applicable intervention measures and to generate "standard-operation procedures" (SOP's) for the cleaning and disinfection of animal transporters. At two out of five locations vehicles have left the abattoir without cleaning and disinfection. In 31-97% of all vehicles, only a cleaning of the vehicle was carried out, a subsequent disinfection did not take place. A cleaning followed by disinfecting took place in only 3-59% of all vehicles. The results indicate a considerable need for improvement and standardisation in this relevant field of disease prevention.

Essential neonatal care utilization and associated factors among mothers in public health facilities of Aksum Town, North Ethiopia, 2016.

PubMed

Berhe, Megbey; Medhaniye, Araya Abraha; Kahsay, Gizienesh; Birhane, Ermyas; Abay, Mebrahtu

2017-01-01

Globally, neonatal death accounts about 44% of child death in 2013. Ethiopia is one of the ten countries with the highest number of neonatal death. Worldwide, more than 43% of deaths among under five year children is contributed by neonates. Half of the neonatal death occur in the first day of life. Recommendations about newborn care practices may conflict with local beliefs and practices. So, it is important to understand the existing newborn care practice and factors affecting it in order to take interventions so as to decrease neonatal death. To assess magnitude of essential neonatal care utilization and associated factors among women visiting public health facilities in Aksum Town, Tigray, Northern Ethiopia, 2015. Facility based cross sectional study was conducted from December 30, 2015 to January 31, 2016.The sampled population are 423 women who gave live births within the last 6 months prior to data collection. Systematic random sampling technique was employed. Data were entered, coded and cleaned using Epi info version 7, and SPSS Version 21 software was used for analysis. Both bivariable and multivariable logistic regression models were used to determine factors associated with essential neonatal care utilization. Variables with P-value <0.2 in the bivariable logistic regression model were included in to multivariable logistic regression model, and finally variables with P-value <0.05 were considered as independent factors. Odds ratio was used to measure strength of association at 95% confidence level. A total of 423 mothers included in the study. Prevalence of safe cord care, optimal breast feeding, thermal care and baby received Tetracycline eye ointment and vaccine at birth were 42.8%, 63.1%, 32.6% and 44.7% among the respondents respectively. Only 113(26.7%) of the participants fulfilled essential new born care practice. Occupation, parity and counseling on essential new born care during delivery were significantly associated with utilization of essential new born care. Employed women (AOR = 7.08; 95% CI (2.21, 12.72), 2-3 number of deliveries (AOR = 1.84; 95% CI (1.04, 3.26) and received counseling about essential new born car during delivery (AOR = 3.36; 95% CI (1.86, 6.08) were more likely to practice essential neonatal care practice than their counterparts. Around three-fourth of mothers were not practicing Essential Newborn Care (ENC). Occupation, parity and essential new born care counseling during delivery were significantly associated with utilization of ENC. Promotion of information at community level, women empowerment and staff training is recommended.

Self-ear cleaning practices and the associated risk of ear injuries and ear-related symptoms in a group of university students.

PubMed

Khan, Nasim Banu; Thaver, Sivashnee; Govender, Samantha Marlene

2017-12-31

Self-ear cleaning is the insertion of objects into the ear canal to clean it, a widespread practice that has the potential to compromise its integrity as a natural, selfcleansing mechanism, and a risk factor for possible injuries. The practice is common among young adults and highest in university than any other graduates. This study aimed to determine the self-ear cleaning practices and associated risk of injury and related symptoms in undergraduate students at KwaZulu-Natal University. The descriptive survey utilized a self-administered questionnaire. Of the 206 participants that responded, 98% engaged in self-ear cleaning, with 75% indicating that it was beneficial. The commonest method (79.6%) being the use of cotton buds, with an associated injury rate of 2.4%. There was no statistically significant associations between those who used or did not use cotton buds and the symptoms experienced. The complications indicate that self-ear cleaning does pose a risk for injury, necessitating more community information and education.

Community and provider perceptions of traditional and skilled birth attendants providing maternal health care for pastoralist communities in Kenya: a qualitative study.

PubMed

Byrne, Abbey; Caulfield, Tanya; Onyo, Pamela; Nyagero, Josephat; Morgan, Alison; Nduba, John; Kermode, Michelle

2016-03-01

Kenya has a high burden of maternal and newborn mortality. Consequently, the Government of Kenya introduced health system reforms to promote the availability of skilled birth attendants (SBAs) and proscribed deliveries by traditional birth attendants (TBAs). Despite these changes, only 10% of women from pastoralist communities are delivered by an SBA in a health facility, and the majority are delivered by TBAs at home. The aim of this study is to better understand the practices and perceptions of TBAs and SBAs serving the remotely located, semi-nomadic, pastoralist communities of Laikipia and Samburu counties in Kenya, to inform the development of an SBA/TBA collaborative care model. This descriptive qualitative study was undertaken in 2013-14. We conducted four focus group discussions (FGDs) with TBAs, three with community health workers, ten with community women, and three with community men. In-depth interviews were conducted with seven SBAs and eight key informants. Topic areas covered were: practices and perceptions of SBAs and TBAs; rewards and challenges; managing obstetric complications; and options for SBA/TBA collaboration. All data were translated, transcribed and thematically analysed. TBAs are valued and accessible members of their communities who adhere to traditional practices and provide practical and emotional support to women during pregnancy, delivery and post-partum. Some TBA practices are potentially harmful to women e.g., restricting food intake during pregnancy, and participants recognised that TBAs are unable to manage obstetric complications. SBAs are acknowledged as having valuable technical skills and resources that contribute to safe and clean deliveries, especially in the event of complications, but there is also a perception that SBAs mistreat women. Both TBAs and SBAs identified a range of challenges related to their work, and instances of mutual respect and informal collaborations between SBAs and TBAs were described. These findings clearly indicate that an SBA/TBA collaborative model of care consistent with Kenyan Government policy is a viable proposition. The transition from traditional birth to skilled birth attendance among the pastoralist communities of Laikipia and Samburu is going to be a gradual one, and an interim collaborative model is likely to increase the proportion of SBA assisted deliveries, improve obstetric outcomes, and facilitate the transition.

Implementing AORN recommended practices for environmental cleaning.

PubMed

Allen, George

2014-05-01

In recent years, researchers have developed an increasing awareness of the role of the environment in the development of health care-associated infections. AORN's "Recommended practices for environmental cleaning" is an evidence-based document that provides specific guidance for cleaning processes, for the selection of appropriate cleaning equipment and supplies, and for ongoing education and quality improvement. This updated recommended practices document has an expanded focus on the need for health care personnel to work collaboratively to accomplish adequately thorough cleanliness in a culture of safety and mutual support. Perioperative nurses, as the primary advocates for patients while they are being cared for in the perioperative setting, should help ensure that a safe, clean environment is reestablished after each surgical procedure. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Can commonly-used fan-driven air cleaning technologies improve indoor air quality? A literature review

NASA Astrophysics Data System (ADS)

Zhang, Yinping; Mo, Jinhan; Li, Yuguo; Sundell, Jan; Wargocki, Pawel; Zhang, Jensen; Little, John C.; Corsi, Richard; Deng, Qihong; Leung, Michael H. K.; Fang, Lei; Chen, Wenhao; Li, Jinguang; Sun, Yuexia

2011-08-01

Air cleaning techniques have been applied worldwide with the goal of improving indoor air quality. The effectiveness of applying these techniques varies widely, and pollutant removal efficiency is usually determined in controlled laboratory environments which may not be realized in practice. Some air cleaners are largely ineffective, and some produce harmful by-products. To summarize what is known regarding the effectiveness of fan-driven air cleaning technologies, a state-of-the-art review of the scientific literature was undertaken by a multidisciplinary panel of experts from Europe, North America, and Asia with expertise in air cleaning, aerosol science, medicine, chemistry and ventilation. The effects on health were not examined. Over 26,000 articles were identified in major literature databases; 400 were selected as being relevant based on their titles and abstracts by the first two authors, who further reduced the number of articles to 160 based on the full texts. These articles were reviewed by the panel using predefined inclusion criteria during their first meeting. Additions were also made by the panel. Of these, 133 articles were finally selected for detailed review. Each article was assessed independently by two members of the panel and then judged by the entire panel during a consensus meeting. During this process 59 articles were deemed conclusive and their results were used for final reporting at their second meeting. The conclusions are that: (1) None of the reviewed technologies was able to effectively remove all indoor pollutants and many were found to generate undesirable by-products during operation. (2) Particle filtration and sorption of gaseous pollutants were among the most effective air cleaning technologies, but there is insufficient information regarding long-term performance and proper maintenance. (3) The existing data make it difficult to extract information such as Clean Air Delivery Rate (CADR), which represents a common benchmark for comparing the performance of different air cleaning technologies. (4) To compare and select suitable indoor air cleaning devices, a labeling system accounting for characteristics such as CADR, energy consumption, volume, harmful by-products, and life span is necessary. For that purpose, a standard test room and condition should be built and studied. (5) Although there is evidence that some air cleaning technologies improve indoor air quality, further research is needed before any of them can be confidently recommended for use in indoor environments.

In situ thermally enhanced biodegradation of petroleum fuel hydrocarbons and halogenated organic solvents

DOEpatents

Taylor, Robert T.; Jackson, Kenneth J.; Duba, Alfred G.; Chen, Ching-I

1998-01-01

An in situ thermally enhanced microbial remediation strategy and a method for the biodegradation of toxic petroleum fuel hydrocarbon and halogenated organic solvent contaminants. The method utilizes nonpathogenic, thermophilic bacteria for the thermal biodegradation of toxic and carcinogenic contaminants, such as benzene, toluene, ethylbenzene and xylenes, from fuel leaks and the chlorinated ethenes, such as trichloroethylene, chlorinated ethanes, such as 1,1,1-trichloroethane, and chlorinated methanes, such as chloroform, from past solvent cleaning practices. The method relies on and takes advantage of the pre-existing heated conditions and the array of delivery/recovery wells that are created and in place following primary subsurface contaminant volatilization efforts via thermal approaches, such as dynamic underground steam-electrical heating.

In situ thermally enhanced biodegradation of petroleum fuel hydrocarbons and halogenated organic solvents

DOEpatents

Taylor, R.T.; Jackson, K.J.; Duba, A.G.; Chen, C.I.

1998-05-19

An in situ thermally enhanced microbial remediation strategy and a method for the biodegradation of toxic petroleum fuel hydrocarbon and halogenated organic solvent contaminants are described. The method utilizes nonpathogenic, thermophilic bacteria for the thermal biodegradation of toxic and carcinogenic contaminants, such as benzene, toluene, ethylbenzene and xylenes, from fuel leaks and the chlorinated ethenes, such as trichloroethylene, chlorinated ethanes, such as 1,1,1-trichloroethane, and chlorinated methanes, such as chloroform, from past solvent cleaning practices. The method relies on and takes advantage of the pre-existing heated conditions and the array of delivery/recovery wells that are created and in place following primary subsurface contaminant volatilization efforts via thermal approaches, such as dynamic underground steam-electrical heating. 21 figs.

Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings.

PubMed

Forrester, Jared A; Koritsanszky, Luca A; Amenu, Demisew; Haynes, Alex B; Berry, William R; Alemu, Seifu; Jiru, Fekadu; Weiser, Thomas G

2018-06-01

Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. We introduced Clean Cut at a tertiary hospital in Ethiopia. Infection prevention standards included skin antisepsis, ensuring a sterile field, instrument decontamination/sterilization, prophylactic antibiotic administration, routine swab/gauze counting, and use of a surgical safety checklist. Processes were mapped by a visiting surgical fellow and local operating theater staff to facilitate the development of contextually relevant solutions; processes were reassessed for improvements. Process mapping helped identify barriers to using alcohol-based hand solution due to skin irritation, inconsistent administration of prophylactic antibiotics due to variable delivery outside of the operating theater, inefficiencies in assuring sterility of surgical instruments through lack of confirmatory measures, and occurrences of retained surgical items through inappropriate guidelines, staffing, and training in proper routine gauze counting. Compliance with most processes improved significantly following organizational changes to align tasks with specific process goals. Enumerating the steps involved in surgical infection prevention using a process mapping technique helped identify opportunities for improving adherence and plotting contextually relevant solutions, resulting in superior compliance with antiseptic standards. Simplifying these process maps into an adaptable tool could be a powerful strategy for improving safe surgery delivery in LMICs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Assessment of hospital daily cleaning practices using ATP bioluminescence in a developing country.

PubMed

Zambrano, Alejandra A; Jones, Alex; Otero, Paula; Ajenjo, Maria Cristina; Labarca, Jaime A

2014-01-01

Visual assessment of surfaces may not be enough to document the level of cleanliness in the hospital setting. It is necessary to introduce quantitative methods to document the results of this practice. To evaluate the efficacy of hospital terminal cleaning procedures, using an adenosine triphosphate (ATP) bioluminescence method in a teaching hospital. During 2008 we conducted an evaluation using ATP bioluminescence LIGHTNING MVP™ (Arquimed) of external and internal housekeeping service. After conducting an initial evaluation we implemented education of cleaning practices and finally we did a post intervention evaluation. Using chi-square method we compared prior versus after cleaning, quality of cleaning performed by external versus internal personnel, single versus double terminal cleaning procedures and prior versus after intervention. A finding of three RLU or less was considered a clean surface. We performed 198 evaluations in 33 patient units and nine OR. Internal personnel accomplished 25.37% of clean surfaces before and 80% after the education intervention (p=0.01). In contrast, external personnel obtained 68.8% before and 73.33% after intervention (p=0.3). This study suggests that visual assessment is not enough to ensure quality of the process and it is necessary to document the level of cleanliness by quantitative methods. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

Perioperative hair removal: A review of best practice and a practice improvement opportunity.

PubMed

Spencer, Maureen; Barnden, Marsha; Johnson, Helen Boehm; Fauerbach, Loretta Litz; Graham, Denise; Edmiston, Charles E

2018-06-01

The current practice of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the practice which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant practice improvement in the perioperative hair removal clean-up process. These improvements include not only further mitigation of potential infection risk but also substantial OR time and cost savings.

40 CFR 22.44 - Supplemental rules of practice governing the termination of permits under section 402(a) of the...

Code of Federal Regulations, 2014 CFR

2014-07-01

... governing the termination of permits under section 402(a) of the Clean Water Act or under section 3008(a)(3... Supplemental rules of practice governing the termination of permits under section 402(a) of the Clean Water Act... permits under section 402(a) of the Clean Water Act or under section 3008(a)(3) of the Resource...

40 CFR 22.44 - Supplemental rules of practice governing the termination of permits under section 402(a) of the...

Code of Federal Regulations, 2010 CFR

2010-07-01

... governing the termination of permits under section 402(a) of the Clean Water Act or under section 3008(a)(3... Supplemental rules of practice governing the termination of permits under section 402(a) of the Clean Water Act... permits under section 402(a) of the Clean Water Act or under section 3008(a)(3) of the Resource...

40 CFR 22.44 - Supplemental rules of practice governing the termination of permits under section 402(a) of the...

Code of Federal Regulations, 2011 CFR

2011-07-01

... governing the termination of permits under section 402(a) of the Clean Water Act or under section 3008(a)(3... Supplemental rules of practice governing the termination of permits under section 402(a) of the Clean Water Act... permits under section 402(a) of the Clean Water Act or under section 3008(a)(3) of the Resource...

40 CFR 22.44 - Supplemental rules of practice governing the termination of permits under section 402(a) of the...

Code of Federal Regulations, 2012 CFR

2012-07-01

... governing the termination of permits under section 402(a) of the Clean Water Act or under section 3008(a)(3... Supplemental rules of practice governing the termination of permits under section 402(a) of the Clean Water Act... permits under section 402(a) of the Clean Water Act or under section 3008(a)(3) of the Resource...

7 CFR 51.570 - Clean.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Standards for Celery Definitions § 51.570 Clean. Clean means that the stalk is practically free from dirt or other foreign material. Stalks shall be permitted to have a small amount of dirt on the inside of the...

Effects of retrofit emission controls and work practices on perchloroethylene exposures in small dry-cleaning shops.

PubMed

Ewers, Lynda M; Ruder, Avima M; Petersen, Martin R; Earnest, G Scott; Goldenhar, Linda M

2002-02-01

The effectiveness of commercially available interventions for reducing workers' perchloroethylene exposures in three small dry-cleaning shops was evaluated. Depending upon machine configuration, the intervention consisted of the addition of either a refrigerated condenser or a closed-loop carbon adsorber to the existing dry-cleaning machine. These relatively inexpensive (less than $5000) engineering controls were designed to reduce perchloroethylene emissions when dry-cleaning machine doors were opened for loading or unloading. Effectiveness of the interventions was judged by comparing pre- and postintervention perchloroethylene exposures using three types of measurements in each shop: (1) full-shift, personal breathing zone, air monitoring, (2) next-morning, end-exhaled worker breath concentrations of perchloroethylene, and (3) differences in the end-exhaled breath perchloroethylene concentrations before and after opening the dry-cleaning machine door. In general, measurements supported the hypothesis that machine operators' exposures to perchloroethylene can be reduced. However, work practices, especially maintenance practices, influenced exposures more than was originally anticipated. Only owners of dry-cleaning machines in good repair, with few leaks, should consider retrofitting them, and only after consultation with their machine's manufacturer. If machines are in poor condition, a new machine or alternative technology should be considered. Shop owners and employees should never circumvent safety features on dry-cleaning machines.

Distributed Generation of Electricity and its Environmental Impacts

EPA Pesticide Factsheets

Distributed generation refers to technologies that generate electricity at or near where it will be used. Learn about how distributed energy generation can support the delivery of clean, reliable power to additional customers.

Whole house particle removal and clean air delivery rates for in-duct and portable ventilation systems.

PubMed

Macintosh, David L; Myatt, Theodore A; Ludwig, Jerry F; Baker, Brian J; Suh, Helen H; Spengler, John D

2008-11-01

A novel method for determining whole house particle removal and clean air delivery rates attributable to central and portable ventilation/air cleaning systems is described. The method is used to characterize total and air-cleaner-specific particle removal rates during operation of four in-duct air cleaners and two portable air-cleaning devices in a fully instrumented test home. Operation of in-duct and portable air cleaners typically increased particle removal rates over the baseline rates determined in the absence of operating a central fan or an indoor air cleaner. Removal rates of 0.3- to 0.5-microm particles ranged from 1.5 hr(-1) during operation of an in-duct, 5-in. pleated media filter to 7.2 hr(-1) for an in-duct electrostatic air cleaner in comparison to a baseline rate of 0 hr(-1) when the air handler was operating without a filter. Removal rates for total particulate matter less than 2.5 microm in aerodynamic diameter (PM2.5) mass concentrations were 0.5 hr(-1) under baseline conditions, 0.5 hr(-1) during operation of three portable ionic air cleaners, 1 hr(-1) for an in-duct 1-in. media filter, 2.4 hr(-1) for a single high-efficiency particle arrestance (HEPA) portable air cleaner, 4.6 hr(-1) for an in-duct 5-in. media filter, 4.7 hr(-1) during operation of five portable HEPA filters, 6.1 hr(-1) for a conventional in-duct electronic air cleaner, and 7.5 hr(-1) for a high efficiency in-duct electrostatic air cleaner. Corresponding whole house clean air delivery rates for PM2.5 attributable to the air cleaner independent of losses within the central ventilation system ranged from 2 m3/min for the conventional media filter to 32 m3/min for the high efficiency in-duct electrostatic device. Except for the portable ionic air cleaner, the devices considered here increased particle removal indoors over baseline deposition rates.

Recreational Vessels and the Clean Boating Act

EPA Pesticide Factsheets

Homepage for content on the Clean Boating Act, which requires the EPA to develop best management practices for discharges from recreational vessels. The page links to information about the Clean Water Act amendment, its history and public participation.

SC3: Protecting Students and Staff with Green Cleaning

ERIC Educational Resources Information Center

US Environmental Protection Agency, 2008

2008-01-01

EPA's Schools Chemical Cleanout Campaign (SC3) is working to encourage schools to use green cleaning practices to safely clean their classrooms and grounds. From elementary school maintenance closets to high school chemistry labs, schools use a variety of chemicals. Some of the most essential chemicals are those that keep schools clean and safe…

Cleaning practices and cleaning products in nurseries and schools: to what extent can they impact indoor air quality?

PubMed

Wei, W; Boumier, J; Wyart, G; Ramalho, O; Mandin, C

2016-08-01

In the framework of a nationwide survey on indoor air quality conducted from September 2009 to June 2011 in 310 nurseries, kindergartens, and elementary schools in all regions of France, cleaning practices and products were described through an extensive questionnaire completed on-site by expert building inspectors. The questionnaire included the cleaning frequencies and periods, cleaning techniques, whether windows were open during cleaning, and the commercial names of the products used. Analysis of the questionnaire responses showed that cleaning was generally performed daily for furniture and floors. It was performed mostly in the evening with wet mopping and with one or more windows open. Five hundred eighty-four different cleaning products were listed, among which 218 safety data sheets (SDSs) were available and analyzed. One hundred fifty-two chemical substances were identified in the SDSs. The typical substances in cleaning products included alcohols, chlorides, terpenes, aldehydes, and ethers; more than half of them are irritants. Two endocrine disruptors, 2-phenylphenol and Galaxolide, were identified in two cleaning products used every day to clean the floors, in seven kindergartens and in a nursery respectively. Eleven reactive substances containing C=C double bonds, mostly terpenes, were identified in a wide variety of cleaning products. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Removal of biofilm from contact lens storage cases.

PubMed

Wu, Yvonne T; Zhu, Hua; Willcox, Mark; Stapleton, Fiona

2010-12-01

Lens case hygiene practices are important in maintaining safe contact lens wear. However, the effectiveness of various lens case cleaning practices have not been evaluated and compared. This in vitro study aimed to evaluate and compare the efficacy of cleaning practices that are most commonly carried out by lens wearers and recommended by practitioners. Pseudomonas aeruginosa 122, Serratia marcescens ATCC 13880, and Staphylococcus aureus ATCC 6538 were the challenge bacteria for biofilm formation on unused lens cases from two different manufacturers. After establishment of the biofilm, each lens case was subjected to one of the six cleaning regimens: "rinsed," "rubbed and rinsed," "air-dried," "soaked in a multipurpose contact lens solution," "tissue-wiped," and "lids recapped." The level of residual biofilm was quantified at the end of each cleaning regimen. The efficacy of each cleaning regimen was then compared. Mechanical rubbing and wiping of lens cases were the most effective cleaning regimen tested in reducing biofilm. Soaking lenses in disinfecting solution for 6 hours removed the majority of biofilm from lens cases. Rinsing lens cases alone provided only minimal efficacy in reducing biofilm. Air-drying or recapping the cases with the lid without any other additional cleaning methods were the least efficient at removing biofilm. Based on this study, digital rubbing and rinsing and/or wiping the lens cases with tissue is recommended. Air-drying or recapping the lens case lids after use without any additional cleaning methods should be discouraged with non-antimicrobial lens cases.

Cleaning Up.

ERIC Educational Resources Information Center

Musgrave, Chuck; Spencer-Workman, Sarah

2000-01-01

Provides a nine-step process in designing athletic facility laundry rooms that are attractive and functional. Steps include determining the level of laundry services needed, ensuring adequate storage and compatible delivery systems, selecting laundry equipment, and choosing suitable flooring. (GR)

Birth preparedness, complication readiness and other determinants of place of delivery among mothers in Goba District, Bale Zone, South East Ethiopia.

PubMed

Belda, Semere Sileshi; Gebremariam, Mulugeta Betre

2016-04-06

Ethiopia is one of the countries with the highest maternal mortality ratio 676/100,000 LB and the lowest skilled delivery at birth (10%) in 2011. Skilled delivery care and provision of emergency obstetric care prevents many of these deaths. Despite implementation of birth preparedness and complication readiness packages to antenatal care users since 2007 in the study area, yet an overwhelming proportion of births take place at home. The effect of birth preparedness and complication readiness on place of delivery is not well known and studied in this context. A community based case control study preceded by initial census was conducted on a total of 358 sampled respondents (119 cases and 239 controls) who were selected using stratified two stage sampling technique. A pre-tested and standardized questionnaire with a face-to-face interview was used to collect the data, and then data was cleaned, coded and entered in to SPSS version-21 for analysis. Binary logistic regression models were run to identify predictors of place of delivery and Odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. The mean (± Standard Deviation) age of respondents was; 27.41(±5.8) and 28.84(±5.7) years for the cases and the controls respectively. Two third (67.1%) of the childbirths took place in the respondents house while only (32.9%) gave birth in health facilities. Great proportion (79.7%) of the cases and two third (34.0%) of the controls were well-prepared for birth and complication. Maternal education, religion, distance from health facility, knowledge of availability of ambulance transport and history of obstetric complication were significantly associated with place of delivery (P-value <0.01). Birth preparedness and complication readiness practice had an independent effect on place of delivery (AOR =2.55, 95% CI: 1.12, 5.84). The study identified better institutional delivery service utilization by mothers who were well-prepared for birth and complication. Strategies that increase the preparedness of mothers for birth and complication ahead of childbirth are recommended to improve institutional delivery service utilization.

Notification: Audit of City of Houston’s Use of Funds and Contracting Practices Under the Clean Water State Revolving Fund Program

EPA Pesticide Factsheets

Project #OA-FY17-0380, November 7, 2017. The EPA OIG plans to begin preliminary research on the city of Houston, Texas’s, use of funds and contracting practices under the Clean Water State Revolving Fund (CWSRF) program.

Newborn umbilical cord and skin care in Sylhet District, Bangladesh: Implications for promotion of umbilical cord cleansing with topical chlorhexidine

PubMed Central

Alam, Ashraful; Ali, Nabeel Ashraf; Sultana, Nighat; Mullany, Luke C.; Teela, Katherine C.; Khan, Nazib Uz Zaman; Baqui, Abdullah H.; Arifeen, Shams El; Mannan, Ishtiaq; Darmstadt, Gary L.; Winch, Peter J.

2010-01-01

Background Newborn cord care practices may directly contribute to infections, which account for a large proportion of the 4 million annual global neonatal deaths. This formative research study assessed current umbilical and skin care knowledge and practices for neonates in Sylhet, Bangladesh in preparation for a cluster-randomised trial of the impact of topical chlorhexidine cord cleansing on neonatal mortality and omphalitis. Methodology Unstructured interviews (n=60), structured observations (n=20), rating and ranking exercises (n=40), and household surveys (n=400) were conducted to elicit specific behaviours regarding newborn cord and skin care practices. These included hand-washing, skin and cord care at the time of birth, persons engaged in cord care, cord cutting practices, topical applications to the cord at the time of birth, wrapping/dressing of the cord stump, and use of skin-to-skin care. Results Ninety percent of deliveries occurred at home. The umbilical cord was almost always (98%) cut after delivery of the placenta, and cut by mothers in more than half the cases (57%). Substances were commonly (52%) applied to the stump after cord cutting; turmeric was the most common application (83%). Umbilical stump care revolved around bathing, skin massage with mustard oil, and heat massage on the umbilical stump. Forty-two percent of newborns were bathed on the day of birth. Mothers were the principal provider for skin and cord care during the neonatal period and 9% reported umbilical infections in their infants. Discussion Unhygienic cord care practices are prevalent in the study area. Efforts to promote hand washing, cord cutting with clean instruments, and avoiding unclean home applications to the cord may reduce exposure and improve neonatal outcomes. Such efforts should broadly target a range of caregivers, including mothers and other female household members. PMID:19057570

Use of a fluorescent chemical as a quality indicator for a hospital cleaning program.

PubMed

Blue, Jennifer; O'Neill, Cindy; Speziale, Paul; Revill, Jeff; Ramage, Lee; Ballantyne, Lisa

2008-01-01

Hamilton Health Sciences is a large teaching hospital with over 1,000 beds and consists of three acute care sites, one Regional Cancer Center and two Rehabilitation/Chronic Care facilities. An environmental cleaning pilot project was initiated at the acute care Henderson site, following an outbreak of vancomycin-resistant Enterococcus (VRE). Healthcare-associated infections (HAI) due to antibiotic-resistant organisms are increasing in Southern Ontario. Environmental cleaning plays a key role in eradicating resistant organisms that live in hospital environments, thereby helping to reduce HAIs. The environmental cleaning practices on the Orthopaedic Unit were identified as a contributing factor to the VRE outbreak after visual assessments were completed using a Brevis GlitterBug product, a chemical that fluoresces under an ultraviolet (UV) lamp. These findings led to a hospital-wide cleaning improvement initiative on all units except critical care areas. The GlitterBug potion was employed by Infection Control and Customer Support Services (CSS) as a tool to evaluate the daily cleaning of patient washrooms as well as discharge cleaning of contact precaution isolation rooms. Over a four-week period, the GlitterBug potion was applied to seven frequently touched standard targets in randomly selected patient bathrooms on each unit and 14 frequently touched targets prior to cleaning in the rooms used for isolation. The targets were then evaluated using the UV lamp to detect objects that were not cleaned and the results were recorded on a standardized form. The rate of targets cleaned versus the targets missed was calculated. The overall rate for daily cleaning of bathrooms and cleaning of isolation rooms was poor with only 23% of the targets cleaned. Based on these findings, several interventions were implemented. This resulted in a significant improvement in cleaning practices during the pilot project. Greater than 80% of the targets were cleaned compared to the baseline findings of 23%. Subsequently, nosocomial cases of VRE have declined despite the increased prevalence of VRE in the Hamilton and surrounding regions. The GlitterBug product is an effective tool to evaluate environmental cleaning and adherence to policies and procedures and this method was superior to previous visual inspection methods. The use of GlitterBug potion improved physical cleaning and enhanced staff contribution. The Brevis GlitterBug product was incorporated into the CSS environmental cleaning program at Hamilton Health Sciences as a quality indicator to monitor environmental cleaning practices.

Delivery practices of traditional birth attendants in Dhaka slums, Bangladesh.

PubMed

Fronczak, N; Arifeen, S E; Moran, A C; Caulfield, L E; Baqui, A H

2007-12-01

This paper describes associations among delivery-location, training of birth attendants, birthing practices, and early postpartum morbidity in women in slum areas of Dhaka, Bangladesh. During November 1993-May 1995, data on delivery-location, training of birth attendants, birthing practices, delivery-related complications, and postpartum morbidity were collected through interviews with 1,506 women, 489 home-based birth attendants, and audits in 20 facilities where the women from this study gave birth. Associations among maternal characteristics, birth practices, delivery-location, and early postpartum morbidity were specifically explored. Self-reported postpartum morbidity was associated with maternal characteristics, delivery-related complications, and some birthing practices. Dais with more experience were more likely to use potentially-harmful birthing practices which increased the risk of postpartum morbidity among women with births at home. Postpartum morbidity did not differ by birth-location. Safe motherhood programmes must develop effective strategies to discourage potentially-harmful home-based delivery practices demonstrated to contribute to morbidity.

Safe delivery and newborn care practices in Sindh, Pakistan: a community-based investigation of mothers and health workers.

PubMed

Hassan, Hamid; Jokhio, Abdul Hakeem; Winter, Heather; Macarthur, Christine

2012-08-01

to determine the prevalence of specific intrapartum practices in Sindh province, Pakistan. a cross-sectional, questionnaire based study. 6 health clinics in Mirpurkhas, Sindh province, rural Pakistan. 225 mothers and 82 health workers. outcome measures were indicators of safe delivery practices and referral following an obstetric complication. Prevalence of unhygienic and unsafe practices in deliveries attended by Traditional Birth Attendants (TBAs) was common. Deliveries by skilled attendants were significantly safer but with some failures in hygienic practices. 29% of women who had experienced an obstetric complication had not received emergency obstetric care. safe delivery practices and newborn care needs to be improved in rural Pakistan. This may be achieved by training health workers and TBAs in safe delivery practices, using safe delivery kits and with an effective referral system. Copyright © 2011 Elsevier Ltd. All rights reserved.

Environmental Assessment Addressing the Expansion of Sortie-Operations at Moody Air Force Base, Georgia

DTIC Science & Technology

2012-08-01

include the tactical delivery of air-to-ground munitions, laser designation of targets from ground and airborne platforms, and threat evasion. These...world events, which include the tactical delivery of air-to-ground munitions, laser designation of targets from ground and airborne platforms, and...Closure CAA Clean Air Act CAU Classic Associate Unit CEQ Council on Environmental Quality CFR Code of Federal Regulations CO carbon monoxide

A pilot study to evaluate incorporating eye care for children into reproductive and child health services in Dar-es-Salaam, Tanzania: a historical comparison study

PubMed Central

2014-01-01

Background Many blinding eye conditions of childhood are preventable or treatable, particularly in developing countries. However, primary eye care (PEC) for children is poorly developed, leading to unnecessary visual loss. Activities for control by health workers entail interventions for systemic conditions (measles, vitamin A deficiency), identification and referral of children with sight threatening conditions and health education for caregivers. This pilot study evaluated integrating a package of activities to promote child eye health into Reproductive and Child Health (RCH) services in Dar-es-Salaam, Tanzania. Methods Design: historical comparison study. Fifteen Clinical Officers and 15 nurses in 15 randomly selected RCH clinics were trained in PEC for children in July 2010. They were given educational materials (poster and manual) and their supervisors were orientated. Knowledge and practices were assessed before and 3 weeks after training. One year later their knowledge and practices were compared with a different group of 15 Clinical Officers and 15 nurses who had not been trained. Results Before training staff had insufficient knowledge to identify, treat and refer children with eye diseases, even conjunctivitis. Some recommended harmful practices or did not know that cataract requires urgent referral. Eye examination, vitamin A supplementation of mothers after delivery and cleaning the eyes at birth with instillation of antibiotics (Crede’s prophylaxis) were not routine, and there were no eye-specific educational materials. Three weeks after training several clinics delivering babies started Crede’s prophylaxis, vitamin A supplementation of women after delivery increased from 83.7% to 100%, and all staff included eye conditions in health education sessions. At one year, trained staff were more likely to correctly describe, diagnose and treat conjunctivitis (z=2.34, p=0.04)(30%-vs-60.7%). Mystery mothers observed health education sessions in 7/10 RCH clinics with trained staff, five (71.4%) of which included eye conditions. Conclusions Primary eye care for children in Dar-es-Salaam is inadequate but training RCH staff can improve knowledge in the short term and change practices. Attendance by mothers and their children is high in RCH clinics, making them ideal for delivery of PEC. Ongoing supportive supervision is required to maintain knowledge and practices, as well as systems to track referrals. PMID:24932133

IMPROVED EQUIPMENT CLEANING IN COATED AND LAMINATED SUBSTRATE MANUFACTURING FACILITIES (PHASE I)

EPA Science Inventory

The report gives results of a Phase I study to characterize current equipment cleaning practices in the coated and laminated substrate manufacturing industry, to identify alternative cleaning technologies, and to identify demonstrable technologies and estimate their emissions imp...

40 CFR 63.803 - Work practice standards.

Code of Federal Regulations, 2012 CFR

2012-07-01

... containers for storing finishing, gluing, cleaning, and washoff materials. (h) Application equipment... solvent used for line cleaning into a normally closed container. (j) Gun cleaning. Each owner or operator... closed container. (k) Washoff operations. Each owner or operator of an affected source shall control...

40 CFR 63.803 - Work practice standards.

Code of Federal Regulations, 2014 CFR

2014-07-01

... containers for storing finishing, gluing, cleaning, and washoff materials. (h) Application equipment... solvent used for line cleaning into a normally closed container. (j) Gun cleaning. Each owner or operator... closed container. (k) Washoff operations. Each owner or operator of an affected source shall control...

40 CFR 63.803 - Work practice standards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... containers for storing finishing, gluing, cleaning, and washoff materials. (h) Application equipment... solvent used for line cleaning into a normally closed container. (j) Gun cleaning. Each owner or operator... closed container. (k) Washoff operations. Each owner or operator of an affected source shall control...

Use of fluorescent tagging for assessment of environmental cleaning and disinfection in a veterinary hospital.

PubMed

Weese, J S; Lowe, T; Walker, M

2012-09-01

Environmental cleaning was assessed at a small animal veterinary referral hospital and associated primary healthcare facility. A convenience sample of surfaces was contaminated with fluorescent dye, and then cleaning was assessed 24 hours later by UV light visualisation. Five hundred sixty-three sites were assessed; however, 70 sites were unable to be evaluated 24 hours later because equipment had been removed or because rooms were occupied at the time of re-evaluation. Overall, dye was removed from 212/493 (43%) of sites. Site-specific rates ranged from 14% (computer keyboards and mice, 9/66 site cleaned) to 81% (examination tables, 44/54 sites cleaned). There was a significant difference in the prevalence of successful cleaning by general location (P < 0.0001) and surface type (P < 0.0001). Environmental tagging was an easy and low-cost tool to assess cleaning practices. Results prompted further infection control investigations to explain selected deficiencies, leading to identification of inadequacies in protocols and practices. Environmental tagging may be a useful infection control tool for establishing baseline cleaning rates, identifying deficiencies in protocols, evaluating the effects of interventions and education of personnel.

Qualification of local advanced cryogenic cleaning technology for 14nm photomask fabrication

NASA Astrophysics Data System (ADS)

Taumer, Ralf; Krome, Thorsten; Bowers, Chuck; Varghese, Ivin; Hopkins, Tyler; White, Roy; Brunner, Martin; Yi, Daniel

2014-10-01

The march toward tighter design rules, and thus smaller defects, implies stronger surface adhesion between defects and the photomask surface compared to past generations, thereby resulting in increased difficulty in photomask cleaning. Current state-of-the-art wet clean technologies utilize functional water and various energies in an attempt to produce similar yield to the acid cleans of previous generations, but without some of the negative side effects. Still, wet cleans have continued to be plagued with issues such as persistent particles and contaminations, SRAF and feature damages, leaving contaminants behind that accelerate photo-induced defect growth, and others. This paper details work done through a design of experiments (DOE) utilized to qualify an improved cryogenic cleaning technology for production in the Advanced Mask Technology Center (AMTC) advanced production lines for 20 and 14 nm processing. All work was conducted at the AMTC facility in Dresden, Germany utilizing technology developed by Eco-Snow Systems and RAVE LLC for their cryogenic local cleaning VC1200F platform. This system uses a newly designed nozzle, improved gaseous CO2 delivery, extensive filtration to remove hydrocarbons and minimize particle adders, and other process improvements to overcome the limitations of the previous generation local cleaning tool. AMTC has successfully qualified this cryogenic cleaning technology and is currently using it regularly to enhance production yields even at the most challenging technology nodes.

Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

PubMed

Colomar, Mercedes; Cafferata, Maria Luisa; Aleman, Alicia; Tomasso, Giselle; Betran, Ana Pilar

2017-03-31

Antenatal care reduces maternal and perinatal mortality and morbidity through the detection and treatment of some conditions, but its coverage is less than optimal within certain populations. Supply kits for maternal health were designed to overcome barriers present when providing care during pregnancy and childbirth particularly to women from underserved population.We conducted a mixed-methods systematic review on the use of supply kits. This manuscript presents the findings from qualitative studies that reported barriers, facilitators, and user's recommendation in the adoption and implementation of any type of kit designed to be used during pregnancy or childbirth.This review included eight studies, and seven were implemented in developing countries. Most studies assessed the implementation of clean delivery kits to be used during labour and delivery, and contributed to gain insights into factors that may hinder or foster the use of kits.Clean delivery kits were conceived to cope with barriers related mainly to access. The most important barrier identified were those related to the socio-cultural and the lack of knowledge dimension such as who held the decision-making authority in the household, as well as popular beliefs behind the idea that birth preparation could bring bad luck, may prevent clients from adhering to their use. In addition, financial constraints and limited understanding of the instructions of use were accessibility barriers found. On the other hand, once used, clean delivery kits for maternal health were accepted by women and health workers. Convenience, hygienic components, and avoidance of delays in receiving care were viewed as satisfactory features.Supply kits are mostly affordable and easily deployable. Increasing awareness among the population about the offered kits and providing information on their benefits emerges as a critical step to foster use in settings where kits are available. Implementation of this strategy requires low complexity resources and could make the use of kits an accepted alternative to increase the use of evidence-based interventions and thus improve quality of care during pregnancy, childbirth and neonatal period mainly at the community level in low income countries and remote areas with low access.

Safe delivery practices: experience from cross-sectional data of Bangladeshi women.

PubMed

Kabir, M A; Goh, Kim-Leng; Khan, M M H; Al-Amin, Abul Quasem; Azam, Mohammad Nurul

2015-03-01

This study examines the safe delivery practices of Bangladeshi women using data on 4905 ever-married women aged 15 to 49 years from the 2007 Bangladesh Demographic and Health Survey. Variables that included age, region of origin, education level of respondent and spouse, residence, working status, religion, involvement in NGOs, mass media exposure, and wealth index were analyzed to find correlates of safe delivery practices. More than 80% of the deliveries took place at home, and only 18% were under safe and hygienic conditions. The likelihood of safe deliveries was significantly lower among younger and older mothers than middle-aged mothers and higher among educated mothers and those living in urban areas. Economically better-off mothers and those with greater exposure to mass media had a significantly higher incidence of safe delivery practices. A significant association with religion and safe delivery practices was revealed. Demographic, socioeconomic, cultural, and programmatic factors that are strongly associated with safe delivery practices should be considered in the formulation of reproductive health policy. © 2012 APJPH.

18 CFR 367.4160 - Account 416, Costs and expenses of merchandising, jobbing and contract work.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Receiving and handling customer orders for merchandise or for jobbing services. (7) Cleaning and tidying... sales rooms or of equipment. (10) Transportation expense in delivery and pick-up of appliances by the...

Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial.

PubMed

Hall, Lisa; Farrington, Alison; Mitchell, Brett G; Barnett, Adrian G; Halton, Kate; Allen, Michelle; Page, Katie; Gardner, Anne; Havers, Sally; Bailey, Emily; Dancer, Stephanie J; Riley, Thomas V; Gericke, Christian A; Paterson, David L; Graves, Nicholas

2016-03-24

The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Australia New Zealand Clinical Trial Registry ACTRN12615000325505.

Role of ultraviolet (UV) disinfection in infection control and environmental cleaning.

PubMed

Qureshi, Zubair; Yassin, Mohamed H

2013-06-01

Ultraviolet (UV) radiation is capable of disinfecting surfaces, water and air. The UV technology was used for many years. However, safer and more effective delivery systems of UV radiation, make it a very useful option for disinfection. Effective disinfection of environmental surfaces is a key step in the prevention of spread of infectious agents. The traditional manual cleaning is essential in assuring adequate elimination of contamination. However, terminal cleaning is frequently suboptimal or unpredictable in many circumstances. UV-C radiation is an adjunctive disinfectant new technology that could kill a wide array of microorganisms including both vegetative and spore forming pathogens. The technology is getting more affordable and has produced consistent reproducible significant reduction of bacterial contamination.

Pregnancy after orthotopic continent urinary diversion.

PubMed

Kennedy, W A; Hensle, T W; Reiley, E A; Fox, H E; Haus, T

1993-10-01

Continent urinary diversion has become a common form of bladder management for the female exstrophy patient in whom primary reconstruction has failed. Reported are the results of successful pregnancies in four young adult females, who had previously undergone a flap vaginoplasty as part of earlier management and more recently a continent right colonic urinary reservoir with a perineal stoma (Indiana pouch). Pregnancy in each of these patients was characterized by several urinary tract infections, cervical prolapse and mild to severe maternal hydronephrosis. All of the patients had some degree of difficulty with clean intermittent catheterization. One patient required an indwelling catheter with prolonged bed rest. Maternal hydronephrosis resolved after delivery in all instances. All four patients delivered their infants by way of cesarean section, either emergently for maternal or fetal distress or electively. Cervical prolapse did not resolve in three patients and will require surgical repair. After delivery, all patients returned to their previous pattern of clean intermittent catheterization without loss of continence. All the infants delivered were healthy with appropriate weights and high Apgar scores (more than 8). Orthotopic (perineal stoma) continent urinary diversion is not a contraindication to pregnancy. However, our experience mandates delivery by cesarean section with close monitoring for maternal or fetal distress during gestation.

Issues and approaches for ensuring effective communication on acceptable daily exposure (ADE) values applied to pharmaceutical cleaning.

PubMed

Olson, Michael J; Faria, Ellen C; Hayes, Eileen P; Jolly, Robert A; Barle, Ester Lovsin; Molnar, Lance R; Naumann, Bruce D; Pecquet, Alison M; Shipp, Bryan K; Sussman, Robert G; Weideman, Patricia A

2016-08-01

This manuscript centers on communication with key stakeholders of the concepts and program goals involved in the application of health-based pharmaceutical cleaning limits. Implementation of health-based cleaning limits, as distinct from other standards such as 1/1000th of the lowest clinical dose, is a concept recently introduced into regulatory domains. While there is a great deal of technical detail in the written framework underpinning the use of Acceptable Daily Exposures (ADEs) in cleaning (for example ISPE, 2010; Sargent et al., 2013), little is available to explain how to practically create a program which meets regulatory needs while also fulfilling good manufacturing practice (GMP) and other expectations. The lack of a harmonized approach for program implementation and communication across stakeholders can ultimately foster inappropriate application of these concepts. Thus, this period in time (2014-2017) could be considered transitional with respect to influencing best practice related to establishing health-based cleaning limits. Suggestions offered in this manuscript are intended to encourage full and accurate communication regarding both scientific and administrative elements of health-based ADE values used in pharmaceutical cleaning practice. This is a large and complex effort that requires: 1) clearly explaining key terms and definitions, 2) identification of stakeholders, 3) assessment of stakeholders' subject matter knowledge, 4) formulation of key messages fit to stakeholder needs, 5) identification of effective and timely means for communication, and 6) allocation of time, energy, and motivation for initiating and carrying through with communications. Copyright © 2016 Elsevier Inc. All rights reserved.

Stethoscope Hygiene: Practice and Attitude of Medical Students.

PubMed

Gazibara, Tatjana; Radovanovic, Sanja; Maric, Gorica; Rancic, Biljana; Kisic-Tepavcevic, Darija; Pekmezovic, Tatjana

2015-01-01

The purpose of this study was to evaluate the frequency and attitude of medical students towards cleaning their stethoscopes. A cross-sectional study was carried out in the first week of December 2013. The study included 771 students (397 in their fourth and 374 in their sixth year) from the Faculty of Medicine, University of Belgrade, Serbia. An anonymous questionnaire was distributed to students before the start of compulsory lessons in classrooms. 317 of the 397 fourth-year students (79.8%) and 306 of the 374 sixth-year students (81.9%) cleaned their stethoscope. The stethoscope diaphragm was most commonly cleaned, while the flexible tubing was the least commonly cleaned area, mainly using ethyl alcohol-based agents. The strongest positive attitude was observed for the statement 'It is important that my stethoscope is clean' (4.3 out of 5.0). A positive correlation (Spearman's x03C1; = 0.105) was observed between a higher frequency of cleaning and the stronger positive notion that a stethoscope should be cleaned. A considerably high proportion of the students studied had ever cleaned their stethoscopes. Based on the students' responses, it would be useful to implement instructions on stethoscope hygiene in the regular practical curriculum with the aim of applying stethoscope disinfection in daily work. © 2015 S. Karger AG, Basel.

Reprocessing anesthesia instruments and devices.

