The Crusades and Islam. Fulbright-Hays Summer Seminars Abroad, 1998 (Israel and Jordan).

ERIC Educational Resources Information Center

Serota, Laurie

These two mini-units are designed to supplement the areas of study dictated by the Core Knowledge Sequence, a content-rich curriculum used in the educator/curriculum developer's school. The mini-units fall in the middle of a 6-month-long study of the Middle Ages and incorporate the depth of content required to support the larger unit on the Middle…

l48_ghi_10km

Science.gov Websites

information on the solar resource potential for the 48 Contiguous United States. This data provides monthly latitude and longitude, or about 10 km in size. This data was developed using the State University of New images from geostationary weather satellites, daily snow cover data, and monthly averages of atmospheric

Monthly hydroclimatology of the continental United States

NASA Astrophysics Data System (ADS)

Petersen, Thomas; Devineni, Naresh; Sankarasubramanian, A.

2018-04-01

Physical/semi-empirical models that do not require any calibration are of paramount need for estimating hydrological fluxes for ungauged sites. We develop semi-empirical models for estimating the mean and variance of the monthly streamflow based on Taylor Series approximation of a lumped physically based water balance model. The proposed models require mean and variance of monthly precipitation and potential evapotranspiration, co-variability of precipitation and potential evapotranspiration and regionally calibrated catchment retention sensitivity, atmospheric moisture uptake sensitivity, groundwater-partitioning factor, and the maximum soil moisture holding capacity parameters. Estimates of mean and variance of monthly streamflow using the semi-empirical equations are compared with the observed estimates for 1373 catchments in the continental United States. Analyses show that the proposed models explain the spatial variability in monthly moments for basins in lower elevations. A regionalization of parameters for each water resources region show good agreement between observed moments and model estimated moments during January, February, March and April for mean and all months except May and June for variance. Thus, the proposed relationships could be employed for understanding and estimating the monthly hydroclimatology of ungauged basins using regional parameters.

Associations Between Hormonal Biomarkers and Cognitive, Motor, and Language Developmental Status in Very Low Birth Weight Infants.

PubMed

Cho, June; Holditch-Davis, Diane; Su, Xiaogang; Phillips, Vivien; Biasini, Fred; Carlo, Waldemar A

Male infants are more prone to health problems and developmental delays than female infants. On the basis of theories of gender differences in brain development and social relationships, we explored associations between testosterone and cortisol levels with infant cognitive, motor, and language development ("infant development") in very low birth weight (VLBW) infants, controlling for mother-infant interactions, characteristics of mothers and infants, and days of saliva collection after birth. A total of 62 mother-VLBW infant pairs were recruited from the newborn intensive care unit of a tertiary medical center in the Southeast United States. Data were collected through infant medical record review, biochemical measurement, observation of mother-infant interactions, and standard questionnaires. Infant development was assessed at 6 months corrected age (CA), and mother-infant interactions were observed at 3 and 6 months CA. General linear regression with separate analyses for each infant gender showed that high testosterone levels were positively associated with language development of male infants after controlling for mother-infant interactions and other covariates, whereas high cortisol levels were negatively associated with motor development of female infants after controlling for mother-infant interactions. Steroid hormonal levels may well be more fundamental factors for assessing infant development than infant gender or mother-infant interactions at 6 months CA.

Reduction in Operating Room Plasma Waste After Evidence-Based Quality Improvement Initiative.

PubMed

Meyer, Matthew J; Dzik, Walter H; Levine, Wilton C

2018-05-01

Anesthesiologists request units of plasma in anticipation of transfusion. The amount of plasma transfused intraoperatively is less than that issued (requested, thawed, and sent). We presented institutional-specific data on plasma usage including anesthesiologist-specific ratios of plasma issued-to-transfused. In month-to-month comparisons from the year before the presentation (June-December 2015) to 7 months after (June-December 2016), plasma issued to the operating room was reduced from 434.9 ± 81 to 327.3 ± 65 units, a change of 107.6 units per month (95% confidence interval [CI], 22-193); plasma discarded by the blood bank was reduced from 109.7 ± 48 units to 69.1 ± 9 units, a change of 40.6 units per month (95% CI, 0.2-81); and plasma transfused went from 188.4 ± 42 units to 160.7 ± 52 units, a nonsignificant change of 27.7 units per month (95% CI, -27 to 83).

Neuromotor outcomes in infants with bronchopulmonary dysplasia.

PubMed

Karagianni, Paraskevi; Tsakalidis, Christos; Kyriakidou, Maria; Mitsiakos, Georgios; Chatziioanidis, Helias; Porpodi, Maria; Evangeliou, Athanasios; Nikolaides, Nikolaos

2011-01-01

We examine the neuromotor outcomes of preterm infants with bronchopulmonary dysplasia. Two hundred and nineteen infants (gestational age, ≤ 32 weeks; birth weight, ≤ 1500 g) were studied. Neuromotor development was assessed using the Hammersmith Infant Neurological Examination. All potential risk factors associated with neuromotor scores (P < 0.015) were included in the generalized linear model (multiple linear regression) to determine if bronchopulmonary dysplasia had an independent relationship with neuromotor scores. Infants with severe bronchopulmonary dysplasia had lower global scores at ages 6 and 12 months. After adjustment for confounding factors, scores of infants with severe bronchopulmonary dysplasia were reduced by 13.2 units, whereas scores for those with periventricular leukomalacia were reduced by 11.1 units, at age 6 months. At age 12 months, scores for those with periventricular leukomalacia were reduced by 11.9 units. Duration of hospital stay reduced scores by 0.1 for each additional day increase in hospital. Bronchopulmonary dysplasia constitutes a major cause of poor neuromotor outcomes at age 6 months, but improvements in motor outcomes occur over time. Copyright © 2011 Elsevier Inc. All rights reserved.

Preventing patient-to-worker violence in hospitals: outcome of a randomized controlled intervention

PubMed Central

Arnetz, Judith E.; Hamblin, Lydia; Russell, Jim; Upfal, Mark J.; Luborsky, Mark; Janisse, James; Essenmacher, Lynnette

2016-01-01

Objective To evaluate the effects of a randomized controlled intervention on the incidence of patient-to-worker (Type II) violence and related injury in hospitals. Methods Forty-one units across 7 hospitals were randomized into intervention (n=21) and control (n=20) groups. Intervention units received unit-level violence data to facilitate development of an action plan for violence prevention; no data were presented to control units. Main outcomes were rates of violent events and injuries across study groups over time. Results Six months post-intervention, incident rate ratios of violent events were significantly lower on intervention units compared to controls (IRR 0.48, 95% CI 0.29-0.80). At 24 months, the risk for violence-related injury was lower on intervention units, compared to controls (IRR 0.37, 95% CI 0.17-0.83). Conclusion This data-driven, worksite-based intervention was effective in decreasing risks of patient-to-worker violence and related injury. PMID:28045793

Subconjunctival sirolimus in the treatment of diabetic macular edema.

PubMed

Krishnadev, Nupura; Forooghian, Farzin; Cukras, Catherine; Wong, Wai; Saligan, Leorey; Chew, Emily Y; Nussenblatt, Robert; Ferris, Frederick; Meyerle, Catherine

2011-11-01

Diabetic macular edema (DME) is a leading cause of blindness in the developed world. Sirolimus has been shown to inhibit the production, signaling, and activity of many growth factors relevant to the development of diabetic retinopathy. This phase I/II study assesses the safety of multiple subconjunctival sirolimus injections for the treatment of DME, with some limited efficacy data. In this phase I/II prospective, open-label pilot study, five adult participants with diabetic macular edema involving the center of the fovea and best-corrected ETDRS visual acuity score of ≤74 letters (20/32 or worse) received 20 μl (440 μg) of subconjunctival sirolimus at baseline, month 2 and every 2 months thereafter, unless there was resolution of either retinal thickening on OCT or leakage on fluorescein angiography. Main outcome measures included best-corrected visual acuity and central retinal thickness on OCT at 6 months and 1 year, as well as safety outcomes. Repeated subconjunctival sirolimus injections were well-tolerated, with no significant drug-related adverse events. There was no consistent treatment effect related to sirolimus; one participant experienced a 2-line improvement in visual acuity and 2 log unit decrease in retinal thickness at 6 months and 1 year, two remained essentially stable, one had stable visual acuity but improvement of central retinal thickness of 1 and 3 log units at 6 months and 1 year respectively, and one had a 2-line worsening of visual acuity and a 1 log unit increase in retinal thickness at 6 months and 1 year. Results in the fellow eyes with diabetic macular edema, not treated with sirolimus, were similar. Subconjunctival sirolimus appears safe to use in patients with DME. Assessment of possible treatment benefit will require a randomized trial.

Subconjunctival sirolimus in the treatment of diabetic macular edema

PubMed Central

Krishnadev, Nupura; Forooghian, Farzin; Cukras, Catherine; Wong, Wai; Saligan, Leorey; Chew, Emily Y.; Nussenblatt, Robert; Ferris, Frederick

2011-01-01

Background Diabetic macular edema (DME) is a leading cause of blindness in the developed world. Sirolimus has been shown to inhibit the production, signaling, and activity of many growth factors relevant to the development of diabetic retinopathy. This phase I/II study assesses the safety of multiple subconjunctival sirolimus injections for the treatment of DME, with some limited efficacy data. Methods In this phase I/II prospective, open-label pilot study, five adult participants with diabetic macular edema involving the center of the fovea and best-corrected ETDRS visual acuity score of ≤74 letters (20/32 or worse) received 20 μl (440 μg) of subconjunctival sirolimus at baseline, month 2 and every 2 months thereafter, unless there was resolution of either retinal thickening on OCT or leakage on fluorescein angiography. Main outcome measures included best-corrected visual acuity and central retinal thickness on OCT at 6 months and 1 year, as well as safety outcomes. Results Repeated subconjunctival sirolimus injections were well-tolerated, with no significant drug-related adverse events. There was no consistent treatment effect related to sirolimus; one participant experienced a 2-line improvement in visual acuity and 2 log unit decrease in retinal thickness at 6 months and 1 year, two remained essentially stable, one had stable visual acuity but improvement of central retinal thickness of 1 and 3 log units at 6 months and 1 year respectively, and one had a 2-line worsening of visual acuity and a 1 log unit increase in retinal thickness at 6 months and 1 year. Results in the fellow eyes with diabetic macular edema, not treated with sirolimus, were similar. Conclusions Subconjunctival sirolimus appears safe to use in patients with DME. Assessment of possible treatment benefit will require a randomized trial. PMID:21567211

20 CFR 404.460 - Nonpayment of monthly benefits to aliens outside the United States.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Nonpayment of monthly benefits to aliens... Benefits § 404.460 Nonpayment of monthly benefits to aliens outside the United States. (a) Nonpayment of monthly benefits to aliens outside the United States more than 6 months. Except as described in paragraph...

20 CFR 404.460 - Nonpayment of monthly benefits to aliens outside the United States.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Nonpayment of monthly benefits to aliens... Benefits § 404.460 Nonpayment of monthly benefits to aliens outside the United States. (a) Nonpayment of monthly benefits to aliens outside the United States more than 6 months. Except as described in paragraph...

Statistical model for forecasting monthly large wildfire events in western United States

Treesearch

Haiganoush K. Preisler; Anthony L. Westerling

2006-01-01

The ability to forecast the number and location of large wildfire events (with specified confidence bounds) is important to fire managers attempting to allocate and distribute suppression efforts during severe fire seasons. This paper describes the development of a statistical model for assessing the forecasting skills of fire-danger predictors and producing 1-month-...

Instituting parent education practices in the neonatal intensive care unit: an administrative case report of practice evaluation and statewide action.

PubMed

Dusing, Stacey C; Van Drew, Catherine M; Brown, Shaaron E

2012-07-01

Infants born preterm are at high risk of developmental disabilities and benefit from early developmental intervention programs. Physical therapists with neonatal expertise are ideally suited to educate parents about ways to support their infant's development in the first months of life. However, administrative policies are needed to support the therapist in providing adequate parent education in the neonatal intensive care unit (NICU). This administrative case report describes the process used by a team of neonatal therapists to evaluate clinical practice, determine the need for change, and develop and implement a new parent education program in the NICU. Physical therapy parent education practices were evaluated in an academic medical center with a 36-bed, level-3 NICU. Physical therapists with neonatal expertise covered multiple units within the hospital each day. A series of focus groups, a small descriptive study, and staff discussion were used to evaluate parent education practices in this academic medical center. A new parent education program was developed based on data collected and literature to improve clinical care. The new parent education model was implemented over the course of several months using overlapping initiatives. Administrative support for the change was developed through collaboration, open communication, and presentation of clinical data. In addition, this hospital-based program contributed to the development of a statewide initiative to educate parents of preterm infants about the importance of supporting development in the first months of life. A collaborative and data-driven approach to evaluating parent education practices supported the development of a new parent education practice while acknowledging the need to meet staff productivity standards and provide excellent care throughout the hospital.

Instituting Parent Education Practices in the Neonatal Intensive Care Unit: An Administrative Case Report of Practice Evaluation and Statewide Action

PubMed Central

Van Drew, Catherine M.; Brown, Shaaron E.

2012-01-01

Background and Purpose Infants born preterm are at high risk of developmental disabilities and benefit from early developmental intervention programs. Physical therapists with neonatal expertise are ideally suited to educate parents about ways to support their infant's development in the first months of life. However, administrative policies are needed to support the therapist in providing adequate parent education in the neonatal intensive care unit (NICU). This administrative case report describes the process used by a team of neonatal therapists to evaluate clinical practice, determine the need for change, and develop and implement a new parent education program in the NICU. Case Description Physical therapy parent education practices were evaluated in an academic medical center with a 36-bed, level-3 NICU. Physical therapists with neonatal expertise covered multiple units within the hospital each day. A series of focus groups, a small descriptive study, and staff discussion were used to evaluate parent education practices in this academic medical center. A new parent education program was developed based on data collected and literature to improve clinical care. Outcomes The new parent education model was implemented over the course of several months using overlapping initiatives. Administrative support for the change was developed through collaboration, open communication, and presentation of clinical data. In addition, this hospital-based program contributed to the development of a statewide initiative to educate parents of preterm infants about the importance of supporting development in the first months of life. Discussion A collaborative and data-driven approach to evaluating parent education practices supported the development of a new parent education practice while acknowledging the need to meet staff productivity standards and provide excellent care throughout the hospital. PMID:22466024

PISA for Development and the Sustainable Development Goals. PISA for Development Brief 17

ERIC Educational Resources Information Center

OECD Publishing, 2017

2017-01-01

The PISA for Development brief series is a set of concise monthly education policy-oriented notes published by the OECD which are designed to describe a specific PISA for Development topic. In this brief, PISA's role in monitoring the fourth United Nations Sustainable Development Goal--to "ensure inclusive and equitable quality education and…

24 CFR 968.230 - Progress reports.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Progress reports. 968.230 Section 968.230 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... Fewer Than 250 Units) § 968.230 Progress reports. For each six-month period ending March 31 and...

78 FR 14431 - Irish-American Heritage Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-06

...-American Heritage Month, 2013 By the President of the United States of America A Proclamation For more than... united by their belief in a better day. This month, we celebrate the Irish-American journey, and we... Month, let us retell those stories of sweat and striving. And as two nations united by people and...

Crop weather models of barley and spring wheat yield for agrophysical units in North Dakota

NASA Technical Reports Server (NTRS)

Leduc, S. (Principal Investigator)

1982-01-01

Models based on multiple regression were developed to estimate barley yield and spring wheat yield from weather data for Agrophysical units(APU) in North Dakota. The predictor variables are derived from monthly average temperature and monthly total precipitation data at meteorological stations in the cooperative network. The models are similar in form to the previous models developed for Crop Reporting Districts (CRD). The trends and derived variables were the same and the approach to select the significant predictors was similar to that used in developing the CRD models. The APU models show sight improvements in some of the statistics of the models, e.g., explained variation. These models are to be independently evaluated and compared to the previously evaluated CRD models. The comparison will indicate the preferred model area for this application, i.e., APU or CRD.

Prototype solar heating and cooling systems

NASA Technical Reports Server (NTRS)

1978-01-01

A collection of monthly status reports on the development of eight prototype solar heating and cooling systems is presented. The effort calls for the development, manufacture, test, system installation, maintenance, problem resolution, and performance evaluation. The systems are 3, 25, and 75 ton size units.

Prototype solar heating and cooling systems

NASA Technical Reports Server (NTRS)

1978-01-01

A collection of monthly status reports are given on the development of eight prototype solar heating and cooling systems. This effort calls for the development, manufacturing, test, system installation, maintenance, problem resolution, and performance evaluation. The systems are 3-, 25-, and 75-ton size units.

Handing It Over: Giving Students Responsibility for Teaching in a Sheltered Content Course.

ERIC Educational Resources Information Center

Heuser, Linda; Tabet, J. Sirena

1998-01-01

To expand cognitive knowledge, increase language competency, and promote active learning, a content instructor and a language professor collaborated to develop a final unit in which teams of Japanese college sophomores, studying in a 10-month program in the United States, teach their classmates in English about a topic of interest concerning…

Effectiveness of Multipurpose Unit Early Classroom Intervention Program for 4-5-Year-Old Children

ERIC Educational Resources Information Center

Celebioglu Morkoc, Ozlem; Aktan Acar, Ebru

2014-01-01

This research examined the effectiveness of Multipurpose Unit Early Classroom Intervention Program (MUECIP) prepared for 4-5-year-old (48-60 months) children whose development is at risk because of their families' socioeconomic conditions. The research adopted a preliminary test-final test control group trial model. The research participants were…

Molecular Epidemiological Study of Aspergillus fumigatus in a Bone Marrow Transplantation Unit by PCR Amplification of Ribosomal Intergenic Spacer Sequences

PubMed Central

Radford, Sarah A.; Johnson, Elizabeth M.; Leeming, John P.; Millar, Michael R.; Cornish, Jacqueline M.; Foot, Annabel B. M.; Warnock, David W.

1998-01-01

We have developed a PCR-based method for the subspecific discrimination of Aspergillus fumigatus types by using two primers designed to amplify the intergenic spacer regions between ribosomal DNA transcription units. The method permitted the reproducible discrimination of 11 distinct DNA types among a total of 119 isolates of A. fumigatus collected from patients and from the environment of a bone marrow transplantation (BMT) unit over a three-year period. Ten DNA types of A. fumigatus were isolated from patients in the BMT unit; eight of these types were also found in the hospital environment, and six of these were present in the unit itself. Thirteen BMT patients developed infection with one of three DNA types some months after these had first been found in the environment of the unit. In other instances, the same DNA types of A. fumigatus were isolated from BMT patients that were later recovered from the environment of the unit. Several DNA types of A. fumigatus were found in the hospital environment over an 18-month period. Molecular typing of multiple isolates of A. fumigatus, obtained from postmortem tissue samples, showed that one patient was infected with a single DNA type, but two others had up to three different DNA types. Our findings suggest that A. fumigatus infection in BMT recipients may be nosocomial in origin and underline the need for careful environmental monitoring of units in which high-risk patients are housed. PMID:9574694

Infant media exposure and toddler development.

PubMed

Tomopoulos, Suzy; Dreyer, Benard P; Berkule, Samantha; Fierman, Arthur H; Brockmeyer, Carolyn; Mendelsohn, Alan L

2010-12-01

To determine whether duration and content of media exposure in 6-month-old infants are associated with development at age 14 months. Longitudinal analysis of 259 mother-infant dyads participating in a long-term study related to early child development, from November 23, 2005, through January 14, 2008. An urban public hospital. Mothers with low socioeconomic status and their infants. Duration and content of media exposure at age 6 months. Cognitive and language development at age 14 months. Of 259 infants, 249 (96.1%) were exposed to media at age 6 months, with mean (SD) total exposure of 152.7 (124.5) min/d. In unadjusted and adjusted analyses, duration of media exposure at age 6 months was associated with lower cognitive development at age 14 months (unadjusted: r = -0.17, P < .01; adjusted: β = -0.15, P = .02) and lower language development (r = -0.16, P < .01; β = -0.16, P < .01). Of 3 types of content assessed, only 1 (older child/adult-oriented) was associated with lower cognitive and language development at age 14 months. No significant associations were seen with exposure to young child-oriented educational or noneducational content. This study is the first, to our knowledge, to have longitudinally assessed associations between media exposure in infancy and subsequent developmental outcomes in children from families with low socioeconomic status in the United States. Findings provide strong evidence in support of the American Academy of Pediatrics recommendations of no media exposure prior to age 2 years, although further research is needed.

Migrating from Mexico and Sharing Pretend with Peers in the United States

ERIC Educational Resources Information Center

Howes, Carollee; Wishard Guerra, Alison G.; Zucker, Eleanor

2008-01-01

The intent of this study was to examine the development of peer interaction in low-income Mexican-heritage families in the United States. Eighty-eight children (44 girls) were observed and mothers interviewed when children were 14, 24, 36, and 54 months old. We used the Attachment Q-Set (Waters, 1990), the Peer Play Scale (Howes & Matheson, 1992),…

Test Review: Wechsler, D. (2005). "Wechsler Intelligence Scale for Children-Fourth Edition Spanish." San Antonio, TX: Harcourt Assessment

ERIC Educational Resources Information Center

Braden, Jeffery P.; Iribarren, Jacqueline A.

2007-01-01

In this article, the authors review the Wechsler Intelligence Scale for Children-Fourth Edition Spanish (WISC-IV Spanish), a Spanish translation and adaptation of the WISC-IV. The test was developed to measure the intellectual ability of Spanish-speaking children in the United States ages 6 years, 0 months, through 16 years, 11 months. These…

Does size matter? Animal units and animal unit months

Treesearch

Lamar Smith; Joe Hicks; Scott Lusk; Mike Hemmovich; Shane Green; Sarah McCord; Mike Pellant; John Mitchell; Judith Dyess; Jim Sprinkle; Amanda Gearhart; Sherm Karl; Mike Hannemann; Ken Spaeth; Jason Karl; Matt Reeves; Dave Pyke; Jordan Spaak; Andrew Brischke; Del Despain; Matt Phillippi; Dave Weixelmann; Alan Bass; Jessie Page; Lori Metz; David Toledo; Emily Kachergis

2017-01-01

The concepts of animal units, animal unit months, and animal unit equivalents have long been used as standards for range management planning, estimating stocking rates, reporting actual use, assessing grazing fees, ranch appraisal, and other purposes. Increasing size of cattle on rangelands has led some to suggest that the definition of animal units and animal unit...

Evaluation of the PotoClean® decontamination technology for reprocessing of water supply lines in dental units during routine work

PubMed Central

Kramer, Axel; Koburger, Torsten; Taube, Lisa-Dorothea; Menzel, Michael; Meyer, Georg; Assadian, Ojan

2012-01-01

Background: A frequent problem in dental units is the microbial contamination of water and biofilm formation in the water supply lines. After random identification of a bacterial contaminated dental unit (310 cfu/ml) in a practise with 3 dental units we implemented the present study to evaluate the efficacy of the PotoClean® technology, based on anodic oxidation. Method: The efficacy of a regular low concentrated permanent decontamination (1 mg Cl/L) with an additional intensive decontamination by PotoClean® (three times 20 mg Cl/ml for 2 h) on three dental units was tested over 7 months. Microbial contamination, total chlorine concentration and redox potential have been analyzed. Dental unit A and B was 15 years old, unit C 5 years. Results: After 3 intensive decontaminations, in dental unit A and B the number of bacteria and moulds could be reduced less than 7 d. Thereafter the bacteria counts increased again during the subsequent 7 month period and the amount of moulds was with some exceptions 300 cfu/ml, although PotoClean® was constantly added in the system (1 mg Cl/L). After further 7.5 month only with low concentrated permanent disinfection (1 mg Cl/L) both units were successful decontaminated. Dental unit C represented an object which was easier to decontaminate because of the advanced construction (prevention of water stagnation) and the shorter useful life. At the beginning of the decontamination it was no bacterial contamination, but moulds were contained (300 cfu/ml). Already after the first intensive decontamination, no further bacteria and moulds could be detected. Discussion: An important factor for the efficacy of PotoClean® was the age of the units and their construction. For a new generation of dental units PotoClean® was effective during the whole period of monitoring. For two old types of dental unit with massive biofilm development the successful decontamination needed more than 7 month. Conclusion: The PotoClean® technology has resulted in even old-type turbines with intensive biofilm formation to complete decontamination. In a recent turbine design already after the first intensive decontamination with PotoClean® and its continuous use (1 mg Cl/L) no more contamination by bacteria and moulds were detectable. PMID:22558044

Evaluation of the PotoClean(®) decontamination technology for reprocessing of water supply lines in dental units during routine work.

PubMed

Kramer, Axel; Koburger, Torsten; Taube, Lisa-Dorothea; Menzel, Michael; Meyer, Georg; Assadian, Ojan

2012-01-01

A frequent problem in dental units is the microbial contamination of water and biofilm formation in the water supply lines. After random identification of a bacterial contaminated dental unit (310 cfu/ml) in a practise with 3 dental units we implemented the present study to evaluate the efficacy of the PotoClean(®) technology, based on anodic oxidation. The efficacy of a regular low concentrated permanent decontamination (1 mg Cl/L) with an additional intensive decontamination by PotoClean(®) (three times 20 mg Cl/ml for 2 h) on three dental units was tested over 7 months. Microbial contamination, total chlorine concentration and redox potential have been analyzed. Dental unit A and B was 15 years old, unit C 5 years. After 3 intensive decontaminations, in dental unit A and B the number of bacteria and moulds could be reduced less than 7 d. Thereafter the bacteria counts increased again during the subsequent 7 month period and the amount of moulds was with some exceptions 300 cfu/ml, although PotoClean(®) was constantly added in the system (1 mg Cl/L). After further 7.5 month only with low concentrated permanent disinfection (1 mg Cl/L) both units were successful decontaminated. Dental unit C represented an object which was easier to decontaminate because of the advanced construction (prevention of water stagnation) and the shorter useful life. At the beginning of the decontamination it was no bacterial contamination, but moulds were contained (300 cfu/ml). Already after the first intensive decontamination, no further bacteria and moulds could be detected. An important factor for the efficacy of PotoClean(®) was the age of the units and their construction. For a new generation of dental units PotoClean(®) was effective during the whole period of monitoring. For two old types of dental unit with massive biofilm development the successful decontamination needed more than 7 month. The PotoClean(®) technology has resulted in even old-type turbines with intensive biofilm formation to complete decontamination. In a recent turbine design already after the first intensive decontamination with PotoClean(®) and its continuous use (1 mg Cl/L) no more contamination by bacteria and moulds were detectable.

Early Literacy Individual Growth and Development Indicators (EL-IGDIs): Growth Trajectories Using a Large, Internet-Based Sample

ERIC Educational Resources Information Center

Roseth, Cary J.; Missall, Kristen N.; McConnell, Scott R.

2012-01-01

Early literacy individual growth and development indicators (EL-IGDIs) assess preschoolers' expressive vocabulary development and phonological awareness. This study investigated longitudinal change in EL-IGDIs using a large (N=7355), internet-based sample of 36- to 60-month-old United States preschoolers without identified risks for later…

Breastfeeding Reduces Childhood Obesity Risks.

PubMed

Wang, Liang; Collins, Candice; Ratliff, Melanie; Xie, Bin; Wang, Youfa

2017-06-01

The present study examined the effects of breastfeeding and its duration on the development of childhood obesity from 24 months through grade 6. U.S. longitudinal data collected from 1234 children were analyzed using logistic regression models and generalized estimating equation (GEE). Child height and weight were measured six times at ages of 24 months, 36 months, 54 months, grade 1, grade 3, and grade 6. During the early 1990s, prevalence of breastfeeding was low in the United States, 60% and 48% at 1 and 6 months, respectively. Nonsmoking, white, married mothers with both parents in the household, and with income above the poverty line, were more likely to breastfeed at 1 month of age of their babies. Obesity rate of the children increased with age from 24 months to grade 6. Logistic regression showed that breastfeeding at month 1 was associated with 53% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.30-0.73) and 47% (OR: 0.53, 95% CI: 0.36-0.78) decreased risks for childhood obesity at grades 1 and 6, respectively. GEE analysis showed that breastfeeding at 1 month reduced risk for childhood obesity by 36% (95% CI: 0.47-0.88) from ages 24 months through grade 6. Regarding breastfeeding duration, more than 6 months (vs. never) was associated with a decreased risk for childhood obesity by 42% (OR: 0.58, 95% CI: 0.36-0.94). Breastfeeding at 1 month and more than 6 months reduced the risk of childhood obesity. Rate of breastfeeding was low in the United States in the 1990s, which may have had long-term implications on children.

[The development and benefits of working together in geriatric short stay units].

PubMed

Dumont, Magali

2014-01-01

Ambroise-Paré hospital (AP-HP, 92) set up a new work organisation based on the nurse/nursing auxiliary partnership in the geriatric short stay unit in response to the wishes of the healthcare manager and nursing team. It was introduced over three months and in several stages in order to limit sticking points and support the team in its new practice.

Don't wait for Paris summit to improve health.

PubMed

Soares, Andréia Azevedo; Figueres, Christiana

2015-11-01

How developing countries will make the transition to sustainable clean-energy economies is a major challenge for the United Nations summit that opens in Paris this month. Christiana Figueres talks to Andréia Azevedo Soares.

Chronic kidney disease in patients at high risk of cardiovascular disease in the United Arab Emirates: A population-based study.

PubMed

Al-Shamsi, S; Regmi, D; Govender, R D

2018-01-01

Chronic kidney disease has become an increasingly significant clinical and public health issue, accounting for 1.1 million deaths worldwide. Information on the epidemiology of chronic kidney disease and associated risk factors is limited in the United Arab Emirates. Therefore, this study aimed to evaluate the incidence and causes of chronic kidney disease stages 3-5 in adult United Arab Emirates nationals with or at high risk of cardiovascular disease. This retrospective study included 491 adults with or at high risk of cardiovascular disease (diabetes mellitus or associated clinical disease) who attended outpatient clinics at a tertiary care hospital in Al-Ain, United Arab Emirates. Estimated glomerular filtration rate was assessed every 3 months from baseline to June 30, 2017. Chronic kidney disease stages 3-5 were defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 for ≥ 3 months. Multivariable Cox's proportional hazards analysis was used to determine the independent risk factors associated with developing chronic kidney disease stages 3-5. The cumulative incidence of chronic kidney disease stages 3-5 over a 9-year period was 11.4% (95% confidence interval 8.6, 14.0). The incidence rate of these disease stages was 164.8 (95% confidence interval 121.6, 207.9) per 10,000 person-years. The independent risk factors for developing chronic kidney disease stages 3-5 were older age, history of coronary heart disease, history of diabetes mellitus, and history of smoking. These data may be useful to develop effective strategies to prevent chronic kidney disease development in high-risk United Arab Emirates nationals.

75 FR 17839 - National Cancer Control Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

... Cancer Control Month, 2010 By the President of the United States of America A Proclamation Cancer is.... During National Cancer Control Month, let us renew our commitment to combat this disease by raising... as ``Cancer Control Month.'' NOW, THEREFORE, I, BARACK OBAMA, President of the United States of...

76 FR 68613 - National Adoption Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-04

... National Adoption Month, 2011 By the President of the United States of America A Proclamation As a Nation... without families. During National Adoption Month, we celebrate the acts of compassion and love that unite... the foster care system. Last year, during National Adoption Month, I signed the International Adoption...

Long-Term Daily and Monthly Climate Records from Stations Across the Contiguous United States (U.S.Historical Climatology Network) (NDP-019)

DOE Data Explorer

Menne, M. J. [National Climatic Data Center, National Oceanic and Atmospheric Administration; Williams, Jr., C. N. [National Climatic Data Center, National Oceanic and Atmospheric Administration; Vose, R. S. [National Climatic Data Center, National Oceanic and Atmospheric Administration

2016-01-01

The United States Historical Climatology Network (USHCN) is a high-quality data set of daily and monthly records of basic meteorological variables from 1218 observing stations across the 48 contiguous United States. Daily data include observations of maximum and minimum temperature, precipitation amount, snowfall amount, and snow depth; monthly data consist of monthly-averaged maximum, minimum, and mean temperature and total monthly precipitation. Most of these stations are U.S. Cooperative Observing Network stations located generally in rural locations, while some are National Weather Service First-Order stations that are often located in more urbanized environments. The USHCN has been developed over the years at the National Oceanic and Atmospheric Administration's (NOAA) National Climatic Data Center (NCDC) to assist in the detection of regional climate change. Furthermore, it has been widely used in analyzing U.S. climte. The period of record varies for each station. USHCN stations were chosen using a number of criteria including length of record, percent of missing data, number of station moves and other station changes that may affect data homogeneity, and resulting network spatial coverage. Collaboration between NCDC and CDIAC on the USHCN project dates to the 1980s (Quinlan et al. 1987). At that time, in response to the need for an accurate, unbiased, modern historical climate record for the United States, the Global Change Research Program of the U.S. Department of Energy and NCDC chose a network of 1219 stations in the contiguous United States that would become a key baseline data set for monitoring U.S. climate. This initial USHCN data set contained monthly data and was made available free of charge from CDIAC. Since then it has been comprehensively updated several times [e.g., Karl et al. (1990) and Easterling et al. (1996)]. The initial USHCN daily data set was made available through CDIAC via Hughes et al. (1992) and contained a 138-station subset of the USHCN. This product was updated by Easterling et al. (1999) and expanded to include 1062 stations. In 2009 the daily USHCN dataset was expanded to include all 1218 stations in the USHCN.

Neurocognitive predictors of financial capacity in traumatic brain injury.

PubMed

Martin, Roy C; Triebel, Kristen; Dreer, Laura E; Novack, Thomas A; Turner, Crystal; Marson, Daniel C

2012-01-01

To develop cognitive models of financial capacity (FC) in patients with traumatic brain injury (TBI). Longitudinal design. Inpatient brain injury rehabilitation unit. Twenty healthy controls, and 24 adults with moderate-to-severe TBI were assessed at baseline (30 days postinjury) and 6 months postinjury. The FC instrument (FCI) and a neuropsychological test battery. Univariate correlation and multiple regression procedures were employed to develop cognitive models of FCI performance in the TBI group, at baseline and 6-month time follow-up. Three cognitive predictor models of FC were developed. At baseline, measures of mental arithmetic/working memory and immediate verbal memory predicted baseline FCI performance (R = 0.72). At 6-month follow-up, measures of executive function and mental arithmetic/working memory predicted 6-month FCI performance (R = 0.79), and a third model found that these 2 measures at baseline predicted 6-month FCI performance (R = 0.71). Multiple cognitive functions are associated with initial impairment and partial recovery of FC in moderate-to-severe TBI patients. In particular, arithmetic, working memory, and executive function skills appear critical to recovery of FC in TBI. The study results represent an initial step toward developing a neurocognitive model of FC in patients with TBI.

Changes in contractile properties and action potentials of motor units in the rat medial gastrocnemius muscle during maturation.

PubMed

Dobrzynska, Z; Celichowski, J

2016-02-01

The early phase of development of muscles stops following the disappearance of embryonic and neonatal myosin and the elimination of polyneuronal innervation of muscle fibres with the formation of motor units (MUs), but later the muscle mass still considerably increases. It is unknown whether the three types are visible among newly formed MUs soon after the early postnatal period and whether their proportion is similar to that in adult muscle. Moreover, the processes responsible for MU-force regulation by changes in motoneuronal firing rate as well as properties of motor unit action potentials (MUAPs) during maturation are unknown. Three groups of Wistar rats were investigated - 1 month old, 2 months old and the adult, 9 months old. The basic contractile properties and action potentials of MUs in the medial gastrocnemius (MG) muscle were analysed. The three types of MUs were distinguishable in all age groups, but higher proportion of slow MUs was noticed in young rats (29%, 18% and 11% in 1, 2 and 9 months rats, respectively). The fatigue index for fast fatigable MUs in 1 month old rats was about 2 times higher than in 9 months old rats. The twitch time parameters of fast MUs were shortened during the maturation; for these units, the force-frequency curves in young rats were shifted towards lower frequencies, which suggested that fast motoneurons of young animals generate lower firing rates. Higher twitch-to-tetanus ratios noted for the three MU types in young rats suggested the smaller role of rate coding in force regulation processes, and the higher role of MU recruitment in young rats. No significant differences in MUAP parameters between two groups of young and adult animals were observed. Concluding, the maturation process evokes deeper changes in fast MUs than in slow ones.

77 FR 13183 - Irish-American Heritage Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

...-American Heritage Month, 2012 By the President of the United States of America A Proclamation For centuries... Heritage Month, we recall their legacy of hard work and perseverance, and we carry forward that singular... laws of the United States, do hereby proclaim March 2012 as Irish- American Heritage Month. I call upon...

Properties of single motor units in medial gastrocnemius muscles of adult and old rats.

PubMed Central

Kadhiresan, V A; Hassett, C A; Faulkner, J A

1996-01-01

1. The purpose of this study was to determine the role of motor unit remodelling in the deficit that develops in the maximum isometric tetanic force (Fo) of whole medial gastrocnemius (MGN) muscles in old compared with adult rats. The Fo values and morphological data were determined for MGN muscles and eighty-two single motor units in muscles of adult (10-12 months) and sixty-two units in those of old (24-26 months) F344 rats. During an unfused tetanus, fast and slow (S) motor units were identified by the presence and absence of sag, respectively. Fast-fatigable (FF) and fast-fatigue-resistant (FR) units were classified by fatigue indices less than or greater than 0.50, respectively. 2. For old rats, whole MGN muscle Fo was 29% less than the value of 11.2 N measured for adult rats. The deficit in whole muscle Fo of old rats resulted from equivalent decreases in the number of motor units, 16% smaller than the adult value of ninety-seven, and in the mean motor unit Fo value, 14% less than the adult value of 117 mN. 3. With ageing, little motor unit remodelling occurred in FR units, whereas the S and FF motor units demonstrated dramatic, but opposing, changes. For S units, the number of units remained constant, but the number of fibres per motor unit increased 3-fold from 57 to 165. In contrast, the number of FF units decreased by 34% and the number of fibres per motor unit of the remaining units decreased to 86% of the adult value of 333. The age-related remodelling of motor units appeared to involve denervation of fast muscle fibres with reinnervation of denervated fibres by axonal sprouting from slow fibres. PMID:8782115

Recent trends for drug lag in clinical development of oncology drugs in Japan: does the oncology drug lag still exist in Japan?

PubMed

Maeda, Hideki; Kurokawa, Tatsuo

2015-12-01

This study exhaustively and historically investigated the status of drug lag for oncology drugs approved in Japan. We comprehensively investigated oncology drugs approved in Japan between April 2001 and July 2014, using publicly available information. We also examined changes in the status of drug lag between Japan and the United States, as well as factors influencing drug lag. This study included 120 applications for approval of oncology drugs in Japan. The median difference over a 13-year period in the approval date between the United States and Japan was 875 days (29.2 months). This figure peaked in 2002, and showed a tendency to decline gradually each year thereafter. In 2014, the median approval lag was 281 days (9.4 months). Multiple regression analysis identified the following potential factors that reduce drug lag: "Japan's participation in global clinical trials"; "bridging strategies"; "designation of priority review in Japan"; and "molecularly targeted drugs". From 2001 to 2014, molecularly targeted drugs emerged as the predominant oncology drug, and the method of development has changed from full development in Japan or bridging strategy to global simultaneous development by Japan's taking part in global clinical trials. In line with these changes, the drug lag between the United States and Japan has significantly reduced to less than 1 year.

Financial impact of nursing professionals staff required in an Intensive Care Unit 1

PubMed Central

de Araújo, Thamiris Ricci; Menegueti, Mayra Gonçalves; Auxiliadora-Martins, Maria; Castilho, Valéria; Chaves, Lucieli Dias Pedreschi; Laus, Ana Maria

2016-01-01

ABSTRACT Objective: to calculate the cost of the average time of nursing care spent and required by patients in the Intensive Care Unit (ICU) and the financial expense for the right dimension of staff of nursing professionals. Method: a descriptive, quantitative research, using the case study method, developed in adult ICU patients. We used the workload index - Nursing Activities Score; the average care time spent and required and the amount of professionals required were calculated using equations and from these data, and from the salary composition of professionals and contractual monthly time values, calculated the cost of direct labor of nursing. Results: the monthly cost of the average quantity of available professionals was US$ 35,763.12, corresponding to 29.6 professionals, and the required staff for 24 hours of care is 42.2 nurses, with a monthly cost of US$ 50,995.44. Conclusion: the numerical gap of nursing professionals was 30% and the monthly financial expense for adaptation of the structure is US$ 15,232.32, which corresponds to an increase of 42.59% in the amounts currently paid by the institution. PMID:27878219

Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.

PubMed

Sekhon, Mypinder S; Gooderham, Peter; Toyota, Brian; Kherzi, Navid; Hu, Vivien; Dhingra, Vinay K; Hameed, Morad S; Chittock, Dean R; Griesdale, Donald E

2017-07-01

Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

A passive-solar design manual for the United States Navy

NASA Astrophysics Data System (ADS)

Wray, W. O.; Biehl, F. A.; Kosiewicz, C. E.; Miles, C. E.; Durlak, E. R.

1982-06-01

A passive solar design manual for single-family detached residences and dormitory-type buildings is developed. The design procedure employed in the manual is a simplification of the original monthly solar load ratio (SLR) method. The new SLR correlations involve a single constant for each system. The correlation constant appears as a scale factor permitting the use of a universal performance curve for all passive systems. Furthermore, by providing location-dependent correlations between the annual solar heating fraction (SHF) and the minimum monthly SHF, the need to perform an SLR calculation for each month of the heating season is eliminated.

Passive-solar design manual for the United States Navy

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

Wray, W.O.; Biehl, F.A.; Kosiewicz, C.R.