PubMed

Ball, K

2000-02-01

Reprocessing anesthesia instruments and devices can often present a challenge for anesthesia providers because anesthesia devices have become more complex, cross-contamination with disease-forming pathogens can occur, and the importance of appropriate reprocessing may not be fully understood. Based on accepted practice recommendations, regulations, and research, reprocessing must be performed by skilled individuals who understand asepsis, cleaning, disinfection, and sterilization principles. This article describes the art of reprocessing and includes highlighted information on recommended practices, Spaulding's classifications, personal protective attire, precleaning, leak testing of flexible endoscopes, device disassembly, cleaning supplies and solutions, cleaning methods, rinsing, reassembly of the device, inspection, disinfection, and sterilization.

Gas-phase optical fiber photocatalytic reactors for indoor air application: a preliminary study on performance indicators

NASA Astrophysics Data System (ADS)

Palmiste, Ü.; Voll, H.

2017-10-01

The development of advanced air cleaning technologies aims to reduce building energy consumption by reduction of outdoor air flow rates while keeping the indoor air quality at an acceptable level by air cleaning. Photocatalytic oxidation is an emerging technology for gas-phase air cleaning that can be applied in a standalone unit or a subsystem of a building mechanical ventilation system. Quantitative information on photocatalytic reactor performance is required to evaluate the technical and economic viability of the advanced air cleaning by PCO technology as an energy conservation measure in a building air conditioning system. Photocatalytic reactors applying optical fibers as light guide or photocatalyst coating support have been reported as an approach to address the current light utilization problems and thus, improve the overall efficiency. The aim of the paper is to present a preliminary evaluation on continuous flow optical fiber photocatalytic reactors based on performance indicators commonly applied for air cleaners. Based on experimental data, monolith-type optical fiber reactor performance surpasses annular-type optical fiber reactors in single-pass removal efficiency, clean air delivery rate and operating cost efficiency.

Factors associated with hand hygiene practices in two neonatal intensive care units.

PubMed

Cohen, Bevin; Saiman, Lisa; Cimiotti, Jeannie; Larson, Elaine

2003-06-01

To determine whether hand hygiene practices differ between levels of contact with neonates; to characterize the hand hygiene practices of different types of personnel; and to compare hand hygiene practices in neonatal intensive care units (NICUs) using different products. Research assistants observed staff hand hygiene practices during 38 sessions in two NICUs. Patient touches were categorized as touching within the neonates' environment but only outside the Isolette (Level 1), touching within the Isolette but not the neonate directly (Level 2) or directly touching the neonate (Level 3). Hand hygiene practices for each touch were categorized into five groups: cleaned hands and new gloves; uncleaned hands and new gloves; used gloves; clean hands and no gloves; uncleaned hands and no gloves. Research assistants observed 1472 touches. On average each neonate or his or her immediate environment was touched 78 times per shift. Nurses (P = 0.001), attending physicians (P = 0.02) and physicians-in-training (P = 0.03) were more likely to use appropriate practices during Level 3 touches, but only 22.8% of all touches were with cleaned and/or newly gloved hands. The mean number of direct touches by staff members with cleaned hands was greater in the NICU using an alcohol-based hand rub than in the NICU using antimicrobial soap (P < 0.01). Hand hygiene was suboptimal in this high risk setting; administrative action and improved products may be needed to assure acceptable practice. In this study use of an alcohol-based product was associated with significantly improved hand hygiene and should be encouraged, as recommended in the new CDC hand hygiene guideline.

Telehealth infection control: a movement toward best practice.

PubMed

Suter, Paula; Yueng, Carole; Johnston, Donna; Suter, W Newton

2009-05-01

As healthcare transitions to the home environment, there is an increasing need to prevent and control infections traced to telehealth equipment. Background information about infection control is presented, and the need for a survey of agency cleaning policies is described. Findings from 31 agencies using telehealth equipment are described followed by suggested Best Practice Guidelines for the cleaning of telehealth equipment.

75 FR 49949 - Notice of Lodging of Consent Decree Under The Clean Water Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

... DEPARTMENT OF JUSTICE Notice of Lodging of Consent Decree Under The Clean Water Act Notice is... Southern District of Texas. In this action, the United States alleges civil claims under the Clean Water...) improve pipeline operation and integrity management practices, and (3) enhance leak detection capabilities...

Clean Cities: Building Partnerships to Reduce Petroleum Use in Transportation (Brochure)

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

Not Available

2012-03-01

This fact sheet provides an overview of the U.S. Department of Energy's Clean Cities program, which builds partnerships to reduce petroleum use in transportation in communities across the country. The U.S. Department of Energy's Clean Cities initiative advances the nation's economic, environmental, and energy security by supporting local actions to reduce petroleum consumption in transportation. Clean Cities accomplishes this work through the activities of nearly 100 local coalitions. These coalitions provide resources and technical assistance in the deployment of alternative and renewable fuels, idle-reduction measures, fuel economy improvements, and new transportation technologies, as they emerge. Clean Cities overarching goal ismore » to reduce U.S. petroleum use by 2.5 billion gallons per year by 2020. To achieve this goal, Clean Cities employs three strategies: (1) Replace petroleum with alternative and renewable fuels, including natural gas, propane, electricity, ethanol, biodiesel, and hydrogen; (2) Reduce petroleum consumption through smarter driving practices and fuel economy improvements; and (3) Eliminate petroleum use through idle reduction and other fuel-saving technologies and practices.« less

Bioinspired Multifunctional Paper-Based rGO Composites for Solar-Driven Clean Water Generation.

PubMed

Lou, Jinwei; Liu, Yang; Wang, Zhongyong; Zhao, Dengwu; Song, Chengyi; Wu, Jianbo; Dasgupta, Neil; Zhang, Wang; Zhang, Di; Tao, Peng; Shang, Wen; Deng, Tao

2016-06-15

Reusing polluted water through various decontamination techniques has appeared as one of the most practical approaches to address the global shortage of clean water. Rather than relying on single decontamination mechanism, herein we report the preparation and utilization of paper-based composites for multifunctional solar-driven clean water generation that is inspired by the multiple water purification approaches in biological systems. The reduced graphene oxide (rGO) sheets within such composites can efficiently remove organic contaminants through physical adsorption mechanism. Under solar irradiation, the floating rGO composites can instantly generate localized heating, which not only can directly generate clean water through distillation mechanism but also significantly enhance adsorption removal performance with the assistance of upward vapor flow. Such porous-structured paper-based composites allow for facile incorporation of photocatalysts to regenerate clean water out of contaminated water with combined adsorption, photodegradation, and interfacial heat-assisted distillation mechanisms. Within a homemade all-in-one water treatment device, the practical applicability of the composites for multifunctional clean water generation has been demonstrated.

7 CFR 51.1552 - Clean.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., CERTIFICATION, AND STANDARDS) United States Standards for Grades of Potatoes 1 Definitions § 51.1552 Clean... staining and practically no loose dirt or other foreign matter is present in the container. ...

7 CFR 51.1552 - Clean.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., CERTIFICATION, AND STANDARDS) United States Standards for Grades of Potatoes 1 Definitions § 51.1552 Clean... staining and practically no loose dirt or other foreign matter is present in the container. ...

Maternal occupation and the risk of neural tube defects in offspring.

PubMed

Kim, Jihye; Langlois, Peter H; Mitchell, Laura E; Agopian, A J

2017-07-19

We evaluated the association between maternal occupation and the risk of neural tube defects (NTDs) in offspring. Data for 491 nonsyndromic cases were obtained from the Texas Birth Defects Registry for deliveries between 1999 and 2009. We randomly selected 2,291 controls among all live births in Texas during this time. Maternal occupations were classified using automated software and manual assignment. Multivariable logistic regression analyses were used to examine the relationship between maternal occupation and risk for any NTD, adjusting for maternal race/ethnicity, any diabetes, and maternal body mass index. These analyses were repeated for spina bifida specifically. Some maternal occupations, particularly those related to business/finance, health care practice, and cleaning/maintenance, were significantly associated with increased risk of spina bifida and/or any NTD. Further research is needed to identify the specific occupational exposures related to NTD risk.

Preventing Occupational Skin Disease: A Review of Training Programs.

PubMed

Zack, Bethany; Arrandale, Victoria H; Holness, D Linn

Occupational contact dermatitis (OCD) is a common occupational disease that impacts a variety of worker groups. Skin protection and disease prevention training programs have shown promise for improving prevention practices and reducing the incidence of OCD. This review details the features of training programs for primary prevention of OCD and identifies gaps in the literature. Twelve studies were identified for in-depth review: many studies included wet workers employed in health care, hairdressing, cleaning, and food preparation; 1 program featured manufacturing workers. Few programs provided content on allergic contact dermatitis, and only 1 was evaluated for long-term effectiveness. Effective programs were similar in content, delivery method, and timing and were characterized by industry specificity, multimodal learning, participatory elements, skin care resource provision, repeated sessions, and management engagement. Long-term effectiveness, generalizability beyond OCD, workplace health and safety culture impact, and translation of programs in the North American context represent areas for future research.

[Assessment of decontamination processes: cleaning, disinfection and sterilization in dental practice in Poland in the years 2011-2012].

PubMed

Röhm-Rodowald, Ewa; Jakimiak, Bozenna; Chojecka, Agnieszka; Zmuda-Baranowska, Magdalena; Kanclerski, Krzysztof

2012-01-01

Effective decontamination of instruments is a key element of infection control and the provision of high quality in dental care. The aim of the study was to evaluate the efficiency of decontamination procedures including cleaning, disinfection and sterilization of re-usable instruments in dental practices in Poland. The efficiency of disinfection and sterilization processes have been evaluated on the results of the questionnaires. The following information were taken into account: setting where disinfection and sterilization had been performed, preparation of dental equipment for sterilization (disinfection, washing and cleaning, packaging), the types of autoclaves and used types of sterilization cycles, routine monitoring and documentation of sterilization processes, treatment of handpieces and the frequency of surface decontamination. Data were collected from 43 dental practices (35 dental offices and 8 clinics). Disinfection and cleaning processes were performed manually in 63% of dental offices and ultrasonic baths were used in 53% of settings. Washer disinfectors were used in 23% of dental practices: in every researched clinic and in a few dental offices. All sterilization processes were performed in steam autoclaves, mainly in small steam sterilizers (81%). Dental handpieces were sterilized in 72% of practices, but only 33% of them performed sterilization in recommended cycle B. Sterilization processes were monitored with chemical indicators in 33% of practices. Biological monitoring of the processes was carried out at different intervals. Incorrect documentation of instruments and surfaces decontamination was recorded in several settings. There is still a need for improvement of decontamination processes in dental practice in Poland. Areas for improvement include: replacement of manual cleaning and disinfection processes with automatic processes, sterilization of dental handpieces after each patient, monitoring of a sterilization process with chemical and biological indicators. Reported incorrect procedures in decontamination of medical devices performed by questioned dentists and lack or inadequate response to asked questions indicate the lack of adequate knowledge about decontamination. Personnel who performs decontamination processes should be continuously trained.

About the Clean Boating Act (CBA)

EPA Pesticide Factsheets

Provides a description of the Clean Boating Act using frequently asked questions (FAQs) about the background, scope and implementation of the amendment. The page also discusses compliance questions and best management practices.

75 FR 27327 - National Institute on Disability and Rehabilitation Research (NIDRR)-Disability and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... Centers (RRTCs)-- Effective Vocational Rehabilitation (VR) Service Delivery Practices Catalog of Federal... priority for an RRTC on Effective Vocational Rehabilitation (VR) Service Delivery Practices. The Assistant... priority. Effective Vocational Rehabilitation (VR) Service Delivery Practices Background: The...

Cleaning frequency and the microbial load in ice-cream.

PubMed

Holm, Sonya; Toma, Ramses B; Reiboldt, Wendy; Newcomer, Chris; Calicchia, Melissa

2002-07-01

This study investigates the efficacy of a 62 h cleaning frequency in the manufacturing of ice-cream. Various product and product contact surfaces were sampled progressively throughout the time period between cleaning cycles, and analyzed for microbial growth. The coliform and standard plate counts (SPC) of these samples did not vary significantly over time after 0, 24, 48, or 62 h from Cleaning in Place (CiP). Data for product contact surfaces were significant for the SPC representing sample locations. Some of the variables in cleaning practices had significant influence on microbial loads. An increase in the number of flavors manufactured caused a decrease in SPC within the 24 h interval, but by the 48 h interval the SPC increased. More washouts within the first 24 h interval were favorable, as indicated by decreased SPC. The more frequently the liquefier was sanitized within the 62 h interval, the lower the SPC. This study indicates that food safety was not compromised and safety practices were effectively implemented throughout the process.

Water splitting: Taking cobalt in isolation

NASA Astrophysics Data System (ADS)

Wang, Aiqin; Zhang, Tao

2016-01-01

The sustainable production of hydrogen is key to the delivery of clean energy in a hydrogen economy; however, lower-cost alternatives to platinum electrocatalysts are needed. Now, isolated, earth-abundant cobalt atoms dispersed over nitrogen-doped graphene are shown to efficiently electrolyse water to generate hydrogen.

Evaluation of Consumer Product Co-occurrence to Inform Chemical Exposure

EPA Science Inventory

Consumer products are an important target of chemical innovation. Used daily for personal hygiene, home care, disinfection and cleaning, consumer products provide a host of benefits, and also an efficient delivery vehicle for a variety of chemicals into our homes and bodies. Al...

Improved site-specific recombinase-based method to produce selectable marker- and vector-backbone-free transgenic cells

NASA Astrophysics Data System (ADS)

Yu, Yuan; Tong, Qi; Li, Zhongxia; Tian, Jinhai; Wang, Yizhi; Su, Feng; Wang, Yongsheng; Liu, Jun; Zhang, Yong

2014-02-01

PhiC31 integrase-mediated gene delivery has been extensively used in gene therapy and animal transgenesis. However, random integration events are observed in phiC31-mediated integration in different types of mammalian cells; as a result, the efficiencies of pseudo attP site integration and evaluation of site-specific integration are compromised. To improve this system, we used an attB-TK fusion gene as a negative selection marker, thereby eliminating random integration during phiC31-mediated transfection. We also excised the selection system and plasmid bacterial backbone by using two other site-specific recombinases, Cre and Dre. Thus, we generated clean transgenic bovine fetal fibroblast cells free of selectable marker and plasmid bacterial backbone. These clean cells were used as donor nuclei for somatic cell nuclear transfer (SCNT), indicating a similar developmental competence of SCNT embryos to that of non-transgenic cells. Therefore, the present gene delivery system facilitated the development of gene therapy and agricultural biotechnology.

Self-cleaning feed distributing delivery device for glass melters

DOEpatents

Mensink, Daniel L.

1992-01-01

A self cleaning, plug resistant, adjustable parameter feed distributing and delivery apparatus for a glass melter comprising a housing with a passage therethrough for a glass slurry, a cold finger within the passage for creating a dispersion pattern of the slurry, a movable slotted tube for controlling the confluence of air propellant and slurry in the passage, and a plurality of ribs that extend through the slots in the slotted tube to urge the slurry forward if it becomes stuck or resists forward movement. Coolant passages in the housing and the cold finger maintain the slurry temperature below that of the melter plenum. The cold finger is axially movable to adjust the dispersion pattern to the desired consistency. Other design features of size can be applied for use in situations requiring different parameters of pattern, particle size, rate, and feed consistencies. The device utilizes air as both a propellant and a surface cleansing mechanism. Other fluids may be used as propellants where process compatibility requires.

Multiple Information Failure: A Case of Different Investments in Form and Content in Graphic Design

ERIC Educational Resources Information Center

Barnes, Carolyn; Taffe, Simone; Miceli, Lucy

2009-01-01

This paper considers a sequence of failures in the design of information. It focuses on the Safe and Sustainable Indoor Cleaning study (SASI Clean), a 2007 government-funded study into cleaning practices in Australian childcare centers. Empowerment through participation was integral to the study, childcare workers being seen as collaborators in…

Data cleaning and management protocols for linked perinatal research data: a good practice example from the Smoking MUMS (Maternal Use of Medications and Safety) Study.

PubMed

Tran, Duong Thuy; Havard, Alys; Jorm, Louisa R

2017-07-11

Data cleaning is an important quality assurance in data linkage research studies. This paper presents the data cleaning and preparation process for a large-scale cross-jurisdictional Australian study (the Smoking MUMS Study) to evaluate the utilisation and safety of smoking cessation pharmacotherapies during pregnancy. Perinatal records for all deliveries (2003-2012) in the States of New South Wales (NSW) and Western Australia were linked to State-based data collections including hospital separation, emergency department and death data (mothers and babies) and congenital defect notifications (babies in NSW) by State-based data linkage units. A national data linkage unit linked pharmaceutical dispensing data for the mothers. All linkages were probabilistic. Twenty two steps assessed the uniqueness of records and consistency of items within and across data sources, resolved discrepancies in the linkages between units, and identified women having records in both States. State-based linkages yielded a cohort of 783,471 mothers and 1,232,440 babies. Likely false positive links relating to 3703 mothers were identified. Corrections of baby's date of birth and age, and parity were made for 43,578 records while 1996 records were flagged as duplicates. Checks for the uniqueness of the matches between State and national linkages detected 3404 ID clusters, suggestive of missed links in the State linkages, and identified 1986 women who had records in both States. Analysis of content data can identify inaccurate links that cannot be detected by data linkage units that have access to personal identifiers only. Perinatal researchers are encouraged to adopt the methods presented to ensure quality and consistency among studies using linked administrative data.

Cleaning and other control and validation strategies to prevent allergen cross-contact in food-processing operations.

PubMed

Jackson, Lauren S; Al-Taher, Fadwa M; Moorman, Mark; DeVries, Jonathan W; Tippett, Roger; Swanson, Katherine M J; Fu, Tong-Jen; Salter, Robert; Dunaif, George; Estes, Susan; Albillos, Silvia; Gendel, Steven M

2008-02-01

Food allergies affect an estimated 10 to 12 million people in the United States. Some of these individuals can develop life-threatening allergic reactions when exposed to allergenic proteins. At present, the only successful method to manage food allergies is to avoid foods containing allergens. Consumers with food allergies rely on food labels to disclose the presence of allergenic ingredients. However, undeclared allergens can be inadvertently introduced into a food via cross-contact during manufacturing. Although allergen removal through cleaning of shared equipment or processing lines has been identified as one of the critical points for effective allergen control, there is little published information on the effectiveness of cleaning procedures for removing allergenic materials from processing equipment. There also is no consensus on how to validate or verify the efficacy of cleaning procedures. The objectives of this review were (i) to study the incidence and cause of allergen cross-contact, (ii) to assess the science upon which the cleaning of food contact surfaces is based, (iii) to identify best practices for cleaning allergenic foods from food contact surfaces in wet and dry manufacturing environments, and (iv) to present best practices for validating and verifying the efficacy of allergen cleaning protocols.

Stethoscope Hygiene: Practice and Attitude of Medical Students

PubMed Central

Gazibara, Tatjana; Radovanovic, Sanja; Maric, Gorica; Rancic, Biljana; Kisic-Tepavcevic, Darija; Pekmezovic, Tatjana

2015-01-01

Objective The purpose of this study was to evaluate the frequency and attitude of medical students towards cleaning their stethoscopes. Subjects and Methods A cross-sectional study was carried out in the first week of December 2013. The study included 771 students (397 in their fourth and 374 in their sixth year) from the Faculty of Medicine, University of Belgrade, Serbia. An anonymous questionnaire was distributed to students before the start of compulsory lessons in classrooms. Results 317 of the 397 fourth-year students (79.8%) and 306 of the 374 sixth-year students (81.9%) cleaned their stethoscope. The stethoscope diaphragm was most commonly cleaned, while the flexible tubing was the least commonly cleaned area, mainly using ethyl alcohol-based agents. The strongest positive attitude was observed for the statement ‘It is important that my stethoscope is clean’ (4.3 out of 5.0). A positive correlation (Spearman's ρ = 0.105) was observed between a higher frequency of cleaning and the stronger positive notion that a stethoscope should be cleaned. Conclusion A considerably high proportion of the students studied had ever cleaned their stethoscopes. Based on the students' responses, it would be useful to implement instructions on stethoscope hygiene in the regular practical curriculum with the aim of applying stethoscope disinfection in daily work. PMID:26202790

Committee Opinion No. 679: Immersion in Water During Labor and Delivery.

PubMed

2016-11-01

Immersion in water during labor or delivery has been popularized over the past several decades. The prevalence of this practice in the United States is uncertain because it has not been studied in births outside of the home and birth centers, and the data are not recorded on birth certificates. Among randomized controlled trials included in a 2009 Cochrane systematic review that addressed immersion in the first stage of labor, results were inconsistent with regard to maternal benefits. Neither the Cochrane systematic review nor any individual trials included in that review reported any benefit to the newborn from maternal immersion during labor or delivery. Immersion in water during the first stage of labor may be associated with shorter labor and decreased use of spinal and epidural analgesia and may be offered to healthy women with uncomplicated pregnancies between 37 0/7 weeks and 41 6/7 weeks of gestation. There are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water. A woman who requests to give birth while submerged in water should be informed that the maternal and perinatal benefits and risks of this choice have not been studied sufficiently to either support or discourage her request. Facilities that plan to offer immersion during labor and delivery need to establish rigorous protocols for candidate selection; maintenance and cleaning of tubs and pools; infection control procedures, including standard precautions and personal protective equipment for health care personnel; monitoring of women and fetuses at appropriate intervals while immersed; and moving women from tubs if urgent maternal or fetal concerns or complications develop.

Kinematic and kinetic improvements associated with action observation facilitated learning of the power clean in Australian footballers.

PubMed

Sakadjian, Alex; Panchuk, Derek; Pearce, Alan J

2014-06-01

This study investigated the effectiveness of action observation (AO) on facilitating learning of the power clean technique (kinematics) compared with traditional strength coaching methods and whether improvements in performance (kinetics) were associated with an improvement in lifting technique. Fifteen subjects (age, 20.9 ± 2.3 years) with no experience in performing the power clean exercise attended 12 training and testing sessions over a 4-week period. Subjects were assigned to 2 matched groups, based on preintervention power clean performance and performed 3 sets of 5 repetitions of the power clean exercise at each training session. Subjects in the traditional coaching group (TC; n = 7) received the standard coaching feedback (verbal cues and physical practice), whereas subjects in the AO group (n = 8) received similar verbal coaching cues and physical practice but also observed a video of a skilled model before performing each set. Kinematic data were collected from video recordings of subjects who were fitted with joint center markings during testing, whereas kinetic data were collected from a weightlifting analyzer attached to the barbell. Subjects were tested before intervention, at the end of weeks 2 and 3, and at after intervention at the end of week 4. Faster improvements (3%) were observed in power clean technique with AO-facilitated learning in the first week and performance improvements (mean peak power of the subject's 15 repetitions) over time were significant (p < 0.001). In addition, performance improvement was significantly associated (R = 0.215) with technique improvements. In conclusion, AO combined with verbal coaching and physical practice of the power clean exercise resulted in significantly faster technique improvements and improvement in performance compared with traditional coaching methods.

Understanding Barriers to Optimal Cleaning and Disinfection in Hospitals: A Knowledge, Attitudes, and Practices Survey of Environmental Services Workers.

PubMed

Bernstein, Daniel A; Salsgiver, Elizabeth; Simon, Matthew S; Greendyke, William; Eiras, Daniel P; Ito, Masahiro; Caruso, Dean A; Woodward, Timothy M; Perriel, Odette T; Saiman, Lisa; Furuya, E Yoko; Calfee, David P

2016-12-01

In this study, we used an online survey to assess knowledge, attitudes, and practices related to environmental cleaning and other infection prevention strategies among environmental services workers (ESWs) at 5 hospitals. Our findings suggest that ESWs could benefit from additional education and feedback as well as new strategies to address workflow challenges. Infect Control Hosp Epidemiol 2016;1492-1495.

Prevention and control practices for human noroviruses in long-term care facilities in South Carolina.

PubMed

Leone, Cortney M; Jayasekara, Lalani; Sharp, Julia; Fraser, Angela

2015-12-01

Long-term care facilities (LTCFs) are the most common setting for human norovirus (HuNoV) outbreak. Our study aimed to determine gaps in prevention and control practices for HuNoV in LTCFs in South Carolina (SC). Two researchers visited a convenience sample of 26 LTCFs in SC during July-November 2013. Directors were interviewed to determine facility prevention and control practices. Relative frequencies and means were calculated using SAS 9.3 (SAS Institute, Cary, NC). Most directors had little knowledge of proper sanitizing and disinfecting products and reported missing written procedures for cleaning staff-visitor bathrooms. Only 18 had recommendations for when residents should wash hands. Many used the wrong products for pathogen removal after vomit-fecal events, had no written procedures for cleaning contaminated soft surfaces, did not remove other individuals during clean-up of vomit-fecal episodes, and did not clean a large area surrounding vomit-fecal episodes. Eighteen did not assign specific staff to care for sick; 16 did not designate specific toilets for sick; and 15 did not restrict visitors during an outbreak. Directors' responses indicated gaps in prevention and control practices for HuNoV in LTCFs in SC. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods

PubMed Central

Eckstein, Brittany C; Adams, Daniel A; Eckstein, Elizabeth C; Rao, Agam; Sethi, Ajay K; Yadavalli, Gopala K; Donskey, Curtis J

2007-01-01

Background Contaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens. In this study, we assessed the adequacy of cleaning practices in rooms of patients with Clostridium difficile-associated diarrhea (CDAD) and vancomycin-resistant Enterococcus (VRE) colonization or infection and examined whether an intervention would result in improved decontamination of surfaces. Methods During a 6-week period, we cultured commonly touched surfaces (i.e. bedrails, telephones, call buttons, door knobs, toilet seats, and bedside tables) in rooms of patients with CDAD and VRE colonization or infection before and after housekeeping cleaning, and again after disinfection with 10% bleach performed by the research staff. After the housekeeping staff received education and feedback, additional cultures were collected before and after housekeeping cleaning during a 10-week follow-up period. Results Of the 17 rooms of patients with VRE colonization or infection, 16 (94%) had one or more positive environmental cultures before cleaning versus 12 (71%) after housekeeping cleaning (p = 0.125), whereas none had positive cultures after bleach disinfection by the research staff (p < 0.001). Of the 9 rooms of patients with CDAD, 100% had positive cultures prior to cleaning versus 7 (78%) after housekeeping cleaning (p = 0.50), whereas only 1 (11%) had positive cultures after bleach disinfection by research staff (p = 0.031). After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced. Conclusion Our findings provide additional evidence that simple educational interventions directed at housekeeping staff can result in improved decontamination of environmental surfaces. Such interventions should include efforts to monitor cleaning and disinfection practices and provide feedback to the housekeeping staff. PMID:17584935

Silver nanoparticle toxicity to retinal pigment epithelial cells in vitro is influenced by particle size and coating, but not UVA radiation

EPA Science Inventory

Silver nanoparticles (AgNP) are being introduced into textiles, medical devices, cleaning/disinfecting products and other goods because of their antibiotic properties. Some nanomaterials, including silver, have been developed into drug delivery systems that can be administered di...

Current Faculty Development Practices for Alternative Delivery Systems in Christian Higher Education Institutions: A Qualitative Study

ERIC Educational Resources Information Center

Yates, Steven Lowell

2009-01-01

This research study was an investigation of current faculty development practices for alternative delivery systems. Attention was given to faculty development in general as well as specific facets of faculty development for alternative delivery systems. Future or intended faculty development practices were pursued, along with factors that…

40 CFR 22.38 - Supplemental rules of practice governing the administrative assessment of civil penalties under...

Code of Federal Regulations, 2012 CFR

2012-07-01

... governing the administrative assessment of civil penalties under the Clean Water Act. 22.38 Section 22.38... of civil penalties under the Clean Water Act. (a) Scope. This section shall apply, in conjunction... penalty under section 309(g) or section 311(b)(6) of the Clean Water Act (“CWA”)(33 U.S.C. 1319(g) and...

40 CFR 22.38 - Supplemental rules of practice governing the administrative assessment of civil penalties under...

Code of Federal Regulations, 2010 CFR

2010-07-01

... governing the administrative assessment of civil penalties under the Clean Water Act. 22.38 Section 22.38... of civil penalties under the Clean Water Act. (a) Scope. This section shall apply, in conjunction... penalty under section 309(g) or section 311(b)(6) of the Clean Water Act (“CWA”)(33 U.S.C. 1319(g) and...

40 CFR 22.38 - Supplemental rules of practice governing the administrative assessment of civil penalties under...

Code of Federal Regulations, 2014 CFR

2014-07-01

... governing the administrative assessment of civil penalties under the Clean Water Act. 22.38 Section 22.38... of civil penalties under the Clean Water Act. (a) Scope. This section shall apply, in conjunction... penalty under section 309(g) or section 311(b)(6) of the Clean Water Act (“CWA”)(33 U.S.C. 1319(g) and...

40 CFR 22.38 - Supplemental rules of practice governing the administrative assessment of civil penalties under...

Code of Federal Regulations, 2011 CFR

2011-07-01

... governing the administrative assessment of civil penalties under the Clean Water Act. 22.38 Section 22.38... of civil penalties under the Clean Water Act. (a) Scope. This section shall apply, in conjunction... penalty under section 309(g) or section 311(b)(6) of the Clean Water Act (“CWA”)(33 U.S.C. 1319(g) and...

Evaluation of knowledge, practices, and possible barriers among healthcare providers regarding medical waste management in Dhaka, Bangladesh.

PubMed

Sarker, Mohammad Abul Bashar; Harun-Or-Rashid, Md; Hirosawa, Tomoya; Abdul Hai, Md Shaheen Bin; Siddique, Md Ruhul Furkan; Sakamoto, Junichi; Hamajima, Nobuyuki

2014-12-09

Improper handling of medical wastes, which is common in Bangladesh, could adversely affect the hospital environment and community at large, and poses a serious threat to public health. We aimed to assess the knowledge and practices regarding medical waste management (MWM) among healthcare providers (HCPs) and to identify possible barriers related to it. A cross-sectional study was carried out during June to September, 2012 including 1 tertiary, 3 secondary, and 3 primary level hospitals in Dhaka division, Bangladesh through 2-stage cluster sampling. Data were collected from 625 HCPs, including 245 medical doctors, 220 nurses, 44 technologists, and 116 cleaning staff who were directly involved in MWM using a self-administered (researcher-administered for cleaning staff), semi-structured questionnaire. Nearly one-third of medical doctors and nurses and two-thirds of technologists and cleaning staff had inadequate knowledge, and about half of medical doctors (44.0%) and cleaning staff (56.0%) had poor practices. HCPs without prior training on MWM were more likely to have poor practices compared to those who had training. Lack of personal protective equipment, equipment for final disposal, MWM-related staff, proper policy/guideline, and lack of incinerator were identified as the top 5 barriers. Strengthening and expansion of ongoing educational programs/training is necessary to improve knowledge and practices regarding MWM. The government should take necessary steps and provide financial support to eliminate the possible barriers related to proper MWM.

Cross-sectional study of frequency and factors associated with stethoscope cleaning among medical practitioners in Pakistan.

PubMed

Hyder, O

2012-07-01

Stethoscope diaphragms are frequently colonized by bacteria. This cross-sectional study described the frequency and factors associated with reporting ever cleaning stethoscopes among 408 medical students and doctors at a medical college and 2 teaching hospitals in Rawalpindi, Pakistan. A minority of the respondents (37.7%) reported having ever cleaned their stethoscope. Following normal clinical use, wiping with a dry cloth was the most frequently reported method of cleaning (53.2%). After contamination of the diaphragm with blood or secretions, cleaning with an alcoholic swab was the most common method (64.3%). In univariate and multivariate analyses, history of receiving information on stethoscope cleaning, utilization of personal stethoscope at last use and affiliation with internal medicine department were factors strongly associated with ever cleaning of stethoscope. Future research for improving stethoscope cleaning practices should explore educational interventions aimed at health care professionals.

Emerging nicotine delivery products. Implications for public health.

PubMed

Benowitz, Neal L

2014-02-01

The idea of clean nicotine delivery systems that would satisfy nicotine craving and promote smoking cessation has been considered as a possible public health tool for many years. Nicotine medications have been useful for smoking cessation but have not found widespread popularity among smokers, perhaps because of slow nicotine delivery and other sensory characteristics that differ from cigarettes. Traditional smokeless tobacco delivers as much nicotine as cigarettes and has been advocated for harm reduction but contains carcinogenic nitrosamines and has not been proven to promote cessation. Furthermore, there is concern that dual use of smokeless tobacco and cigarettes may inhibit quitting smoking. Newer oral dissolvable tobacco products contain lower levels of toxicants than other smokeless tobacco but also deliver much less nicotine and have not been popular with consumers. Electronic cigarettes that aerosolize nicotine without generating toxic tobacco combustion products have become quite popular and hold promise as a way to attract smokers away from cigarettes, although efficacy in promoting smoking cessation has not yet been demonstrated. There are concerns about safety of long-term use, and there is evidence that youth, including nonsmokers, are taking up e-cigarette use. E-cigarettes are marketed for use when one cannot smoke conventional cigarettes, and such use might result in more persistent cigarette smoking. Although their benefits and risks are being vigorously debated, e-cigarettes or other clean nicotine delivery devices could play an important role as an adjunct to a U.S. Food and Drug Administration regulatory intervention to make cigarettes less addictive and in this context could contribute to the end of cigarette smoking and smoking-induced disease.

NHS connecting for health: healthcare professionals, mobile technology, and infection control.

PubMed

Brady, Richard R W; Chitnis, Shruti; Stewart, Ross W; Graham, Catriona; Yalamarthi, Satheesh; Morris, Keith

2012-05-01

Mobile phones improve the efficiency of clinical communication and are increasingly involved in all areas of healthcare delivery. Despite this, healthcare workers' mobile phones provide a known reservoir of pathogenic bacteria, with the potential to undermine infection control efforts aimed at the reducing bacterial cross-contamination in hospitals. This potential could be amplified further when employers require doctors to carry additional electronic devices for communication, without concurrently providing appropriate guidance on decontamination or use. Eighty-seven on-call doctors' mobile phones were sampled for bacterial growth prior to, and 12 h after, a cleaning intervention involving 70% isopropyl alcohol. Seventy-eight percent of doctors were aware that mobile phones could carry pathogenic bacteria, but only 8% cleaned their phones regularly. The cleaning intervention reduced the number of phones that grew bacteria by 79% (55% [48 of 87] before versus 16% [14 of 87] after cleaning). Eight percent of the phones grew Staphyloccus aureus, and 44.8% of phones grew Gram-positive cocci. All S. aureus isolates were methicillin-sensitive. Bacterial contamination was not associated with gender, specialty, or seniority of the phone user (p>0.05). Simple cleaning interventions can reduce the surface bioburden of hospital-provided doctors' mobile phones and therefore the potential for cross-contamination. This cleaning intervention is inexpensive, easily instituted, and effective. Healthcare workers should carry the minimum number of electronic devices on their person, maintain good hand hygiene, and clean their device appropriately in order to minimize the potential for cross-contamination in the work place.

Clean fuels for resource-poor settings: A systematic review of barriers and enablers to adoption and sustained use.

PubMed

Puzzolo, Elisa; Pope, Daniel; Stanistreet, Debbi; Rehfuess, Eva A; Bruce, Nigel G

2016-04-01

Access to, and sustained adoption of, clean household fuels at scale remains an aspirational goal to achieve sufficient reductions in household air pollution (HAP) in order to impact on the substantial global health burden caused by reliance on solid fuels. To systematically appraise the current evidence base to identify: (i) which factors enable or limit adoption and sustained use of clean fuels (namely liquefied petroleum gas (LPG), biogas, solar cooking and alcohol fuels) in low- and middle-income countries; (ii) lessons learnt concerning equitable scaling-up of programmes of cleaner cooking fuels in relation to poverty, urban-rural settings and gender. A mixed-methods systematic review was conducted using established review methodology and extensive searches of published and grey literature sources. Data extraction and quality appraisal of quantitative, qualitative and case studies meeting inclusion criteria were conducted using standardised methods with reliability checking. Forty-four studies from Africa, Asia and Latin America met the inclusion criteria (17 on biogas, 12 on LPG, 9 on solar, 6 on alcohol fuels). A broad range of inter-related enabling and limiting factors were identified for all four types of intervention, operating across seven pre-specified domains (i.e. fuel and technology characteristics, household and setting characteristics, knowledge and perceptions, financial, tax and subsidy aspects, market development, regulation, legislation and standards, and programme and policy mechanisms) and multiple levels (i.e. household, community, national). All domains matter and the majority of factors are common to all clean fuels interventions reviewed although some are fuel and technology-specific. All factors should therefore be taken into account and carefully assessed during planning and implementation of any small- and large-scale initiative aiming at promoting clean fuels for household cooking. Despite limitations in quantity and quality of the evidence this systematic review provides a useful starting point for the design, delivery and evaluation of programmes to ensure more effective adoption and use of LPG, biogas, alcohol fuels and solar cooking. This review was funded by the Department for International Development (DfID) of the United Kingdom. The authors would also like to thank the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) for their technical support. Copyright © 2016 Elsevier Inc. All rights reserved.

Agenda and Presentations from Circumpolar Workshop: Transport and Clean Air

EPA Pesticide Factsheets

EPA and its partners convened Transport and Clean Air, a Circumpolar Workshop held in December 2013. This seminar allowed leading experts to share best practices on reducing emissions of particulates and black carbon from diesel sources in the Arctic.

7 CFR 51.314 - Clean.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE REGULATIONS AND STANDARDS UNDER THE AGRICULTURAL MARKETING ACT OF 1946... Standards for Grades of Apples Definitions § 51.314 Clean. “Clean” means that the apples are free from...

Clean Water Act Section 404(q):Memorandum of Agreement

EPA Pesticide Factsheets

A memorandum of agreement between EPA and the Army Corps of Engineers to minimize, to the maximum extent practicable, duplication, needless paperwork and delays in the issuance of permits related to Section 404(q) of the Clean Water Act.

The applied technologies to access clean water for remote communities

NASA Astrophysics Data System (ADS)

Rabindra, I. B.

2018-01-01

A lot of research is done to overcome the remote communities to access clean water, yet very little is utilized and implemented by the community. Various reasons can probably be made for, which is the application of research results is assessed less practical. The aims of this paper is seeking a practical approach, how to establish criteria for the design can be easier applied, at the proper locations, the simple construction, effectively producing a volume and quality of clean water designation. The methods used in this paper is a technological model assessment of treatment/filtering clean water produced a variety of previous research, to establish a model of appropriate technology for remote communities. Various research results collected from the study of literature, while the identification of opportunities and threats to its application is done using a SWOT analysis. This article discussion is looking for alternative models of clean water filtration technology from the previous research results, to be selected as appropriate technology, easily applied and bring of many benefits to the remote communities. The conclusions resulting from the discussion in this paper, expected to be used as the basic criteria of design model of clean water filtration technologies that can be accepted and applied effectively by the remote communities.

Antibiotic prophylaxis audit and questionnaire study: Traffic Light Poster improves adherence to protocol in gastrointestinal surgery.

PubMed

Cameron, Michaella; Jones, Stacey; Adedeji, Olufunso

2015-07-01

To measure adherence to antibiotic prophylaxis (AP) protocol amongst surgeons and anesthetists and explore their understanding of AP prescribing in practice. A prospective audit of AP in gastrointestinal surgery and re-audit after intervention. A questionnaire survey of practice. 58 (38%- clean; 62%- clean contaminated) operations were audited and 73 (48%-clean; 51%-clean contaminated) operations were re-audited after intervention with "Traffic Light Poster" (TFP) .55 colleagues (32 consultants and 23 trainees) were recruited for questionnaire survey in three West Midlands hospitals. Audit and Re-Audits. Only 31% of procedures followed the protocol correctly in the initial audit and this increased to 73% in the re-audit. 73% of patients undergoing clean procedures received AP inappropriately in the initial audit but reduced significantly to 20% (p < 0.002) in the re-audit. In the initial audit, 62% of clean contaminated procedures did not receive the appropriate first line AP but this fell to 35% (p < 0.05) in the re-audit. Questionnaire Survey- Only 30% of respondents would not give AP in clean surgery as recommended. 45% would use appropriate AP for clean-contaminated wounds. 73% of respondents will give AP at induction, 20% 1 h pre op and 7% just before incision. There is poor compliance with AP protocols in gastrointestinal surgery in part due to general lack of awareness. An educational intervention in the form of a 'Traffic Light Poster' improved adherence to AP protocol two fold. There was improved rationalizing of AP. Clean procedures, in particular, had less inappropriate prescribing. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

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.

Innovations in Agriculture in Oregon: Farmers Irrigation District Improves Water Quality, Maximizes Water Conservation, and Generates Clean, Renewable Energy

EPA Pesticide Factsheets

The Hood River Farmers Irrigation District used $36.2 million in CWSRF loans for a multiple-year endeavor to convert the open canal system to a piped, pressurized irrigation system to maximize water conservation and restore reliable water delivery to crops

40 CFR 745.225 - Accreditation of training programs: target housing and child-occupied facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... equipment to be used for lecture and hands-on training. (B) A copy of the course test blueprint for each..., the delivery of the lecture, course test, hands-on training, and assessment activities. This includes... containment and cleanup methods, and post-renovation cleaning verification. (vii) The dust sampling technician...

40 CFR 745.225 - Accreditation of training programs: target housing and child-occupied facilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... equipment to be used for lecture and hands-on training. (B) A copy of the course test blueprint for each..., the delivery of the lecture, course test, hands-on training, and assessment activities. This includes... containment and cleanup methods, and post-renovation cleaning verification. (vii) The dust sampling technician...

Tubal factor infertility in Benin City, Nigeria - sociodemographics of patients and aetiopathogenic factors.

PubMed

Umeora, O U J; Mbazor, J O; Okpere, E E

2007-04-01

In Africa, infertility constitutes a major gynaecological complaint and causes enormous socio-psychological stress to the patients. This study examined retrospective data at the University of Benin Teaching Hospital, Benin City, Nigeria, over a 5-year period to determine the factors associated with tubal infertility. Tubal infertility was confirmed in 13.5% of the 1181 new cases of infertility over the study period. The mean age of the patients was 33.2+/-9.5 years. Over 65% were nulliparous and all socioeconomic classes were affected. Major associated factors included infections such as post-abortal sepsis, puerperal sepsis and pelvic inflammatory disease (PID). Infertility is largely preventable. Attention should be focused on reducing the incidence of unsafe abortion and its consequences, providing clean and safe delivery as well as reducing the incidence of and ensuring proper treatment of any cases of PID. Infertility is largely preventable. Attention should be focused on reducing the incidence of unsafe abortion and its consequences, providing clean and safe delivery as well as reducing the incidence of and ensuring proper treatment of any cases of PID.

7 CFR 58.241 - Packaging, repackaging and storage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... contamination. The room should be vacuumed as often as necessary and kept clean and orderly. ... clean, sound commercially accepted container or packaging material which will satisfactorily protect the... them practically free of residual product before being transferred from the filling room to the...

7 CFR 58.241 - Packaging, repackaging and storage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... contamination. The room should be vacuumed as often as necessary and kept clean and orderly. ... clean, sound commercially accepted container or packaging material which will satisfactorily protect the... them practically free of residual product before being transferred from the filling room to the...

Test rig and particulate deposit and cleaning evaluation processes using the same

DOEpatents

Schroder, Mark Stewart; Woodmansee, Donald Ernest; Beadie, Douglas Frank

2002-01-01

A rig and test program for determining the amount, if any, of contamination that will collect in the passages of a fluid flow system, such as a power plant fluid delivery system to equipment assemblies or sub-assemblies, and for establishing methods and processes for removing contamination therefrom. In the presently proposed embodiment, the rig and test programs are adapted in particular to utilize a high-pressure, high-volume water flush to remove contamination from substantially the entire fluid delivery system, both the quantity of contamination and as disposed or deposited within the system.

'Am I covered?': an analysis of a national enquiry database on scope of practice.

PubMed

Brady, Anne-Marie; Fealy, Gerard; Casey, Mary; Hegarty, Josephine; Kennedy, Catriona; McNamara, Martin; O'Reilly, Pauline; Prizeman, Geraldine; Rohde, Daniela

2015-10-01

Analysis of a national database of enquiries to a professional body pertaining to the scope of nursing and midwifery practice. Against a backdrop of healthcare reform is a demand for flexibility in nursing and midwifery roles with unprecedented redefinition of role boundaries and/or expansion. Guidance from professional regulatory bodies is being sought around issues of concern that are arising in practice. Qualitative thematic analysis. The database of telephone enquiries (n = 9818) made by Registered Nurses and midwives to a national regulatory body (2001-2013) was subjected to a cleaning process and examined to detect those concerns that pertained to scope of practice. A total of 978 enquiries were subjected to thematic analysis. Enquiries were concerned with three main areas: medication management, changing and evolving scope of practice and professional role boundaries. The context was service developments, staff shortages and uncertainty about role expansion and professional accountability. Other concerns related to expectations around responsibility and accountability for other support staff. Efforts by employers to maximize the skill mix of their staff and optimally deploy staff to meet service needs and/or address gaps in service represented the primary service context from which many enquiries arose. The greatest concern for nurses arises around medication management but innovation in healthcare delivery and the demands of service are also creating challenges for nurses and midwives. Maintaining and developing competence is a concern among nurses and midwives particularly in an environment of limited resources and where re-deployment is common. © 2015 John Wiley & Sons Ltd.

An investigation into the bacterial contamination of goniolenses in use in clinical practice.

PubMed

Grundon, Rachael; Scurrell, Emma; Mould, John; Hayton-Lee, Emma; Heinrich, Christine

2017-12-18

Objectives To report the incidence and evaluate the clinical significance of goniolens bacterial contamination in clinical use in dogs with three different usage protocols and one with an added cleaning protocol. Animals Studied and Methods Three groups of twenty dogs undergoing gonioscopy at a private practice in the UK had the goniolenses swabbed for bacteriology culture and identification prior to placement on the cornea. Three protocols of lens use, with 2 different types of goniolens, were studied. One protocol was then repeated with 21 dogs with a lens cleaning protocol prior to storage. Results Low levels of bacterial contamination were found in all 3 initial groups (10-15%). No correlation was found between usage protocol used and rate of contamination and no correlation was found between length of storage between use and contamination. All bacteria cultured were considered naturally occurring commensals for the canine eye and environment. The group with a cleaning protocol had a 4.7% contamination rate. This was not statistically different from the non-cleaning groups. Conclusions The rate of bacterial contamination of goniolenses in clinical practice is low and the bacterial contaminants consist of commensal bacteria, unlikely to be of detriment to the eye. Minimal contamination of the goniolenses was found and this did not appear to be of clinical significance. The introduction of a simple cleaning protocol did not produce a statistically significant reduction in bacterial contamination. © 2017 American College of Veterinary Ophthalmologists.

40 CFR 88.202-94 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 1992 model year. Averaging for clean-fuel vehicles means the sale of clean-fuel vehicles that meet more... emissions credits, for use in future model-year certification as permitted by regulation. Sales means vehicles that are produced, sold, and distributed (in accordance with normal business practices and...

9 CFR 114.7 - Personnel at licensed establishments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... worn by persons while preparing biological products shall be clean. All persons, immediately before entering laboratory rooms of a licensed establishment, shall change their outer clothing or effectively cover the same with gowns or other satisfactory clean garments. (2) Unsanitary practices such as, but...

9 CFR 114.7 - Personnel at licensed establishments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... worn by persons while preparing biological products shall be clean. All persons, immediately before entering laboratory rooms of a licensed establishment, shall change their outer clothing or effectively cover the same with gowns or other satisfactory clean garments. (2) Unsanitary practices such as, but...