1982-01-01

A passive solar design manual for single-family detached residences and dormitory-type buildings is being developed. The design procedure employed in the manual is a simplification of the original monthly solar load ratio (SLR) method. The new SLR correlations involve a single constant for each system. The correlation constant appears as a scale factor permitting the use of a universal performance curve for all passive systems. Furthermore, by providing location-dependent correlations between the annual solar heating fraction (SHF)* and the minimum monthly SHF, we have eliminated the need to perform an SLR calculation for each month of the heating season.

How EIA Estimates Natural Gas Production

EIA Publications

2004-01-01

The Energy Information Administration (EIA) publishes estimates monthly and annually of the production of natural gas in the United States. The estimates are based on data EIA collects from gas producing states and data collected by the U. S. Minerals Management Service (MMS) in the Department of Interior. The states and MMS collect this information from producers of natural gas for various reasons, most often for revenue purposes. Because the information is not sufficiently complete or timely for inclusion in EIA's Natural Gas Monthly (NGM), EIA has developed estimation methodologies to generate monthly production estimates that are described in this document.

Research and Clinical Center for Child Development Annual Report, 1994-1995, No. 18.

ERIC Educational Resources Information Center

Wakai, Kunio, Ed.; Chen, Shing-Jen, Ed.

This annual report discusses several topics related to the work of the Research and Clinical Center for Child Development. Seven topics are covered in the report. The articles are: (1) "Fathers' Participation in the Lives of Their 4-Month-Old Infants: The United States and Japan" (Marguerite Stevenson Barratt, Koichi Negayama and…

Prevention of Posttraumatic Contractures with Ketotifen (PERK)

DTIC Science & Technology

2016-10-01

the Peer Reviewed Orthopaedic Research Program (PRORP) Clinical Trial Award (CTA), W81XWH-16-PRORP-CTA, was submitted. Database development and Pre...and Safety Months Identify database and partner – Clinical Research Unit 1-2 Completed Develop Case Report Forms, consent forms 6-12 Case...report forms completed, consent forms pending – 80% completed Develop database and multicenter submission process 12-18 In progress, 30% completed

Cost-effectiveness of a new short-stay unit to "rule out" acute myocardial infarction in low risk patients.

PubMed

Gaspoz, J M; Lee, T H; Weinstein, M C; Cook, E F; Goldman, P; Komaroff, A L; Goldman, L

1994-11-01

This study attempted to determine the safety and costs of a new short-stay unit for low risk patients who may be admitted to a hospital to rule out myocardial infarction or ischemia. One strategy to reduce the costs of ruling out acute myocardial infarction in low risk patients is to develop alternatives to coronary care units. The short-term and 6-month clinical outcomes and costs for 592 patients admitted to a short-stay coronary observation unit at Brigham and Women's Hospital with a low (< or = 10%) probability of acute myocardial infarction were compared with those for 924 consecutive comparison patients who were eligible for the same unit but were admitted to other hospital settings or discharged home. Actual costs were calculated using detailed cost-accounting methods that incorporated nursing intensity weights. The rate of major complications, recurrent myocardial infarction or cardiac death during 6 months after the initial presentation of the 592 patients admitted to the coronary observation unit was similar to that of the 924 comparison patients before and after adjustment for clinical factors influencing triage and initial diagnoses (adjusted relative risk 0.86, 95% confidence interval 0.49 to 1.53). Their median total costs (25th, 75th percentile) at 6 months ($1,927; 1,455, 3,650) were significantly lower than for comparison patients admitted to the wards $4,712; 1,868, 11,187), to stepdown or intermediate care units ($4,031; 2,069, 9,169) or to the coronary care unit ($9,201; 3,171, 20,011) but were higher than for comparison patients discharged home from the emergency department ($403; 403,927) before and after the same adjustments (all adjusted p < 0.0001). These data suggest that the coronary observation unit may be a safe and cost-saving alternative to current triage strategies for patients with a low risk of acute myocardial infarction admitted from the emergency department. Its replication in other hospitals should be tested.

Interventional Radiation Oncology (IRO): Transition of a magnetic resonance simulator to a brachytherapy suite.

PubMed

Anderson, Roberta; Armour, Elwood; Beeckler, Courtney; Briner, Valerie; Choflet, Amanda; Cox, Andrea; Fader, Amanda N; Hannah, Marie N; Hobbs, Robert; Huang, Ellen; Kiely, Marilyn; Lee, Junghoon; Morcos, Marc; McMillan, Paige E; Miller, Dave; Ng, Sook Kien; Prasad, Rashmi; Souranis, Annette; Thomsen, Robert; DeWeese, Theodore L; Viswanathan, Akila N

As a core component of a new gynecologic cancer radiation program, we envisioned, structured, and implemented a novel Interventional Radiation Oncology (IRO) unit and magnetic resonance (MR)-brachytherapy environment in an existing MR simulator. We describe the external and internal processes required over a 6-8 month time frame to develop a clinical and research program for gynecologic brachytherapy and to successfully convert an MR simulator into an IRO unit. Support of the institution and department resulted in conversion of an MR simulator to a procedural suite. Development of the MR gynecologic brachytherapy program required novel equipment, staffing, infrastructural development, and cooperative team development with anesthetists, nurses, therapists, physicists, and physicians to ensure a safe and functional environment. Creation of a separate IRO unit permitted a novel billing structure. The creation of an MR-brachytherapy environment in an MR simulator is feasible. Developing infrastructure includes several collaborative elements. Unique to the field of radiation oncology, formalizing the space as an Interventional Radiation Oncology unit permits a sustainable financial structure. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Monthly Solar Photovoltaic Module Shipments Report

EIA Publications

2017-01-01

This report contains newly collected monthly summary data beginning in January 2017, for the photovoltaic industry in the United States. The subset of respondents who now must report monthly represents approximately 90% of photovoltaic (PV) activity in the United States, based on prior year’s data. Data include manufacturing, imports, and exports of modules in the United States and its territories. Summary data include volumes in peak kilowatts and average prices. Where possible, imports and exports are listed by country, and shipments to the United States are listed by state.

A digital model for planning water management at Benton Lake National Wildlife Refuge, west-central Montana

USGS Publications Warehouse

Nimick, David A.; McCarthy, Peter M.; Fields, Vanessa

2011-01-01

Benton Lake National Wildlife Refuge is an important area for waterfowl production and migratory stopover in west-central Montana. Eight wetland units covering about 5,600 acres are the essential features of the refuge. Water availability for the wetland units can be uncertain owing to the large natural variations in precipitation and runoff and the high cost of pumping supplemental water. The U.S. Geological Survey, in cooperation with the U.S. Fish and Wildlife Service, has developed a digital model for planning water management. The model can simulate strategies for water transfers among the eight wetland units and account for variability in runoff and pumped water. This report describes this digital model, which uses a water-accounting spreadsheet to track inputs and outputs to each of the wetland units of Benton Lake National Wildlife Refuge. Inputs to the model include (1) monthly values for precipitation, pumped water, runoff, and evaporation; (2) water-level/capacity data for each wetland unit; and (3) the pan-evaporation coefficient. Outputs include monthly water volume and flooded surface area for each unit for as many as 5 consecutive years. The digital model was calibrated by comparing simulated and historical measured water volumes for specific test years.

Environmental factors influencing biological rhythms in newborns: From neonatal intensive care units to home.

PubMed

Bueno, Clarissa; Menna-Barreto, Luiz

2016-01-01

Photic and non-photic environmental factors are suggested to modulate the development of circadian rhythms in infants. Our aim is to evaluate the development of biological rhythms (circadian or ultradian) in newborns in transition from Neonatal Intensive Care Units (NICU) to home and along the first 6 months of life, to identify masking and entraining environment factors along development. Ten newborns were evaluated in their last week inside the NICU and in the first week after being delivered home; 6 babies were also followed until 6 months of corrected age. Activity, recorded with actimeters, wrist temperature and observed sleep and feeding behavior were recorded continuously along their last week inside the NICU and in the first week at home and also until 6 months of corrected age for the subjects who remained in the study. Sleep/wake and activity/rest cycle showed ultradian patterns and the sleep/wake was strongly influenced by the 3 h feeding schedule inside the NICU, while wrist temperature showed a circadian pattern that seemed no to be affected by environmental cycles. A circadian rhythm emerges for sleep/wake behavior in the first week at home, whereas the 3 h period vanishes. Both activity/rest and wrist temperature presented a sudden increase in the contribution of the circadian component immediately after babies were delivered home, also suggesting a masking effect of the NICU environment. We found a positive correlation of postconceptional age and the increase in the daily component of activity and temperature along the following 6 months, while feeding behavior became arrhythmic.

24 CFR 990.150 - Limited vacancies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... shall pay operating subsidy for a limited number of vacant units under an ACC if the annualized vacancy... percent of the unit months under an ACC) for the period July 1, 2004, to June 30, 2005, and (2) Three... to five vacant units not to exceed 100 percent of the unit months under an ACC. For example, a PHA...

24 CFR 990.150 - Limited vacancies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... shall pay operating subsidy for a limited number of vacant units under an ACC if the annualized vacancy... percent of the unit months under an ACC) for the period July 1, 2004, to June 30, 2005, and (2) Three... to five vacant units not to exceed 100 percent of the unit months under an ACC. For example, a PHA...

Atypical social development in neonatal intensive care unit survivors at 12 months.

PubMed

Yamada, Yasumasa; Yoshida, Futoshi; Hemmi, Hayato; Ito, Miharu; Kakita, Hiroki; Yoshikawa, Toru; Hishida, Manabu; Iguchi, Toshiyuki; Seo, Tomoko; Nakanishi, Keiko

2011-12-01

Owing to advances in neonatal intensive care, many infants who are hospitalized in neonatal intensive care units (NICU) can survive and grow, and are referred to as NICU survivors. However, social development in NICU survivors has not been fully explored. To examine the social development of NICU survivors, a questionnaire consisting of the Modified Checklist for Autism in Toddlers (M-CHAT) was used. The M-CHAT was completed by the parents of either NICU survivors (n= 117) or normally delivered children (control group, n= 112) during their regular medical checkups at a corrected age of 12 months. Ninety percent of NICU survivors and 63% of control children did not pass the M-CHAT screen. As it was originally designed for children aged 18-30 months, failed M-CHAT items could have been due to developmental issues and not due to autistic spectrum disorders. However, there was a significant difference in the total number of items failed between the two groups. In particular, many NICU survivors did not pass on M-CHAT items, such as oversensitivity to noise, unusual finger movements, and attempts to attract attention. Concerning perinatal complications, infants with low birthweight and/or the need for respiratory support tended to have a higher number of failures on all M-CHAT items. NICU survivors may have distinct developmental patterns of social communication, and should be followed up for assessment of social skills and neurological development. © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

76 FR 6303 - American Heart Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-03

... Vol. 76 Thursday, No. 23 February 3, 2011 Part IV The President Proclamation 8625--American Heart..., 2011 American Heart Month, 2011 By the President of the United States of America A Proclamation Heart... in the United States is living with some form of cardiovascular disease, American Heart Month...

Extravehicular Mobility Unit (EMU) / International Space Station (ISS) Coolant Loop Failure and Recovery

NASA Technical Reports Server (NTRS)

Lewis, John F.; Cole, Harold; Cronin, Gary; Gazda, Daniel B.; Steele, John

2006-01-01

Following the Colombia accident, the Extravehicular Mobility Units (EMU) onboard ISS were unused for several months. Upon startup, the units experienced a failure in the coolant system. This failure resulted in the loss of Extravehicular Activity (EVA) capability from the US segment of ISS. With limited on-orbit evidence, a team of chemists, engineers, metallurgists, and microbiologists were able to identify the cause of the failure and develop recovery hardware and procedures. As a result of this work, the ISS crew regained the capability to perform EVAs from the US segment of the ISS.

Studying cross-cultural differences in the development of infant temperament: People's Republic of China, the United States of America, and Spain.

PubMed

Gartstein, Maria A; Gonzalez, Carmen; Carranza, Jose A; Ahadi, Stephan A; Ye, Renmin; Rothbart, Mary K; Yang, Suh Wen

2006-01-01

Investigated early development of temperament across three cultures: People's Republic of China (PRC), United States of America (US), and Spain, utilizing a longitudinal design (assessments at 3, 6, and 9 months of age). Selection of these countries presented an opportunity to conduct Eastern-Western/Individualistic-Collectivistic comparisons. The greatest number of significant differences (i.e., involving more temperament dimensions) was anticipated for the US (Western/Individualistic) and PRC (Eastern/Collectivistic) comparisons. The US sample included 66, the PRC group 69, and the Spanish sample, 60 mothers, all of whom completed the Infant Behavior Questionnaire (IBQ) 3 times, when their infants were 3, 6, and 9 months of age. Results related to mean group differences were generally consistent with our hypotheses, demonstrating a greater number of significant differences for US versus PRC, with fewer differences observed for US and Spain. Analyses addressing developmental changes in temperament indicated patterns consistent with a priori expectations and cross-cultural differences.

The Early Development of Sight-Reading Skills in Adulthood: A Study of Eye Movements

ERIC Educational Resources Information Center

Penttinen, Marjaana; Huovinen, Erkki

2011-01-01

In this study the effects of skill development on the eye movements of beginning adult sight-readers were examined, focusing on changes in the allocation of visual attention within metrical units as well as in the processing of larger melodic intervals. The participants were future elementary school teachers, taking part in a 9-month-long music…

Changes in unit structures and infanticide observed in Arsi geladas.

PubMed

Mori, Akio; Belay, Gurja; Iwamoto, Toshitaka

2003-07-01

In 1989 a new gelada baboon ( Theropithecus gelada) population was found in Arsi, on the opposite side of the Rift Valley to that of the known gelada populations of Semien and Showa. Previous comparisons of units of the band at Gado Goro, Arsi, in the same season in consecutive years, indicated that unit structure is less stable among Arsi geladas as compared to the Semien population. Gelada units of the band at Gado-Goro were studied for 7 months in order to investigate the processes of social changes. Changes in unit structure were observed. Provisioning was carried out for 1.5 months at the beginning of the 7-month study period, in order to capture and obtain blood samples from the geladas. Following this, changes in male leadership of some units were observed, presumably as a consequence of the capture. However, natural changes also occurred. One change in unit structure occurred after a female gave birth, and changes in another unit occurred after the disappearance of the leader male. These changes involved female desertion of a unit, her subsequent transfer to a male unit, and culminated in the formation of a unit consisting of one female and one male. One successful and one attempted case of unification of units, and one case of change of a unit leader male are reported. These changes occurred among eight resident units in a period of 7 months (196 female months). Though the types of social changes were not much different from previous observations in Semien National Park, their frequencies seemed to be much higher. The characteristics of Arsi gelada social changes are proposed to be related to the small size of the units. We also describe a new confirmed case and one suspected case of infanticide, as well as one case of abortion at the time of male leader change.

76 FR 68615 - National Alzheimer's Disease Awareness Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-04

... National Alzheimer's Disease Awareness Month, 2011 By the President of the United States of America A... disease is a pain they know all too well. Alzheimer's disease burdens an increasing number of our Nation's... health. During National Alzheimer's Disease Awareness Month, we stand united in our commitment to improve...

3 CFR 9007 - Proclamation 9007 of August 30, 2013. National Childhood Obesity Awareness Month, 2013

Code of Federal Regulations, 2014 CFR

2014-01-01

... Childhood Obesity Awareness Month, 2013 9007 Proclamation 9007 Presidential Documents Proclamations Proclamation 9007 of August 30, 2013 Proc. 9007 National Childhood Obesity Awareness Month, 2013By the President of the United States of America A Proclamation In the United States, obesity affects millions of...

Goldmann tonometer calibration: a national survey.

PubMed

Kumar, N; Hillier, R J

2009-02-01

Recent studies suggest that Goldmann tonometers can rapidly develop calibration errors (CEs) in clinical use and routine checks are necessary to ensure accuracy. To determine current practice regarding CE checks in the United Kingdom and assess the views of senior nursing staff in charge of running ophthalmology outpatient clinics as to whom they feel to be responsible for CE checks. Every ophthalmology unit with training recognition in England, Northern Ireland, Scotland, and Wales was contacted. Senior nurses responded to a structured telephone questionnaire regarding local tonometer calibration practice and their views regarding who is responsible for CE checks. A total of 155 eye units were identified and contacted. The response rate was 100%. CEs were checked for daily in 8 units (5.2%), weekly in 20 units (12.9%), fortnightly in 1 unit (0.6%), monthly in 12 units (7.7%), trimonthly in 5 units (3.2%), biannually in 27 units (17.4%), and annually in 21 units (13.5%). CEs were either never checked or checked in a very random manner (no identifiable pattern) in 61 units (39.4%). Sixty-three (40.6%) of the respondents felt CE checks were a departmental responsibility, 48 (31.0%) felt it to be the doctor's responsibility, and 44 (28.4%) felt CE checks should be performed by the nursing staff. Our national survey suggests that very few units check their tonometers for CEs at intervals which ensure their accuracy. Our previous survey of doctors suggests that they believe nurses should check for CE, whereas the nursing staff believe CE checks are not their responsibility. This lack of communication between health-care professionals may lead to inaccurate tonometers being used in clinical practice. We suggest that every eye unit should have a protocol, which clearly identifies individuals responsible for checking for CEs at least on a monthly basis.

Parameter regionalization of a monthly water balance model for the conterminous United States

USGS Publications Warehouse

Bock, Andrew R.; Hay, Lauren E.; McCabe, Gregory J.; Markstrom, Steven L.; Atkinson, R. Dwight

2016-01-01

A parameter regionalization scheme to transfer parameter values from gaged to ungaged areas for a monthly water balance model (MWBM) was developed and tested for the conterminous United States (CONUS). The Fourier Amplitude Sensitivity Test, a global-sensitivity algorithm, was implemented on a MWBM to generate parameter sensitivities on a set of 109 951 hydrologic response units (HRUs) across the CONUS. The HRUs were grouped into 110 calibration regions based on similar parameter sensitivities. Subsequently, measured runoff from 1575 streamgages within the calibration regions were used to calibrate the MWBM parameters to produce parameter sets for each calibration region. Measured and simulated runoff at the 1575 streamgages showed good correspondence for the majority of the CONUS, with a median computed Nash–Sutcliffe efficiency coefficient of 0.76 over all streamgages. These methods maximize the use of available runoff information, resulting in a calibrated CONUS-wide application of the MWBM suitable for providing estimates of water availability at the HRU resolution for both gaged and ungaged areas of the CONUS.

Parameter regionalization of a monthly water balance model for the conterminous United States

NASA Astrophysics Data System (ADS)

Bock, Andrew R.; Hay, Lauren E.; McCabe, Gregory J.; Markstrom, Steven L.; Atkinson, R. Dwight

2016-07-01

A parameter regionalization scheme to transfer parameter values from gaged to ungaged areas for a monthly water balance model (MWBM) was developed and tested for the conterminous United States (CONUS). The Fourier Amplitude Sensitivity Test, a global-sensitivity algorithm, was implemented on a MWBM to generate parameter sensitivities on a set of 109 951 hydrologic response units (HRUs) across the CONUS. The HRUs were grouped into 110 calibration regions based on similar parameter sensitivities. Subsequently, measured runoff from 1575 streamgages within the calibration regions were used to calibrate the MWBM parameters to produce parameter sets for each calibration region. Measured and simulated runoff at the 1575 streamgages showed good correspondence for the majority of the CONUS, with a median computed Nash-Sutcliffe efficiency coefficient of 0.76 over all streamgages. These methods maximize the use of available runoff information, resulting in a calibrated CONUS-wide application of the MWBM suitable for providing estimates of water availability at the HRU resolution for both gaged and ungaged areas of the CONUS.

A shuttle and space station manipulator system for assembly, docking, maintenance, cargo handling and spacecraft retrieval (preliminary design). Volume 3: Concept analysis. Part 2: Development program

NASA Technical Reports Server (NTRS)

1972-01-01

A preliminary estimate is presented of the resources required to develop the basic general purpose walking boom manipulator system. It is assumed that the necessary full scale zero g test facilities will be available on a no cost basis. A four year development effort is also assumed and it is phased with an estimated shuttle development program since the shuttle will be developed prior to the space station. Based on delivery of one qualification unit and one flight unit and without including any ground support equipment or flight test support it is estimated (within approximately + or - 25%) that a total of 3551 man months of effort and $17,387,000 are required.

An evaluation of the critical care assistant role within an acute NHS Trust Critical Care Unit.

PubMed

McGloin, Sarah; Knowles, Judie

2005-01-01

This study provides an evaluation of a training programme designed for developing six critical care assistants to work alongside registered nurses to care for patients within the critical care environment. The programme was run as a pilot funded from the Department of Health's 'critical care bid'. At 18 months long, the programme incorporated a foundation programme, and National Vocational Qualification (NVQ) level 3 in care and adapted Operating Department Practitioner (ODP) NVQ units. Six critical care assistants successfully completed the programme; however, they all then left the unit to undertake further study for pre-registration nursing qualifications. Upon evaluation, a number of key issues were identified. Clear definition of the critical care assistants's role is essential as are dedicated practice development staff, who focus purely on developing the critical care assistant role. More importantly, however, with such key changes in the staffing structure within critical care units, appropriate change management techniques should be employed, ensuring that all staff contributing to the training and development are fully involved from the start.

[Visual acuity and magnification requirement after ranibizumab in patients with wet age-related macular degeneration].

PubMed

Kloos, P; Bernasconi, P; Estermann, S; Bachmann, B; Rutishauser, Y; Thölen, A

2008-05-01

The purpose of this study was to examine the visual outcome by measuring visual acuity (VA) and magnification requirement (MR) in patients with wet AMD after repeated intravitreal injections of ranibizumab. A total of 195 eyes were treated with repeated intravitreal injections of ranibizumab "as needed". VA (Snellen chart) and MR (SZB reading chart) at baseline of 114 eyes with occult or minimally classic lesions, 42 eyes with predominantly classic lesions and 39 with retinal angiomatous proliferations (RAP) were compared at 3 and 6 months after beginning of treatment. The whole group of 195 patients with wet AMD (688 intravitreal injections within 6 months) demonstrated a mean improvement of VA of 0.72 lines after 3 months (p < 0.001) and 1.54 lines after 6 months (p < 0.001) and a mean improvement of MR of 0.59 log units after 3 months (p < 0.001) and 0.73 log units after 6 months (p < 0.001). Mean change in VA after 3 and 6 months demonstrated a significant improvement (p < 0.001 to p < 0.05) for eyes with occult CNV (+ 0.8 /+ 1.6 lines) and RAP (+ 1.2 /+ 1.9 lines) whereas mean improvement in VA for classic CNV (+ 0.02 /+ 0.87 lines) did not reach significance compared to baseline. Comparable results were obtained for the mean change of MR after 3 and 6 months for eyes with occult CNV (+ 0.75 log units/+ 0.92 log units). For eyes with RAP mean improvement of MR was + 0.74 log units after 3 months (p < 0.05) and it was not significant with + 0.8 log units after 6 months (p > 0.05). MR did not show a significant change during follow-up for classic CNV. Apart from eyes with classic CNV, in more than 90 % of the eyes both VA and MR remained stable or improved (loss < 3 lines in VA or deterioration of MR of < 3 log units). Although 45 % of the eyes with predominantly classic CNV had received photodynamic therapies with Verteporfin prior to the intravitreal injections with ranibizumab, MR remained stable in 80 % over 6 months. With repeated injections of ranibizumab "as needed", VA could be improved as well as MR could be lowered in a majority of patients with wet AMD and therefore reading ability could be optimized. Over 6 months the treatment frequency was lower compared to the monthly administration.

From early stress to 12-month development in very preterm infants: Preliminary findings on epigenetic mechanisms and brain growth.

PubMed

Fumagalli, Monica; Provenzi, Livio; De Carli, Pietro; Dessimone, Francesca; Sirgiovanni, Ida; Giorda, Roberto; Cinnante, Claudia; Squarcina, Letizia; Pozzoli, Uberto; Triulzi, Fabio; Brambilla, Paolo; Borgatti, Renato; Mosca, Fabio; Montirosso, Rosario

2018-01-01

Very preterm (VPT) infants admitted to Neonatal Intensive Care Unit (NICU) are at risk for altered brain growth and less-than-optimal socio-emotional development. Recent research suggests that early NICU-related stress contributes to socio-emotional impairments in VPT infants at 3 months through epigenetic regulation (i.e., DNA methylation) of the serotonin transporter gene (SLC6A4). In the present longitudinal study we assessed: (a) the effects of NICU-related stress and SLC6A4 methylation variations from birth to discharge on brain development at term equivalent age (TEA); (b) the association between brain volume at TEA and socio-emotional development (i.e., Personal-Social scale of Griffith Mental Development Scales, GMDS) at 12 months corrected age (CA). Twenty-four infants had complete data at 12-month-age. SLC6A4 methylation was measured at a specific CpG previously associated with NICU-related stress and socio-emotional stress. Findings confirmed that higher NICU-related stress associated with greater increase of SLC6A4 methylation at NICU discharge. Moreover, higher SLC6A4 discharge methylation was associated with reduced anterior temporal lobe (ATL) volume at TEA, which in turn was significantly associated with less-than-optimal GMDS Personal-Social scale score at 12 months CA. The reduced ATL volume at TEA mediated the pathway linking stress-related increase in SLC6A4 methylation at NICU discharge and socio-emotional development at 12 months CA. These findings suggest that early adversity-related epigenetic changes might contribute to the long-lasting programming of socio-emotional development in VPT infants through epigenetic regulation and structural modifications of the developing brain.

Migration timing and parenting practices: Contributions to social development in preschoolers with foreign-born and native-born mothers

PubMed Central

Glick, Jennifer E.; Hanish, Laura D.; Yabiku, Scott T.; Bradley, Robert H.

2012-01-01

Little is known about how key aspects of parental migration or child-rearing history affect social development across children from immigrant families. Relying on data on approximately 6,400 children from the Early Childhood Longitudinal Study – Birth Cohort, analyses assessed the role of mothers’ age at migration on children’s social development in the United States (sociability and problem behaviors). Consistent with models of divergent adaptation and assimilation, the relationship between age at arrival and children’s social development is not linear. Parenting practices, observed when children were approximately 24 months of age, partially mediated the relation between mothers’ age at arrival and children’s social development reported at approximate age 48 months, particularly in the case of mothers who arrived as adults. PMID:22966921

77 FR 60613 - National Energy Action Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-04

... National Energy Action Month, 2012 By the President of the United States of America A Proclamation A secure... sustainable, vibrant economy. We took bold action to double our use of renewable energy sources like solar... the laws of the United States, do hereby proclaim October 2012 as National Energy Action Month. I call...

Building a Better Model: A Comprehensive Breast Cancer Risk Model Incorporating Breast Density to Stratify Risk and Improve Application of Resources

DTIC Science & Technology

2013-10-01

A preliminary review of the data was performed and reviewed at our Annual Team Meeting on September 23, 2013. Emerging points of interest...coordination (month 1) Completed. A listserve was developed for the group early on . Bi-weekly conference calls are held on Tuesdays at noon. An agenda...was completed during Year 2. The new dataset included 100 images from a GE unit and 100 images from a Hologic unit. These were reviewed during

Sexual Harassment in the United States Military: The Development of the DoD Survey

DTIC Science & Technology

1988-09-30

confirmed equal opportunity complaints in the first half of fiscal year 1988 and in all of fiscal year 1987 (USAF Social 7 Actions Program Statistical Summary...State University Normal, Illinois for The Defense Equal Opportunity Management Institute Patrick Air Force Base, Florida United States Navy-ASEE 1988...Month, Day) 5. PAGE COUNT Final FROM 16ay TO _2_3J 880930 20 16. SUPPLEMENTARY NOTATION Prepared as a part of the Defense Equal Opportunity Management

The SMP mobilizes a bright idea: a CSM cinema on wheels.

PubMed

1985-01-01

The Bangladesh Family Planning Social Marketing Project (SMP) provides 1 of the best examples of the use of the mass media to promote social marketing. Using a fleet of 7 vans and 1 motor launch, the SMP brings films about family planning to more than a million rural couples a month living in isolated villages. Each film unit has two 16 mm projectors, a generator, a screen and speaker system and is operated by a projectionist and an assistant. 1 mobile unit gives about 25 shows a month at a cost of $75US per show, or less than 2 cents per person. The message reels and advertising spots were produced in Bangladesh, and the musical numbers are taken from local feature films. Every 3-4 months, the vans switch message and musical films, but all units keep separate copies of the advertising spots for Raja and Panther condoms and Maya and Ovacon pills. The motivational films were developed through extensive research, and they address basic social issues. During the show, various promotional items are sold, including calendars with family planning messages, plastic bags, key rings, and contraceptives. According to Robert Ciszewski, executive director of Population Services International, these mobile films are making a profound social change in Bangladesh.

A Multicomponent Fall Prevention Strategy Reduces Falls at an Academic Medical Center.

PubMed

France, Dan; Slayton, Jenny; Moore, Sonya; Domenico, Henry; Matthews, Julia; Steaban, Robin L; Choma, Neesha

2017-09-01

While the reduction in fall rates has not kept pace with the reduction of other hospital-acquired conditions, patient safety research and quality improvement (QI) initiatives at the system and hospital levels have achieved positive results and provide insights into potentially effective risk reduction strategies. An academic medical center developed a QI-based multicomponent strategy for fall prevention and pilot tested it for six months in three high-risk units-the Neuroscience Acute Care Unit, the Myelosuppression/Stem Cell Transplant Unit, and the Acute Care for the Elderly Unit-before implementing and evaluating the strategy hospitalwide. The multicomponent fall strategy was evaluated using a pre-post study design. The main outcome measures were falls and falls with harm measured in events per 1,000 patient-days. Fall rates were monitored and compared for three classes of falls: (1) accidental, (2) anticipated physiologic, and (3) unanticipated physiologic. Statistical process control charts showed that the pilot units had achieved significant reductions in falls with harm during the last five months of data collection. Wald test and segmented regression analyses revealed significant improvements in pooled postintervention fall rates, stratified by fall type. The hospitalwide implementation of the program resulted in a 47% overall reduction in falls in the postintervention period. A fall prevention strategy that targeted the spectrum of risk factors produced measurable improvement in fall rates and rates of patient harm. Hospitals must continue developing, rigorously testing, and sharing their results and experiences in implementing and sustaining multicomponent fall prevention strategies. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Early Rockets

NASA Image and Video Library

1957-10-04

The Army Ballistic Missile Agency incorporated the von Braun team in key positions with Dr. von Braun as a head of the Development Operations Division. On October 4, 1957, the Nation was shocked when the Russians launched Sputnik, the world's first artificial satellite. Two months later, the United States suffered disappointment when a Navy Vanguard rocket, with its satellite payload, failed to develop sufficient thrust and toppled over on the launch pad.

Sputnik

NASA Technical Reports Server (NTRS)

1957-01-01

The Army Ballistic Missile Agency incorporated the von Braun team in key positions with Dr. von Braun as a head of the Development Operations Division. On October 4, 1957, the Nation was shocked when the Russians launched Sputnik, the world's first artificial satellite. Two months later, the United States suffered disappointment when a Navy Vanguard rocket, with its satellite payload, failed to develop sufficient thrust and toppled over on the launch pad.

Two consecutive pregnancies in early and late stage of amyotrophic lateral sclerosis.

PubMed

Sarafov, Stayko; Doitchinova, Maryana; Karagiozova, Zhvka; Slancheva, Boriana; Dengler, Reinhard; Petri, Susanne; Kollewe, Katja

2009-01-01

There are few reports on pregnancies in sporadic and familial amyotrophic lateral sclerosis (ALS). We report on a young woman with sporadic ALS who gave birth twice during the course of her disease. The first pregnancy occurred 13 months after the onset of symptoms, and one month after diagnosis. The pregnancy was uncomplicated and resulted in vaginal delivery of a healthy boy. Fifteen months later, when she was already bed-ridden, she became pregnant again. She received a percutaneous endoscopic gastrostomy in the 21st gestational week and underwent early Caesarean section in the 34th week of gestation. The child was ventilated for 72 h in a neonatological unit. The patient was tracheotomized and ventilated two months later, i.e. 47 months after symptom onset, and died nine months later from gastrointestinal haemorrhage. Her two children have developed without abnormalities to date. This case confirms that pregnancies in early-stage ALS can develop normally and may result in uncomplicated vaginal delivery. Pregnancies in late stages may be critical for mother and child, and early delivery by Caesarean section may become necessary although neonatal outcome can be good.

[Central Patients Admission (CPA) unit--connecting inpatient and outpatient care].

PubMed

Fleck, Martin; Zeuner, Martin; Schölmerich, Jürgen

2009-12-15

Due to the novel reimbursement policies, hospitals face substantial conflicts regarding best patient care and optimal utilization of resources. In order to optimize patient treatment, a central patients admission (CPA) unit has been established. All patients electively referred to the hospital were primarily treated by a medical specialist at the CPA unit. According to an appropriateness evaluation protocol established with the medical service of the health insurances of Bavaria ("MDK-Bayern"), patients were treated as inpatients or outpatients. The impact of this novel admission procedure was assessed for a period of 30 months. Within 30 months following establishment of the CPA unit, 10% of the patients were treated as outpatients, whereas 90% of referred patients were admitted as inpatients. Nonetheless, numbers of inpatients increased by 20.7% after 24 months compared to 12 months following establishment of the CPA unit with a substantial increase of patients referred by external medical specialists. In addition, there were no cases of inappropriate admission. The CPA unit is an ideal instrument for treating patients cross-sectorally as well as more effectively and economically advocating reorganization. Establishment of a CPA unit leads to greater satisfaction among patients, referring physicians, and medical staff.

Statistical Patterns in Children's Early Writing

ERIC Educational Resources Information Center

Pollo, Tatiana Cury; Kessler, Brett; Treiman, Rebecca

2009-01-01

Many theories of spelling development claim that before children begin to spell phonologically, their spellings are random strings of letters. We evaluated this idea by testing young children (mean age = 4 years 9 months) in Brazil and the United States and selecting a group of prephonological spellers. The spellings of this prephonological group…

24 CFR 891.635 - Security deposits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Security deposits. 891.635 Section... Assistance § 891.635 Security deposits. The general requirements for security deposits on assisted units are... a security deposit equal to one month's rent payable by the family. (b) The Borrower shall maintain...

Faculty Perceptions of Strategic Visioning.

ERIC Educational Resources Information Center

Marcus, Laurence R.; Smith, Richard

This report presents an examination of the use of a participative model in the strategic planning process at a publicly-supported, comprehensive institution in the middle Atlantic region of the United States. Specific attention is given to the process of developing the vision statement, an undertaking of approximately 15 months preceding Board of…

World Peace News. Volume 2, Number 6.

ERIC Educational Resources Information Center

1971

The purpose of this independent monthly newsletter is to report what universities, non-governmental organizations, governmental agencies, the United Nations, religious groups, and concerned individuals do and think about peace and the development of enforceable world law. Main articles in this issue are on the following: 1) pollution as a…

International Comparisons of Educational Attainment. Indicator of the Month.

ERIC Educational Resources Information Center

National Center for Education Statistics (ED), Washington, DC.

Information from the International Indicators Project of the Organization for Economic Co-operation and Development, Center for Educational Research and Innovation is used to compare completion rates of secondary and higher education in the United States with those of other highly industrialized countries, namely, Canada, France, Germany, Italy,…

Monitoring the World Health Organization Global Target 2025 for Exclusive Breastfeeding: Experience From the United States.

PubMed

Gupta, Priya M; Perrine, Cria G; Chen, Jian; Elam-Evans, Laurie D; Flores-Ayala, Rafael

2017-08-01

Exclusive breastfeeding under 6 months, calculated from a single 24-hour recall among mothers of children 0 to 5 months of age, is a World Health Organization (WHO) indicator used to monitor progress on the 2025 global breastfeeding target. Many upper-middle-income and high-income countries, including the United States, do not have estimates for this indicator. Research aim: To describe the prevalence of exclusive breastfeeding under 6 months in the United States. We used a single 24-hour dietary recall from the National Health and Nutrition Examination Survey 2009-2012 to calculate the prevalence of exclusive breastfeeding under 6 months. We discuss our results in the context of routine breastfeeding surveillance, which is reported from a national survey with different methodology. Among children younger than 6 months, 24.4%, 95% confidence interval [17.6, 31.1], were exclusively breastfed the previous day. To our knowledge, this is the first estimate of the WHO indicator of exclusive breastfeeding under 6 months for the United States. This study supports the global surveillance and data strategy for reporting to the WHO on the 2025 target for exclusive breastfeeding.

Effectiveness of Part C Early Intervention Physical, Occupational, and Speech Therapy Services for Preterm or Low Birth Weight Infants in Wisconsin, United States

PubMed Central

McManus, Beth M.; Carle, Adam C.; Poehlmann, Julie

2013-01-01

Objective To determine the effectiveness of policy-driven therapy (ie, Part C early intervention [EI]) in the context of varying maternal supports among preterm infants in Wisconsin. Methods A longitudinal study of mother–infant dyads recruited from 3 newborn intensive care units in southeastern Wisconsin. Participation in EI-based therapy was collected at 36 months via parent-report. Cognitive function was measured at 16 months by use of the Bayley Scales of Infant Development (Mental Developmental Index), 2nd edition and at 24 and 36 months postterm via use of the Stanford-Binet Intelligence scale, 5th edition. Maternal support was measured at 4 months with the Maternal Support Scale. Propensity score matching was used to reduce selection bias. Latent growth models of matched pairs estimated the effect of EI therapy on cognitive function trajectories. Ordinary least squares regression estimated the differential effect of EI therapy on cognitive function at 16, 24, and 36 months postterm for mothers reporting more maternal supports. Results Of the 128 infants, 41 received EI therapy and, of those, 32 (78%) were successfully matched with controls. The results of the matched analysis (n = 64) reveal that 1) receipt of therapy is inversely associated with cognitive function baseline (P = .04) and positively associated with trajectories (P =.03), 2) the number of maternal supports is positively associated with cognitive function for families receiving Part C early intervention, at 16 months (P = .05), 24 months (P <.01), and 36 months (P = .05) postterm. Conclusions Participation in EI therapy may be associated with more optimal cognitive function trajectories. Among preterm children whose mothers have more supports, receiving therapy appears particularly beneficial. PMID:22230187

MOBILE-izing Adolescent Sexual and Reproductive Health Care: A Pilot Study Using a Mobile Health Unit in Chicago.

PubMed

Stefansson, Lilja S; Webb, M Elizabeth; Hebert, Luciana E; Masinter, Lisa; Gilliam, Melissa L

2018-03-01

Adolescents experience numerous barriers to obtaining sexual and reproductive health care (SRHC). Mobile Health Units (MHUs) can remove some barriers by traveling to the community. This pilot study developed Mobile SRHC through an iterative process on an existing MHU and evaluated it among adolescents and providers. Mobile SRHC was developed through a mixed-method, multiphase study. Three key informant interviews with MHU providers, an adolescent needs assessment survey, and a Youth Model Development Session informed model development. Emergency contraception (EC), oral contraceptive pills (OCPs), and depot-medroxyprogesterone acetate (DMPA) were sequentially incorporated into MHU services. Administrative data assessed method distribution and surveys assessed patient satisfaction. Key informants held positive attitudes toward implementing Mobile SRHC into their practice. Needs assessment surveys (N = 103) indicated a majority was interested in learning about sexual health (66.0%) and obtaining birth control (54.4%) on an MHU. Over 3 months, 123 adolescents participated in Mobile SRHC. Seven packs and 9 prescriptions of EC, 8 3-month packs and 10 prescriptions of OCPs, and 5 injections and 5 prescriptions of DMPA were distributed. Ninety-two percent of adolescent participants reported they would recommend Mobile SRHC to friends. Mobile SRHC is a feasible approach for reproductive health care among adolescents. © 2018, American School Health Association.

Modeling Seasonality in Carbon Dioxide Emissions From Fossil Fuel Consumption

NASA Astrophysics Data System (ADS)

Gregg, J. S.; Andres, R. J.

2004-05-01

Using United States data, a method is developed to estimate the monthly consumption of solid, liquid and gaseous fossil fuels using monthly sales data to estimate the relative monthly proportions of the total annual national fossil fuel use. These proportions are then used to estimate the total monthly carbon dioxide emissions for each state. From these data, the goal is to develop mathematical models that describe the seasonal flux in consumption for each type of fuel, as well as the total emissions for the nation. The time series models have two components. First, the general long-term yearly trend is determined with regression models for the annual totals. After removing the general trend, two alternatives are considered for modeling the seasonality. The first alternative uses the mean of the monthly proportions to predict the seasonal distribution. Because the seasonal patterns are fairly consistent in the United States, this is an effective modeling technique. Such regularity, however, may not be present with data from other nations. Therefore, as a second alternative, an ordinary least squares autoregressive model is used. This model is chosen for its ability to accurately describe dependent data and for its predictive capacity. It also has a meaningful interpretation, as each coefficient in the model quantifies the dependency for each corresponding time lag. Most importantly, it is dynamic, and able to adapt to anomalies and changing patterns. The order of the autoregressive model is chosen by the Akaike Information Criterion (AIC), which minimizes the predicted variance for all models of increasing complexity. To model the monthly fuel consumption, the annual trend is combined with the seasonal model. The models for each fuel type are then summed together to predict the total carbon dioxide emissions. The prediction error is estimated with the root mean square error (RMSE) from the actual estimated emission values. Overall, the models perform very well, with relative RMSE less than 10% for all fuel types, and under 5% for the national total emissions. Development of successful models is important to better understand and predict global environmental impacts from fossil fuel consumption.