9 CFR 114.7 - Personnel at licensed establishments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... worn by persons while preparing biological products shall be clean. All persons, immediately before entering laboratory rooms of a licensed establishment, shall change their outer clothing or effectively cover the same with gowns or other satisfactory clean garments. (2) Unsanitary practices such as, but...

Angler awareness of aquatic nuisance species and potential transport mechanisms

USGS Publications Warehouse

Gates, K.K.; Guy, C.S.; Zale, A.V.; Horton, T.B.

2009-01-01

The role anglers play in transporting aquatic nuisance species (ANS) is important in managing infestations and preventing introductions. The objectives of this study were to: (1) quantify angler movement patterns in southwestern Montana, ANS awareness and equipment cleaning practices; and (2) quantify the amount of soil transported on boots and waders. Mean distance travelled by residents from their home to the survey site was 115 km (??17, 95% CI). Mean distance travelled by non-residents was 1738 km (??74). Fifty-one percent of residents and 49% of non-residents reported occasionally, rarely or never cleaning their boots and waders between uses. Mean weight of soil carried on one boot leg was 8.39 g (??1.50). Movement and equipment cleaning practices of anglers in southwestern Montana suggest that future control of ANS dispersal may require restricting the use of felt-soled wading boots, requiring river-specific wading equipment or providing cleaning stations and requiring their use. ?? 2009 Blackwell Publishing Ltd.

A new kind of transparent and self-cleaning film for solar cells.

PubMed

Xu, Qi; Zhao, Qi; Zhu, Xiaofei; Cheng, Li; Bai, Suo; Wang, Zenghua; Meng, Leixing; Qin, Yong

2016-10-20

A kind of one step and in situ etching method is developed to fabricate a highly optically transparent and flexible self-cleaning superhydrophobic film (SSF). This SSF exhibits a very rough surface morphology with hierarchical structure, which makes it have a contact angle of 154.6° and a sliding angle of smaller than 1°. And the SSF can also be self-cleaned in the wind. The SSF hierarchical structure scatters the incident light, but it almost doesn't attenuate the light. So the SSF has antireflection properties and a high light transmittance of 94%. The excellent self-cleaning property, high light transmittance and antireflection property mean that the SSF greatly enhances the performance of solar cells in practical working conditions. The solar cell's efficiency maintains at 95.8% of its initial value after covering with the SSF, which is about 1.7 times higher than that of the solar cell covered with dust, as in practical conditions.

Simultaneous imaging/reflectivity measurements to assess diagnostic mirror cleaning.

PubMed

Skinner, C H; Gentile, C A; Doerner, R

2012-10-01

Practical methods to clean ITER's diagnostic mirrors and restore reflectivity will be critical to ITER's plasma operations. We describe a technique to assess the efficacy of mirror cleaning techniques and detect any damage to the mirror surface. The method combines microscopic imaging and reflectivity measurements in the red, green, and blue spectral regions and at selected wavelengths. The method has been applied to laser cleaning of single crystal molybdenum mirrors coated with either carbon or beryllium films 150-420 nm thick. It is suitable for hazardous materials such as beryllium as the mirrors remain sealed in a vacuum chamber.

Maternal and newborn care practices in Sierra Leone: a mixed methods study of four underserved districts.

PubMed

Sharkey, Alyssa; Yansaneh, Aisha; Bangura, Peter Soulaiman; Kabano, Augustin; Brady, Eoghan; Yumkella, Fatu; Diaz, Theresa

2017-03-01

Despite recent progress, Sierra Leone’s lifetime risk of maternal death remains high (1 in 21), as does neonatal mortality (35 per 1000 live births). We present findings on maternal and neonatal care practices from a mixed methods study conducted in four districts during July–August 2012. We conducted a household cluster survey with data on maternal and newborn care practices collected from women ages 15–49 years who had ever given birth. We also conducted focus group discussions and in-depth interviews in two communities in each of the four districts. Participants included pregnant women, mothers of young children, older caregivers, fathers, community health volunteers, traditional birth attendants (TBAs) and health workers. We explored personal experiences and understandings of pregnancy, childbirth, the newborn period and social norms. Data analysis was conducted using STATA (quantitative) and thematic analysis using Dedoose software (qualitative). Antenatal care was high (84.2%, 95% CI: 82.0–86.3%), but not timely due to distance, transport, and social norms to delay care-seeking until a pregnancy is visible, particularly in the poorer districts of Kambia and Pujehun. Skilled delivery rates were lower (68.9%, 95% CI: 64.8–72.9%), particularly in Kambia and Tonkolili where TBAs are considered effective. Clean cord care, delaying first baths and immediate breastfeeding were inadequate across all districts. Timely postnatal checks were common among women with facility deliveries (94.1%, 95% CI: 91.9–96.6%) and their newborns (94.5%, 95% CI: 92.5–96.5%). Fewer women with home births received postnatal checks (53.6%, 95% CI: 46.2–61.3%) as did their newborns (75.8%, 95% CI: 68.9–82.8%). TBAs and practitioners are well-respected providers, and traditional beliefs impact many behaviours. Challenges remain with respect to maternal and neonatal health in Sierra Leone; these were likely exacerbated by service interruptions during the 2014–2016 Ebola Virus Disease epidemic. The reasons behind existing practices must be examined to identify appropriate strategies to improve maternal and newborn survival.

A study of visual and blood contamination on reprocessed endodontic files from general dental practice.

PubMed

Letters, S; Smith, A J; McHugh, S; Bagg, J

2005-10-22

This study examined methods used for reprocessing endodontic instruments in general dental practice and determined the degree of residual visual contamination and blood contamination on 250 reprocessed files collected from 25 general dental practices. A questionnaire was administered to 25 general dental practitioners to obtain information on the re-processing of used endodontic files. Ten files which had been used and reprocessed were also collected from each practice. These were examined visually under a dissecting light microscope for residual contamination and then tested for blood deposits using the Kastle-Meyer test. Nineteen of the 25 practices used stainless steel hand files. No practitioners used endodontic files as single use devices. Ninety-two per cent of the practitioners discarded and replaced files when they were bent or damaged. Several decontamination methods were reported. The two combinations employed most frequently were manual cleaning and autoclaving or manual cleaning, followed by ultrasonic cleaning and autoclaving. Of the 250 files, 75% showed some degree of visual contamination and seven percent tested positive for residual blood. Blood contaminated files were significantly more heavily contaminated when examined visually. Large variations were found in residual contamination of files collected from practices using the same methods of decontamination. While all practitioners re-used endodontic files, the variations in decontamination methods reported indicate a lack of clarity on best practice. This study demonstrates that endodontic files are not reliably decontaminated by methods currently employed in dental practice.

Nanosecond laser ablated copper superhydrophobic surface with tunable ultrahigh adhesion and its renewability with low temperature annealing

NASA Astrophysics Data System (ADS)

He, An; Liu, Wenwen; Xue, Wei; Yang, Huan; Cao, Yu

2018-03-01

Recently, metallic superhydrophobic surfaces with ultrahigh adhesion have got plentiful attention on account of their significance in scientific researches and industrial applications like droplet transport, drug delivery and novel microfluidic devices. However, the long lead time and transience hindered its in-depth development and industrial application. In this work, nanosecond laser ablation was carried out to construct grid of micro-grooves on copper surface, whereafter, by applying fast ethanol assisted low-temperature annealing, we obtained surface with superhydrophobicity and ultrahigh adhesion within hours. And the ultrahigh adhesion force was found tunable by varying the groove spacing. Using ultrasonic cleaning as the simulation of natural wear and tear in service, the renewability of superhydrophobicity was also investigated, and the result shows that the contact angle can rehabilitate promptly by the processing of ethanol assisted low-temperature annealing, which gives a promising fast and cheap circuitous strategy to realize the long wish durable metallic superhydrophobic surfaces in practical applications.

7 CFR 58.246 - Cleaning of dryers, collectors, conveyors, ducts, sifters and storage bins.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) REGULATIONS AND STANDARDS UNDER THE AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG... and the frequency of cleaning shall be based upon observation of actual operating results and...

Evaluating and improving terminal hygiene practices on broiler farms to prevent Campylobacter cross-contamination between flocks.

PubMed

Battersby, Tara; Walsh, D; Whyte, P; Bolton, D

2017-06-01

The objectives of this study were to evaluate current cleaning practices in broiler houses by testing a range of sites after cleaning and disinfection and to test the efficacy of the most commonly used methods in a commercial broiler house after flock harvesting. Cleaning procedures on 20 broiler houses (10 separate farms) were examined by testing a range of sampling points (feeders, drinkers, walls, etc.) for total viable count (TVC), total Enterobacteriaceae count (TEC) and Campylobacter spp. after cleaning and disinfection, using culture based methods. In a second experiment, the six most commonly used commercially available disinfectants and/or detergent products were evaluated. The results of the first study demonstrated that critical areas in 12 of the 20 broiler houses were not effectively cleaned and disinfected between flocks as the tarmac apron, ante-room, house door, feeders, drinkers, walls, columns, barriers and/or bird weighs were Campylobacter positive. Thermal fogging with the combination of potassium peroxymonosulfate, sulfamic acid and sodium chloride (5%, v/v) or the glutaraldehyde and quaternary ammonium complex (0.3%, v/v) were the most effective treatments while other disinfectant treatments were considerably less effective. It was therefore concluded that farmers should review their broiler house cleaning and disinfection procedures if Campylobacter cross-contamination between successive flocks is to be prevented. Copyright © 2016 Elsevier Ltd. All rights reserved.

Generation and Use of Thermal Energy in the U.S. Industrial Sector and Opportunities to Reduce its Carbon Emissions

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

McMillan, Colin; Boardman, Richard; McKellar, Michael

This report quantifies greenhouse gas (GHG) emissions from the industrial sector and identifies opportunities for non-GHG-emitting thermal energy sources to replace the most significant GHG-emitting U.S. industries based on targeted, process-level analysis of industrial heat requirements. The intent is to provide a basis for projecting opportunities for clean energy use. This provides a prospectus for small modular nuclear reactors (including nuclear-renewable hybrid energy systems), solar industrial process heat, and geothermal energy. This report provides a complement to analysis of process-efficiency improvement by considering how clean energy delivery and use by industry could reduce GHG emissions.

Combining fire and erosion modeling to target forest management activities

Treesearch

William J. Elliot; Mary Ellen Miller; Nic Enstice

2015-01-01

Forests deliver a number of important ecosystem services including clean water. When forests are disturbed by wildfire, the timing, quantity and quality of runoff are altered. A modeling study was carried out in a forested watershed in California to determine the risk of wildfire, and the potential post-fire sediment delivery from approximately 6-ha hillslope polygons...

Targeting forest management through fire and erosion modeling

Treesearch

William J. Elliot; Mary Ellen Miller; Nic Enstice

2016-01-01

Forests deliver a number of important ecosystem services, including clean water. When forests are disturbed by wildfire, the timing, quantity and quality of runoff are altered. A modelling study was conducted in a forested watershed in California, USA, to determine the risk of wildfire, and the potential post-fire sediment delivery from ~4-ha hillslope polygons within...

40 CFR 51.120 - Requirements for State Implementation Plan revisions relating to new motor vehicles.

Code of Federal Regulations, 2012 CFR

2012-07-01

...-Methane Organic Gases (NMOG), Carbon Monoxide (CO), Oxides of Nitrogen (NOX), Formaldehyde (HCHO), and... be required to meet the fleet average NMOG exhaust emission values for production and delivery for... section 177 of the Clean Air Act. (2) States are not required to include the mandate for production of...

40 CFR 51.120 - Requirements for State Implementation Plan revisions relating to new motor vehicles.

Code of Federal Regulations, 2014 CFR

2014-07-01

...-Methane Organic Gases (NMOG), Carbon Monoxide (CO), Oxides of Nitrogen (NOX), Formaldehyde (HCHO), and... be required to meet the fleet average NMOG exhaust emission values for production and delivery for... section 177 of the Clean Air Act. (2) States are not required to include the mandate for production of...

40 CFR 51.120 - Requirements for State Implementation Plan revisions relating to new motor vehicles.

Code of Federal Regulations, 2011 CFR

2011-07-01

...-Methane Organic Gases (NMOG), Carbon Monoxide (CO), Oxides of Nitrogen (NOX), Formaldehyde (HCHO), and... be required to meet the fleet average NMOG exhaust emission values for production and delivery for... section 177 of the Clean Air Act. (2) States are not required to include the mandate for production of...

40 CFR 51.120 - Requirements for State Implementation Plan revisions relating to new motor vehicles.

Code of Federal Regulations, 2013 CFR

2013-07-01

...-Methane Organic Gases (NMOG), Carbon Monoxide (CO), Oxides of Nitrogen (NOX), Formaldehyde (HCHO), and... be required to meet the fleet average NMOG exhaust emission values for production and delivery for... section 177 of the Clean Air Act. (2) States are not required to include the mandate for production of...

Case Study - Propane Bakery Delivery Step Vans

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

Laughlin, M.; Burnham, A.

2016-04-01

A switch to propane from diesel by a major Midwest bakery fleet showed promising results, including a significant displacement of petroleum, a drop in greenhouse gases and a fuel cost savings of seven cents per mile, according to a study recently completed by the U.S. Department of Energy's Argonne National Laboratory for the Clean Cities program.

Interdental cleaning among persons with diabetes: relationships with individual characteristics.

PubMed

Strauss, S M; Stefanou, L B

2014-05-01

Given the existence of many potential oral health complications for adults with diabetes (especially for those who do not practise regular oral self-care), and the specific importance of regular interdental cleaning, the research determined the proportion of U.S. adults with diabetes who practise daily interdental cleaning and their socio-demographic, economic and oral health characteristics related to this practice. Analyses were conducted using data collected from 573 dentulous adults with diabetes ≥ 30 years who participated in the U.S. 2009-2010 National Health and Nutrition Examination survey. Using complex sample survey software, findings were extrapolated to >15 million U.S. adults. Descriptive statistics were used to determine the frequency of interdental cleaning, and chi-square tests were used to identify salient individual characteristics related to this practice. 41.2% reported that they never used any interdental device, while 24.8% indicated that they practised interdental cleaning daily. Statistically significant relationships (P < 0.05) with daily interdental cleaning included female sex, ever having had treatment for gum disease and using mouthwash daily for a dental problem. Because so many adults with diabetes do not practise regular interdental cleaning, and in view of the important role that dental hygienists fulfil as oral healthcare educators, there is a great need for dental hygienists to teach and motivate adults with diabetes to practise regular interdental cleaning. This need is especially great for subgroups of these adults who are men, have not been treated for periodontitis and do not regularly use a mouthwash for dental problems. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Improving urban environment through public commitment toward the implementation of clean and healthy living behaviors.

PubMed

Hartini, Nurul; Ariana, Atika Dian; Dewi, Triana Kesuma; Kurniawan, Afif

2017-01-01

Some parts of northern Surabaya are slum areas with dense populations, and the majority of the inhabitants are from low-income families. The condition of these areas is seemingly different from the fact that Surabaya city has won awards for its cleanliness, healthy environment preservation, and maintenance. This study aimed at turning the researched site into a clean and healthy environment. The research was conducted using a quasi-experiment technique with a non-randomized design and pretest-posttest procedures. The research subjects were 121 inhabitants who actively participated in the public commitment and psychoeducation program initiated by the researchers to learn and practice clean and healthy living behaviors. The statistical data showed that there was a substantial increase in the aspects of public commitment ( t -value = 4.008, p = 0.001) and psychoeducation ( t -value = 4.038, p = 0.001) to begin and maintain a clean and healthy living behaviors. A public commitment in the form of a collective declaration to keep learning and practicing a clean and healthy living behaviors were achieved. This commitment followed by psychoeducation aimed at introducing and exercising such behaviors was found to have effectively increased the research subjects' awareness to actively participate in preserving environmental hygiene. Developing communal behaviors toward clean and healthy living in inhabitants residing in an unhealthy slum area was a difficult task. Therefore, public commitment and psychoeducation must be aligned with the formulation of continuous habits demonstrating a clean and healthy living behaviors. These habits include the cessation of littering while putting trash in its place, optimizing the usage of public toilets, planting and maintaining vegetation around the area, joining and contributing to the "garbage bank" program, and participating in the Green and Clean Surabaya competition.

Clean Energy Generation and Dispatch in Reformed Wholesale Electricity Markets: Experience in the United States

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

Zhou, Shengru; Hurlbut, David J; Li, Ma

In recent years, the US electricity market has undergone several stages of reform, and gradually formed the market where the wholesale electricity price is determined by the supply and demand. The US electricity market also changes along with the rapid development of clean energy, forming a number of the market mechanisms that is specifically developed for clean energy power generation characteristics. On the basis of discussing the pricing mechanism of US electricity market, this paper analyzes the experience and practice of encouraging renewable energy development policy and clean energy dispatch from the angle of market mechanism and dispatching decision, andmore » puts forward the reference for clean energy dispatching in China.« less

Guidelines for Psychological Practice in Health Care Delivery Systems

ERIC Educational Resources Information Center

American Psychologist, 2013

2013-01-01

Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

Delivery of Clinical Preventive Services in Family Medicine Offices

PubMed Central

Crabtree, Benjamin F.; Miller, William L.; Tallia, Alfred F.; Cohen, Deborah J.; DiCicco-Bloom, Barbara; McIlvain, Helen E.; Aita, Virginia A.; Scott, John G.; Gregory, Patrice B.; Stange, Kurt C.; McDaniel, Reuben R.

2005-01-01

BACKGROUND This study aimed to elucidate how clinical preventive services are delivered in family practices and how this information might inform improvement efforts. METHODS We used a comparative case study design to observe clinical preventive service delivery in 18 purposefully selected Midwestern family medicine offices from 1997 to 1999. Medical records, observation of outpatient encounters, and patient exit cards were used to calculate practice-level rates of delivery of clinical preventive services. Field notes from direct observation of clinical encounters and prolonged observation of the practice and transcripts from in-depth interviews of practice staff and physicians were systematically examined to identify approaches to delivering clinical preventive services recommended by the US Preventive Services Task Force. RESULTS Practices developed individualized approaches for delivering clinical preventive services, with no one approach being successful across practices. Clinicians acknowledged a 3-fold mission of providing acute care, managing chronic problems, and prevention, but only some made prevention a priority. The clinical encounter was a central focus for preventive service delivery in all practices. Preventive services delivery rates often appeared to be influenced by competing demands within the clinical encounter (including between different preventive services), having a physician champion who prioritized prevention, and economic concerns. CONCLUSIONS Practice quality improvement efforts that assume there is an optimal approach for delivering clinical preventive services fail to account for practices’ propensity to optimize care processes to meet local contexts. Interventions to enhance clinical preventive service delivery should be tailored to meet the local needs of practices and their patient populations. PMID:16189059

ASSESSMENT OF PHYSICAL COAL CLEANING PRACTICES FOR SULFUR REMOVAL

EPA Science Inventory

The report gives results of a study of the current level of coal cleaning activity in the U.S. n 1983, the U.S. DOE's Energy Information Administration (EIA) expanded coal data collection activities to include information on the extent and type of coal preparation conducted in ea...

21 CFR 211.182 - Equipment cleaning and use log.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Equipment cleaning and use log. 211.182 Section 211.182 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Records and...

21 CFR 211.67 - Equipment cleaning and maintenance.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 4 2013-04-01 2013-04-01 false Equipment cleaning and maintenance. 211.67 Section 211.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Equipment § 211.67...

21 CFR 211.182 - Equipment cleaning and use log.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 4 2013-04-01 2013-04-01 false Equipment cleaning and use log. 211.182 Section 211.182 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Records and...

21 CFR 211.67 - Equipment cleaning and maintenance.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 4 2014-04-01 2014-04-01 false Equipment cleaning and maintenance. 211.67 Section 211.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Equipment § 211.67...

21 CFR 211.67 - Equipment cleaning and maintenance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Equipment cleaning and maintenance. 211.67 Section 211.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Equipment § 211.67...

21 CFR 211.182 - Equipment cleaning and use log.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 4 2014-04-01 2014-04-01 false Equipment cleaning and use log. 211.182 Section 211.182 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Records and...

21 CFR 211.67 - Equipment cleaning and maintenance.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 4 2012-04-01 2012-04-01 false Equipment cleaning and maintenance. 211.67 Section 211.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Equipment § 211.67...

21 CFR 211.182 - Equipment cleaning and use log.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 4 2012-04-01 2012-04-01 false Equipment cleaning and use log. 211.182 Section 211.182 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Records and...

7 CFR 982.101 - Grade requirements for shelled hazelnuts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Foreign Material: 0.02 of one percent, for foreign material. (2) For Defects: Five percent for kernels or... or portions of hazelnut kernels shall meet the following requirements: (1) Well dried and clean; (2... firm and crisp, not containing more than 6 percent moisture. (2) Clean means practically free from...

7 CFR 982.101 - Grade requirements for shelled hazelnuts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Foreign Material: 0.02 of one percent, for foreign material. (2) For Defects: Five percent for kernels or... or portions of hazelnut kernels shall meet the following requirements: (1) Well dried and clean; (2... firm and crisp, not containing more than 6 percent moisture. (2) Clean means practically free from...

40 CFR Table 4 to Subpart Wwww of... - Work Practice Standards

Code of Federal Regulations, 2010 CFR

2010-07-01

.... a new or existing closed molding operation using compression/injection molding uncover, unwrap or... new or existing cleaning operation not use cleaning solvents that contain HAP, except that styrene may... contacts resin. 3. a new or existing materials HAP-containing materials storage operation keep containers...

Assessing edge-of-field nutrient runoff from agricultural lands in the United States: How clean is clean enough?

USDA-ARS?s Scientific Manuscript database

Excess nutrients from numerous sources (e.g., agricultural and urban runoff, treatment plant discharge, streambank erosion) continue to adversely impact water resources in spite of improved treatment technologies and management practices. In fact, determination of cause(s) of accelerated nutrient e...

40 CFR 63.803 - Work practice standards.

Code of Federal Regulations, 2011 CFR

2011-07-01

... containers for storing finishing, gluing, cleaning, and washoff materials. (h) Application equipment... from a container that has a volume of no more than 2.0 gallons. (3) When spray is automated, that is... shall pump or drain all organic HAP solvent used for line cleaning into a normally closed container. (j...

21 CFR 211.67 - Equipment cleaning and maintenance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Equipment cleaning and maintenance. 211.67 Section 211.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Equipment § 211.67...

Day to Day

ERIC Educational Resources Information Center

Jurecki, Dennis

2006-01-01

A clean, healthy and safe school provides students, faculty and staff with an environment conducive to learning and working. However, budget and staff reductions can lead to substandard cleaning practices and unsanitary conditions. Some school facility managers have been making the switch to a day-schedule to reduce security and energy costs, and…

7 CFR 51.56 - Buildings and structures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... waste disposal and plumbing system maintained in good repair; (d) Each room in which the product is graded or stored shall be designed and constructed as to insure operating conditions of a clean and orderly character and shall be maintained in a clean and sanitary manner; and, (e) Every practical...

7 CFR 51.56 - Buildings and structures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... waste disposal and plumbing system maintained in good repair; (d) Each room in which the product is graded or stored shall be designed and constructed as to insure operating conditions of a clean and orderly character and shall be maintained in a clean and sanitary manner; and, (e) Every practical...

Best Practices for Effective Clinical Partnerships with Indigenous Populations of North America (American Indian, Alaska Native, First Nations, Métis, and Inuit).

PubMed

Haozous, Emily A; Neher, Charles

2015-09-01

This article presents a review of the literature to identify best practices for clinical partnerships with indigenous populations of North America, specifically American Indian/Alaska Native, First Nations, Métis, and Inuit of Canada. The authors have identified best practices and lessons learned from collaborating with indigenous populations, presented in 2 categories: conceptual guidelines and health care delivery guidelines. Major themes include the importance of trust and communication, the delivery of culturally congruent health care, and the necessity of working in partnership with tribal entities for successful delivery of health care. Best practices in health care delivery with indigenous populations are presented. Copyright © 2015 Elsevier Inc. All rights reserved.

Technologies for safe births.

PubMed

1984-01-01

The basic elements of a safe birth are proper prenatal care, adequate preparation of the mother, health worker, and site, awareness of the progress of labor and safe delivery, recognition of danger signs, and appropriate follow-up care. Technologies are differentiated by determining 1) the needs of rural birth attendants, 2) the nature of delivery kits, 3) proper cleanliness of the hands and equipment, and appropriate use of 5) disinfecting equipment, 6) drugs and medications, 7) the vertical position, 8) specialized instruments, and 9) records and support materials. Alternatives for measuring time are indicated. Customized kits available from UNICEF are described; some of the problems with these kits are reported. The logistics, referral procedures, and training and supervision needed for appropriate program managements are discussed. Adapting technologies to the local environment requires assessing the practices of traditional birth attendants (TBAs), the provision of kits (cost, ease of use and maintenance, replacement, durability, availability), the training required for proper use of equipment, the logistics of kit use, side effects of technologies, community attitudes, and evaluation. The advantages and disadvantages of including or not including particular supplies in the kit are discussed, i.e., the container for boiling water would either be a local pot or the aluminum carrying case. In lieu of a fingernail brush, a twig may be used for nail cleaning. Hand washing where water shortages exist might entail using a tin with a hole plugged with a stick to let water trickle as needed. Antiseptic solutions such a Dettol or Savlon can be used where a severe shortage exists. Basic equipment includes: soap and water, a container for boiling, other sterile containers, a protective cover of delivery area, towels, swabs, an optional apron, cord ties, a cutting instrument, gauze, a receiving blanket, records, and a carrying case.

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

PubMed

Peikes, Deborah; Dale, Stacy; Ghosh, Arkadipta; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Day, Timothy J; Duda, Nancy; Singh, Pragya; Anglin, Grace; Sessums, Laura L; Brown, Randall S

2018-06-01

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

American-built hardware for ASPT undergoes pre-delivery preparations

NASA Image and Video Library

1974-09-11

S74-28295 (September 1974) --- American-built hardware for the joint U.S.-USSR Apollo-Soyuz Test Project mission undergoes pre-delivery preparations in the giant clean room at Rockwell International Corporation?s Space Division at Downey, California. The U.S. portion of the ASTP docking system is in the right foreground. In the right background is the cylindrical-shaped docking module, which is designed to link the Apollo and Soyuz spacecraft when they dock in Earth orbit next summer. In the left background is the Apollo Command Module which they will carry the three American astronauts into Earth orbit. Photo credit: NASA

Sonochemical cleaning efficiencies in dental instruments

NASA Astrophysics Data System (ADS)

Tiong, T. Joyce; Walmsley, A. Damien; Price, Gareth J.

2012-05-01

Ultrasound has been widely used for cleaning purposes in a variety of situations, including in dental practice. Cleaning is achieved through a combination of acoustically driven streaming effects and sonochemical effects arising from the production of inertial cavitation in a liquid. In our work, various dental instruments used for endodontic (root canal) treatment have been evaluated for their efficiency in producing sonochemical effects in an in-vitro cleaning environment. The areas where cavitation was produced were mapped by monitoring chemiluminescence from luminol solutions and this was correlated with their cleaning efficiencies - assessed by the ability to bleach a dye, to form an emulsion by mixing immiscible components and also to remove ink from a glass surface. The results showed good correlation (Pearson's coefficient > 0.9) between the cavitation and cleaning efficiencies, suggesting that the former plays an important role in cleaning. The methods developed and the results will be beneficial in endodontics research in order to optimise future root canal instruments and treatments.

Comparison of Domiciliary and Institutional Delivery-care Practices in Rural Rajasthan, India

PubMed Central

Iyengar, Kirti; Suhalka, Virendra; Agarwal, Kumaril

2009-01-01

A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population–279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1,947 (96%) of 2,031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home- and institutional delivery respectively. While 34% of the women delivered in health facilities, modern care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1,336 (US$ 30), Rs 2,419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts. PMID:19489423

Short communication: Microbial quality of raw milk following commercial long-distance hauling.

PubMed

Darchuk, Emily M; Meunier-Goddik, Lisbeth; Waite-Cusic, Joy

2015-12-01

Hauling is a critical part of the commercial milk supply chain, yet very few studies have aimed to understand its effect on raw milk quality. This study focused on the effect of extended-duration tanker use during hauling on raw milk quality at a commercial facility. Standard tanker use [cleaned-in-place (CIP) once per 24h] served as a control and an incremental between-load water rinse with sanitizer treatment (RS) was evaluated to mitigate any effect from extended duration hauling. During this study, 1 commercial truck with 2 trailers was monitored for 10d. The truck collected milk at a large dairy farm, transported the milk to a manufacturing facility, and then returned to the same farm for a second load. Each round-trip journey took between 10 and 12h, allowing for 2 loads per 24-h use period. Following the second delivery, the truck was cleaned by CIP treatment starting a new treatment day. Producer samples were collected from the raw milk bulk tank on the farm before loading milk into the tanker. The same milk was sampled directly out of the tanker truck before unloading at the manufacturer. Effect on individual bacteria count, thermophilic spore count, and preliminary incubation count was quantified through common industry tests. Surface sponge swabs were also used to monitor tanker sanitation and the efficacy of cleaning treatments. Results did not identify a negative effect on raw milk quality due to extended duration hauling. Whereas the addition of RS did not provide any measurable quality benefits for the microbial milk quality, swab results demonstrated that the RS treatment was able to reduce surface bacteria in the tanker, although not to the same level as the full CIP treatment. Based on this study, current CIP practices for long distance milk hauling appear to be effective in mitigating any measurable effect on raw milk quality. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Clinicians' practice environment is associated with a higher likelihood of recommending cesarean deliveries.

PubMed

Cheng, Yvonne W; Snowden, Jonathan M; Handler, Stephanie; Tager, Ira B; Hubbard, Alan; Caughey, Aaron B

2014-08-01

Little data exist regarding clinicians' role in the rising annual incidence rate of cesarean delivery in the US. We aimed to examine if clinicians' practice environment is associated with recommending cesarean deliveries. This is a survey study of clinicians who practice obstetrics in the US. This survey included eight clinical vignettes and 27 questions regarding clinicians' practice environment. Chi-square test and multivariable logistic regression were used for statistical comparison. Of 27 675 survey links sent, 3646 clinicians received and opened the survey electronically, and 1555 (43%) participated and 1486 (94%) completed the survey. Clinicians were categorized into three groups based on eight common obstetric vignettes as: more likely (n = 215), average likelihood (n = 1099), and less likely (n = 168) to recommend cesarean. Clinician environment factors associated with a higher likelihood of recommending cesarean included Laborists/Hospitalists practice model (p < 0.001), as-needed anesthesia support (p = 0.003), and rural/suburban practice setting (p < 0.001). We identified factors in clinicians' environment associated with their likelihood of recommending cesarean delivery. The decision to recommend cesarean delivery is a complicated one and is likely not solely based on patient factors.

A first look at chorioamnionitis management practice variation among US obstetricians.

PubMed

Greenberg, Mara B; Anderson, Britta L; Schulkin, Jay; Norton, Mary E; Aziz, Natali

2012-01-01

Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.

A Secular Trend in Birth Weight and Delivery Practices in Periurban Vietnam During 2005-2012.

PubMed

Duong, Duc Minh; Nguyen, Anh Duy; Nguyen, Chuong Canh; Le, Vui Thi; Hoang, Son Ngoc; Bui, Ha Thi Thu

2017-07-01

The remarkable increase in Vietnamese economic conditions can increase the birth weight in neonates and better delivery practices among women. The Chi Linh Health and Demographic Surveillance System started in 2004. An open cohort of data consisting of about 57 561 people from 17 993 households has been followed primarily with respect to demography, economy, and education. The aim of this research is to study secular trends in delivery practice and birth weight in the past decade (2005-2012) in Chi Linh. We found a significant change in delivery rates at hospitals and cesarean section rates, but the birth weights over a decade of drastic economic development were stable. Furthermore, the findings show significant associations of birth weight and delivery practices with the child's sex, mother's age, and household income. Our results might be considered as representative for other similar periurban settings in Vietnam. We suggest that appropriate policies should be developed given the reduction in the use of delivery services in commune health centers in urban areas.

Injection Drug Users' Perceived Barriers to Using Self-Initiated Harm Reduction Strategies.

PubMed

Bonar, Erin E; Rosenberg, Harold

2014-08-01

Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs' perceived barriers to engaging in these behaviors. We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one's drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants' most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated.

Injection Drug Users’ Perceived Barriers to Using Self-Initiated Harm Reduction Strategies

PubMed Central

Rosenberg, Harold

2014-01-01

Introduction and Aims Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs’ perceived barriers to engaging in these behaviors. Method We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. Results The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one’s drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants’ most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Discussion and Conclusions Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated. PMID:25419201

Observation of High School Students' Food Handling Behaviors: Do They Improve following a Food Safety Education Intervention?

PubMed

Diplock, Kenneth J; Dubin, Joel A; Leatherdale, Scott T; Hammond, David; Jones-Bitton, Andria; Majowicz, Shannon E

2018-06-01

Youth are a key audience for food safety education. They often engage in risky food handling behaviors, prepare food for others, and have limited experience and knowledge of safe food handling practices. Our goal was to investigate the effectiveness of an existing food handler training program for improving safe food handling behaviors among high school students in Ontario, Canada. However, because no schools agreed to provide control groups, we evaluated whether behaviors changed following delivery of the intervention program and whether changes were sustained over the school term. We measured 32 food safety behaviors, before the intervention and at 2-week and 3-month follow-up evaluations by in-person observations of students ( n = 119) enrolled in grade 10 and 12 Food and Nutrition classes ( n = 8) and who individually prepared recipes. We examined within-student changes in behaviors across the three time points, using mixed effects regression models to model trends in the total food handling score (of a possible 32 behaviors) and subscores for "clean" (17 behaviors), "separate" (14 behaviors), and "cook" (1 behavior), adjusting for student characteristics. At baseline, students ( n = 108) averaged 49.1% (15.7 of 32 behaviors; standard deviation = 5.8) correct food handling behaviors, and only 5.5% (6) of the 108 students used a food thermometer to check the doneness of the chicken (the "cook" behavior). All four behavior score types increased significantly ∼2 weeks postintervention and remained unchanged ∼3 months later. Student characteristics (e.g., having taken a prior food handling course) were not significant predictors of the total number of correctly performed food handling behaviors or of the "clean" or "separate" behaviors, working or volunteering in a food service establishment was the only characteristic significantly associated with food thermometer use (i.e., "cook"). Despite the significant increase in correct behaviors, students continued to use risky practices postintervention, suggesting that the risk of foodborne disease remained.

OBSERVATIONAL STUDY OF FINAL CLEANING AND AHERA CLEARANCE SAMPLING AT ASBESTOS-ABATEMENT SITES IN NEW JERSEY

EPA Science Inventory

A study was conducted during the summer of 1988 to document final cleaning procedures and evaluate Asbestos Hazard Emergency Response Act (AHERA) clearance air sampling practices used at 20 asbestos-abatement sites in New Jersey. Each abatement took place in a school building and...

Data Cleaning in Mathematics Education Research: The Overlooked Methodological Step

ERIC Educational Resources Information Center

Hubbard, Aleata

2017-01-01

The results of educational research studies are only as accurate as the data used to produce them. Drawing on experiences conducting large-scale efficacy studies of classroom-based algebra interventions for community college and middle school students, I am developing practice-based data cleaning procedures to support scholars in conducting…

16 CFR 423.5 - Unfair or deceptive acts or practices.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... (a) Textile wearing apparel and certain piece goods. In connection with the sale, in or affecting... for a manufacturer or importer: (1) To fail to disclose to a purchaser, prior to sale, instructions...) To fail to warn a purchaser, prior to sale, when the product cannot be cleaned by any cleaning...

7 CFR 51.56 - Buildings and structures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... be an efficient waste disposal and plumbing system maintained in good repair; (d) Each room in which... a clean and orderly character and shall be maintained in a clean and sanitary manner; and, (e) Every practical precaution shall be taken to exclude dogs, cats, rodents and other vermin from the rooms in which...

7 CFR 51.56 - Buildings and structures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... be an efficient waste disposal and plumbing system maintained in good repair; (d) Each room in which... a clean and orderly character and shall be maintained in a clean and sanitary manner; and, (e) Every practical precaution shall be taken to exclude dogs, cats, rodents and other vermin from the rooms in which...

Experiences and Attitudes Among Psychiatric Mental Health Advanced Practice Nurses in the Use of Telemental Health: Results of an Online Survey.

PubMed

Baird, Martha B; Whitney, Lucinda; Caedo, Cassie E

Telemental health (TMH) growth is driven by recent trends in health delivery systems and disparities in access to mental health services. There are currently no standard educational guidelines to prepare psychiatric mental health advanced practice nurses (PMH-APRNs) in TMH delivery. To survey practicing PMH-APRNs across the United States about their experiences and attitudes about use of TMH. Eighty-three participants from the American Psychiatric Nurses Association online discussion board completed a nine-item survey. Length of time practicing as a PMH-APRN, TMH use in practice, populations served, and TMH background. A majority had been practicing as a PMH-APRN for less than a decade and had used TMH, although most reported no prior education or training in this delivery method. Participants did indicate a desire for TMH education. This survey affirms the prevalence of TMH use among PMH-APRN providers, lack of formal training, and necessity for standardized educational guidelines in TMH delivery.

One-step fabrication of robust superhydrophobic and superoleophilic surfaces with self-cleaning and oil/water separation function.

PubMed

Zhang, Zhi-Hui; Wang, Hu-Jun; Liang, Yun-Hong; Li, Xiu-Juan; Ren, Lu-Quan; Cui, Zhen-Quan; Luo, Cheng

2018-03-01

Superhydrophobic surfaces have great potential for application in self-cleaning and oil/water separation. However, the large-scale practical applications of superhydrophobic coating surfaces are impeded by many factors, such as complicated fabrication processes, the use of fluorinated reagents and noxious organic solvents and poor mechanical stability. Herein, we describe the successful preparation of a fluorine-free multifunctional coating without noxious organic solvents that was brushed, dipped or sprayed onto glass slides and stainless-steel meshes as substrates. The obtained multifunctional superhydrophobic and superoleophilic surfaces (MSHOs) demonstrated self-cleaning abilities even when contaminated with or immersed in oil. The superhydrophobic surfaces were robust and maintained their water repellency after being scratched with a knife or abraded with sandpaper for 50 cycles. In addition, stainless-steel meshes sprayed with the coating quickly separated various oil/water mixtures with a high separation efficiency (>93%). Furthermore, the coated mesh maintained a high separation efficiency above 95% over 20 cycles of separation. This simple and effective strategy will inspire the large-scale fabrication of multifunctional surfaces for practical applications in self-cleaning and oil/water separation.

Retail Deli Slicer Inspection Practices: An EHS-Net Study.

PubMed

Lipcsei, Lauren E; Brown, Laura G; Hoover, E Rickamer; Faw, Brenda V; Hedeen, Nicole; Matis, Bailey; Nicholas, David; Ripley, Danny

2018-05-01

The Centers for Disease Control and Prevention (CDC) estimates that 3,000 people die in the United States each year from foodborne illness, and Listeria monocytogenes causes the third highest number of deaths. Risk assessment data indicate that L. monocytogenes contamination of particularly delicatessen meats sliced at retail is a significant contributor to human listeriosis. Mechanical deli slicers are a major source of L. monocytogenes cross-contamination and growth. In an attempt to prevent pathogen cross-contamination and growth, the U.S. Food and Drug Administration (FDA) created guidance to promote good slicer cleaning and inspection practices. The CDC's Environmental Health Specialists Network conducted a study to learn more about retail deli practices concerning these prevention strategies. The present article includes data from this study on the frequency with which retail delis met the FDA recommendation that slicers should be inspected each time they are properly cleaned (defined as disassembling, cleaning, and sanitizing the slicer every 4 h). Data from food worker interviews in 197 randomly selected delis indicate that only 26.9% of workers ( n = 53) cleaned and inspected their slicers at this frequency. Chain delis and delis that serve more than 300 customers on their busiest day were more likely to have properly cleaned and inspected slicers. Data also were collected on the frequency with which delis met the FDA Food Code provision that slicers should be undamaged. Data from observations of 685 slicers in 298 delis indicate that only 37.9% of delis ( n = 113) had slicers that were undamaged. Chain delis and delis that provide worker training were more likely to have slicers with no damage. To improve slicer practices, food safety programs and the retail food industry may wish to focus on worker training and to focus interventions on independent and smaller delis, given that these delis were less likely to properly inspect their slicers and to have undamaged slicers.

Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study.

PubMed

O'Donnell, Amy; Haighton, Catherine; Chappel, David; Shevills, Colin; Kaner, Eileen

2016-11-25

Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact. A sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations. Screening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs' beliefs about patient-centred practice. Financial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs that shape how GPs' provide care.

Maternal mortality in India: current status and strategies for reduction.

PubMed

Prakash, A; Swain, S; Seth, A

1991-12-01

The causes (medical, reproductive factors, health care delivery system, and socioeconomic factors) of maternal mortality in India and strategies for reducing maternal mortality are presented. Maternal mortality rates (MMR) are very high in Asia and Africa compared with Northern Europe's 4/100,000 live births. An Indian hospital study found the MMR to be 4.21/1000 live births. 50-98% of maternal deaths are caused by direct obstetric causes (hemorrhage, infection, and hypertensive disorders, ruptured uterus, hepatitis, and anemia). 50% of maternal deaths due to sepsis are related to illegal induced abortion. MMR in India has not declined significantly in the past 15 years. Age, primi and grande multiparity, unplanned pregnancy, and related illegal abortion are the reproductive causes. In 1985 WHO reported that 63-80% of maternal deaths due to direct obstetric causes and 88-98% of all maternal deaths could probably have been prevented with proper handling. In India, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care. Mass illiteracy is another cause. Effective strategies for reducing the MMR are 1) to place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH; 2) to give attention to care during labor and delivery, which is the most critical period for complications; 3) to provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers; 4) to improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral); 5) to improve quality of care at the primary health care level (emergency care and proper referral); 6) to include in the postpartum program MCH and family planning services; 7) to examine the feasibility of a national blood transfusion service network; 8) to improve transportation; 9) to educate young girls on health and sex; 10) to informally educate the masses on MCH; 11) to focus obstetrics and gynecology training primarily on practical skills in management of labor and delivery; 12) to research reproductive behavior; and 13) to assure every women the right to safe motherhood.

Public-Private roundtables at the fourth Clean Energy Ministerial, 17-18 April 2013, New Delhi, India

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

Crowe, Tracey

2013-06-30

The Clean Energy Ministerial (CEM) is a high-level global forum to share best practices and promote policies and programs that advance clean energy technologies and accelerate the transition to a global clean energy economy. The CEM works to increase energy efficiency, expand clean energy supply, and enhance clean energy access worldwide. To achieve these goals, the CEM pursues a three-part strategy that includes high-level policy dialogue, technical cooperation, and engagement with the private sector and other stakeholders. Each year, energy ministers and other high-level delegates from the 23 participating CEM governments come together to discuss clean energy, review clean energymore » progress, and identify tangible next steps to accelerate the clean energy transition. The U.S. Department of Energy, which played a crucial role in launching the CEM, hosted the first annual meeting of energy ministers in Washington, DC, in June 2010. The United Arab Emirates hosted the second Clean Energy Ministerial in 2011, and the United Kingdom hosted the third Clean Energy Ministerial in 2012. In April 2013, India hosted the fourth Clean Energy Ministerial (CEM4) in New Delhi. Key insights from CEM4 are summarized in the report. It captures the ideas and recommendations of the government and private sector leaders who participated in the discussions on six discussion topics: reducing soft costs of solar PV; energy management systems; renewables policy and finance; clean vehicle adoption; mini-grid development; and power systems in emerging economies.« less

Stethoscope Cleaning During Patient Care.

PubMed

Ghumman, Ghazi Wahla; Ahmad, Nina; Pop-Vicas, Aurora; Iftikhar, Sadia

2018-05-01

We conducted a cross-sectional survey of healthcare workers in two community teaching hospitals to better understand clinicians' beliefs and practices related to cleaning of their stethoscopes. The study was conducted from September 2015 to May 2016. Among the total 358 responses received, 45%, 40%, 10% and 5% were from attending physicians, medical students, nurses, and resident physicians, respectively. Although the majority of the respondents (76%) frequently used a stethoscope at work, and almost all (93%) believed that stethoscopes can be involved in pathogen transmission, only 29% of participants reported cleaning their stethoscopes after every use. Hospitals should include stethoscope cleaning into their overall infection prevention efforts. [Full article available at http://rimed.org/rimedicaljournal-2018-05.asp].

Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis.

PubMed

Gage, Anastasia J; Ilombu, Onyebuchi; Akinyemi, Akanni Ibukun

2016-10-06

Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services. Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15-49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs. The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery. Supply-side factors appeared to play a role in health facility delivery after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural-urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care.

Current Practices in Special Education Service Delivery and Differences between Instructional Settings

ERIC Educational Resources Information Center

Platt, Marguerite D.

2013-01-01

Despite nationwide advances in special education service delivery practices, disparities exist between the educational outcomes of students with disabilities versus students without disabilities. There is often disparity in teachers' roles and instructional practices in coteaching classrooms, as well as in their pullout resource classroom…

Safety Gear Decontamination Practices Among Florida Firefighters: Analysis of a Text-Based Survey Methodology.

PubMed

Moore, Kevin J; Koru-Sengul, Tulay; Alvarez, Armando; Schaefer-Solle, Natasha; Harrison, Tyler R; Kobetz, Erin N; Caban-Martinez, Alberto J

2018-02-01

Despite the National Fire Protection Association (NFPA) 1851 Personal Protective Equipment Care and Maintenance guidelines, little is known about the routine cleaning of firefighter bunker gear. In collaboration with a large Florida firefighter union, a mobile phone text survey was administered, which included eight questions in an item logic format. In total, 250 firefighters participated in the survey of which 65% reported cleaning their bunker gear in the past 12 months. Approximately 32% ( n = 52) indicated that they had above average confidence in gear cleaning procedures. Arriving at a fire incident response was a significant predictor of gear cleaning in the 12 months preceding survey administration. Using mobile phone-based texting for periodic queries on adherence to NFPA cleaning guidelines and safety message distribution may assist firefighters to increase decontamination procedure frequency.

40 CFR Appendix 7 to Subpart A of... - API Recommended Practice 13B-2

Code of Federal Regulations, 2010 CFR

2010-07-01

... facilitate cleaning and funnel-shaped top to catch falling drops. For compliance monitoring under the NPDES... condenser. b. Pack the retort body with steel wool. c. Apply lubricant/sealant to threads of retort cup and... the clean and dry liquid receiver. This is mass (C), grams. Place the receiver below condenser outlet...

40 CFR Appendix 7 to Subpart A of... - API Recommended Practice 13B-2

Code of Federal Regulations, 2011 CFR

2011-07-01

... facilitate cleaning and funnel-shaped top to catch falling drops. For compliance monitoring under the NPDES... condenser. b. Pack the retort body with steel wool. c. Apply lubricant/sealant to threads of retort cup and... the clean and dry liquid receiver. This is mass (C), grams. Place the receiver below condenser outlet...

9 CFR 590.544 - Spray process powder; definitions and requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

...-blended: Provided, That the blending is done in a room as provided in § 590.548 or in a closed blending system and in accordance with clean, sanitary practices and such procedures as may be prescribed by the... accomplished in a clean, sanitary manner and in accordance with such procedures as may be prescribed by the...