Effect of Home Visit Training Program on Growth and Development of Preterm Infants: A Double Blind Randomized Controlled Trial

PubMed Central

Edraki, Mitra; Moravej, Hossian; Rambod, Masoume

2015-01-01

Background: Home visit program can be effective in infants’ growth and development. The present study aimed to investigate the effect of home visit program on preterm infants’ growth and development within 6 months. Methods: It was a double-blind clinical trial study. The study was conducted in Hafez, Hazrat-e-Zeinab, and Namazee Hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from 2010 to 2011. Preterm infants were divided into intervention (n=30) and control groups (n=30) through blocked randomization. The intervention group received home visit training program for 6 months, while the control group only received the hospital’s routine care. Then, the infants’ growth indexes, including weight, height, and head circumference, and development criteria were compared on the first day of admission in Neonatal Intensive Care Unit, and then first, second, third, and sixth months. The data were analyzed using Chi-square, independent t-test, and repeated measures ANCOVA. Results: The mean weight of the intervention and control group infants was 7207.3±1129.74 and 6366.7±922.26 gr in the sixth month. Besides, the intervention group infants’ mean weight was higher compared to the control group after six months (t=-3.05, P=0.03). Also, a significant difference was found between the two groups regarding development indexes, such as following moving objects with the head, keeping the head stable when changing the position from lying to sitting,  producing “Agha” sound, and taking objects by hand (P<0.05) during six months of age. Conclusion: The results showed that the home visit program was effective in preterm infants’ weight gain and some development indexes at the sixth month. Considering the importance of infants’ growth and development, healthcare staff is recommended to incorporate home visit training into their programs, so that steps can be taken towards improvement of preterm infants’ health. Trial Registration Number: IRCT2014082013690N3  PMID:25553330

Effect of home visit training program on growth and development of preterm infants: a double blind randomized controlled trial.

PubMed

Edraki, Mitra; Moravej, Hossian; Rambod, Masoume

2015-01-01

Home visit program can be effective in infants' growth and development. The present study aimed to investigate the effect of home visit program on preterm infants' growth and development within 6 months. It was a double-blind clinical trial study. The study was conducted in Hafez, Hazrat-e-Zeinab, and Namazee Hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from 2010 to 2011. Preterm infants were divided into intervention (n=30) and control groups (n=30) through blocked randomization. The intervention group received home visit training program for 6 months, while the control group only received the hospital's routine care. Then, the infants' growth indexes, including weight, height, and head circumference, and development criteria were compared on the first day of admission in Neonatal Intensive Care Unit, and then first, second, third, and sixth months. The data were analyzed using Chi-square, independent t-test, and repeated measures ANCOVA. The mean weight of the intervention and control group infants was 7207.3±1129.74 and 6366.7±922.26 gr in the sixth month. Besides, the intervention group infants' mean weight was higher compared to the control group after six months (t=-3.05, P=0.03). Also, a significant difference was found between the two groups regarding development indexes, such as following moving objects with the head, keeping the head stable when changing the position from lying to sitting,  producing "Agha" sound, and taking objects by hand (P<0.05) during six months of age. The results showed that the home visit program was effective in preterm infants' weight gain and some development indexes at the sixth month. Considering the importance of infants' growth and development, healthcare staff is recommended to incorporate home visit training into their programs, so that steps can be taken towards improvement of preterm infants' health. IRCT2014082013690N3 

Demands on Finite Cognitive Capacity Cause Infants' Perseverative Errors

ERIC Educational Resources Information Center

Berger, Sarah E.

2004-01-01

This research unites traditionally disparate developmental domains--cognition and locomotion--to examine the classic cognitive issue of the development of inhibition in infancy. In 2 locomotor A-not-B tasks, 13-month-old walking infants inhibited a prepotent response under low task demands (walking on flat ground), but perseverated under increased…

Cross-Cultural Experience in Preservice Teacher Education

ERIC Educational Resources Information Center

Sahin, Mehmet

2008-01-01

The study investigated the effect of international student teaching experience on the professional and personal development of preservice teachers. Within the framework of their internship program, 26 graduate students in a private university in Turkey had a two-month internship in a mid western state in the United States, the main component of…

Discourse Formulation in Children with Closed Head Injury

ERIC Educational Resources Information Center

Hay, Emma; Moran, Catherine

2005-01-01

In this study, narrative and expository discourse-retelling abilities were compared in 9 children with closed head injury (CHI) age 9;5-15;3 (years;months) and 9 typically developing age-matched peers. Narrative and expository retellings were analyzed according to language variables (i.e., number of words, number of T-units, and sentential…

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

Law and Entrepreneurship Education: A Proposed Model for Curriculum Development

ERIC Educational Resources Information Center

Gordon, Jason; Bursuc, Vlad

2018-01-01

Entrepreneurship can be understood as "the introduction of new economic activity that leads to change in the marketplace." The effect of new firms on economic activity is notable, as firms formed within the previous twelve months generally employ more than three million individuals within the United States. As such, entrepreneurship…

Creating Multimedia Courseware for ESP.

ERIC Educational Resources Information Center

Goertzen, Philip; Howard, Ron

1995-01-01

This report details the development of computer software to teach English-as-a-Second-Language skills for medical diagnosis. Design of a prototype unit of multimedia materials using a common authoring tool required about 300 hours of work over a period of 9 months. The report describes the overall design of the courseware, hardware used, stages of…

Air quality climate in the Columbia River Basin.

Treesearch

Sue A. Ferguson

1998-01-01

Aspects of climate that influence air quality in the Columbia River basin of the Northwestern United States are described. A few, relatively simple, analytical tools were developed to show the spatial and temporal patterns of mean-monthly mixing heights, precipitation scavenging, upper level and surface trajectory winds, and drought that inhibit pollution uptake. Also...

Community Colleges Take on Global Challenges

ERIC Educational Resources Information Center

McMurtrie, Beth

2008-01-01

Community colleges in the United States are increasingly seen as a model by developing countries looking to train a skilled work force, even as the institutions wrestle with what it means to educate globally competent students, said speakers at the American Association of Community Colleges' annual meeting here this month. China in particular is…

Environmental history impacts on gene expression during diapause development in Megachile rotundata

USDA-ARS?s Scientific Manuscript database

The alfalfa leafcutting bee is the primary pollinator used in the production of alfalfa seed in the United States and Canada. The alfalfa leafcutting bee spends approximately 9 months of the year in a dormancy state known as diapause, which makes this the primary stage managed by bee keepers. In ord...

Infant Feeding Practices of Emirati Women in the Rapidly Developing City of Abu Dhabi, United Arab Emirates.

PubMed

Gardner, Hazel; Green, Katherine; Gardner, Andrew

2015-09-02

Rapid economic and cultural transition in the United Arab Emirates (UAE) has been accompanied by new challenges to public health; most notably a rapid rise in chronic disease. Breastfeeding is known to improve health outcomes in adulthood, is associated with reduced risk of developing chronic disease, and is therefore an important public health issue for this rapidly increasing population. Factors associated with infant feeding practices were examined in a cohort of 125 Emirati women and their infants, with data collected at birth and 3, 6 and 15 months postpartum by questionnaires and interviews. Participants were recruited in the Corniche Hospital, the main maternity hospital in the city of Abu Dhabi. Factors affecting the duration of breastfeeding and the introduction of complementary foods were investigated using univariate and multivariate statistics. Recommended infant feeding practices, such as exclusive breastfeeding for the first six months of life and timely introduction of appropriate complementary foods, were poorly adhered to. Factors implicated in early cessation of breastfeeding included: time to first breastfeed, mother's education level, employment status and early introduction of complementary foods.

Infant Feeding Practices of Emirati Women in the Rapidly Developing City of Abu Dhabi, United Arab Emirates

PubMed Central

Gardner, Hazel; Green, Katherine; Gardner, Andrew

2015-01-01

Rapid economic and cultural transition in the United Arab Emirates (UAE) has been accompanied by new challenges to public health; most notably a rapid rise in chronic disease. Breastfeeding is known to improve health outcomes in adulthood, is associated with reduced risk of developing chronic disease, and is therefore an important public health issue for this rapidly increasing population. Factors associated with infant feeding practices were examined in a cohort of 125 Emirati women and their infants, with data collected at birth and 3, 6 and 15 months postpartum by questionnaires and interviews. Participants were recruited in the Corniche Hospital, the main maternity hospital in the city of Abu Dhabi. Factors affecting the duration of breastfeeding and the introduction of complementary foods were investigated using univariate and multivariate statistics. Recommended infant feeding practices, such as exclusive breastfeeding for the first six months of life and timely introduction of appropriate complementary foods, were poorly adhered to. Factors implicated in early cessation of breastfeeding included: time to first breastfeed, mother’s education level, employment status and early introduction of complementary foods. PMID:26404348

20 CFR 404.462 - Nonpayment of hospital and medical insurance benefits of alien outside United States for more...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Nonpayment of hospital and medical insurance benefits of alien outside United States for more than 6 months. 404.462 Section 404.462 Employees' Benefits... alien outside United States for more than 6 months. No payments may be made under part A (hospital...

Pre-Intensive Care Unit Cognitive Status, Subsequent Disability, and New Nursing Home Admission among Critically Ill Older Adults.

PubMed

Ferrante, Lauren E; Murphy, Terrence E; Gahbauer, Evelyne A; Leo-Summers, Linda S; Pisani, Margaret A; Gill, Thomas M

2018-05-01

Cognitive impairment is common among older adults, yet little is known about the association of pre-intensive care unit cognitive status with outcomes relevant to older adults maintaining independence after a critical illness. To evaluate whether pre-intensive care unit cognitive status is associated with post-intensive care unit disability, new nursing home admission, and mortality after a critical illness among older adults. In this prospective cohort study, 754 persons aged 70 years or more were monitored from March 1998 to December 2013 with monthly assessments of disability. Cognitive status was assessed every 18 months, using the Mini-Mental State Examination (range, 0-30), with scores classified as 28 or higher (cognitively intact), 24-27 (minimal impairment), and less than 24 (moderate impairment). The primary outcome was disability count (range, 0-13), assessed monthly over 6 months after an intensive care unit stay. The secondary outcomes were incident nursing home admission and time to death after intensive care unit admission. The analytic sample included 391 intensive care unit admissions. The mean age was 83.5 years. The prevalence of moderate impairment, minimal impairment, and intact cognition (the comparison group) was 17.3, 46.2, and 36.5%, respectively. In the multivariable analysis, moderate impairment was associated with nearly a 20% increase in disability over the 6-month follow-up period (adjusted relative risk, 1.19; 95% confidence interval, 1.04-1.36), and minimal impairment was associated with a 16% increase in post-intensive care unit disability (adjusted relative risk, 1.16; 95% confidence interval, 1.02-1.32). Moderate impairment was associated with more than double the likelihood of a new nursing home admission (adjusted odds ratio, 2.37; 95% confidence interval, 1.01-5.55). Survival differed significantly across the three cognitive groups (log-rank P = 0.002), but neither moderate impairment (adjusted hazard ratio, 1.19; 95% confidence interval, 0.65-2.19) nor minimal impairment (adjusted hazard ratio, 1.00; 95% confidence interval, 0.61-1.62) was significantly associated with mortality in the multivariable analysis. Among older adults, any impairment (even minimal) in pre-intensive care unit cognitive status was associated with an increase in post-intensive care unit disability over the 6 months after a critical illness; moderate cognitive impairment doubled the likelihood of a new nursing home admission. Pre-intensive care unit cognitive impairment was not associated with mortality from intensive care unit admission through 6 months of follow-up. Pre-intensive care unit cognitive status may provide prognostic information about the likelihood of older adults maintaining independence after a critical illness.

Parameter regionalization of a monthly water balance model for the conterminous United States

NASA Astrophysics Data System (ADS)

Bock, A. R.; Hay, L. E.; McCabe, G. J.; Markstrom, S. L.; Atkinson, R. D.

2015-09-01

A parameter regionalization scheme to transfer parameter values and model uncertainty information from gaged to ungaged areas for a monthly water balance model (MWBM) was developed and tested for the conterminous United States (CONUS). The Fourier Amplitude Sensitivity Test, a global-sensitivity algorithm, was implemented on a MWBM to generate parameter sensitivities on a set of 109 951 hydrologic response units (HRUs) across the CONUS. The HRUs were grouped into 110 calibration regions based on similar parameter sensitivities. Subsequently, measured runoff from 1575 streamgages within the calibration regions were used to calibrate the MWBM parameters to produce parameter sets for each calibration region. Measured and simulated runoff at the 1575 streamgages showed good correspondence for the majority of the CONUS, with a median computed Nash-Sutcliffe Efficiency coefficient of 0.76 over all streamgages. These methods maximize the use of available runoff information, resulting in a calibrated CONUS-wide application of the MWBM suitable for providing estimates of water availability at the HRU resolution for both gaged and ungaged areas of the CONUS.

Group cohesion and nurse satisfaction: examination of a team-building approach.

PubMed

DiMeglio, Karen; Padula, Cynthia; Piatek, Carolyn; Korber, Susan; Barrett, Ann; Ducharme, Maria; Lucas, Sandra; Piermont, Nicole; Joyal, Elaine; DeNicola, Virginia; Corry, Karen

2005-03-01

The purpose of this study was to determine the impact of a team-building intervention on group cohesion, nurse satisfaction, and turnover rates. Creating an environment that supports and retains nurses represents a formidable challenge for nursing leaders. Research related to strategies that positively impact the culture in which nurses practice, thus potentially improving nurse satisfaction and reducing turnover, is critically needed. Registered nurses (RNs) employed on inpatient units in a 247-bed, private acute care Magnet teaching hospital participated in this quasi experimental preintervention and postintervention design. The RN-RN interaction subscale from the National Database of Nursing Quality Indicators Adapted Index of Work Satisfaction, the National Database of Nursing Quality Indicators Adapted Index of Job Enjoyment, the Group Cohesion Scale, and a facilitator-developed measure were completed preimplementation and postimplementation of unit-tailored intervention strategies, which took place over a 12-month period. Turnover rates were collected 6 month preintervention and postintervention. Improvement in group cohesion, RN-RN interaction, job enjoyment, and turnover was demonstrated. Targeted, unit-based strategies can be an effective means of reducing turnover rates and improving group cohesion and nurse satisfaction.

Evaluation of abnormal radiological findings in children aged 2 to 36 months followed by recurrent urinary tract infection: a retrospective study.

PubMed

Ozen, Cinar; Ertan, Pelin; Aras, Feray; Gumuser, Gul; Ozkol, Mine; Horasan Dinc, Gonul

2017-11-01

Our aim is to determine the rational usage of imaging techniques in order to prevent or minimize permanent renal damage in recurrent urinary tract infections (UTIs). This study was enrolled children aged between 2 and 36 months, following-up with the diagnosis of recurrent UTI. All children had ultrasonography (USG) and dimercaptosuccinic acid scanning, 39 of them had underwent on voiding cystourethrography. There were 133 children (87 girls, 46 boys) with the mean age of 32.82 ± 38.10 months included into the study. Forty-three kidney units were normal in ultrasonogram of which seven units had reflux whereas among 35 units with hydronephrosis 22 units had reflux. Sensitivity and specificity presence of hydronephrosis in ultrasonogram for prediction of reflux was 75.9% and 73.5%, respectively. There were 19 dilated ureters in ultrasonogram, and among them 14 had reflux. Sensitivity and specificity of presence with ureteral dilatation in ultrasonogram for prediction of reflux was found as 48.3% and 89.8%, respectively. The sensitivity of parenchymal thinning seen in ultrasonogram for the evaluation of renal parenchyma was 15.9%, whereas specificity was 98.2% .Sensitivity and specificity of dimercaptosuccinic acid for prediction of reflux was 51.6% and 72.3%, respectively. The normal ultrasonogram findings cannot rule out neither possibility of reflux presence nor development of renal scarring. Therefore, DMSA scanning has major role both in determination of parenchymal damage and prevention of scarring. Also we get an important result as ureteral dilatation seen in USG, related to presence of reflux.

Estimating the urban bias of surface shelter temperatures using upper-air and satellite data. Part 1: Development of models predicting surface shelter temperatures

NASA Technical Reports Server (NTRS)

Epperson, David L.; Davis, Jerry M.; Bloomfield, Peter; Karl, Thomas R.; Mcnab, Alan L.; Gallo, Kevin P.

1995-01-01

Multiple regression techniques were used to predict surface shelter temperatures based on the time period 1986-89 using upper-air data from the European Centre for Medium-Range Weather Forecasts (ECMWF) to represent the background climate and site-specific data to represent the local landscape. Global monthly mean temperature models were developed using data from over 5000 stations available in the Global Historical Climate Network (GHCN). Monthly maximum, mean, and minimum temperature models for the United States were also developed using data from over 1000 stations available in the U.S. Cooperative (COOP) Network and comparative monthly mean temperature models were developed using over 1150 U.S. stations in the GHCN. Three-, six-, and full-variable models were developed for comparative purposes. Inferences about the variables selected for the various models were easier for the GHCN models, which displayed month-to-month consistency in which variables were selected, than for the COOP models, which were assigned a different list of variables for nearly every month. These and other results suggest that global calibration is preferred because data from the global spectrum of physical processes that control surface temperatures are incorporated in a global model. All of the models that were developed in this study validated relatively well, especially the global models. Recalibration of the models with validation data resulted in only slightly poorer regression statistics, indicating that the calibration list of variables was valid. Predictions using data from the validation dataset in the calibrated equation were better for the GHCN models, and the globally calibrated GHCN models generally provided better U.S. predictions than the U.S.-calibrated COOP models. Overall, the GHCN and COOP models explained approximately 64%-95% of the total variance of surface shelter temperatures, depending on the month and the number of model variables. In addition, root-mean-square errors (rmse's) were over 3 C for GHCN models and over 2 C for COOP models for winter months, and near 2 C for GHCN models and near 1.5 C for COOP models for summer months.

A trial of sugar-free or sugar-sweetened beverages and body weight in children.

PubMed

de Ruyter, Janne C; Olthof, Margreet R; Seidell, Jacob C; Katan, Martijn B

2012-10-11

The consumption of beverages that contain sugar is associated with overweight, possibly because liquid sugars do not lead to a sense of satiety, so the consumption of other foods is not reduced. However, data are lacking to show that the replacement of sugar-containing beverages with noncaloric beverages diminishes weight gain. We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age. Participants were randomly assigned to receive 250 ml (8 oz) per day of a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage that provided 104 kcal (sugar group). Beverages were distributed through schools. At 18 months, 26% of the children had stopped consuming the beverages; the data from children who did not complete the study were imputed. The z score for the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) increased on average by 0.02 SD units in the sugar-free group and by 0.15 SD units in the sugar group; the 95% confidence interval (CI) of the difference was -0.21 to -0.05. Weight increased by 6.35 kg in the sugar-free group as compared with 7.37 kg in the sugar group (95% CI for the difference, -1.54 to -0.48). The skinfold-thickness measurements, waist-to-height ratio, and fat mass also increased significantly less in the sugar-free group. Adverse events were minor. When we combined measurements at 18 months in 136 children who had discontinued the study with those in 477 children who completed the study, the BMI z score increased by 0.06 SD units in the sugar-free group and by 0.12 SD units in the sugar group (P=0.06). Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children. (Funded by the Netherlands Organization for Health Research and Development and others; DRINK ClinicalTrials.gov number, NCT00893529.).

Calcar bone graft

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

Bargar, W.L.; Paul, H.A.; Merritt, K.

1986-01-01

A canine model was developed to investigate the use of an autogeneic iliac bone graft to treat the calcar deficiency commonly found at the time of revision surgery for femoral component loosening. Five large male mixed-breed dogs had bilateral total hip arthroplasty staged at three-month intervals, and were sacrificed at six months. Prior to cementing the femoral component, an experimental calcar defect was made, and a bicortical iliac bone graft was fashioned to fill the defect. Serial roentgenograms showed the grafts had united with no resorption. Technetium-99 bone scans showed more uptake at three months than at six months inmore » the graft region. Disulfine blue injection indicated all grafts were perfused at both three and six months. Thin section histology, fluorochromes, and microradiographs confirmed graft viability in all dogs. Semiquantitative grading of the fluorochromes indicated new bone deposition in 20%-50% of each graft at three months and 50%-80% at six months. Although the calcar bone graft was uniformly successful in this canine study, the clinical application of this technique should be evaluated by long-term results in humans.« less

Insights into software development in Japan

NASA Technical Reports Server (NTRS)

Duvall, Lorraine M.

1992-01-01

The interdependence of the U.S.-Japanese economies makes it imperative that we in the United States understand how business and technology developments take place in Japan. We can gain insight into these developments in software engineering by studying the context in which Japanese software is developed, the practices that are used, the problems encountered, the setting surrounding these problems, and the resolution of these problems. Context includes the technological and sociological characteristics of the software development environment, the software processes applied, personnel involved in the development process, and the corporate and social culture surrounding the development. Presented in this paper is a summary of results of a study that addresses these issues. Data for this study was collected during a three month visit to Japan where the author interviewed 20 software managers representing nine companies involved in developing software in Japan. These data are compared to similar data from the United States in which 12 managers from five companies were interviewed.

African American Adolescent Mothers' Early Caregiving Involvement and Childrens' Behavior and Academic Performance at Age 7

ERIC Educational Resources Information Center

Oberlander, Sarah E.; Black, Maureen M.

2011-01-01

The United States continues to have the highest incidence of adolescent births among industrialized nations. This study used transactional and life span theories of development to examine whether caregiving patterns assessed over the first 24 months postpartum predicted children's behavior and academic achievement at 7 years. Participants included…

Strengthening Education in the Muslim World. Summary of the Desk Study. Issue Paper.

ERIC Educational Resources Information Center

Benoliel, Sharon

This issue paper, one in a series that United States Agency for International Development (USAID) produces, provides analytical input to policy makers and practitioners on ways to address the pressing educational challenges in the Muslim world. The paper summarizes the findings and guidance contained in a full report of a three month desk study…

A New Sand-Culture Apparatus for Tree Nutrition Research

Treesearch

B. G. Blackmon; N. E. Linnartz

1970-01-01

Research in tree nutrition often necessitates the use of rather large-scale installations of sand-culture equipment. The apparatus described below was developed during the course of experiments at Louisiana State University and provided daily irrigation to 102 culture units of loblolly pine (Pinus taeda L.) for a period of 10 months. This apparatus is a modification of...

Classes within a Class: The Discourses of Race, Ethnicity, Gender, and Socioeconomic Status in a Preschool Classroom

ERIC Educational Resources Information Center

Maldonado, Camilo, III

2013-01-01

Over the course of 12 months, I conducted an ethnographic study in an urban preschool classroom in the northeastern Unites States. Employing a sociocultural perspective of early childhood development, I investigated the various social and academic discourses related to race and ethnicity, gender, and socioeconomic status (SES) presented in a…

Statistical Clustering and the Contents of the Infant Vocabulary

ERIC Educational Resources Information Center

Swingley, Daniel

2005-01-01

Infants parse speech into word-sized units according to biases that develop in the first year. One bias, present before the age of 7 months, is to cluster syllables that tend to co-occur. The present computational research demonstrates that this statistical clustering bias could lead to the extraction of speech sequences that are actual words,…

A survey of the administration of drugs to young infants. The Alspac Survey Team. Avon Longitudinal Study of Pregnancy and Childhood.

PubMed Central

Hawkins, N; Golding, J

1995-01-01

Medication which is given to young infants during the first months of life, an important period of development, may have effects on development which would not be observed in adults receiving the same drugs. The aim of this study was to estimate the numbers of children receiving various types of medication, including both prescription and non-prescription drugs, during the first 6 months of life. Self-completion questionnaires were posted to mothers participating in the Avon Longitudinal Study of Pregnancy & Childhood (ALSPAC) when their children were 6 months of age. These questionnaires included enquiries about the administration of drugs to the study children. The study was based in the three Bristol-based health districts of Avon in the United Kingdom. The study population comprised of 6973 children born in the 12 month period between the 1st July 1991 and the 30th June 1992. The majority of mothers, 96%, reported that their children had received medication, excluding vaccines, during the first 6 months of life. 35% had been given drugs from four or more different classes. Paracetamol had been given to 84% of the children, antibiotics to 30%. In view of potential effects of drug exposure on long term development, it is important that drugs which are administered to children are carefully assessed to ensure that they are not harmful. PMID:8527273

Association of food security status with overweight and dietary intake: exploration of White British and Pakistani-origin families in the Born in Bradford cohort.

PubMed

Yang, T C; Sahota, P; Pickett, K E; Bryant, M

2018-04-24

Food insecurity has been associated with dietary intake and weight status in UK adults and children although results have been mixed and ethnicity has not been explored. We aimed to compare prevalence and trajectories of weight and dietary intakes among food secure and insecure White British and Pakistani-origin families. At 12 months postpartum, mothers in the Born in Bradford cohort completed a questionnaire on food security status and a food frequency questionnaire (FFQ) assessing their child's intake in the previous month; at 18 months postpartum, mothers completed a short-form FFQ assessing dietary intake in the previous 12 months. Weights and heights of mothers and infants were assessed at 12-, 24-, and 36-months postpartum, with an additional measurement of children taken at 4-5 years. Associations between food security status and dietary intakes were assessed using Wilcoxon-Mann-Whitney for continuous variables and χ 2 or Fisher's exact tests for categorical variables. Quantile and logistic regression were used to determine dietary intakes adjusting for mother's age. Linear mixed effects models were used to assess longitudinal changes in body mass index (BMI) in mothers and BMI z-scores in children. At 12 months postpartum, White British mothers reported more food insecurity than Pakistani-origin mothers (11% vs 7%; p < 0.01) and more food insecure mothers were overweight. Between 12 and 36 months postpartum, BMI increased more among food insecure Pakistani-origin mothers (β = 0.77 units, [95% Confidence Interval [CI]: 0.40, 1.10]) than food secure (β = 0.44 units, 95% CI: 0.33, 0.55). This was also found in Pakistani-origin children (BMI z-score: food insecure β = 0.40 units, 95% CI: 0.22, 0.59; food secure β = 0.25 units, 95% CI: 0.20, 0.29). No significant increases in BMI were observed for food secure or insecure White British mothers while BMI z-score increased by 0.17 (95% CI: 0.13, 0.21) for food secure White British children. Food insecure mothers and children had dietary intakes of poorer quality, with fewer vegetables and higher consumption of sugar-sweetened drinks. Food security status is associated with body weight and dietary intakes differentially by ethnicity. These are important considerations for developing targeted interventions.

Parent Grief 1–13 Months After Death in Neonatal and Pediatric Intensive Care Units

PubMed Central

Youngblut, JoAnne M.; Brooten, Dorothy; Glaze, Joy; Promise, Teresita; Yoo, Changwon

2016-01-01

Objective Describe changes in mothers’ and fathers’ grief from 1 to 13 months after infant/child neonatal/pediatric intensive care unit death and identify factors related to their grief. Methods Mothers (n = 130) and fathers (n = 52) of 140 children (newborn-18 years) completed the Hogan Grief Reaction Checklist at 1, 3, 6, and 13 months post-death. Results Grief decreased from 3 to 13 months for mothers and from 3 to 6 months for fathers. Grief was more intense for: mothers of deceased adolescents and mothers whose child was declared brain dead. Conclusion Mothers’ and fathers’ grief intensity may not coincide, resulting in different needs during the 13 months after infant/child death. PMID:28239302

Improving groundwater predictions utilizing seasonal precipitation forecasts from general circulation models forced with sea surface temperature forecasts

USGS Publications Warehouse

Almanaseer, Naser; Sankarasubramanian, A.; Bales, Jerad

2014-01-01

Recent studies have found a significant association between climatic variability and basin hydroclimatology, particularly groundwater levels, over the southeast United States. The research reported in this paper evaluates the potential in developing 6-month-ahead groundwater-level forecasts based on the precipitation forecasts from ECHAM 4.5 General Circulation Model Forced with Sea Surface Temperature forecasts. Ten groundwater wells and nine streamgauges from the USGS Groundwater Climate Response Network and Hydro-Climatic Data Network were selected to represent groundwater and surface water flows, respectively, having minimal anthropogenic influences within the Flint River Basin in Georgia, United States. The writers employ two low-dimensional models [principle component regression (PCR) and canonical correlation analysis (CCA)] for predicting groundwater and streamflow at both seasonal and monthly timescales. Three modeling schemes are considered at the beginning of January to predict winter (January, February, and March) and spring (April, May, and June) streamflow and groundwater for the selected sites within the Flint River Basin. The first scheme (model 1) is a null model and is developed using PCR for every streamflow and groundwater site using previous 3-month observations (October, November, and December) available at that particular site as predictors. Modeling schemes 2 and 3 are developed using PCR and CCA, respectively, to evaluate the role of precipitation forecasts in improving monthly and seasonal groundwater predictions. Modeling scheme 3, which employs a CCA approach, is developed for each site by considering observed groundwater levels from nearby sites as predictands. The performance of these three schemes is evaluated using two metrics (correlation coefficient and relative RMS error) by developing groundwater-level forecasts based on leave-five-out cross-validation. Results from the research reported in this paper show that using precipitation forecasts in climate models improves the ability to predict the interannual variability of winter and spring streamflow and groundwater levels over the basin. However, significant conditional bias exists in all the three modeling schemes, which indicates the need to consider improved modeling schemes as well as the availability of longer time-series of observed hydroclimatic information over the basin.

TRMM-3B43 Bias Correction over the High Elevations of the Contiguous United States

NASA Astrophysics Data System (ADS)

Hashemi, H.; Nordin, K. M.; Lakshmi, V.; Knight, R. J.

2016-12-01

Precipitation can be quantified using a rain gauge network, or a remotely sensed precipitation product. Ultimately, the choice of dataset depends on the particular application, the catchment size, climate and the time period of study. In a region with a long record and a dense rain gauge network, the elevation-modified ground-based precipitation product, PRISM, has been found to work well. However, in poorly gauged regions the use of remotely sensed precipitation products is an absolute necessity. The Tropical Rainfall Measuring Mission (TRMM) has provided valuable precipitation datasets for hydrometeorological studies over the past two decades (1998-2015). One concern regarding the usage of TRMM data is the accuracy of the precipitation estimates, when compared to those obtained using PRISM. The reason for this concern is that TRMM and PRISM do not always agree and, typically, TRMM underestimates PRISM over the mountainous regions of the United States. In this study, we develop a correction function to improve the accuracy of the TRMM monthly product (TRMM-3B43) by estimating and removing the bias in the satellite data using the ground-based precipitation product, PRISM. We observe a strong relationship between the bias and land surface elevation; TRMM-3B43 tends to underestimate the PRISM product at altitudes greater than 1500 m above mean sea level (m.amsl) in the contiguous United States. A relationship is developed between TRMM-PRISM bias and elevation. The correction function is used to adjust the TRMM monthly precipitation using PRISM and elevation data. The model is calibrated using 25% of the available time period and the remaining 75% of the time period is used for validation. The corrected TRMM-3B43 product is verified for the high elevations over the contiguous United States and two local regions in the mountainous areas of the western United States. The results show a significant improvement in the accuracy of the TRMM product in the high elevations of the contiguous United States.

Declining estimates of infertility in the United States: 1982-2002.

PubMed

Stephen, Elizabeth Hervey; Chandra, Anjani

2006-09-01

To determine if the decline in infertility has been uniform across subgroups. Periodic data from the National Fertility Survey and the National Survey of Family Growth were used to determine which factors contributed to the decline in 12-month infertility in the United States. National Survey of Family Growth, a periodic US nationally representative study. A nationally representative sample of married women aged 15-44 years, N = 15,303 for pooled data across 4 survey years. None. Estimates of infertility prevalence among married women aged 15-44 years. The decline in 12-month infertility in the United States from 8.5% in 1982 and 7.4% in 2002 was significant. This decline was evident in nearly all subgroups of married women. In the multivariate analysis, 12-month infertility was more likely among women who were older and nulliparous, were non-Hispanic black or Hispanic, and did not have a college degree. The decline in 12-month infertility was observed even after controlling for the compositional differences of the population over time. Among married women in the United States, there has been a significant decline in 12-month infertility, which cannot be explained by changes in the composition of the population from 1982-2002.

The Development of Health for Hearts United: A Longitudinal Church-based Intervention to Reduce Cardiovascular Risk in Mid-life and Older African Americans

PubMed Central

Ralston, Penny A.; Young-Clark, Iris; Coccia, Catherine

2017-01-01

This article describes Health for Hearts United, a longitudinal church-based intervention to reduce cardiovascular disease (CVD) risk in mid-life and older African Americans. Using community-based participatory research (CBPR) approaches and undergirded by both the Socio-ecological Theory and the Transtheoretical Model of Behavior Change, the 18-month intervention was developed in six north Florida churches, randomly assigned as treatment or comparison. The intervention was framed around three conceptual components: awareness building (individual knowledge development); clinical learning (individual and small group educational sessions); and efficacy development (recognition and sustainability). We identified three lessons learned: providing consistency in programming even during participant absences; providing structured activities to assist health ministries in sustainability; and addressing changes at the church level. Recommendations include church-based approaches that reflect multi-level CBPR and the collaborative faith model. PMID:28115818

Chronic In Vivo Stability Assessment of Carbon Fiber Microelectrode Arrays

PubMed Central

Patel, Paras R.; Zhang, Huanan; Robbins, Matthew T.; Nofar, Justin B.; Marshall, Shaun P.; Kobylarek, Michael J.; Kozai, Takashi D. Y.; Kotov, Nicholas A.; Chestek, Cynthia A.

2016-01-01

Objective Individual carbon fiber microelectrodes can record unit activity in both acute and semi-chronic (∼1 month) implants. Additionally, new methods have been developed to insert a 16 channel array of carbon fiber microelectrodes. Before assessing the in vivo long-term viability of these arrays, accelerated soak tests were carried out to determine the most stable site coating material. Next, a multi-animal, multi-month, chronic implantation study was carried out with carbon fiber microelectrode arrays and silicon electrodes. Approach Carbon fibers were first functionalized with one of two different formulations of PEDOT and subjected to accelerated aging in a heated water bath. After determining the best PEDOT formula to use, carbon fiber arrays were chronically implanted in rat motor cortex. Some rodents were also implanted with a single silicon electrode, while others received both. At the end of the study a subset of animals were perfused and the brain tissue sliced. Tissue sections were stained for astrocytes, microglia, and neurons. The local reactive responses were assessed using qualitative and quantitative methods. Main results Electrophysiology recordings showed the carbon fibers detecting unit activity for at least 3 months with average amplitudes of ∼200 μV. Histology analysis showed the carbon fiber arrays with a minimal to non-existent glial scarring response with no adverse effects on neuronal density. Silicon electrodes showed large glial scarring that impacted neuronal counts. Significance This study has validated the use of carbon fiber microelectrode arrays as a chronic neural recording technology. These electrodes have demonstrated the ability to detect single units with high amplitude over 3 months, and show the potential to record for even longer periods. In addition, the minimal reactive response should hold stable indefinitely, as any response by the immune system may reach a steady state after 12 weeks. PMID:27705958

Chronic in vivo stability assessment of carbon fiber microelectrode arrays

NASA Astrophysics Data System (ADS)

Patel, Paras R.; Zhang, Huanan; Robbins, Matthew T.; Nofar, Justin B.; Marshall, Shaun P.; Kobylarek, Michael J.; Kozai, Takashi D. Y.; Kotov, Nicholas A.; Chestek, Cynthia A.

2016-12-01

Objective. Individual carbon fiber microelectrodes can record unit activity in both acute and semi-chronic (∼1 month) implants. Additionally, new methods have been developed to insert a 16 channel array of carbon fiber microelectrodes. Before assessing the in vivo long-term viability of these arrays, accelerated soak tests were carried out to determine the most stable site coating material. Next, a multi-animal, multi-month, chronic implantation study was carried out with carbon fiber microelectrode arrays and silicon electrodes. Approach. Carbon fibers were first functionalized with one of two different formulations of PEDOT and subjected to accelerated aging in a heated water bath. After determining the best PEDOT formula to use, carbon fiber arrays were chronically implanted in rat motor cortex. Some rodents were also implanted with a single silicon electrode, while others received both. At the end of the study a subset of animals were perfused and the brain tissue sliced. Tissue sections were stained for astrocytes, microglia, and neurons. The local reactive responses were assessed using qualitative and quantitative methods. Main results. Electrophysiology recordings showed the carbon fibers detecting unit activity for at least 3 months with average amplitudes of ∼200 μV. Histology analysis showed the carbon fiber arrays with a minimal to non-existent glial scarring response with no adverse effects on neuronal density. Silicon electrodes showed large glial scarring that impacted neuronal counts. Significance. This study has validated the use of carbon fiber microelectrode arrays as a chronic neural recording technology. These electrodes have demonstrated the ability to detect single units with high amplitude over 3 months, and show the potential to record for even longer periods. In addition, the minimal reactive response should hold stable indefinitely, as any response by the immune system may reach a steady state after 12 weeks.

High-resolution Monthly Satellite Precipitation Product over the Conterminous United States

NASA Astrophysics Data System (ADS)

Hashemi, H.; Fayne, J.; Knight, R. J.; Lakshmi, V.

2017-12-01

We present a data set that enhanced the Tropical Rainfall Measuring Mission (TRMM) Multi-satellite Precipitation Analysis (TMPA) monthly product 3B43 in its accuracy and spatial resolution. For this, we developed a correction function to improve the accuracy of TRMM 3B43, spatial resolution of 25 km, by estimating and removing the bias in the satellite data using a ground-based precipitation data set. We observed a strong relationship between the bias and land surface elevation; TRMM 3B43 tends to underestimate the ground-based product at elevations above 1500 m above mean sea level (m.amsl) over the conterminous United States. A relationship was developed between satellite bias and elevation. We then resampled TRMM 3B43 to the Digital Elevation Model (DEM) data set at a spatial resolution of 30 arc second ( 1 km on the ground). The produced high-resolution satellite-based data set was corrected using the developed correction function based on the bias-elevation relationship. Assuming that each rain gauge represents an area of 1 km2, we verified our product against 9,200 rain gauges across the conterminous United States. The new product was compared with the gauges, which have 50, 60, 70, 80, 90, and 100% temporal coverage within the TRMM period of 1998 to 2015. Comparisons between the high-resolution corrected satellite-based data and gauges showed an excellent agreement. The new product captured more detail in the changes in precipitation over the mountainous region than the original TRMM 3B43.

77 FR 207 - National Mentoring Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-03

... Month, 2012 Proclamation 8769--National Stalking Awareness Month, 2012 #0; #0; #0; Presidential... National Mentoring Month, 2012 By the President of the United States of America A Proclamation Every day... Nation's youth for a bright future. During National Mentoring Month, we celebrate the contributions of...

78 FR 61805 - National Breast Cancer Awareness Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-04

... National Breast Cancer Awareness Month, 2013 By the President of the United States of America A Proclamation Every October, America stands in solidarity with those battling breast cancer and those at risk for breast cancer. This disease touches every corner of the United States--in 2013 alone, more than...

78 FR 54739 - National Childhood Obesity Awareness Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

... National Childhood Obesity Awareness Month, 2013 By the President of the United States of America A Proclamation In the United States, obesity affects millions of children and teenagers, raising their risk of... pressure. While childhood obesity remains a serious public health issue, we have made significant strides...

A Year in the Life of an Open University Student in the United Kingdom.

ERIC Educational Resources Information Center

Ismail, Nazira

1988-01-01

Describes a Ugandan student's first-year experiences at the Open University in the United Kingdom. Discusses how the University operates; comments on course texts and supplementary materials; and presents a month-by-month breakdown of university and course activities and requirements. (GEA)

Electrophysiological evidence of statistical learning of long-distance dependencies in 8-month-old preterm and full-term infants.

PubMed

Kabdebon, C; Pena, M; Buiatti, M; Dehaene-Lambertz, G

2015-09-01

Using electroencephalography, we examined 8-month-old infants' ability to discover a systematic dependency between the first and third syllables of successive words, concatenated into a monotonous speech stream, and to subsequently generalize this regularity to new items presented in isolation. Full-term and preterm infants, while exposed to the stream, displayed a significant entrainment (phase-locking) to the syllabic and word frequencies, demonstrating that they were sensitive to the word unit. The acquisition of the systematic dependency defining words was confirmed by the significantly different neural responses to rule-words and part-words subsequently presented during the test phase. Finally, we observed a correlation between syllabic entrainment during learning and the difference in phase coherence between the test conditions (rule-words vs part-words) suggesting that temporal processing of the syllable unit might be crucial in linguistic learning. No group difference was observed suggesting that non-adjacent statistical computations are already robust at 8 months, even in preterm infants, and thus develop during the first year of life, earlier than expected from behavioral studies. Copyright © 2015 Elsevier Inc. All rights reserved.

An analysis of mobile whole blood collection labor efficiency.

PubMed

Rose, William N; Dayton, Paula J; Raife, Thomas J

2011-07-01

Labor efficiency is desirable in mobile blood collection. There are few published data on labor efficiency. The variability in the labor efficiency of mobile whole blood collections was analyzed. We determined to improve our labor efficiency using lean manufacturing principles. Workflow changes in mobile collections were implemented with the goal of minimizing labor expenditures. To measure success, data on labor efficiency measured by units/hour/full-time equivalent (FTE) were collected. The labor efficiency in a 6-month period before the implementation of changes, and in months 1 to 6 and 7 to 12 after implementation was analyzed and compared. Labor efficiency in the 6-month period preceding implementation was 1.06 ± 0.4 units collected/hour/FTE. In months 1 to 6, labor efficiency declined slightly to 0.92 ± 0.4 units collected/hour/FTE (p = 0.016 vs. preimplementation). In months 7 to 12, the mean labor efficiency returned to preimplementation levels of 1.09 ±0.4 units collected/hour/FTE. Regression analysis correlating labor efficiency with total units collected per drive revealed a strong correlation (R(2) = 0.48 for the aggregate data from all three periods), indicating that nearly half of labor efficiency was associated with drive size. The lean-based changes in workflow were subjectively favored by employees and donors. The labor efficiency of our mobile whole blood drives is strongly influenced by size. Larger drives are more efficient, with diminishing returns above 40 units collected. Lean-based workflow changes were positively received by employees and donors. © 2011 American Association of Blood Banks.

Intercomparison of Downscaling Methods on Hydrological Impact for Earth System Model of NE United States

NASA Astrophysics Data System (ADS)

Yang, P.; Fekete, B. M.; Rosenzweig, B.; Lengyel, F.; Vorosmarty, C. J.