9 CFR 590.544 - Spray process powder; definitions and requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

...-blended: Provided, That the blending is done in a room as provided in § 590.548 or in a closed blending system and in accordance with clean, sanitary practices and such procedures as may be prescribed by the... accomplished in a clean, sanitary manner and in accordance with such procedures as may be prescribed by the...

9 CFR 590.544 - Spray process powder; definitions and requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

...-blended: Provided, That the blending is done in a room as provided in § 590.548 or in a closed blending system and in accordance with clean, sanitary practices and such procedures as may be prescribed by the... accomplished in a clean, sanitary manner and in accordance with such procedures as may be prescribed by the...

9 CFR 590.544 - Spray process powder; definitions and requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

...-blended: Provided, That the blending is done in a room as provided in § 590.548 or in a closed blending system and in accordance with clean, sanitary practices and such procedures as may be prescribed by the... accomplished in a clean, sanitary manner and in accordance with such procedures as may be prescribed by the...

Evaluation and its importance for nursing practice.

PubMed

Moule, Pam; Armoogum, Julie; Douglass, Emma; Taylor, Dr Julie

2017-04-26

Evaluation of service delivery is an important aspect of nursing practice. Service evaluation is being increasingly used and led by nurses, who are well placed to evaluate service and practice delivery. This article defines evaluation of services and wider care delivery and its relevance in NHS practice and policy. It aims to encourage nurses to think about how evaluation of services or practice differs from research and audit activity and to consider why and how they should use evaluation in their practice. A process for planning and conducting an evaluation and disseminating findings is presented. Evaluation in the healthcare context can be a complicated activity and some of the potential challenges of evaluation are described, alongside possible solutions. Further resources and guidance on evaluation activity to support nurses' ongoing development are identified.

76 FR 19989 - New York State Prohibition of Discharges of Vessel Sewage; Receipt of Petition and Tentative...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

... readily available for pumpout while the ferries are docked in Bridgeport. SUNY Maritime College's large...: Notice is hereby given that, pursuant to Clean Water Act, Section 312(f)(3) (33 U.S.C. 1322(f)(3)), the... and Hand Delivery/Courier: Moses Chang, U.S. EPA Region 2, 290 Broadway, 24th Floor, New York, NY...

Special Advanced Studies for Pollution Prevention. Delivery Order 0058: The Monitor - Winter 2000

DTIC Science & Technology

2001-04-01

Burning/Open Detonation of Energetic Materials ➨Emission factors from a draft EPA report are incorporated into the guidance Site Restoration ➨Method...Aqueous Cleaner Recycle System Microfiltration Removes oil/grease & TSS from alkaline and acid cleaning baths Commodore Separation Technologies, Inc... Microfiltration Removes all heavy metals from wastewater and recycles water Infinity Chemicals Group Infinity Prep-L Deoxidizing Chemical

Nutrient and carbon retention in riparian and hillslope forests after mountain pine beetle infestation and timber harvesting in Colorado (Abstract)

Treesearch

Chuck Rhoades; Carl Chambers; Kelly Elder; Derek Pierson; Banning Starr

2012-01-01

Mountain pine beetle outbreaks have caused an unprecedented amount of tree mortality in northern Colorado and southern Wyoming forests over the past decade. The extensive overstory mortality and associated salvage logging activities may threaten the sustained delivery of clean water from beetle-affected forests. In this study, we evaluate nutrient retention by riparian...

BRASS FOUNDRY ROOM SHOWING GATE CUTTERS USED TO REMOVE RUNNERS ...

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

BRASS FOUNDRY ROOM SHOWING GATE CUTTERS USED TO REMOVE RUNNERS AND SPRUES FROM BRONZE CASTINGS TOO SOFT TO BE CLEANED IN TUMBLING MILLS. ALSO SHOWN ARE MOLD MACHINES AND THE SAND DELIVERY SYSTEM USED TO CREATE GREEN SAND MOLDS, POURED AT THE OTHER END OF THE GRAVITY CONVEYORS. - Stockham Pipe & Fittings Company, Brass Foundry, 4000 Tenth Avenue North, Birmingham, Jefferson County, AL

Conservation of artists' acrylic emulsion paints: XPS, NEXAFS and ATR-FTIR studies of wet cleaning methods

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

Willneff, E. A.; Ormsby, B. A.; Stevens, J. S.

Works of art prepared with acrylic emulsion paints became commercially available in the 1960s. It is increasingly necessary to undertake and optimise cleaning and preventative conservation treatments to ensure their longevity. Model artists' acrylic paint films covered with artificial soiling were thus prepared on a canvas support and exposed to a variety of wet cleaning treatments based on aqueous or hydrocarbon solvent systems. This included some with additives such as chelating agents and/or surfactants, and microemulsion systems made specifically for conservation practice. The impact of cleaning (soiling removal) on the paint film surface was examined visually and correlated with resultsmore » of attenuated total reflection Fourier transform infrared, XPS and near-edge X-ray absorption fine structure analyses – three spectroscopic techniques with increasing surface sensitivity ranging from approximately $-$ 1000, 10 and 5 nm, respectively. Visual analysis established the relative cleaning efficacy of the wet cleaning treatments in line with previous results. X-ray spectroscopy analysis provided significant additional findings, including evidence for (i) surfactant extraction following aqueous swabbing, (ii) modifications to pigment following cleaning and (iii) cleaning system residues.« less

Conservation of artists' acrylic emulsion paints: XPS, NEXAFS and ATR-FTIR studies of wet cleaning methods

DOE PAGES

Willneff, E. A.; Ormsby, B. A.; Stevens, J. S.; ...

2014-02-17

Works of art prepared with acrylic emulsion paints became commercially available in the 1960s. It is increasingly necessary to undertake and optimise cleaning and preventative conservation treatments to ensure their longevity. Model artists' acrylic paint films covered with artificial soiling were thus prepared on a canvas support and exposed to a variety of wet cleaning treatments based on aqueous or hydrocarbon solvent systems. This included some with additives such as chelating agents and/or surfactants, and microemulsion systems made specifically for conservation practice. The impact of cleaning (soiling removal) on the paint film surface was examined visually and correlated with resultsmore » of attenuated total reflection Fourier transform infrared, XPS and near-edge X-ray absorption fine structure analyses – three spectroscopic techniques with increasing surface sensitivity ranging from approximately $-$ 1000, 10 and 5 nm, respectively. Visual analysis established the relative cleaning efficacy of the wet cleaning treatments in line with previous results. X-ray spectroscopy analysis provided significant additional findings, including evidence for (i) surfactant extraction following aqueous swabbing, (ii) modifications to pigment following cleaning and (iii) cleaning system residues.« less

To Give or Not to Give: Approaches to Early Childhood Immunization Delivery in Oregon Rural Primary Care Practices

ERIC Educational Resources Information Center

Fagnan, Lyle J.; Shipman, Scott A.; Gaudino, James A.; Mahler, Jo; Sussman, Andrew L.; Holub, Jennifer

2011-01-01

Context: Little is known about rural clinicians' perspectives regarding early childhood immunization delivery, their adherence to recommended best immunization practices, or the specific barriers they confront. Purpose: To examine immunization practices, beliefs, and barriers among rural primary care clinicians for children in Oregon and compare…

Current Practices in the Delivery of Undergraduate Exercise Physiology Content

ERIC Educational Resources Information Center

Fisher, Michele M.

2013-01-01

The purpose of this study was to identify current practices for the delivery of exercise physiology content at the undergraduate level. An anonymous 22-item survey was sent to instructors of exercise physiology to collect information concerning the structure of course offerings and instructional practices. One hundred ten instructors responded to…

Cleaning with Bulk Nanobubbles.

PubMed

Zhu, Jie; An, Hongjie; Alheshibri, Muidh; Liu, Lvdan; Terpstra, Paul M J; Liu, Guangming; Craig, Vincent S J

2016-11-01

The electrolysis of aqueous solutions produces solutions that are supersaturated in oxygen and hydrogen gas. This results in the formation of gas bubbles, including nanobubbles ∼100 nm in size that are stable for ∼24 h. These aqueous solutions containing bubbles have been evaluated for cleaning efficacy in the removal of model contaminants bovine serum albumin and lysozyme from surfaces and in the prevention of the fouling of surfaces by these same proteins. Hydrophilic and hydrophobic surfaces were investigated. It is shown that nanobubbles can prevent the fouling of surfaces and that they can also clean already fouled surfaces. It is also argued that in practical applications where cleaning is carried out rapidly using a high degree of mechanical agitation the role of cleaning agents is not primarily in assisting the removal of soil but in suspending the soil that is removed by mechanical action and preventing it from redepositing onto surfaces. This may also be the primary mode of action of nanobubbles during cleaning.

Clinical Opinion: "Doing Something" About the Cesarean Delivery Rate.

PubMed

Clark, S L; Garite, T J; Hamilton, E J; Belfort, M A; Hankins, G D

2018-05-04

There is a general consensus that the cesarean delivery rate in the U.S. is too high, and that practice patterns of obstetricians are largely to blame for this situation. In reality, the U.S. cesarean delivery rate is the result of 3 forces largely beyond the control of the practicing clinician: patient expectations and misconceptions regarding the safety of labor, the medical-legal system, and limitations in technology. Efforts to "do something" about the cesarean delivery rate by promulgating practice directives which are marginally evidence-based or influenced by social pressures are both ineffective and potentially harmful. We examine both the recent ACOG/SMFM Care Consensus Statement "Safe Prevention of Primary Cesarean Delivery" document and the various iterations of the ACOG guidelines for vaginal birth after cesarean delivery in this context. Adherence to arbitrary time limits for active phase or second stage arrest without incorporating other clinical factors into the decision making process is unwise. In a similar manner, ever-changing practice standards for vaginal birth after cesarean driven by factors other than changing data are unlikely to be effective in lowering the cesarean delivery rate. Whether too high or too low, the current U.S. cesarean delivery rate is the expected result of the unique demographic, geographic and social forces driving it and is unlikely to change significantly given the limitations of current technology to otherwise satisfy the demands of these forces. Copyright © 2018 Elsevier Inc. All rights reserved.

Neonatal resuscitation equipment: A hidden risk for our babies?

PubMed

Winckworth, Lucinda C; McLaren, Emma; Lingeswaran, Arvin; Kelsey, Michael

2016-05-01

Neonatal infections carry a heavy burden of morbidity and mortality. Poor practice can result in unintentional colonisation of medical equipment with potentially pathogenic organisms. This study will determine the prevalence and type of bacterial contamination on exposed neonatal resuscitation equipment in different clinical settings and explore simple measures to reduce contamination risk. A survey determined the rates of resuscitation equipment usage. All environmentally exposed items were identified on resuscitaires hospital-wide and swabbed for bacterial contamination. A new cleaning and storage policy was implemented and the prevalence of environmentally exposed equipment re-measured post-intervention. Resuscitation equipment was used in 28% of neonatal deliveries. Bacterial colony forming units were present on 44% of the 236 exposed equipment pieces swabbed. There was no significant difference in contamination rates between equipment types. Coagulase negative staphylococcus was the most prevalent species (59 pieces, 25%) followed by Escherichia coli and Enterobacter cloacae (20 pieces, 9% each). Opened items stored inside plastic remained sterile, whilst those in low-use areas had significantly less contamination than those in high-use areas (22% vs. 51%, P < 0.05). Implementing a simple educational programme led to a significant reduction in environmentally exposed equipment (79% reduction, P < 0.01). Pathogenic bacteria can colonise commonly used pieces of neonatal resuscitation equipment. Whilst the clinical significance remains uncertain, equipment should be kept packaged until required and discarded once open, even if unused. Standardising cleaning policies results in rapid and significant improvements in equipment storage conditions, reducing microbial colonisation opportunities. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Implementation of a solvent management program to control paint shop volatile organic compounds

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

Floer, M.M.; Hicks, B.H.

1997-12-31

The majority of automobile assembly plant volatile organic compound (VOC) emissions are generated from painting operations. Typical paint operations generate more than 90 percent of the total plant emissions and, up to, 50 percent can be released by cleaning sources. Plant practices which contribute to the release of VOC emissions include the cleaning of paint lines and equipment, tanks, spray booths, floors and vehicles. Solvents continue to be the largest contributing source of VOC emissions in an automotive paint shop. To reduce overall VOC emissions, environmental regulations and guidelines were introduced under the Clean Air Act; Pollution Prevention and Wastemore » Minimization programs, Control Techniques, and special air permit conditions. The introduction of these regulations and guidelines has driven industry toward continual refinement of their present cleaning methods while pursuing new techniques and technologies. Industry has also shown a proactive approach by introducing new waterborne and powder coating paint technologies to reduce overall emissions. As new paint technologies are developed and introduced, special attention must be given to the types of materials utilized for cleaning. The development and implementation of a solvent management program allows a facility to standardize a program to properly implement materials, equipment, technologies and work practices to reduce volatile organic compound emissions, meet strict cleaning requirements posed by new paint technologies and produce a vehicle which meets the high quality standards of the customer. This paper will assess the effectiveness of a solvent management program by examining pollution prevention initiatives and data from four different painting operations.« less

Cleanliness audit of clinical surfaces and equipment: who cleans what?

PubMed

Anderson, R E; Young, V; Stewart, M; Robertson, C; Dancer, S J

2011-07-01

Current guidelines recommend regular cleaning of clinical equipment. We monitored items on a surgical ward for predominant user, hand-touch frequency, cleaning responsibilities and measurement of organic soil. Equipment was assessed in triplicate against a cleanliness benchmark of 100 relative light units (RLU) using the Hygiena® ATP system. There were 44 items, of which 21 were cleaned by clinical support workers (CSWs), five by domestic staff; three by nurses, three by doctors, and 12 with no designated cleaning responsibility. Geometric mean RLUs ranged from 60 to 550/100 cm² for small items such as hand-gel containers, bed control, blood pressure cuff and clinical notes; with similar values of 80-540/100 cm² RLU for larger items such as electrocardiogram machine, defibrillator, trolleys and tables. Overall geometric mean was 249/100 cm² RLU for all surfaces, with 84% (37 of 44) items exceeding the 100RLU benchmark. Of 27 items cleaned by clinical staff, 24 (89%) failed the benchmark. Of 12 sites with no cleaning specification, 11 (92%) failed the benchmark. Three of seven 'clean' sites (<100/100 cm² RLU) were cleaned by domestic staff. Average log(10) RLU of surfaces cleaned by domestics were 64% lower compared with surfaces cleaned by CSWs (95% confidence interval: 35%, 80%; P=0.019). In conclusion, clinical equipment frequently demonstrates high levels of organic soil, whether or not items have assigned cleaning responsibility. These findings suggest that cleaning practices for clinical equipment may require review, along with education of staff with specific cleaning responsibilities. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Birth preparedness and complication readiness (BPCR) among pregnant women in hard-to-reach areas in Bangladesh.

PubMed

Moinuddin, Md; Christou, Aliki; Hoque, Dewan Md Emdadul; Tahsina, Tazeen; Salam, Shumona Sharmin; Billah, Sk Masum; Kuppens, Lianne; Matin, Md Ziaul; Arifeen, Shams El

2017-01-01

Birth preparedness and complication readiness aims to reduce delays in care seeking, promote skilled birth attendance, and facility deliveries. Little is known about birth preparedness practices among populations living in hard-to-reach areas in Bangladesh. To describe levels of birth preparedness and complication readiness among recently delivered women, identify determinants of being better prepared for birth, and assess the impact of greater birth preparedness on maternal and neonatal health practices. A cross-sectional survey with 2,897 recently delivered women was undertaken in 2012 as part of an evaluation trial done in five hard-to-reach districts in rural Bangladesh. Mothers were considered well prepared for birth if they adopted two or more of the four birth preparedness components. Descriptive statistics and multivariable logistic regression were used for analysis. Less than a quarter (24.5%) of women were considered well prepared for birth. Predictors of being well-prepared included: husband's education (OR = 1.3; CI: 1.1-1.7), district of residence, exposure to media in the form of reading a newspaper (OR = 2.2; CI: 1.2-3.9), receiving home visit by a health worker during pregnancy (OR = 1.5; CI: 1.2-1.8), and receiving at least 3 antenatal care visits from a qualified provider (OR = 1.4; CI: 1.0-1.9). Well-prepared women were more likely to deliver at a health facility (OR = 2.4; CI: 1.9-3.1), use a skilled birth attendant (OR = 2.4, CI: 1.9-3.1), practice clean cord care (OR = 1.3, CI: 1.0-1.5), receive post-natal care from a trained provider within two days of birth for themselves (OR = 2.6, CI: 2.0-3.2) or their newborn (OR = 2.6, CI: 2.1-3.3), and seek care for delivery complications (OR = 1.8, CI: 1.3-2.6). Greater emphasis on BPCR interventions tailored for hard to reach areas is needed to improve skilled birth attendance, care seeking for complications and essential newborn care and facilitate reductions in maternal and neonatal mortality in low performing districts in Bangladesh.

"Please Do Not Leave Any Notes for the Cleaning Lady, as Many Do Not Speak English Fluently": Policy, Power, and Language Brokering in a Multilingual Workplace

ERIC Educational Resources Information Center

Gonçalves, Kellie; Schluter, Anne

2017-01-01

This article investigates the covert language policy and micro-language planning practices of one female Brazilian-American entrepreneur, Magda, within her multilingual cleaning company. Because Magda is plurilingual (Spolsky in "Language policy." Cambridge University Press, Cambridge, 2004), she is able to draw on her metalinguistic…

Newborn care knowledge and practices among mothers attending pediatric outpatient clinic of a hospital in Karachi, Pakistan

PubMed Central

Gul, Saadia; Khalil, Rehana; Yousafzai, M. Tahir; Shoukat, Faiza

2014-01-01

Objectives To assess newborn care knowledge and practices among mothers. Methodology A cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. A total of 170 mothers accompanying their infants attending the Paediatric Out Patient Department were interviewed through a structured questionnaire. Areas of inquiry included Antenatal care seeking, delivery care, cord care, eye care, bathing and breastfeeding practices. Results Ninety-two percent mothers reported at least one antenatal care visit. Tetanus Toxoid coverage was 88%. Home deliveries were 18%. Seventy-four percent reported applying various substances like coconut oil, mustard oil, purified butter and turmeric to the cord stump. Kohl application to newborn’s eyes was 68%, while 86% reported first bath within 24 hrs of birth. 48% mothers initiated breastfeeding within 2 hours of delivery. Colostrum was discarded by 43% and prelacteal feeds given by 73%. Exclusive Breast Feeding rate was 26%. Family income of Rs. 10, 000 (USD120) or less/month and maternal education level of primary or less were significantly associated with home delivery, unhygienic cord care and kohl application to the newborn’s eyes. Home delivery was a risk factor for poor cord care (OR=4.07) and discarding colostrum (OR= 3.18). Conclusion Antenatal care coverage was good, but knowledge regarding newborn care was poor. Harmful practices regarding newborn care were prevalent among mothers. Institutional deliveries did not guarantee optimal practices. Tradition and culture played a significant role. Health education can improve the mothers’ knowledge regarding newborn care practices. PMID:25246884

An Open Port Sampling Interface for Liquid Introduction Atmospheric Pressure Ionization Mass Spectrometry

DOE PAGES

Van Berkel, Gary J.; Kertesz, Vilmos

2015-08-25

RATIONALE: A simple method to introduce unprocessed samples into a solvent for rapid characterization by liquid introduction atmospheric pressure ionization mass spectrometry has been lacking. The continuous flow, self-cleaning open port sampling interface introduced here fills this void. METHODS: The open port sampling interface used a vertically aligned, co-axial tube arrangement enabling solvent delivery to the sampling end of the device through the tubing annulus and solvent aspiration down the center tube and into the mass spectrometer ionization source via the commercial APCI emitter probe. The solvent delivery rate to the interface was set to exceed the aspiration rate creatingmore » a continuous sampling interface along with a constant, self-cleaning spillover of solvent from the top of the probe. RESULTS: Using the open port sampling interface with positive ion mode APCI and a hybrid quadrupole time of flight mass spectrometer, rapid, direct sampling and analysis possibilities are exemplified with plastics, ballpoint and felt tip ink pens, skin, and vegetable oils. These results demonstrated that the open port sampling interface could be used as a simple, versatile and self-cleaning system to rapidly introduce multiple types of unprocessed, sometimes highly concentrated and complex, samples into a solvent flow stream for subsequent ionization and analysis by mass spectrometry. The basic setup presented here could be incorporated with any self-aspirating liquid introduction ionization source (e.g., ESI, APCI, APPI, ICP, etc.) or any type of atmospheric pressure sampling ready mass spectrometer system. CONCLUSIONS: The open port sampling interface provides a means to introduce and quickly analyze unprocessed solid or liquid samples with liquid introduction atmospheric pressure ionization source without fear of sampling interface or ionization source contamination.« less

PERSPECTIVES REGARDING ANTENATAL CARE, DELIVERY AND BREAST FEEDING PRACTICES OF WOMEN FROM BALUCHISTAN, PAKISTAN.

PubMed

Khoso, Aneeta; Khan, Ayesha Zahid; Sayed, Sayeeda Amber; Rafique, Ghazala

2016-01-01

Antenatal Care is one of the fundamental rights for women to safeguard their health. Neonatal mortality rates have remained relatively static, compared to the decline in infant and under 5 mortality rates, adverse practices regarding breast feeding and pre-lacteal feeds being the important factors responsible. This study aimed to explore the Antenatal Care, delivery and breastfeeding practices in three districts of Baluchistan. It was a qualitative phenomenological design using Constructivist approach. The study was conducted in three districts of Baluchistan province, Gwadar, Quetta, Qila Saifullah. There were a total of 14 Focus Group Discussions with women regarding Antenatal Care, delivery and Breastfeeding practices, followed by audio taping, transcription as verbatim and analysis through Nvivo version 2. A process was deployed for identification and reporting of the components in order to ensure quality and validity of the qualitative findings. Across the sites, women attended ANC at least once. However, their descriptions of ANC often varied. The women preferred Dais instead of doctors, due to the affordability, customs and availability. A lack of trained doctors and long distances to get a check-up lead to home deliveries in the study setting. Colostrum was discarded by majority of the mothers, while prelacteal feed was a common practice. This paper has explored factors affecting ANC attendance, delivery and breast feeding practices across three settings. Both the demand and supply side factors have an important influence on practices.

Sun safety knowledge and practice in UK postal delivery workers.

PubMed

Houdmont, J; Davis, S; Griffiths, A

2016-06-01

Postal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK. To describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential strategies for improving sun safety in this occupational group. Postal delivery workers completed a questionnaire that collected data on occupational sun safety knowledge and practice in addition to demographic, personal and workplace characteristics. One-way analysis of variances were applied to assess differences in knowledge and practice by these characteristics. A total of 1153 postal delivery workers completed the questionnaire, a 60% response rate. Thirty-three per cent reported receiving sun safety training within the previous 12 months. The majority of respondents reported correct knowledge on three of the six domains and good practice on four of the six behavioural domains. However, only one-fifth of respondents reported wearing sunglasses and ensuring a plentiful intake of water. Knowledge and practice differed significantly according to demographic, personal and workplace characteristics. There is a need to raise the profile of occupational skin cancer in this occupational group and to increase the priority given to occupational sun safety policies alongside targeted and tailored interventions, the effect of which can be evaluated. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine.

Evaluation of Urban Freight Deliveries using Microsimulation and Surrogate Safety Measures

DOT National Transportation Integrated Search

2018-02-01

Freight deliveries on signalized urban streets are known to cause lane blockages during deliveries. When delivery vehicles block lanes of traffic near signalized intersections, the capacity of the intersection is affected. Current practice is for tra...

A perspective study on green cleaning for Malaysian public hospital

NASA Astrophysics Data System (ADS)

Ramli, N. A.; Zawawi, E. M.; Arif, N. R. M.; Mahbob, N. S.; Sulaiman, Z.; Zainol, N. N.

2018-02-01

Cleaning being a major contributor to the operations and maintenance expenditure and also Indoor Environmental Quality (IEQ) issues. Improper and ineffective cleaning can harm the environment and poses greatest risk to health. The use of traditional cleaning products presents a variety of human health and ecological concerns; and may contribute to poor IEQ. As an effort to reduce the issue of operations and maintenance costs and IEQ issues in a building, it is important to establish a green cleaning programme to ensure that the buildings are cleaned in a green way. Numbers of scholars has pointed out the factors which had prevented the green cleaning implementation in hospital buildings. Nonetheless, the significance of these factors has yet to be practically explored in the Malaysian context. Hence, the aim of the paper is to identify the most critical factor that prevents the implementation of green cleaning in Malaysian hospital building. A questionnaire survey and personal communication (i.e. interview) was conducted which involved two groups of respondents. They are the hospital maintenance staff (Cleansing Service Department) and cleaning contractors. Frequency and criticality index calculations have been used to rank these factors according to the level of importance. The result showed that an “unclear components and requirements of green cleaning” indicated as the most critical factor that prevent the implementation of green cleaning in Malaysian hospital building. In the concern for a successful implementation of green cleaning, it is hope that the findings of these studies can be enlightenment to the cleaning contractors as well as the hospital maintenance management team in Malaysia.

Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals .

PubMed

Carling, P C; Parry, M F; Von Beheren, S M

2008-01-01

The quality of environmental hygiene in hospitals is under increasing scrutiny from both healthcare providers and consumers because the prevalence of serious infections due to multidrug-resistant pathogens has reached alarming levels. On the basis of the results from a small number of hospitals, we undertook a study to evaluate the thoroughness of disinfection and cleaning in the patient's immediate environment and to identify opportunities for improvement in a diverse group of acute care hospitals. Prospective multicenter study to evaluate the thoroughness of terminal room cleaning in hospitals using a novel targeting method to mimic the surface contamination of objects in the patient's immediate environment. Twenty-three acute care hospitals. The overall thoroughness of terminal cleaning, expressed as a percentage of surfaces evaluated, was 49% (range for all 23 hospitals, 35%-81%). Despite the tight clustering of overall cleaning rates in 21 of the hospitals, there was marked variation within object categories, which was particularly notable with respect to the cleaning of toilet handholds, bedpan cleaners, light switches, and door knobs (mean cleaning rates, less than 30%; institutional ranges, 0%-90%). Sinks, toilet seats, and tray tables, in contrast, were consistently relatively well cleaned (mean cleaning rates, over 75%). Patient telephones, nurse call devices, and bedside rails were inconsistently cleaned. We identified significant opportunities in all participating hospitals to improve the cleaning of frequently touched objects in the patient's immediate environment. The information obtained from such assessments can be used to develop focused administrative and educational interventions that incorporate ongoing feedback to the environmental services staff, to improve cleaning and disinfection practices in healthcare institutions.

Use of cryopumps on large space simulation systems

NASA Technical Reports Server (NTRS)

Mccrary, L. E.

1980-01-01

The need for clean, oil free space simulation systems has demanded the development of large, clean pumping systems. The assurance of optically dense liquid nitrogen baffles over diffusion pumps prevents backstreaming to a large extent, but does not preclude contamination from accidents or a control failure. Turbomolecular pumps or ion pumps achieve oil free systems but are only practical for relatively small chambers. Large cryopumps were developed and checked out which do achieve clean pumping of very large chambers. These pumps can be used as the original pumping system or can be retrofitted as a replacement for existing diffusion pumps.

Assessment of infection control practices in maternity units in Southern Nigeria.

PubMed

Friday, Okonofua; Edoja, Okpokunu; Osasu, Aigbogun; Chinenye, Nwandu; Cyril, Mokwenye; Lovney, Kanguru; Julia, Hussein

2012-12-01

Puerperal sepsis accounts for 12% of maternal deaths in Nigeria. To date, little is known about the background hospital factors that predispose pregnant women to puerperal infection that leads to mortality. The objective of this study was to investigate the nature and pattern of existing policies and practices relating to infection control in maternity care centres in Edo state, South-South Nigeria. Cross-sectional study consisting of in-depth interviews with service providers, observation of clinical practices and examination of medical records. Public and private health-care facilities in eight local government areas (LGAs) selected from the three senatorial districts of Edo State, Nigeria. Health providers from 63 primary, secondary and tertiary maternity care centres. Sixty-three health-care facilities were sampled from eight LGAs from the three senatorial districts in Edo State. Three pre-tested tools were adapted to the local setting and used to interview key informants in the health facilities and to observe for practices and records relating to infection control. Of the 63 health facilities, 68% (43) reported that they had infection control procedures in place, while only 25% (16) reported that they documented these as manuals or charts. Only 13% (8) of facilities had infection control committees; 11% (7) routinely carried out audits of maternal deaths, while 33% (21) reported that they had an ongoing programme for staff training on infection control. A high proportion of the health facilities reported that staff routinely wash their hands before and after sterile procedures, but only half of the facilities were observed to have 24-h running water and only two-thirds had soap and antiseptic solutions in delivery and operating theatre areas. Although more than 90% (57) of the health facilities reported that they use sterile gloves routinely, unused sterile gloves were found in only 60% (38) of these facilities, and recycled gloves in 11.1% (7). The results of this study suggest the need for improved record-keeping procedures, the development of appropriate policies and protocols for infection control and staff training on infection control in maternity care facilities in Edo State. A public health education and advocacy programme to create awareness on clean delivery places as an approach for reducing maternal morbidity and mortality and to build political will for implementing related activities is also urgently needed.

Financial Incentives to Enable Clean Energy Deployment: Policy Overview and Good Practices

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

Cox, Sadie

Financial incentives have been widely implemented by governments around the world to support scaled up deployment of renewable energy and energy efficiency technologies and practices. As of 2015, at least 48 countries have adopted financial incentives to support renewable energy and energy efficiency deployment. Broader clean energy strategies and plans provide a crucial foundation for financial incentives that often complement regulatory policies such as renewable energy targets, standards, and other mandates. This policy brief provides a primer on key financial incentive design elements, lessons from different country experiences, and curated support resources for more detailed and country-specific financial incentive designmore » information.« less

Evaluation of a hygiene monitor for detection of contamination in dental surgeries.

PubMed

Douglas, C W; Rothwell, P S

1991-05-11

Routines for disinfecting working surfaces in dental surgeries are difficult to monitor without time-consuming and labour-intensive microbiological techniques, yet effective monitoring is a vital part of cross-infection control. Easy to use, on-site methods would be valuable in this context. This study evaluates a portable monitor, the Biotrace Hygiene Monitor, which uses bioluminescence to measure adenosine triphosphate (ATP) on surfaces. Under laboratory conditions, the ability of the monitor to detect whole saliva and Streptococcus sanguis was determined and, in the general practice environment, the level of ATP on surfaces in five dental surgeries was assessed. The minimum amount of saliva detectable was 0.5 microliters and in surgeries, the monitor readily identified numerous surfaces with fairly high levels of ATP. Routine cleaning methods sometimes left ATP on surfaces at levels which represented a cross-infection risk, if it is assumed that the ATP derived from patients' saliva. Modification of cleaning methods resulted in a reduction of ATP levels to within that which could be considered reasonably practicably safe. It is concluded that the Biotrace Hygiene Monitor offers a simple and valuable means of monitoring dental practice cleaning routines.

Needle and Syringe Cleaning Practices among Injection Drug Users.

ERIC Educational Resources Information Center

Fisher, Dennis G.; Harbke, Colin R.; Canty, John R.; Reynolds, Grace L.

2002-01-01

Evaluates the effect of needle exchange on the bleach-mediated disinfection (BMD) practices of 176 needle and syringe sharing injection drug users (IDUs). Results reveal that IDUs who traded sex for money or drugs were less likely to practice BMD, and IDUs who reported a reduced number of sex partners were more likely to practice BMD. (Contains 36…

Family-centred care delivery: comparing models of primary care service delivery in Ontario.

PubMed

Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

2013-11-01

To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Cross-sectional study. Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. A total of 137 practices, 363 providers, and 5144 patients. Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.

Practice Bulletin No. 161 Summary: External Cephalic Version.

PubMed

2016-02-01

In the United States, there is a widespread belief that the overall cesarean delivery rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean delivery, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.

Practice Bulletin No. 161: External Cephalic Version.

PubMed

2016-02-01

In the United States, there is a widespread belief that the overall cesarean delivery rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean delivery, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.

An Innovation for Global Clean Water

NASA Technical Reports Server (NTRS)

1995-01-01

Under contract to NASA, Umpqua Research developed the Microbial Check Valve (MCV) iodine-dispensing system for the Space Shuttle Orbiter, introduced in 1979 to purify astronauts' drinking water. In 1989, NASA awarded the company a new contract to develop a system for continuous iodine release over long periods for use in the International Space Station. In 1993, the company demonstrated the Regenerable Biocide Delivery Unit, and NASA granted it an exclusive license.

Small bugs with big impacts: Ecosystem and watershed-level responses to the MPB epidemic [Chapter 7

Treesearch

Rob Hubbard; Kelly Elder; Chuck Rhoades; Polly Hays; Bruce Sims

2014-01-01

Mountain pine beetle (MPB) outbreaks have the potential for prolonged impacts on the delivery of clean water from infested subalpine watersheds throughout the West. Sixty-five percent of the West’s water supply originates on forested land (Brown and others 2008), much of which has been affected by an unprecedented MPB epidemic over the past decade. Some lodgepole pine...

Refining and validating a conceptual model of Clinical Nurse Leader integrated care delivery.

PubMed

Bender, Miriam; Williams, Marjory; Su, Wei; Hites, Lisle

2017-02-01

To empirically validate a conceptual model of Clinical Nurse Leader integrated care delivery. There is limited evidence of frontline care delivery models that consistently achieve quality patient outcomes. Clinical Nurse Leader integrated care delivery is a promising nursing model with a growing record of success. However, theoretical clarity is necessary to generate causal evidence of effectiveness. Sequential mixed methods. A preliminary Clinical Nurse Leader practice model was refined and survey items developed to correspond with model domains, using focus groups and a Delphi process with a multi-professional expert panel. The survey was administered in 2015 to clinicians and administrators involved in Clinical Nurse Leader initiatives. Confirmatory factor analysis and structural equation modelling were used to validate the measurement and model structure. Final sample n = 518. The model incorporates 13 components organized into five conceptual domains: 'Readiness for Clinical Nurse Leader integrated care delivery'; 'Structuring Clinical Nurse Leader integrated care delivery'; 'Clinical Nurse Leader Practice: Continuous Clinical Leadership'; 'Outcomes of Clinical Nurse Leader integrated care delivery'; and 'Value'. Sample data had good fit with specified model and two-level measurement structure. All hypothesized pathways were significant, with strong coefficients suggesting good fit between theorized and observed path relationships. The validated model articulates an explanatory pathway of Clinical Nurse Leader integrated care delivery, including Clinical Nurse Leader practices that result in improved care dynamics and patient outcomes. The validated model provides a basis for testing in practice to generate evidence that can be deployed across the healthcare spectrum. © 2016 John Wiley & Sons Ltd.

A model for choosing an automated ultraviolet-C disinfection system and building a case for the C-suite: Two case reports.

PubMed

Spencer, Maureen; Vignari, Michelle; Bryce, Elizabeth; Johnson, Helen Boehm; Fauerbach, Loretta; Graham, Denise

2017-03-01

Environmental disinfection has become the new frontier in the ongoing battle to reduce the risk of health care-associated infections. Evidence demonstrating the persistent contamination of environmental surfaces despite traditional cleaning and disinfection methods has led to the widespread acceptance that there is both a need for reassessing traditional cleaning protocols and for using secondary disinfection technologies. Ultraviolet-C (UV-C) disinfection is one type of no-touch technology shown to be a successful adjunct to manual cleaning in reducing environmental bioburden. The dilemma for the infection preventionist, however, is how to choose the system best suited for their facility among the many UV-C surface disinfection delivery systems available and how to build a case for acquisition to present to the hospital administration/C-suite. This article proposes an approach to these dilemmas based in part on the experience of 2 health care networks. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

[Waste management in hospitals. Current situation in the state of North Rhine-Westphalia].

PubMed

Popp, W; Hansen, D; Hilgenhöner, M; Grandek, M; Heinemann, A; Blättler, T

2009-07-01

In 20 hospitals in North Rhine-Westphalia in-plant handling wastes and the delivery of the waste to the disposer were examined. Deficits were seen regarding risk assessment and operating instructions, support by company doctors, personal protection equipment, and break areas for the waste collecting personnel. Also the qualification of the waste management officer and his/her time contingent, correct declaration of the wastes, the training of the waste collecting personnel, the cleaning of multi-use containers and transportation vehicles, storage of the wastes at the collecting points, and the use of sharp collecting boxes were to be partly criticized. Consequences and recommendations are given, concerning the company's obligations (e.g., provide risk assessment, operating instructions), waste management officer (e.g., qualification, enough time contingent, regular inspections), waste collecting personnel (e.g., training courses), industrial safety (e.g., protection equipment, break area wash places), company doctors, transportation vehicles in the house (e.g., regular cleaning), one-way collectors (e.g., labelling at the site of the collection), multi-use collectors (e.g., cleaning), and compressing containers (e.g., larger maintenance openings).

The medicalization of addiction treatment professionals.

PubMed

Roy, A Kenison; Miller, Michael M

2012-01-01

In a previous article, the authors described the changes initiated by recent health care legislation, and how those changes might affect the practice of medicine and the delivery of addiction services. This article reviews the same changes with respect to how they have the potential to change the practice activities of addiction physicians, addiction therapists, addiction counselors and addiction nurses, as well as the activities of administrators and service delivery financial personnel. Developments in delivery systems and the impact of those developments on professionals who work in addiction treatment are considered; current problems, potential solutions, and opportunities for clinicians under health reform are addressed. The goals envisioned for health system reform and the potential for realization of those goals via changes in addiction service delivery design and clinical practice are discussed.

Military Standard: Sanitation Standards for Food Storage Facilities

DTIC Science & Technology

1989-08-31

maintenance of equipment and utensils ---------------------- 10 5.11 Cleaning and sanitizing treatment ------------- 10 5.12 Methods ...STD-909 3. DEFINITIONS 3.1 Adequate. Methods that are needed to accomplish the intended purpose in keeping with accepted public health practices. 3.2...Inspection and Grading Programs" or approved by the Major Army Command (MACON) Surgeon. 5.11 Cleaning and sanitizing treatment. The methods used for

7 CFR 51.2956 - Practically clean.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., CERTIFICATION, AND STANDARDS) United States Standards for Grades of Walnuts in the Shell Definitions § 51.2956... practically free from adhering dirt or other foreign matter, and that individual walnuts are not damaged by... not be considered as dirt or foreign matter. ...

7 CFR 51.2956 - Practically clean.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., CERTIFICATION, AND STANDARDS) United States Standards for Grades of Walnuts in the Shell Definitions § 51.2956... practically free from adhering dirt or other foreign matter, and that individual walnuts are not damaged by... not be considered as dirt or foreign matter. ...

Clean dealing. Legal considerations for buy/sell agreements.

PubMed

Johnson, Bruce A

2002-01-01

Buy/sell agreements for medical practices relate as much to governance and power as to dollars and cents. A practice should consider strategic, financial and legal issues in the buy/sell arrangement and express them in the group's legal documents.

Wheelchair cleaning and disinfection in Canadian health care facilities: "That's wheelie gross!".

PubMed

Gardner, Paula; Muller, Matthew P; Prior, Betty; So, Ken; Tooze, Jane; Eum, Linda; Kachur, Oksana

2014-11-01

Wheelchairs are complex equipment that come in close contact with individuals at increased risk of transmitting and acquiring antibiotic-resistant organisms and health care-associated infection. The purpose of this study was to determine the status of wheelchair cleaning and disinfection in Canadian health care facilities. Acute care hospitals (ACHs), chronic care hospitals (CCHs), and long-term care facilities (LTCFs) were contacted and the individual responsible for oversight of wheelchair cleaning and disinfection was identified. A structured interview was conducted that focused on current practices and concerns, barriers to effective wheelchair cleaning and disinfection, and potential solutions. Interviews were completed at 48 of the 54 facilities contacted (89%), including 18 ACHs, 16 CCHs, and 14 LTCFs. Most (n = 24) facilities had 50-200 in-house wheelchairs. Respondents were very concerned about wheelchair cleaning as an infection control issue. Specific concerns included the lack of reliable systems for tracking and identifying dirty and clean wheelchairs (71%, 34/48), failure to clean and disinfect wheelchairs between patients (52%, 25/48), difficulty cleaning cushions (42%, 20/48), lack of guidelines (35%, 27/48), continued use of visibly soiled wheelchairs (29%, 14/48) and lack of resources (25%, 12/48). Our results suggest that wheelchair cleaning and disinfection is not optimally performed at many Canadian hospitals and LTCFs. Specific guidance on wheelchair cleaning and disinfection is necessary. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

"The Invisible Staff": A Qualitative Analysis of Environmental Service Workers' Perceptions of the VA Clostridium difficile Prevention Bundle Using a Human Factors Engineering Approach.

PubMed

Yanke, Eric; Moriarty, Helene; Carayon, Pascale; Safdar, Nasia

2018-06-11

Using a novel human factors engineering approach, the Systems Engineering Initiative for Patient Safety model, we evaluated environmental service workers' (ESWs) perceptions of barriers and facilitators influencing adherence to the nationally mandated Department of Veterans Affairs Clostridium difficile infection (CDI) prevention bundle. A focus group of ESWs was conducted. Qualitative analysis was performed employing a visual matrix display to identify barrier/facilitator themes related to Department of Veterans Affairs CDI bundle adherence using the Systems Engineering Initiative for Patient Safety work system as a framework. Environmental service workers reported adequate cleaning supplies/equipment and displayed excellent knowledge of CDI hand hygiene requirements. Environmental service workers described current supervisory practices as providing an acceptable amount of time to clean CDI rooms, although other healthcare workers often pressured ESWs to clean rooms more quickly. Environmental service workers reported significant concern for CDI patients' family members as well as suggesting uncertainty regarding the need for family members to follow infection prevention practices. Small and cluttered patient rooms made cleaning tasks more difficult, and ESW cleaning tasks were often interrupted by other healthcare workers. Environmental service workers did not feel comfortable asking physicians for more time to finish cleaning a room nor did ESWs feel comfortable pointing out lapses in physician hand hygiene. Multiple work system components serve as barriers to and facilitators of ESW adherence to the nationally mandated Department of Veterans Affairs CDI bundle. Environmental service workers may represent an underappreciated resource for hospital infection prevention, and further efforts should be made to engage ESWs as members of the health care team.

Infection prevention and control in home nursing: case study of four organisations in Australia.

PubMed

Felemban, Ohood; St John, Winsome; Shaban, Ramon Zenel

2015-09-01

The aim of this case study was to explore the environmental challenges nurses experience with infection control practice, and the strategies they use to overcome those challenges. An exploratory case study was conducted in four home visiting nursing organisations in southeast Queensland, Australia, using data triangulation (document review, individual interviews, and focus groups). Data were analysed using a framework approach to identify themes. Three major infection prevention and control challenges were experienced in the community context. The first challenge is the nature of the work environment, including: poor cleanliness in clients' home environments, pets or vermin, inadequate hand-washing facilities, and a lack of appropriate storage space for clinical materials. The second challenge occurs when nurses lack access to appropriate infection control equipment, including wound-management materials and sharps containers. The third challenge is dealing with clients' poor personal hygiene and health status. Participants addressed these issues by offering assistance, using clean surfaces at clients' homes, applying an alcohol-based hand rub, providing client education, and reducing the cost of purchasing equipment for clients. It is imperative that policy is developed to support nurses' decision making and practices as they address infection control challenges in the community environment. Ensuring staff are well-supported with resources, education, policy, and guidelines to address these challenges is important for the delivery of safe and high-quality care in community settings.

The changing health care delivery structure: opportunities for nursing practice and administration.

PubMed

Barter, M; Graves, J; Phoon, J; Corder, K

1995-01-01

The increase in national health care expenditures has placed great stress on the economy and has contributed to a widespread consensus that reform of the health care delivery system is necessary. Three interrelated strategies are frequently used to cope with the turbulent environment in the health care industry today: managed care, hospital merger and acquisition to form integrated health care delivery systems, and redefined roles for nurses and other health care workers. These strategies have profound implications and will offer great opportunities for nursing administrators to foster nursing practice in new and improved systems of care delivery.

Examining factors that influence the effectiveness of cleaning antineoplastic drugs from drug preparation surfaces: a pilot study.

PubMed

Hon, Chun-Yip; Chua, Prescillia Ps; Danyluk, Quinn; Astrakianakis, George

2014-06-01

Occupational exposure to antineoplastic drugs has been documented to result in various adverse health effects. Despite the implementation of control measures to minimize exposure, detectable levels of drug residual are still found on hospital work surfaces. Cleaning these surfaces is considered as one means to minimize the exposure potential. However, there are no consistent guiding principles related to cleaning of contaminated surfaces resulting in hospitals to adopt varying practices. As such, this pilot study sought to evaluate current cleaning protocols and identify those factors that were most effective in reducing contamination on drug preparation surfaces. Three cleaning variables were examined: (1) type of cleaning agent (CaviCide®, Phenokil II™, bleach and chlorhexidine), (2) application method of cleaning agent (directly onto surface or indirectly onto a wipe) and (3) use of isopropyl alcohol after cleaning agent application. Known concentrations of antineoplastic drugs (either methotrexate or cyclophosphamide) were placed on a stainless steel swatch and then, systematically, each of the three cleaning variables was tested. Surface wipes were collected and quantified using high-performance liquid chromatography-tandem mass spectrometry to determine the percent residual of drug remaining (with 100% being complete elimination of the drug). No one single cleaning agent proved to be effective in completely eliminating all drug contamination. The method of application had minimal effect on the amount of drug residual. In general, application of isopropyl alcohol after the use of cleaning agent further reduced the level of drug contamination although measureable levels of drug were still found in some cases.

Application of planetary quarantine methodology and spacecraft sterilization technology to improved health care delivery.

NASA Technical Reports Server (NTRS)

Green, R. H.

1972-01-01

In 1969 the Jet Propulsion Laboratory undertook an investigation to determine which of its space-derived capabilities could make significant contributions to the improvement of health care delivery in the U.S. The area of planetary quarantine was identified as one of high relevance. Two studies were conducted in this connection. The first study, which could contribute to infection reduction and control, was concerned with conversion of infection implicated complex, nonheat sterilizable equipment to dry heat, sterilizable equipment by changes in design and materials of construction. The second study area related to hospital acquired infection is clean room technology. A definite investigation has been performed to demonstrate and statistically evaluate performance under controlled conditions.

Spacecraft surgical scrub system

NASA Technical Reports Server (NTRS)

Abbate, M.

1980-01-01

Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

Society of Behavioral Medicine's (SBM) position on emerging policy issues regarding electronic nicotine delivery systems (ENDS): A need for regulation.

PubMed

Rojewski, Alana M; Coleman, Nortorious; Toll, Benjamin A

2016-09-01

Electronic nicotine delivery systems (ENDS), commonly known as electronic cigarettes (or e-cigarettes), are widely available in the USA, yet almost entirely unregulated on a national level. Researchers are currently gathering data to understand the individual and public health effects of ENDS, as well as the role that ENDS may play in tobacco treatment. Given these uncertainties, regulatory efforts should be aimed at understanding and minimizing any potential harms of ENDS. The Society of Behavioral Medicine (SBM) supports stronger regulation of ENDS, incorporation of ENDS into clean air policies, and special consideration of safety standards to protect vulnerable populations. SBM also supports research on ENDS to guide policy decisions.

Creating Welcoming Spaces for Lesbian, Gay, Bisexual, and Transgender (LGBT) Patients: An Evaluation of the Health Care Environment.