2012-12-01

Atmospheric dynamics are essential inputs to Regional-scale Earth System Models (RESMs). Variables including surface air temperature, total precipitation, solar radiation, wind speed and humidity must be downscaled from coarse-resolution, global General Circulation Models (GCMs) to the high temporal and spatial resolution required for regional modeling. However, this downscaling procedure can be challenging due to the need to correct for bias from the GCM and to capture the spatiotemporal heterogeneity of the regional dynamics. In this study, the results obtained using several downscaling techniques and observational datasets were compared for a RESM of the Northeast Corridor of the United States. Previous efforts have enhanced GCM model outputs through bias correction using novel techniques. For example, the Climate Impact Research at Potsdam Institute developed a series of bias-corrected GCMs towards the next generation climate change scenarios (Schiermeier, 2012; Moss et al., 2010). Techniques to better represent the heterogeneity of climate variables have also been improved using statistical approaches (Maurer, 2008; Abatzoglou, 2011). For this study, four downscaling approaches to transform bias-corrected HADGEM2-ES Model output (daily at .5 x .5 degree) to the 3'*3'(longitude*latitude) daily and monthly resolution required for the Northeast RESM were compared: 1) Bilinear Interpolation, 2) Daily bias-corrected spatial downscaling (D-BCSD) with Gridded Meteorological Datasets (developed by Abazoglou 2011), 3) Monthly bias-corrected spatial disaggregation (M-BCSD) with CRU(Climate Research Unit) and 4) Dynamic Downscaling based on Weather Research and Forecast (WRF) model. Spatio-temporal analysis of the variability in precipitation was conducted over the study domain. Validation of the variables of different downscaling methods against observational datasets was carried out for assessment of the downscaled climate model outputs. The effects of using the different approaches to downscale atmospheric variables (specifically air temperature and precipitation) for use as inputs to the Water Balance Model (WBMPlus, Vorosmarty et al., 1998;Wisser et al., 2008) for simulation of daily discharge and monthly stream flow in the Northeast US for a 100-year period in the 21st century were also assessed. Statistical techniques especially monthly bias-corrected spatial disaggregation (M-BCSD) showed potential advantage among other methods for the daily discharge and monthly stream flow simulation. However, Dynamic Downscaling will provide important complements to the statistical approaches tested.

Streamlining a blood center and hospital transfusion service supply chain with an informatics vendor-managed inventory solution: development, implementation, and 3-month follow-up.

PubMed

Tsang, Hamilton C; Garcia, Adam; Scott, Robert; Lancaster, David; Geary, Dianne; Nguyen, Anh-Thu; Shankar, Raina; Buchanan, Leslie; Pham, Tho D

2018-05-16

The ordering process at Stanford Health Care involved twice-daily shipments predicated upon current stock levels from the blood center to the hospital transfusion service. Manual census determination is time consuming and error prone. We aimed to enhance inventory management by developing an informatics platform to streamline the ordering process and reallocate staff productivity. The general inventory accounts for more than 50 product categories based on characteristics including component, blood type, irradiation status, and cytomegalovirus serology status. Over a 5-month calibration period, inventory levels were determined algorithmically and electronically. An in-house software program was created to determine inventory levels, optimize the electronic ordering process, and reduce labor time. A 3-month pilot period was implemented using this program. This system showed noninferiority while saving labor time. The average weekly transfused:stocked ratios for cryoprecipitate, plasma, and red blood cells, respectively, were 1.03, 1.21, and 1.48 before the pilot period, compared with 0.88, 1.17, and 1.40 during (p = 0.28). There were 27 (before) and 31 (during) average STAT units ordered per week (p = 0.86). The number of monthly wasted products due to expiration was 226 (before) and 196 (during) units, respectively (p = 0.28). An estimated 7 hours per week of technologist time was reallocated to other tasks. An in-house electronic ordering system can enhance information fidelity, reallocate and optimize valuable staff productivity, and further standardize ordering. This system showed noninferiority to the labor-intensive manual system while freeing up over 360 hours of staff time per year. © 2018 AABB.

Cross-Sectional and Longitudinal Relations among Peer-Reported Trustworthiness, Social Relationships, and Psychological Adjustment in Children and Early Adolescents from the United Kingdom and Canada

ERIC Educational Resources Information Center

Rotenberg, Ken J.; McDougall, Patricia; Boulton, Michael J.; Vaillancourt, Tracy; Fox, Claire; Hymel, Shelley

2004-01-01

Trustworthiness was examined in children and early adolescents from two countries. In Study 1,505 children in the fifth and sixth school years in the United Kingdom (mean age = 9 years 7 months) were tested across an 8-month period. In Study 2,350 sixth- through eighth-grade Canadian children and early adolescents (mean age = 12 years 11 months)…

Language Profile in Congenital Hypothyroid Children Receiving Replacement Therapy.

PubMed

Soliman, Hend; Abdel Hady, Aisha Fawzy; Abdel Hamid, Asmaa; Mahmoud, Heba

2016-01-01

The aim of this work was to evaluate receptive and expressive language skills in children with congenital hypothyroidism receiving early hormonal replacement treatment before the age of 3 months and to identify any subtle areas of weaknesses in their language development to check the necessity for future language intervention. The study was conducted on 30 hypothyroid children receiving hormonal replacement. They were subdivided into group I (5-8 years 11 months; 12 cases) and group II (9-12 years 11 months; 18 cases). All patients were subjected to a protocol of assessment applied in the Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU) and evaluation of language skills by the REAL scale. The younger group reached average Arabic language scores, while the older group showed moderate language delay. Early replacement therapy supports language development in young children. However, longitudinal and follow-up studies are required to identify difficulties presenting at older ages that may affect children in the academic settings. © 2016 S. Karger AG, Basel.

The potential of SMAP soil moisture data for analyzing droughts

NASA Astrophysics Data System (ADS)

Rajasekaran, E.; Das, N. N.; Entekhabi, D.; Yueh, S. H.

2017-12-01

Identification of the onset and the end of droughts are important for socioeconomic planning. Different datasets and tools are either available or being generated for drought analysis to recognize the status of drought. The aim of this study is to understand the potential of the SMAP soil moisture (SM) data for identification of onset, persistence and withdrawal of droughts over the Contiguous United States. We are using the SMAP-passive level 3 soil moisture observations and the United States Drought Monitor (http://droughtmonitor.unl.edu) data for understanding the relation between change in SM and drought severity. The daily observed SM data are temporally averaged to match the weekly drought monitor data and subsequently the weekly, monthly, 3 monthly and 6 monthly change in SM and drought severity were estimated. The analyses suggested that the change in SM and drought severity are correlated especially over the mid-west and west coast of USA at monthly and longer time scales. The spatial pattern of the SM change maps clearly indicated the regions that are moving between different levels of drought severity. Further, the time series of effective saturation [Se =(θ-θr)/(θs-θr)] indicated the temporal dynamics of drought conditions over California which is recovering from a long-term drought. Additional analyses are being carried out to develop statistics between drought severity and soil moisture level.

Anatrophic nephrolithotomy for removal of staghorn or branched renal calculi.

PubMed

James, R; Novick, A C; Straffon, R A; Stewart, B H

1980-02-01

Forty anatrophic nephrolithotomies were performed in 38 patients between November, 1965, and December, 1977, to remove staghorn or branched renal calculi. Thirty-six (95 per cent) of the patients' preoperative urine cultures were infected, and postoperatively 35 of the cultures (88 per cent) were sterile. Magnesium ammonium phosphate calculi were present in the majority of patients (67 per cent). In 6 patients (15 per cent) transient nephrocutaneous fistulas developed. Thirty-six of the 40 renal units (90 per cent) had improved or stable intravenous pyelograms postoperatively. The patients had been followed for an average of twenty months (four to one hundred and twelve months). In 6 patients (15 per cent) recurrent renal calculi developed, and 3 patients (8 per cent) had residual calculi during this period.

Wernicke-Korsakoff Syndrome following Small Bowel Obstruction

PubMed Central

Deb, Shoumitro; Law-Min, Richard; Fearnley, David

2002-01-01

We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention. PMID:12446948

Inter-annual and spatial variability of Hamon potential evapotranspiration model coefficients

USGS Publications Warehouse

McCabe, Gregory J.; Hay, Lauren E.; Bock, Andy; Markstrom, Steven L.; Atkinson, R. Dwight

2015-01-01

Monthly calibrated values of the Hamon PET coefficient (C) are determined for 109,951 hydrologic response units (HRUs) across the conterminous United States (U.S.). The calibrated coefficient values are determined by matching calculated mean monthly Hamon PET to mean monthly free-water surface evaporation. For most locations and months the calibrated coefficients are larger than the standard value reported by Hamon. The largest changes in the coefficients were for the late winter/early spring and fall months, whereas the smallest changes were for the summer months. Comparisons of PET computed using the standard value of C and computed using calibrated values of C indicate that for most of the conterminous U.S. PET is underestimated using the standard Hamon PET coefficient, except for the southeastern U.S.

Prophylactic Sacral Dressing for Pressure Ulcer Prevention in High-Risk Patients.

PubMed

Byrne, Jaime; Nichols, Patricia; Sroczynski, Marzena; Stelmaski, Laurie; Stetzer, Molly; Line, Cynthia; Carlin, Kristen

2016-05-01

Patients in intensive care units are likely to have limited mobility owing to hemodynamic instability and activity orders for bed rest. Bed rest is indicated because of the severity of the disease process, which often involves intubation, sedation, paralysis, surgical procedures, poor nutrition, low flow states, and poor circulation. These patients are predisposed to the development and/or the progression of pressure ulcers not only because of their underlying diseases, but also because of limited mobility and deconditioned states of health. To assess whether treating high-risk patients with a prophylactic sacral dressing decreases the incidence of unit-acquired sacral pressure ulcers. An evidence-based tool for identifying patients at high risk for pressure ulcers was used in 3 intensive care units at an urban tertiary care hospital and academic medical center. Those patients deemed at high risk had a prophylactic sacral dressing applied. Incidence rates were collected and compared for the 7 months preceding use of the dressings and for 7 months during the trial period when the dressing was used. After the sacral dressing began being used, the number of unit-acquired sacral pressure ulcers decreased by 3.4 to 7.6 per 1000 patient days depending on the unit. A prophylactic sacral dressing may help prevent unit-acquired sacral pressure ulcers. Implementation of an involved care team with heightened awareness and increased education along with a prophylactic sacral dressing in patients deemed high risk for skin breakdown are all essential for success. ©2016 American Association of Critical-Care Nurses.

Spreading a medication administration intervention organizationwide in six hospitals.

PubMed

Kliger, Julie; Singer, Sara; Hoffman, Frank; O'Neil, Edward

2012-02-01

Six hospitals from the San Francisco Bay Area participated in a 12-month quality improvement project conducted by the Integrated Nurse Leadership Program (INLP). A quality improvement intervention that focused on improving medication administration accuracy was spread from two pilot units to all inpatient units in the hospitals. INLP developed a 12-month curriculum, presented in a combination of off-site training sessions and hospital-based training and consultant-led meetings, to teach clinicians the key skills needed to drive organizationwide change. Each hospital established a nurse-led project team, as well as unit teams to address six safety processes designed to improve medication administration accuracy: compare medication to the medication administration record; keep medication labeled throughout; check two patient identifications; explain drug to patient (if applicable); chart immediately after administration; and protect process from distractions and interruptions. From baseline until one year after project completion, the six hospitals improved their medication accuracy rates, on average, from 83.4% to 98.0% in the spread units. The spread units also improved safety processes overall from 83.1% to 97.2%. During the same time, the initial pilot units also continued to improve accuracy from 94.0% to 96.8% and safety processes overall from 95.3% to 97.2%. With thoughtful planning, engaging those doing the work early and focusing on the "human side of change" along with technical knowledge of improvement methodologies, organizations can spread initiatives enterprisewide. This program required significant training of frontline workers in problem-solving skills, leading change, team management, data tracking, and communication.

Modeling physical and chemical climate of the northeastern United States for a geographic information system

Treesearch

Scott V. Ollinger; John D. Aber; Anthony C. Federer; Gary M. Lovett; Jennifer M. Ellis

1995-01-01

A model of physical and chemical climate was developed for New York and New England that can be used in a GIs for integration with ecosystem models. The variables included are monthly average maximum and minimum daily temperatures, precipitation, humidity, and solar radiation, as well as annual atmospheric deposition of sulfur and nitrogen. Equations generated from...

Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study.

PubMed

Mangino, Julie E; Peyrani, Paula; Ford, Kimbal D; Kett, Daniel H; Zervos, Marcus J; Welch, Verna L; Scerpella, Ernesto G; Ramirez, Julio A

2011-01-01

In 2005 the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) published guidelines for managing hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and healthcare-associated pneumonia (HCAP). Although recommendations were evidence based, collective guidelines had not been validated in clinical practice and did not provide specific tools for local implementation. We initiated a performance improvement project designated Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) at four academic centers in the United States. Our objectives were to develop and implement the project, and to assess compliance with quality indicators in adults admitted to intensive care units (ICUs) with HAP, VAP, or HCAP. The project was conducted in three phases over 18 consecutive months beginning 1 February 2006: 1) a three-month planning period for literature review to create the consensus pathway for managing nosocomial pneumonia in these ICUs, a data collection form, quality performance indicators, and internet-based repository; 2) a six-month implementation period for customizing ATS/IDSA guidelines into center-specific guidelines via educational forums; and 3) a nine-month post-implementation period for continuing education and data collection. Data from the first two phases were combined (pre-implementation period) and compared with data from the post-implementation period. We developed a consensus pathway based on ATS/IDSA guidelines and customized it at the local level to accommodate formulary and microbiologic considerations. We implemented multimodal educational activities to teach ICU staff about the guidelines and continued education throughout post-implementation. We registered 432 patients (pre- vs post-implementation, 274 vs 158). Diagnostic criteria for nosocomial pneumonia were more likely to be met during post-implementation (247/257 (96.1%) vs 150/151 (99.3%); P = 0.06). Similarly, empiric antibiotics were more likely to be compliant with ATS/IDSA guidelines during post-implementation (79/257 (30.7%) vs 66/151 (43.7%); P = 0.01), an effect that was sustained over quarterly intervals (P = 0.0008). Between-period differences in compliance with obtaining cultures and use of de-escalation were not statistically significant. Developing a multi-center performance improvement project to operationalize ATS/IDSA guidelines for HAP, VAP, and HCAP is feasible with local consensus pathway directives for implementation and with quality indicators for monitoring compliance with guidelines.

E-learning in Saudi Arabia: 'To E or not to E, that is the question'.

PubMed

Al-Shehri, Ali M

2010-09-01

The Kingdom of Saudi Arabia (KSA) has witnessed unprecedented growth in higher education and E-learning in recent times. In the last five years, one university and five colleges have been commissioned every month; 800 scholarships have been awarded every month for overseas study; a national center for E-learning has been established; and E-units or departments have been set-up in almost every university. E-learning has become important for discussion to quote Shakespeare 'To E or not to E that is the question.' To examine current and future developments and challenges of E-learning in KSA. A qualitative approach was used to explore views of 30 senior academicians involved in E-learning during their attendance at a two-week course on the subject. All participants considered themselves as decision makers on E-learning in their units or departments. They felt that E-learning had come to stay, but acknowledged challenges in respect of resources, organization, management, and information technology. The fast development of E-learning poses many challenges. Clear vision and strategic planning with prospective E-learners in mind are essential to make E-learning programs cost effective.

Recipient area folliculitis after follicular-unit transplantation: characterization of clinical features and analysis of associated factors.

PubMed

Bunagan, M J Kristine S; Pathomvanich, Damkerng; Laorwong, Kongkiat

2010-07-01

Postoperative recipient-area folliculitis may be a cause of less or delayed growth of transplanted hair and an obvious cause of distress to the patient. No study has been done to elaborate on its clinical features and assess possible factors that may correlate with its occurrence. To study the clinical features and possible factors that may be associated with the development of recipient-area folliculitis after follicular-unit transplantation (FUT). Retrospective analysis of 27 patients who developed folliculitis after FUT and 28 patients without such complication. Lesion onset ranged from 2 days to 6 months after FUT (mean 1.44 months). Lesions were mostly pustules that resolved without sequela. Statistical analysis showed that, in terms of patient characteristics (e.g., hair features, scalp condition) and the number of grafts transplanted, there was no statistically significant difference in assessed parameters between those with and without folliculitis (p<.05). Main clinical features of postoperative folliculitis consist mostly of few to moderate self-limited pustules. In this study, regardless of management, lesions healed without scarring and without affecting graft growth. Neither patient characteristics nor number of grafts transplanted was associated with this complication.

Rapid Crop Cover Mapping for the Conterminous United States.

PubMed

Dahal, Devendra; Wylie, Bruce; Howard, Danny

2018-06-05

Timely crop cover maps with sufficient resolution are important components to various environmental planning and research applications. Through the modification and use of a previously developed crop classification model (CCM), which was originally developed to generate historical annual crop cover maps, we hypothesized that such crop cover maps could be generated rapidly during the growing season. Through a process of incrementally removing weekly and monthly independent variables from the CCM and implementing a 'two model mapping' approach, we found it viable to generate conterminous United States-wide rapid crop cover maps at a resolution of 250 m for the current year by the month of September. In this approach, we divided the CCM model into one 'crop type model' to handle the classification of nine specific crops and a second, binary model to classify the presence or absence of 'other' crops. Under the two model mapping approach, the training errors were 0.8% and 1.5% for the crop type and binary model, respectively, while test errors were 5.5% and 6.4%, respectively. With spatial mapping accuracies for annual maps reaching upwards of 70%, this approach demonstrated a strong potential for generating rapid crop cover maps by the 1 st of September.

Drug-indiced aseptic meningitis: development of subacute sclerosing panencephalitis following repeated intraventricular infusion therapy with interferon alpha/beta.

PubMed

Imataka, George; Nakagawa, Eiji; Yamanouchi, Hideo; Arisaka, Osamu

2011-12-01

Interferon (IFN)-α was reported to be effective in longterm intrathecal treatment of subacute sclerosing panencephalitis (SSPE). However, the side effects related with longterm use of IFN-α/β are unclear. We evaluated the therapeutic effects of IFN-α/β in a 13-years-old patient with SSPE. The cerebrospinal fluid (CSF) measles antibody titer was 64 × NT/128×HI, IgG-index was 4.5, and the SSPE diagnosis was based on electroencephalography (Jabbour-stage II on admission). With Inosiplex (INP) given orally, IFN-α (3 × 10(6) units) was infused intraventricularly twice-a-week for 1-year. Resultantly, CSF cell count was elevated (2502/3), total protein and glucose levels were normal; however, DIAM occurred repeatedly. Consequently, reduced IFN-α (5 × 10(5) units) with hydrocorton was administered at 2-months interval for 19 months, during which, DIAM occurred four times. Therefore, IFN-β (3 × 10(6) units; twice-a-week) therapy was started and continued for 3 years. Although the symptoms were improved considerably, DIAM recurred after 15-months therapy and CSF cell counts were also elevated (2121/3). Since SSPE progressed to Jabbour-stage IV, indicated by irreversible consciousness disorder, IFN therapy was discontinued and INP monotherapy was followed for another 3 years. We, therefore, concluded that the longterm intraventricular IFN-α/β infusion therapy of SSPE involved the potential risk of DIAM with serious irreversible neurological sequelae and should be monitored carefully.

Infants' statistical learning: 2- and 5-month-olds' segmentation of continuous visual sequences.

PubMed

Slone, Lauren Krogh; Johnson, Scott P

2015-05-01

Past research suggests that infants have powerful statistical learning abilities; however, studies of infants' visual statistical learning offer differing accounts of the developmental trajectory of and constraints on this learning. To elucidate this issue, the current study tested the hypothesis that young infants' segmentation of visual sequences depends on redundant statistical cues to segmentation. A sample of 20 2-month-olds and 20 5-month-olds observed a continuous sequence of looming shapes in which unit boundaries were defined by both transitional probability and co-occurrence frequency. Following habituation, only 5-month-olds showed evidence of statistically segmenting the sequence, looking longer to a statistically improbable shape pair than to a probable pair. These results reaffirm the power of statistical learning in infants as young as 5 months but also suggest considerable development of statistical segmentation ability between 2 and 5 months of age. Moreover, the results do not support the idea that infants' ability to segment visual sequences based on transitional probabilities and/or co-occurrence frequencies is functional at the onset of visual experience, as has been suggested previously. Rather, this type of statistical segmentation appears to be constrained by the developmental state of the learner. Factors contributing to the development of statistical segmentation ability during early infancy, including memory and attention, are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

Department of Defense Manpower Requirements Report, FY 1985. Volume III. Force Readiness Report.

DTIC Science & Technology

1984-02-01

forces are made up of a variety of different types of units. Each unit has associated with it a collection of positions that must be filled by...available inventory, accession arid separation predictions, fiscal constraints, manpower ceilings--the list seems endless. The collection of positions that...units complete collective training and remain in FORSCOM for 18 months if deploying to a long-tour area such as Europe; or for 24 months if pre- paring

A new surveillance system for undiagnosed serious infectious illness for the London 2012 Olympic and Paralympic Games.

PubMed

Heinsbroek, E; Said, B; Kirkbride, H

2012-08-02

A new surveillance system was developed to detect possible new or emerging infections presenting as undiagnosed serious infectious illness (USII) for use during the London 2012 Olympic and Paralympic Games. Designated clinicians in sentinel adult and paediatric intensive care units (ICU/ PICUs) reported USII using an online reporting tool or provided a weekly nil notification. Reported cases were investigated for epidemiological links. A pilot study was undertaken for six months between January and July 2011 to evaluate the feasibility and acceptability of the system. In this six-month period, 5 adults and 13 children were reported by six participating units (3 ICUs, 3 PICUs). Of these 18 patients, 12 were reported within four days after admission to an ICU/PICU. Nine patients were subsequently diagnosed and were thus excluded from the surveillance. Therefore, only nine cases of USII were reported. No clustering was identified.On the basis of the pilot study, we conclude that the system is able to detect cases of USII and is feasible and acceptable to users. USII surveillance has been extended to a total of 19 sentinel units in London and the south-east of England during the London 2012 Olympic and Paralympic Games.

A beaded collar for dual micro GPS/VHF transmitter attachment to nutria

USGS Publications Warehouse

Haramis, G.M.; White, T.S.

2011-01-01

We report on the development of an approximately 85-g beaded collar for dual micro GPS/VHF transmitter attachment to semi-aquatic nutria (Myocastor coypus). Prototype collars were tested on captive nutria and refined during field trials. Central to the design was novel use of the VHF transmitter antenna as a collar. A circular collar was formed by passing the 44-cm antenna cable through a pre-made hole in the transmitter, leaving an approximately 16-cm upright antenna. GPS units were mounted separately via a hole in the base of each unit. For good satellite contact, GPS units (28 g) were maintained at the nape of the neck by counterbalance of the heavier VHF transmitters (50 g) positioned under the neck. To reduce friction, we lined the collar with alternate-sized plastic and, later, more durable nylon beads. The final collar configuration was worn for approximately 1 month deployments with only minor neck abrasion; one collar was worn successfully for 5 months. Foot entanglement remained the greatest risk of injury from the collar. By fitting collars tightly, we reduced the incidence of foot entanglement to 2 of 33 deployments (6%). Successful GPS tracks were acquired on 29 of 33 deployments (88%).

Psychological consequences in pediatric intensive care unit survivors: the neglected outcome.

PubMed

Muranjan, Mamta N; Birajdar, Suresh B; Shah, Henal R; Sundaraman, Preeti; Tullu, Milind S

2008-02-01

To determine whether Pediatric Intensive Care Unit (PICU) hospitalization results in adverse psychological effects and to identify the contributory factors. Level III PICU of a tertiary center. Prospective cohort study. Consecutive patients 5 years or older admitted to PICU for at least 48 hours constituted the study population. Controls were age and sex matched children hospitalized in the pediatric wards for at least 48 hours. Severity of illness was assessed by the Pediatric Risk of Mortality (PRISM) score. Level of therapeutic intervention was determined by the Therapeutic Interventions Scoring System (TISS--76 score). Temperament Measurement Schedule was used to assess the premorbid temperament. Psychological assessment was performed using Impact of Event Scale (IES), Birleson Depression Scale and the Self-Esteem Scale. Follow-up evaluation was done one month after discharge. There were 30 children each in the study and control groups. They had comparable pre-morbid temperament as well as scores on the self-esteem and depression scales. Significantly higher proportion of patients in PICU had intrusive thoughts (43%) as compared to controls (6.7%). Development of intrusive thoughts correlated significantly with the degree of intervention. Demographic parameters, nature of the disease, duration of hospitalization and severity of illness did not correlate with the psychological outcome. One month after discharge, scores in both groups were comparable. Children subjected to therapeutic interventions in the PICU develop transient psychological impairment manifested by experiencing intrusive thoughts that resolve within a month.

76 FR 27843 - National Building Safety Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-13

... 8672 of May 9, 2011 National Building Safety Month, 2011 By the President of the United States of... Building Safety Month. I encourage citizens, government agencies, private businesses, nonprofit...

77 FR 26905 - Jewish American Heritage Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-07

... Heritage Month, 2012 Proclamation 8814--National Foster Care Month, 2012 #0; #0; #0; Presidential Documents... Heritage Month, 2012 By the President of the United States of America A Proclamation Three hundred and... imagine. Our country is stronger for their contributions, and this month, we commemorate the myriad ways...

75 FR 25099 - Jewish American Heritage Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-07

... 8513 of April 30, 2010 Jewish American Heritage Month, 2010 By the President of the United States of... also maintained their own unique identity. During Jewish American Heritage Month we celebrate this... Jewish American Heritage Month. I call upon all Americans to observe this month with appropriate programs...

76 FR 11925 - American Red Cross Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-03

... Month, 2011 Proclamation 8629--Irish-American Heritage Month, 2011 Proclamation 8630--Women's History Month, 2011 Proclamation 8631--50th Anniversary of the Peace Corps Proclamation 8632--Death of Army... American Red Cross Month, 2011 By the President of the United States of America A Proclamation For over a...

75 FR 75611 - Critical Infrastructure Protection Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-03

... Part IV The President Proclamation 8607--Critical Infrastructure Protection Month, 2010..., 2010 Critical Infrastructure Protection Month, 2010 By the President of the United States of America A Proclamation During Critical Infrastructure Protection Month, we highlight the vast network of systems and...

Correlates of age at attainment of developmental milestones in HIV-infected infants receiving early antiretroviral therapy.

PubMed

Benki-Nugent, Sarah; Eshelman, Christal; Wamalwa, Dalton; Langat, Agnes; Tapia, Ken; Okinyi, Helen Moraa; John-Stewart, Grace

2015-01-01

Infant HIV-1 infection is associated with impaired neurologic and motor development. Antiretroviral therapy (ART) has the potential to improve developmental outcomes but the relative contributions of pre-ART disease status, growth, treatment regimen and ART response during infancy are unknown. Kenyan ART-naive infants <5-months old initiated ART and had monthly assessment of age of full neck control, unsupported walking and monosyllabic speech during 24 months of follow-up. Pre-ART and post-ART correlates of age at milestone attainment were evaluated using t tests or multivariate linear regression. Among 99 infants, pre-ART correlates of later milestone attainment included: underweight and stunted (neck control, walking and speech, all P values <0.05), missed prevention of mother-to-child transmission (P = 0.04) (neck control), previous hospitalization, World Health Organization (WHO) Stage III/IV, low CD4 count, and wasting (speech and walking, all P values <0.05), and low maternal CD4 (speech, P = 0.04). Infants initiated ART at a median of 14 days following enrollment. Infants receiving nevirapinevs lopinavir/ritonavir-based ART attained later speech (18.1 vs. 15.5 months, P = 0.003) [corrected]. Adjusting for pre-ART level, lower 6-month gain in CD4% was associated with later walking (0.18 months earlier per unit increase in CD4%; P = 0.004) and speech (0.12 months earlier per unit increase in CD4%; P = 0.05), and lower 6-month gains in weight-for-age (P = 0.009), height-for-age (P = 0.03) and weight-for-height (P = 0.02) were associated with later walking. In HIV-infected infants, compromised pre-ART immune and growth status, poor post-ART immune and growth responses, and use of nevirapine- vs. lopinavir/ritonavir-based ART were each associated with later milestone attainment [corrected]. The long-term consequences of these delays are unknown.

75 FR 54453 - National Prostate Cancer Awareness Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-07

... National Prostate Cancer Awareness Month, 2010 By the President of the United States of America A Proclamation Although its mortality rate has steadily fallen in the last decade, prostate cancer is still the second leading cause of cancer deaths among men in the United States. This year alone, nearly 218,000 men...

24 CFR 983.352 - Vacancy payment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... unit and containing the date when the family moved out (to the best of the owner's knowledge and belief... month. If an assisted family moves out of the unit, the owner may keep the housing assistance payment payable for the calendar month when the family moves out (“move-out month”). However, the owner may not...

20 CFR 210.5 - Creditability of service.

Code of Federal Regulations, 2010 CFR

2010-04-01

... total years of service equal, but not exceed, 30 years (360 months). (2) An employee is considered to... totals less than 30 years (360 months), then the service before January 1, 1937, is included but only up...) Service performed outside the United States by an employee who is not a citizen or resident of the United...

Do medical complications impact long-term outcomes in prolonged disorders of consciousness?

PubMed

Estraneo, Anna; Loreto, Vincenzo; Masotta Psy, Orsola; Pascarella, Angelo; Trojano, Luigi

2018-05-25

to investigate medical complications (MC) occuring within 6 months post-injury in brain-injured patients with prolonged disorders of consciousness (DoC) and to evaluate impact of MC on mortality and long-term clinical outcomes. prospective observational cohort study. rehabilitation unit for acquired DoC. 194 patients with DoC (142 in vegetative state, 52 in minimally conscious state; traumatic etiology: 43, anoxic: 69, vascular: 82) consecutively admitted to a neurorehabilitation unit within 1-3 months after onset. not applicable. mortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised and Disability Rating Scale) at 12, 24 and 36 months post-onset. within 6 months post-injury, more than 95% of patients (188/194) developed at least 1 MC and 73% of them (142) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MC were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189/194 patients, showed that male sex and endocrine-metabolic MC were associated to higher risk for mortality at all timepoints. Older age, anoxic etiology, lower CRS-R total scores and diagnosis of vegetative state at study entry predicted no clinical and functional improvements at most timepoints, whereas epilepsy predicted no improvement in diagnosis at 24 months post-onset only. MC are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology and age. Endocrino-metabolic MC are independent predictors of mortality at all timepoints, whereas epilepsy predicted poor long-term outcome. Occurrence and severity of MC in patients with DoC call for long-term appropriate levels of care after the post-acute phase. Copyright © 2018. Published by Elsevier Inc.

Head Start: Ensuring Dollars Benefit the Children. Hearing before the Subcommittee on Education and Early Childhood Development of the Committee on Health, Education, Labor, and Pensions, United States Senate, One Hundred Ninth Congress, First Session (April 5, 2005). Senate Hearing 109-119

ERIC Educational Resources Information Center

US Senate, 2005

2005-01-01

In his opening statement, Senator Lamar Alexander (R-TN), chairman, Subcommittee on Education and Early Childhood Development, stated that one responsibility of Congress is to ensure that taxpayer dollars are being spent for the purposes intended and for the children intended. Between January 2003 and the first months of this year, there were…

Audit of rheumatology services for adolescents and young adults in the UK. British Paediatric Rheumatology Group.

PubMed

McDonagh, J E; Foster, H E; Hall, M A; Chamberlain, M A

2000-06-01

Juvenile idiopathic arthritis (JIA) is associated with significant morbidity in adulthood with at least one third of children continuing to have active inflammatory disease into their adult years and up to 60% of all patients continuing to have some limitation of their activities of daily living. A survey of service provision for these young people in the transition from paediatric to adult rheumatology care was therefore undertaken. A postal questionnaire was sent to all 92 members of the British Paediatric Rheumatology Group, representing 61 units providing a paediatric rheumatology service in the UK and Eire. Fifty-five replies were received representing a 60% completion rate of doctors and 84% of units on the mailing list. The majority of respondents were adult rheumatologists (n = 36, 65%) with 42% of respondents based in teaching hospitals. A median of 24 patients (new and follow-up, range 1-225) were seen in a median of two paediatric rheumatology clinics (range 0-15) per month. Eighteen per cent of units had a dedicated adolescent clinic (n = 9) with a median of one clinic per month and a median number of new patients per month of two (range 0-24) and 10 review patients (4-32). All the adolescent clinics involved an adult rheumatologist with five having a paediatrician in clinic and four having access to a paediatrician. The majority of clinics involved a specialist registrar (n = 6), a nurse specialist (n = 6), an occupational therapist (n = 6) and a physiotherapist (n = 5). The majority of clinics had flexible entry and exit criteria. In seven clinics there was a standardized process of transfer, first discussed at a median age of 13 yr (range 12-16) but no unit provided literature or organized pre-visits for this process. A demand for patient information resources (e.g. disease and drug information, careers) specifically aimed at adolescents with rheumatic diseases was identified. Generic health issues were only addressed by two clinics. Obstacles to current service provision and ideas for future developments were identified. This survey identifies a heterogeneity of provision of healthcare for adolescents with rheumatic disease and highlights the potential for further research and development.

Restricted Albumin Utilization Is Safe and Cost Effective in a Cardiac Surgery Intensive Care Unit.

PubMed

Rabin, Joseph; Meyenburg, Timothy; Lowery, Ashleigh V; Rouse, Michael; Gammie, James S; Herr, Daniel

2017-07-01

Volume expansion is often necessary after cardiac surgery, and albumin is often administered. Albumin's high cost motivated an attempt to reduce its utilization. This study analyzes the impact limiting albumin infusion in a cardiac surgery intensive care unit. This retrospective study analyzed albumin use between April 2014 and April 2015 in patients admitted to a cardiac surgery intensive care unit. During the first 9 months, there were no restrictions. In January 2015, institutional guidelines limited albumin use to patients requiring more than 3 L crystalloid in the early postoperative period, hypoalbuminemic patients, and to patients considered fluid overloaded. Albumin utilization was obtained from pharmacy records and compared with outcome quality metrics. In all, 1,401 patients were admitted over 13 months. Albumin use, mortality, ventilator days, patients receiving transfusions, and length of stay were compared for 961 patients before and 440 patients after guidelines were initiated. After restrictive guidelines were instituted, albumin utilization was reduced from a mean of 280 monthly doses to a mean of 101 monthly doses (p < 0.001). There was also a trend toward reduced ventilator days. Mortality, length of stay, and transfusion requirements demonstrated no significant change. Based on an average wholesale price and an average monthly reduction of 180 albumin doses, the cardiac surgery intensive care unit demonstrated more than $45,000 of wholesale savings per month after restrictions were implemented. Albumin restriction in the cardiac surgery intensive care unit was feasible and safe. Significant reductions in utilization and cost with no changes in morbidity or mortality were demonstrated. These findings may provide a strategy for reducing cost while maintaining quality of care. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

The Sharjah Baby-Friendly Campaign: A Community-Based Model for Breastfeeding Promotion, Protection, and Support.

PubMed

Al Ghazal, Hessa; Rashid, Shehnaz; Ruf, Evelyne

2015-11-01

Breastfeeding promotion, protection, and support are one of the most cost-effective public health interventions to advance maternal and child health. The World Health Organization, the United Nations International Children's Emergency Fund, and numerous health organizations have recommended exclusive breastfeeding for the first 6 months of life, which is a key indicator of breastfeeding promotion programs worldwide. Despite the recommendations and various initiatives to promote breastfeeding, most women do not reach the exclusive breastfeeding target in both developed and developing countries. Such has been the case in the United Arab Emirates (UAE). Therefore, based on the decree for breastfeeding promotion, protection, and support by the ruler of the Emirate of Sharjah, UAE, H.H. Sheikh Doctor Sultan Al Qasimi, a multisectorial, multidirectional breastfeeding campaign--the Sharjah Baby-Friendly Campaign--was launched in March 2012 by H.E. Sheikha Bodour Al Qasimi, under her patronage. It consisted of four initiatives-namely, Baby-Friendly Health Facility, Mother-Friendly Workplace, Breastfeeding-Friendly Nursery, and Mother-Baby Friendly Public Place. Once an organization met the criteria for any of these initiatives, it was awarded the designation or accreditation of that initiative. The campaign initiatives worked through capacity building of healthcare workers, provided professional support and facilitation for the accreditation process, developed breastfeeding education content and resources, and organized and conducted breastfeeding promotion seminars in health facilities and community, as well as community outreach through social media and an innovative mobile mother' room. The positive impact of the campaign on breastfeeding promotion, protection, and support is evident by the increased exclusive breastfeeding rate at 6 months and decreased bottle feeding rates at both 4 and 6 months.

Spatial and monthly trends in speciated fine particle concentration in the United States

NASA Astrophysics Data System (ADS)

Malm, William C.; Schichtel, Bret A.; Pitchford, Marc L.; Ashbaugh, Lowell L.; Eldred, Robert A.

2004-02-01

In the spring of 1985 an interagency consortium of federal land management agencies and the Environmental Protection Agency established the Interagency Monitoring of Protected Visual Environments (IMPROVE) network to assess visibility and aerosol monitoring for the purpose of tracking spatial and temporal trends of visibility and visibility-impairing particles in rural areas. The program was initiated with 20 monitoring sites and was expanded to 165 sites between 2000 and 2003. This paper reports on fine aerosol data collected in the year 2001 at 143 sites. The major fine (dp < 2.5 μm) particle aerosol species, sulfates, nitrates, organics, light-absorbing carbon, and wind-blown dust, and coarse gravimetric mass are monitored, and at some sites, light scattering and/or extinction are measured. Sulfates, carbon, and crustal material are responsible for most of the fine mass at the majority of locations throughout the United States, while at sites in southern California and the midwestern United States, nitrates can contribute significantly. In the eastern United States, sulfates contribute between 50 and 60% of the fine mass. Sulfate concentrations tend to be highest in the summer months while organic concentrations can be high in the spring, summer, or fall seasons, depending upon fire-related emissions. However, at the two urban sites, Phoenix, Arizona, and Puget Sound, Washington, organics peak during the winter months. Nitrate concentrations also tend to be highest during the winter months. During the spring months in many areas of the western United States, fine soil can contribute as much as 40% of fine mass. The temporal changes in soil concentration that occur simultaneously over much of the western United States including the Rocky Mountain region suggest a large source region, possibly long-range transport of Asian dust.

Seasonal variation of acute toxoplasmic lymphadenopathy in the United States.

PubMed

Contopoulos-Ioannidis, D; Talucod, J; Maldonado, Y; Montoya, J G

2015-07-01

We describe the seasonal variation of acute toxoplasmosis in the United States. Acute toxoplasmic lymphadenopathy (ATL) can be a surrogate of acute toxoplasmosis in patients in whom the date of onset of lymphadenopathy matches the window of acute infection predicted by serological tests performed at a reference laboratory. We used the electronic database of the Palo Alto Medical Foundation Toxoplasma Serology Laboratory (PAMF-TSL) (1997-2011) to identify cases of ATL. We tested the uniformity of distribution of ATL cases per month, across the 12 calendar months, using circular statistics uniformity tests. We identified 112 consecutive cases of ATL. The distribution of cases was not uniform across the 12 calendar months. We observed the highest peak of cases in December and a second highest peak in September. Similar months were identified in patients with acute toxoplasmosis in rural areas in France. The results were similar when we performed weighted analyses, weighting for the total number of Toxoplasma gondii IgG tests performed per month in the PAMF-TSL laboratory. This is the largest study to date of the seasonal variation of ATL in the United States. Physicians should advise high-risk individuals to avoid risk factors associated with T. gondii infections especially around those months.

Impact of Scheduled Attrition Rates on Meeting Monthly Sortie Goals in United States Air Force Bomb Wings

DTIC Science & Technology

2009-06-12

predict future losses in the monthly flying schedules. The purpose of the attrition is to ensure that units meet their sortie contract consistently. In...an era of decreasing force size, it is important for units to maximize aircrew training operations, without wasting manpower and resources. Thus, the ...primary research question is as follows: Is the current USAF scheduling technique of using a 5-year historical attrition rate an effective way to

Cost and efficacy comparison of integrated pest management strategies with monthly spray insecticide applications for German cockroach (Dictyoptera: Blattellidae) control in public housing.

PubMed

Miller, D M; Meek, F

2004-04-01

The long-term costs and efficacy of two treatment methodologies for German cockroach, Blattella germanica (L.), control were compared in the public housing environment. The "traditional" treatment for German cockroaches consisted of monthly baseboard and crack and crevice treatment (TBCC) by using spray and dust formulation insecticides. The integrated pest management treatment (IPM) involved initial vacuuming of apartments followed by monthly or quarterly applications of baits and insect growth regulator (IGR) devices. Cockroach populations in the IPM treatment were also monitored with sticky traps. Technician time and the amount of product applied were used to measure cost in both treatments. Twenty-four hour sticky trap catch was used as an indicator of treatment efficacy. The cost of the IPM treatment was found to be significantly greater than the traditional treatment, particularly at the initiation of the test. In the first month (clean-out), the average cost per apartment unit was dollar 14.60, whereas the average cost of a TBCC unit was dollar 2.75. In the second month of treatment, the average cost of IPM was still significantly greater than the TBCC cost. However, after month 4 the cost of the two treatments was no longer significantly different because many of the IPM apartments were moved to a quarterly treatment schedule. To evaluate the long-term costs of the two treatments over the entire year, technician time and product quantities were averaged over all units treated within the 12-mo test period (total 600 U per treatment). The average per unit cost of the IPM treatment was (dollar 4.06). The average IPM cost was significantly greater than that of the TBCC treatment at dollar 1.50 per unit. Although the TBCC was significantly less expensive than the IPM treatment, it was also less effective. Trap catch data indicated that the TBCC treatment had little, if any, effect on the cockroach populations over the course of the year. Cockroach populations in the TBCC treatment remained steady for the first 5 mo of the test and then had a threefold increase during the summer. Cockroach populations in the IPM treatment were significantly reduced from an average of 24.7 cockroaches per unit before treatment to an average 3.9 cockroaches per unit in month 4. The suppressed cockroach populations (< 5 per unit) in the IPM treatment remained constant for the remaining 8 mo of the test.