PubMed

McClain, Zachary; Hawkins, Linda A; Yehia, Baligh R

2016-01-01

Health outcomes are affected by patient, provider, and environmental factors. Previous studies have evaluated patient-level factors; few focusing on environment. Safe clinical spaces are important for lesbian, gay, bisexual, and transgender (LGBT) communities. This study evaluates current models of LGBT health care delivery, identifies strengths and weaknesses, and makes recommendations for LGBT spaces. Models are divided into LGBT-specific and LGBT-embedded care delivery. Advantages to both models exist, and they provide LGBT patients different options of healthcare. Yet certain commonalities must be met: a clean and confidential system. Once met, LGBT-competent environments and providers can advocate for appropriate care for LGBT communities, creating environments where they would want to seek care.

Characterization and Delivery of Hanford High-Level Radioactive Waste Slurry

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

Thien, Michael G.; Denslow, Kayte M.; Lee, K. P.

2014-11-15

Two primary challenges to characterizing Hanford’s high-level radioactive waste slurry prior to transfer to a treatment facility are the ability to representatively sample million-gallon tanks and to estimate the critical velocity of the complex slurry. Washington River Protection Solutions has successfully demonstrated a sampling concept that minimizes sample errors by collecting multiple sample increments from a sample loop where the mixed tank contents are recirculated. Pacific Northwest National Laboratory has developed and demonstrated an ultrasonic-based Pulse-Echo detection device that is capable of detecting a stationary settled bed of solids in a pipe with flowing slurry. These two concepts are essentialmore » elements of a feed delivery strategy that drives the Hanford clean-up mission.« less

Acute dialysis and continuous renal replacement: the emergence of new technology involving the nephrologist in the intensive care setting.

PubMed

Yagi, N; Paganini, E P

1997-07-01

The emergence of dialytic support for patients with reversible renal failure was one of the most significant advances in critical care medicine. Supporting a patient with a failed organ till organ recovery has not had the same success with other organ failures. Despite the indispensable nature of the support, dialysis was intermittent at best, and carried its own morbidity. The emergence of a "continuous" dialysis delivery system, originally through an arteriovenous access and later through veno-venous methodology, began to simulate the continuity of the natural kidney, and lifted much of the fluid and drug restrictions imposed by the intermittent nature of standard dialytic therapies. Components of the system were next reviewed for improvement and biocompatability. Differences in patient outcome were documented with various component comparisons, and disparate patient tolerance of delivery modality was also clearly proven. The hemodynamic stability of continuous treatment created utilization to be focused on the more unstable, the more severely compromised patient group. In this context, comparative studies with intermittent delivery methods showed improved hemodynamic stability among patients treated with continuous renal replacement therapies (CRRT), but no clear difference in patient mortality. Patient characteristics and severity scoring have recently been undertaken to better describe the population, and attempts at dialysis dosing is currently being developed for ARF dialysis recipients. Early results seem to point toward a dialysis dose effect on mortality in certain groups of ICU acute renal failure patients. However, the dialytic process is only depurative and artificial. Plastic membrane bio-incompatibility, human physiological responses to foreign material exposure, either in the circuit material itself or introduced from therapy methodology, pose practical and theoretical problems. Recent advances in the field of bio-artificial technology have allowed the development of functioning hybrid "blood processors," which function as a renal tubule and may be able to not only "clean" blood, but also allow for other cellular functions not currently possible with dead membrane technology. Combining living cells with a continuous delivery method may be the next significant step toward a fully functional renal replacement therapy.

The impact of the Quality and Outcomes Framework on practice organisation and service delivery: summary of evidence from two qualitative studies.

PubMed

Checkland, Kath; Harrison, Stephen

2010-01-01

In 2003, the new General Medical Services Contract introduced a pay-for-performance programme know as the Quality and Outcomes Framework (QOF) into UK general practice, with payment for meeting a number of both clinical and organisational quality standards. To investigate in detail the impact of the QOF on practice organisation and service delivery. Two linked qualitative case studies in England and Scotland, using interviews and observation to investigate in depth the impact of the QOF in four general medical practices. A number of significant changes to practice organisation and service delivery were observed, including: changes to practice organisational structures; an increased role for information technology; a move towards a more biomedical form of medical care; and changes to roles and relationships, including the introduction of internal peer-review and surveillance. In spite of this, the practices maintained a narrative of 'no change', arguing that they had 'fitted QOF in' to their routines with little trouble.

Navigating change: how outreach facilitators can help clinicians improve patient outcomes.

PubMed

Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

2012-01-01

The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care. We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program. Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access. The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve.

Use of previous maternal health services has a limited role in reattendance for skilled institutional delivery: cross-sectional survey in Northwest Ethiopia

PubMed Central

Kebede, Bekana; Gebeyehu, Abebaw; Andargie, Gashaw

2013-01-01

Background Maternal mortality rates are unacceptably high in Ethiopia. Institutional delivery with skilled care of the mother is one of the interventions proven to reduce the risk of complications that can cause maternal and neonatal mortality. Quality of service given during antenatal visits and childbirth are important measures. The purpose of this study was to investigate the use of skilled institutional delivery and its repeat use during a subsequent pregnancy and to identify any reasons why women avoid institutional delivery. Methods A community-based cross-sectional study was conducted from March to June 2012 in Chilga Woreda, Northwest Ethiopia. Data were collected from women who gave birth during the year preceding the survey. Information was entered and cleaned using the Statistical Package for Social Sciences. Multivariate and binary logistic regression was used to identify the relative effect of each explanatory variable on the outcome. Results A total of 402 (84.2%) women gave birth at home. Previous experience of skilled institutional delivery had a limited role in subsequent acceptance or use of institutional delivery. Most mothers who had previously had institutional delivery gave birth at home. Although 111 (40.8%) women visited the health facility during their pregnancy only because of illness, 184 (38.8%) did not know when to visit for antenatal care. In multivariate analysis, lower maternal education, being a rural resident, previous use of institutional delivery, remoteness of the health facility, and multiparity were factors significantly associated with less likelihood of institutional delivery. Number of months pregnant at the time of the first antenatal visit had no role in increasing the likelihood of institutional delivery. Conclusion The quality of the obstetric services presently available for women living in Ethiopia needs review. PMID:23459063

Modeling the Delivery Physiology of Distributed Learning Systems.

ERIC Educational Resources Information Center

Paquette, Gilbert; Rosca, Ioan

2003-01-01

Discusses instructional delivery models and their physiology in distributed learning systems. Highlights include building delivery models; types of delivery models, including distributed classroom, self-training on the Web, online training, communities of practice, and performance support systems; and actors (users) involved, including experts,…

Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

PubMed

Jones, Judith A; Snyder, John J; Gesko, David S; Helgeson, Michael J

2017-09-01

Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Simulation of conservation practices using the APEX model

USDA-ARS?s Scientific Manuscript database

Information on agricultural Best Management Practices (BMPs) and their effectiveness in controlling agricultural non-point source pollution is crucial in developing Clean Water Act programs such as the Total Maximum Daily Loads for impaired watersheds. A modeling study was conducted to evaluate var...

40 CFR 22.38 - Supplemental rules of practice governing the administrative assessment of civil penalties under...

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Supplemental rules of practice governing the administrative assessment of civil penalties under the Clean Water Act. 22.38 Section 22.38 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CONSOLIDATED RULES OF PRACTICE GOVERNING THE ADMINISTRATIVE ASSESSMENT OF CIVIL...

Future trends in health and health care: implications for social work practice in an aging society.

PubMed

Spitzer, William J; Davidson, Kay W

2013-01-01

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.

Community knowledge, awareness and preventive practices regarding dengue fever in Puducherry - South India.

PubMed

Jeelani, S; Sabesan, S; Subramanian, S

2015-06-01

To ascertain the knowledge, attitudes and practices of adult population in Puducherry, India, regarding Dengue Fever (DF). A cross-sectional survey was carried out to assess the Knowledge, Awareness and Preventive practices (KAP) among a selected community in Puducherry on DF, following a major dengue outbreak in 2012. Between October 2012 & February 2013, an epidemiological survey was conducted among 400 households (HHs) from the most affected areas during dengue outbreak, which came under eight health delivery jurisdictions i.e. Primary Health Centres (PHCs) in Puducherry. Knowledge of dengue and the use of preventive measures were assessed by means of a pre-tested structured questionnaire. Logistic regression analysis was done to examine the association between different levels of education and income status with the knowledge of DF. The DF knowledge map was created based on the results achieved through the questionnaire using Arc GIS 10.2 software. Although about 86% of the participants had heard of dengue, although there was no adequate knowledge on dengue vector breeding habitat as 68% of the respondents thought drains & garbage as breeding places of dengue vectors. Only 25% of participants were aware of clean water as a breeding habitat. Insufficient knowledge of disease symptoms was found, with fever (59%) being the most common symptom. There is a lack of in-depth knowledge on dengue epidemiology in the Puducherry community and observation revealed that more needs to be done by the Government as well as community members to prevent vector mosquito breeding. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Lessons learned from a single institution's retrospective analysis of emergent cesarean delivery following external cephalic version with and without neuraxial anesthesia.

PubMed

Ainsworth, A; Sviggum, H P; Tolcher, M C; Weaver, A L; Holman, M A; Arendt, K W

2017-05-01

To evaluate the risk of emergent cesarean delivery with the use of neuraxial anesthesia for external cephalic version in a single practice. Randomized trials have shown increased external cephalic version success when neuraxial anesthesia is used, without additional risk. We hypothesized that in our actual clinical practice, outside the confines of randomized trials, neuraxial anesthesia could be associated with an increased risk of emergent cesarean delivery. This retrospective cohort study included all women who underwent external cephalic version at a single institution with and without neuraxial anesthesia. The primary outcome was the incidence of emergent cesarean delivery (defined as delivery within 4hours of version). Secondary outcomes were version success and ultimate mode of delivery. A total of 135 women underwent external cephalic version procedures; 58 with neuraxial anesthesia (43.0%) and 77 without (57.0%). Location of the procedure, tocolytic therapy, and gestational age were different between groups. An increased rate of emergent cesarean delivery was found in procedures with neuraxial anesthesia compared to procedures without (5/58 (8.6%) compared to 0/77 (0.0%); 95% CI for difference, 1.4 to 15.8%; P=0.013). In this single hospital's practice, patients who may be at higher risk of complications and have a lesser likelihood of success were provided NA for ECV. As a result, the use of neuraxial anesthesia for external cephalic version was associated with a higher rate of emergent cesarean delivery. Obstetric and anesthetic practices should evaluate their patient selection and procedure protocol for external cephalic version under neuraxial anesthesia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Amplification of pressure waves in laser-assisted endodontics with synchronized delivery of Er:YAG laser pulses.

PubMed

Lukač, Nejc; Jezeršek, Matija

2018-05-01

When attempting to clean surfaces of dental root canals with laser-induced cavitation bubbles, the resulting cavitation oscillations are significantly prolonged due to friction on the cavity walls and other factors. Consequently, the collapses are less intense and the shock waves that are usually emitted following a bubble's collapse are diminished or not present at all. A new technique of synchronized laser-pulse delivery intended to enhance the emission of shock waves from collapsed bubbles in fluid-filled endodontic canals is reported. A laser beam deflection probe, a high-speed camera, and shadow photography were used to characterize the induced photoacoustic phenomena during synchronized delivery of Er:YAG laser pulses in a confined volume of water. A shock wave enhancing technique was employed which consists of delivering a second laser pulse at a delay with regard to the first cavitation bubble-forming laser pulse. Influence of the delay between the first and second laser pulses on the generation of pressure and shock waves during the first bubble's collapse was measured for different laser pulse energies and cavity volumes. Results show that the optimal delay between the two laser pulses is strongly correlated with the cavitation bubble's oscillation period. Under optimal synchronization conditions, the growth of the second cavitation bubble was observed to accelerate the collapse of the first cavitation bubble, leading to a violent collapse, during which shock waves are emitted. Additionally, shock waves created by the accelerated collapse of the primary cavitation bubble and as well of the accompanying smaller secondary bubbles near the cavity walls were observed. The reported phenomena may have applications in improved laser cleaning of surfaces during laser-assisted dental root canal treatments.

75 FR 39216 - Office of Special Education and Rehabilitative Services; Overview Information; National Institute...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-08

...)-- Effective Vocational Rehabilitation (VR) Service Delivery Practices; Notice Inviting Applications for New... in the Federal Register on February 1, 2008 (73 FR 6132). The Effective Vocational Rehabilitation (VR... Centers (RRTC) Requirements and Effective Vocational Rehabilitation (VR) Service Delivery Practices. Note...

Weatherization and Intergovernmental Programs Office FY 2017 Budget At-A-Glance

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

None

2016-03-01

The Weatherization and Intergovernmental Programs (WIP) Office is part of EERE’s balanced research, development, demonstration, and deployment approach to accelerate America’s transition to a clean energy economy. WIP’s mission is to partner with state and local organizations to improve energy security and to significantly accelerate the deployment of clean energy technologies and practices by a wide range of government, community, and business stakeholders.

Selection of a Non-ODC Solvent for Rubber Processing Equipment Cleaning

NASA Technical Reports Server (NTRS)

Morgan, R. E.; Thornton, T. N.; Semmel, L.; Selvidge, S. A.; Cash, Steve (Technical Monitor)

2002-01-01

NASA/MSFC has recently acquired new equipment for the manufacture and processing of rubber and rubber containing items that are used in the RSRM (Reusable Solid Rocket Motor) system. Work with a previous generation of rubber equipment at MSFC (Marshall Space Flight Center) in the 1970's had involved the use of ODC's such as 1,1,1-Trichloroethane or VOC's such as Toluene as the solvents of choice in cleaning the equipment. Neither of these options is practical today. This paper addresses the selection and screening of candidate cleaning solvents that are not only effective, but also meet the new environmental standards.

Selection of a Non-ODC Solvent for Rubber Processing Equipment Cleaning

NASA Technical Reports Server (NTRS)

Morgan, R. E.; Thornton, T. N.; Semmel, L.; Selvidge, S. A.

2003-01-01

NASA/MSFC has recently acquired new equipment for the manufacture and processing of rubber and rubber containing items that are used in the Redesigned Solid Rocket Motor (RSRM) system. Work with a previous generation of rubber equipment at MSFC in the 1970's had involved the use of Oxygen Deficient Center (ODC's) such as 1,1,1-Trichloroethane or VOC's such as Toluene as the solvents of choice in cleaning the equipment. Neither of these options is practical today. This paper addresses the selection and screening of candidate cleaning solvents that are not only effective, but also meet the new environmental standards.

Outdoor cooking prevalence in developing countries and its implication for clean cooking policies

NASA Astrophysics Data System (ADS)

Langbein, Jörg; Peters, Jörg; Vance, Colin

2017-11-01

More than 3 billion people use wood fuels for their daily cooking needs, with detrimental health implications related to smoke emissions. Best practice global initiatives emphasize the dissemination of clean cooking stoves, but these are often expensive and suffer from interrupted supply chains that do not reach rural areas. This emphasis neglects that many households in the developing world cook outdoors. Our calculations suggest that for such households, the use of less expensive biomass cooking stoves can substantially reduce smoke exposure. The cost-effectiveness of clean cooking policies can thus be improved by taking cooking location and ventilation into account.

Environmental cleaning and disinfection.

PubMed

Traverse, Michelle; Aceto, Helen

2015-03-01

The guidelines in this article provide veterinarians, veterinary technicians, and veterinary health care workers with an overview of evidence-based recommendations for the best practices associated with environmental cleaning and disinfection of a veterinary clinic that deals with small animals. Hospital-associated infections and the control and prevention programs necessary to alleviate them are addressed from an environmental perspective. Measures of hospital cleaning and disinfection include understanding mechanisms and types of contamination in veterinary settings, recognizing areas of potential concern, addressing appropriate decontamination techniques and selection of disinfectants, the management of potentially contaminated equipment, laundry, and waste management, and environmental surveillance strategies. Copyright © 2015 Elsevier Inc. All rights reserved.

International Assistance for Low-Emission Development Planning: Coordinated Low Emissions Assistance Network (CLEAN) Inventory of Activities and Tools--Preliminary Trends

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

Cox, S.; Benioff, R.

2011-05-01

The Coordinated Low Emissions Assistance Network (CLEAN) is a voluntary network of international practitioners supporting low-emission planning in developing countries. The network seeks to improve quality of support through sharing project information, tools, best practices and lessons, and by fostering harmonized assistance. CLEAN has developed an inventory to track and analyze international technical support and tools for low-carbon planning activities in developing countries. This paper presents a preliminary analysis of the inventory to help identify trends in assistance activities and tools available to support developing countries with low-emission planning.

A mild and efficient flow procedure for the transfer hydrogenation of ketones and aldehydes using hydrous zirconia.

PubMed

Battilocchio, Claudio; Hawkins, Joel M; Ley, Steven V

2013-05-03

A flow chemistry Meerwein-Ponndorf-Verley (MPV) reduction procedure using partially hydrated zirconium oxide via a machine-assisted approach is reported. The heterogeneous reductive system could be applied to a wide range of functionalized substrates, allowing clean and fast delivery of the alcohol products within a few minutes (6-75 min). In three examples the system was scaled to deliver 50 mmol of product.

Soldering and brazing safety guide: A handbook on space practice for those involved in soldering and brazing

NASA Astrophysics Data System (ADS)

This manual provides those involved in welding and brazing with effective safety procedures for use in performance of their jobs. Hazards exist in four types of general soldering and brazing processes: (1) cleaning; (2) application of flux; (3) application of heat and filler metal; and (4) residue cleaning. Most hazards during those operations can be avoided by using care, proper ventilation, protective clothing and equipment. Specific process hazards for various methods of brazing and soldering are treated. Methods to check ventilation are presented as well as a check of personal hygiene and good maintenance practices are stressed. Several emergency first aid treatments are described.

Attitude and Practice of Birth Attendants Regarding the Presence of Male Partner at Delivery in Nigeria.

PubMed

Adeniran, Abiodun; Adesina, Kikelomo; Aboyeji, Abiodun; Balogun, Olayinka; Adeniran, Peace; Fawole, Adegboyega

2017-03-01

Despite increasing request for the male partners' presence at delivery in developing countries, the view and practice of birth attendants remained poorly understood.This study aimed to evaluate the perception, attitude and practice of birth attendants concerning the requests in Nigeria. A prospective, cross-sectional survey involving consenting birth attendants was conducted in six public and six private health facilities in North Central Nigeria. Statistical analysis was done with SPSS-version 20.0; p-value <0.05 was considered statistically significant. Among 564 participants (24.8% male, 75.2% female), 465(82.4%) support the presence of male partners at delivery, 409(72.5%) desire to be with their partner at delivery, 434(77.0%) had previous request for male partner's presence at delivery while 225(51.8%) declined it due to perception that men will disturb. Among the male partners allowed at delivery, 92(44.0%) did not disturb the birth attendant while 5(2.4%) ended in litigation. Among birth attendants who allowed men at delivery in the past, 160(76.6%) will allow men in the future. There was no statistical significance regarding the age, gender, cadre or year of service of birth attendants and attitude to a protocol change to allow men at delivery. Birth attendants who support the presence of men at delivery showed positive attitude (OR33.178, 95%CI6.996-157.358; p<0.001) while those who opined that men would disturb at delivery had a negative attitude (OR0.306, 95%CI0.124-0.755); p0.010) to possible protocol change. Despite perceived negative effects of allowing male partners at delivery, many birth attendants are willing to allow them if necessary structural modifications are instituted.

Evaluation of the hygiene of ready-to-eat food preparation areas and practices in mobile food vendors in the UK.

PubMed

Little, Christine; Sagoo, Satnam

2009-12-01

This study was undertaken to assess the cleanliness of food preparation areas, cleaning methods used, and the microbiological quality of water used by 1258 mobile food vendors in the UK. Samples collected included potable water (1102), cleaning cloths (801) and environmental swabs from food preparation surfaces (2704). Cleaning cloths were more heavily contaminated with Aerobic Colony Counts, Enterobacteriaceae, Escherichia coli, and Staphylococcus aureus compared to surfaces sampled. Surfaces that were visually dirty, wet, and chopping boards that were plastic or damaged also had high levels of these bacteria. Fifty-four percent of potable water samples were of poor microbiological quality; i.e. contained coliforms, E. coli and/or enterococci. A documented food safety management system was only evident in 40.1% of vendors and cleaning schedules were only used by 43.6%. Deficiencies in the correct use of cleaning materials, such as dilution factors and the minimum contact time for disinfectants, were identified.

Design and development of automatic sharia compliant wheelchair wheels cleaner

NASA Astrophysics Data System (ADS)

Shaari, Muhammad Farid; Rasli, Ibrahim Ismail Mohammad; Jamaludin, M. Z. Z. Wan; Isa, W. A. Mohamad; M., H.; Rashid, A. H. Abdul

2017-04-01

Sharia compliant wheelchair wheel cleaner was developed in order to assist the muslim Person with Disabilities (PWD) to pray in the mosque without leaving their wheelchair because of the filthy wheels. Though there are many wheelchair wheel cleaning system in the market, it is very rare to find sharia compliant cleaning system that applies sertu concept which is one of the cleaning and purification technique in Islamic practice. The sertu concept is based on 6:1 ratio that refers to the six times pipe water cleaning and one time soiled water cleaning. The development process consists of design stage, fabrication and system installation stage and followed by testing stage. During the design stage, the proposed prototype underwent design brainstorming, operation programming and structural simulation analysis. Once fabricated, the cleaner prototype underwent was tested. The results showed that the prototype can cater load up to 100kg with 1.31×10-6 mm shaft bending displacement. The water ejection timing varied approximately 3% compared to the program.

Doping of magnetite nanoparticles facilitates clean harvesting of diatom oil as biofuel for sustainable energy

NASA Astrophysics Data System (ADS)

Kumar, Vikas; Singh, Ramesh; Thakur, Shipra; Ballabh Joshi, Khashti; Vinayak, Vandana

2018-04-01

Photosynthetic unicellular brown algae diatoms are considered as photobioreactors (PBRs) that synthesize and store oil in the form of lipid droplets and the much of the crude oil we use comes from fossil diatoms. The clean extraction of this crude oil from diatoms is difficult task. The construction of green chemical protocols for the clean separation of diatom oil from cells without killing or to harm the diatom cells is still in its primitive stage. In this report we would like to propose that facile doping of magnetite on diatoms can be used for clean oil separation in PBRs. We doped magnetite nanoparticles onto the surface of diatom Diadesmis confervaceae a diatom which oozes oil naturally. Doping magnetite onto diatoms can also facilitate easy separation of oil when cells are kept in an electromagnetic field. The cell wall of diatom besides having SiOH group has 281 amino acids of which 187–188 amino acids are conserved and are known for metal binding sites. The magnetite nanoparticles bind to the SiOH groups and metal binding sites of amino acids. The presence of appropriate amine functionalized linkers forming peptide aminosilane shells can further facilitate the binding of peptide/polypeptides which can be used in drug delivery. Besides this the magnetite doped diatoms have wide applications in removal of phosphates and chromium from waste water too.

Creating Opportunities: Good Practice in Small Business Training for Australian Rural Women.

ERIC Educational Resources Information Center

Simpson, Lyn; Daws, Leonie; Wood, Leanne

2002-01-01

To overcome barriers to participation in small business training faced by rural Australian women, training needs and delivery issues were identified and a good practice matrix was developed with the following components: marketing, content, delivery, support, impact, and innovation. Underlying principles included unique needs, diversity, use of…

Assessment of test methods for evaluating effectiveness of cleaning flexible endoscopes.

PubMed

Washburn, Rebecca E; Pietsch, Jennifer J

2018-06-01

Strict adherence to each step of reprocessing is imperative to removing potentially infectious agents. Multiple methods for verifying proper reprocessing exist; however, each presents challenges and limitations, and best practice within the industry has not been established. Our goal was to evaluate endoscope cleaning verification tests with particular interest in the evaluation of the manual cleaning step. The results of the cleaning verification tests were compared with microbial culturing to see if a positive cleaning verification test would be predictive of microbial growth. This study was conducted at 2 high-volume endoscopy units within a multisite health care system. Each of the 90 endoscopes were tested for adenosine triphosphate, protein, microbial growth via agar plate, and rapid gram-negative culture via assay. The endoscopes were tested in 3 locations: the instrument channel, control knob, and elevator mechanism. This analysis showed substantial level of agreement between protein detection postmanual cleaning and protein detection post-high-level disinfection at the control head for scopes sampled sequentially. This study suggests that if protein is detected postmanual cleaning, there is a significant likelihood that protein will also be detected post-high-level disinfection. It also infers that a cleaning verification test is not predictive of microbial growth. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Self-Reported Halitosis in relation to Oral Hygiene Practices, Oral Health Status, General Health Problems, and Multifactorial Characteristics among Workers in Ilala and Temeke Municipals, Tanzania

PubMed Central

Mumghamba, E. G.

2017-01-01

Aim. To assess self-reported halitosis, oral hygiene practices, oral health conditions, general health problems, sociodemographic factors, and behavioural and psychological characteristics among workers in Ilala and Temeke municipals. Materials and Methods. This was a cross-sectional descriptive study. Four hundred workers were recruited using a self-administered structured questionnaire. Results. Self-reported tooth brushing practice was 100%, tongue cleaning 58.5%, dental flossing 4.3%, gum bleeding on tooth brushing 79.3%, presence of hard deposits on teeth 32%, mobile teeth 15.3%, and self-reported halitosis (SRH) 48.5%. Tea users were 95%, coffee users 75.8%, smokers 21%, and alcohol consumers 47%. The SRH was significantly associated with bleeding gums, hard deposits, and mobile and malaligned teeth. Tongue cleaning and regular change of toothbrush were associated with low prevalence of SRH (P < 0.001). Higher occurrence of SRH was significantly related to low education and smoking. Conclusion. Self-reported halitosis was prevalent among workers and was significantly associated with bleeding gums, hard dental deposits, mobile teeth, and smoking. All participants brushed their teeth and cleaned the tongue regularly but use of dental floss was extremely low. Oral health education and health promotion are recommended. PMID:28280509

Self-Reported Halitosis in relation to Oral Hygiene Practices, Oral Health Status, General Health Problems, and Multifactorial Characteristics among Workers in Ilala and Temeke Municipals, Tanzania.

PubMed

Kayombo, C M; Mumghamba, E G

2017-01-01

Aim. To assess self-reported halitosis, oral hygiene practices, oral health conditions, general health problems, sociodemographic factors, and behavioural and psychological characteristics among workers in Ilala and Temeke municipals. Materials and Methods. This was a cross-sectional descriptive study. Four hundred workers were recruited using a self-administered structured questionnaire. Results. Self-reported tooth brushing practice was 100%, tongue cleaning 58.5%, dental flossing 4.3%, gum bleeding on tooth brushing 79.3%, presence of hard deposits on teeth 32%, mobile teeth 15.3%, and self-reported halitosis (SRH) 48.5%. Tea users were 95%, coffee users 75.8%, smokers 21%, and alcohol consumers 47%. The SRH was significantly associated with bleeding gums, hard deposits, and mobile and malaligned teeth. Tongue cleaning and regular change of toothbrush were associated with low prevalence of SRH ( P < 0.001). Higher occurrence of SRH was significantly related to low education and smoking. Conclusion. Self-reported halitosis was prevalent among workers and was significantly associated with bleeding gums, hard dental deposits, mobile teeth, and smoking. All participants brushed their teeth and cleaned the tongue regularly but use of dental floss was extremely low. Oral health education and health promotion are recommended.

Hand Washing Practices Among Emergency Medical Services Providers.

PubMed

Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

2015-09-01

Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

Hand Washing Practices Among Emergency Medical Services Providers

PubMed Central

Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

2015-01-01

Introduction Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. Methods We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Conclusion Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing. PMID:26587098

Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model

PubMed Central

2014-01-01

Background More than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice. Methods Data from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis. Results Many practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners’ confidence and motivation to perform HKCs. Conclusion Application of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners’ training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children. PMID:24886520

Globalization and sustainable development an E7 point of view

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

Strassburg, W.

1998-07-01

The energy sector is a crucial feedstock to economic development. One example of this industry sector's contribution towards sustainable development is the so-called E7 initiative on sustainable energy development of some of the biggest electric utilities. E7 members from Canada, France, Germany, Italy, Japan and the US are demonstrating the functioning of the requested globally synchronized approach between developed and developing countries. E7 members focus their activities on (1) the efficient use of primary energy resources, (2) maximizing the use of renewable energy resources, (3) maximizing efficiency in the generation, delivery, and use of electricity, (4) minimizing environmental impacts ofmore » energy production and use and, (5) implementing innovative options to promote win-win benefits for the environment and the economy through their network of expertise on a pro bono basis. A main emphasis lies in the consistent Joint Implementation given the fact that innovative and efficient Green House Gas reduction measures will be the core of future E7 activities. Especially commercial projects will provide valuable contributions to Green House Gas reductions as well as to economic development of the recipient country. Other instruments, such Emission Trading and Clean Development Mechanism will have to be investigated appropriately in terms of their practicability for Green House Gas reductions so that their will be a notification by the international climate protection regime. Therefore Emission Trading and Clean Development Mechanism are of importance for E7 members' future operations, too. With respect to Sustainable Development industry, energy and environmental policy in leading industry countries must be more closely aligned to a global approach than has so far been the case. The electricity sector is called on to make a major contribution.« less

Green initiative impact on stock prices: A quantitative study of the clean energy industry

NASA Astrophysics Data System (ADS)

Jurisich, John M.

The purpose of this quantitative ex post facto research study was to explore the relationship between green initiative expense disclosures and stock prices of 46 NASDAQ listed Clean Edge Green Energy global companies from 2007 to 2010. The independent variables were sales and marketing, environmental, customer and supplier, community, and corporate governance practices that were correlated with the dependent variable in the study of stock prices. Expense disclosures were examined in an effort to measure the impact of green initiative programs and to expose the interrelationships between green initiative expense disclosures and fluctuations of stock prices. The data for the research was secondary data from existing annual reports. A statistically significant relationship was revealed between environmental practices and changes in stock prices. The study results also provided substantial evidence for leadership and managerial decision making to reduce or increase green initiative practices to maximize shareholder wealth of their respective organizations.

Expanding services in a shrinking economy: desktop document delivery in a dental school library.

PubMed

Gushrowski, Barbara A

2011-07-01

How can library staff develop and promote a document delivery service and then expand the service to a wide audience? The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated.

Effectiveness of reprocessing for flexible bronchoscopes and endobronchial ultrasound bronchoscopes.

PubMed

Ofstead, Cori L; Quick, Mariah R; Wetzler, Harry P; Eiland, John E; Heymann, Otis L; Sonetti, David A; Ferguson, J Scott

2018-05-30

Infections have been linked to inadequately-reprocessed flexible bronchoscopes, and recent investigations determined that pathogen transmission occurred even when bronchoscope cleaning and disinfection practices aligned with current guidelines. This multisite, prospective study evaluated the effectiveness of real-world bronchoscope reprocessing methods using a systematic approach. This study involved direct observation of reprocessing methods for flexible bronchoscopes, multifaceted evaluations performed after manual cleaning and after high-level disinfection, and assessments of storage conditions. Visual inspections of ports and channels were performed using lighted magnification and borescopes. Contamination was detected using microbial cultures and tests for protein, hemoglobin, and adenosine triphosphate. Researchers assessed reprocessing practices, and storage cabinet cleanliness was evaluated by visual inspection and adenosine triphosphate tests. Researchers examined 24 clinically used bronchoscopes. After manual cleaning, 100% of bronchoscopes had residual contamination. Microbial growth was found in 14 (58%) fully-reprocessed bronchoscopes, including mold, Stenotrophomonas maltophilia, and Escherichia coli/Shigella spp. Visible irregularities were observed in 100% of bronchoscopes, including retained fluid; brown, red, or oily residue; scratches; damaged insertion tubes and distal ends; and filamentous debris in channels. Reprocessing practices were substandard at two of three sites. Damaged and contaminated bronchoscopes were in use at all sites. Inadequate reprocessing practices may have contributed to bioburden found on bronchoscopes. However, even when guidelines were followed, high-level disinfection was not effective. A shift toward the use of sterilized bronchoscopes is recommended. In the meantime, quality management programs and updated reprocessing guidelines are needed. Copyright © 2018. Published by Elsevier Inc.

Tribal Waste Management Program

EPA Pesticide Factsheets

The EPA’s Tribal Waste Management Program encourages environmentally sound waste management practices that promote resource conservation through recycling, recovery, reduction, clean up, and elimination of waste.

Explaining the de-prioritization of primary prevention: Physicians' perceptions of their role in the delivery of primary care

PubMed Central

Mirand, Amy L; Beehler, Gregory P; Kuo, Christina L; Mahoney, Martin C

2003-01-01

Background While physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery. Methods A focus group with regional primary care physician (PCP) Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine) participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology. Results The PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care. Conclusions The secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration. PMID:12729463

Maternal infection rates after cesarean delivery by Pfannenstiel or Joel-Cohen incision: a multicenter surveillance study.

PubMed

Dumas, Anne Marie; Girard, Raphaële; Ayzac, Louis; Caillat-Vallet, Emmanuelle; Tissot-Guerraz, Françoise; Vincent-Bouletreau, Agnès; Berland, Michel

2009-12-01

Our purpose was to evaluate maternal nosocomial infection rates according to the incision technique used for caesarean delivery, in a routine surveillance study. This was a prospective study of 5123 cesarean deliveries (43.2% Joel-Cohen, 56.8% Pfannenstiel incisions) in 35 maternity units (Mater Sud Est network). Data on routine surveillance variables, operative duration, and three additional variables (manual removal of the placenta, uterine exteriorization, and/or cleaning of the parieto-colic gutter) were collected. Multiple logistic regression analysis was used to identify independent risk factors for infection. The overall nosocomial infection and endometritis rates were higher for the Joel-Cohen than Pfannenstiel incision (4.5% vs. 3.3%, 0.8% vs. 0.3%, respectively). The higher rate of nosocomial infections with the Joel-Cohen incision was due to a greater proportion of patients presenting risk factors (i.e., emergency delivery, primary cesarean, blood loss > or =800 mL, no manual removal of the placenta and no uterine exteriorization). However, the Joel-Cohen technique was an independent risk factor for endometritis. The Joel-Cohen technique is faster than the Pfannenstiel technique but is associated with a higher incidence of endometritis.

Effective Practices for Online Delivery of Quantitative Business Courses

ERIC Educational Resources Information Center

Lam, Helen; Khare, Anshuman

2010-01-01

Online delivery of university-level courses has grown exponentially in the last decade and is increasingly being recognised as a viable and effective alternative to face-to-face classroom teaching. Many scholars have already written about the benefits and best practices of online teaching in general. However, not many studies have paid specific…

Design and Delivery of Technical Module for the Business Intelligence Course

ERIC Educational Resources Information Center

Wang, Shouhong; Wang, Hai

2013-01-01

IS programs are increasingly being called on to offer courses in business intelligence. This article presents the pedagogical design and the delivery method of a practicable technical module for a non-technically oriented Business Intelligence course. It is a tutorial for the instructors who wish to incorporate a practical technical element in…

THE CLEAN ENERGY-ENVIRONMENT GUIDE TO ACTION ...

EPA Pesticide Factsheets

The Guide to Action identifies and describes sixteen clean energy policies and strategies that are delivering economic and environmental results for states. For each policy, the Guide describes: Objectives and benefits of the policy; Examples of states that have implemented the policy; Responsibilities of key players at the state level, including typical roles of the main stakeholders; Opportunities to coordinate implementation with other federal and state policies, partnerships and technical assistance resources; Best practices for policy design, implementation, and evaluation, including state examples; Action steps for states to take when adopting or modifying their clean energy policies, based on existing state experiences; Resources for additional information on individual state policies, legislative and regulatory language, and analytical tools and methods. States participating in the Clean Energy-Environment State Partnership Program will use the Guide to Action to: Develop their own Clean Energy-Environment Action Plan that is appropriate to their state; Identify the roles and responsibilities of key decision-makers, such as environmental regulators, state legislatures, public utility commissioners, and state energy offices; Access and apply technical assistance resources, models, and tools available for state-specific analyses and program implementation; and Learn from each other as they develop their own clean energy programs and policies.

Arguments for amending smoke-free legislation in U.S. states to restrict use of electronic nicotine delivery systems.

PubMed

Phan, Tiffany M; Bianco, Cezanne A; Nikitin, Dmitriy; Timberlake, David S

2018-03-01

The uneven diffusion of local and state laws restricting the use of electronic nicotine delivery systems (ENDS) in the United States may be a function of inconclusive scientific evidence and lack of guidance from the federal government. The objective of this study was to assess whether the rationale for amending clean indoor air acts (CIAAs) is being conflated by issues that are not directly relevant to protecting the health of ENDS non-users. Online sources were used in identifying bills ( n  = 25) that were presented in U.S. state legislatures from January 2009 to December 2015. The bills were categorized into one of three groups: 1) bills amending comprehensive CIAAs ( n  = 11), 2) bills prohibiting use of ENDS in places frequented by youth ( n  = 5), and 3) remaining bills that varied between the two categories ( n  = 9). Arguments presented in committee hearings were coded as scientific, public health, economic, enforcement, freedom, or regulatory. Arguments pertaining to amendment of clean indoor air acts spanned several categories, many of which were not directly relevant to the aims of the legislation. This finding could assist lawmakers and expert witnesses in making arguments that yield greater success in amending legislation. Alternatively, inconclusive scientific data on the hazards of ENDS aerosols might encourage lawmakers to propose legislation that prohibits ENDS use in places frequented by youths.

Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil.

PubMed

Monguilhott, Juliana Jacques da Costa; Brüggemann, Odaléa Maria; Freitas, Paulo Fontoura; d'Orsi, Eleonora

2018-01-01

OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.

Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil

PubMed Central

Monguilhott, Juliana Jacques da Costa; Brüggemann, Odaléa Maria; Freitas, Paulo Fontoura; d'Orsi, Eleonora

2018-01-01

ABSTRACT OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted. PMID:29364356

7 CFR 58.220 - Drying systems.

Code of Federal Regulations, 2012 CFR

2012-01-01

... filter system shall comply with the applicable requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying Systems. The filtering system shall be cleaned or component parts replaced... shall comply with the requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying...

7 CFR 58.220 - Drying systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

... filter system shall comply with the applicable requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying Systems. The filtering system shall be cleaned or component parts replaced... shall comply with the requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying...

7 CFR 58.220 - Drying systems.

Code of Federal Regulations, 2013 CFR

2013-01-01

... filter system shall comply with the applicable requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying Systems. The filtering system shall be cleaned or component parts replaced... shall comply with the requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying...

7 CFR 58.220 - Drying systems.

Code of Federal Regulations, 2014 CFR

2014-01-01

... filter system shall comply with the applicable requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying Systems. The filtering system shall be cleaned or component parts replaced... shall comply with the requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying...

The normalization of deviance in healthcare delivery

PubMed Central

Banja, John

2009-01-01

Many serious medical errors result from violations of recognized standards of practice. Over time, even egregious violations of standards of practice may become “normalized” in healthcare delivery systems. This article describes what leads to this normalization and explains why flagrant practice deviations can persist for years, despite the importance of the standards at issue. This article also provides recommendations to aid healthcare organizations in identifying and managing unsafe practice deviations before they become normalized and pose genuine risks to patient safety, quality care, and employee morale. PMID:20161685

Virucidal effects of rodent cage-cleaning practices on the viability of adenovirus vectors.

PubMed

Porter, Jacqueline D; Lyons, Russette M

2002-09-01

Human adenoviruses and adenoviral vectors are classified as Risk Group 2 agents and require BSL2 containment and practices. An additional consideration in using adenoviruses and viral vectors in laboratory animal studies is the possible transmission of these agents to other animals and/or personnel as a result of viral shedding in animal urine and feces. When handling BSL2 agents, cage-wash staff are required to wear appropriate personnel protective equipment, including scrubs, Tyvek suit, hair covering, dust mask, shoes covers, and gloves. Current decontamination procedures are to bag and autoclave soiled rodent cages containing bedding prior to washing in the cage washer to prevent possible adenoviral transmission. However, the practice of autoclaving softens the polycarbonate-based rodent cages, allowing damaging agents or conditions to affect the integrity of the plastic and degrade the cages. The objective of this study was to determine whether current rodent cage-cleaning practices produced virucidal effects for use in lieu of or prior to autoclaving the cages. We found that heating an Av3GFP vector in a test tube to a temperature of 74 degrees C (165 degrees F) for 6 min conditions equivalent to those of the cage washer resulted in greater than an 11-log reduction in infectivity of the vector as evaluated by its cytopathic effect on cells. The combination of heating and a liquid, phosphate-free alkaline detergent produced the same reduction in vector infectivity. However, common cage-cleaning solutions alone possessed no virucidal activity. The high temperatures used in cage-washing procedures alone or in combination with a cleaning solution reduced or eliminated the risk of transmission from viral shedding through urine and feces even at vector concentrations far greater than would ever be expected to be present. Autoclaving cages diminishes the stability and integrity of the polycarbonate cages without providing a further reduction in the risk of virus or vector transmission. On the basis of results from this study, new cage-wash recommendations include dumping the contaminated bedding into a HEPA-filtered waste disposal system and autoclaving the bags of bedding before disposal, then cleaning the cages in the rack washer at wash temperatures of 74 degrees C (165 F) and rinse temperatures of 82 degrees C (180 F).

Cleaning and disinfection of patient care items, in relation to small animals.

PubMed

Weese, J Scott

2015-03-01

Patient care involves several medical and surgical items, including those that come into contact with sterile or other high-risk body sites and items that have been used on other patients. These situations create a risk for infection if items are contaminated, and the implications can range from single infections to large outbreaks. To minimize the risk, proper equipment cleaning, disinfection/sterilization, storage, and monitoring practices are required. Risks posed by different items; the required level of cleaning, disinfection, or sterilization; the methods that are available and appropriate; and how to ensure efficacy, must be considered when designing and implementing an infection control program. Copyright © 2015 Elsevier Inc. All rights reserved.

Factors associated with adverse clinical outcomes among obstetric trainees

PubMed Central

Aiken PhD, Catherine E.; Aiken, Abigail; Park, Hannah; Brockelsby, Jeremy C.; Prentice, Andrew

2016-01-01

Objective To determine whether UK obstetric trainees transitioning from directly to indirectly-supervised practice have a higher likelihood of adverse patient outcomes from operative deliveries compared to other indirectly supervised trainees and to examine whether performing more procedures under direct supervision is associated with fewer adverse outcomes in initial indirect practice. Methods We examined all deliveries (13,861) conducted by obstetricians at a single centre over 5 years (2008-2013). Mixed-effects logistic regression models were used to compare estimated blood loss, maternal trauma, umbilical arterial pH, delayed neonatal respiration, failed instrumental delivery, and critical incidents for trainees in their first indirectly-supervised year with trainees in all other years of indirect practice. Outcomes for trainees in their first indirectly-supervised 3 months were compared to their outcomes for the remainder of the year. Linear regression was used to examine the relationship between number of procedures performed under direct supervision and initial outcomes under indirect supervision. Results Trainees in their first indirectly-supervised year had a higher likelihood of >2 litres estimated blood loss at any delivery (OR 1.32;CI(1.01-1.64) p<0.05) and of failed instrumental delivery (OR 2.33;CI(1.37-3.29) p<0.05) compared with other indirectly-supervised trainees. Other measured outcomes showed no significant differences. Within the first three months of indirect supervision, the likelihood of operative vaginal deliveries with >1litre estimated blood loss (OR 2.54;CI(1.88-3.20) p<0.05) was higher compared to the remainder of the first year. Performing more deliveries under direct supervision prior to beginning indirectly-supervised training was associated with decreased risk of >1litre estimated blood loss (p<0.05). Conclusions Obstetric trainees in their first year of indirectly-supervised practice have a higher likelihood of immediate adverse delivery outcomes, which are primarily maternal rather than neonatal. Undertaking more directly supervised procedures prior to transitioning to indirectly-supervised practice may reduce adverse outcomes, suggesting that experience is a key consideration in obstetric training programme design. PMID:26077215

Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice.

PubMed

Saunders, Hannele

2015-07-01

To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes. © 2015 John Wiley & Sons Ltd.

Synthesis of the project leadership staffing needs for successful development of alternative delivery programs.

DOT National Transportation Integrated Search

2017-08-01

This research provides a synthesis of practices in organizational structuring and professional staffing of the innovative delivery units in several state DOTs across the nation that are actively utilizing alternative project delivery. Several major c...

Delivery and postpartum practices among new mothers in Laputta, Myanmar: intersecting traditional and modern practices and beliefs.

PubMed

Diamond-Smith, Nadia; Thet, May Me; Khaing, Ei Ei; Sudhinaraset, May

2016-09-01

Myanmar is witnessing increased access to modern maternity care, along with shifting norms and practices. Past research has documented low rates of facility-based deliveries in the country, along with adverse maternal and child health outcomes. Research has also documented diverse traditional practices in the postpartum period, related to maternity care and maternal food intake. Through 34 qualitative interviews with women who recently gave birth and their mothers-in-law in one township in Myanmar (Laputta), we explore factors influencing decision-making around postpartum care and the practices that women engage in. We find that women use both modern and traditional providers because different types of providers play particular roles in the delivery and postpartum period. Despite knowledge of about healthy foods to eat postpartum, many women restrict the intake of certain foods, and mothers-in-laws' beliefs in these practices are particularly strong. Findings suggest that women and their families are balancing two different sets of practices and beliefs, which at times come in conflict. Educational campaigns and programmes should address both modern and traditional beliefs and practices to help women be better able to access safe care and improve their own and their children's health.

Reducing hazardous cleaning product use: a collaborative effort.

PubMed

Pechter, Elise; Azaroff, Lenore S; López, Isabel; Goldstein-Gelb, Marcy

2009-01-01

Workplace hazards affecting vulnerable populations of low-wage and immigrant workers present a special challenge to the practice of occupational health. Unions, Coalition for Occupational Safety and Health (COSH) groups, and other organizations have developed worker-led approaches to promoting safety. Public health practitioners can provide support for these efforts. This article describes a successful multiyear project led by immigrant cleaning workers with their union, the Service Employees International Union (SEIU) Local 615, and with support from the Massachusetts COSH (MassCOSH) to address exposure to hazardous chemicals. After the union had identified key issues and built a strategy, the union and MassCOSH invited staff from the Massachusetts Department of Public Health's Occupational Health Surveillance Program (OHSP) to provide technical information about health effects and preventive measures. Results included eliminating the most hazardous chemicals, reducing the number of products used, banning mixing products, and improving safety training. OHSP's history of public health practice regarding cleaning products enabled staff to respond promptly. MassCOSH's staff expertise and commitment to immigrant workers allowed it to play a vital role.

Effectiveness of Surface Cleaning and Disinfection in a Brazilian Healthcare Facility

PubMed Central

Santos-Junior, Aires G.; Ferreira, Adriano M.; Frota, Oleci P.; Rigotti, Marcelo A.; Barcelos, Larissa da S.; Lopes de Sousa, Alvaro Francisco; de Andrade, Denise; Guerra, Odanir G.; R. Furlan, Mara C.

2018-01-01

Background: Failures in the processes of cleaning and disinfecting health service surfaces may result in the spread and transfer of pathogens that are often associated with healthcare-related infections and outbreaks. Aims: To assess the effectiveness of environmental surface cleaning and disinfection in a hospital clinic. Method: The study was conducted in a nursing ward with 45 beds. A total of 80 samples from five high-touch surfaces were evaluated before and after cleaning and disinfection, using the following methods: visual inspection, adenosine triphosphate bioluminescence assay, aerobic colony count, Staphylococcus aureus colony count, and evaluation of resistance to methicillin. The data analysis used nonparametric comparative and correlative tests to observe any differences in the pre- and post- cleaning and disinfection results for the surfaces assessed. Results: Effective cleaning and disinfection had a significant effect on only two surfaces when measured for the presence of adenosine triphosphate, the inner bathroom door handle (p=0.007) and the toilet bowl (p=0.01). When evaluated for Staphylococcus aureus colony count, the toilet flush handle also demonstrated a significant effect (p=0.04). Conclusion: The effectiveness of cleaning and disinfection of the surfaces tested was not satisfactory. An educational intervention is recommended for the cleaning and disinfection staff and the nursing team at the healthcare facility. Relevance to Clinical Practice: The data in the study revealed that daily hospital cleaning and disinfection in the sampled sites are not sufficient in medical and surgical wards. Hospital cleanliness must be reevaluated from the point of view of materials, such as an adequate supply of clean cloths, in addition to establishing more precise cleanliness protocols and accurate monitoring systems. PMID:29643951

Certified Athletic Trainers' Knowledge of Methicillin-Resistant Staphylococcus aureus and Common Disinfectants

PubMed Central

Kahanov, Leamor; Gilmore, Elizabeth J.; Eberman, Lindsey E.; Roberts, Jeffrey; Semerjian, Tamar; Baldwin, Linda

2011-01-01

Context: Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly common in athletic settings. The MRSA knowledge and infection-control practices of certified athletic trainers (ATs) and the cleanliness of the athletic training room are important factors in preventing MRSA infections. Objective: To assess knowledge of MRSA and the use of common disinfectants among ATs and to explore their infection-control practices. Design: Cross-sectional study. Setting: High school and collegiate athletic training rooms. Patients or Other Participants: A total of 163 ATs from National Collegiate Athletic Association Divisions I, II, and III and high schools, representing all 10 National Athletic Trainers' Association districts. Main Outcome Measure(s): Frequencies, analyses of variance, and χ2 tests were used to assess current practices and opinions and relationships between factors. Results: Methicillin-resistant Staphylococcus aureus was perceived as a national problem by 92% of respondents; 57% perceived MRSA as a problem in their practice setting. Most respondents had treated general infections (88%), staphylococcal infections (75%), and MRSA infections (57%). Male sex was associated with treating all 3 types of infections (χ2 test, P < .05). Noncurriculum education was associated with a lack of recognition of environmental issues as risk factors and with the use of isopropyl alcohol for disinfection (χ2 test, P < .05). For example, 10% of respondents did not recognize that contaminated whirlpools can be a source of MRSA infection. Respondents also incorrectly identified effective cleaning solutions. Thirty percent of respondents cleaned their hands frequently or sometimes before treating each athlete and 35% cleaned their hands sometimes, occasionally, or never after seeing each athlete. Conclusions: The majority of ATs were informed about MRSA and made correct disinfection choices. However, improvements are still needed, and not all ATs were using proper disinfection practices. PMID:21944074

76 FR 52946 - Clean Air Act Operating Permit Program; Petition for Objection to State Operating Permit for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-24

...This document announces that the EPA Administrator has responded to a citizen petition asking EPA to object to an operating permit (Permit Number P026R2) issued by the New Mexico Environment Department, Air Quality Bureau (NMED). Specifically, the Administrator has granted the April 14, 2010 petition, submitted by WildEarth Guardians and San Juan Citizens Alliance (Petitioners) to object to the March 19, 2010, operating permit issued to Williams Four Corners, LLC, for the Sims Mesa Central Delivery Point (CDP) compressor station in northwestern Rio Arriba County, New Mexico. Pursuant to sections 307(b) and 505(b)(2) of the Clean Air Act (CAA), a petition for judicial review of those parts of the Order that deny issues in the petition may be filed in the United States Court of Appeals for the appropriate circuit within 60 days from the date this notice appears in the Federal Register.

An Automated Microfluidic Multiplexer for Fast Delivery of C. elegans Populations from Multiwells

PubMed Central

Ghorashian, Navid; Gökçe, Sertan Kutal; Guo, Sam Xun; Everett, William Neil; Ben-Yakar, Adela

2013-01-01

Automated biosorter platforms, including recently developed microfluidic devices, enable and accelerate high-throughput and/or high-resolution bioassays on small animal models. However, time-consuming delivery of different organism populations to these systems introduces a major bottleneck to executing large-scale screens. Current population delivery strategies rely on suction from conventional well plates through tubing periodically exposed to air, leading to certain disadvantages: 1) bubble introduction to the sample, interfering with analysis in the downstream system, 2) substantial time drain from added bubble-cleaning steps, and 3) the need for complex mechanical systems to manipulate well plate position. To address these concerns, we developed a multiwell-format microfluidic platform that can deliver multiple distinct animal populations from on-chip wells using multiplexed valve control. This Population Delivery Chip could operate autonomously as part of a relatively simple setup that did not require any of the major mechanical moving parts typical of plate-handling systems to address a given well. We demonstrated automatic serial delivery of 16 distinct C. elegans worm populations to a single outlet without introducing any bubbles to the samples, causing cross-contamination, or damaging the animals. The device achieved delivery of more than 90% of the population preloaded into a given well in 4.7 seconds; an order of magnitude faster than delivery modalities in current use. This platform could potentially handle other similarly sized model organisms, such as zebrafish and drosophila larvae or cellular micro-colonies. The device’s architecture and microchannel dimensions allow simple expansion for processing larger numbers of populations. PMID:24069313

Policies to Enable Bioenergy Deployment: Key Considerations and Good Practices

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

Smolinksi, Sharon; Cox, Sadie

2016-05-01

Bioenergy is renewable energy generated from biological source materials, and includes electricity, transportation fuels and heating. Source materials are varied types of biomass, including food crops such as corn and sugarcane, non-edible lignocellulosic materials such as agricultural and forestry waste and dedicated crops, and municipal and livestock wastes. Key aspects of policies for bioenergy deployment are presented in this brief as part of the Clean Energy Solutions Center's Clean Energy Policy Brief Series.

Autoclave use in dental practice in the Republic of Ireland.

PubMed

Healy, C M; Kearns, H P O; Coulter, W A; Stevenson, M; Burke, F J T

2004-08-01

To assess by postal questionnaire, cross-infection control methods, especially sterilisation procedures, of 700 general dental practitioners in the Republic of Ireland, and to biologically monitor steam pressure sterilisers or autoclaves in their practices. Methods of instrument cleaning and sterilisation, autoclave efficacy. A response rate of 40% with all, except one practitioner, using steam sterilisation. 49% also reported the use of chemical sterilisation with a quarter of these using glutaraldehyde. However, instrument soaking time varied greatly from 2.5 minutes to 74 hours. Methods of instrument cleaning prior to autoclaving were as follows: scrubbing by hand 41.5%, ultrasonic cleaning 7.0%, combination of both 50%. 52.9% of the respondents did not autoclave their dental handpieces and only 44.7% disinfected impressions before sending them to the laboratory. The autoclaves of thirty practitioners (11.3%) did not pass the initial biological test. Following counselling about possible causes of failure, four autoclaves (1.5%) failed a repeat biological test. However, seven practitioners did not return the repeat biological test. Some aspects of recommended cross-infection control procedures are well adhered to, e.g. instrument cleaning, but further education is required in certain key areas, in particular the use of chemical sterilisation, dental handpiece autoclaving and impression disinfection. There is also a need to increase awareness of the importance of routine autoclave servicing and calibration, along with validation and monitoring.

Bacterial contamination of stethoscopes used by health workers: public health implications.

PubMed

Uneke, Chigozie J; Ogbonna, Annayo; Oyibo, Patrick G; Onu, Christian M

2010-08-04

This study was designed to assess both the potential for bacterial transmission by stethoscopes used by health-care workers in Nigeria and the implications for patient safety and control of hospital-acquired infections. A structured questionnaire was administered to health workers and the surface of the diaphragm of their stethoscopes swabbed for bacteriological analysis using standard techniques. Of the 107 stethoscopes surveyed, 84 (79%) were contaminated with bacteria; 59 (81%) of the contaminated stethoscopes belonged to physicians and 25 (74%) were from other health workers. Isolates included Staphylococcus aureus (54%), Pseudomonas aeruginosa (19%), Enterococcus faecalis (14%), and Escherichia coli (13%). All stethoscopes that had never been cleaned were contaminated while lower levels of contamination were found on those cleaned one week or less before the survey (chi(2) = 22.4, P < .05). Contamination was significantly higher on stethoscopes cleaned with only water (100%) compared to those cleaned with alcohol (49%) (chi(2) = 30.17, P < .05). Significantly fewer (9%) stethoscopes from health workers who washed their hands after seeing each patient were contaminated when compared with the instruments (86%) of those who did not practice hand washing (chi(2) = 23.79, P < .05). E. coli showed the highest antibiotic resistance, while S. aureus showed the highest antibiotic susceptibility. Strict adherence to stethoscope disinfection practices by health workers can minimize cross-contamination and ensure improved patient safety in hospital environments.

Short communication: Reactivity of diacetyl with cleaning and sanitizing agents.

PubMed

Rincon-Delgadillo, M I; Lopez-Hernandez, A; Rankin, S A

2013-01-01

Diacetyl is used to impart a buttery flavor to numerous food products such as sour cream, cottage cheese, vegetable oil-based spreads, baked goods, and beverages. Recent studies have linked exposure to high concentrations of diacetyl and the onset of bronchiolitis obliterans. Due to the reported risks that diacetyl may pose, many food companies have altered practices to reduce worker exposure to diacetyl, including the use of personal respirators, improved air handling systems, and adequate cleaning practices. Commonly used cleaning and sanitizing agents may be reactive with diacetyl; however, the efficacy of these chemicals has not been studied in detail and remains unclear. The objective of this work was to study the reaction chemistry of diacetyl with common industrial cleaning and sanitizing chemicals. The reactions were assessed at equimolar concentrations and analyzed by gas chromatography-mass spectrometry. Peroxyacetic acid was most reactive with diacetyl (95% reduction in diacetyl), followed by sodium hypochlorite (76% reduction), and hydrogen peroxide (26% reduction). Benzalkonium chloride (BAC) did not react with diacetyl. Acetic acid was detected as the main product of reactions of diacetyl with peroxyacetic acid, sodium hypochlorite, and hydrogen peroxide. 1,1-Dichloro-2-propanone and 1,1,1-trichloropropanone were also identified as volatile reaction products in the sodium hypochlorite reactions. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Cleaning, disinfection and sterilization of surface prion contamination.

PubMed

McDonnell, G; Dehen, C; Perrin, A; Thomas, V; Igel-Egalon, A; Burke, P A; Deslys, J P; Comoy, E

2013-12-01

Prion contamination is a risk during device reprocessing, being difficult to remove and inactivate. Little is known of the combined effects of cleaning, disinfection and sterilization during a typical reprocessing cycle in clinical practice. To investigate the combination of cleaning, disinfection and/or sterilization on reducing the risk of surface prion contamination. In vivo test methods were used to study the impact of cleaning alone and cleaning combined with thermal disinfection and high- or low-temperature sterilization processes. A standardized test method, based on contamination of stainless steel wires with high titres of scrapie-infected brain homogenates, was used to determine infectivity reduction. Traditional chemical methods of surface decontamination against prions were confirmed to be effective, but extended steam sterilization was more variable. Steam sterilization alone reduced the risk of prion contamination under normal or extended exposure conditions, but did show significant variation. Thermal disinfection had no impact in these studies. Cleaning with certain defined formulations in combination with steam sterilization can be an effective prion decontamination process, in particular with alkaline formulations. Low-temperature, gaseous hydrogen peroxide sterilization was also confirmed to reduce infectivity in the presence and absence of cleaning. Prion decontamination is affected by the full reprocessing cycle used on contaminated surfaces. The correct use of defined cleaning, disinfection and sterilization methods as tested in this report in the scrapie infectivity assay can provide a standard precaution against prion contamination. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Evaluating a new paradigm for comparing surface disinfection in clinical practice.

PubMed

Carling, Philip C; Perkins, Jennifer; Ferguson, JoAnn; Thomasser, Anita

2014-11-01

Despite an increasing understanding of the importance of near-patient surfaces in the transmission of healthcare-associated pathogens, there remains a need to define the relative clinical effectiveness of disinfection interventions. A serial 2-phase evaluation of the clinical effectiveness of 2 surface disinfectants. A general acute care hospital. A unique system for quantifying bioburden reduction while monitoring the possible impact of differences in cleaning thoroughness was used to compare the clinical effectiveness of a traditional quaternary ammonium compound (QAC) and a novel peracetic acid/hydrogen peroxide disinfectant (ND) as part of terminal room cleaning. As a result of QAC cleaning, 93 (40%) of 237 cleaned surfaces confirmed by fluorescent marker (DAZO) removal were found to have complete removal of aerobic bioburden. During the ND phase of the study, bioburden was removed from 211 (77%) of 274 cleaned surfaces. Because there was no difference in the thoroughness of cleaning with either disinfectant (65.3% and 66.4%), the significant ([Formula: see text]) difference in bioburden reduction can be attributed to better cleaning efficacy with the ND. In the context of the study design, the ND was 1.93 times more effective in removing bacterial burden than the QAC ([Formula: see text]). Furthermore, the study design represents a new research paradigm in which 2 interventions can be compared by concomitantly and objectively analyzing both the product and process variables in a manner that can be used to define the relative effectiveness of all disinfection cleaning interventions.

Comparing Sanitation Delivery Modalities in Urban Informal Settlement Schools: A Randomized Trial in Nairobi, Kenya

PubMed Central

Bohnert, Kate; Chard, Anna N.; Mwaki, Alex; Kirby, Amy E.; Muga, Richard; Nagel, Corey L.; Thomas, Evan A.; Freeman, Matthew C.

2016-01-01

The provision of safely managed sanitation in informal settlements is a challenge, especially in schools that require durable, clean, sex-segregated facilities for a large number of children. In informal settlements in Nairobi, school sanitation facilities demand considerable capital costs, yet are prone to breakage and often unhygienic. The private sector may be able to provide quality facilities and services to schools at lower costs as an alternative to the sanitation that is traditionally provided by the government. We conducted a randomized trial comparing private sector service delivery (PSSD) of urine-diverting dry latrines with routine waste collection and maintenance and government standard delivery (GSD) of cistern-flush toilets or ventilated improved pit latrines. The primary outcomes were facility maintenance, use, exposure to fecal contamination, and cost. Schools were followed for one school year. There were few differences in maintenance and pathogen exposure between PSSD and GSD toilets. Use of the PSSD toilets was 128% higher than GSD toilets, as measured with electronic motion detectors. The initial cost of private sector service delivery was USD 2053 (KES 210,000) per school, which was lower than the average cost of rehabilitating the government standard flush-type toilets (USD 9306 (KES 922,638)) and constructing new facilities (USD 114,889 (KES 1,169,668)). The private sector delivery of dry sanitation provided a feasible alternative to the delivery of sewage sanitation in Nairobi informal settlements and might elsewhere in sub-Saharan Africa. PMID:27916914

Comparing Sanitation Delivery Modalities in Urban Informal Settlement Schools: A Randomized Trial in Nairobi, Kenya.

PubMed

Bohnert, Kate; Chard, Anna N; Mwaki, Alex; Kirby, Amy E; Muga, Richard; Nagel, Corey L; Thomas, Evan A; Freeman, Matthew C

2016-11-30

The provision of safely managed sanitation in informal settlements is a challenge, especially in schools that require durable, clean, sex-segregated facilities for a large number of children. In informal settlements in Nairobi, school sanitation facilities demand considerable capital costs, yet are prone to breakage and often unhygienic. The private sector may be able to provide quality facilities and services to schools at lower costs as an alternative to the sanitation that is traditionally provided by the government. We conducted a randomized trial comparing private sector service delivery (PSSD) of urine-diverting dry latrines with routine waste collection and maintenance and government standard delivery (GSD) of cistern-flush toilets or ventilated improved pit latrines. The primary outcomes were facility maintenance, use, exposure to fecal contamination, and cost. Schools were followed for one school year. There were few differences in maintenance and pathogen exposure between PSSD and GSD toilets. Use of the PSSD toilets was 128% higher than GSD toilets, as measured with electronic motion detectors. The initial cost of private sector service delivery was USD 2053 (KES 210,000) per school, which was lower than the average cost of rehabilitating the government standard flush-type toilets (USD 9306 (KES 922,638)) and constructing new facilities (USD 114,889 (KES 1,169,668)). The private sector delivery of dry sanitation provided a feasible alternative to the delivery of sewage sanitation in Nairobi informal settlements and might elsewhere in sub-Saharan Africa.

NYPA/TH!NK Clean Commute Program Report – Inception Through May 2004

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

Don Karner; James Francfort; Randall Solomon

The Clean Commute Program uses TH!NK city electric vehicles from Ford Motor Company’s electric vehicle group, TH!NK Mobility, to demonstrate the feasibility of using electric vehicles for transportation in urban applications. Suburban New York City railroad commuters use the TH!NK city vehicles to commute from their private residences to railroad stations, where they catch commuter trains into New York City. Electric vehicle charging infrastructure for the TH!NK city vehicles is located at the commuters’ private residences as well as seven train stations. Ford leased 97 TH!NK city electric vehicles to commuters from Westchester, Putnam, Rockland, Queens, Nassau, and Suffolk countiesmore » for $199 per month per vehicle. The first Clean Commute Program vehicle deliveries occurred late in 2001, with data collection commencing in February 2002. Through May 2004, 24 of the lessees have returned their vehicles to Ford and no longer participate in the Clean Commute Program. Reasons given for returning the vehicles include relocation out of the Program area, change in employment status, change in commuting status, and, in a few cases, dissatisfaction with the vehicle. Additionally, 13 vehicles have been returned to Ford as their leases have completed. In August 2002, Ford announced that it was ceasing production of the TH!NK city and would not extend any TH!NK city leases. Through May 2004, participants in the Clean Commute Program have driven their vehicles over 370,000 miles, avoiding the use of over 17,000 gallons of gasoline. The TH!NK city vehicles are driven an average of between 180 and 230 miles per month, and over 95% of all trips taken with the TH!NK city vehicles replace trips previously taken in gasoline vehicles. This report covers the period from Program inception through May 2004.« less

Rural and Urban Differences in Vocational Rehabilitation Case Mix, Delivery Practices, and Employment Outcomes

ERIC Educational Resources Information Center

Ipsen, Catherine; Swicegood, Grant

2015-01-01

Purpose: To examine rural and urban differences in Vocational Rehabilitation (VR) case mix, delivery practices, and employment outcomes. Methods: Rehabilitation Services Administration 911 (RSA-911) case data do not include location indicators that allow for rural analyses. We compiled RSA-911 data with county and ZIP code information from 47 VR…

Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations

PubMed Central

Drum, Katherine B.; Littleton, Heather L.

2014-01-01

Technology-assisted mental health services are becoming much more routinely utilized by clients and practitioners alike. Clinicians practicing telepsychology must prepare themselves in order to provide competent care in this ever-evolving context of service delivery. Although much has been written with regards to considerations of ethical and legal practice, practical and logistical guidelines, and the advantages and disadvantages of the delivery of services via the use of technology, little to no attention has been paid to issues related to therapeutic boundaries in the telepsychology relationship. Clinicians must consider how to maintain appropriate boundaries in telepsychology settings in order to prevent harm and optimize treatment gains. Such considerations are also necessary given that it is probable that the telepsychology clinician will encounter novel boundary issues that are unlikely to occur in the traditional face-to-face therapy setting. We discuss the clinical utility of boundaries, potential boundary issues in telepsychology settings, and suggested best practice recommendations to ensure competent, ethical, and efficacious treatment in this novel context of service delivery. PMID:25414540

Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations.

PubMed

Drum, Katherine B; Littleton, Heather L

2014-10-01

Technology-assisted mental health services are becoming much more routinely utilized by clients and practitioners alike. Clinicians practicing telepsychology must prepare themselves in order to provide competent care in this ever-evolving context of service delivery. Although much has been written with regards to considerations of ethical and legal practice, practical and logistical guidelines, and the advantages and disadvantages of the delivery of services via the use of technology, little to no attention has been paid to issues related to therapeutic boundaries in the telepsychology relationship. Clinicians must consider how to maintain appropriate boundaries in telepsychology settings in order to prevent harm and optimize treatment gains. Such considerations are also necessary given that it is probable that the telepsychology clinician will encounter novel boundary issues that are unlikely to occur in the traditional face-to-face therapy setting. We discuss the clinical utility of boundaries, potential boundary issues in telepsychology settings, and suggested best practice recommendations to ensure competent, ethical, and efficacious treatment in this novel context of service delivery.

Delivery of paclitaxel from cobalt–chromium alloy surfaces without polymeric carriers

PubMed Central

Mani, Gopinath; Macias, Celia E.; Feldman, Marc D.; Marton, Denes; Oh, Sunho; Agrawal, C. Mauli

2014-01-01

Polymer-based carriers are commonly used to deliver drugs from stents. However, adverse responses to polymer coatings have raised serious concerns. This research is focused on delivering drugs from stents without using polymers or any carriers. Paclitaxel (PAT), an anti-restenotic drug, has strong adhesion towards a variety of material surfaces. In this study, we have utilized such natural adhesion property of PAT to attach these molecules directly to cobalt–chromium (Co–Cr) alloy, an ultra-thin stent strut material. Four different groups of drug coated specimens were prepared by directly adding PAT to Co–Cr alloy surfaces: Group-A (PAT coated, unheated, and ethanol cleaned); Group-B (PAT coated, heat treated, and ethanol cleaned); Group-C (PAT coated, unheated, and not ethanol cleaned); and Group-D (PAT coated, heat treated and not ethanol cleaned). In vitro drug release of these specimens was investigated using high performance liquid chromatography. Groups A and B showed sustained PAT release for up to 56 days. A simple ethanol cleaning procedure after PAT deposition can remove the loosely bound drug crystals from the alloy surfaces and thereby allowing the remaining strongly bound drug molecules to be released at a sustained rate. The heat treatment after PAT coating further improved the stability of PAT on Co–Cr alloy and allowed the drug to be delivered at a much slower rate, especially during the initial 7 days. The specimens which were not cleaned in ethanol, Groups C and D, showed burst release. PAT coated Co–Cr alloy specimens were thoroughly characterized using scanning electron microscopy, atomic force microscopy, and X-ray photoelectron spectroscopy. These techniques were collectively useful in studying the morphology, distribution, and attachment of PAT molecules on Co–Cr alloy surfaces. Thus, this study suggests the potential for delivering paclitaxel from Co–Cr alloy surfaces without using any carriers. PMID:20398928

The community-based delivery of an innovative neonatal kit to save newborn lives in rural Pakistan: design of a cluster randomized trial.

PubMed

Turab, Ali; Pell, Lisa G; Bassani, Diego G; Soofi, Sajid; Ariff, Shabina; Bhutta, Zulfiqar A; Morris, Shaun K

2014-09-08

Worldwide, an estimated 2.9 million neonatal deaths occurred in 2012, accounting for 44% of all under-five deaths. In Pakistan, more than 200,000 newborns die annually and neonatal mortality rates are higher than in any other South Asian country and haven't changed over the last three decades. The high number of neonatal deaths highlights the urgent need for effective and sustainable interventions that target newborn mortality in Pakistan. This cluster randomized trial aims at evaluating the impact of delivering an integrated neonatal kit to pregnant women during the third trimester of pregnancy and providing education on how to use the contents (intervention arm) compared to the current standard of care (control arm) in the district of Rahimyar Khan, Punjab province, Pakistan. The kit, which will be distributed through the national Lady Health Worker program, comprises a clean delivery kit (sterile blade, cord clamp, clean plastic sheet, surgical gloves and hand soap), sunflower oil emollient, chlorhexidine, ThermoSpot™, Mylar infant sleeve, and a reusable instant heat pack. Lady health workers will be provided with a standard portable hand-held electric weighing scale. The primary outcome measure is neonatal mortality (death in the first 28 days of life). While many cost-effective, evidence-based interventions to save newborn lives exist, they are not always accessible nor have they been integrated into a portable kit designed for home-based implementation entirely by caregivers. The implementation of cost-effective, portable, and easy-to-use interventions has tremendous potential for sustainably reducing neonatal mortality and long-term improvements in population health. The bundling of interventions and commodities together also has much potential for cost-effective delivery and maximizing gains from points of contact. This study will provide empirical evidence on the feasibility and effectiveness of the delivery of an innovative neonatal kit to pregnant women in Pakistan. Together, these findings will help inform policy on the most appropriate interventions to improve newborn survival. ClinicalTrial.gov NCT02130856. Registered May 1, 2014.

Comparison of clean intermittent and transurethral indwelling catheterization for the treatment of overt urinary retention after vaginal delivery: a multicentre randomized controlled clinical trial.

PubMed

Mulder, Femke E M; Hakvoort, Robert A; de Bruin, Jan P; van der Post, Joris A M; Roovers, Jan-Paul W R

2017-08-30

Overt postpartum urinary retention (PUR) is the inability to void after delivery and affects up to 7% of patients. Clean intermittent catheterization (CIC) and transurethral indwelling catheterization (TIC) are both standard treatments, but have not previously been compared. Clinical guidelines on postpartum bladder management are lacking. A total of 85 patients were randomised for TIC (n=45) and CIC (n=40). In total 68 patients (34 patients with TIC and 34 patients with CIC) completed the UDI-6 questionnaire 3 months after delivery.. Patients allocated to TIC received an indwelling catheter for 24 h and if necessary, another catheter for 48 h. Patients with CIC were intermittently catheterized or taught to self-catheterize until adequate voiding with a postvoid residual volume (PVRV) of <150 mL was achieved. The primary outcome was the presence of bothersome micturition symptoms as measured using the Dutch-validated Urogenital Distress Inventory (UDI-6). Only seven patients (10%) reported bothersome micturition problems 3 months after delivery. No significant differences in the occurrence of micturition symptoms were found. Median PVRV was 800 mL in the CIC group and 650 mL in the TIC group. PVRV was ≥1,000 mL in 24% of the patients. The median duration of catheterization was significantly shorter in the CIC group than in the TIC group (12 h vs. 24 h, p < 0,01). In patients with CIC, 35% required only one catheterization before complete bladder emptying occurred. The duration of treatment was not related to the initial PVRV. Both treatments were equally well accepted by the patients. In patients with overt PUR, CIC is the preferred treatment as a considerable percentage of patients appear to be over-treated when the standard duration of TIC is 24 h. The occurrence of micturition symptoms is not associated with the catheterization method used. CIC is well tolerated in patients with overt PUR.

Green related practices for construction procurement

NASA Astrophysics Data System (ADS)

Bidin, Z. A.; Bohari, A. A. M.; Rais, S. L. A.; Saferi, M. M.

2018-04-01

Environment degradation issue has been a worldwide problem and various efforts have been done to minimise the problem. Construction sectors are pointed as one of the major contributors to its construction activities. Green-oriented procurement [GP] is considered as an environmental strategy to integrate the environmental practices into the construction delivery. Thus, this paper reviews the concept of GP and the practices related to it. The outcome of this research findings provides a basis for understanding the concept of GP and the further development of GP. The listed GP practices identified from this paper can serve as guidelines for industry practitioners to design, implement, and benchmarking the green practices in their procurement delivery.

Generation of dissolved organic matter and byproducts from activated sludge during contact with sodium hypochlorite and its implications to on-line chemical cleaning in MBR.

PubMed

Cai, Weiwei; Liu, Jiaqi; Zhang, Xiangru; Ng, Wun Jern; Liu, Yu

2016-11-01

On-line chemical cleaning of membranes with sodium hypochlorite (NaClO) has been commonly employed for maintaining a constant permeability of membrane bioreactor (MBR) due to its simple and efficient operation. However, activated sludge is inevitably exposed to NaClO during this cleaning process. In spite of the broad applications of on-line chemical cleaning in MBR such as chemical cleaning-in-place (CIP) and chemical enhanced backwash (CEB), little information is currently available for the release of emerging dissolved organic matter (DOM) and byproducts from this prevalent practice. Therefore, in this study, activated sludge suspended in a phosphate buffered saline solution was exposed to different doses of NaClO in order to determine the generation of potential DOM and byproducts. The results showed the occurrence of significant DOM release (up to 24.7 mg/L as dissolved organic carbon) after exposure to NaClO for 30 min. The dominant components of the released DOM were characterized to be humic acid-like as well as protein-like substances by using an excitation-emission matrix fluorescence spectrophotometer. Furthermore, after the contact of activated sludge with NaClO, 19 kinds of chlorinated and brominated byproducts were identified by ultra performance liquid chromatography/electrospray ionization-triple quadrupole mass spectrometry, eight of which were confirmed and characterized with standard compounds. Many byproducts were found to be halogenated aromatic compounds, including halopyrroles and halo(hydro)benzoquinones, which had been reported to be significantly more toxic than the halogenated aliphatic ones. Consequently, this study offers new insights into the practice of on-line chemical cleaning, and opens up a window to re-examine the current operation of MBR by looking into the generation of micropollutants. Copyright © 2016 Elsevier Ltd. All rights reserved.

Policies and Practices in the Delivery of HIV Services in Correctional Agencies and Facilities: Results from a Multi-Site Survey

PubMed Central

Belenko, Steven; Hiller, Matthew; Visher, Christy; Copenhaver, Michael; O’Connell, Daniel; Burdon, William; Pankow, Jennifer; Clarke, Jennifer; Oser, Carrie

2013-01-01

HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of among CJ-DATS correctional agency partners revealed that HIV policies and practices in prevention, detection and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections. PMID:24078624

9 CFR 3.2 - Indoor housing facilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... those breeds that cannot tolerate lower temperatures without stress or discomfort (such as short-haired... in maintaining good housekeeping practices, adequate cleaning, adequate inspection of animals, and...

9 CFR 3.2 - Indoor housing facilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... those breeds that cannot tolerate lower temperatures without stress or discomfort (such as short-haired... in maintaining good housekeeping practices, adequate cleaning, adequate inspection of animals, and...

9 CFR 3.2 - Indoor housing facilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... those breeds that cannot tolerate lower temperatures without stress or discomfort (such as short-haired... in maintaining good housekeeping practices, adequate cleaning, adequate inspection of animals, and...

A qualitative evaluation of New Zealand consumers perceptions of general practice nurses

PubMed Central

2013-01-01

Background An important consideration in health service delivery is ensuring that services meet consumer needs and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored consumer satisfaction with nurses in general practice. Methods A sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed using thematic analysis. Results Four major themes emerged from the data. These themes highlighted that, despite confusion experienced by some consumers regarding the practice nurse role, consumers were happy with the level of care provided by them. Consumers felt valued by Practice Nurses and considered them competent and highly knowledgeable. Findings also convey that consumers appreciate the accessibility and financial benefits of utilising the services of practice nurses. Conclusions Consumers are highly satisfied with practice nurse service delivery and value their relationships with these health professionals. Consumers revealed that greater clarity around the practice nurse role and their scope of practice may enhance their utilisation. Spreading the message of practice nurses being the right person to deliver care, within their scope of practice, at the right time may have the potential to provide more timely care within the primary care setting. PMID:23433311

Family-Centered Service Delivery.

ERIC Educational Resources Information Center

Higgins, Cindy, Ed.

1997-01-01

This theme issue focuses on family-centered practices and policies for service delivery. The first article, "Family-Centered Service Delivery," reports on a study of 130 published sources in education, social work, nursing, psychology, occupational therapy, and related disciplines, which found that the key components of family-centered…

A modeling approach to evaluate the impact of conservation practices on runoff and sediments in Sasumua watershed, Kenya

USDA-ARS?s Scientific Manuscript database

Degradation of agricultural watersheds often reduces their capacity to provide vital environmental services such as food production, clean potable water, water bodies for recreation and generation of hydro-electric power. Soil and water conservation practices on agricultural lands can enhance the ca...

Standard practice for washing and cleaning concrete bridge decks and substructure bridge seats including bridge bearings and expansion joints to prevent structural deterioration.

DOT National Transportation Integrated Search

2013-12-01

This study is a supplement to a previous study of bridge washing practices that focused on steel : superstructures. This study examined the perceived costs and benefits of routine washing of both : steel and concrete bridges, with emphasis on substru...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

Managing physical therapy resources: an analogy to the freedom of the commons and the need for collective action.

PubMed

Brennan, Gerard P

2012-06-01

Tragedy results when we each pursue our own best interest in a society that believes in the freedom of a commons, such as clean air, fresh water, or natural fishing grounds. The purpose of this editorial is to consider how resources related to healthcare, and specifically to the delivery of physical therapy, can suffer the tragedy of the commons, and to consider an alternative strategy by which we can manage physical therapy resources effectively through collective action.

Biosafety level 3 laboratory for autopsies of patients with severe acute respiratory syndrome: principles, practices, and prospects.

PubMed

Li, Ling; Gu, Jiang; Shi, Xicheng; Gong, Encong; Li, Xingwang; Shao, Hongquan; Shi, Xueying; Jiang, Huijun; Gao, Xiaoqiang; Cheng, Daiyun; Guo, Lizhu; Wang, Hao; Shi, Xiaohong; Wang, Peizhi; Zhang, Qianying; Shen, Bing

2005-09-15

During the outbreak of the emergent severe acute respiratory syndrome (SARS) infection, >30% of the approximately 8000 infected persons were health care workers. The highly infectious nature of SARS coronavirus (SARS-CoV) compelled our pathologists to consider biosafety issues in the autopsy room and for tissue processing procedures. A specially designed biosafety level 3 (BSL-3) autopsy laboratory was constructed and divided into a clean area, a semicontaminated area, a contaminated area, and 2 buffer zones. High-efficiency particulate air filters were placed in the air supply and exhaust systems. Laminar air flow was from the clean areas to the less clean areas. The negative pressures of the contaminated, semicontaminated, and clean areas were approximately -50 pa, -25 pa, and -5 pa, respectively. Personal protective equipment, including gas mask, impermeable protective clothing, and 3 layers of gloves worn during autopsies; the equipment was decontaminated before it was allowed to exit the facility. Strict BSL-3 practices were followed. When a given concentration of particulate sarin simulant was introduced into the contaminated area, it could not be detected in either the semicontaminated area or clean area, and particles >0.3 microm in size were not detected in the exhaust air. A total of 16 complete postmortem examinations for probable and suspected SARS were performed during a 2-month period. Of these, 7 reported confirmed cases of SARS. None of the 23 pathologists and technicians who participated in these autopsies was infected with SARS-CoV. Our experience suggests that BSL-3 laboratory operating principles should be among the special requirements for performing autopsies of contaminated bodies and that they can safeguard the clinicians and the environment involved in these procedures.

Expanding services in a shrinking economy: desktop document delivery in a dental school library

PubMed Central

Gushrowski, Barbara A

2011-01-01

Question: How can library staff develop and promote a document delivery service and then expand the service to a wide audience? Setting: The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. Method: A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. Main results: IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Conclusion: Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated. PMID:21753911

Exploring Current and Future Roles of Non-Dental Professionals: Implications for Dental Hygiene Education.

PubMed

Maxey, Hannah L; Farrell, Christine; Gwozdek, Anne

2017-09-01

The health care system is undergoing transformation in which oral health is not only valued as an aspect of overall health, but health care delivery systems are aligning to better deliver total patient care. As a result of this transformation, education for many non-dental professionals incorporates oral health content to prepare them to practice in comprehensive delivery models. While some non-dental professionals already incorporate oral health care in their service, many opportunities exist for expansion of oral health care delivery by other non-dental professionals, including radiologic technicians, nursing staff, and human services professionals. As non-dental professionals take on expanded roles in oral health care, the dental hygiene workforce must be prepared to practice in settings with new types of professionals. Dental hygiene curricula should prioritize interprofessional education to best prepare these students for practice in evolved delivery models. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Tool use for corpse cleaning in chimpanzees

NASA Astrophysics Data System (ADS)

van Leeuwen, Edwin J. C.; Cronin, Katherine A.; Haun, Daniel B. M.

2017-03-01

For the first time, chimpanzees have been observed using tools to clean the corpse of a deceased group member. A female chimpanzee sat down at the dead body of a young male, selected a firm stem of grass, and started to intently remove debris from his teeth. This report contributes novel behaviour to the chimpanzee’s ethogram, and highlights how crucial information for reconstructing the evolutionary origins of human mortuary practices may be missed by refraining from developing adequate observation techniques to capture non-human animals’ death responses.

Best practices in disinfection of noncritical surfaces in the health care setting: creating a bundle for success.

PubMed

Havill, Nancy L

2013-05-01

Because increasing evidence suggests that the environment plays a role in transmission of health care-associated infections, more attention is focusing on environmental cleaning and improving its efficacy. Creating and sustaining a successful cleaning and disinfection program should include several key components using a bundle approach and requires ongoing commitment within the institution. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

State Clean Energy Policies Analysis. State, Utility, and Municipal Loan Programs

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

Lantz, Eric

2010-05-01

This report relies on six in-depth interviews with loan program administrators to provide descriptions of existing programs. Findings from the interviews are combined with a review of relevant literature to elicit best practices and lessons learned from existing loan programs. Data collected from each of the loan programs profiled are used to quantify the impacts of these specific loan programs on the commonly cited, overarching state clean energy goals of energy security, economic development, and environmental protection.

[Underwater delivery. Consensus of the Spanish Neonatology Society and the Perinatal Section of the Spanish Obstetrics and Gynecology Society].

PubMed

Iriondo Sanz, M; Sánchez Luna, M; Botet Mussons, F; Martínez-Astorquiza, T; Lailla Vicens, J M; Figueras Aloy, J

2015-02-01

Immersion in water during labor and delivery as an alternative to traditional delivery is a practice that has increased in many countries. This technique is effective in reducing pain and duration of labor. The American Academy of Pediatrics and The American College of Obstetricians and Gynecologists have published a clinical report which indicates the potential maternal benefits during the first stage of labor but, questions the performance of this technique during delivery and birth of the newborn. In this report, the Spanish Society of Neonatology and the Spanish Society of Obstetrics and Gynecology analyze the current scientific evidence on water immersion delivery, and the impact this practice could have in the mother and especially in the wellbeing of newborn. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

A Best Practice Modular Design of a Hybrid Course Delivery Structure for an Executive Education Program

ERIC Educational Resources Information Center

Klotz, Dorothy E.; Wright, Thomas A.

2017-01-01

This article highlights a best practice approach that showcases the highly successful deployment of a hybrid course delivery structure for an Operations core course in an Executive MBA Program. A key design element of the approach was the modular design of both the course itself and the learning materials. While other hybrid deployments may stress…

21 CFR 211.52 - Washing and toilet facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Buildings and Facilities... cold water, soap or detergent, air driers or single-service towels, and clean toilet facilities easily...

21 CFR 211.52 - Washing and toilet facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Buildings and Facilities... cold water, soap or detergent, air driers or single-service towels, and clean toilet facilities easily...

21 CFR 211.52 - Washing and toilet facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Buildings and Facilities... cold water, soap or detergent, air driers or single-service towels, and clean toilet facilities easily...

21 CFR 211.52 - Washing and toilet facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Buildings and Facilities... cold water, soap or detergent, air driers or single-service towels, and clean toilet facilities easily...

21 CFR 211.52 - Washing and toilet facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Buildings and Facilities... cold water, soap or detergent, air driers or single-service towels, and clean toilet facilities easily...

9 CFR 3.5 - Mobile or traveling housing facilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... temperatures, for those breeds that cannot tolerate lower temperatures without stress or discomfort (such as... sufficient illumination to aid in maintaining good housekeeping practices, adequate cleaning, adequate...

9 CFR 3.5 - Mobile or traveling housing facilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... temperatures, for those breeds that cannot tolerate lower temperatures without stress or discomfort (such as... sufficient illumination to aid in maintaining good housekeeping practices, adequate cleaning, adequate...

9 CFR 3.5 - Mobile or traveling housing facilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... temperatures, for those breeds that cannot tolerate lower temperatures without stress or discomfort (such as... sufficient illumination to aid in maintaining good housekeeping practices, adequate cleaning, adequate...

Below room temperature: How the photocatalytic activity of dense and mesoporous TiO2 coatings is affected

NASA Astrophysics Data System (ADS)

Cedillo-González, Erika Iveth; Riccò, Raffaele; Costacurta, Stefano; Siligardi, Cristina; Falcaro, Paolo

2018-03-01

Different parameters such as morphology, porosity, crystalline phase or doping agents affect the self-cleaning performance of photocatalytic TiO2-based coatings. However, also environmental conditions have been found to play a major role on the photocatalytic self-cleaning property. Substrate temperature is a significant environmental variable that can drastically affect this process. This variable becomes of great importance especially for outdoor applications: many self-cleaning photocatalytic materials have been designed to be exposed to outdoor environments and consequently, can be exposed to variable temperatures depending on the season of the year and the typical weather of the geographical zone. Thus, understanding the influence of the most common outdoor temperatures on the self-cleaning performance of TiO2-based coatings is essential for the fabrication of any kind of photocatalytic self-cleaning materials (fabricated by coating technology) that is expected to be subjected to outdoor environments. In this work, the photocatalytic activity was studied by Fourier Transformed Infrared (FTIR) Spectroscopy varying the temperature in the 0 to 30 °C range for dense and mesoporous TiO2 coatings. The temperature conditions at which these coatings present better performances were identified, providing a deeper insight for the practical application of TiO2-based self-cleaning coatings.

Improving the delivery of preventive care services.

PubMed

Hung, Dorothy Y

2007-05-01

Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

Clinical Nurse Leader Integration Into Practice: Developing Theory To Guide Best Practice.

PubMed

Bender, Miriam

2016-01-01

Numerous policy bodies have identified the clinical nurse leader (CNL) as an innovative new role for meeting higher health care quality standards. Although there is growing evidence of improved care environment and patient safety and quality outcomes after redesigning care delivery microsystems to integrate CNL practice, significant variation in CNL implementation has been noted across reports, making it difficult to causally link CNL practice to reported outcomes. This variability reflects the overall absence in the literature of a well-defined CNL theoretical framework to help guide standardized application in practice. To address this knowledge gap, an interpretive synthesis with a grounded theory analysis of CNL narratives was conducted to develop a theoretical model for CNL practice. The model clarifies CNL practice domains and proposes mechanisms by which CNL-integrated care delivery microsystems improve health care quality. The model highlights the need for a systematic approach to CNL implementation including a well-thought out strategy for care delivery redesign; a consistent, competency-based CNL workflow; and sustained macro-to-micro system leadership support. CNL practice can be considered an effective approach to organizing nursing care that maximizes the scope of nursing to influence the ways care is delivered by all professions within a clinical microsystem. Copyright © 2016 Elsevier Inc. All rights reserved.

Perspectives of men on antenatal and delivery care service utilisation in rural western Kenya: a qualitative study

PubMed Central

2013-01-01

Background Poor utilisation of facility-based antenatal and delivery care services in Kenya hampers reduction of maternal mortality. Studies suggest that the participation of men in antenatal and delivery care is associated with better health care seeking behaviour, yet many reproductive health programs do not facilitate their involvement. This qualitative study conducted in rural Western Kenya, explored men’s perceptions of antenatal and delivery care services and identified factors that facilitated or constrained their involvement. Methods Eight focus group discussions were conducted with 68 married men between 20-65 years of age in May 2011. Participants were of the Luo ethnic group residing in Asembo, western Kenya. The area has a high HIV-prevalence and polygamy is common. A topic guide was used to guide the discussions and a thematic framework approach for data analysis. Results Overall, men were positive in their views of antenatal and delivery care, as decision makers they often encouraged, some even ‘forced’, their wives to attend for antenatal or delivery care. Many reasons why it was beneficial to accompany their wives were provided, yet few did this in practice unless there was a clinical complication. The three main barriers relating to cultural norms identified were: 1) pregnancy support was considered a female role; and the male role that of provider; 2) negative health care worker attitudes towards men’s participation, and 3) couple unfriendly antenatal and delivery unit infrastructure. Conclusion Although men reported to facilitate their wives’ utilisation of antenatal and delivery care services, this does not translate to practice as adherence to antenatal-care schedules and facility based delivery is generally poor. Equally, reasons proffered why they should accompany their wives are not carried through into practice, with barriers outweighing facilitators. Recommendations to improve men involvement and potentially increase services utilisation include awareness campaigns targeting men, exploring promotion of joint HIV testing and counselling, staff training, and design of couple friendly antenatal and delivery units. PMID:23800139

Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India.

PubMed

Iyengar, Kirti; Jain, Motilal; Thomas, Sunil; Dashora, Kalpana; Liu, William; Saini, Paramsukh; Dattatreya, Rajesh; Parker, Indrani; Iyengar, Sharad

2014-08-13

After the launch of Janani Suraksha Yojana, a conditional cash transfer scheme in India, the proportion of women giving birth in institutions has rapidly increased. However, there are important gaps in quality of childbirth services during institutional deliveries. The aim of this intervention was to improve the quality of childbirth services in selected high caseload public health facilities of 10 districts of Rajasthan. This intervention titled "Parijaat" was designed by Action Research & Training for Health, in partnership with the state government and United Nations Population Fund. The intervention was carried out in 44 public health facilities in 10 districts of Rajasthan, India. These included district hospitals (9), community health centres (32) and primary health centres (3). The main intervention was orientation training of doctors and program managers and regular visits to facilities involving assessment, feedback, training and action. The adherence to evidence based practices before, during and after this intervention were measured using structured checklists and scoring sheets. Main outcome measures included changes in practices during labour, delivery or immediate postpartum period. Use of several unnecessary or harmful practices reduced significantly. Most importantly, proportion of facilities using routine augmentation of labour reduced (p = 0), episiotomy for primigravidas (p = 0.0003), fundal pressure (p = 0.0003), and routine suction of newborns (0 = 0.0005). Among the beneficial practices, use of oxytocin after delivery increased (p = 0.0001) and the practice of listening foetal heart sounds during labour (p = 0.0001). Some practices did not show any improvements, such as dorsal position for delivery, use of partograph, and hand-washing. An intervention based on repeated facility visits combined with actions at the level of decision makers can lead to substantial improvements in quality of childbirth practices at health facilities.

Nanothermite-Based Microsystem for Drug Delivery and Cell Transfection

DTIC Science & Technology

2008-12-01

micropyrotechnic-based system in which a nanothermite energy source is coupled to a biological target for gene transfer and drug delivery ... delivery of particulate vaccines and drugs to human skin with a practical, hand-held shock tube-based system . Shock Waves, 12, 23-30. Kodama, T., M...1 NANOTHERMITE-BASED MICROSYSTEM FOR DRUG DELIVERY AND CELL TRANSFECTION S. Apperson, R. Thiruvengadathan, A. Bezmelnitsyn, K. Gangopadhyay, S

Green Remediation Best Management Practices: Bioremediation

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Principles for Greener Cleanups outlines the Agency's policy for evaluating and minimizing the environmental 'footprint' of activities undertaken when cleaning up a contaminated site.

Extending dental nurses' duties: a national survey investigating skill-mix in Scotland's child oral health improvement programme (Childsmile).