RiceAtlas, a spatial database of global rice calendars and production.

PubMed

Laborte, Alice G; Gutierrez, Mary Anne; Balanza, Jane Girly; Saito, Kazuki; Zwart, Sander J; Boschetti, Mirco; Murty, M V R; Villano, Lorena; Aunario, Jorrel Khalil; Reinke, Russell; Koo, Jawoo; Hijmans, Robert J; Nelson, Andrew

2017-05-30

Knowing where, when, and how much rice is planted and harvested is crucial information for understanding the effects of policy, trade, and global and technological change on food security. We developed RiceAtlas, a spatial database on the seasonal distribution of the world's rice production. It consists of data on rice planting and harvesting dates by growing season and estimates of monthly production for all rice-producing countries. Sources used for planting and harvesting dates include global and regional databases, national publications, online reports, and expert knowledge. Monthly production data were estimated based on annual or seasonal production statistics, and planting and harvesting dates. RiceAtlas has 2,725 spatial units. Compared with available global crop calendars, RiceAtlas is nearly ten times more spatially detailed and has nearly seven times more spatial units, with at least two seasons of calendar data, making RiceAtlas the most comprehensive and detailed spatial database on rice calendar and production.

Breastfeeding duration, social and occupational characteristics of mothers in the French 'EDEN mother-child' cohort.

PubMed

Bonet, Mercedes; Marchand, Laetitia; Kaminski, Monique; Fohran, Anne; Betoko, Aisha; Charles, Marie-Aline; Blondel, Béatrice

2013-05-01

Socio-demographic characteristics of mothers have been associated with exclusive breastfeeding duration, but little is known about the association with maternal full- and part-time employment and return to work in European countries. To study the associations between breastfeeding, any and almost exclusive (infants receiving breast milk as their only milk) breastfeeding, at 4 months of infant's age and the socio-demographic and occupational characteristics of mothers. We used the EDEN mother-child cohort, a prospective study of 2002 singleton pregnant women in two French university hospitals. We selected all mothers (n = 1,339) who were breastfeeding at discharge from the maternity unit. Data on feeding practices were collected at the maternity unit and by postal questionnaires at 4, 8 and 12 months after the birth. Among infants breastfed at discharge, 93% were still receiving any breastfeeding (83% almost exclusive breastfeeding) at the 3rd completed week of life, 78% (63%) at the 1st completed month, and 42% (20%) at the 4th completed month. Time of return to work was a major predictor for stopping breastfeeding: the sooner the mothers returned to work, the less they breastfed their babies at 4 months of infant's age, independently of full-time or part-time employment. The association was stronger for almost exclusive breastfeeding mothers than for any breastfeeding ones. In a society where breastfeeding is not the norm, women may have difficulties combining work and breastfeeding. Specific actions need to be developed and assessed among mothers who return to work and among employers.

78 FR 26215 - Jewish American Heritage Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... American Heritage Month, 2013 By the President of the United States of America A Proclamation In his second... American shores. We take this month to celebrate the progress that followed, and the bright future that... May 2013 as Jewish American Heritage Month. I call upon all Americans to visit www.JewishHeritageMonth...

78 FR 57459 - National Hispanic Heritage Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-18

... Hispanic Heritage Month, 2013 Proclamation 9017--National Farm Safety and Health Week, 2013 Proclamation... Hispanic Heritage Month, 2013 By the President of the United States of America A Proclamation From the... breakthroughs. This month, America acknowledges these vital contributions and celebrates our Hispanic heritage...

78 FR 54747 - National Wilderness Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

... National Wilderness Month, 2013 By the President of the United States of America A Proclamation In... landscapes, leaving their beauty unmarred. This month, we uphold that proud tradition and resolve that future... businesses and supporting American jobs. During National Wilderness Month, we reflect on the profound...

75 FR 81083 - National Mentoring Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... National Mentoring Month, 2011 By the President of the United States of America A Proclamation Across our.... During National Mentoring Month, we honor these important individuals who unlock the potential and... 2011 as National Mentoring Month. I call upon all public officials, business and community leaders...

76 FR 58373 - National Hispanic Heritage Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-20

... Hispanic Heritage Month, 2011 Proclamation 8713--National POW/MIA Recognition Day, 2011 #0; #0; #0..., 2011 National Hispanic Heritage Month, 2011 By the President of the United States of America A... country because of the contributions of Hispanics, and during National Hispanic Heritage Month, we...

Stochastic Price Models and Optimal Tree Cutting: Results for Loblolly Pine

Treesearch

Robert G. Haight; Thomas P. Holmes

1991-01-01

An empirical investigation of stumpage price models and optimal harvest policies is conducted for loblolly pine plantations in the southeastern United States. The stationarity of monthly and quarterly series of sawtimber prices is analyzed using a unit root test. The statistical evidence supports stationary autoregressive models for the monthly series and for the...

20 CFR 408.208 - What happens if you establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What happens if you establish residence outside the United States within 4 calendar months? 408.208 Section 408.208 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

20 CFR 408.208 - What happens if you establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What happens if you establish residence outside the United States within 4 calendar months? 408.208 Section 408.208 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

20 CFR 408.208 - What happens if you establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What happens if you establish residence outside the United States within 4 calendar months? 408.208 Section 408.208 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

20 CFR 408.208 - What happens if you establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What happens if you establish residence outside the United States within 4 calendar months? 408.208 Section 408.208 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

20 CFR 408.208 - What happens if you establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What happens if you establish residence outside the United States within 4 calendar months? 408.208 Section 408.208 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

Similarities and Differences in Maternal Responsiveness in Three Societies: Evidence From Fiji, Kenya, and the United States.

PubMed

Broesch, Tanya; Rochat, Philippe; Olah, Kata; Broesch, James; Henrich, Joseph

2016-05-01

The first relationship between an infant and her caregiver, typically the mother, lays the foundation for cognitive, social, and emotional development. Maternal responsiveness and affect mirroring have been studied extensively in Western societies yet very few studies have systematically examined these caregiving features in non-Western settings. Sixty-six mother-infant dyads (7 months, SD = 3.1) were observed in a small-scale, rural island society in Fiji, a village in Kenya, and an urban center in the United States. Mothers responded similarly to infant bids overall, but differences were found across societies in the ways mothers selectively respond to affective displays. This has implications for understanding early emotion socialization as well as understanding variation in infant social ecologies across the globe. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

Value Development Underlies the Benefits of Parents’ Involvement in Children’s Learning: A Longitudinal Investigation in the United States and China

PubMed Central

Cheung, Cecilia Sin-Sze; Pomerantz, Eva M.

2014-01-01

This research examined whether the benefits of parents’ involvement in children’s learning are due in part to value development among children. Four times over the seventh and eighth grades, 825 American and Chinese children (mean age = 12.73 years) reported on their parents’ involvement in their learning and their perceptions of the value their parents place on school achievement as well as the value they themselves place on it. Children’s academic functioning was assessed via children’s reports and school records. Value development partially explained the effects of parents’ involvement on children’s academic functioning in the United States and China. For example, the more children reported their parents as involved, the more they perceived them as placing value on achievement six months later; such perceptions in turn predicted the subsequent value children placed on achievement, which foreshadowed enhanced grades. PMID:25937669

HydroUnits: A Python-based Physical Units Management Tool in Hydrologic Computing Systems

NASA Astrophysics Data System (ADS)

Celicourt, P.; Piasecki, M.

2015-12-01

While one objective of data management systems is to provide the units when annotating the collected data, another is that the units must be correctly manipulated during conversion steps. This is not a trivial task however and the units conversion time and errors for large datasets can be quite expensive. To date, more than a dozen Python modules have been developed to deal with units attached to quantities. However, they fall short in many ways and also suffer from not integrating with a units controlled vocabulary. Moreover, none of them permits the encoding of some complex units defined in the Consortium of Universities for the Advancement of Hydrologic Sciences, Inc.'s Observations Data Model (CUAHSI ODM) as a vectorial representation for storage demand reduction and does not incorporate provision to accommodate unforeseen standards-based units. We developed HydroUnits, a Python-based units management tool for three specific purposes: encoding of physical units in the Transducer Electronic Data Sheet (TEDS) as defined in the IEEE 1451.0 standard, performing dimensional analysis and on-the-fly conversion of time series allowing users to retrieve data from a data source in a desired equivalent unit while accommodating unforeseen and user-defined units. HydroUnits differentiates itself to existing tools by a number of factors including the implementation approach adopted, the adoption of standard-based units naming conventions and more importantly the emphasis on units controlled vocabularies which are a critical aspect of units treatment. Additionally, HydroUnits supports unit conversion for quantities with additive scaling factor, and natively supports time series conversion and takes leap years into consideration for units consisting of the time dimension (e.g., month, minute). Due to its overall implementation approach, HydroUnits exhibits a high level of versatility that no other tool we are aware of has achieved.

[Poetry Instruction.] Motivator of the Month. [Compiled from Columns in Three issues of "Notes Plus," January and November 1984 and September 1985.

ERIC Educational Resources Information Center

Notes Plus, 1985

1985-01-01

The teaching activities presented in the four journal columns extracted here focus on understanding and writing poetry. The first column (by Carol Case) presents an introduction to poetry unit containing five preliminary steps designed to help students develop an understanding of poetry. The second column (by Carol Anderson) describes a week of…

SENSITIVITY OF THE REGIONAL WATER BALANCE IN THE COLUMBIA RIVER BASIN TO CLIMATE VARIABILITY: APPLICATION OF A SPATIALLY DISTRIBUTED WATER BALANCE MODEL

EPA Science Inventory

A one-dimensional water balance model was developed and used to simulate water balance for the Columbia River Basin. he model was run over a 10 km X 10 km grid for the United State's portion of the basin. he regional water balance was calculated using a monthly time-step for a re...

The three-dimensional feto-maternal vascular interrelationship during early bovine placental development: a scanning electron microscopical study

PubMed Central

PFARRER, CHRISTIANE; EBERT, BRIGITTE; MIGLINO, MARIA ANGELICA; KLISCH, KARL; LEISER, RUDOLF

2001-01-01

Both the fetal and maternal microvasculature of bovine placentomes was examined by scanning electron microscopy of vascular casts. So far the development of the vascular architecture of the bovine placentome in early gestation has only been studied 2-dimensionally due to technical difficulties arising from the fragility of the early placental blood vessels. Repeated experiments led to the selection of the microvascular corrosion casts presented here. The vasculature of the maternal compartment is supplied by large caruncular stalk or spiral arteries, which release short maternal stem arteries. In the 3rd month of gestation, these arteries branch into several arterioles at their base, thus providing the vascular framework for the lower part of the septal walls of the primary crypts. In the 4th month, due to progressive longitudinal growth of the stem arteries, branching into arterioles occurs not only at the base, but over the whole length of the stem arteries. These arterioles supply the capillary complexes of the septa which resemble the major part of the septal vasculature and face the secondary crypts. Further indentation results in the formation of tertiary crypt capillary complexes, encircling the earlier secondary unit. From the 6th month of gestation the architecture resembles the fully developed maternal placenta with stem arteries running directly to the fetal side to branch into 4 to 6 arterioles, which turn back to enter secondary and tertiary septa. Maternal venules, collecting the blood from the capillary bed of secondary and tertiary septa, converge onto stem veins leaving the caruncle via branches of the uterine vein. The fetal part of the placentome is supplied by the cotyledonary arteries, which branch into fetal stem arteries that are the tributary to single villous trees. Over their whole course towards the maternal side, these give off arterioles entering secondary villi. The tertiary or terminal villous vasculature consists of capillaries, which are organised in serial capillary loops. This system is progressively elaborated in the course of gestation. In the 4th month there are only finger-like loops, whereas from the 6th month large fan-like structures can be observed. In early gestation the maternal and fetal blood vessels meet predominantly in a countercurrent fashion, changing to the less efficient crosscurrent exchange when the tertiary unit develops. These results indicate the development of a highly elaborated fetomaternal villous-crypt exchange system, already established in the 1st half of gestation, thus meeting the increasing needs of the fetus. PMID:11430698

Obstetric team simulation program challenges.

PubMed

Bullough, A S; Wagner, S; Boland, T; Waters, T P; Kim, K; Adams, W

2016-12-01

To describe the challenges associated with the development and assessment of an obstetric emergency team simulation program. The goal was to develop a hybrid, in-situ and high fidelity obstetric emergency team simulation program that incorporated weekly simulation sessions on the labor and delivery unit, and quarterly, education protected sessions in the simulation center. All simulation sessions were video-recorded and reviewed. Labor and delivery unit and simulation center. Medical staff covering labor and delivery, anesthesiology and obstetric residents and obstetric nurses. Assessments included an on-line knowledge multiple-choice questionnaire about the simulation scenarios. This was completed prior to the initial in-situ simulation session and repeated 3 months later, the Clinical Teamwork Scale with inter-rater reliability, participant confidence surveys and subjective participant satisfaction. A web-based curriculum comprising modules on communication skills, team challenges, and team obstetric emergency scenarios was also developed. Over 4 months, only 6 labor and delivery unit in-situ sessions out of a possible 14 sessions were carried out. Four high-fidelity sessions were performed in 2 quarterly education protected meetings in the simulation center. Information technology difficulties led to the completion of only 18 pre/post web-based multiple-choice questionnaires. These test results showed no significant improvement in raw score performance from pre-test to post-test (P=.27). During Clinical Teamwork Scale live and video assessment, trained raters and program faculty were in agreement only 31% and 28% of the time, respectively (Kendall's W=.31, P<.001 and W=.28, P<.001). Participant confidence surveys overall revealed confidence significantly increased (P<.05), from pre-scenario briefing to after post-scenario debriefing. Program feedback indicates a high level of participant satisfaction and improved confidence yet further program refinement is required. Copyright © 2016 Elsevier Inc. All rights reserved.

76 FR 32857 - Great Outdoors Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-07

... Outdoors Month, 2011 By the President of the United States of America A Proclamation For generations... through stone-faced cliffs. During Great Outdoors Month, we rededicate ourselves to experiencing and... natural heritage. This month, let each of us resolve to protect our great outdoors; discover their wonders...

76 FR 19263 - National Financial Literacy Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-06

... Financial Literacy Month, 2011 By the President of the United States of America A Proclamation Americans... Financial Literacy Month, we recommit to improving financial literacy and ensuring all Americans have access... hereby proclaim April 2011 as National Financial Literacy Month. I call upon all Americans to observe...

77 FR 55097 - National Preparedness Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

... National Preparedness Month, 2012 By the President of the United States of America A Proclamation As... of our country. During National Preparedness Month, we renew our commitment to promoting emergency... people and as one American family. This month, let us honor that spirit by standing with all those...

Development of Regional Power Sector Coal Fuel Costs (Prices) for the Short-Term Energy Outlook (STEO) Model

EIA Publications

2017-01-01

The U.S. Energy Information Administration's Short-Term Energy Outlook (STEO) produces monthly projections of energy supply, demand, trade, and prices over a 13-24 month period. Every January, the forecast horizon is extended through December of the following year. The STEO model is an integrated system of econometric regression equations and identities that link data on the various components of the U.S. energy industry together in order to develop consistent forecasts. The regression equations are estimated and the STEO model is solved using the EViews 9.5 econometric software package from IHS Global Inc. The model consists of various modules specific to each energy resource. All modules provide projections for the United States, and some modules provide more detailed forecasts for different regions of the country.

28 CFR 541.49 - Review of control unit placement.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Once every 30 days, the control unit team, comprised of the control unit manager and other members... required to attend the team meeting in order to be eligible for the previous month's stay in the control unit to be credited towards the projected duration of confinement in that unit. The unit team shall...

Improvement for enhancing effectiveness of universal power system (UPS) continuous testing process

NASA Astrophysics Data System (ADS)

Sriratana, Lerdlekha

2018-01-01

This experiment aims to enhance the effectiveness of the Universal Power System (UPS) continuous testing process of the Electrical and Electronic Institute by applying work scheduling and time study methods. Initially, the standard time of testing process has not been considered that results of unaccurate testing target and also time wasting has been observed. As monitoring and reducing waste time for improving the efficiency of testing process, Yamazumi chart and job scheduling theory (North West Corner Rule) were applied to develop new work process. After the improvements, the overall efficiency of the process possibly increased from 52.8% to 65.6% or 12.7%. Moreover, the waste time could reduce from 828.3 minutes to 653.6 minutes or 21%, while testing units per batch could increase from 3 to 4 units. Therefore, the number of testing units would increase from 12 units up to 20 units per month that also contribute to increase of net income of UPS testing process by 72%.

Element Material Exposure Experiment by EFFU

NASA Technical Reports Server (NTRS)

Hashimoto, Yoshihiro; Ito, Masaaki; Ishii, Masahiro

1992-01-01

The National Space Development Agency of Japan (NASDA) is planning to perform an 'Element Material Exposure Experiment' using the Exposed Facility Flyer Unit (EFFU). This paper presents an initial design of experiments proposed for this project by our company. The EFFU is installed on the Space Flyer Unit (SFU) as a partial model of the Space Station JEM exposed facility. The SFU is scheduled to be launched by H-2 rocket in January or February of 1994, then various tests will be performed for three months, on orbit of 500 km altitude, and it will be retrieved by the U.S. Space Shuttle and returned to the ground. The mission sequence is shown.

Characterizing the urban temperature trend using seasonal unit root analysis: Hong Kong from 1970 to 2015

NASA Astrophysics Data System (ADS)

To, Wai-Ming; Yu, Tat-Wai

2016-12-01

This paper explores urban temperature in Hong Kong using long-term time series. In particular, the characterization of the urban temperature trend was investigated using the seasonal unit root analysis of monthly mean air temperature data over the period January 1970 to December 2013. The seasonal unit root test makes it possible to determine the stochastic trend of monthly temperatures using an autoregressive model. The test results showed that mean air temperature has increased by 0.169°C (10 yr)-1 over the past four decades. The model of monthly temperature obtained from the seasonal unit root analysis was able to explain 95.9% of the variance in the measured monthly data — much higher than the variance explained by the ordinary least-squares model using annual mean air temperature data and other studies alike. The model accurately predicted monthly mean air temperatures between January 2014 and December 2015 with a root-mean-square percentage error of 4.2%. The correlation between the predicted and the measured monthly mean air temperatures was 0.989. By analyzing the monthly air temperatures recorded at an urban site and a rural site, it was found that the urban heat island effect led to the urban site being on average 0.865°C warmer than the rural site over the past two decades. Besides, the results of correlation analysis showed that the increase in annual mean air temperature was significantly associated with the increase in population, gross domestic product, urban land use, and energy use, with the R2 values ranging from 0.37 to 0.43.

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review.

PubMed

Pearce, J; Taylor, M A; Langley-Evans, S C

2013-10-01

The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 months (two studies), 4 months (2 studies) or 20 weeks (one study) was associated with a higher BMI in childhood. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhood overweight.

Motor Unit Changes Seen With Skeletal Muscle Sarcopenia in Oldest Old Rats

PubMed Central

Kung, Theodore A.; van der Meulen, Jack H.; Urbanchek, Melanie G.; Kuzon, William M.; Faulkner, John A.

2014-01-01

Sarcopenia leads to many changes in skeletal muscle that contribute to atrophy, force deficits, and subsequent frailty. The purpose of this study was to characterize motor unit remodeling related to sarcopenia seen in extreme old age. Whole extensor digitorum longus muscle and motor unit contractile properties were measured in 19 adult (11–13 months) and 12 oldest old (36–37 months) Brown-Norway rats. Compared with adults, oldest old rats had significantly fewer motor units per muscle, smaller muscle cross-sectional area, and lower muscle specific force. However, mean motor unit force generation was similar between the two groups due to an increase in innervation ratio by the oldest old rats. These findings suggest that even in extreme old age both fast- and slow-twitch motor units maintain the ability to undergo motor unit remodeling that offsets some effects of sarcopenia. PMID:24077596

Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital.

PubMed

Duarte, Péricles A D; Costa, Jaquilene Barreto; Duarte, Silvana Trilo; Taba, Sheila; Lordani, Claudia Regina Felicetti; Osaku, Erica Fernanda; Costa, Claudia Rejane Lima Macedo; Miglioranza, Dalas Cristina; Gund, Daniela Prochnow; Jorge, Amaury Cesar

2017-12-01

To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

Comparison of the Natural History of Genital HPV Infection among Men by Country: Brazil, Mexico, and the United States.

PubMed

Sudenga, Staci L; Torres, B Nelson; Silva, Roberto; Villa, Luisa L; Lazcano-Ponce, Eduardo; Abrahamsen, Martha; Baggio, Maria Luiza; Salmeron, Jorge; Quiterio, Manuel; Giuliano, Anna R

2017-07-01

Background: Male genital human papillomavirus (HPV) prevalence and incidence has been reported to vary by geographical location. Our objective was to assess the natural history of genital HPV by country among men with a median of 48 months of follow-up. Methods: Men ages 18-70 years were recruited from United States ( n = 1,326), Mexico ( n = 1,349), and Brazil ( n = 1,410). Genital specimens were collected every 6 months and HPV genotyping identified 37 HPV genotypes. Prevalence of HPV was compared between the three countries using the Fisher exact test. Incidence rates and 95% confidence intervals were calculated. The median time to HPV clearance among men with an incident infection was estimated using the Kaplan-Meier method. Results: The prevalence and incidence of the genital HPV types known to cause disease in males (HPV 16 and 6) was significantly higher among men from Brazil than men from Mexico. Prevalence and incidence of those genital HPV types in the United States varied between being comparable with those of Mexico or Brazil. Although genital HPV16 duration was significantly longer in Brazil ( P = 0.04) compared with Mexico and the United States, HPV6 duration was shortest in Brazil ( P = 0.03) compared with Mexico and the United States. Conclusions: Men in Brazil and Mexico often have similar, if not higher prevalence of HPV compared with men from the United States. Impact: Currently, there is no routine screening for genital HPV among males and while HPV is common in men, and most naturally clear the infection, a proportion of men do develop HPV-related diseases. Men may benefit from gender-neutral vaccine policies. Cancer Epidemiol Biomarkers Prev; 26(7); 1043-52. ©2017 AACR . ©2017 American Association for Cancer Research.

Practice development 'without walls' and the quandary of corporate practice.

PubMed

Graham, Iain; Fielding, Carol; Rooke, Debbie; Keen, Steven

2006-08-01

The context of this study is a group of clinical nurse specialists from across a Trust seeking accreditation as a practice development unit. The university was asked to facilitate the accreditation process via 11 2-hour learning sessions (including a one-hour focus group). During initial discussions between the university and practice development unit, the overarching research question for this study was set as: 'what are the main roles and responsibilities of clinical nurse specialists?' Although there is no known study of a practice development unit based beyond a ward or speciality, the central tenet of the practice development unit literature is that units must demonstrate their worth if they are to survive and harness senior management support in doing so. Data gleaned from the transcribed audio tape-recordings of the learning sessions were studied at least three times to ensure transcription accuracy and produce detailed charts. Ethical approval was granted by the appropriate Local Research Ethics Committee and written informed consent obtained from clinical nurse specialists. The study lasted 30 months and ended in October 2004. The four crucial statements that give meaning to specialist practice are: quality care giver; expert; information giver and initiator of change. Further analysis reveals the area of corporate and political practice as being missing from this and other lists of clinical nurse specialist attributes found in the literature. Clinical nurse specialists characterize their relationship with the Trust in terms of dichotomy--differing agendas and perceptions of value. The specialist role requires professional development in the areas of corporate and political acumen and professional business management. While the findings of this study relate to one Trust and a group of 16 clinical nurse specialists, with careful application they may be transferable to other settings and groups of senior nurses.

Sensitivity of Regional Hydropower Generation to the Projected Changes in Future Watershed Hydrology

NASA Astrophysics Data System (ADS)

Kao, S. C.; Naz, B. S.; Gangrade, S.

2015-12-01

Hydropower is a key contributor to the renewable energy portfolio due to its established development history and the diverse benefits it provides to the electric power systems. With the projected change in the future watershed hydrology, including shift of snowmelt timing, increasing occurrence of extreme precipitation, and change in drought frequencies, there is a need to investigate how the regional hydropower generation may change correspondingly. To evaluate the sensitivity of watershed storage and hydropower generation to future climate change, a lumped Watershed Runoff-Energy Storage (WRES) model is developed to simulate the annual and seasonal hydropower generation at various hydropower areas in the United States. For each hydropower study area, the WRES model use the monthly precipitation and naturalized (unregulated) runoff as inputs to perform a runoff mass balance calculation for the total monthly runoff storage in all reservoirs and retention facilities in the watershed, and simulate the monthly regulated runoff release and hydropower generation through the system. The WRES model is developed and calibrated using the historic (1980-2009) monthly precipitation, runoff, and generation data, and then driven by a large set of dynamically- and statistically-downscaled Coupled Model Intercomparison Project Phase 5 climate projections to simulate the change of watershed storage and hydropower generation under different future climate scenarios. The results among different hydropower regions, storage capacities, emission scenarios, and timescales are compared and discussed in this study.

How I Became a "Different" English Speaker and Listener

ERIC Educational Resources Information Center

Hashimoto, Ryota

2016-01-01

The author went to the United States to study applied linguistics. Although he was there for nine months, his English proficiency did not improve as much as he had hoped, considering that he was using English almost exclusively every day. After his time in the United States, he spent 10 months in Australia working and traveling on a working…

40 CFR Table 3 to Subpart Rrr of... - Summary of Monitoring Requirements for New and Existing Affected Sources and Emission Units

Code of Federal Regulations, 2014 CFR

2014-07-01

...; certify every 6 months. Group 1 furnace without add-on controls Fluxing in sidewell furnace hearth... sources and emission units with an add-on air pollution control device Emission capture and collection... to manufacturers specifications, or at least once every 6 months. Group 1 furnace, group 2 furnace...

20 CFR 408.210 - What happens if you do not establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What happens if you do not establish residence outside the United States within 4 calendar months? 408.210 Section 408.210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

20 CFR 408.210 - What happens if you do not establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What happens if you do not establish residence outside the United States within 4 calendar months? 408.210 Section 408.210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

20 CFR 408.210 - What happens if you do not establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What happens if you do not establish residence outside the United States within 4 calendar months? 408.210 Section 408.210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

20 CFR 408.210 - What happens if you do not establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What happens if you do not establish residence outside the United States within 4 calendar months? 408.210 Section 408.210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

20 CFR 408.210 - What happens if you do not establish residence outside the United States within 4 calendar months?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What happens if you do not establish residence outside the United States within 4 calendar months? 408.210 Section 408.210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS SVB Qualification and...

77 FR 26647 - National Building Safety Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

... Building Safety Month, 2012 By the President of the United States of America A Proclamation In... to an America built to last, and during National Building Safety Month, we recommit to strengthening... critical role in making America safe, strong, and sustainable. This month, we celebrate their work, and we...

75 FR 23557 - National Foster Care Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-04

... 8505 of April 28, 2010 National Foster Care Month, 2010 By the President of the United States of... entering the system through no fault of their own. During National Foster Care Month, we recognize the... coverage for them in every State. This month, caring foster parents and professionals across our Nation...

76 FR 11929 - Irish-American Heritage Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-03

...-American Heritage Month, 2011 By the President of the United States of America A Proclamation Our diverse... future. During Irish-American Heritage Month, we honor the contributions Irish Americans have made, and...-American Heritage Month and St. Patrick's Day, our Nation pays tribute to the proud lineage passed down to...

78 FR 1125 - National Stalking Awareness Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-07

... National Stalking Awareness Month, 2013 By the President of the United States of America A Proclamation... go unreported and unprosecuted. During National Stalking Awareness Month, we rededicate ourselves to... Awareness Month, we resolve to keep building on this momentum until no American lives in fear of this crime...

77 FR 66525 - National Family Caregivers Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-06

... National Family Caregivers Month, 2012 By the President of the United States of America A Proclamation Our... hours to providing care to their relatives or loved ones. During National Family Caregivers Month, we... Month is a time to reflect on the compassion and dedication that family caregivers embody every day. As...

78 FR 26217 - National Building Safety Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Building Safety Month, 2013 By the President of the United States of America A Proclamation When natural.... This month, as we pay tribute to professionals who design, construct, and secure our infrastructure... standards. This month, we take up those tasks once more and recommit to safety in the year ahead. NOW...

78 FR 853 - National Mentoring Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-07

... 8922 of December 31, 2012 National Mentoring Month, 2013 By the President of the United States of... mission to serve others. During National Mentoring Month, we pay special tribute to the men and women who... proclaim January 2013 as National Mentoring Month. I call upon public officials, business and community...

77 FR 13185 - Women's History Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

... History Month, 2012 By the President of the United States of America A Proclamation As Americans, ours is... of full and enduring equality. During Women's History Month, we commemorate their struggles... support to women in areas of conflict and improving the chances for lasting peace. In the months ahead, my...

75 FR 9323 - American Red Cross Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-01

... Part III The President Proclamation 8478--American Red Cross Month, 2010 #0; #0; #0; Presidential... American Red Cross Month, 2010 By the President of the United States of America A Proclamation From... Red Cross Month, we honor the organizations across our country that contribute to our Nation's ongoing...

75 FR 67905 - National Hospice Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-04

... National Hospice Month, 2010 By the President of the United States of America A Proclamation During National Hospice Month, we recognize the dignity hospice care can provide to patients who need it most, and... their lives, in spite of a terminal illness. During this month, let us recognize those who allow the...

75 FR 81085 - National Stalking Awareness Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... National Stalking Awareness Month, 2011 By the President of the United States of America A Proclamation... mischaracterized as harmless. During Stalking Awareness Month, we acknowledge the seriousness of stalking, we... January 2011 as National Stalking Awareness Month. I call on all Americans to learn to recognize the signs...

75 FR 23559 - Older Americans Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-04

... Americans Month, 2010 By the President of the United States of America A Proclamation Older Americans have.... During Older Americans Month, we show our support and appreciation for these treasured individuals who have contributed so much to our Nation. This year's theme for Older Americans Month, ``Age Strong, Live...

78 FR 66609 - National Adoption Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-05

... National Adoption Month, 2013 By the President of the United States of America A Proclamation Every young..., adoptive families give that chance to over a million children and teenagers. During National Adoption Month... service providers, and it will provide greater safeguards to both parents and children. This month, we...

Agrichemicals in surface water and birth defects in the United States

PubMed Central

Winchester, Paul D; Huskins, Jordan; Ying, Jun

2009-01-01

Objectives: To investigate if live births conceived in months when surface water agrichemicals are highest are at greater risk for birth defects. Methods: Monthly concentrations during 1996–2002 of nitrates, atrazine and other pesticides were calculated using United States Geological Survey's National Water Quality Assessment data. Monthly United States birth defect rates were calculated for live births from 1996 to 2002 using United States Centers for Disease Control and Prevention natality data sets. Birth defect rates by month of last menstrual period (LMP) were then compared to pesticide/nitrate means using logistical regression models. Results: Mean concentrations of agrichemicals were highest in April–July. Total birth defects, and eleven of 22 birth defect subcategories, were more likely to occur in live births with LMPs between April and July. A significant association was found between the season of elevated agrichemicals and birth defects. Conclusion: Elevated concentrations of agrichemicals in surface water in April–July coincided with higher risk of birth defects in live births with LMPs April–July. While a causal link between agrichemicals and birth defects cannot be proven from this study an association might provide clues to common factors shared by both variables. PMID:19183116

Gene expression suggests spontaneously hypertensive rats may have altered metabolism and reduced hypoxic tolerance.

PubMed

Ritz, Marie-Françoise; Grond-Ginsbach, Caspar; Engelter, Stefan; Lyrer, Philippe

2012-02-01

Cerebral small vessel disease (SVD) is an important cause of stroke, cognitive decline and vascular dementia (VaD). It is associated with diffuse white matter abnormalities and small deep cerebral ischemic infarcts. The molecular mechanisms involved in the development and progression of SVD are unclear. As hypertension is a major risk factor for developing SVD, Spontaneously Hypertensive Rats (SHR) are considered an appropriate experimental model for SVD. Prior work suggested an imbalance between the number of blood microvessels and astrocytes at the level of the neurovascular unit in 2-month-old SHR, leading to neuronal hypoxia in the brain of 9-month-old animals. To identify genes and pathways involved in the development of SVD, we compared the gene expression profile in the cortex of 2 and 9-month-old of SHR with age-matched normotensive Wistar Kyoto (WKY) rats using microarray-based technology. The results revealed significant differences in expression of genes involved in energy and lipid metabolisms, mitochondrial functions, oxidative stress and ischemic responses between both groups. These results strongly suggest that SHR suffer from chronic hypoxia, and therefore are unable to tolerate ischemia-like conditions, and are more vulnerable to high-energy needs than WKY. This molecular analysis gives new insights about pathways accounting for the development of SVD.

Human resources in primary health care: investments and the driving force of production.

PubMed

Maeda, Sayuri Tanaka; Moleiro, Priscilla Francescucci; Egry, Emiko Yoshikawa; Ciosak, Suely Itsuko

2011-12-01

The present study describes the composition, the qualification, the salary investment, the workforce produce, and discusses users' accessibility in terms of time at Basic Health Units (BHUs). The study was performed at two BHUs from January to December 2008, and developed by analyzing administrative documents. In both, the composition of professionals according to education level revealed: 21% with a university degree, 27% with a secondary education, and50% with a primary education; showing a positive salary variation. The medical and nursing conducts were the majority at both. The production indicators confirmed: 25 and 37 min/person/month for accessibility, respectively for BHU A and B; R$ 8.43 and R$ 12.11/person/month for the salary investment at both BHUs, and 0.07 appointments/person/month at both BHUs. The professionals' available time is scarce compared to the potential of the demand. The production indicated an opportunity of care < 1 per person/month at a reduced cost.

Intergenerational Consequences: Women's Experiences of Discrimination in Pregnancy Predict Infant Social-Emotional Development at 6 Months and 1 Year.

PubMed

Rosenthal, Lisa; Earnshaw, Valerie A; Moore, Joan M; Ferguson, Darrah N; Lewis, Tené T; Reid, Allecia E; Lewis, Jessica B; Stasko, Emily C; Tobin, Jonathan N; Ickovics, Jeannette R

2018-04-01

Racial/ethnic and socioeconomic disparities in infant development in the United States have lifelong consequences. Discrimination predicts poorer health and academic outcomes. This study explored for the first time intergenerational consequences of women's experiences of discrimination reported during pregnancy for their infants' social-emotional development in the first year of life. Data come from a longitudinal study with predominantly Black and Latina, socioeconomically disadvantaged, urban young women (N = 704, Mage = 18.53) across pregnancy through 1 year postpartum. Women were recruited from community hospitals and health centers in a Northeastern US city. Linear regression analyses examined whether women's experiences of everyday discrimination reported during pregnancy predicted social-emotional development outcomes among their infants at 6 months and 1 year of age, controlling for potentially confounding medical and sociodemographic factors. Path analyses tested if pregnancy distress, anxiety, or depressive symptoms mediated significant associations. Everyday discrimination reported during pregnancy prospectively predicted greater inhibition/separation problems and greater negative emotionality, but did not predict attention skills or positive emotionality, at 6 months and 1 year. Depressive symptoms mediated the association of discrimination with negative emotionality at 6 months, and pregnancy distress, anxiety, and depressive symptoms mediated the association of discrimination with negative emotionality at 1 year. Findings support that there are intergenerational consequences of discrimination, extending past findings to infant social-emotional development outcomes in the first year of life. It may be important to address discrimination before and during pregnancy and enhance support to mothers and infants exposed to discrimination to promote health equity across the life span.

Transitional neonatal hydronephrosis: fact or fantasy

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

Homsy, Y.L.; Williot, P.; Danais, S.

1986-07-01

Hydronephrosis secondary to an anomalous ureteropelvic junction was detected antenatally in more than 60 neonatal renal units Those 21 units that exhibited partial obstruction or dilatation without obstruction were selected for this study. They were assessed and followed by serial diuretic isotope renography (99mtechnetium-diethylenetriaminepentaacetic acid augmented with furosemide) and ultrasonography. Excretory urography was used selectively. Of the 17 renal units that could be assessed 88 per cent demonstrated labile ureteropelvic junctions. Indeed, in 3 to 6 months, when the definitive status seemed to be attained, 41 per cent (7 units) had deteriorated, 12 per cent (2 units) remained stable andmore » 47 per cent (8 units) underwent spontaneous improvement. We recommend a 3 to 6-month observation period for patients with hydronephrosis secondary to ureteropelvic junction anomalies when definite obstruction cannot be confirmed by isotope renography.« less

Reliability of reservoir firm yield determined from the historical drought of record

USGS Publications Warehouse

Archfield, S.A.; Vogel, R.M.

2005-01-01

The firm yield of a reservoir is typically defined as the maximum yield that could have been delivered without failure during the historical drought of record. In the future, reservoirs will experience droughts that are either more or less severe than the historical drought of record. The question addressed here is what the reliability of such systems will be when operated at the firm yield. To address this question, we examine the reliability of 25 hypothetical reservoirs sited across five locations in the central and western United States. These locations provided a continuous 756-month streamflow record spanning the same time interval. The firm yield of each reservoir was estimated from the historical drought of record at each location. To determine the steady-state monthly reliability of each firm-yield estimate, 12,000-month synthetic records were generated using the moving-blocks bootstrap method. Bootstrapping was repeated 100 times for each reservoir to obtain an average steady-state monthly reliability R, the number of months the reservoir did not fail divided by the total months. Values of R were greater than 0.99 for 60 percent of the study reservoirs; the other 40 percent ranged from 0.95 to 0.98. Estimates of R were highly correlated with both the level of development (ratio of firm yield to average streamflow) and average lag-1 monthly autocorrelation. Together these two predictors explained 92 percent of the variability in R, with the level of development alone explaining 85 percent of the variability. Copyright ASCE 2005.

High-reliability emergency response teams in the hospital: improving quality and safety using in situ simulation training.

PubMed

Wheeler, Derek S; Geis, Gary; Mack, Elizabeth H; LeMaster, Tom; Patterson, Mary D

2013-06-01

In situ simulation training is a team-based training technique conducted on actual patient care units using equipment and resources from that unit, and involving actual members of the healthcare team. We describe our experience with in situ simulation training in a major children's medical centre. In situ simulations were conducted using standardised scenarios approximately twice per month on inpatient hospital units on a rotating basis. Simulations were scheduled so that each unit participated in at least two in situ simulations per year. Simulations were conducted on a revolving schedule alternating on the day and night shifts and were unannounced. Scenarios were preselected to maximise the educational experience, and frequently involved clinical deterioration to cardiopulmonary arrest. We performed 64 of the scheduled 112 (57%) in situ simulations on all shifts and all units over 21 months. We identified 134 latent safety threats and knowledge gaps during these in situ simulations, which we categorised as medication, equipment, and/or resource/system threats. Identification of these errors resulted in modification of systems to reduce the risk of error. In situ simulations also provided a method to reinforce teamwork behaviours, such as the use of assertive statements, role clarity, performance of frequent updating, development of a shared mental model, performance of independent double checks of high-risk medicines, and overcoming authority gradients between team members. Participants stated that the training programme was effective and did not disrupt patient care. In situ simulations can identify latent safety threats, identify knowledge gaps, and reinforce teamwork behaviours when used as part of an organisation-wide safety programme.

Good to Great: Quality-Improvement Initiative Increases and Sustains Pediatric Health Care Worker Hand Hygiene Compliance.

PubMed

McLean, Heather S; Carriker, Charlene; Bordley, William Clay

2017-04-01

The Joint Commission, the Centers for Disease Control and Prevention, and the World Health Organization challenge hospitals to achieve and sustain compliance with effective hand hygiene (HH) practice; however, many inpatient units fail to achieve a high level of reliability. The aim of the project was to increase and sustain health care worker (HCW) compliance with HH protocols from 87% (level of reliability [LOR] 1) to ≥95% (LOR 2) within 9 months on 2 pediatric inpatient units in an academic children's hospital. This study was a time-series, quality-improvement project. Interventions were tested through multiple plan-do-study-act cycles on 2 pediatric inpatient units. HH compliance audits of HCWs on these units were performed randomly each week by the hospital infection prevention program. Control charts of percentages of HCW HH compliance were constructed with 3-σ (data within 3 SDs from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Charts were annotated with interventions including (1) increasing awareness, (2) providing timely feedback, (3) empowering patients and families to participate in mitigation, (4) providing focused education, and (5) developing interdisciplinary HH champions. HH compliance rates improved from an average of 87% (LOR 1) to ≥95% (LOR 2) within 9 months, and this improvement has been sustained for >2 years on both pediatric inpatient units. Significant and sustained gains in HH compliance rates of ≥95% (LOR 2) can be achieved by applying high-reliability human-factor interventions. Copyright © 2017 by the American Academy of Pediatrics.

Functional level during the first 2 years after moderate and severe traumatic brain injury.