PubMed

Gnich, Wendy; Deas, Leigh; Mackenzie, Sarah; Burns, Jacqueline; Conway, David I

2014-11-25

Childsmile is Scotland's national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses' ability to fully deliver their extended roles is necessary to ensure nurses' potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs' roles by EDDNs, in general dental practice across Scotland. A cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses': role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data. Seventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA). This study has provided insight into EDDNs' experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs' roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement.

A new approach involving a multi transducer ultrasonic system for cleaning turbine engines' oil filters under practical conditions.

PubMed

Nguyen, Dinh Duc; Ngo, Huu Hao; Yoon, Yong Soo; Chang, Soon Woong; Bui, Hong Ha

2016-09-01

The purpose of this paper is to provide a green technology that can clean turbine engine oil filters effectively in ships using ultrasound, with ultrasonic devices having a frequency of 25kHz and different powers of 300W and 600W, respectively. The effects of temperature, ultrasonic cleaning times, pressure losses through the oil filter, solvent washing, and ultrasonic power devices were investigated. In addition, the cleaning efficiency of three modes (hand washing, preliminary washing and ultrasonic washing) were compared to assess their relative effectiveness. Experimental results revealed that the necessary ultrasonic time varied significantly depending on which solvent was used for washing. For instance, the optimum ultrasonic cleaning time was 50-60min when the oil filter was cleaned in a solvent of kerosene oil (KO) and over 80min when in a solvent of diesel oil (DO) using the same ultrasonic generator device (25kHz, 600W) and experimental conditions. Furthermore, microscopic examination did not reveal any damage or breakdown on or within the structure of the filter after ultrasonic cleaning, even in the filter's surfaces at a constantly low frequency of 25kHz and power specific capacity (100W/gal). Overall, it may be concluded that ultrasound-assisted oil filter washing is effective, requiring a significantly shorter time than manual washing. This ultrasonic method also shows promise as a green technology for washing oil filters in turbine engines in general and Vietnamese navy ships in particular, because of its high cleaning efficiency, operational simplicity and savings. Copyright © 2016 Elsevier B.V. All rights reserved.

Determinants of institutional delivery among childbearing age women in Western Ethiopia, 2013: unmatched case control study.

PubMed

Feyissa, Tesfaye Regassa; Genemo, Gebi Agero

2014-01-01

Place of delivery is a crucial factor which affects the health and wellbeing of the mother and newborn. Institutional delivery helps the women to access skilled assistance, drugs, equipment, and referral transport. Even though 34% of pregnant women received at least one antenatal care from a skilled provider in Ethiopia by 2013, institutional delivery was 10%. The main objective of the study was to assess determinants of institutional delivery in Western Ethiopia. Retrospective unmatched case control study design was used to assess determinants of institutional delivery in Western Ethiopia from September to October 2013. A total of 320 respondents from six districts of East Wollega zone, West Ethiopia were included. Data were collected using pretested and structured questionnaires. Data were entered and cleaned by Epi-info then exported and analyzed using SPSS software. Statistical significance was determined through a 95% confidence level. Education [Adjusted Odds Ratio (AOR) (95% Confidence Interval (CI)) = 2.754(1.510-8.911)], family size [AOR (95% CI) = .454(.209-.984)], residence [AOR (95% CI) = 3.822 (1.766-8.272)] were important predictors of place of delivery. Four or more antenatal care [(ANC) (AOR (95% CI) = 2.914(1.105-7.682)], birth order [(AOR (95% CI) = .136(.054-.344), age at last delivery [(AOR (95% CI) = 9.995(2.101-47.556)], birth preparedness [AOR (95% CI) = 6.957(2.422-19.987)], duration of labour [AOR (95% CI) = 3.541(1.732-7.239)] were significantly associated with institutional delivery. Moreover service related factors such as distance from health institutions [AOR (95% CI) = .665(.173-.954)], respondents' awareness of skill of health care professionals [AOR (95% CI) = 2.454 (1.663-6.255)], mode of transportations [AOR (95% CI) = .258(.122-.549)] were significantly associated with institutional delivery. Policy makers, health service organizations, community leaders and other concerned bodies have to consider the predictors of institutional delivery like education, birth order, antenatal care utilization and residence to improve institutional delivery in the area.

40 CFR 257.3-7 - Air.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Air. 257.3-7 Section 257.3-7... and Practices § 257.3-7 Air. (a) The facility or practice shall not engage in open burning of... 110 of the Clean Air Act, as amended. (c) As used in this section “open burning” means the combustion...

40 CFR 257.3-7 - Air.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Air. 257.3-7 Section 257.3-7... and Practices § 257.3-7 Air. (a) The facility or practice shall not engage in open burning of... 110 of the Clean Air Act, as amended. (c) As used in this section “open burning” means the combustion...

40 CFR 257.3-7 - Air.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Air. 257.3-7 Section 257.3-7 Protection... and Practices § 257.3-7 Air. (a) The facility or practice shall not engage in open burning of... 110 of the Clean Air Act, as amended. (c) As used in this section “open burning” means the combustion...

A Roadmap for Reducing Cardiac Device Infections: a Review of Epidemiology, Pathogenesis, and Actionable Risk Factors to Guide the Development of an Infection Prevention Program for the Electrophysiology Laboratory.

PubMed

Branch-Elliman, Westyn

2017-08-16

Cardiovascular implantable electronic device (CIED) infections are highly morbid, common, and costly, and rates are increasing (Sohail et al. Arch Intern Med 171(20):1821-8 2011; Voigt et al. J Am Coll Cardiol 48(3):590-1 2006). Factors that contribute to the development of CIED infections include patient factors (comorbid conditions, self-care, microbiome), procedural details (repeat procedure, contamination during procedure, appropriate pre-procedural prep, and antimicrobial use), environmental and organizational factors (patient safety culture, facility barriers, such as lack of space to store essential supplies, quality of environmental cleaning), and microbial factors (type of organism, virulence of organism). Each of these can be specifically targeted with infection prevention interventions. Basic prevention practices, such as administration of systemic antimicrobials prior to incision and delaying the procedure in the setting of fever or elevated INR, are helpful for day-to-day prevention of cardiac device infections. Small single-center studies provide proof-of-concept that bundled prevention interventions can reduce infections, particularly in outbreak settings. However, data regarding which prevention strategies are the most important is limited as are data regarding the optimal prevention program for day-to-day prevention (Borer et al. Infect Control Hosp Epidemiol 25(6):492-7 2004; Ahsan et al. Europace 16(10):1482-9 2014). Evolution of infection prevention programs to include ambulatory and procedural areas is crucial as healthcare delivery is increasingly provided outside of hospitals and operating rooms. The focus on traditional operating rooms and inpatient care leaves the vast majority of healthcare delivery-including cardiac device implantations in the electrophysiology laboratory-uncovered.

[Current status of practice of providing dietary advice to pregnant women by members of the Japanese Midwives' Association. Knowledge and utilization of the "Dietary Guidelines for Pregnant and Lactating Women"].

PubMed

Takimoto, Hidemi; Yonezawa, Junko; Shimada, Marie; Kato, Noriko; Yokoyama, Tetsuji

2013-01-01

Midwives are actively involved in providing dietary advice to pregnant women. In order to describe the current status of prenatal dietary advice provided by midwives, we conducted a questionnaire survey inquiring about their knowledge and usage of the "Dietary Guidelines for Pregnant and Lactating Women" (Guidelines) issued by the Ministry of Health, Labour, and Welfare in 2006. In total, 2000 members of the Japanese Midwives' Association were randomly selected for administration of the questionnaire. The recovery rate was 42.1%, and 785 responses were eligible for analyses. The questionnaire collected information on the respondent's age, years of work experience, current involvement in delivery practice, number of deliveries per year in the current affiliation, provision of dietary advice to pregnant women, and knowledge and usage of the Guidelines. The proportion of respondents in their 20 s was low (1.8%). About half of the respondents were practicing delivery. Further, 66.1% (519 midwives) reported they had knowledge of the Guidelines. Among those who had knowledge of the Guidelines and were currently providing dietary advice (426 midwives), 88.0% were using the Guidelines. The most frequently used item in the Guidelines was "Diet for preventing anemia" (75.8%). The least used item was "Shoku-iku (diet and nutrition education) for pregnant and lactating women" (58.5%). Midwives who were practicing delivery showed a significantly lower usage of the Guidelines than those who were not (84.9% vs. 92.6%, P = 0.02). Among midwives practicing delivery, the most common reason for not using the Guidelines was "using original educational material produced by oneself or the facility." Providing dietary advice to pregnant women constituted a large fraction of midwives' duties as well as delivery practice. About 90% of the midwives, who had knowledge of the Guidelines and provided dietary advice, were using the Guidelines. In order to increase the usage of individual items of the Guidelines, ready-to-use brochures should be developed for midwives.

Corrosion behaviour of laser-cleaned AA7024 aluminium alloy

NASA Astrophysics Data System (ADS)

Zhang, F. D.; Liu, H.; Suebka, C.; Liu, Y. X.; Liu, Z.; Guo, W.; Cheng, Y. M.; Zhang, S. L.; Li, L.

2018-03-01

Laser cleaning has been considered as a promising technique for the preparation of aluminium alloy surfaces prior to joining and welding and has been practically used in the automotive industry. The process is based on laser ablation to remove surface contaminations and aluminium oxides. However the change of surface chemistry and oxide status may affect corrosion behaviour of aluminium alloys. Until now, no work has been reported on the corrosion characteristics of laser cleaned metallic surfaces. In this study, we investigated the corrosion behaviour of laser-cleaned AA7024-T4 aluminium alloy using potentiodynamic polarisation, electrochemical impedance spectroscopy (EIS) and scanning vibrating electrode technique (SVET). The results showed that the laser-cleaned surface exhibited higher corrosion resistance in 3.5 wt.% NaCl solution than as-received hot-rolled alloy, with significant increase in impedance and decrease in capacitance, while SVET revealed that the active anodic points appeared on the as-received surface were not presented on the laser-cleaned surfaces. Such corrosion behaviours were correlated to the change of surface oxide status measured by glow discharge optical emission spectrometry (GDOES) and X-ray photoelectron spectroscopy (XPS). It was suggested that the removal of the original less protective oxide layer consisting of MgO and MgAl2O4 on the as-received surfaces and the newly formed more protective oxide layer containing mainly Al2O3 and MgO by laser cleaning were responsible for the improvement of the corrosion performance.

Alcohol brief interventions practice following training for multidisciplinary health and social care teams: A qualitative interview study

PubMed Central

Fitzgerald, Niamh; Molloy, Heather; MacDonald, Fiona; McCambridge, Jim

2015-01-01

Introduction and Aims Few studies of the implementation of alcohol brief interventions (ABI) have been conducted in community settings such as mental health, social work and criminal justice teams. This qualitative interview study sought to explore the impact of training on ABI delivery by staff from a variety of such teams. Design and Methods Fifteen semi-structured telephone interviews were carried out with trained practitioners and with managers to explore the use of, perceived need for and approaches to ABI delivery and recording with clients, and compatibility of ABIs with current practice. Interviews were analysed thematically using an inductive approach. Results Very few practitioners reported delivery of any ABIs following training primarily because they felt ABIs to be inappropriate for their clients. According to practitioners, this was either because they drank too much or too little to benefit. Practitioners reported a range of current activities relating to alcohol, and some felt that their knowledge and confidence were improved following training. One practitioner reported ABI delivery and was considered a training success, while expectations of ABIs did not fit with current practice including assessment procedures for the remainder. Discussion and Conclusions Identified barriers to ABI delivery included issues relating to individual practitioners, their teams, current practice and the ABI model. They are likely to be best addressed by strategic team- and setting-specific approaches to implementation, of which training is only one part. [Fitzgerald N, Molloy H, MacDonald F, McCambridge J. Alcohol brief interventions practice following training for multidisciplinary health and social care teams: A qualitative interview study. Drug Alcohol Rev 2015;34:185–93] PMID:25196713

Obstetrician perceptions of the causes of high cesarean delivery rates in Turkey.

PubMed

Küçük, Mert

2017-07-01

To assess obstetricians' perceptions surrounding cesarean delivery rates in Turkey. The present cross-sectional descriptive study was performed between May 1 and June 30, 2016. Practicing obstetricians with contact details known by the researchers and those attending a conference in Turkey were asked to complete a self-administered questionnaire that collected demographic data and information on participants' opinions, beliefs, knowledge, attitudes, and practices related to cesarean delivery. There were 100 obstetricians who responded to the survey. Awareness of high cesarean delivery rates was reported by 96 (96%) participants and 95 (95%) respondents said they were supportive of efforts to reduce it. There were 60 (60%), 83 (83%), and 100 (100%) participants aware of associations between high cesarean delivery rates and increased maternal and infant mortality; increased risk of uterine rupture; and increased risk of placenta previa, placenta accreta, and emergency cesarean hysterectomy, respectively. The most commonly reported reason for high cesarean delivery rates was high compensation costs during medical litigation legal proceedings, reported by all 100 (100%) participants. Participants were generally aware of the risks associated with high cesarean delivery rates. The results suggest that the greatest concern among obstetricians who perform cesarean deliveries was malpractice litigation. © 2017 International Federation of Gynecology and Obstetrics.

77 FR 52060 - Notice of Lodging of Consent Decree Pursuant to the Clean Water Act

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-28

... through best management practices, (c) capacity, management, operation and maintenance corrective action, (d) construction site inspection and enforcement, and (e) industrial facility stormwater pollution...

Clean catch urine sample

MedlinePlus

... JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 99. Nicolle LE, Norrby SR. Approach to the patient with urinary ...

Green Remediation Best Management Practices: Site Investigation

EPA Pesticide Factsheets

The U.S. EPA Principles for Greener Cleanups outline the Agency's policy for evaluating and minimizing the environmental 'footprint' of activities undertaken when cleaning up a contaminated site and conducting site investigation.

40 CFR 35.937-7 - Profit.

Code of Federal Regulations, 2012 CFR

2012-07-01

... ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.937-7 Profit. The objective of negotiations shall be the exercise of sound business judgment and good administrative practice including the...

40 CFR 35.937-7 - Profit.

Code of Federal Regulations, 2014 CFR

2014-07-01

... ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.937-7 Profit. The objective of negotiations shall be the exercise of sound business judgment and good administrative practice including the...

40 CFR 35.937-7 - Profit.

Code of Federal Regulations, 2013 CFR

2013-07-01

... ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.937-7 Profit. The objective of negotiations shall be the exercise of sound business judgment and good administrative practice including the...

40 CFR 35.937-7 - Profit.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.937-7 Profit. The objective of negotiations shall be the exercise of sound business judgment and good administrative practice including the...

Obsessive-Compulsive Disorder (For Parents)

MedlinePlus

... a bad thing, or sinned something is clean, dirty, or germy something is straight, even, or placed ... and it's important to go to them all. Practice the things the therapist recommends. Encourage your child. ...

Recent progress on fabrication and drug delivery applications of nanostructured hydroxyapatite.

PubMed

Mondal, Sudip; Dorozhkin, Sergy V; Pal, Umapada

2018-07-01

Through this brief review, we provide a comprehensive historical background of the development of nanostructured hydroxyapatite (nHAp), and its application potentials for controlled drug delivery, drug conjugation, and other biomedical treatments. Aspects associated with efficient utilization of hydroxyapatite (HAp) nanostructures such as their synthesis, interaction with drug molecules, and other concerns, which need to be resolved before they could be used as a potential drug carrier in body system, are discussed. This review focuses on the evolution of perceptions, practices, and accomplishments in providing improved delivery systems for drugs until date. The pioneering developments that have presaged today's fascinating state of the art drug delivery systems based on HAp and HAp-based composite nanostructures are also discussed. Special emphasis has been given to describe the application and effectiveness of modified HAp as drug carrier agent for different diseases such as bone-related disorders, carriers for antibiotics, anti-inflammatory, carcinogenic drugs, medical imaging, and protein delivery agents. As only a very few published works made comprehensive evaluation of HAp nanostructures for drug delivery applications, we try to cover the three major areas: concepts, practices and achievements, and applications, which have been consolidated and patented for their practical usage. The review covers a broad spectrum of nHAp and HAp modified inorganic drug carriers, emphasizing some of their specific aspects those needed to be considered for future drug delivery applications. This article is categorized under: Implantable Materials and Surgical Technologies > Nanomaterials and Implants Therapeutic Approaches and Drug Discovery > Nanomedicine for Respiratory Disease Nanotechnology Approaches to Biology > Cells at the Nanoscale. © 2017 Wiley Periodicals, Inc.

The State of Essential Newborn Care by Delivery Location in Bangladesh.

PubMed

Kim, Eunsoo Timothy; Singh, Kavita

2017-11-01

Introduction Essential newborn care (ENC) around the time of birth is critical in improving neonatal survival. There is currently a gap in our knowledge of the use of ENC by place of delivery in Bangladesh. This study assesses the provision of ENC and examines the odds of newborns receiving ENC by different levels of delivery care in Bangladesh. Methods Descriptive statistics and logistic regressions were performed on ENC practices from the 2011 Bangladesh Demographic and Health Survey dataset. ENC practices included nonapplication of substances to the cord; application of antiseptic to the cord; drying newborn within 5 min; wrapping newborn within 5 min; delaying first bath until the first 72 h; and breastfeeding within 1 h. Key predictors included home delivery with a lay attendant, delivery with primary healthcare services and delivery with higher-level healthcare services. Results Coverage of ENC practices was low. Women who delivered with primary and higher-level healthcare services generally reported greater odds of their newborns receiving recommended ENC than women who had home delivery with a lay attendant, the referent category. However, the odds of delayed first bath until 72 h and breastfeeding within 1 h were not statistically different for newborns who were delivered with primary healthcare services. Discussion These findings have significant public health implications as primary healthcare facilities are the first point of entry into the healthcare system. Provision of ENC, particularly delayed first bath until 72 h and breastfeeding within 1 h, should be encouraged for all healthy mother-newborn pairs in Bangladesh.

ARSH 1: Reproductive and sexual health problems of adolescents and young adults: a cross sectional community survey on knowledge, attitude and practice.

PubMed

Nair, M K C; Leena, M L; Thankachi, Yamini; George, Babu; Russell, Paul Swamidhas Sudhakar

2013-11-01

To understand the problems faced and the difference in knowledge, attitude and practice of young people across the age group of 10-24 y on reproductive and sexual health issues and to get their suggestions regarding adolescent care services. This cross sectional community survey involving three districts in Kerala was conducted among adolescents and young adults of 10-24 y using a population proportion to sample size technique. The main problems faced by the young people between 10 and 24 y of age were financial, substance abuse in family, poor academic performance, difference of opinion, disease in self/family, mental problems, lack of talent, strict parents, difficulty in mingling, love failure, broken family, loneliness and problems at school/office in the descending order. As the age advances higher percentage of both boys (43.4%) and girls (61.7%) discuss reproductive sexual health issues among themselves. There was a statistically significant difference in personal hygiene practices like changing napkins/cloths more than once a day (94.3%), cleaning genital organs with soap every day (71.7%), washing after urination (69.2%), washing from front to back after defecation (62.2%) and washing hands with soap after defecation (73.2%) between 10-14, 15-19, and 20-24 y age group with higher percentages in the older groups. In order to make the service more useful, more of the older group participants suggested giving information on adolescent services to parents, adolescents and society as a whole by creating better societal acceptance and keeping confidentiality in service delivery. This study has shown an overall inadequacy in reproductive health knowledge in all age groups, but increasing knowledge gain and better attitude and practices on reproductive and sexual health as the age increases. The suggestions made by the group regarding need for adolescent reproductive sexual health (ARSH) and counseling services with privacy and confidentiality ensured, is useful for planning ARSH services under National Rural Health Mission.

The Oral Health Care Delivery System in 2040: Executive Summary.

PubMed

Bailit, Howard L

2017-09-01

This executive summary for Section 4 of the "Advancing Dental Education in the 21 st Century" project examines the projected oral health care delivery system in 2040 and the likely impact of system changes on dental education. Dental care is at an early stage of major changes with the decline in solo practice and increase in large group practices. These groups are not consolidated at the state level, but further consolidation is expected as they try to increase their negotiating leverage with dental insurers. At this time, there is limited integration of medical and dental care in terms of financing, regulation, education, and delivery. This pattern may change as health maintenance organizations and integrated medical systems begin to offer dental care to their members. By 2040, it is expected that many dentists will be employed in large group practices and working with allied dental staff with expanded duties and other health professionals, and more dental graduates will seek formal postdoctoral training to obtain better positions in group practices.

Are nutrition messages lost in transmission? Assessing the quality and consistency of diabetes guideline recommendations on the delivery of nutrition therapy.

PubMed

Hale, Kelli; Capra, Sandra; Bauer, Judy

2016-12-01

To provide an overview of (1) the consistency of Type 2 Diabetes Clinical Practice Guidelines recommendations on the delivery of nutrition therapy and (2) Clinical Practice Guideline quality. Large international clinical practice guideline repositories, diabetes organisation websites, and electronic databases (Pubmed, Scopus), were searched to identify Clinical Practice Guidelines for adults with type 2 diabetes published 2005 to August 2014. Recommendations on the delivery of nutrition therapy were extracted and inductive content analysis was used to analyse consistency. Two researchers independently assessed guideline quality using the AGREE II tool. Nine topics were identified from the recommendations. Overall the consistency of the recommendations was related to guideline type. Compared with nutrition-specific guidelines, the broad ones had a broader focus and included more patient-focused recommendations. The ten Clinical Practice Guidelines assessed included six broad guidelines and four nutrition specific guidelines. Based on AGREE II analysis, the broad guidelines were higher quality than nutrition-specific ones. Broad Clinical Practice Guidelines were higher quality and included more patient-focused recommendations than nutrition-specific ones. Our findings suggest a need for nutrition-specific guidelines to be modified to include greater patient-focus, or for practitioners delivering nutrition therapy to adopt broad Clinical Practice Guidelines. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Association of intervention outcomes with practice capacity for change: Subgroup analysis from a group randomized trial

PubMed Central

Litaker, David; Ruhe, Mary; Weyer, Sharon; Stange, Kurt C

2008-01-01

Background The relationship between health care practices' capacity for change and the results and sustainability of interventions to improve health care delivery is unclear. Methods In the setting of an intervention to increase preventive service delivery (PSD), we assessed practice capacity for change by rating motivation to change and instrumental ability to change on a one to four scale. After combining these ratings into a single score, random effects models tested its association with change in PSD rates from baseline to immediately after intervention completion and 12 months later. Results Our measure of practices' capacity for change varied widely at baseline (range 2–8; mean 4.8 ± 1.6). Practices with greater capacity for change delivered preventive services to eligible patients at higher rates after completion of the intervention (2.7% per unit increase in the combined effort score, p < 0.001). This relationship persisted for 12 months after the intervention ended (3.1%, p < 0.001). Conclusion Greater capacity for change is associated with a higher probability that a practice will attain and sustain desired outcomes. Future work to refine measures of this practice characteristic may be useful in planning and implementing interventions that result in sustained, evidence-based improvements in health care delivery. PMID:18485216

Personalizing knowledge delivery services: a conceptual framework

NASA Technical Reports Server (NTRS)

Majchrzak, Ann; Chelleppa, Ramnath K.; Cooper, Lynne P.; Hars, Alexander

2003-01-01

Consistent with the call of the Minnesota Symposium for new theory in knowledge management, we offer a new conceptualization of Knowledge Management Systems (KMS) as a portfolio of personalized knowledge delivery services. Borrowing from research on online consumer behavior, we describe the challenges imposed by personalized knowledge delivery services, and suggest design parameters that can help to overcome these challenges. We develop our design constructs through a set of hypotheses and discuss the research implications of our new conceptualization. Finally, we describe practical implications suggested by our conceptualization - practical suggestions that we hope to gain some experience with as part of an ongoing action research project at our partner organization.

Green Remediation Best Management Practices: Landfill Cover Systems & Energy Production

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Principles for Greener Cleanups outline the Agency's policy for evaluating and minimizing the environmental 'footprint' of activities undertaken when cleaning up a contaminated site.

A Blueprint for IAQ.

ERIC Educational Resources Information Center

Quraishi, Arif; Kapfer, Tom

1999-01-01

Presents practical solutions to school indoor-air-quality problems. Areas where school administrators should set IAQ goals and provide resources are listed, and tips for HVAC maintenance and cleaning to reduce air pollutants are provided. (GR)

7 CFR 51.2956 - Practically clean.

Code of Federal Regulations, 2010 CFR

2010-01-01

... dirt or other foreign matter, and that individual walnuts are not damaged by such means. A slightly chalky deposit on the shell is characteristic of many bleached nuts and shall not be considered as dirt...

7 CFR 51.2339 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... means the fruit is practically free from dirt, dust, or other foreign material. Fairly clean means the fruit is reasonably free from dirt, dust, or other foreign material. Well formed means the fruit has the...

Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention.

PubMed

Quinn, Margaret M; Henneberger, Paul K; Braun, Barbara; Delclos, George L; Fagan, Kathleen; Huang, Vanthida; Knaack, Jennifer L S; Kusek, Linda; Lee, Soo-Jeong; Le Moual, Nicole; Maher, Kathryn A E; McCrone, Susan H; Mitchell, Amber Hogan; Pechter, Elise; Rosenman, Kenneth; Sehulster, Lynne; Stephens, Alicia C; Wilburn, Susan; Zock, Jan-Paul

2015-05-01

The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel. The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice. An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives. A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

PubMed Central

Russell, Grant M.; Dahrouge, Simone; Hogg, William; Geneau, Robert; Muldoon, Laura; Tuna, Meltem

2009-01-01

PURPOSE New approaches to chronic disease management emphasize the need to improve the delivery of primary care services to meet the needs of chronically ill patients. This study (1) assessed whether chronic disease management differed among 4 models of primary health care delivery and (2) identified which practice organizational factors were independently associated with high-quality care. METHODS We undertook a cross-sectional survey with nested qualitative case studies (2 practices per model) in 137 randomly selected primary care practices from 4 delivery models in Ontario Canada: fee for service, capitation, blended payment, and community health centers (CHCs). Practice and clinician surveys were based on the Primary Care Assessment Tool. A chart audit assessed evidence-based care delivery for patients with diabetes, congestive heart failure, and coronary artery disease. Intermediate outcomes were calculated for patients with diabetes and hypertension. Multiple linear regression identified those organizational factors independently associated with chronic disease management. RESULTS Chronic disease management was superior in CHCs. Clinicians in CHCs found it easier than those in the other models to promote high-quality care through longer consultations and interprofessional collaboration. Across the whole sample and independent of model, high-quality chronic disease management was associated with the presence of a nurse-practitioner. It was also associated with lower patient-family physician ratios and when practices had 4 or fewer full-time-equivalent family physicians. CONCLUSIONS The study adds to the literature supporting the value of nurse-practitioners within primary care teams and validates the contributions of Ontario’s CHCs. Our observation that quality of care decreased in larger, busier practices suggests that moves toward larger practices and greater patient-physician ratios may have unanticipated negative effects on processes of care quality. PMID:19597168

Establishing Obstetric Anesthesiology Practice Guidelines in the Republic of Armenia: A Global Health Collaboration.

PubMed

Yuill, Gordon; Amroyan, Ashot; Millar, Simon; Vardapetyan, Emil; Habib, Ashraf S; Owen, Medge D

2017-08-01

Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia. An invited multinational team of physicians conducted six visits to Armenia between 2006 and 2015 to observe current practice and establish standards of obstetric anesthesia care. The Armenian Society of Anaesthesiologists and Intensive Care specialists collected data on the numbers of vaginal delivery, cesarean delivery, and neuraxial anesthesia use in maternity units during the period. Data were analyzed with the Fisher exact or chi-square test, as appropriate. Neuraxial anesthesia use for cesarean delivery increased significantly (P < 0.0001) in all 10 maternity hospitals within the capital city of Yerevan. For epidural labor analgesia, there was sustained or increased use in only two hospitals. For hospitals located outside the capital city, there was a similar increase in the use of neuraxial anesthesia for cesarean delivery that was greater in hospitals that were visited by an external team (P < 0.0001); however, use of epidural labor analgesia was not increased significantly. Over the course of the collaboration, guidelines for obstetric anesthesia were drafted and approved by the Armenian Ministry of Health. Collaboration between Armenian anesthesiologists and dedicated visiting physicians to update and standardize obstetric anesthesia practices led to national practice guidelines and sustained improvements in clinical care in the Republic of Armenia.

Effect of commercial hauling practices and tanker cleaning treatments on raw milk microbiological quality.

PubMed

Darchuk, Emily M; Waite-Cusic, Joy; Meunier-Goddik, Lisbeth

2015-10-01

Consolidation of the US milk industry has led to use of tankers for up to 24 h in between thorough cleanings. As the heavy use of tankers has not been previously studied, the effect of this form of hauling on raw milk quality is unknown. This study focused on the effect of frequent tanker use during hauling on raw milk quality at a commercial facility. Standard tanker use (cleaned-in-place once per 24 h) served as our control and incremental cleaning treatments (water rinse after each load, water rinse after each load with a sanitizer treatment after 12 h, and 12 h of sanitizer treatment) were added to the study to understand if any effect could be mitigated by more frequent cleaning. Producer samples were collected from the farm before loading milk into the tanker as well as sampling the same milk directly out of the tanker truck before unloading at the manufacturer. The study was repeated at 2 different dairy manufacturing facilities, once during the summer and once during the winter. Milk quality was quantified through industry-relevant microbiological tests: individual bacteria count, thermophilic spore count, and preliminary incubation count. Within the study we defined a negative effect on milk quality as a statistically significant difference between the tanker and producer samples in any of the 3 microbial tests conducted between treatments. Results from the study showed no clear effect due to hauling in individual bacteria count, thermophilic spore count, or preliminary incubation counts. There was also no difference in milk quality between the 2 plants, suggesting that neither season nor location affected our results in the standard use variable. As we did not see a negative effect on milk quality in the standard use variable, the addition of cleaning treatments did not appear to provide any clear benefit. Tanker surface swabs and ATP swabs were also used to monitor tanker sanitation and the efficacy of cleaning treatments. Both surface and ATP swabs revealed differences between cleaning efficacy at the 2 facilities. Although the differences in efficacy did not influence tanker milk quality within our study, variability in sanitation may provide a source of contamination that could negatively affect raw milk quality in other areas. Based on this study, current hauling practices appear to be effective in mitigating any measurable effect on raw milk quality; however, further investigation is needed before making industry-wide recommendations. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

PubMed Central

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-01-01

Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. PMID:25231492

Transportation risk management : international practices for program development and project delivery.

DOT National Transportation Integrated Search

2012-08-01

Managing transportation networks, including agency : management, program development, and project : delivery, is extremely complex and fraught with : uncertainty. Administrators, planners, and engineers : coordinate a multitude of organizational and ...

Oral Hygiene Practices and Teeth Cleaning Techniques Among Medical Students

PubMed Central

Fatima, Syeda H; Ghazanfar, Haider; Haq, Sana; Khan, Najeeb A; Mehmood, Moeez; Ghazanfar, Ali

2017-01-01

Objectives Oral health is essential for general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infections and sores, periodontal disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity to bite, chew, smile, and speak; it affects psychosocial well-being too. The objective of our study was to assess teeth cleaning techniques and oral hygiene practices among medical students. Methods The data of the study were collected in two stages. The first stage involved the administration of a self-constructed questionnaire among medical students. In the second step, the students were asked to demonstrate their teeth cleaning techniques on a model. A standard teeth cleaning checklist was used to evaluate the students. The students were then given the checklist and a video on teeth cleaning techniques was shown to them. The data obtained was analyzed on IBM's statistical package for the social sciences (SPSS) version 21.  Results Out of a total of 444 students, 256 (57.7 percent) were males while 188 (42.3 percent) were females. About 254 (57.2 percent) participants were preclinical medical students while 190 (42.8 percent) were clinical year medical students. A majority of medical students used medium consistency toothbrushes (177; 39.9 percent) and soft consistency toothbrushes (137; 30.9 percent). Most medical students (248; 55.9 percent) brushed two times a day while 163 (36.7 percent) brushed only one time. About 212 (47.7 percent) of the medical students used mouthwash along with a toothbrush while only 36 (8.1 percent) used floss along with a toothbrush. About 157 participants (35.4 percent) changed their toothbrush once in two months while 132 (26.7 percent) changed their toothbrush once in three months. The mean duration that participants brushed their teeth was 134.99 ± 69.01 seconds. Conclusion Medical students were found to have a faulty teeth cleaning technique. There is a dire need to spread awareness about correct teeth cleaning techniques because poor oral hygiene can have a detrimental effect on the overall health and quality of life of an individual. PMID:28944126

Plastics processing: statistics, current practices, and evaluation.

PubMed

Cooke, F

1993-11-01

The health care industry uses a huge quantity of plastic materials each year. Much of the machinery currently used, or supplied, for plastics processing is unsuitable for use in a clean environment. In this article, the author outlines the reasons for the current situation and urges companies to re-examine their plastic-processing methods, whether performed in-house or subcontracted out. Some of the factors that should be considered when evaluating plastics-processing equipment are outlined to assist companies in remaining competitive and complying with impending EC regulations on clean room standards for manufacturing areas.

Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards.

PubMed

Hor, Su-Yin; Hooker, Claire; Iedema, Rick; Wyer, Mary; Gilbert, Gwendolyn L; Jorm, Christine; O'Sullivan, Matthew Vincent Neil

2017-07-01

Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Street dust: implications for stormwater and air quality, and environmental through street sweeping.

PubMed

Calvillo, Steven J; Williams, E Spencer; Brooks, Bryan W

2015-01-01

Street dust represents a source of dual potential risk to stormwater and air quality. It has been well documented that street dust washes into local watersheds and can degrade water quality. Research has also demonstrated that ambient particulate matter (PM10) , which is associated with adverse health outcomes, can arise from resuspension of accumulated street dust. Furthermore, many contaminants, including metals, are present at higher concentrations in the smallest available particles, which are more likely to be resuspended in air and stormwater runoff. Although street cleaning is listed as a best management practice for storm water quality by the EPA, data are limited on the critical parameters (technology, environment, usage), which determine the effectiveness of any street cleaning program, particularly in the peer-reviewed literature. The purpose of the present study was to develop a comprehensive understanding of the efficacy of various street cleaning technologies and practices to protect both water quality and public health. Few studies have compared the effectiveness of street sweeping technologies to remove street dust. Unfortunately, the dearth of comprehensive data on exposure, contaminant concentrations, and efficacy of various sweeping technologies and strategies precludes developing quantitative estimates for potential risk to humans and the environment. Based on the few studies available, regenerative air street sweepers appear to provide the most benefit with regard to collection of small particles and prevention of re-entrainment. It is also clear from the available data that local conditions, climate, and specific needs are critical determinants of the ideal street sweeping strategy (technology, frequency, speed, targeted areas, etc.). Given the critical need for protection of water and air quality in rapidly expanding urban regions (e.g., megacities), further research is necessary to develop best practices for street dust management. Herein, we provide a framework for future experimental studies to support risk-based assessments of street cleaning technologies.

The development and implementation of a theory-informed, integrated mother-child intervention in rural Uganda.

PubMed

Singla, Daisy R; Kumbakumba, Elias

2015-12-01

A randomised cluster effectiveness trial of a parenting intervention in rural Uganda found benefits to child development among children 12-36 months, relevant parenting practices related to stimulation, hygiene and diet, and prevented the worsening of mothers' depressive symptoms. An examination of underlying implementation processes allows researchers and program developers to determine whether the program was implemented as intended and highlight barriers and facilitators that may influence replication and scale-up. The objectives of this study were to describe and critically examine (a) perceived barriers and facilitators related to implementation processes of intervention content, training and supervision and delivery from the perspectives of delivery agents and supervisors; (b) perceived barriers and facilitators related to enactment of practices from the perspective of intervention mothers participating in the parenting program; and c) whether the program was implemented as intended. Semi-structured interviews were conducted at midline with peer delivery agents (n = 12) and intervention mothers (n = 31) and at endline with supervisors (n = 4). Content analysis was used to analyze qualitative data in terms of barriers and facilitators of intervention content, training and supervision, delivery and enactment. Additionally, mothers' recall and enactment of practices were coded and analyzed statistically. Monitoring of group sessions and home visits were examined to reveal whether the program was implemented as intended. Among the program's five key messages, 'love and respect' targeting maternal psychological well-being was the most practiced by mothers, easiest to implement by delivery agents, and mothers reported the most internal facilitators for this message. A detailed manual and structured monitoring forms were perceived to facilitate training, intervention delivery, and supervision. Interactive and active strategies based on social-cognitive learning theory were reported as facilitators to intervention delivery. Only program attendance, but not barriers, facilitators or message recall, was significantly positively related to message enactment. Monitoring of group sessions and home visits showed that the program was largely implemented as intended. This implementation assessment revealed a number of important barriers and facilitators from the perspectives of delivery agents, supervisors and program participants. The methods and results are useful to examining and informing the content, delivery, and scaling up of the current program as well as future mother-child interventions in LMIC settings. Copyright © 2015 Elsevier Ltd. All rights reserved.

Delivery of Antibiotics from Cementless Titanium-Alloy Cubes May Be a Novel Way to Control Postoperative Infections

PubMed Central

Bezuidenhout, Martin B.; van Staden, Anton D.; Oosthuizen, Gert A.; Dimitrov, Dimitar M.; Dicks, Leon M. T.

2015-01-01

Bacterial colonisation and biofilm formation onto orthopaedic devices are difficult to eradicate. In most cases infection is treated by surgical removal of the implant and cleaning of the infected area, followed by extensive treatment with broad-spectrum antibiotics. Such treatment causes great discomfort, is expensive, and is not always successful. In this study we report on the release of vancomycin through polyethersulfone membranes from channels in cementless titanium-alloy cubes. The cubes were constructed with LaserCUSING from Ti6Al4V ELI powder. Vancomycin was released by non-Fickian anomalous (constraint) diffusion. Approximately 50% of the vancomycin was released within the first 17 h. However, sustained delivery of vancomycin for 100 h was possible by reinjecting the channels. Refillable implants may be a novel way to control postoperative infections. PMID:25861649

Development of an Inhaled Dry-Powder Formulation of Tobramycin Using PulmoSphere™ Technology

PubMed Central

Weers, Jeffry; Heuerding, Silvia

2011-01-01

Abstract At present, the only approved inhaled antipseudomonal antibiotics for chronic pulmonary infections in patients with cystic fibrosis (CF) are nebulized solutions. However, prolonged administration and cleaning times, high administration frequency, and cumbersome delivery technologies with nebulizers add to the high treatment burden in this patient population. PulmoSphere™ technology is an emulsion-based spray-drying process that enables the production of light porous particle, dry-powder formulations, which exhibit improved flow and dispersion from passive dry powder inhalers. This review explores the fundamental characteristics of PulmoSphere technology, focusing on the development of a dry powder formulation of tobramycin for the treatment of chronic pulmonary Pseudomonas aeruginosa (Pa) infection in CF patients. This dry powder formulation provides substantially improved intrapulmonary deposition efficiency, faster delivery, and more convenient administration over nebulized formulations. The availability of more efficient and convenient treatment options may improve treatment compliance, and thereby therapeutic outcomes in CF. PMID:21395432

High-Quality Traineeships: Identifying What Works. A National Vocational Education and Training Research and Evaluation Program Report

ERIC Educational Resources Information Center

Smith, Erica; Comyn, Paul; Kemmis, Roslin Brennan; Smith, Andy

2009-01-01

This study explores the common features of high-quality traineeships using case studies from the cleaning, child care, construction, retail, finance and insurance, and meat processing areas. The research identifies a range of policy measures that could improve both the practice and image of traineeships. A good practice guide has also been…

Gasoline risk management: a compendium of regulations, standards, and industry practices.

PubMed

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

2014-11-01

This paper is part of a special series of publications regarding gasoline toxicology testing and gasoline risk management; this article covers regulations, standards, and industry practices concerning gasoline risk management. Gasoline is one of the highest volume liquid fuel products produced globally. In the U.S., gasoline production in 2013 was the highest on record (API, 2013). Regulations such as those pursuant to the Clean Air Act (CAA) (Clean Air Act, 2012: § 7401, et seq.) and many others provide the U.S. federal government with extensive authority to regulate gasoline composition, manufacture, storage, transportation and distribution practices, worker and consumer exposure, product labeling, and emissions from engines and other sources designed to operate on this fuel. The entire gasoline lifecycle-from manufacture, through distribution, to end-use-is subject to detailed, complex, and overlapping regulatory schemes intended to protect human health, welfare, and the environment. In addition to these legal requirements, industry has implemented a broad array of voluntary standards and best management practices to ensure that risks from gasoline manufacturing, distribution, and use are minimized. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Trial of a novel plasma gas disinfection system (Radica) to reduce mattress residual bacterial contamination in the acute hospital setting: a preliminary study.

PubMed

Shiely, F; Fallon, D; Casey, C; Kerins, D M; Eustace, J A

2017-02-01

In routine clinical practice, mattresses are manually cleaned using specialised cleaning and high-level disinfecting fluids. While effective against a wide range of organisms, the success of this approach is dependent on a thorough and complete application and is likely to be susceptible to human error and thus variable. The efficacy of available infection control measures to reduce such mattress contamination is unknown as it is not subject to quality control measures. There is a pressing need to identify more effective methods to prevent cross contamination within the medical environment, given the lack of available treatment strategies. The purpose of this study is to investigate the ability of a new technology, gaseous technology, to reduce colonization levels, compared to standard cleaning, and so attenuate superficial nosocomial infections. We conducted a prospective, single-centre, open-label, non-randomized trial with blinded outcome assessments, comparing the standard cleaning of hospital mattresses with a novel plasma based disinfection system Radica™, followed by a standard post-cleaning culturing protocol (five swabs/mattress). The median (interquartile range) maximal colony count per mattress for the 20 Radica versus 7 routinely cleaned mattresses was 1 (1-2.7) versus Too-Numerous-to-Count (TNTC) (32-TNTC), respectively, p = 0.002. Of the 20 Radica™ treated mattresses, 12 (60 %) had no positive culture result while all of the standard cleaned mattresses had at least two positive cultures. The plasma based Radica disinfection system reduces mattress bacterial colonization levels as compared to routine cleaning. This is a potentially important technology in the health care system to reduce surface colonisation and hence nosocomial infections.

Enhancing assertiveness in district nurse specialist practice.

PubMed

Green, Julie

2016-08-02

District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and prioritise care delivery effectively. This article explores the need for assertiveness skills in this role in response to Australian research, and outlines the pedagogic interventions implemented during the SPQ DN course to enhance this skill. Assertiveness scores were monitored for the duration of the course and demonstrated a significant increase-a topic that is now the subject of a future, funded study.

Turning theory into practice: the development of modern transdermal drug delivery systems and future trends.

PubMed

Perumal, O; Murthy, S N; Kalia, Y N

2013-01-01

Despite its remarkable barrier function, the skin remains an attractive site for systemic drug delivery given its easy accessibility, large surface area and the possibility to bypass the gastrointestinal tract and the liver and so modify drug absorption kinetics. The pioneering work of Scheuplein, Higuchi and others in the 1960s helped to explain the processes involved in passive percutaneous absorption and led to the development of mathematical models to describe transdermal drug delivery. The intervening years have seen these theories turned to practice and a significant number of transdermal systems are now available including some that employ active drug delivery. This review briefly discusses the evolution of transdermal therapeutic systems over the years and the potential of newer transdermal technologies to deliver hydrophilic drugs and macromolecules through the skin. © 2013 S. Karger AG, Basel.

Spatial and temporal analogies in microbial communities in natural drinking water biofilms.

PubMed

Douterelo, I; Jackson, M; Solomon, C; Boxall, J

2017-03-01

Biofilms are ubiquitous throughout drinking water distribution systems (DWDS), playing central roles in system performance and delivery of safe clean drinking water. However, little is known about how the interaction of abiotic and biotic factors influence the microbial communities of these biofilms in real systems. Results are presented here from a one-year study using in situ sampling devices installed in two operational systems supplied with different source waters. Independently of the characteristics of the incoming water and marked differences in hydraulic conditions between sites and over time, a core bacterial community was observed in all samples suggesting that internal factors (autogenic) are central in shaping biofilm formation and composition. From this it is apparent that future research and management strategies need to consider the specific microorganisms found to be able to colonise pipe surfaces and form biofilms, such that it might be possible to exclude these and hence protect the supply of safe clean drinking water. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Where are we on the diffusion curve? Trends and drivers of primary care physicians' use of health information technology.

PubMed

Audet, Anne-Marie; Squires, David; Doty, Michelle M

2014-02-01

To describe trends in primary care physicians' use of health information technology (HIT) between 2009 and 2012, examine practice characteristics associated with greater HIT capacity in 2012, and explore factors such as delivery system and payment reforms that may affect adoption and functionality. We used data from the 2012 and 2009 Commonwealth Fund International Health Policy Surveys of Primary Care Physicians. The data were collected in both years by postal mail between March and July among a nationally representative sample of primary care physicians in the United States. We compared primary care physicians' HIT capacity in 2009 and 2012. We employed multivariable logistic regression to analyze whether participating in an integrated delivery system, sharing resources and support with other practices, and being eligible for financial incentives were associated with greater HIT capacity in 2012. Primary care physicians' HIT capacity has significantly expanded since 2009, although solo practices continue to lag. Practices that are part of an integrated delivery system or share resources with other practices have higher rates of electronic medical record (EMR) adoption, multifunctional HIT, electronic information exchange, and electronic access for patients. Receiving or being eligible for financial incentives is associated with greater adoption of EMRs and information exchange. Federal efforts to increase adoption have coincided with a rapid increase in HIT capacity. Delivery system and payment reforms and federally funded extension programs could offer promising pathways for further diffusion. © Health Research and Educational Trust.

Green Remediation Best Management Practices: Integrating Renewable Energy into Site Cleanup

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Principles for Greener Cleanups outline the Agency's policy for evaluating and minimizing the environmental 'footprint' of activities undertaken when cleaning up a contaminated site.

Green Remediation Best Management Practices: Pump and Treat Technologies

EPA Pesticide Factsheets

The U.S. EPA Principles for Greener Cleanups outline the Agency's policy for evaluating and minimizing the environmental 'footprint' of activities undertaken when cleaning up a contaminated site with pump and treat technologies.

Green Remediation Best Management Practices: Sites with Leaking Underground Storage Tank Systems

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency (EPA) Principles for Greener Cleanups outline the Agency's policy for evaluating and minimizing the environmental 'footprint' of activities undertaken when cleaning up a contaminated site.

49 CFR 176.805 - On deck stowage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for leakage from any package to drain away from other cargo into an overboard scupper or freeing port... stowage is not practical, sufficient clean dry sand must be placed under and around the lower tier of...

Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland.

PubMed

Hanna, Lisa; May, Carl; Fairhurst, Karen

2011-01-01

Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers' attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients. To investigate practice managers' attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies. We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews. Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand. Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics. Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/communication technologies.

Family-centred care delivery

PubMed Central

Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

2013-01-01

Abstract Objective To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Design Cross-sectional study. Setting Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. Participants A total of 137 practices, 363 providers, and 5144 patients. Main outcome measures Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Results Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Conclusion Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC. PMID:24235195

Organic cleanliness of the Mars Science Laboratory sample transfer chain.

PubMed

Blakkolb, B; Logan, C; Jandura, L; Okon, A; Anderson, M; Katz, I; Aveni, G; Brown, K; Chung, S; Ferraro, N; Limonadi, D; Melko, J; Mennella, J; Yavrouian, A

2014-07-01

One of the primary science goals of the Mars Science Laboratory (MSL) Rover, Curiosity, is the detection of organics in Mars rock and regolith. To achieve this, the Curiosity rover includes a robotic sampling system that acquires rock and regolith samples and delivers it to the Sample Analysis at Mars (SAM) instrument on board the rover. In order to provide confidence that any significant organics detection result was Martian and not terrestrial in origin, a requirement was levied on the flight system (i.e., all sources minus the SAM instrument) to impart no more than 36 parts per billion (ppb by weight) of total reduced carbon terrestrial contamination to any sample transferred to the SAM instrument. This very clean level was achieved by a combination of a rigorous contamination control program on the project, and then using the first collected samples for a "dilution cleaning" campaign of the sample chain prior to delivering a sample to the SAM instrument. Direct cleanliness assays of the sample-contacting and other Flight System surfaces during pre-launch processing were used as inputs to determine the number of dilution cleaning samples needed once on Mars, to enable delivery of suitably clean samples to the SAM experiment. Taking into account contaminant redistribution during launch thorough landing of the MSL on Mars, the amount of residue present on the sampling hardware prior to the time of first dilution cleaning sample acquisition was estimated to be 60 ng/cm(2) on exposed outer surfaces of the sampling hardware and 20 ng/cm(2) on internal sample contacting surfaces; residues consisting mainly of aliphatic hydrocarbons and esters. After three dilution cleaning samples, estimated in-sample contamination level for the first regolith sample delivered to the SAM instrument at the Gale Crater "Rocknest" site was bounded at ≤10 ppb total organic carbon. A Project decision to forego ejecting the dilution cleaning sample and instead transfer the first drill-acquired sample at the "John Klein" site to SAM resulted in an estimated level of terrestrial contamination of ≤430 ppb. The estimated terrestrial contamination for portions from the second drill-acquired sample, at Cumberland, was ≤69 ppb; the estimate for a future, third, drilled sample is ≤38 ppb. These levels are comparable in magnitude to the SAM instrument blanks at the nanomole level (as chlorohydrocarbon).

Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece.

PubMed

Oikonomidou, Despoina; Anagnostopoulos, Fotios; Dimitrakaki, Christine; Ploumpidis, Dimitrios; Stylianidis, Stylianos; Tountas, Yannis

2017-06-01

There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.

Alcohol brief interventions practice following training for multidisciplinary health and social care teams: a qualitative interview study.

PubMed

Fitzgerald, Niamh; Molloy, Heather; MacDonald, Fiona; McCambridge, Jim

2015-03-01

Few studies of the implementation of alcohol brief interventions (ABI) have been conducted in community settings such as mental health, social work and criminal justice teams. This qualitative interview study sought to explore the impact of training on ABI delivery by staff from a variety of such teams. Fifteen semi-structured telephone interviews were carried out with trained practitioners and with managers to explore the use of, perceived need for and approaches to ABI delivery and recording with clients, and compatibility of ABIs with current practice. Interviews were analysed thematically using an inductive approach. Very few practitioners reported delivery of any ABIs following training primarily because they felt ABIs to be inappropriate for their clients. According to practitioners, this was either because they drank too much or too little to benefit. Practitioners reported a range of current activities relating to alcohol, and some felt that their knowledge and confidence were improved following training. One practitioner reported ABI delivery and was considered a training success, while expectations of ABIs did not fit with current practice including assessment procedures for the remainder. Identified barriers to ABI delivery included issues relating to individual practitioners, their teams, current practice and the ABI model. They are likely to be best addressed by strategic team- and setting-specific approaches to implementation, of which training is only one part. © 2014 The Authors. Drug and Alcohol Review published by Wiley Publishing Asia Pty Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.

Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data.

PubMed

Bee, Margaret; Shiroor, Anushree; Hill, Zelee

2018-04-16

Recommended immediate newborn care practices include thermal care (immediate drying and wrapping, skin-to-skin contact after delivery, delayed bathing), hygienic cord care and early initiation of breastfeeding. This paper systematically reviews quantitative and qualitative data from sub-Saharan Africa on the prevalence of key immediate newborn care practices and the factors that influence them. Studies were identified by searching relevant databases and websites, contacting national and international academics and implementers and hand-searching reference lists of included articles. English-language published and unpublished literature reporting primary data from sub-Saharan Africa (published between January 2001 and May 2014) were included if it met the quality criteria. Quantitative prevalence data were extracted and summarized. Qualitative data were synthesized through thematic analysis, with deductive coding used to identify emergent themes within each care practice. A framework approach was used to identify prominent and divergent themes. Forty-two studies were included as well as DHS data - only available for early breastfeeding practices from 33 countries. Results found variation in the prevalence of immediate newborn care practices between countries, with the exception of skin-to-skin contact after delivery which was universally low. The importance of keeping newborn babies warm was well recognized, although thermal care practices were sub-optimal. Similar factors influenced practices across countries, including delayed drying and wrapping because the birth attendant focused on the mother; bathing newborns soon after delivery to remove the dirt and blood; negative beliefs about the vernix; applying substances to the cord to make it drop off quickly; and delayed breastfeeding because of a perception of a lack of milk or because the baby needs to sleep after delivery or does not showing signs of hunger. The majority of studies included in this review came from five countries (Ethiopia, Ghana, Malawi, Tanzania and Uganda). There is a need for more research from a wider geographical area, more research on newborn care practices at health facilities and standardization in measuring newborn care practices. The findings of this study could inform behaviour change interventions to improve the uptake of immediate newborn care practices.

Efficient and effective implementation of alternative project delivery methods.

DOT National Transportation Integrated Search

2017-05-01

Over the past decade, the Maryland Department of Transportation State Highway : Administration (MDOT SHA) has implemented Alternative Project Delivery (APD) methods : in a number of transportation projects. While these innovative practices have produ...

Delivery should happen soon and my pain will be reduced: understanding women's perception of good delivery care in India.

PubMed

Bhattacharyya, Sanghita; Srivastava, Aradhana; Avan, Bilal Iqbal

2013-11-22

Understanding a woman's perspective and her needs during childbirth and addressing them as part of quality-improvement programmes can make delivery care safe, affordable, and respectful. It has been pointed out that the patient's judgement on the quality and goodness of care is indispensible to improving the management of healthcare systems. The objective of the study is to understand the aspects of care that women consider important during childbirth. Individual in-depth interviews (IDIs) and focus-group discussions (FGDs) with women who recently delivered were the techniques used. Seventeen IDIs and four FGDs were conducted in Jharkhand state in east India between January and March 2012. Women who had normal deliveries with live births at home and in primary health centres were included. To minimise recall bias, interviews were conducted within 42 days of childbirth. Using the transcripts of interviews, the data were analysed thematically. Aspects of care most commonly cited by women to be important were: availability of health providers and appropriate medical care (primarily drugs) in case of complications; emotional support; privacy; clean place after delivery; availability of transport to reach the institution; monetary incentives that exceed expenses; and prompt care. Other factors included kind interpersonal behaviour, cognitive support, faith in the provider's competence, and overall cleanliness of the facility and delivery room. Respondents belonging to low socio-economic strata with basic literacy levels might not understand appropriate clinical aspects of care, but they want care that is affordable and accessible, along with privacy and emotional support during delivery. The study highlighted that healthcare quality-improvement programmes in India need to include non-clinical aspects of care as women want to be treated humanely during delivery--they desire respectful treatment, privacy, and emotional support. Further research into maternal satisfaction could be made more policy relevant by assessing the relative strength of various factors in influencing maternal satisfaction; this could help in prioritising appropriate interventions for improved quality of care (QoC).

Exploring the decision-making process in the delivery of physiotherapy in a stroke unit.

PubMed

McGlinchey, Mark P; Davenport, Sally

2015-01-01

The aim of this study was to explore the decision-making process in the delivery of physiotherapy in a stroke unit. A focused ethnographical approach involving semi-structured interviews and observations of clinical practice was used. A purposive sample of seven neurophysiotherapists and four patients participated in semi-structured interviews. From this group, three neurophysiotherapists and four patients were involved in observation of practice. Data from interviews and observations were analysed to generate themes. Three themes were identified: planning the ideal physiotherapy delivery, the reality of physiotherapy delivery and involvement in the decision-making process. Physiotherapists used a variety of clinical reasoning strategies and considered many factors to influence their decision-making in the planning and delivery of physiotherapy post-stroke. These factors included the therapist's clinical experience, patient's presentation and response to therapy, prioritisation, organisational constraints and compliance with organisational practice. All physiotherapists highlighted the importance to involve patients in planning and delivering their physiotherapy. However, there were varying levels of patient involvement observed in this process. The study has generated insight into the reality of decision-making in the planning and delivery of physiotherapy post-stroke. Further research involving other stroke units is required to gain a greater understanding of this aspect of physiotherapy. Implications for Rehabilitation Physiotherapists need to consider multiple patient, therapist and organisational factors when planning and delivering physiotherapy in a stroke unit. Physiotherapists should continually reflect upon how they provide physiotherapy, with respect to the duration, frequency and time of day sessions are delivered, in order to guide current and future physiotherapy delivery. As patients may demonstrate varying levels of participation in deciding and understanding how physiotherapy is delivered, physiotherapists need to adjust how they engage patients in the decision-making process and manage patient expectations accordingly.

The Integration of the 241-Z Building Decontamination and Decommissioning Under Cercla with RCRA Closure at the Plutonium Finishing Plant

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

Mattlin, E.; Charboneau, S.; Johnston, G.

2007-07-01

The 241-Z treatment and storage tanks, a hazardous waste Treatment, Storage and Disposal (TSD) unit permitted pursuant to the Resource Conservation and Recovery Act of 1976 (RCRA) and Washington State Hazardous Waste Management Act, RCW 70.105, , have been deactivated and are being actively decommissioned under the provisions of the Hanford Federal Facility Agreement and Consent Order (HFFACO), RCRA and Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) 42 U.S.C. 9601 et seq. The 241-Z TSD unit managed non-listed radioactive contaminated waste water, containing trace RCRA characteristic constituents. The 241-Z TSD unit consists of below grade tanks (D-4,more » D-5, D-7, D-8, and an overflow tank) located in a concrete containment vault, sample glovebox GB-2-241-ZA, and associated ancillary piping and equipment. The tank system is located beneath the 241-Z building. The 241-Z building is not a portion of the TSD unit. The sample glovebox is housed in the above-grade building. Waste managed at the TSD unit was received via underground piping from Plutonium Finishing Plant (PFP) sources. Tank D-6, located in the D-6 vault cell, is a past-practice tank that was taken out of service in 1972 and has never operated as a portion of the RCRA TSD unit. CERCLA actions will address Tank D-6, its containment vault cell, and soil beneath the cell that was potentially contaminated during past-practice operations and any other potential past-practice contamination identified during 241-Z closure, while outside the scope of the Hanford Facility Dangerous Waste Closure Plan, 241-Z Treatment and Storage Tanks. Under the RCRA closure plan, the 241-Z TSD unit is anticipated to undergo clean closure to the performance standards of the State of Washington with respect to dangerous waste contamination from RCRA operations. The TSD unit will be clean closed if physical closure activities identified in the plan achieve clean closure standards for all 241-Z locations. Clean closed 241-Z treatment and storage tanks, equipment and/or structures will remain after RCRA clean closure for future disposition in conjunction with PFP decommissioning activities which are integrated with CERCLA. (authors)« less

Delivery, immediate newborn and cord care practices in Pemba Tanzania: a qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices

PubMed Central

2014-01-01

Background Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial. Methods 80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2. Results Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby’s first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and awareness. Conclusion The willingness of community in accepting a CHX cord care practice was very high; the only requirement was that a MCH worker needs to do and demonstrate the use to the mother. Trial registration ClinicalTrials.gov: NCT01528852 PMID:24885689

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children's Mental Health Services.

PubMed

Brookman-Frazee, Lauren; Zhan, Chanel; Stadnick, Nicole; Sommerfeld, David; Roesch, Scott; Aarons, Gregory A; Innes-Gomberg, Debbie; Bando, Lillian; Lau, Anna S

2018-01-01

Evidence-based practice (EBP) implementation requires substantial resources in workforce training; yet, failure to achieve long-term sustainment can result in poor return on investment. There is limited research on EBP sustainment in mental health services long after implementation. This study examined therapists' continued vs. discontinued practice delivery based on administrative claims for reimbursement for six EBPs [Cognitive Behavioral Interventions for Trauma in Schools (CBITS), Child-Parent Psychotherapy, Managing and Adapting Practices (MAP), Seeking Safety (SS), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), and Positive Parenting Program] adopted in a system-driven implementation effort in public mental health services for children. Our goal was to identify agency and therapist factors associated with a sustained EBP delivery. Survival analysis (i.e., Kaplan-Meier survival functions, log-rank tests, and Cox regressions) was used to analyze 19 fiscal quarters (i.e., approximately 57 months) of claims data from the Prevention and Early Intervention Transformation within the Los Angeles County Department of Mental Health. These data comprised 2,322,389 claims made by 6,873 therapists across 88 agencies. Survival time was represented by the time elapsed from therapists' first to final claims for each practice and for any of the six EBPs. Results indicate that therapists continued to deliver at least one EBP for a mean survival time of 21.73 months (median = 18.70). When compared to a survival curve of the five other EBPs, CBITS, SS, and TP demonstrated a higher risk of delivery discontinuation, whereas MAP and TF-CBT demonstrated a lower risk of delivery discontinuation. A multivariate Cox regression model revealed that agency (centralization and service setting) and therapist (demographics, discipline, and case-mix characteristics) characteristics were significantly associated with risk of delivery discontinuation for any of the six EBPs. This study illustrates a novel application of survival analysis to administrative claims data in system-driven implementation of multiple EBPs. Findings reveal variability in the long-term continuation of therapist-level delivery of EBPs and highlight the importance of both agency and workforce characteristics in the sustained delivery of EBPs. Findings direct the field to potential targets of sustainment interventions (e.g., strategic assignment of therapists to EBP training and strategic selection of EBPs by agencies).

Human growth hormone treatment: synthesis of literature on product delivery systems and administration practices.

PubMed

Bhosle, Monali; Klingman, David; Aagren, Mark; Wisniewski, Tami; Lee, Won Chan

2011-01-01

To synthesize current literature on recombinant human growth hormone (rhGH) use and to identify areas of research that have received little to no attention in light of administration practice and patient perception/behavior. Relevant articles for a systematic review were identified through PubMed. A total of 43 articles were identified: 9 (15.9%) studies on product administration practices and 34 (84.1%) on patient behavior patterns. Patients primarily preferred simple, convenient, and easy-to-use delivery devices. However, literature addressing the effect of convenient product administration practices on treatment outcomes using real-world patient/caregiver data is lacking. Better understanding of real-world product administration practices will help nurses identify areas of improvement in patient education and training. © 2010, Wiley Periodicals, Inc.

Availability of manufacturers' information on efficacy and compatibility of detergents used for cleaning dental instruments.

PubMed

Calvert, G; Murray, C A; Smith, A J; Hurrell, D

2012-05-25

To review physico-chemical data supplied for commercially available detergents marketed for manual and/or ultrasonic cleansing of reusable dental instruments. Manufacturers/suppliers of commercially available detergents for manual or ultrasonic cleaning of dental instruments within primary dental care were invited to supply product information. A structured questionnaire requested details on a range of physical and chemical properties for each detergent. Seventeen detergent manufacturers/suppliers, encompassing 31 commercially available detergents were identified. Ten of the 17 manufacturers provided information on 23 (74%) of the detergent formulations. Nine detergents were of neutral pH, ten mild alkalis (pH 7.5-10.5) and four strong alkalis (pH >10.5). Sixteen detergents were recommended for ultrasonic and manual cleaning, four stated ultrasonic use and three manual only. Ten detergents cited enzymatic activity as their main mode of action, but only six manufacturers provided detailed information. Four detergents recommended by manufacturers as suitable for manual washing had a strong alkaline pH (>10.5), presenting chemical hazards to users. Two strong alkaline detergents did not warn users of potential adverse effects of such alkaline solutions (corrosion) upon aluminium containing instruments. Only one detergent had investigated the potential toxicity of detergent residuals remaining on instruments after reprocessing. It has proven challenging to collate physico-chemical data on detergents suitable for use in manual and/or ultrasonic cleaning of dental instruments in general dental practice. Standardisation of information on the nature and efficacy of dental detergents in a readily accessible form would be beneficial to dental practice.

Summary of: availability of manufacturers' information on efficacy and compatibility of detergents used for cleaning dental instruments.

PubMed

Barker, Chris

2012-05-25

To review physico-chemical data supplied for commercially available detergents marketed for manual and/or ultrasonic cleansing of reusable dental instruments. Manufacturers/suppliers of commercially available detergents for manual or ultrasonic cleaning of dental instruments within primary dental care were invited to supply product information. A structured questionnaire requested details on a range of physical and chemical properties for each detergent. Seventeen detergent manufacturers/suppliers, encompassing 31 commercially available detergents were identified. Ten of the 17 manufacturers provided information on 23 (74%) of the detergent formulations. Nine detergents were of neutral pH, ten mild alkalis (pH 7.5-10.5) and four strong alkalis (pH >10.5). Sixteen detergents were recommended for ultrasonic and manual cleaning, four stated ultrasonic use and three manual only. Ten detergents cited enzymatic activity as their main mode of action, but only six manufacturers provided detailed information. Four detergents recommended by manufacturers as suitable for manual washing had a strong alkaline pH (>10.5), presenting chemical hazards to users. Two strong alkaline detergents did not warn users of potential adverse effects of such alkaline solutions (corrosion) upon aluminium containing instruments. Only one detergent had investigated the potential toxicity of detergent residuals remaining on instruments after reprocessing. It has proven challenging to collate physico-chemical data on detergents suitable for use in manual and/or ultrasonic cleaning of dental instruments in general dental practice. Standardisation of information on the nature and efficacy of dental detergents in a readily accessible form would be beneficial to dental practice.

The delivery of clinical preventive services: acute care intervention.

PubMed

Hahn, D L

1999-10-01

. Evidence-based clinical preventive services are underutilized. We explored the major factors associated with delivery of these services in a large physician-owned community-based group practice that provided care for both fee-for-service (FFS) and health maintenance organization (HMO) patient populations. We performed a cross-sectional audit of the computerized billing data of all adult outpatients seen at least once by any primary care provider in 1995 (N = 75,621). Delivery of preventive services was stratified by age, sex, visit frequency, insurance status (FFS or HMO), and visit type (acute care only or scheduled preventive visit). Insurance status and visit type were the strongest predictors of clinical preventive service delivery. Patients with FFS coverage received 6% to 13% (absolute difference) fewer of these services than HMO patients. Acute-care-only patients received 9% to 45% fewer services than patients who scheduled preventive visits. The combination of these factors was associated with profound differences. Having insurance to pay for preventive services is an important factor in the delivery of such care. Encouraging all patients to schedule preventive visits has been suggested as a strategy for increasing delivery, but that is not practical in this setting. Assessing the need for preventive services and offering them during acute care visits has equal potential for increasing delivery.

Implementation of Paste Backfill Mining Technology in Chinese Coal Mines

PubMed Central

Chang, Qingliang; Zhou, Huaqiang; Bai, Jianbiao

2014-01-01

Implementation of clean mining technology at coal mines is crucial to protect the environment and maintain balance among energy resources, consumption, and ecology. After reviewing present coal clean mining technology, we introduce the technology principles and technological process of paste backfill mining in coal mines and discuss the components and features of backfill materials, the constitution of the backfill system, and the backfill process. Specific implementation of this technology and its application are analyzed for paste backfill mining in Daizhuang Coal Mine; a practical implementation shows that paste backfill mining can improve the safety and excavation rate of coal mining, which can effectively resolve surface subsidence problems caused by underground mining activities, by utilizing solid waste such as coal gangues as a resource. Therefore, paste backfill mining is an effective clean coal mining technology, which has widespread application. PMID:25258737

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

Romm, J.J.

Many American companies have found that saving energy and cutting pollution dramatically improves the bottom line. But beyond these gains, businesses that launch energy efficiency programs to save money are often astonished to discover unforeseen benefits: energy efficient lighting, heating, cooling, motors, and industrial processes can increase worker productivity, decrease absenteeism, and improve the quality of work performed. Profits created by the jump in worker productivity can exceed energy savings by a factor of ten. Energy efficiency and pollution prevention represent the next wave in manufacturing, following the quality revolution launched by the Japanese in the 1960s. Unless America leadsmore » the lean and clean revolution, economic health will be undermined as other countries develop clean processes and products and US companies suffer competitively. Also, developing countries will leapfrog their wasteful model and buy products and manufacturing processes from foreign firms already practicing lean and clean.« less

Implementation of paste backfill mining technology in Chinese coal mines.

PubMed

Chang, Qingliang; Chen, Jianhang; Zhou, Huaqiang; Bai, Jianbiao

2014-01-01

Implementation of clean mining technology at coal mines is crucial to protect the environment and maintain balance among energy resources, consumption, and ecology. After reviewing present coal clean mining technology, we introduce the technology principles and technological process of paste backfill mining in coal mines and discuss the components and features of backfill materials, the constitution of the backfill system, and the backfill process. Specific implementation of this technology and its application are analyzed for paste backfill mining in Daizhuang Coal Mine; a practical implementation shows that paste backfill mining can improve the safety and excavation rate of coal mining, which can effectively resolve surface subsidence problems caused by underground mining activities, by utilizing solid waste such as coal gangues as a resource. Therefore, paste backfill mining is an effective clean coal mining technology, which has widespread application.

Investigating the failure of repeated standard cleaning and disinfection of a Pseudomonas aeruginosa-infected pancreatic and biliary endoscope.

PubMed

Qiu, Lijun; Zhou, Zhihui; Liu, Qifang; Ni, Yuhua; Zhao, Feng; Cheng, Hao

2015-08-01

Digestive endoscopy is an important technique for the diagnosis and treatment of digestive system disease. To assure medical safety, a digestive endoscope must be cleaned and disinfected before its use in an operation on the next patient. The most common treatment procedure on a digestive endoscope is high-level disinfection. The potential risk associated with digestive endoscopes is always the focus of endoscopic management in clinical practice. In this study, a polluted pancreatic and biliary endoscope after surgery was cleaned and disinfected multiple times with the standard procedure but still tested positive for Pseudomonas aeruginosa culture, which is very rare and has not been reported in China or abroad. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

NYPA/TH!NK Clean Commute Program Final Report - Inception through December 2004

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

James Francfort; Don Karner

The Clean Commute Program uses TH!NK city electric vehicles from Ford Motor Company’s electric vehicle group, TH!NK Mobility, to demonstrate the feasibility of using electric transportation in urban applications. Suburban New York City railroad commuters use the TH!NK city vehicles to commute from their private residences to railroad stations, where they catch commuter trains into New York City. Electric vehicle charging infrastructure for the TH!NK city vehicles is located at the commuters’ private residences as well as seven train stations. Ford leased at total of 97 TH!NK city electric vehicles to commuters from Westchester, Putnam, Rockland, Queens, Nassau, and Suffolkmore » counties for $199 per month. First Clean Commute Program vehicle deliveries occurred late in 2001, with data collection commencing in February 2002. Through May, 2004, 24 of the lessees have returned their vehicles to Ford and no longer participate in the Clean Commute Program. Reasons given for leaving the Program include relocation out of the Program area, change in employment status, change in commuting status, and, in a few cases, dissatisfaction with the vehicle. Additionally, 13 vehicles were returned to Ford when the lease was completed. In August 2002, Ford announced that it was ceasing production of the TH!NK city and would not extend any TH!NK city leases. Mileage accumulation dropped in the last quarter of the program as vehicle leases were returned to Ford. The impact of the program overall was significant as participants in the Clean Commute Program drove their vehicles over 406,074 miles, avoiding the use of over 18,887 gallons of gasoline. During the active portion of the program, the TH!NK city vehicles were driven an average of between 180 and 230 miles per month. Over 95% of all trips taken with the TH!NK city vehicles replaced trips previously taken in gasoline vehicles. This report covers the period from Program inception through December 2004.« less

Private sector approaches to workforce enhancement.

PubMed

Wendling, Wayne R

2010-06-01

This paper addresses the private practice model of dental care delivery in the US. The great majority of dental care services are delivered through this model and thus changes in the model represent a means to substantially change the supply and availability of dental services. The two main forces that change how private practices function are broad economic factors, which alter the demand for dental care and innovations in practice structure and function which alter the supply and cost of services. Economics has long recognized that although there are private market solutions for many issues, not all problems can be addressed through this model. The private practice of dentistry is a private market solution that works for a substantial share of the market. However, the private market may not work to resolve all issues associated with access and utilization. Solutions for some problems call for creative private - public arrangements - another form of innovation; and market-based solutions may not be feasible for each and every problem. This paper discusses these economic factors and innovation as they relate to the private practice of dentistry, with special emphasis on those elements that have increased the capacity of the dental practice to offer services to those with limited means to access fee-based care. Innovations are frequently described as new care delivery models or new workforce models. However, innovation can occur on an ongoing and regular basis as dental practices examine new ways to combine capital and human resources and to leverage the education and skill of the dentists to a greater number of patients. Innovation occurs within a market context as the current and projected economic returns reward the innovation. Innovation can also occur through private-public arrangements. There are indications of available capacity within the existing delivery system to expand service delivery. The Michigan Medicaid Healthy Kids Dental program is discussed as one example of how dental services to Medicaid insured children were effectively expanded using the private practice model.

Cleaning and Disinfection of Bacillus cereus Biofilm.

PubMed

Deal, Amanda; Klein, Dan; Lopolito, Paul; Schwarz, John Spencer

2016-01-01

Methodology has been evolving for the testing of disinfectants against bacterial single-species biofilms, as the difficulty of biofilm remediation continues to gain much-needed attention. Bacterial single-species biofilm contamination presents a real risk to good manufacturing practice-regulated industries. However, mixed-species biofilms and biofilms containing bacterial spores remain an even greater challenge for cleaning and disinfection. Among spore-forming microorganisms frequently encountered in pharmaceutical manufacturing areas, the spores of Bacillus cereus are often determined to be the hardest to disinfect and eradicate. One of the reasons for the low degree of susceptibility to disinfection is the ability of these spores to be encapsulated within an exopolysachharide biofilm matrix. In this series of experiments, we evaluated the disinfectant susceptibility of B. cereus biofilms relative to disassociated B. cereus spores and biofilm from a non-spore-forming species. Further, we assessed the impact that pre-cleaning has on increasing that susceptibility. Methodology has been evolving for the testing of disinfectants against bacterial single-species biofilms, as the difficulty of biofilm remediation continues to gain much-needed attention. Bacterial single-species biofilm contamination presents a real risk to good manufacturing practice-regulated industries. However, mixed-species biofilms and biofilms containing bacterial spores remain an even greater challenge for cleaning and disinfection. Among spore-forming microorganisms frequently encountered in pharmaceutical manufacturing areas, the spores of Bacillus cereus are often determined to be the hardest to disinfect and eradicate. One of the reasons for the low degree of susceptibility to disinfection is the ability of these spores to be encapsulated within an exopolysachharide biofilm matrix. In this series of experiments, we evaluated the disinfectant susceptibility of B. cereus biofilms relative to disassociated B. cereus spores and biofilm from a non-spore-forming species. Further, we assessed the impact that pre-cleaning has on increasing that susceptibility. © PDA, Inc. 2016.

EPA Principles for Greener Cleanups

EPA Pesticide Factsheets

A goal of the U.S. Environmental Protection Agency (EPA) Office and Land and Emergency Management (OLEM) and its many partners is to preserve and restore land by promoting and using protective waste management practices and by assessing and cleaning..

Vessel-to-Reef Projects

EPA Pesticide Factsheets

Using vessels as artificial reefs is an option for disposal. Artificial reefs serve to benefit the environment. Vessel-to-reef projects can follow the best management practices guidance. Guidance are provided for how to clean up vessels for use as reefs.

A regional protocol for evaluating the effectiveness of forestry best management practices at controlling erosion and sedimentation

Treesearch

Roger Ryder; Pamela Edwards; Pamela Edwards

2006-01-01

Forestry operations do not have permitting requirements under the Clean Water Act because there is a ccsilvicultural exemption" given in that law, as long as best management practices (BMPs) are used to help control non-point source pollution. However, states' monitoring of BMP effectiveness often has been sporadic and anecdotal, and the procedures used have...

40 CFR 22.44 - Supplemental rules of practice governing the termination of permits under section 402(a) of the...

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Supplemental rules of practice governing the termination of permits under section 402(a) of the Clean Water Act or under section 3008(a)(3) of the Resource Conservation and Recovery Act. 22.44 Section 22.44 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CONSOLIDATED...

Physician strives to create lean, clean health care machine. Studies of manufacturing processes may one day help make your practice more efficient.

PubMed

Hill, D

2001-01-01

Elisabeth Hager, MD, MMM, CPE, is teaming up with scientists and industrialists to teach physicians how to apply principles of lean, total-quality manufacturing to their practices. She believes innovation and efficiencies can help doctors resurrect their profession's image and their control over it--and perhaps even reinvent American health care.

Trends in newborn umbilical cord care practices in Sokoto and Bauchi States of Nigeria: the where, who, how, what and the ubiquitous role of traditional birth attendants: a lot quality assurance sampling survey.

PubMed

Abegunde, Dele; Orobaton, Nosa; Beal, Katherine; Bassi, Amos; Bamidele, Moyosola; Akomolafe, Toyin; Ohanyido, Francis; Umar-Farouk, Olayinka; Danladi, Saba'atu

2017-11-09

Neonatal infections caused by unsafe umbilical cord practices account for the majority of neonatal deaths in Nigeria. We examined the trends in umbilical cord care practices between 2012 and 2015 that coincided with the introduction of chlorhexidine digluconate 7.1% gel in Bauchi and Sokoto States. We obtained data from three rounds of lot quality assurance samples (LQAS) surveys conducted in 2012, 2013 and 2015. Households were randomly sampled in each round that totaled 1140 and 1311 households in Bauchi and Sokoto States respectively. Mothers responded to questions on cord care practices in the last delivery. Coverage estimates of practice indicators were obtained for each survey period. Local Government Area (LGA) estimates for each indicator were obtained with α ≤ 5%, and β ≤20% statistical errors and aggregated to State-level estimates with finite sample correction relative to the LGA population. Over 75 and 80% of deliveries in Bauchi and Sokoto States respectively took place at home. The proportion of deliveries in public facilities reported by mothers ranged from 19% in 2012 to 22.4% in 2015 in Bauchi State and from 12.9 to 13.2% in 2015 in Sokoto State. Approximately 50% of deliveries in Bauchi and more than 80% in Sokoto States were assisted by traditional birth attendants (TBAs) or relatives and friends, with little change in the survey periods. In Bauchi and in Sokoto States, over 75% and over 80% of newborn cords were cut with razor blades underscoring the pervasive role of the TBAs in the immediate postpartum period. Use of chlorhexidine digluconate 7.1% gel for cord dressing significantly increased to the highest level in 2015 in both States. Health workers who attended deliveries in health facilities switched from methylated spirit to chlorhexidine. There were no observable changes in cord care practices among the TBAs. Unsafe umbilical cord care practices remained prevalent in Bauchi and Sokoto States of Nigeria, although a recent introduction of chlorhexidine digluconate 7.1% gel positively changed the cord care practices toward safer practices among public health providers. TBAs, friends and relatives played the strongest immediate postpartum roles and mostly retained the unsafe cord care practices such as use of ash, cow dung and hot compress. We recommend that existing TBAs are retrained and refocused to forge stronger links between communities and the primary health centers to increase mothers' access to skilled birth attendants.

Physiology of Breastfeeding

USDA-ARS?s Scientific Manuscript database

This powerpoint presentation summaries physiology of lactation and the impact of a variety of clinical practices on lactation from delivery through weaning. Factors that inhibit lactogenesis stage II are explained, including retained placenta, excess blood loss during delivery, and hypoplastic brea...

Environmental and energy benefits of freight delivery consolidation in urban area.

DOT National Transportation Integrated Search

2013-03-01

Among new, innovative city logistics strategies, delivery cooperation has received increasing academic and : practical attention mostly in Europe and Japan. The idea is to establish cooperation among the suppliers, carriers : and the customers throug...

A community of practice approach to bioanalysis delivery: the role of the Preclinical Bioanalysis and Toxicokinetics department at AstraZeneca.

PubMed

Wilson, Amanda; Silvester, Stephen; Woods, Karen

2014-05-01

Retaining regulated bioanalysis within AstraZeneca (AZ) is important for the effective delivery of nonclinical and clinical bioanalysis. The focus for the in-house team is the delivery of high-throughput bioanalysis and toxicokinetics support for investigational toxicology; however, by retaining GLP compliance, AZ will have an in-house understanding of every candidate drug that is progressed into development by supporting the first rodent GLP study for each project. The majority of nonclinical bioanalysis and all of the clinical bioanalysis are delivered by two external partnership models. This article describes the key benefits of retaining GLP compliance, the partnership interactions, discusses the management of non-GLP support in a GLP environment and how, having practical experience of regulatory facing method development, validation and study execution adds value to the AZ portfolio delivery.

Developing a tool to support diagnostic delivery of dementia.

PubMed

Bennett, Claire E; De Boos, Danielle; Moghaddam, Nima G

2018-01-01

It is increasingly recognised that there are challenges affecting the current delivery of dementia diagnoses. Steps are required to address this. Current good practice guidelines provide insufficient direction and interventions from other healthcare settings do not appear to fully translate to dementia care settings. This project has taken a sequential two-phase design to developing a tool specific to dementia diagnostic delivery. Interviews with 14 participants explored good diagnostic delivery. Thematic analysis produced key themes (overcoming barriers, navigation of multiple journeys and completing overt and covert tasks) that were used to inform the design of a tool for use by clinicians, patients and companions. The tool was evaluated for acceptability in focused group discussions with 13 participants, which indicated a desire to use the tool and that it could encourage good practice. Adaptations were highlighted and incorporated to improve acceptability. Future research is now required to further evaluate the tool.

Design Project on Controlled-Release Drug Delivery Devices: Implementation, Management, and Learning Experiences

ERIC Educational Resources Information Center

Xu, Qingxing; Liang, Youyun; Tong, Yen Wah; Wang, Chi-Hwa

2010-01-01

A design project that focuses on the subject of controlled-release drug delivery devices is presented for use in an undergraduate course on mass transfer. The purpose of the project is to introduce students to the various technologies used in the fabrication of drug delivery systems and provide a practical design exercise for understanding the…

Teaching and practicing of pelvic floor muscle exercises in primiparous women during pregnancy and the postpartum period.

PubMed

Fine, Paul; Burgio, Kathryn; Borello-France, Diane; Richter, Holly; Whitehead, William; Weber, Anne; Brown, Morton

2007-07-01

The purpose of this study was to describe the teaching and practicing of pelvic floor muscle exercise (PFME) before and after delivery. This was a secondary data analysis from a prospective multicenter cohort study, the Childbirth and Pelvic Symptoms study, by the Pelvic Floor Disorders Network. Primiparous women (n = 759) with term singleton delivery were interviewed 6 months after delivery. Sixty-four percent of the women had been taught PFME, most with verbal (76%) and/or written instructions (55%) and a few (10%) during pelvic examination. Women with anal sphincter tears were not more likely to receive instruction or reminders after delivery. More white women (75%) were taught PFME than were Asian women (48%), African American women (36%), or Hispanic women (39%; P < .0001). More women with college education (74%) were taught, compared with women without a college education (37%; P < .0001). Of those women who were taught, 68% performed PFME after delivery, and 63% were still performing the exercises 6 months after delivery. Results reveal tremendous potential for the improvement of PFME education and targeting at-risk women in the peripartum period.

Women's perception of quality of maternity services: a longitudinal survey in Nepal.

PubMed

Karkee, Rajendra; Lee, Andy H; Pokharel, Paras K

2014-01-24

In the context of maternity service, the mother's assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal. A cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression. Within the health facility sub-scale, birth centre was rated lowest on items 'adequacy of medical equipment', 'health staff suited to women's health' and 'adequacy of health staff', whereas public hospital was rated the lowest with respect to 'adequacy of room', 'adequacy of water', 'environment clean', 'privacy' and 'adequacy of information'. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001). Overall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.

Influenza vaccine delivery delays from the perspective of primary care physicians.

PubMed

O'Leary, Sean T; Barrow, Jennifer C; McQuillan, Lon; Daley, Matthew F; Crane, Lori A; Beaty, Brenda L; Babbel, Christine I; Dickinson, L Miriam; Kempe, Allison

2011-06-01

The effects of delayed influenza vaccine delivery on primary practices are currently unknown. To describe, among primary care physicians nationally regarding the 2006-2007 influenza season: (1) how physicians defined influenza vaccine delay; (2) the extent of reported vaccine delays; and (3) the perceived effects of vaccine delays. Between March and June 2007, a total of 1268 primary care physicians nationally were surveyed. Survey response was 74% (n=940). The majority of physicians (79%) defined "influenza vaccine delay" as not receiving vaccine by November 1. Fifty-three percent reported a vaccine delay. Providers reported the following as effects of delays: reduced satisfaction of patients or parents in the practice (72%); decreased percentage in their practice who received the vaccination (65%); disruption of scheduling influenza clinics (55%); increased referral of patients elsewhere for vaccination (55%); and negative financial impact caused by unused vaccine (46%). Those who reported experiencing delays more often reported not meeting demand for vaccine (adjusted risk ratio [ARR]=1.83, 95% CI=1.64, 2.07); that grocery stores, retail outlets, or pharmacies had vaccine before their practices did (ARR=1.82, 95% CI=1.53, 2.26); not receiving all vaccine that was ordered (ARR=1.19, 95% CI=1.06, 1.36); and having leftover vaccine (ARR=1.17, 95% CI=1.04, 1.32). During the 2006-2007 influenza season, a non-shortage season, the majority of respondents reported experiencing an influenza vaccine delivery delay. Experiencing a delay was thought to decrease vaccination use, increase referrals elsewhere, and have a negative financial impact on practices. Delayed delivery of influenza vaccine is disruptive for primary care practices, and it consequently may affect vaccination coverage. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Communicable disease control in China: From Mao to now

PubMed Central

Hipgrave, David

2011-01-01

China’s progress on communicable disease control (CDC) in the 30 years after establishment of the People’s Republic in 1949 is widely regarded as remarkable. Life expectancy soared by around 30 years, infant mortality plummeted and smallpox, sexually transmitted diseases and many other infections were either eliminated or decreased massively in incidence, largely as a result of CDC. By the mid-1970s, China was already undergoing the epidemiologic transition, years ahead of other nations of similar economic status. These early successes can be attributed to population mobilization, mass campaigns and a focus on sanitation, hygiene, clean water and clean delivery, and occurred despite political instability and slow economic progress. The 10-year Cultural Revolution from 1966 brought many hardships, but also clinical care and continuing public health programs to the masses through community-funded medical schemes and the establishment of community-based health workers. These people-focused approaches broke down with China’s market reforms from 1980. Village doctors turned to private practice as community funding ceased, and the attention paid to rural public health declined. CDC relied on vertical programs, some of them successful (such as elimination of lymphatic filariasis and child immunisation), but others (such as control of schistosomiasis and tuberculosis) demonstrating only intermittent progress due to failed strategies or reliance on support by the poorest governments and health workers, who could not or would not collaborate. In addition, China’s laissez-faire approach to public health placed it at great risk, as evidenced by the outbreak in 2003 of the Severe Acute Respiratory Syndrome. Since then, major changes to disease reporting, the priority given to CDC including through major new domestic resources and reform of China’s health system offer encouragement for CDC. While decentralized funding and varying quality diagnosis, reporting and treatment of infectious diseases remain major challenges, national priority on CDC in China is high. PMID:23198121

Engineers Clean Mirror with Carbon Dioxide Snow

NASA Image and Video Library

2015-01-22

Just like drivers sometimes use snow to clean their car mirrors in winter, two Exelis Inc. engineers are practicing "snow cleaning'" on a test telescope mirror for the James Webb Space Telescope at NASA's Goddard Space Flight Center in Greenbelt, Maryland. By shooting carbon dioxide snow at the surface, engineers are able to clean large telescope mirrors without scratching them. "The snow-like crystals (carbon dioxide snow) knock contaminate particulates and molecules off the mirror," said Lee Feinberg, NASA optical telescope element manager. This technique will only be used if the James Webb Space Telescope's mirror is contaminated during integration and testing. The Webb telescope is the scientific successor to NASA's Hubble Space Telescope. It will be the most powerful space telescope ever built. With a mirror seven times as large as Hubble's and infrared capability, Webb will be capturing light from 13.5 billion light years away. To do this, its mirror must be kept super clean. "Small dust particles or molecules can impact the science that can be done with the Webb," said Feinberg. "So cleanliness especially on the mirrors is critical." Webb is an international project led by NASA with its partners, the European Space Agency and the Canadian Space Agency. Image credit: NASA/Goddard/Chris Gunn

Diverging effects of clean versus dirty money on attitudes, values, and interpersonal behavior.

PubMed

Yang, Qing; Wu, Xiaochang; Zhou, Xinyue; Mead, Nicole L; Vohs, Kathleen D; Baumeister, Roy F

2013-03-01

Does the cue of money lead to selfish, greedy, exploitative behaviors or to fairness, exchange, and reciprocity? We found evidence for both, suggesting that people have both sets of meaningful associations, which can be differentially activated by exposure to clean versus dirty money. In a field experiment at a farmers' market, vendors who handled dirty money subsequently cheated customers, whereas those who handled clean money gave fair value (Experiment 1). In laboratory studies with economic games, participants who had previously handled and counted dirty money tended toward selfish, unfair practices-unlike those who had counted clean money or dirty paper, both of which led to fairness and reciprocity. These patterns were found with the trust game (Experiment 2), the prisoner's dilemma (Experiment 4), the ultimatum game (Experiment 5), and the dictator game (Experiment 6). Cognitive measures indicated that exposure to dirty money lowered moral standards (Experiment 3) and reduced positive attitudes toward fairness and reciprocity (Experiments 6-7), whereas exposure to clean money had the opposite effects. Thus, people apparently have 2 contradictory sets of associations (including behavioral tendencies) to money, which is a complex, powerful, and ubiquitous aspect of human social life and cultural organization. PsycINFO Database Record (c) 2013 APA, all rights reserved

Evaluating and operationalizing an environmental auditing program: a pilot study.

PubMed

Gordon, Laura; Bruce, Natalie; Suh, Kathryn N; Roth, Virginia

2014-07-01

Environmental auditing is an important tool to ensure consistent and effective cleaning. Our pilot study compared an alcohol-based fluorescent marking product and an adenosine-5'-triphosphate bioluminescence product for use in an environmental auditing program to determine which product was more practical and acceptable to users. Both products were tested on 15 preselected high touch objects in randomly selected patient rooms, following regular daily cleaning. A room was considered a "pass" if ≥80% of surfaces were adequately cleaned as defined by manufacturers' guidelines. A qualitative survey assessed user preference and operational considerations. Using fluorescent marking, 9 of 37 patient rooms evaluated (24%) were considered a "pass" after daily cleaning. Using adenosine-5'-triphosphate bioluminescence, 21 of 37 patient rooms passed (57%). There was great variability in results between different high touch objects. Eighty percent of users preferred the alcohol-based fluorescent marking product because it provided an effective visual aid to coach staff on proper cleaning techniques and allowed simple and consistent application. Environmental auditing using translucent, alcohol-based fluorescent marking best met the requirements of our organization. Our results reinforce the importance of involving a multidisciplinary team in evaluating and operationalizing an environmental auditing program. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Virtual healthcare delivery: defined, modeled, and predictive barriers to implementation identified.

PubMed

Harrop, V M

2001-01-01

Provider organizations lack: 1. a definition of "virtual" healthcare delivery relative to the products, services, and processes offered by dot.coms, web-compact disk healthcare content providers, telemedicine, and telecommunications companies, and 2. a model for integrating real and virtual healthcare delivery. This paper defines virtual healthcare delivery as asynchronous, outsourced, and anonymous, then proposes a 2x2 Real-Virtual Healthcare Delivery model focused on real and virtual patients and real and virtual provider organizations. Using this model, provider organizations can systematically deconstruct healthcare delivery in the real world and reconstruct appropriate pieces in the virtual world. Observed barriers to virtual healthcare delivery are: resistance to telecommunication integrated delivery networks and outsourcing; confusion over virtual infrastructure requirements for telemedicine and full-service web portals, and the impact of integrated delivery networks and outsourcing on extant cultural norms and revenue generating practices. To remain competitive provider organizations must integrate real and virtual healthcare delivery.

Virtual healthcare delivery: defined, modeled, and predictive barriers to implementation identified.

PubMed Central

Harrop, V. M.

2001-01-01

Provider organizations lack: 1. a definition of "virtual" healthcare delivery relative to the products, services, and processes offered by dot.coms, web-compact disk healthcare content providers, telemedicine, and telecommunications companies, and 2. a model for integrating real and virtual healthcare delivery. This paper defines virtual healthcare delivery as asynchronous, outsourced, and anonymous, then proposes a 2x2 Real-Virtual Healthcare Delivery model focused on real and virtual patients and real and virtual provider organizations. Using this model, provider organizations can systematically deconstruct healthcare delivery in the real world and reconstruct appropriate pieces in the virtual world. Observed barriers to virtual healthcare delivery are: resistance to telecommunication integrated delivery networks and outsourcing; confusion over virtual infrastructure requirements for telemedicine and full-service web portals, and the impact of integrated delivery networks and outsourcing on extant cultural norms and revenue generating practices. To remain competitive provider organizations must integrate real and virtual healthcare delivery. PMID:11825189

Transdermal drug delivery

PubMed Central

Prausnitz, Mark R.; Langer, Robert

2009-01-01

Transdermal drug delivery has made an important contribution to medical practice, but has yet to fully achieve its potential as an alternative to oral delivery and hypodermic injections. First-generation transdermal delivery systems have continued their steady increase in clinical use for delivery of small, lipophilic, low-dose drugs. Second-generation delivery systems using chemical enhancers, non-cavitational ultrasound and iontophoresis have also resulted in clinical products; the ability of iontophoresis to control delivery rates in real time provides added functionality. Third-generation delivery systems target their effects to skin’s barrier layer of stratum corneum using microneedles, thermal ablation, microdermabrasion, electroporation and cavitational ultrasound. Microneedles and thermal ablation are currently progressing through clinical trials for delivery of macromolecules and vaccines, such as insulin, parathyroid hormone and influenza vaccine. Using these novel second- and third-generation enhancement strategies, transdermal delivery is poised to significantly increase impact on medicine. PMID:18997767

Mattress cleanliness: the role of monitoring and maintenance.

PubMed

Aziz, Ann-Marie

A clean and tidy environment provides the right setting for good patient care. It is fundamental in preventing and/or controlling the spread of healthcare-associated infections (HCAI). Cleanliness is an essential component for the comfort and dignity of patients, particularly those for whom a hospital is home for any length of time. Patients spend a lot of their time in bed so it is important for them to be provided with well maintained and clean mattresses. Beds, and especially the mattresses, should be cleaned and inspected regularly so patients know they are being cared for in a clean and safe environment. To prolong the life of the mattress and reduce infection risks, inspections for damage and contamination must take place on a regular basis. Assessment criteria for the audit of a mattress can include a visual inspection, a cover permeability test and a foam support surface test. These assessments will ensure the mattress is compliant with current standards and identify whether or not they require condemning. Mattress care can be improved by adopting unified good practices that can be standardized and audited regularly.