PubMed

Sandhaug, Maria; Andelic, Nada; Langhammer, Birgitta; Mygland, Aase

2015-01-01

Long-term outcomes after TBI are examined to a large extent, but longitudinal studies with more than 1-year follow-up time after injury have been fewer in number. The course of recovery may vary due to a number of factors and it is still somewhat unclear which factors are contributing. The aim of this study was to describe the functional level at four time points up to 24 months after traumatic brain injury (TBI) and to evaluate the predictive impact of pre-injury and injury-related factors. A cohort study. Outpatient. Sixty-five patients with moderate (n = 21) or severe (n = 44) TBI. The patients with TBI were examined with Functional Independence Measure (FIM) and Glasgow Outcome Scale Extended (GOSE) at 3 months, 12 months and 24 months after injury. Possible predictors were analysed in a regression model using FIM total score at 24 months as the outcome measure. FIM scores improved significantly from rehabilitation unit discharge to 24 months after injury, with peak levels at 3 and 24 months after injury (p < 0.001), for the whole TBI group and the group with severe TBI. The moderate TBI group did not show significant FIM score improvement during this time period. GOSE scores for the whole group and the moderate group improved significantly over time, but the severe group did not. FIM at admission to the rehabilitation unit and GCS score at admission to the rehabilitation unit were closest to being significant predictors of FIM total scores 24 months after injury (B = 0.265 and 2.883, R(2 )= 0.39, p = 0.073, p = 0.081). FIM levels improved during the period from rehabilitation unit discharge to 3 months follow-up; thereafter, there was a 'plateauing' of recovery. In contrast, GOSE 'plateauing' of recovery was at 12 months. The study results may indicate that two of the most used outcome measures in TBI research are more relevant for assessment of the functional recovery in a sub-acute phase than in later stages of TBI recovery.

Impact of Healthy Vending Machine Options in a Large Community Health Organization.

PubMed

Grivois-Shah, Ravi; Gonzalez, Juan R; Khandekar, Shashank P; Howerter, Amy L; O'Connor, Patrick A; Edwards, Barbara A

2017-01-01

To determine whether increasing the proportion of healthier options in vending machines decreases the amount of calories, fat, sugar, and sodium vended, while maintaining total sales revenue. This study evaluated the impact of altering nutritious options to vending machines throughout the Banner Health organization by comparing vended items' sales and nutrition information over 6 months compared to the same 6 months of the previous year. Twenty-three locations including corporate and patient-care centers. Changing vending machine composition toward more nutritious options. Comparisons of monthly aggregates of sales, units vended, calories, fat, sodium, and sugar vended by site. A pre-post analysis using paired t tests comparing 6 months before implementation to the equivalent 6 months postimplementation. Significant average monthly decreases were seen for calories (16.7%, P = .002), fat (27.4%, P ≤ .0001), sodium (25.9%, P ≤ .0001), and sugar (11.8%, P = .045) vended from 2014 to 2015. Changes in revenue and units vended did not change from 2014 to 2015 ( P = .58 and P = .45, respectively). Increasing the proportion of healthier options in vending machines from 20% to 80% significantly lowered the amount of calories, sodium, fat, and sugar vended, while not reducing units vended or having a negative financial impact.

The EXCITE Trial: Predicting a Clinically Meaningful Motor Activity Log Outcome

PubMed Central

Park, Si-Woon; Wolf, Steven L.; Blanton, Sarah; Winstein, Carolee; Nichols-Larsen, Deborah S.

2013-01-01

Background and Objective This study determined which baseline clinical measurements best predicted a predefined clinically meaningful outcome on the Motor Activity Log (MAL) and developed a predictive multivariate model to determine outcome after 2 weeks of constraint-induced movement therapy (CIMT) and 12 months later using the database from participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial. Methods A clinically meaningful CIMT outcome was defined as achieving higher than 3 on the MAL Quality of Movement (QOM) scale. Predictive variables included baseline MAL, Wolf Motor Function Test (WMFT), the sensory and motor portion of the Fugl-Meyer Assessment (FMA), spasticity, visual perception, age, gender, type of stroke, concordance, and time after stroke. Significant predictors identified by univariate analysis were used to develop the multivariate model. Predictive equations were generated and odds ratios for predictors were calculated from the multivariate model. Results Pretreatment motor function measured by MAL QOM, WMFT, and FMA were significantly associated with outcome immediately after CIMT. Pretreatment MAL QOM, WMFT, proprioception, and age were significantly associated with outcome after 12 months. Each unit of higher pretreatment MAL QOM score and each unit of faster pretreatment WMFT log mean time improved the probability of achieving a clinically meaningful outcome by 7 and 3 times at posttreatment, and 5 and 2 times after 12 months, respectively. Patients with impaired proprioception had a 20% probability of achieving a clinically meaningful outcome compared with those with intact proprioception. Conclusions Baseline clinical measures of motor and sensory function can be used to predict a clinically meaningful outcome after CIMT. PMID:18780883

The EXCITE Trial: Predicting a clinically meaningful motor activity log outcome.

PubMed

Park, Si-Woon; Wolf, Steven L; Blanton, Sarah; Winstein, Carolee; Nichols-Larsen, Deborah S

2008-01-01

This study determined which baseline clinical measurements best predicted a predefined clinically meaningful outcome on the Motor Activity Log (MAL) and developed a predictive multivariate model to determine outcome after 2 weeks of constraint-induced movement therapy (CIMT) and 12 months later using the database from participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial. A clinically meaningful CIMT outcome was defined as achieving higher than 3 on the MAL Quality of Movement (QOM) scale. Predictive variables included baseline MAL, Wolf Motor Function Test (WMFT), the sensory and motor portion of the Fugl-Meyer Assessment (FMA), spasticity, visual perception, age, gender, type of stroke, concordance, and time after stroke. Significant predictors identified by univariate analysis were used to develop the multivariate model. Predictive equations were generated and odds ratios for predictors were calculated from the multivariate model. Pretreatment motor function measured by MAL QOM, WMFT, and FMA were significantly associated with outcome immediately after CIMT. Pretreatment MAL QOM, WMFT, proprioception, and age were significantly associated with outcome after 12 months. Each unit of higher pretreatment MAL QOM score and each unit of faster pretreatment WMFT log mean time improved the probability of achieving a clinically meaningful outcome by 7 and 3 times at posttreatment, and 5 and 2 times after 12 months, respectively. Patients with impaired proprioception had a 20% probability of achieving a clinically meaningful outcome compared with those with intact proprioception. Baseline clinical measures of motor and sensory function can be used to predict a clinically meaningful outcome after CIMT.

Process Improvement to Enhance Quality in a Large Volume Labor and Birth Unit.

PubMed

Bell, Ashley M; Bohannon, Jessica; Porthouse, Lisa; Thompson, Heather; Vago, Tony

The goal of the perinatal team at Mercy Hospital St. Louis is to provide a quality patient experience during labor and birth. After the move to a new labor and birth unit in 2013, the team recognized many of the routines and practices needed to be modified based on different demands. The Lean process was used to plan and implement required changes. This technique was chosen because it is based on feedback from clinicians, teamwork, strategizing, and immediate evaluation and implementation of common sense solutions. Through rapid improvement events, presence of leaders in the work environment, and daily huddles, team member engagement and communication were enhanced. The process allowed for team members to offer ideas, test these ideas, and evaluate results, all within a rapid time frame. For 9 months, frontline clinicians met monthly for a weeklong rapid improvement event to create better experiences for childbearing women and those who provide their care, using Lean concepts. At the end of each week, an implementation plan and metrics were developed to help ensure sustainment. The issues that were the focus of these process improvements included on-time initiation of scheduled cases such as induction of labor and cesarean birth, timely and efficient assessment and triage disposition, postanesthesia care and immediate newborn care completed within approximately 2 hours, transfer from the labor unit to the mother baby unit, and emergency transfers to the main operating room and intensive care unit. On-time case initiation for labor induction and cesarean birth improved, length of stay in obstetric triage decreased, postanesthesia recovery care was reorganized to be completed within the expected 2-hour standard time frame, and emergency transfers to the main hospital operating room and intensive care units were standardized and enhanced for efficiency and safety. Participants were pleased with the process improvements and quality outcomes. Working together as a team using the Lean process, frontline clinicians identified areas that needed improvement, developed and implemented successful strategies that addressed each gap, and enhanced the quality and safety of care for a large volume perinatal service.

Quantitative facial electromyography monitoring after hypoglossal‐facial jump nerve suture

PubMed Central

Flasar, Jan; Volk, Gerd Fabian; Granitzka, Thordis; Geißler, Katharina; Irintchev, Andrey; Lehmann, Thomas

2017-01-01

Objectives/Hypothesis The time course of the reinnervation of the paralyzed face after hypoglossal‐facial jump nerve suture using electromyography (EMG) was assessed. The relation to the clinical outcome was analyzed. Study Design Retrospective single‐center cohort study Methods Reestablishment of motor units was studied by quantitative EMG and motor unit potential (MUP) analysis in 11 patients after hypoglossal‐facial jump nerve suture. Functional recovery was evaluated using the Stennert index (0 = normal; 10 = maximal palsy). Results Clinically, first movements were seen between 6 and >10 months after surgery in individual patients. Maximal improvement was achieved at 18 months. The Stennert index decreased from 7.9 ± 2.0 preoperatively to a final postoperative score of 5.8 ± 2.4. EMG monitoring performed for 2.8 to 60 months after surgery revealed that pathological spontaneous activity disappeared within 2 weeks. MUPs were first recorded after the 2nd month and present in all 11 patients 8–10 months post‐surgery. Polyphasic regeneration potentials first appeared at 4–10 months post‐surgery. The MUP amplitudes increased between the 3rd and 15th months after surgery to values of control muscles. The MUP duration was significantly increased above normal values between the 3rd and 24th months after surgery. Conclusion Reinnervation can be detected at least 2 months earlier by EMG than by clinical evaluation. Changes should be followed for at least 18 months to assess outcome. EMG changes reflected the remodeling of motor units due to axonal regeneration and collateral sprouting by hypoglossal nerve fibers into the reinnervated facial muscle fibers. Level of Evidence 3b. PMID:29094077

One-to-One Wisdom: Expert Tips on How to Approach Professional Development in Laptop Environments

ERIC Educational Resources Information Center

Cutter, Chris

2006-01-01

Laptop computing programs have been in K-12 schools since the 1990s, but in recent months one-to-one learning seems to have reemerged as a top topic in education technology circles. According to Tim Wiley, senior analyst at research firm Eduventures, about 1,000 of the 15,000 school districts in the United States currently have one-to-one…

Development of a Model of Soldier Effectiveness: Retranslation Materials and Results

DTIC Science & Technology

1987-05-01

covering financial responsibility, particularly the family checking account . Consequent- ly, the bad check rate for the unit drop- ped from 70 a month...Alcohol, and Aggressive Acts " Showing prudence in financial management and responsibility in personal/family matters; avoiding alcohol and other drugs or...threatening others, etc. versus " Acting irresponsibly in financial or personal/family affairs such that command time is required to counsel or otherwise

Challenges Confronting American Indian Youth. Oversight Hearing before the Committee on Indian Affairs. United States Senate, One Hundred Fourth Congress, First Session. Part 2.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Indian Affairs.

The Senate Committee on Indian Affairs received testimony from representatives of federal agencies as to how the U.S. government might better address the needs of American Indian youth through the development of federal laws, programs, and policies. The hearing was a followup to an oversight hearing 1 month earlier in which American Indian young…

Development of Technologies for Early Detection and Stratification of Breast Cancer

DTIC Science & Technology

2013-10-01

advances made in breast cancer diagnostics and treatment, it has been estimated that in 2012 the United States will diagnose approximately 200,000 new cases...Task 3. Perform prospective clinical trial for predictive and prognostic markers in women with newly diagnosed breast cancer (Months 1-60...with newly diagnosed breast cancer, women who are being followed after completing treatment for localized breast cancer, and women with active

Rapid crop cover mapping for the conterminous United States

USGS Publications Warehouse

Dahal, Devendra; Wylie, Bruce K.; Howard, Daniel

2018-01-01

Timely crop cover maps with sufficient resolution are important components to various environmental planning and research applications. Through the modification and use of a previously developed crop classification model (CCM), which was originally developed to generate historical annual crop cover maps, we hypothesized that such crop cover maps could be generated rapidly during the growing season. Through a process of incrementally removing weekly and monthly independent variables from the CCM and implementing a ‘two model mapping’ approach, we found it viable to generate conterminous United States-wide rapid crop cover maps at a resolution of 250 m for the current year by the month of September. In this approach, we divided the CCM model into one ‘crop type model’ to handle the classification of nine specific crops and a second, binary model to classify the presence or absence of ‘other’ crops. Under the two model mapping approach, the training errors were 0.8% and 1.5% for the crop type and binary model, respectively, while test errors were 5.5% and 6.4%, respectively. With spatial mapping accuracies for annual maps reaching upwards of 70%, this approach demonstrated a strong potential for generating rapid crop cover maps by the 1st of September.

E-learning in Saudi Arabia: ‘To E or not to E, that is the question’

PubMed Central

Al-Shehri, Ali M.

2010-01-01

Background: The Kingdom of Saudi Arabia (KSA) has witnessed unprecedented growth in higher education and E-learning in recent times. In the last five years, one university and five colleges have been commissioned every month; 800 scholarships have been awarded every month for overseas study; a national center for E-learning has been established; and E-units or departments have been set-up in almost every university. E-learning has become important for discussion to quote Shakespeare ‘To E or not to E that is the question.’ Objectives: To examine current and future developments and challenges of E-learning in KSA. Materials and Methods: A qualitative approach was used to explore views of 30 senior academicians involved in E-learning during their attendance at a two-week course on the subject. Results: All participants considered themselves as decision makers on E-learning in their units or departments. They felt that E-learning had come to stay, but acknowledged challenges in respect of resources, organization, management, and information technology. Conclusion: The fast development of E-learning poses many challenges. Clear vision and strategic planning with prospective E-learners in mind are essential to make E-learning programs cost effective. PMID:21359026

Aiming for zero: decreasing central line associated bacteraemia in the intensive care unit.

PubMed

Seddon, Mary E; Hocking, Catherine J; Mead, Pat; Simpson, Catherine

2011-07-29

To eliminate Central Line Associated Bacteraemia (CLAB) in the Critical Care Complex (CCC)-Intensive Care Unit (ICU) and High Dependency Unit (HDU)-Middlemore Hospital. Multifaceted quality improvement programme that included: engagement with ICU leadership and education of ICU staff; the introduction of a CLAB prevention bundle of care through standardised checklists for central line insertion (December 2008) and line maintenance (July 2009); the development of a central line pack; and rapid, visual feedback of results. Absolute numbers of CLAB in the CCC decreased from 14 in 2008, to 4 in 2009 and 1 in the first 6 months of 2010 (despite increase in bed census and a doubling of admissions). The CLAB rate per 1,000 line days decreased from 6.6 to 0.9. The days between CLAB increased from a median of 30 to >100 days, with zero CLAB for 5 of the last 6 months. Mortality for patients with CLAB was 37%, compared with mortality of 13% for all other ICU patients. The conservative cost savings were $200,000 in 2009 and $260,000 in 2010. Using an evidenced-based quality improvement approach, it is possible to significantly decrease Central Line Associated Bacteraemia in the Critical Care Complex. In doing so patient morbidity and mortality are reduced and money is saved for other healthcare needs.

Nuclear pursuits

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

Not Available

1993-05-01

This table lists quantities of warheads (in stockpile, peak number per year, total number built, number of known test explosions), weapon development milestones (developers of the atomic bomb and hydrogen bomb, date of first operational ICBM, first nuclear-powered naval SSN in service, first MIRVed missile deployed), and testing milestones (first fission test, type of boosted fission weapon, multistage thermonuclear test, number of months from fission bomb to multistage thermonuclear bomb, etc.), and nuclear infrastructure (assembly plants, plutonium production reactors, uranium enrichment plants, etc.). Countries included in the tally are the United States, Soviet Union, Britain, France, and China.

20 CFR 404.461 - Nonpayment of lump sum after death of alien outside United States for more than 6 months.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Nonpayment of lump sum after death of alien outside United States for more than 6 months. 404.461 Section 404.461 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Deductions; Reductions; and Nonpayments of Benefits § 404.461...

3 CFR 8792 - Proclamation 8792 of April 2, 2012. National Donate Life Month, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

... National Donate Life Month, we reflect on that essential quality and recommit to saving lives through organ... Life Month, 2012 8792 Proclamation 8792 Presidential Documents Proclamations Proclamation 8792 of April 2, 2012 Proc. 8792 National Donate Life Month, 2012By the President of the United States of America...

78 FR 26225 - Older Americans Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Americans Month, 2013 By the President of the United States of America A Proclamation For half a century... the month of May. We carry that tradition forward again this year by recognizing their accomplishments..., but also for those to come. Our seniors deserve the best our country has to offer. This month, we pay...

78 FR 26219 - National Foster Care Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Foster Care Month, 2013 By the President of the United States of America A Proclamation As a Nation, we... love, protection, and stability of a permanent family. This month, we recommit to giving them that... action, let us mark this month by showing children and youth in foster care the best our country has to...

76 FR 25519 - National Foster Care Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

... Foster Care Month, 2011 By the President of the United States A Proclamation Progress in America can be... where they can feel secure and thrive. During National Foster Care Month, we renew our commitment to... possible for children when they cannot remain in their own homes. During National Foster Care Month, we...

A method to develop vocabulary checklists in new languages and their validity to assess early language development.

PubMed

Prado, Elizabeth L; Phuka, John; Ocansey, Eugenia; Maleta, Kenneth; Ashorn, Per; Ashorn, Ulla; Adu-Afarwuah, Seth; Oaks, Brietta M; Lartey, Anna; Dewey, Kathryn G

2018-05-11

Since the adoption of United Nations' Sustainable Goal 4.2 to ensure that all children have access to quality early child development (ECD) so that they are ready for primary education, the demand for valid ECD assessments has increased in contexts where they do not yet exist. The development of early language ability is important for school readiness. Our objective was to evaluate the validity of a method to develop vocabulary checklists in new languages to assess early language development, based on the MacArthur-Bates Communicative Development Inventories. Through asking mothers of young children what words their children say and through pilot testing, we developed 100-word vocabulary checklists in multilingual contexts in Malawi and Ghana. In Malawi, we evaluated the validity of the vocabulary checklist among 29 children age 17-25 months compared to three language measures assessed concurrently: Developmental Milestones Checklist-II (DMC-II) language scale, Malawi Developmental Assessment Tool (MDAT) language scale, and the number of different words (NDW) in 30-min recordings of spontaneous speech. In Ghana, we assessed the predictive validity of the vocabulary checklist at age 18 months to forecast language, pre-academic, and other skills at age 4-6 years among 869 children. We also compared the predictive validity of the vocabulary checklist scores to that of other developmental assessments administered at age 18 months. In Malawi, the Spearman's correlation of the vocabulary checklist score with DMC-II language was 0.46 (p = 0.049), with MDAT language was 0.66 (p = 0.016) and with NDW was 0.50 (p = 0.033). In Ghana, the 18-month vocabulary checklist score showed the strongest (rho = 0.12-0.26) and most consistent (8/12) associations with preschool scores, compared to the other 18-month assessments. The largest coefficients were the correlations of the 18-month vocabulary score with the preschool cognitive factor score (rho = 0.26), language score (0.25), and pre-academic score (0.24). We have demonstrated the validity of a method to develop vocabulary checklists in new languages, which can be used in multilingual contexts, using a feasible adaptation process requiring about 2 weeks. This is a promising method to assess early language development, which is associated with later preschool language, cognitive, and pre-academic skills.

Relationship between attrition and neurodevelopmental impairment rates in extremely preterm infants at 18 to 24 months: a systematic review.

PubMed

Guillén, Ursula; DeMauro, Sara; Ma, Li; Zupancic, John; Roberts, Robin; Schmidt, Barbara; Kirpalani, Haresh

2012-02-01

To assess the effect of loss to follow-up rates at 18 to 24 months on neurodevelopmental outcome statistics for infants of less than 1000 g birth weight or less than 28 weeks' gestational age. MEDLINE, EMBASE, PubMed, and Cochrane Library databases (January 1, 2000, to June 30, 2010). We searched for studies reporting outcomes of infants of less than 1000 g birth weight or less than 28 weeks' gestational age who were born after 1990. Eligible articles had to report the primary outcome and follow-up rates at 18 to 24 months. Our primary composite outcome of neurodevelopmental impairment (NDI) was any of a mental developmental quotient 2 SDs below the mean, using the Bayley Scales of Infant Development II; cerebral palsy; visual impairment; or significant hearing impairment. Of 43 publications describing outcomes at 18 to 24 months, 20 provided rates of follow-up, describing a total of 34,185 infants. The NDI rates ranged between 12.4% and 57.5%. Follow-up rates ranged between 71.6% and 100%. Higher rates of NDI were significantly correlated with greater loss to follow-up (r(2) = 0.38, P = .007). Higher rates of both NDI and loss to follow-up were seen in the United States compared with Canada, the United Kingdom, Finland, Denmark, Austria, Germany, and Australia (r(2) = 0.70, P = .001). Ascertainment bias may overestimate NDI in extremely low-birth-weight or extremely low-gestational-age survivors at 18 to 24 months. Alternatively, the characteristics of different populations and health systems may contribute to higher rates of attrition and higher rates of NDI.

A Composite Diagnosis of Synoptic-Scale Extratropical Cyclone Development over the United States

NASA Technical Reports Server (NTRS)

Rolfson, Donald M.; Smith, Phillip J.

1996-01-01

This paper presents a composite diagnosis of synoptic-scale forcing mechanisms associated with extratropical cyclone evolution. Drawn from 12 cyclone cases that occurred over the continental United States during the cool season months, the diagnosis provides a 'climatology' of development mechanisms for difference categories of cyclone evolution ranging from cyclone weakening through three stages of cyclone intensification. Computational results were obtained using an 'extended' form of the Zwack-Okossi equation applied to routine upper-air and surface data analyzed on a 230 km x 230 km grid. Results show that cyclonic vorticity advection, which maximizes in the upper troposphere, was the primary contributor to cyclone development regardless of the stage of development. A second consistent contributor to development was latent heat release. Horizontal temperature advection, often acknowledged as a development mechanism, was found to contribute to development only during more intense stages. During weakening and weaker development stages, temperature advection opposed development, as the warm-air advection invariably found at upper levels was dominated by cold air advection in the lower half of the troposphere. In the more intense stages, development was moderated by dry-adiabatic cooling associated with the ascending vertical motions.

Nature and incidence of severe limbal stem cell deficiency in Australia and New Zealand.

PubMed

Bobba, Samantha; Di Girolamo, Nick; Mills, Richard; Daniell, Mark; Chan, Elsie; Harkin, Damien G; Cronin, Brendan G; Crawford, Geoffrey; McGhee, Charles; Watson, Stephanie

2017-03-01

This study aimed to determine the nature and incidence of severe limbal stem cell deficiency (LSCD) in Australia and New Zealand. A 1-year pilot surveillance study with a 1-year follow-up period was conducted in association with the Australian and New Zealand Ophthalmic Surveillance Unit. The study included patients reported by practising ophthalmologists on the Surveillance Unit's database. Ophthalmologists were provided with a definition of severe limbal stem cell deficiency, contacted on a monthly basis by the Unit and asked to report newly diagnosed cases. Severe LSCD was defined as at least 6 clock hours of whorl-like epitheliopathy, an opaque epithelium arising from the limbus, late fluorescein staining of the involved epithelium and superficial corneal neovascularization or conjunctivalization. On average, 286 report cards were sent by the Surveillance Unit to practising ophthalmologists each month (total 3429 over 12 months) and the Unit received an average of 176 responses per month (total 2111; 62% response rate). During the 1-year study period from April 2013 to March 2014, 14 positive cases were reported to the Unit. A range of underlying aetiologies were implicated, with contact lens over-wear and cicatrizing conjunctivitis being the most common (n = 3). This surveillance study is the first worldwide to document the incidence of limbal stem cell deficiency; however, because of study design limitations, it is likely to have been under-reported. It provides novel data on the demographics, clinical conditions and management of patients with limbal stem cell deficiency as reported by treating ophthalmologists. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

Development, Construct Validity, and Reliability of the Questionnaire on Infant Feeding: A Tool for Measuring Contemporary Infant-Feeding Behaviors.

PubMed

O'Sullivan, Elizabeth J; Rasmussen, Kathleen M

2017-12-01

The breastfeeding surveillance tool in the United States, the National Immunization Survey, considers the maternal-infant dyad to be breastfeeding for as long as the infant consumes human milk (HM). However, many infants consume at least some HM from a bottle, which can lead to health outcomes different from those for at-the-breast feeding. Our aim was to develop a construct-valid questionnaire that categorizes infants by nutrition source, that is, own mother's HM, another mother's HM, infant formula, or other and feeding mode, that is, at the breast or from a bottle, and test the reliability of this questionnaire. The Questionnaire on Infant Feeding was developed through a literature review and modified based on qualitative research. Construct validity was assessed through cognitive interviews and a test-retest reliability study was conducted among mothers who completed the questionnaire twice, 1 month apart. Cognitive interviews were conducted with ten mothers from upstate New York between September and December 2014. A test-retest reliability study was conducted among 44 mothers from across the United States between March and May 2015. Equivalence of questions with continuous responses about the timing of starting and stopping various behaviors and the agreement between responses to questions with categorical responses on the two questionnaires completed 1 month apart. Reliability was assessed using paired-equivalence tests for questions about the timing of starting and stopping behaviors and weighted Cohen's κ for questions about the frequency and intensity of behaviors. Reliability of the Questionnaire on Infant Feeding was moderately high among mothers of infants aged 19 to 35 months, with most questions about the timing of starting and stopping behaviors equivalent to within 1 month. Weighted Cohen's κ for categorical questions indicated substantial agreement. The Questionnaire on Infant Feeding is a construct-valid tool to measure duration, intensity, and mode of infant HM consumption and duration of maternal HM production that is reliable within 19 to 35 months postpartum. Criterion-validity testing of these questions will improve the utility of the Questionnaire on Infant Feeding as a surveillance tool. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Recovering activity and illusion: the nephrology day care unit.

PubMed

Remón Rodríguez, C; Quirós Ganga, P L; González-Outón, J; del Castillo Gámez, R; García Herrera, A L; Sánchez Márquez, M G

2011-01-01

Day Care Units are an alternative to hospital care that improves more efficiency. The Nephrology, by its technical characteristics, would be benefit greatly from further development of this care modality. The objectives of this study are to present the process we have developed the Nephrology Day Care Unit in the Puerto Real University Hospital (Cádiz, Spain). For this project we followed the Deming Management Method of Quality improvement, selecting opportunities, analyzing causes, select interventions, implement and monitor results. The intervention plan includes the following points: 1) Define the place of the Day Care Unit in the organization of our Clinical Department of Nephrology, 2) Define the Manual of organization, 3) Define the structural and equipment resources, 4) Define the Catalogue of services and procedures, 5) Standards of Care Processes. Protocols and Clinical Pathways; and 6) Information and Registration System. In the first 8 months we have been performed nearly 2000 procedures, which corresponds to an average of about 10 procedures per day, and essentially related to Hemodialysis in critical or acute patients, the Interventional Nephrology, the Clinical Nephrology and Peritoneal Dialysis. The development of the Nephrology Day Care Units can help to increase our autonomy, our presence in Hospitals, recover the progressive loss of clinical activity (diagnostic and therapeutic skills) in the past to the benefit of other Specialties. It also contributes to: Promote and develop the Diagnostic and Interventional Nephrology; improve the clinical management of patients with Primary Health Level, promote the Health Education and Investigation, collaborate in the Resources Management, and finally, to make more attractive and exciting our Specialty, both for nephrologists to training specialists.

Mapping Monthly Water Scarcity in Global Transboundary Basins at Country-Basin Mesh Based Spatial Resolution.

PubMed

Degefu, Dagmawi Mulugeta; Weijun, He; Zaiyi, Liao; Liang, Yuan; Zhengwei, Huang; Min, An

2018-02-01

Currently fresh water scarcity is an issue with huge socio-economic and environmental impacts. Transboundary river and lake basins are among the sources of fresh water facing this challenge. Previous studies measured blue water scarcity at different spatial and temporal resolutions. But there is no global water availability and footprint assessment done at country-basin mesh based spatial and monthly temporal resolutions. In this study we assessed water scarcity at these spatial and temporal resolutions. Our results showed that around 1.6 billion people living within the 328 country-basin units out of the 560 we assessed in this study endures severe water scarcity at least for a month within the year. In addition, 175 country-basin units goes through severe water scarcity for 3-12 months in the year. These sub-basins include nearly a billion people. Generally, the results of this study provide insights regarding the number of people and country-basin units experiencing low, moderate, significant and severe water scarcity at a monthly temporal resolution. These insights might help these basins' sharing countries to design and implement sustainable water management and sharing schemes.

Growth Charts for Children With Down Syndrome in the United States.

PubMed

Zemel, Babette S; Pipan, Mary; Stallings, Virginia A; Hall, Waynitra; Schadt, Kim; Freedman, David S; Thorpe, Phoebe

2015-11-01

Children with Down syndrome (DS) have lower birth weights and grow more slowly than children without DS. Advances in and increased access to medical care have improved the health and well-being of individuals with DS; however, it is unknown whether their growth has also improved. Our objective was to develop new growth charts for children with DS and compare them to older charts from the United States and more contemporary charts from the United Kingdom. The Down Syndrome Growing Up Study (DSGS) enrolled a convenience sample of children with DS up to 20 years of age and followed them longitudinally. Growth parameters were measured by research anthropometrists. Sex-specific growth charts were generated for the age ranges birth to 36 months and 2 to 20 years using the LMS method. Weight-for-length and BMI charts were also generated. Comparisons with other curves were presented graphically. New DSGS growth charts were developed by using 1520 measurements on 637 participants. DSGS growth charts for children <36 months of age showed marked improvements in weight compared with older US charts. DSGS charts for 2- to 20-year-olds showed that contemporary males are taller than previous charts showed. Generally, the DSGS growth charts are similar to the UK charts. The DSGS growth charts can be used as screening tools to assess growth and nutritional status and to provide indications of how growth of an individual child compares with peers of the same age and sex with DS. Copyright © 2015 by the American Academy of Pediatrics.

Growth Charts for Children With Down Syndrome in the United States

PubMed Central

Zemel, Babette S.; Pipan, Mary; Stallings, Virginia A.; Hall, Waynitra; Schadt, Kim; Freedman, David S.; Thorpe, Phoebe

2017-01-01

BACKGROUND AND OBJECTIVES Children with Down syndrome (DS) have lower birth weights and grow more slowly than children without DS. Advances in and increased access to medical care have improved the health and well-being of individuals with DS; however, it is unknown whether their growth has also improved. Our objective was to develop new growth charts for children with DS and compare them to older charts from the United States and more contemporary charts from the United Kingdom. METHODS The Down Syndrome Growing Up Study (DSGS) enrolled a convenience sample of children with DS up to 20 years of age and followed them longitudinally. Growth parameters were measured by research anthropometrists. Sex-specific growth charts were generated for the age ranges birth to 36 months and 2 to 20 years using the LMS method. Weight-for-length and BMI charts were also generated. Comparisons with other curves were presented graphically. RESULTS New DSGS growth charts were developed by using 1520 measurements on 637 participants. DSGS growth charts for children <36 months of age showed marked improvements in weight compared with older US charts. DSGS charts for 2- to 20-year-olds showed that contemporary males are taller than previous charts showed. Generally, the DSGS growth charts are similar to the UK charts. CONCLUSIONS The DSGS growth charts can be used as screening tools to assess growth and nutritional status and to provide indications of how growth of an individual child compares with peers of the same age and sex with DS. PMID:26504127

A crossover randomized prospective pilot study evaluating a central venous catheter team in reducing catheter-related bloodstream infections in pediatric oncology patients.

PubMed

Secola, Rita; Azen, Colleen; Lewis, Mary Ann; Pike, Nancy; Needleman, Jack; Sposto, Richard; Doering, Lynn

2012-01-01

Treatment for most children with cancer includes the use of a central venous catheter (CVC). CVCs provide reliable venous access for delivery of chemotherapy and supportive care. This advantage is mitigated by an increased risk of bloodstream infections (BSIs). Despite the ubiquitous use of CVCs, few prospective studies have been conducted to address infection prevention strategies in pediatric oncology patients. Prospective, crossover pilot study of a CVC team intervention versus standard care. Two inpatient oncology units in a metropolitan children's hospital. A total of 41 patients/135 admissions for the experimental unit (EU) and 41/129 admissions for the control unit (CU). Patients received a CVC blood draw bundle procedure by a CVC registered nurse (RN) team member (experimental intervention: EU) for 6 months and by the assigned bedside RN (standard care: CU) for 6 months. Feasibility of implementing a CVC RN team; a significant difference in CVC-related BSIs between the team intervention versus standard care and risk factors associated in the development of CVC-related BSIs were determined. There were 7 CVC-related BSIs/1238 catheter days in the EU group (5.7/1000 catheter days) versus 3 CVC-related BSIs/1419 catheter days in the CU group (2.1/1000 catheter days; P = .97). Selected risk factors were not significantly associated with the development of a CVC-related BSI. A CVC team in the care of pediatric oncology patients is feasible; however, a larger cohort will be required to adequately determine the effectiveness of the team reducing CVC-related BSIs.

Status of Microsurgical Simulation Training in Plastic Surgery: A Survey of United States Program Directors.

PubMed

Al-Bustani, Saif; Halvorson, Eric G

2016-06-01

Various simulation models for microsurgery have been developed to overcome the limitations of Halstedian training on real patients. We wanted to assess the status of microsurgery simulation in plastic surgery residency programs in the United States. Data were analyzed from responses to a survey sent to all plastic surgery program directors in the United States, asking for type of simulation, quality of facilities, utilization by trainees, evaluation of trainee sessions, and perception of the relevance of simulation. The survey response rate was 50%. Of all programs, 69% provide microsurgical simulation and 75% of these have a laboratory with microscope and 52% provide live animal models. Half share facilities with other departments. The quality of facilities is rated as good or great in 89%. Trainee utilization is once every 3 to 6 months in 82% of programs. Only in 11% is utilization monthly. Formal evaluation of simulation sessions is provided by 41% of programs. All program directors agree simulation is relevant to competence in microsurgery, 60% agree simulation should be mandatory, and 43% require trainees to complete a formal microsurgery course prior to live surgery. There seems to be consensus that microsurgical simulation improves competence, and the majority of program directors agree it should be mandatory. Developing and implementing standardized simulation modules and assessment tools for trainees across the nation as part of a comprehensive competency-based training program for microsurgery is an important patient safety initiative that should be considered. Organizing with other departments to share facilities may improve their quality and hence utilization.

Outcome of infants with unrepaired heart disease admitted to the pediatric intensive care unit: single-center developing country perspective.

PubMed

Mohsin, Shazia Samad; Haque, Anwarul; Shaikh, Abdul Sattar; Bano, Surraiya; Hasan, Babar Sultan

2014-01-01

Congenital heart disease (CHD) has an incidence of ∼0.8-1%. Outcome of previously diagnosed CHD patients awaiting surgery (either correction or palliation) in a developing country setting is unknown. We strive to determine the outcome of patients with CHD awaiting surgery who present to pediatric intensive care unit (PICU) setting with an acute illness. Retrospective cross-sectional chart review. Pediatric intensive care unit of The Aga Khan University Hospital, Karachi, Pakistan. Medical records of infants (1-12 months) with CHD awaiting surgery presenting to the PICU with an acute illness between January 2009 and June 2012 were included. Newly diagnosed CHD patients, those not requiring PICU admission, and those transferred to another hospital were excluded. A total of 34 infants met the inclusion criteria. Median age at presentation was 5 months. Seventy-four percent of the infants had CHD lesion characterized by increased pulmonary blood flow (shunt lesions). Though none of the patients met the strict criteria for sepsis or pneumonia, 74% were admitted with a diagnosis of pneumonia or sepsis. Only 15% of patient had congestive heart failure as an admitting diagnosis. Oxygen therapy was given to 94% of these patients. Fifty-nine percent of these patients expired during the admission, 95% of those expired had multiorgan dysfunction. Patients with CHD awaiting surgery and who admitted to the PICU with acute illness are at high risk for mortality. Stringent criteria to diagnose pneumonia or sepsis should be used in these patients. © 2013 Wiley Periodicals, Inc.

Natural Killer/T-cell Neoplasms: Analysis of Incidence, Patient Characteristics, and Survival Outcomes in the United States.

PubMed

Kommalapati, Anuhya; Tella, Sri Harsha; Ganti, Apar Kishore; Armitage, James O

2018-05-04

Limited data are available regarding the incidence, survival patterns, and long-term outcomes of natural killer (NK)/T-cell neoplasms in the United States. We performed a retrospective study of patients with NK/T-cell neoplasms diagnosed from 2001 to 2014 using the Surveillance, Epidemiology, and End Results program database. The Kaplan-Meier method was used to estimate the overall survival difference among the subgroups. Multivariate analyses were used to determine the factors affecting survival. For the 797 patients with NK/T-cell lymphoma, nasal type, the median age at diagnosis was 53 years, and males tended to be younger at diagnosis (P < .0001). The incidence of the disease increased from 0.4 in 2001 to 0.8 in 2014 per 1,000,000 individuals. The incidence was significantly greater in Hispanic patients compared with that in non-Hispanic patients (rate ratio, 3.03; P = .0001). The median overall survival was 20 months (range, 2-73 months) and varied significantly according to the primary site (P < .0001) and the disease stage at diagnosis (P < .0001). NK/T-cell lymphoma patients had an increased risk of acute myeloid leukemia (standardized incidence ratio, 18.77; 95% confidence interval, 2.27-67.81). For the 105 NK/T-cell leukemia patients, the median age at diagnosis was 58 years (range, 4-95 years). The overall incidence of the disease was 0.09 per 1,000,000 individuals and was significantly greater in males (rate ratio, 0.41; P < .0001). Unlike NK/T-cell lymphoma, no racial disparities were found in the incidence. The median overall survival was 17 months (range, 0-36 months). The incidence of NK/T-cell lymphoma, nasal type, in the United States has at least doubled in the past decade, with the greatest predilection among Hispanics. Patients with NK/T-cell lymphoma might have an increased risk of the subsequent development of acute myeloid leukemia. Copyright © 2018 Elsevier Inc. All rights reserved.

Telemedicine Facilitates CHF Home Health Care for Those with Systolic Dysfunction

PubMed Central

Seibert, Pennie S.; Whitmore, Tiffany A.; Patterson, Carin; Parker, Patrick D.; Otto, Caitlin; Basom, Jean; Whitener, Nichole; Zimmerman, Christian G.

2008-01-01

An estimated 5 million Americans have congestive heart failure (CHF) and one in five over the age of 40 will develop CHF. There are numerous examples of CHF patients living beyond the years normally expected for people with the disease, usually attributed to taking an active role in disease management. A relatively new alternative for CHF outpatient care is telemedicine and e-health. We investigated the effects of a 6-week in-home telemedicine education and monitoring program for those with systolic dysfunction on the utilization of health care resources. We also measured the effects of the unit 4.5 months after its removal (a total of 6 months post introduction of the unit into the home). Concurrently, we assessed participants' perceptions of the value of having a telemedicine unit. Participants in the telemedicine group reported weighing more times a week with less variability than did the control group. Telemedicine led to a reduction in physician and emergency department visits and those in the experimental group reported the unit facilitating self-care, though this was not significantly different from the control group (possibly due to small sample size). These findings suggest a possibility for improvement in control of CHF when telemedicine is implemented. Our review of the literature also supports the role of telemedicine in facilitating home health care and self-management for CHF patients. There are many challenges still to be addressed before this potential can be reached and further research is needed to identify opportunities in telemedicine. PMID:18369411

Monthly fractional green vegetation cover associated with land cover classes of the conterminous USA

USGS Publications Warehouse

Gallo, Kevin P.; Tarpley, Dan; Mitchell, Ken; Csiszar, Ivan; Owen, Timothy W.; Reed, Bradley C.

2001-01-01

The land cover classes developed under the coordination of the International Geosphere-Biosphere Programme Data and Information System (IGBP-DIS) have been analyzed for a study area that includes the Conterminous United States and portions of Mexico and Canada. The 1-km resolution data have been analyzed to produce a gridded data set that includes within each 20-km grid cell: 1) the three most dominant land cover classes, 2) the fractional area associated with each of the three dominant classes, and 3) the fractional area covered by water. Additionally, the monthly fraction of green vegetation cover (fgreen) associated with each of the three dominant land cover classes per grid cell was derived from a 5-year climatology of 1-km resolution NOAA-AVHRR data. The variables derived in this study provide a potential improvement over the use of monthly fgreen linked to a single land cover class per model grid cell.

Early life factors associated with the exclusivity and duration of breast feeding in an Irish birth cohort study.

PubMed

Smith, Hazel Ann; O'B Hourihane, Jonathan; Kenny, Louise C; Kiely, Mairead; Murray, Deirdre M; Leahy-Warren, Patricia

2015-09-01

to investigate the influence of parental and infant characteristics on exclusive breast feeding from birth to six months of age and breast feeding rates at two, six and 12 months of age in Ireland. secondary data analysis from the Cork BASELINE Birth Cohort Study (http://www.baselinestudy.net/). Infants were seen at birth and two, six, and 12 months of age. Maternal and paternal history, neonatal course and feeding data were collected at birth and using parental questionnaires at each time point. 1094 singleton infants of primiparous women recruited at 20 weeks' gestation who were breastfeeding on discharge from the maternity hospital. at discharge from the maternity hospital and at two months, neonatal intensive-care unit admission had the strongest influence on exclusive breast feeding status (adjusted OR 0.17, 95% CI 0.07-0.41 at discharge) and at two months (adjusted OR=0.20, 95% CI 0.05-0.83). A shorter duration of breast feeding was significantly associated with younger maternal age, non-tertiary education, Irish nationality and neonatal intensive-care unit admission. There was a significant difference in the duration of any breast feeding between infants who were and were not admitted to the neonatal intensive-care unit, 28(10.50, 32) weeks versus 32(27, 40) weeks. Mothers whose maternity leave was between seven and 12 months (adjusted OR=2.76, 95% CI 1.51-5.05) breast fed for a longer duration compared to mothers who had less than six months of maternity leave. admission to the neonatal intensive care unit negatively influenced both exclusivity and duration of breast feeding. Length of maternity leave, and not employment status, was significantly associated with duration of breast feeding. additional support may be required to ensure continued breast feeding in infants admitted to the neonatal intensive-care unit. Length of maternity leave is a modifiable influence on breast feeding and offers the opportunity for intervention to improve our rates of breast feeding. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impact of Vitamin D Supplementation on Gross Motor Development of Healthy Term Infants: A Randomized Dose-Response Trial.

PubMed

Wicklow, Brandy; Gallo, Sina; Majnemer, Annette; Vanstone, Catherine; Comeau, Kathryn; Jones, Glenville; L'Abbe, Mary; Khamessan, Ali; Sharma, Atul; Weiler, Hope; Rodd, Celia

2016-08-01

In addition to benefits for bone health, vitamin D is implicated in muscle function in children and adults. To determine if vitamin D dosage positively correlated with gross motor development at 3 and 6 months of age. We hypothesized that higher doses would be associated with higher scores for gross motor skills. A consecutive sample of 55 healthy, term, and breastfed infants from Montreal, Canada were recruited from a randomized trial of vitamin D supplementation between 2009 and 2012. Infants were randomized to 400 International Units (IU) (n = 19), 800 IU (n = 18) or 1,200 IU (n = 18) vitamin D3/day. Motor performance at 3 and 6 months was quantified by the Alberta Infant Motor Scale (AIMS). Plasma vitamin D3 metabolites were measured by tandem mass spectrometry. AIMS scores did not differ at 3 months. However, total AIMS scores and sitting subscores were significantly higher at 6 months in infants receiving 400 IU/day compared to 800 IU/day and 1,200 IU/day groups (p < .05). There were weak negative correlations with length and C-3 epimer of 25(OH)D. In contrast to our hypothesis, gross motor achievements were significantly higher in infants receiving 400 IU/day vitamin D. Our findings also support longer infants being slightly delayed.

The effect of increased mobility on morbidity in the neurointensive care unit.

PubMed

Titsworth, W Lee; Hester, Jeannette; Correia, Tom; Reed, Richard; Guin, Peggy; Archibald, Lennox; Layon, A Joseph; Mocco, J

2012-06-01

The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population. This study was a single-institution prospective intervention trial to investigate the effectiveness of increased mobility among neurointensive care unit patients. All patients admitted to the neurointensive care unit of a tertiary care center over a 16-month period (April 2010 through July 2011) were evaluated. The study consisted of a 10-month (8025 patient days) preintervention observation period followed by a 6-month (4455 patient days) postintervention period. The intervention was a comprehensive mobility initiative utilizing the Progressive Upright Mobility Protocol (PUMP) Plus. Implementation of the PUMP Plus increased mobility among neurointensive care unit patients by 300% (p < 0.0001). Initiation of this protocol also correlated with a reduction in neurointensive care unit length of stay (LOS; p < 0.004), hospital LOS (p < 0.004), hospital-acquired infections (p < 0.05), and ventilator-associated pneumonias (p < 0.001), and decreased the number of patient days in restraints (p < 0.05). Additionally, increased mobility did not lead to increases in adverse events as measured by falls or inadvertent line disconnections. Among neurointensive care unit patients, increased mobility can be achieved quickly and safely with associated reductions in LOS and hospital-acquired infections using the PUMP Plus program.

$1.8 Million and counting: how volatile agent education has decreased our spending $1000 per day.

PubMed

Miller, Scott A; Aschenbrenner, Carol A; Traunero, Justin R; Bauman, Loren A; Lobell, Samuel S; Kelly, Jeffrey S; Reynolds, John E

2016-12-01

Volatile anesthetic agents comprise a substantial portion of every hospital's pharmacy budget. Challenged with an initiative to lower anesthetic drug expenditures, we developed an education-based intervention focused on reducing volatile anesthetic costs while preserving access to all available volatile anesthetics. When postintervention evaluation demonstrated a dramatic year-over-year reduction in volatile agent acquisition costs, we undertook a retrospective analysis of volatile anesthetic purchasing data using time series analysis to determine the impact of our educational initiative. We obtained detailed volatile anesthetic purchasing data from the Central Supply of Wake Forest Baptist Health from 2007 to 2014 and integrated these data with the time course of our educational intervention. Aggregate volatile anesthetic purchasing data were analyzed for 7 consecutive fiscal years. The educational initiative emphasized tissue partition coefficients of volatile anesthetics in adipose tissue and muscle and their impact on case management. We used an interrupted time series analysis of monthly cost per unit data using autoregressive integrated moving average modeling, with the monthly cost per unit being the amount spent per bottle of anesthetic agent per month. The cost per unit decreased significantly after the intervention (t=-6.73, P<.001). The autoregressive integrated moving average model predicted that the average cost per unit decreased $48 after the intervention, with 95% confidence interval of $34 to $62. As evident from the data, the purchasing of desflurane and sevoflurane decreased, whereas that of isoflurane increased. An educational initiative focused solely on the selection of volatile anesthetic agent per case significantly reduced volatile anesthetic expense at a tertiary medical center. This approach appears promising for application in other hospitals in the rapidly evolving, value-added health care environment. We were able to accomplish this with instruction on tissue partition coefficients and each agent's individual cost per MAC-hour delivered. Copyright © 2016 Elsevier Inc. All rights reserved.

Stereological study of developing glomerular forms during human fetal kidney development.

PubMed

Dakovic Bjelakovic, Marija; Vlajkovic, Slobodan; Petrovic, Aleksandar; Bjelakovic, Marko; Antic, Milorad

2018-05-01

Human fetal kidney development is a complex and stepwise process. The number, shape, size and distribution of glomeruli provide important information on kidney organization. The aim of this study was to quantify glomerular developing forms during human fetal kidney development using stereological methods. Kidney tissue specimens of 40 human fetuses with gestational ages ranging from 9 to 40 weeks were analyzed. Specimens were divided into eight groups based on gestational age, each corresponding to 1 lunar month. Stereological methods were used at the light microscopy level to estimate volume, surface and numerical density of the glomerular developing forms. During gestation, nephrogenesis continually advanced, and the number of nephrons increased. Volume, surface and numerical densities of vesicular forms and S-shaped bodies decreased gradually in parallel with gradual increases in estimated stereological parameters for vascularized glomeruli. Volume density and surface density of vascularized glomeruli increased gradually during fetal kidney development, and numerical density increased until the seventh lunar month. A relative decrease in vascularized glomeruli per unit volume of cortex occurred during the last 3 lunar months. Nephrogenesis began to taper off by 32 weeks and was completed by 36 weeks of gestation. The last sample in which we observed vesicles was from a fetus aged 32 weeks, and the last sample with S-shaped bodies was from a fetus aged 36 weeks. The present study is one of few quantitative studies conducted on human kidney development. Knowledge of normal human kidney morphogenesis during development could be important for future medical practice. Events occurring during fetal life may have significant consequences later in life.

Electronic monitoring of occlusion treatment for amblyopia in patients aged 7 to 16 years.

PubMed

Fronius, Maria; Bachert, Iris; Lüchtenberg, Marc

2009-10-01

Age limits for the prescription of amblyopia treatment have been debated and challenged recently, due to results of studies from ophthalmology and the neurosciences. Lack of knowledge about compliance with prescribed treatment is still a major factor for the uncertainty about the amount of plasticity in the visual system of older children and adolescents. The development of devices for the electronic recording of patching (Occlusion Dose Monitor, ODM) has allowed the collection of objective data about daily occlusion. In a prospective study, occlusion dose rates were recorded continuously during 4 months by means of the ODM developed in the Netherlands [1] in nine amblyopic patients between 7 and 16 years of age who were prescribed between 5 and 7 hours of daily patching. Visual acuity was assessed every 3 to 6 weeks. The electronic monitoring showed objective occlusion between 2 and 6.25 hours/day (mean 4.61 h/d) during the first month and 0 to 6.5 hours/day (mean 3.47 h/d) during the following 3 months of treatment. The total acuity gain in the amblyopic eye amounted to between -0.1 and 0.4 log units (mean 0.19) for crowded optotypes. Differences to initial acuities were statistically significant. The calculated average dose-response relationship (cumulated hours occlusion*0.1/acuity gain) for 4 months of occlusion was 234 hours of occlusion per 0.1 log unit of acuity gain. This study presents for the first time objective treatment and dose response data in amblyopic patients beyond the "classical" treatment age. Electronic monitoring of occlusion and considerable amounts of patching were shown to be feasible. The acuity results indicate that there is a potential for improvement, yet treatment seemed to be less efficient than shown by previous studies in younger patients. Continuation of this research may advance the discussion about age-dependent evidence-based amblyopia treatment, about preschool screening for amblyopia and about plasticity of the visual system.

A controlled, randomized, delayed-start study of rasagiline in early Parkinson disease.

PubMed

2004-04-01

Treatment with rasagiline mesylate, an irreversible monoamine oxidase type B inhibitor, improves symptoms of early Parkinson disease (PD). Preclinical studies suggest that this compound may also modify the progression of PD. To compare the effects of early and later initiation of rasagiline on progression of disability in patients with PD. Double-blind, parallel-group, randomized, delayed-start clinical trial. Four hundred four subjects with early PD, not requiring dopaminergic therapy, enrolled at 32 sites in the United States and Canada. Subjects were randomized to receive rasagiline, 1 or 2 mg/d, for 1 year or placebo for 6 months followed by rasagiline, 2 mg/d, for 6 months. Change in total Unified Parkinson's Disease Rating Scale score from baseline to 12 months. Three hundred seventy-one subjects were included in the 1-year efficacy analysis. Subjects treated with rasagiline, 2 mg/d, for 1 year had a 2.29-unit smaller increase in mean adjusted total Unified Parkinson's Disease Rating Scale score compared with subjects treated with placebo for 6 months followed by rasagiline, 2 mg/d, for 6 months (P =.01). The mean adjusted difference between the placebo/rasagiline, 2 mg/d, group and those receiving rasagiline, 1 mg/d, for 1 year was -1.82 unit on the Unified Parkinson's Disease Rating Scale score (P =.05). Subjects treated with rasagiline, 2 and 1 mg/d, for 12 months showed less functional decline than subjects whose treatment was delayed for 6 months.

Long-term changes in open field activity of male mice irradiated with low levels of gamma rays at late stage of development.

PubMed

Minamisawa, T; Hirokaga, K

1996-06-01

The open field activity of first generation (F1) hybrid male C57BL/6 x C3H mice irradiated with gamma-rays on the 14th day of gestation was studied at the following ages: 6-7 months, 12-13 months and 19-20 months. Doses were 0.1 Gy or 0.2 Gy. Open field activity was recorded with a camera. The camera output signal was recorded every sec through an A/D converter to a personal computer. The field was divided into 25 units of 8 cm square. All recordings were continuous for 60 min. The time which the 0.2-Gy group recorded at 6-7 months, spent in the 4 squares in the corner fields was high in comparison with the control group at the same age. The walking distance of the 0.1-Gy group recorded at 12-13 months was longer than that for the age matched control group. No effect of radiation was found on any of the behaviors observed and recorded at 19-20 months. The results demonstrate that exposure to low levels of gamma-rays on the 14th day of gestation results in behavioral changes, which occur at 6-7 and 12-13 months but not 19-20 months.

SCOPEOUT: sustainability and spread of quality improvement activities in long-term care- a mixed methods approach.

PubMed

Cranley, Lisa A; Hoben, Matthias; Yeung, Jasper; Estabrooks, Carole A; Norton, Peter G; Wagg, Adrian

2018-03-12

Interventions to improve quality of care for residents of long-term care facilities, and to examine the sustainability and spread of such initiatives, remain a top research priority. The purpose of this exploratory study was to assess the extent to which activities initiated in a quality improvement (QI) collaborative study using care aide led teams were sustained or spread following cessation of the initial project and to identify factors that led to its success. This study used an exploratory mixed methods study design and was conducted in seven residential long-term care facilities in two Canadian provinces. Sustainability and spread of QI activities were assessed by a questionnaire over five time points for 18 months following the collaborative study with staff from both intervention with non-intervention units. Semi-structured interviews were conducted with care managers at six and 12 months. QI team success in applying the QI model was ranked as high, medium, or low using criteria developed by the research team. Descriptive statistics, bivariate analyses, and General Estimating Equations were used to analyze the data. Interview data were analyzed using thematic analysis. In total, 683 surveys were received over the five time periods from 476 unique individuals on a facility unit. Seven managers were interviewed. A total of 533 surveys were analyzed. While both intervention and non-intervention units experienced a decline over time in all outcome measures, this decline was significantly less pronounced on intervention units. Facilities with medium and high success ranking had significantly higher scores in all four outcomes than facilities with a low success ranking. Care aides reported significantly less involvement of others in QI activities, less empowerment and less satisfaction with the quality of their work life than regulated care providers. Manager interviews provided evidence of sustainability of QI activities on the intervention units in four of the seven facilities up to 18 months following the intervention and demonstrated the need for continued staff and leadership engagement. Sustainability of a QI project which empowers and engages care aides is possible and achievable, but requires ongoing staff and leadership engagement.

[Physical and technical quality assurance in German breast cancer screening: progress report of the Reference Center Muenster after three years].

PubMed

Sommer, A; Girnus, R; Wendt, B; Czwoydzinski, J; Wüstenbecker, C; Heindel, W; Lenzen, H

2009-05-01

German breast cancer screening is monitored by a large physical quality assurance program. This report refers to the first experiences of the Reference Center (RC) Muenster after three years of the technical quality control of digital and analog mammography units (MU). This paper also shows whether the presently used quality assurance (QA) method is able to ensure that the MUs in the screening program are functioning without any serious problems. RC Muenster supervises 95 units (May 2008). The daily, weekly and monthly quality assurance of these units is controlled by web-based QA software named "MammoConrol" and developed by RC Muenster. The annual QA for the units must be conducted in the form of an on-site inspection by medical physics experts of the RC and is scored by an objective ranking system. The results of these QA routines were evaluated and analyzed for this paper. During the period from 3/1/2006 to 5/31/2008, 8 % of the analog systems and 1 % of the digital systems exhibited problems in the daily QA. For 9 % of the analog MUs and 17 % of the digital MUs, failures appeared in the monthly QA. In the annual control, 86.7 % of the analog units exhibited slight problems and 13.3 % had serious problems. With respect to the digital units, 12 % were without any defects, 58 % had slight problems, 27 % had serious failures and 3 % had to be reported to the responsible authorities and were temporarily shut down. The special quality control requirements for German breast cancer screening, including annual on-site checks of the units, have shown in the last three years that QA with a high monitoring standard can be ensured for a large number of decentralized MUs. The currently used QA method sufficiently ensures that the screening program is technically safe. Further studies must show whether the density and focus of the QA measures must be reconfigured.

Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study

PubMed Central

Spittal, Matthew J; Grant, Genevieve; O’Donnell, Meaghan; McFarlane, Alexander C; Studdert, David M

2018-01-01

Objectives We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury. Design Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury. Setting Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia. Participants 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme. Primary outcome measures 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey. Results Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes. Conclusions The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions. PMID:29705763

Use of Fibrates in the United States and Canada

PubMed Central

Jackevicius, Cynthia A.; Tu, Jack V.; Ross, Joseph S.; Ko, Dennis T.; Carreon, Daniel; Krumholz, Harlan M.

2012-01-01

Context Interest in the role of fibrates has intensified with the publication of the negative ACCORD trial with fenofibrate, especially since the evidence for clinical outcomes benefit for fibrates is heavily weighted on older fibrates, gemfibrozil and clofibrate. Objective This study seeks to examine trends in the current use of fibrates, and for fenofibrate, to illuminate the relationship between differences in the availability of proprietary versus generic formulations and use and economic implications in the United States (US) compared with Canada. Design/Setting/Patients Population-level, cohort study using IMS Health data in the United States and Canada of patients prescribed fibrates between 2002 and 2009. Main Outcome Measure(s) Fibrate prescribing and expenditures. Results From 2002–2009, fibrate prescriptions increased 117.1% in the US, by 12,000/month to 2.1 million prescriptions/month, yet only increased by 18.1% in Canada. (p<0.001) Fenofibrate use was relatively constant in Canada, while in the US, it increased by 159.3%, comprising 47.9% of total fibrate prescriptions in 2002 and 65.2% in 2009. The annual ratio of generic:brand fenofibrate use in the US from 2002 to 2008 ranged from 0:1 to 0.09:1, while the ratio in Canada steadily increased from 2005 to 2008 from 0.51:1 to 1.89:1. In the US, crude fenofibrate expenditures rose from $33.2 million/month in 2002 to $129.6 million/month in 2009, while those in Canada declined from $5.6 million/month to $5.1 million/month. Fibrate expenditures per 100,000 population were 3-fold higher in the US compared with Canada in 2009. Conclusions During the past decade, prescriptions for fibrates, particularly, fenofibrate, increased in the United States, while prescriptions for fibrates in Canada remained stable. PMID:21427374

78 FR 61809 - National Disability Employment Awareness Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-04

... National Disability Employment Awareness Month, 2013 By the President of the United States of America A... thought, experience, and ability. Every day, Americans with disabilities enrich our communities and... points of view to express. During National Disability Employment Awareness Month, we nurture our culture...

Predictors of retention in a drug-free unit/substance abuse treatment in prison.

PubMed

Casares-López, María José; González-Menéndez, Ana; Festinger, David S; Fernández-García, Paula; Fernández-Hermida, José Ramón; Secades, Roberto; Matejkowski, Jason

2013-01-01

The high rate of dropout from treatment programs is a recurring problem in the field of drug dependence. The purpose of this study was to identify the predictors of retention in a prison-based drug-free unit (DFU). The relationships among subscales of the Addiction Severity Index (ASI) as well as motivation and personality profiles and length of stay in a DFU, of 57 prisoners admitted for the first time to the program were analyzed. The mean dropout rates were 52.9% at six months and 67.8% at one year. The mean length of stay was 195.05 days. Predictors of retention at six months included the ASI Family Composite Score, the motivation subscale Taking Steps, and Narcissistic personality trait score. Predictors of retention at one year included lower ASI Psychological Composite Score, higher scores on the motivation subscale Ambivalence, and higher number of charges pending at the time of admission to the program. Identification of these predictor variables may be useful for developing strategies to increase retention in the context of in-prison substance abuse treatment. Copyright © 2013. Published by Elsevier Ltd.

Incidence of fractures attributable to abuse in young hospitalized children: results from analysis of a United States database.

PubMed

Leventhal, John M; Martin, Kimberly D; Asnes, Andrea G

2008-09-01

The goal was to assess the proportion of children with fractures attributable to abuse and the incidence of fractures caused by abuse among children <36 months of age who were hospitalized in the United States. We used the Kids' Inpatient Database, which has discharge data on 80% of acute pediatric hospitalizations in the United States, for 3 time periods (1997, 2000, and 2003). Fractures attributable to abuse in children <36 months of age were identified by both an International Classification of Diseases, Ninth Revision, Clinical Modification code for fracture and a diagnosis external-cause-of-injury code for abuse. Weighted estimates of the incidence were calculated. Among children <36 months of age who were hospitalized with fractures, the proportions of cases attributable to abuse were 11.9% in 1997, 11.9% in 2000, and 12.1% in 2003. The proportions of cases attributable to abuse decreased with increasing age; for example, in 2003, the proportions attributable to abuse were 24.9% for children <12 months of age, 7.2% for children 12 to 23 months of age, and 2.9% for children 24 to 35 months of age. In 2003, the incidence of fractures caused by abuse was 15.3 cases per 100000 children <36 months of age. The incidence was 36.1 cases per 100000 among children <12 months of age; this decreased to 4.8 cases per 100000 among 12- to 23-month-old children and 4.8 cases per 100000 among 24- to 35-month-old children. The Kids' Inpatient Database can be used to provide reasonable estimates of the incidence of hospitalization with fractures attributable to child abuse. For children <12 months of age, the incidence was 36.1 cases per 100000, a rate similar to that of inflicted traumatic brain injury (25-32 cases per 100000).

Variability of runoff-based drought conditions in the conterminous United States

USGS Publications Warehouse

McCabe, Gregory J.; Wolock, David M.; Austin, Samuel H.

2017-01-01

In this study, a monthly water-balance model is used to simulate monthly runoff for 2109 hydrologic units (HUs) in the conterminous United States (CONUS) for water-years 1901 through 2014. The monthly runoff time series for each HU were smoothed with a 3-month moving average, and then the 3-month moving-average runoff values were converted to percentiles. For each HU, a drought was considered to occur when the HU runoff percentile dropped to the 20th percentile or lower. A drought was considered to end when the HU runoff percentile exceeded the 20th percentile. After identifying drought events for each HU, the frequency and length of drought events were examined. Results indicated that (1) the longest mean drought lengths occur in the eastern CONUS and parts of the Rocky Mountain region and the northwestern CONUS, (2) the frequency of drought is highest in the southwestern and central CONUS, and lowest in the eastern CONUS, the Rocky Mountain region, and the northwestern CONUS, (3) droughts have occurred during all months of the year and there does not appear to be a seasonal pattern to drought occurrence, (4) the variability of precipitation appears to have been the principal climatic factor determining drought, and (5) for most of the CONUS, drought frequency appears to have decreased during the 1901 through 2014 period.

An improved water budget for the El Yunque National Forest, Puerto Rico, as determined by the Water Supply Stress Index Model

Treesearch

Liangxia Zhang; Ge Sun; Erika Cohen; Steven McNulty; Peter Caldwell; Suzanne Krieger; Jason Christian; Decheng Zhou; Kai Duan; Keren J. Cepero-Pérez

2018-01-01

Quantifying the forest water budget is fundamental to making science-based forest management decisions. This study aimed at developing an improved water budget for the El Yunque National Forest (ENF) in Puerto Rico, one of the wettest forests in the United States. We modified an existing monthly scale water balance model, Water Supply Stress Index (WaSSI), to reflect...

Upscaling key ecosystem functions across the conterminous United States by a water‐centric ecosystem model

Treesearch

Ge Sun; Peter Caldwell; Asko Noormets; Steven G. McNulty; Erika Cohen; al. et.

2011-01-01

We developed a water‐centric monthly scale simulation model (WaSSI‐C) by integrating empirical water and carbon flux measurements from the FLUXNET network and an existing water supply and demand accounting model (WaSSI). The WaSSI‐C model was evaluated with basin‐scale evapotranspiration (ET), gross ecosystem productivity (GEP), and net ecosystem exchange (NEE)...

Effect of standardized orders and provider education on head-of-bed positioning in mechanically ventilated patients.

PubMed

Helman, Donald L; Sherner, John H; Fitzpatrick, Thomas M; Callender, Marcia E; Shorr, Andrew F

2003-09-01

Semirecumbent head-of-bed positioning in mechanically ventilated patients decreases the risk of developing ventilator-associated pneumonia (VAP). The purpose of this study was to determine whether the addition of a standardized order followed by the initiation of a provider education program would increase the frequency with which our patients were maintained in the semirecumbent position. Prospective, pre-, and postintervention observational study. A tertiary care, U.S. Army teaching hospital. Mechanically ventilated medical and surgical intensive care unit patients. The first intervention involved the addition of an order for semirecumbent head-of-bed positioning to our intensive care unit order sets. This was followed 2 months later with a second intervention, which was a nurse and physician education program emphasizing semirecumbent positioning. Data regarding head-of-bed positioning were collected on 100 patient observations at baseline and at 1 and 2 months after each of our interventions. The mean angle of head of bed increased from 24 +/- 9 degrees at baseline to 35 +/- 9 degrees (p <.05) 2 months after the addition of the standard order. The percentage of observations with head of bed >45 degrees increased from 3% to 16% 2 months after the standardized order (p <.05). Two months after our provider education program, the mean angle of the head of bed was 34 +/- 11 degrees and the percentage of patients with head of bed >45 degrees was 29% (p = NS compared with values after the first intervention). Data collected 6 months after completion of our education programs showed that these improvements were maintained. Standardizing the process of care via the addition of an order specifying head-of-bed position significantly increased the number of patients who were placed in the semirecumbent position. In an era of cost-conscious medicine, interventions that utilize protocols and education programs should be emphasized.

High frequency of multi drug resistant Gram-negative rods in two neonatal intensive care units in the Philippines

PubMed Central

Litzow, JM; Gill, CJ; Mantaring, JBV; Fox, M; Mendoza, M; Mendoza, S; Scobie, R; Huskins, WC; Goldman, DA; Hamer, DH

2013-01-01

Background Though hospital-acquired infections appear to be a growing threat to newborn survival in the developing world, the epidemiology of this problem remains poorly characterized. Methods Over a 10 month period, we conducted prospective longitudinal surveillance for colonization and bloodstream infections with Gram-negative rods (GNRs) among all infants admitted to the two largest neonatal intensive care units (NICUs) in Manila, the Philippines, determined antibiotic sensitivities, and calculated adjusted odds ratios (OR) for factors for bacteremia using multivariate logistic regression. Results Among 1,831 neonates enrolled over a 10-month period, 1017 (55%) became newly colonized and 358 (19.6%) became bacteremic with a resistant GNR, most commonly Klebsiella species, Enterobacter species, Acinetobacter species, and Pseudomonas aeruginosa. The proportion of invasive isolates with antibiotic resistance was: imipenem 20%, trimethoprim-sulfamethoxazole 41%, amikacin 52%, ampicillin/sulbactam 63%, ceftazidime 67%, and tobramycin 80%. Factors significantly associated with increased risk of bacteremia were mechanical ventilation and prematurity. Additionally, colonization with a resistant GNR was an independent risk for bacteremia. (OR 1.4, 95% CI 1.0 – 1.9) Conclusions Colonization with a resistant GNR was an independent risk factor for sepsis. If our data are typical, the unusually high intensity of colonization pressure and disease with multidrug-resistant GNRs at these two NICUs constitutes an emerging health care crisis in the developing world. Improved infection control methods are therefore critically needed in developing country settings. PMID:19435448

Risk of vancomycin-resistant enterococci bloodstream infection among patients colonized with vancomycin-resistant enterococci.

PubMed

Kara, Ahu; Devrim, İlker; Bayram, Nuri; Katipoğlu, Nagehan; Kıran, Ezgi; Oruç, Yeliz; Demiray, Nevbahar; Apa, Hurşit; Gülfidan, Gamze

2015-01-01

Vancomycin-resistant enterococci colonization has been reported to increase the risk of developing infections, including bloodstream infections. In this study, we aimed to share our experience with the vancomycin-resistant enterococci bloodstream infections following gastrointestinal vancomycin-resistant enterococci colonization in pediatric population during a period of 18 months. A retrospective cohort of children admitted to a 400-bed tertiary teaching hospital in Izmir, Turkey whose vancomycin-resistant enterococci colonization was newly detected during routine surveillances for gastrointestinal vancomycin-resistant enterococci colonization during the period of January 2009 and December 2012 were included in this study. All vancomycin-resistant enterococci isolates found within 18 months after initial detection were evaluated for evidence of infection. Two hundred and sixteen patients with vancomycin-resistant enterococci were included in the study. Vancomycin-resistant enterococci colonization was detected in 136 patients (62.3%) while they were hospitalized at intensive care units; while the remaining majority (33.0%) were hospitalized at hematology-oncology department. Vancomycin-resistant enterococci bacteremia was present only in three (1.55%) patients. All these patients were immunosuppressed due to human immunodeficiency virus (one patient) and intensive chemotherapy (two patients). In conclusion, our study found that 1.55% of vancomycin-resistant enterococci-colonized children had developed vancomycin-resistant enterococci bloodstream infection among the pediatric intensive care unit and hematology/oncology patients; according to our findings, we suggest that immunosupression is the key point for developing vancomycin-resistant enterococci bloodstream infections. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

QUEST/Ada (query utility environment for software testing of Ada: The development of a program analysis environment for Ada, task 1, phase 3

NASA Technical Reports Server (NTRS)

Brown, David B.

1991-01-01

The results of research and development efforts of the first six months of Task 1, Phase 3 of the project are presented. The goals of Phase 3 are: (1) to further refine the rule base and complete the comparative rule base evaluation; (2) to implement and evaluate a concurrency testing prototype; (3) to convert the complete (unit-level and concurrency) testing prototype to a workstation environment; and (4) to provide a prototype development document to facilitate the transfer of research technology to a working environment. These goals were partially met and the results are summarized.

Important role of collective cell migration and nerve fiber density in the development of deep nodular endometriosis.

PubMed

Orellana, Renan; García-Solares, Javier; Donnez, Jacques; van Kerk, Olivier; Dolmans, Marie-Madeleine; Donnez, Olivier

2017-04-01

To evaluate deep nodular endometriotic lesions induced in baboons over 12 months and analyze collective cell migration and nerve fiber density. Morphologic and immunohistochemical analysis of endometriotic lesions induced in baboons over the course of 1 year. Academic research unit. Three female baboons (Papio anubis). Recovery of induced deep nodular endometriotic nodules from baboons. Evaluation of the morphology of glands by analysis of the center of lesions and the invasion front; immunohistochemical staining with Ki67, E-cadherin, and β-catenin for investigation of mitotic activity and cell-cell junctions, and with protein gene product 9.5 and nerve growth factor (NGF) for study of nerve fiber density (NFD). All (100%) of the lesions were invasive 1 year after induction, compared with 42.29% after 6 months. Glands from the invasion front showed significantly reduced thickness but significantly higher mitotic activity. E-Cadherin and β-catenin expression were similar between the center and front. NFD was significantly higher in lesions induced after 1 year than after 6 months, and NGF expression was significantly lower in 1-year lesions than in 6-month lesions. Nodular endometriotic lesions induced in the baboon model were found to be significantly more invasive and innervated after 12 months than after 6 months. The invasive phenotype was highly expressed in glands at the invasion front, and our study suggests that nerve fibers play a role in the development of lesions as observed in women. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Decompressive craniectomy and CSF disorders in children.

PubMed

Manfiotto, Marie; Mottolese, Carmine; Szathmari, Alexandru; Beuriat, Pierre-Aurelien; Klein, Olivier; Vinchon, Matthieu; Gimbert, Edouard; Roujeau, Thomas; Scavarda, Didier; Zerah, Michel; Di Rocco, Federico

2017-10-01

Decompressive craniectomy (DC) is a lifesaving procedure but is associated to several post-operative complications, namely cerebrospinal fluid (CSF) dynamics impairment. The aim of this multicentric study was to evaluate the incidence of such CSF alterations after DC and review their impact on the overall outcome. We performed a retrospective multicentric study to analyze the CSF disorders occurring in children aged from 0 to 17 years who had undergone a DC for traumatic brain injury (TBI) in the major Departments of Pediatric Neurosurgery of France between January 2006 and August 2016. Out of 150 children, ranging in age between 7 months and 17 years, mean 10.75 years, who underwent a DC for TBI in 10 French pediatric neurosurgical centers. Sixteen (6 males, 10 females) (10.67%) developed CSF disorders following the surgical procedure and required an extrathecal CSF shunting. External ventricular drainage increased the risk of further complications, especially cranioplasty infection (p = 0.008). CSF disorders affect a minority of children after DC for TBI. They may develop early after the DC but they may develop several months after the cranioplasty (8 months), consequently indicating the necessity of clinical and radiological close follow-up after discharge from the neurosurgical unit. External ventricular drainage and permanent CSF shunt placement increase significantly the risk of cranioplasty infection.

Distribution and Ecology of Campylobacters in Coastal Plain Streams (Georgia, United States of America)▿

PubMed Central

Vereen, Ethell; Lowrance, R. Richard; Cole, Dana J.; Lipp, Erin K.

2007-01-01

Campylobacter is the leading cause of bacterium-associated diarrhea in the United States and most developed countries. While this disease is considered a food-borne disease, many clinical cases cannot be linked to a food source. In rural and agrarian areas environmental transmission may be an important factor contributing to case loads. Here we investigated the waterborne prevalence of campylobacters in a mixed-use rural watershed in the coastal plain of southern Georgia (United States). Six sites representing various degrees of agricultural and human influence were surveyed biweekly to monthly for 1 year for the presence of culturable thermophilic campylobacters and other measures of water quality. Campylobacters were frequently present in agriculture- and sewage-impacted stretches of streams. The mean campylobacter counts and overall prevalence were highest downstream from a wastewater treatment plant that handled both human and poultry slaughterhouse waste (≤595 CFU ml−1; 100% positive); the concentrations were significantly higher than those for the four upstream sites (P < 0.05). The counts were significantly correlated with the number of fecal coliform bacteria, conductivity, pH, and concentrations of nutrients (NO3−, PO43−, and NH3). Campylobacters were isolated more frequently and larger numbers were present during the summer months, similar to the occurrence of clinical cases of campylobacteriosis in this region. A multivariate model showed that the levels were significantly influenced by increasing precipitation, which also peaked in the summer. The results indicate that loading from both human and domestic animal waste may be high in the watershed studied during the summer months. Mixed-use watersheds supporting agriculture production, human populations, and wildlife may be at risk for contamination by campylobacters and may be an important route for human exposure. PMID:17172457

Diagnostic Evaluation of Nmme Precipitation and Temperature Forecasts for the Continental United States

NASA Astrophysics Data System (ADS)

Karlovits, G. S.; Villarini, G.; Bradley, A.; Vecchi, G. A.

2014-12-01

Forecasts of seasonal precipitation and temperature can provide information in advance of potentially costly disruptions caused by flood and drought conditions. The consequences of these adverse hydrometeorological conditions may be mitigated through informed planning and response, given useful and skillful forecasts of these conditions. However, the potential value and applicability of these forecasts is unavoidably linked to their forecast quality. In this work we evaluate the skill of four global circulation models (GCMs) part of the North American Multi-Model Ensemble (NMME) project in forecasting seasonal precipitation and temperature over the continental United States. The GCMs we consider are the Geophysical Fluid Dynamics Laboratory (GFDL)-CM2.1, NASA Global Modeling and Assimilation Office (NASA-GMAO)-GEOS-5, The Center for Ocean-Land-Atmosphere Studies - Rosenstiel School of Marine & Atmospheric Science (COLA-RSMAS)-CCSM3, Canadian Centre for Climate Modeling and Analysis (CCCma) - CanCM4. These models are available at a resolution of 1-degree and monthly, with a minimum forecast lead time of nine months, up to one year. These model ensembles are compared against gridded monthly temperature and precipitation data created by the PRISM Climate Group, which represent the reference observation dataset in this work. Aspects of forecast quality are quantified using a diagnostic skill score decomposition that allows the evaluation of the potential skill and conditional and unconditional biases associated with these forecasts. The evaluation of the decomposed GCM forecast skill over the continental United States, by season and by lead time allows for a better understanding of the utility of these models for flood and drought predictions. Moreover, it also represents a diagnostic tool that could provide model developers feedback about strengths and weaknesses of their models.

Distribution and ecology of campylobacters in coastal plain streams (Georgia, United States of America).

PubMed

Vereen, Ethell; Lowrance, R Richard; Cole, Dana J; Lipp, Erin K

2007-03-01

Campylobacter is the leading cause of bacterium-associated diarrhea in the United States and most developed countries. While this disease is considered a food-borne disease, many clinical cases cannot be linked to a food source. In rural and agrarian areas environmental transmission may be an important factor contributing to case loads. Here we investigated the waterborne prevalence of campylobacters in a mixed-use rural watershed in the coastal plain of southern Georgia (United States). Six sites representing various degrees of agricultural and human influence were surveyed biweekly to monthly for 1 year for the presence of culturable thermophilic campylobacters and other measures of water quality. Campylobacters were frequently present in agriculture- and sewage-impacted stretches of streams. The mean campylobacter counts and overall prevalence were highest downstream from a wastewater treatment plant that handled both human and poultry slaughterhouse waste (

Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept.

PubMed

Ender, Joerg; Borger, Michael Andrew; Scholz, Markus; Funkat, Anne-Kathrin; Anwar, Nadeem; Sommer, Marcus; Mohr, Friedrich Wilhelm; Fassl, Jens

2008-07-01

The authors compared the safety and efficacy of a newly developed fast-track concept at their center, including implementation of a direct admission postanesthetic care unit, to standard perioperative management. All fast-track patients treated within the first 6 months of implementation of our direct admission postanesthetic care unit were matched via propensity scores and compared with a historical control group of patients who underwent cardiac surgery prior to fast-track implementation. A total of 421 fast-track patients were matched successfully to 421 control patients. The two groups of patients had a similar age (64 +/- 13 vs. 64 +/- 12 yr for fast-track vs. control, P = 0.45) and European System for Cardiac Operative Risk Evaluation-predicted risk of mortality (4.8 +/- 6.1% vs. 4.6 +/- 5.1%, P = 0.97). Fast-track patients had significantly shorter times to extubation (75 min [45-110] vs. 900 min [600-1140]), as well as shorter lengths of stay in the postanesthetic or intensive care unit (4 h [3.0-5] vs. 20 h [16-25]), intermediate care unit (21 h [17-39] vs. 26 h [19-49]), and hospital (10 days [8-12] vs. 11 days [9-14]) (expressed as median and interquartile range, all P < 0.01). Fast-track patients also had a lower risk of postoperative low cardiac output syndrome (0.5% vs. 2.9%, P < 0.05) and mortality (0.5% vs. 3.3%, P < 0.01). The Leipzig fast-track protocol is a safe and effective method to manage cardiac surgery patients after a variety of operations.

A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial.

PubMed

Shirazi, Mandana; Lonka, Kirsti; Parikh, Sagar V; Ristner, Gunilla; Alaeddini, Farshid; Sadeghi, Majid; Wahlstrom, Rolf

2013-02-01

To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders. Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness-to-change, sex, age and work experience. The intervention was a 2-day interactive workshop for a small group of GPs' at a higher stage of readiness-to-change ('intention') and a 2-day interactive large group meeting for those with lower propensity to change ('attitude') at the pre-assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs' performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention. GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001). Activating learning methods, tailored according to the participants' readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development. © 2011 Blackwell Publishing Ltd.

Preoperative Interventions and Charges Before Total Knee Arthroplasty.

PubMed

Cohen, Jeremiah R; Bradley, Alexander T; Lieberman, Jay R

2016-12-01

The cost effectiveness of total knee arthroplasty (TKA) has been well established, but little data exist regarding preoperative interventions and their costs. The purpose of this study was to examine preoperative interventions and their associated charges within the 2-year period before TKA. A retrospective cohort analysis of patients undergoing TKA between 2007 and 2011 was conducted using the PearlDiver Patient Record Database. Patients' inpatient and outpatient billing records were tracked over the 2-year period before receiving a TKA. A total of 35,596 patients from Medicare and 47,064 from United Healthcare underwent TKA from 2009 to 2011. In the 2-year period before TKA, the per patient average charge was $3545.82 for Medicare and $3281.57 for United Healthcare. In the 2-year period before TKA, 21.4% (Medicare) and 23.3% (United Healthcare) of all patients received a magnetic resonance imaging, with between 31.9% (Medicare) and 45.6% (United Healthcare) of these occurring within 3 months of surgery (P < .05). During this same period, 49.4% (Medicare) and 63.2% (United Healthcare) of all patients received an intra-articular injection, with between 29.4% (Medicare) and 44.8% (United Healthcare) of these occurring within 3 months of surgery (P < .05). Interventions and costs before TKA occur largely within 6 months preoperatively, with a substantial portion occurring within 3 months. These interventions may not be clinically or cost effective for certain patients, such as those with moderate-to-severe osteoarthritis. Foregoing these interventions and opting to perform TKA earlier may reduce costs and prevent unnecessary tests and procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Humanitarian obstetric care for refugees of the Syrian war. The first 6 months of experience of Gynécologie Sans Frontières in Zaatari Refugee Camp (Jordan).

PubMed

Bouchghoul, Hanane; Hornez, Emmanuel; Duval-Arnould, Xavier; Philippe, Henri-Jean; Nizard, Jacky

2015-07-01

To report the first 6 months of experience of a nongovernmental-organization-managed obstetric care unit in a war refugee camp, with problems encountered and solutions implemented. Prospective observational study of the maternity activity of Gynécologie Sans Frontières (GSF). GSF's maternity unit, in Zaatari camp (Jordan). All pregnant women among Syrian refugees who came to the unit for delivery. The GSF's maternity unit is a light structure built with three tents, permitting low-risk pregnancy care and childbirth. Emergency cesarean deliveries were performed in the Moroccan army field hospital. High-risk pregnancies were transferred to Al Mafraq or Amman Hospital (Jordan) after assessment. Delivery characteristics, indications for referral. From September 2012 to February 2013, 371 women attended the unit and 299 delivered in it. Delivery rates increased from 5/month to 112/month over the period. Mean gestational age at birth was 39(+3) gestational weeks (SD = 1.9). Median birthweight was 3100 g (25-75% interquartile range 2840-3430 g). Spontaneous vaginal deliveries were dominant and the major maternal complication was postpartum hemorrhage (n = 13). Eighty-two women were referred to Al Mafraq or Amman hospitals, mainly for preterm labor (32%) and congenital malformations (11%). We managed one case of stillbirth. Maternal mortality did not occur. Despite the difficulties of war, high-risk pregnant women were properly identified, permitting referrals when required. Cooperation with other nongovernmental organizations, including the United Nations High Commissioner for Refugees, was essential for the management of situations at risk of complications and to contain perinatal and maternal mortality. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Management of thyroid eye disease in the United Kingdom: A multi-centre thyroid eye disease audit.

PubMed

Mellington, F E; Dayan, C M; Dickinson, A J; Hickey, J L; MacEwen, C J; McLaren, J; Perros, P; Rose, G E; Uddin, J; Vaidya, B; Foley, P; Lazarus, J H; Mitchell, A; Ezra, D G

2017-06-01

This article aims to provide baseline data and highlight any major deficiencies in the current level of care provided for adult patients with thyroid eye disease (TED). We undertook a prospective, nonrandomized cross-sectional multicenter observational study. During a 3-month period June-August 2014, consecutive adult patients with TED who presented to nominated specialist eye clinics in the United Kingdom, completed a standardized questionnaire. Main outcome measures were: demographics, time from diagnosis to referral to tertiary centre, time from referral to review in specialist eye clinic, management of thyroid dysfunction, radioiodine and provision of steroid prophylaxis, smoking, and TED classification. 91 patients (mean age 47.88 years) were included. Female-to-male ratio was 6:1. Mean time since first symptoms of TED = 27.92 (73.71) months; from first visit to any doctor with symptoms to diagnosis = 9.37 (26.03) months; from hyperthyroidism diagnosis to euthyroidism 12.45 (16.81) months. First, 13% had received radioiodine. All those with active TED received prophylactic steroids. Seven patients who received radioiodine and did not have TED at the time went on to develop it. Then, 60% patients were current or ex-smokers. 63% current smokers had been offered smoking cessation advice. 65% patients had active TED; 4% had sight-threatening TED. A large proportion of patients (54%) were unaware of their thyroid status. Not enough patients are being provided with smoking cessation advice and information on the impact of smoking on TED and control of thyroid function.

Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial.

PubMed

Chapman, Donna J; Damio, Grace; Young, Sara; Pérez-Escamilla, Rafael

2004-09-01

Breastfeeding peer counseling has improved breastfeeding rates in developing countries; however, its impact in this country has not been adequately evaluated. To evaluate the effectiveness of an existing, breastfeeding peer counseling program within the United States. Randomized, prospective, controlled trial in which participants were recruited prenatally and randomly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling. An urban hospital serving a large population of low-income Latinas. Pregnant women (< or =26 weeks' gestation) were recruited from the hospital's prenatal clinic. Inclusion criteria specified that participants be low income, be considering breastfeeding, have delivered a healthy, full-term singleton, and have access to a telephone. Intervention Breastfeeding peer counseling services included 1 prenatal home visit, daily perinatal visits, 3 postpartum home visits, and telephone contact as needed. Breastfeeding rates at birth and 1, 3, and 6 months postpartum. The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls (8/90 [9%] vs 17/75 [23%]; relative risk, 0.39; 95% confidence interval, 0.18-0.86). The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month (36% vs 49%; relative risk, 0.72; 95% confidence interval, 0.50-1.05) and 3 months (56% vs 71%; relative risk, 0.78; 95% confidence interval, 0.61-1.00). These findings demonstrate that, in the United States, peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum.

Too Much Television? Prospective Associations Between Early Childhood Televiewing and Later Self-reports of Victimization by Sixth Grade Classmates.

PubMed

Watt, Emmalyne; Fitzpatrick, Caroline; Derevensky, Jeffrey L; Pagani, Linda S

2015-01-01

Using a birth cohort, this study aimed to verify whether televiewing at 29 months, a common early childhood pastime, is prospectively associated with self-reported victimization at age 12. Participants are 991 girls and 1006 boys from the Quebec Longitudinal Study of Child Development. The main predictor comprised parent-reported daily televiewing by their children at 29 months. In the sixth grade, children reported how often they experienced victimization by classmates in the past year. The authors conducted multivariate linear regression, in which child self-reports of victimization were linearly regressed on early televiewing and potential confounders. Every SD unit increase (0.88 hours) in daily televiewing at 29 months predicted an 11% SD unit increase in self-reported peer victimization by sixth grade classmates (unstandardized B = .031, p < .001, 95% confidence interval = 0.014-0.042). This relationship was adjusted for child characteristics (gender, preexisting externalizing behaviors, baseline cognitive abilities, and televiewing at age 12) and family characteristics (family configuration, income, and functioning, and maternal education). Daily televiewing time at 29 months was associated with a subsequent increased risk of victimization by classmates at the end of sixth grade, a period which represents a critical developmental transition to middle school. Youth who experience peer victimization are at an increased risk of long-term mental health issues, such as depression, underachievement, and low self-esteem. This prospective association, across a 10-year period, suggests the need for better parental awareness, acknowledgement, and compliance with existing recommendations put forth by the American Academy of Pediatrics.

American Society of Clinical Oncology National Census of Oncology Practices: Preliminary Report

PubMed Central

Forte, Gaetano J.; Hanley, Amy; Hagerty, Karen; Kurup, Anupama; Neuss, Michael N.; Mulvey, Therese M.

2013-01-01

In response to reports of increasing financial and administrative burdens on oncology practices and a lack of systematic information related to these issues, American Society of Clinical Oncology (ASCO) leadership started an effort to collect key practice-level data from all oncology practices in the United States. The result of the effort is the ASCO National Census of Oncology Practices (Census) launched in June 2012. The initial Census work involved compiling an inventory of oncology practices from existing lists of oncology physicians in the United States. A comprehensive, online data collection instrument was developed, which covered a number of areas, including practice characteristics (staffing configuration, organizational structure, patient mix and volume, types of services offered); organizational, staffing, and service changes over the past 12 months; and an assessment of the likelihood that the practice would experience organizational, staffing, and service changes in the next 12 months. More than 600 practices participated in the Census by providing information. In this article, we present preliminary highlights from the data gathered to date. We found that practice size was related to having experienced practice mergers, hiring additional staff, and increasing staff pay in the past 12 months, that geographic location was related to having experienced hiring additional staff, and that practices in metropolitan areas were more likely to have experienced practice mergers in the past 12 months than those in nonmetropolitan areas. We also found that practice size and geographic location were related to higher likelihoods of anticipating practice mergers, sales, and purchases in the future. PMID:23633966

77 FR 72677 - National Impaired Driving Prevention Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-05

... are also striving to stop substance abuse before it starts by supporting local prevention programs and... National Impaired Driving Prevention Month, 2012 By the President of the United States of America A... Driving Prevention Month reminds us of the importance of celebrating safely. Every year, accidents...

Techniques for estimating streamflow characteristics in the Eastern and Interior coal provinces of the United States

USGS Publications Warehouse

Wetzel, Kim L.; Bettandorff, J.M.

1986-01-01

Techniques are presented for estimating various streamflow characteristics, such as peak flows, mean monthly and annual flows, flow durations, and flow volumes, at ungaged sites on unregulated streams in the Eastern Coal region. Streamflow data and basin characteristics for 629 gaging stations were used to develop multiple-linear-regression equations. Separate equations were developed for the Eastern and Interior Coal Provinces. Drainage area is an independent variable common to all equations. Other variables needed, depending on the streamflow characteristic, are mean annual precipitation, mean basin elevation, main channel length, basin storage, main channel slope, and forest cover. A ratio of the observed 50- to 90-percent flow durations was used in the development of relations to estimate low-flow frequencies in the Eastern Coal Province. Relations to estimate low flows in the Interior Coal Province are not presented because the standard errors were greater than 0.7500 log units and were considered to be of poor reliability.

High Spatial Resolution Forecasting of Long-Term Monthly Precipitation and Mean Temperature Trends in Data Scarce Regions

NASA Astrophysics Data System (ADS)

Mosier, T. M.; Hill, D. F.; Sharp, K. V.

2013-12-01

High spatial resolution time-series data are critical for many hydrological and earth science studies. Multiple groups have developed historical and forecast datasets of high-resolution monthly time-series for regions of the world such as the United States (e.g. PRISM for hindcast data and MACA for long-term forecasts); however, analogous datasets have not been available for most data scarce regions. The current work fills this data need by producing and freely distributing hindcast and forecast time-series datasets of monthly precipitation and mean temperature for all global land surfaces, gridded at a 30 arc-second resolution. The hindcast data are constructed through a Delta downscaling method, using as inputs 0.5 degree monthly time-series and 30 arc-second climatology global weather datasets developed by Willmott & Matsuura and WorldClim, respectively. The forecast data are formulated using a similar downscaling method, but with an additional step to remove bias from the climate variable's probability distribution over each region of interest. The downscaling package is designed to be compatible with a number of general circulation models (GCM) (e.g. with GCMs developed for the IPCC AR4 report and CMIP5), and is presently implemented using time-series data from the NCAR CESM1 model in conjunction with 30 arc-second future decadal climatologies distributed by the Consultative Group on International Agricultural Research. The resulting downscaled datasets are 30 arc-second time-series forecasts of monthly precipitation and mean temperature available for all global land areas. As an example of these data, historical and forecast 30 arc-second monthly time-series from 1950 through 2070 are created and analyzed for the region encompassing Pakistan. For this case study, forecast datasets corresponding to the future representative concentration pathways 45 and 85 scenarios developed by the IPCC are presented and compared. This exercise highlights a range of potential meteorological trends for the Pakistan region and more broadly serves to demonstrate the utility of the presented 30 arc-second monthly precipitation and mean temperature datasets for use in data scarce regions.

Magellan: Preliminary description of Venus surface geologic units

NASA Technical Reports Server (NTRS)

Saunders, R. S.; Arvidson, R.; Head, J. W., III; Schaber, G. G.; Solomon, S. C.; Stofan, E. R.; Basilevsky, Alexander T.; Guest, J. E.; Mcgill, G. E.; Moore, H. J.

1991-01-01

Observations from approximately one-half of the Magellan nominal eight-month mission to map Venus are summarized. Preliminary compilation of initial geologic observations of the planet reveals a surface dominated by plains that are characterized by extensive and intensive volcanism and tectonic deformation. Four broad categories of units have been identified: plains units, linear belts, surficial units, and terrain units.

20 CFR 416.215 - You leave the United States.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false You leave the United States. 416.215 Section... Eligible § 416.215 You leave the United States. You lose your eligibility for SSI benefits for any month during all of which you are outside of the United States. If you are outside of the United States for 30...

20 CFR 416.215 - You leave the United States.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false You leave the United States. 416.215 Section... Eligible § 416.215 You leave the United States. You lose your eligibility for SSI benefits for any month during all of which you are outside of the United States. If you are outside of the United States for 30...

20 CFR 416.215 - You leave the United States.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false You leave the United States. 416.215 Section... Eligible § 416.215 You leave the United States. You lose your eligibility for SSI benefits for any month during all of which you are outside of the United States. If you are outside of the United States for 30...

Early Maternal Employment and Children's Academic and Behavioral Skills in Australia and the United Kingdom.

PubMed

Lombardi, Caitlin McPherran; Coley, Rebekah Levine

2017-01-01

This study assessed the links between early maternal employment and children's later academic and behavioral skills in Australia and the United Kingdom. Using representative samples of children born in each country from 2000 to 2004 (Australia N = 5,093, U.K. N = 18,497), OLS regression models weighted with propensity scores assessed links between maternal employment in the 2 years after childbearing and children's skills in first grade. There were neutral associations between maternal employment and children's first-grade skills in both countries. However, there was a slight indication that more time away from parenting was negatively linked to children's behavioral functioning in Australia and employment begun between 9 and 24 months was positively linked to cognitive skills for U.K. children of low-wage mothers. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

HeartMate II left ventricular assist system: from concept to first clinical use.

PubMed

Griffith, B P; Kormos, R L; Borovetz, H S; Litwak, K; Antaki, J F; Poirier, V L; Butler, K C

2001-03-01

The HeartMate II left ventricular assist device (LVAD) (ThermoCardiosystems, Inc, Woburn, MA) has evolved from 1991 when a partnership was struck between the McGowan Center of the University of Pittsburgh and Nimbus Company. Early iterations were conceptually based on axial-flow mini-pumps (Hemopump) and began with purge bearings. As the project developed, so did the understanding of new bearings, computational fluid design and flow visualization, and speed control algorithms. The acquisition of Nimbus by ThermoCardiosystems, Inc (TCI) sped developments of cannulas, controller, and power/monitor units. The system has been successfully tested in more than 40 calves since 1997 and the first human implant occurred in July 2000. Multicenter safety and feasibility trials are planned for Europe and soon thereafter a trial will be started in the United States to test 6-month survival in end-stage heart failure.

Data collection as the first step in program development: the experience of a chronic care palliative unit.

PubMed

Munn, B; Worobec, F

1997-01-01

This retrospective descriptive study of 73 patients who died in St. Peter's Hospital examines and contrasts the patients profile and referral sources of a palliative care unit in a chronic care hospital over two six-month periods during 1994 and 1995. Shortened length of stay (83.8 and 43.2 days respectively), documentation issues, CPR practices (CPR was desired by seven patients up to the time of death), and lack of referrals from long-term care facilities have led St. Peter's Hospital to ask further questions of its palliative care program, e.g. given the lack of referrals from long-term care facilities, how is palliative care being managed in this sector? In Ontario, palliative care has been placed under the domain of chronic care and program development depends in part on the knowledge of the population it serves. This study is a first step.

Seasonal Difference in National School Lunch Program Participation and Its Impacts on Household Food Security.

PubMed

Huang, Jin; Kim, Youngmi; Barnidge, Ellen

2016-11-20

The National School Lunch Program (NSLP) is one of the most important food assistance programs in the United States to ensure children's food security and healthy development. Previous studies have offered mixed results and challenges in estimating the effects of program participation. This study assesses NSLP's effect on household food security using data from the Survey of Income and Program Participation (SIPP). SIPP collects information on food security that covers four reference months, including both summer (June, July, August) and nonsummer months. The number of summer months in these four reference months varies by SIPP rotation group. These unique features allow this study to address the potential selection bias in the research of NSLP and food security by examining a seasonal difference in program participation. The analysis found that one more summer month in the reference period increases the difference in low food security rates by about 1.5 percentage points between recipients and nonrecipients eligible for free or reduced-price lunch. Findings have important social work and health policy implications for increasing food security among low-income households with children. © 2016 National Association of Social Workers.

A longitudinal test of the Comprehensive Indoor Tanning Expectations Scale: The importance of affective beliefs in predicting indoor tanning behavior.

PubMed

Myrick, Jessica Gall; Noar, Seth M; Kelley, Dannielle; Zeitany, Alexandra E; Morales-Pico, Brenda M; Thomas, Nancy E

2017-01-01

In order to better understand drivers of dangerous indoor tanning behaviors, researchers developed the Comprehensive Indoor Tanning Expectations scale. To examine the longitudinal effectiveness of Comprehensive Indoor Tanning Expectations, we surveyed young women in the Southeastern United States at two time points ( N = 553). The scale demonstrated strong test-retest reliability. Participants who believed indoor tanning would improve their mood and afford social approval were significantly more likely to tan 6 months later, while participants who believed indoor tanning leads to psychological/physical discomfort were significantly less likely to tan 6 months later. Knowing the psychological bases for indoor tanning can inform intervention and message design.

The development of selective attention and inhibition in NICU graduates during the preschool years.

PubMed

Kittler, Phyllis M; Gardner, Judith M; Lennon, Elizabeth M; Flory, Michael J; Mayes, Linda C; Karmel, Bernard Z

2011-01-01

Neonatal intensive care unit (NICU) graduates have a higher incidence of attention problems including attention deficit hyperactivity disorder (ADHD). Thus, we examined the effect of risk factors (birth weight (BW), central nervous system (CNS) injury, gender, maternal education) on attention/inhibition during reaction time, continuous performance and Go/No-Go tasks at 42, 51, and 60 months (n = 271). Very low BW NICU graduates (<1,500 g) performed worse than typical BW ones (>2,500 g), displaying poorer target/non-target discrimination. Males responded faster than females, but made more false alarms and random responses. Despite short duration tasks, attention waned. Performance improved with age, but even at 60 months children had difficulty inhibiting random responding.

Lung protection: an intervention for tidal volume reduction in a teaching intensive care unit.

PubMed

Briva, Arturo; Gaiero, Cristina

2016-01-01

To determine the effect of feedback and education regarding the use of predicted body weight to adjust tidal volume in a lung-protective mechanical ventilation strategy. The study was performed from October 2014 to November 2015 (12 months) in a single university polyvalent intensive care unit. We developed a combined intervention (education and feedback), placing particular attention on the importance of adjusting tidal volumes to predicted body weight bedside. In parallel, predicted body weight was estimated from knee height and included in clinical charts. One hundred fifty-nine patients were included. Predicted body weight assessed by knee height instead of visual evaluation revealed that the delivered tidal volume was significantly higher than predicted. After the inclusion of predicted body weight, we observed a sustained reduction in delivered tidal volume from a mean (standard error) of 8.97 ± 0.32 to 7.49 ± 0.19mL/kg (p < 0.002). Furthermore, the protocol adherence was subsequently sustained for 12 months (delivered tidal volume 7.49 ± 0.54 versus 7.62 ± 0.20mL/kg; p = 0.103). The lack of a reliable method to estimate the predicted body weight is a significant impairment for the application of a worldwide standard of care during mechanical ventilation. A combined intervention based on education and repeated feedbacks promoted sustained tidal volume education during the study period (12 months).

Gastro-oesophageal reflux disease increases the risk of intensive care unit admittance and mechanical ventilation use among patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study.

PubMed

Tsai, Chen-Liang; Lin, Yu-Huei; Wang, Meng-Ting; Chien, Li-Nien; Jeng, Chii; Chian, Chih-Feng; Perng, Wann-Cherng; Chiang, Chi-Huei; Chiou, Hung-Yi

2015-03-24

Gastro-oesophageal reflux disease (GORD) is common among chronic obstructive pulmonary disease (COPD) patients and may have a deleterious effect on COPD prognosis. However, few studies have investigated whether GORD increases the risk of severe outcomes such as intensive care unit (ICU) admittance or mechanical ventilator use among COPD patients. Propensity score matching by age, sex, comorbidities and COPD severity was used to match the 1,210 COPD patients with GORD sourced in this study to 2,420 COPD patients without GORD. The Kaplan-Meier method was used to explore the incidence of ICU admittance and machine ventilation with the log rank test being used to test for differences. Cox regression analysis was used to explore the risk of ICU admittance and mechanical ventilation use for patients with and without GORD. During the 12-month follow-up, GORD patients and non-GORD patients had 5.22 and 3.01 ICU admittances per 1000 person-months, and 4.34 and 2.41 mechanical ventilation uses per 1000 person-month, respectively. The log rank test revealed a difference in the incidence of ICU admittance and machine ventilation between the two cohorts. GORD was found to be an independent predicator of ICU admittance (adjusted hazard ratio (HRadj) 1.75, 95% confidence interval (CI) 1.28-2.38) and mechanical ventilation (HRadj 1.92, 95% CI 1.35-2.72). This is the first investigation to detect a significantly higher incidence rate and independently increased risk of admission to an ICU and mechanical ventilation use among COPD patients who subsequently developed GORD during the first year following their GORD diagnosis than COPD patients who did not develop GORD.

Oseltamivir Pharmacokinetics, Dosing, and Resistance Among Children Aged <2 Years With Influenza

PubMed Central

Kimberlin, David W.; Acosta, Edward P.; Prichard, Mark N.; Sánchez, Pablo J.; Ampofo, Krow; Lang, David; Ashouri, Negar; Vanchiere, John A.; Abzug, Mark J.; Abughali, Nazha; Caserta, Mary T.; Englund, Janet A.; Sood, Sunil K.; Spigarelli, Michael G.; Bradley, John S.; Lew, Judy; Michaels, Marian G.; Wan, Wen; Cloud, Gretchen; Jester, Penelope; Lakeman, Fred D.; Whitley, Richard J.; Giles, Dusty; Cotton, Bari; Judy, Sharon; Cowie, Margaret; Francis, Jeanne; Evans, Candice; O'Donnell, Nan; Shiraishi, Ofelia Vargas; Latiolais, Lisa; Aymami, Valeri; Dole, Ken; Gaultier, Julie; Lofthus, Gerry; Kinnunen, Diane; Lacombe, Kirsten; Stellato, Nancy; Denlinger, Julie; Hingtgen, Sara; Mason, Christina; Jeffrey, Noreen

2013-01-01

Background. Children <2 years of age are at high risk of influenza-related mortality and morbidity. However, the appropriate dose of oseltamivir for children <2 years of age is unknown. Methods. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group evaluated oseltamivir in infants aged <2 years in an age–de-escalation, adaptive design with a targeted systemic exposure. Results. From 2006 to 2010, 87 subjects enrolled. An oseltamivir dose of 3.0 mg/kg produced drug exposures within the target range in subjects 0–8 months of age, although there was a greater degree of variability in infants <3 months of age. In subjects 9–11 months of age, a dose of 3.5 mg/kg produced drug exposures within the target range. Six of 10 subjects aged 12–23 months receiving the Food and Drug Administration–approved unit dose for this age group (ie, 30 mg) had oseltamivir carboxylate exposures below the target range. Virus from 3 subjects developed oseltamivir resistance during antiviral treatment. Conclusions. The appropriate twice-daily oral oseltamivir dose for infants ≤8 months of age is 3.0 mg/kg, while the dose for infants 9–11 months old is 3.5 mg/kg. Clinical Trials Registration. NCT00391768. PMID:23230059

3 CFR 8591 - Proclamation 8591 of October 29, 2010. National Alzheimer's Disease Awareness Month, 2010

Code of Federal Regulations, 2011 CFR

2011-01-01

... Alzheimer's Disease Awareness Month, 2010 8591 Proclamation 8591 Presidential Documents Proclamations Proclamation 8591 of October 29, 2010 Proc. 8591 National Alzheimer's Disease Awareness Month, 2010By the President of the United States of America A Proclamation Alzheimer’s disease tragically robs individuals of...

77 FR 20495 - National Donate Life Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

... Donate Life Month, 2012 By the President of the United States of America A Proclamation With quiet compassion and exceptional generosity, organ and tissue donors leave an indelible mark on the lives of... giving spirit that lies at the heart of our national character. During National Donate Life Month, we...

75 FR 54451 - National Ovarian Cancer Awareness Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-07

... National Ovarian Cancer Awareness Month, 2010 By the President of the United States of America A Proclamation While we have made great strides in the battle against ovarian cancer, this disease continues to claim more lives than any other gynecologic cancer. During National Ovarian Cancer Awareness Month, we...

76 FR 62291 - National Domestic Violence Awareness Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-07

... domestic violence are at a higher risk for failure in school, emotional disorders, and substance abuse, and... National Domestic Violence Awareness Month, 2011 By the President of the United States of America A Proclamation During Domestic Violence Awareness Month, we recognize the significant achievements we have made...

3 CFR 8852 - Proclamation 8852 of August 31, 2012. National Childhood Obesity Awareness Month, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

... Childhood Obesity Awareness Month, 2012 8852 Proclamation 8852 Presidential Documents Proclamations Proclamation 8852 of August 31, 2012 Proc. 8852 National Childhood Obesity Awareness Month, 2012By the President of the United States of America A Proclamation Over the past several decades, childhood obesity...

75 FR 54755 - National Childhood Obesity Awareness Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-08

... Part III The President Proclamation 8554--National Childhood Obesity Awareness Month, 2010 #0; #0... of September 1, 2010 National Childhood Obesity Awareness Month, 2010 By the President of the United... the health and well-being of our children. We now face a national childhood obesity crisis, with...

75 FR 17841 - National Child Abuse Prevention Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

... Child Abuse Prevention Month, 2010 By the President of the United States of America A Proclamation Our children are our most valuable resource, and they need our support to thrive and grow into healthy, productive adults. During National Child Abuse Prevention Month, we renew our unwavering commitment to...

78 FR 26223 - National Physical Fitness and Sports Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Physical Fitness and Sports Month, 2013 By the President of the United States of America A Proclamation... life. During National Physical Fitness and Sports Month, we celebrate that progress and keep striving... at work. Through Let's Move! and the President's Council on Fitness, Sports, and Nutrition, we...

75 FR 6085 - American Heart Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-05

... American Heart Month, 2010 By the President of the United States of America A Proclamation Heart disease is... backgrounds and ethnicities, in all regions of our country. Although heart disease is one of our Nation's most costly and widespread health problems, it is among the most preventable. During American Heart Month, we...

76 FR 62289 - National Disability Employment Awareness Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-07

... National Disability Employment Awareness Month, 2011 By the President of the United States of America A..., and out- build the rest of the world. During National Disability Employment Awareness Month, we recognize the skills that people with disabilities bring to our workforce, and we rededicate ourselves to...

3 CFR 8646 - Proclamation 8646 of March 31, 2011. National Financial Literacy Month, 2011

Code of Federal Regulations, 2012 CFR

2012-01-01

... more information on improving financial literacy, concerned individuals may visit www.MyMoney.gov or... Financial Literacy Month, 2011 8646 Proclamation 8646 Presidential Documents Proclamations Proclamation 8646 of March 31, 2011 Proc. 8646 National Financial Literacy Month, 2011By the President of the United...

Mapping Atmospheric Moisture Climatologies across the Conterminous United States

PubMed Central

Daly, Christopher; Smith, Joseph I.; Olson, Keith V.

2015-01-01

Spatial climate datasets of 1981–2010 long-term mean monthly average dew point and minimum and maximum vapor pressure deficit were developed for the conterminous United States at 30-arcsec (~800m) resolution. Interpolation of long-term averages (twelve monthly values per variable) was performed using PRISM (Parameter-elevation Relationships on Independent Slopes Model). Surface stations available for analysis numbered only 4,000 for dew point and 3,500 for vapor pressure deficit, compared to 16,000 for previously-developed grids of 1981–2010 long-term mean monthly minimum and maximum temperature. Therefore, a form of Climatologically-Aided Interpolation (CAI) was used, in which the 1981–2010 temperature grids were used as predictor grids. For each grid cell, PRISM calculated a local regression function between the interpolated climate variable and the predictor grid. Nearby stations entering the regression were assigned weights based on the physiographic similarity of the station to the grid cell that included the effects of distance, elevation, coastal proximity, vertical atmospheric layer, and topographic position. Interpolation uncertainties were estimated using cross-validation exercises. Given that CAI interpolation was used, a new method was developed to allow uncertainties in predictor grids to be accounted for in estimating the total interpolation error. Local land use/land cover properties had noticeable effects on the spatial patterns of atmospheric moisture content and deficit. An example of this was relatively high dew points and low vapor pressure deficits at stations located in or near irrigated fields. The new grids, in combination with existing temperature grids, enable the user to derive a full suite of atmospheric moisture variables, such as minimum and maximum relative humidity, vapor pressure, and dew point depression, with accompanying assumptions. All of these grids are available online at http://prism.oregonstate.edu, and include 800-m and 4-km resolution data, images, metadata, pedigree information, and station inventory files. PMID:26485026

Alemtuzumab improves contrast sensitivity in patients with relapsing–remitting multiple sclerosis

PubMed Central

Galetta, Steven L; Palmer, Jeffrey; Margolin, David H; Rizzo, Marco; Bilbruck, John; Balcer, Laura J

2013-01-01

Background: Alemtuzumab is a monoclonal antibody directed against CD52 that depletes T and B lymphocytes. Objective: To evaluate the treatment effect of alemtuzumab on low-contrast vision in relapsing–remitting multiple sclerosis (RRMS) patients. Methods: This was a pre-defined exploratory analysis within a randomized, rater-blinded trial (CAMMS223) that was run at 49 academic medical centers in the US and in Europe. Patients with untreated, early, RRMS (McDonald, n = 334) were randomized 1:1:1 to subcutaneous interferon beta-1a (IFNB-1a), or alemtuzumab 12 mg or 24 mg. Visual contrast sensitivity was measured for each eye at baseline and quarterly, with Pelli-Robson charts. Results: The eyes of patients in the pooled alemtuzumab group (versus IFNB-1a) had a greater than 2-fold higher rate of both 3-month and 6-month sustained visual improvement, of at least 0.3 log units (2 triplets, 6 letters) (At 3 months the hazard ratio (HR) = 2.26; CI = 1.19 to 4.31; P = 0.013; and at 6 months the HR = 2.44; CI =1.16 to 5.15; P = 0.019), and they had a lower risk of 3- and 6-month sustained worsening of at least 0.15 log units (1 triplet, 3 letters) (At 3 months the HR = 0.58; CI = 0.38 to 0.89; P = 0.012; and at 6 months HR = 0.55; CI=0.35 to 0.87; P = 0.010). Over the 36-month study period, the eyes of patients in the pooled alemtuzumab group improved in mean contrast sensitivity to a greater extent than those in the IFNB-1a group (0.080 log units versus 0.038 log units; P = 0.0102). Conclusions: Alemtuzumab was associated with a greater chance of improved contrast sensitivity in patients with RRMS and may delay the worsening of visual function. Contrast sensitivity testing was sensitive to treatment effects, even within an active comparator study design. These results support the validity of low-contrast vision testing as a clinical outcome in MS trials. PMID:23459567

Predicting summer residential electricity demand across the U.S.A using climate information

NASA Astrophysics Data System (ADS)

Sun, X.; Wang, S.; Lall, U.

2017-12-01

We developed a Bayesian Hierarchical model to predict monthly residential per capita electricity consumption at the state level across the USA using climate information. The summer period was selected since cooling requirements may be directly associated with electricity use, while for winter a mix of energy sources may be used to meet heating needs. Historical monthly electricity consumption data from 1990 to 2013 were used to build a predictive model with a set of corresponding climate and non-climate covariates. A clustering analysis was performed first to identify groups of states that had similar temporal patterns for the cooling degree days of each state. Then, a partial pooling model was applied to each cluster to assess the sensitivity of monthly per capita residential electricity demand to each predictor (including cooling-degree-days, gross domestic product (GDP) per capita, per capita electricity demand of previous month and previous year, and the residential electricity price). The sensitivity of residential electricity to cooling-degree-days has an identifiable geographic distribution with higher values in northeastern United States.

Non-verbal Communication in a Neonatal Intensive Care Unit: A Video Audit Using Non-verbal Immediacy Scale (NIS-O).

PubMed

Nimbalkar, Somashekhar Marutirao; Raval, Himalaya; Bansal, Satvik Chaitanya; Pandya, Utkarsh; Pathak, Ajay

2018-05-03

Effective communication with parents is a very important skill for pediatricians especially in a neonatal setup. The authors analyzed non-verbal communication of medical caregivers during counseling sessions. Recorded videos of counseling sessions from the months of March-April 2016 were audited. Counseling episodes were scored using Non-verbal Immediacy Scale Observer Report (NIS-O). A total of 150 videos of counseling sessions were audited. The mean (SD) total score on (NIS-O) was 78.96(7.07). Female counseled sessions had significantly higher proportion of low scores (p < 0.001). No video revealed high score. Overall 67(44.67%) sessions revealed low total score. This reflects an urgent need to develop strategies to improve communication skills in a neonatal unit. This study lays down a template on which other Neonatal intensive care units (NICUs) can carry out gap defining audits.

Do predictors of smoking relapse change as a function of duration of abstinence? Findings from the United States, Canada, United Kingdom and Australia.

PubMed

Yong, Hua-Hie; Borland, Ron; Cummings, K Michael; Partos, Timea

2018-07-01

To estimate predictors of time to smoking relapse and test if prediction varied by quit duration. Longitudinal cohort data from the International Tobacco Control Four-Country survey with annual follow up collected between 2002 and 2015. Canada, United States, United Kingdom and Australia. A total of 9171 eligible adult smokers who had made at least one quit attempt during the study period. Time to relapse was the main outcome. Predictor variables included pre-quit baseline measures of nicotine dependence, smoking and quitting-related motivations, quitting capacity and social influence, and also two post-quit measures, use of stop-smoking medications and quit duration (1-7 days, 8-14 days, 15-31 days, 1-3 months, 3-6 months, 6-12 months, 1-2 years and 2+ years), along with socio-demographics. All factors were predictive of relapse within the first 6 months of quitting but only wanting to quit, quit intentions and number of friends who smoke were still predictive of relapse in the 6-12-month period of quitting [hazard ratios (HR) = 1.20, P < 0.05; 1.13, P < 0.05; and 1.21, P < 0.001, respectively]. Number of friends smoking was the only remaining predictor of relapse in the 1-2 years quit period (HR = 1.19, P = 0.001) with none predictive beyond the 2-year quit period. Use of stop-smoking medications during quit attempts was related negatively to relapse during the first 2 weeks of quitting (HR = 0.71-0.84), but related positively to relapse in the 1-6-month quit period (HR = 1.29-1.54). Predictive effects of all factors showed significant interaction with quit duration except for perceiving smoking as an important part of life, prematurely stubbing out a cigarette and wanting to quit. Among adult smokers in the United States, Canada, United Kingdom and Australia, factors associated with smoking relapse differ between the early and later stages of a quit attempt, suggesting that the determinants of relapse change as a function of abstinence duration. © 2018 Society for the Study of Addiction.

Microbial identification system for Space Station Freedom

NASA Technical Reports Server (NTRS)

Brown, Harlan D.; Scarlett, Janie B.; Skweres, Joyce A.; Fortune, Russell L.; Staples, John L.; Pierson, Duane L.

1989-01-01

The Environmental Health System (EHS) and Health Maintenance Facility (HMF) on Space Station Freedom will require a comprehensive microbiology capability. This requirement entails the development of an automated system to perform microbial identifications on isolates from a variety of environmental and clinical sources and, when required, to perform antimicrobial sensitivity testing. The unit currently undergoing development and testing is the Automated Microbiology System II (AMS II) built by Vitek Systems, Inc. The AMS II has successfully completed 12 months of laboratory testing and evaluation for compatibility with microgravity operation. The AMS II is a promising technology for use on Space Station Freedom.

A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital.

PubMed Central

Gladman, J R; Lincoln, N B; Barer, D H

1993-01-01

This study compared the functional ability and perceived health status of stroke patients treated by a domiciliary rehabilitation team or by routine hospital-based services after discharge from hospital. Patients discharged from two acute and three rehabilitation hospitals in Nottingham were randomly allocated in three strata (Health Care of the Elderly, General Medical and Stroke Unit) to receive domiciliary or hospital-based care after discharge. Functional recovery was assessed by the Extended Activities of Daily Living (ADL) scale three and six months after discharge and perceived health at six months was measured by the Nottingham Health Profile. A total of 327 eligible patients of 1119 on a register of acute stroke admissions were recruited over 16 months. Overall there were no differences between the groups in their Extended ADL scores at three or six months, or their Nottingham Health Profile scores at six months. In the Stroke Unit stratum, patients treated by the domiciliary team had higher household (p = 0.02) and leisure activity (p = 0.04) scores at six months than those receiving routine care. In the Health Care of the Elderly stratum, death or a move into long-term institutional care at six months occurred less frequently in patients allocated to the routine service, about half of whom attended a geriatric day hospital. Overall there was no difference in the effectiveness of the domiciliary and hospital-based services, although younger stroke unit patients appeared to do better with home therapy while some frail elderly patients might have benefited from day hospital attendance. PMID:8410035

The U.S. Geological Survey Monthly Water Balance Model Futures Portal

USGS Publications Warehouse

Bock, Andrew R.; Hay, Lauren E.; Markstrom, Steven L.; Emmerich, Christopher; Talbert, Marian

2017-05-03

The U.S. Geological Survey Monthly Water Balance Model Futures Portal (https://my.usgs.gov/mows/) is a user-friendly interface that summarizes monthly historical and simulated future conditions for seven hydrologic and meteorological variables (actual evapotranspiration, potential evapotranspiration, precipitation, runoff, snow water equivalent, atmospheric temperature, and streamflow) at locations across the conterminous United States (CONUS).The estimates of these hydrologic and meteorological variables were derived using a Monthly Water Balance Model (MWBM), a modular system that simulates monthly estimates of components of the hydrologic cycle using monthly precipitation and atmospheric temperature inputs. Precipitation and atmospheric temperature from 222 climate datasets spanning historical conditions (1952 through 2005) and simulated future conditions (2020 through 2099) were summarized for hydrographic features and used to drive the MWBM for the CONUS. The MWBM input and output variables were organized into an open-access database. An Open Geospatial Consortium, Inc., Web Feature Service allows the querying and identification of hydrographic features across the CONUS. To connect the Web Feature Service to the open-access database, a user interface—the Monthly Water Balance Model Futures Portal—was developed to allow the dynamic generation of summary files and plots  based on plot type, geographic location, specific climate datasets, period of record, MWBM variable, and other options. Both the plots and the data files are made available to the user for download 

Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy

PubMed Central

2014-01-01

Background Approximately 1 in 5 pregnant women in the United Kingdom are obese. In addition to being associated generally with poor health, obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity. This paper describes the protocol for a cluster randomised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women’s Body Mass Index at 12 months following birth. Methods/design The study is a cluster randomised controlled trial involving 20 maternity units across England and Wales. The units will be randomised, 10 to the intervention group and 10 to the control group. 570 pregnant women aged 18 years or over, with a Body Mass Index of +/=30 (kg/m2) and between 12 and 20 weeks gestation will be recruited. Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity. In addition to their usual care and the leaflets, women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group, which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives, until 6 weeks postpartum. Participants will be followed up at 36 weeks gestation and at 6 weeks, 6 months and 12 months postpartum. Body Mass Index at 12 months postpartum is the primary outcome. Secondary outcomes include pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity levels, pregnancy and birth complications, social support, self-regulation and self-efficacy. A cost effectiveness analysis and process evaluation will also be conducted. Discussion This study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women. If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child. Trial registration Current Controlled Trials: ISRCTN25260464 Date of registration: 16th April 2010. PMID:24886352

Evaluation of nurse staffing levels and outcomes under the government--recommended staffing levels in Korea.

PubMed

Yu, Soyoung; Kim, Tae Gon

2015-05-01

This study aimed to evaluate registered nurse staffing levels and outcomes enforced by the current Korean nursing regulations. Registered nurse staffing levels are closely related to patient and nurse outcomes. Thus, the government's policy regarding nursing staffing has a practical impact, and better policies could lead to more appropriate nurse staffing. The actual evaluation of the government-recommended staffing levels in Korea is paramount for the establishment of a realistic and effective system that promotes quality care and patient safety. The participating hospital operated under the government-recommended staffing levels (Grade 2 of the Graded Fee of Nursing Management Inpatient System). For unit-level evaluations, one surgical unit was chosen and its staffing level was changed by assigning one additional registered nurse for 6 months. Length of hospitalisation, incidents of death, overtime hours and nursing job performance were measured prior to and after the addition of the extra staff. After 6 months, the length of patient hospitalisation and registered nurse overtime hours reduced and nurse job performance scores in the unit analysed improved. The results demonstrated that increasing the number of registered nurses beyond the current government-recommended staffing level improves patient and nurse outcomes. This indicates the importance and value of empirically assessing the need for changes in the recommended nurse staffing levels to develop appropriate, realistic and effective policies. © 2013 John Wiley & Sons Ltd.

Effect of the full moon on mortality among patients admitted to the intensive care unit.

PubMed

Nadeem, Rashid; Nadeem, Amin; Madbouly, Essam Mohamed; Molnar, Janos; Morrison, Jeanette Levine

2014-02-01

To determine the lunar effect on mortality among patients admitted to the intensive care unit. The retrospective study conducted at Rosalind Franklin University of Medicine and Science, North Chicago, and comprised data of 4387 patients in intensive care unit from December 2002 to November 2004. The subjects were divided into two groups: patients who died on full moon days (the 14th, 15th, and 16th days of the lunar month); and patients who died on the other days of the month. The mortality rates were calculated for patients in both groups. Parameters including patients' age, gender, acute physiology and chronic health evaluation scores, predicted mortality rates, type of intensive care unit, and actual mortality were compared, and non-parametric tests were performed to determine whether there were any differences between the groups. Of the 4387 patients who were followed for 23 months, 297 patients died, including 31 on full moon days and 266 patients on the other days of the month. Both groups were similar in terms of mean age (73.6 +/- 14.59 vs. 71.07 +/- 16.13 years; p = 0.599), acute physiology and chronic health evalutation scores (82.06 +/- 24.19 vs. 76.52 +/- 27.42; p = 0.258), and predicted mortality (0.405 +/- 0.249 vs. 0.370 +/- 0.268; p = 0.305). There was no difference in the frequency of death between the full moon days and the other days (10.33 +/- 0.58 vs. 9.8 +/- 3.46; p = 0.845). The full moon does not affect the mortality of the patients in intensive care unit.

Development and Monitoring the Key Performance Indicators of the Quality of Care for Patients with Cleft Lips/Palates at Srinagarind Hospital.

PubMed

Mongkhonthawornchai, Siriporn; Pradubwong, Suteera; Augsornwan, Darawan; Pathumwiwatana, Pornpen; Sroyhin, Waranya; Pongpagatip, Sumalee; Wongkham, Jamras; Wachirapakorn, Jantira; Lao-unka, Kesorn; Mucnamporn, Tippawan; Chowchuen, Bowornsilp

2015-08-01

Congenital deformities, such as cleft lips and/or cleft palates (CLP), have high incidences in the Northeast of Thailand. These birth defects can affect patient's quality of life. CLP patients need crucial and long-term treatments by a multidisciplinary team starting from prenatal stage to late adulthood. Patients and their families should involve in their own care, and their care objectives should correspond with healthcare providers. Besides the clinical outcome of interdisciplinary team, key performance indicators (KPIs) need to be developed in the hospital service unit in order to improve quality of care and treatment outcomes. 1) to establish KPIs in hospital service units, and 2) to develop the information system to collect, analysis and improve the quality of CLP care. A nurse coordinator was appointed in the Tawanchai Center to coordinate care. The three periods were conducted for the nurse coordinator to work with nine service units in Srinagarind Hospital for consensus on both qualitative and quantitative data to be used as service unit quality measurement. Thirty one KPIs from nine service units were established, collected and analyzed during a four-month period in 2014. The 20 KPIs achieved the unit targets. Two PKIs of the rates of complication with anesthesia during/after surgery in the first 24 hours and the rates of patient/caregiver's satisfaction in acquiring information from the officer were improving. There were 11 KPIs that did not achieve the targets. The coordinator nurse of the Tawanchai Center discussed with the service unit for the cause and how to improve the outcome. The monitoring KPIs will lead to improvement of outcome for better patient quality as well as benchmarking with other hospitals of Cleft Center. The KPIs from hospital service units with the monitoring and analysis of information by the nurse coordinator will enhance and lead to improvement of the quality of the patients and family centered care process.

A Formative Evaluation of Me Now, Unit I, Digestion and Circulation, Life Sciences for the Educable Mentally Handicapped Intermediate Grades (11-13 years).

ERIC Educational Resources Information Center

Robinson, James T.; Tolman, Richard R.

In order to evaluate Unit I (Digestion and Circulation) of the Me Now series of Life Sciences for the Educable Mentally Handicapped, 139 students in an experimental group (mean IQ 72.04; mean CA 144.9 months) and 154 control subjects (mean IQ 70.2; mean CA 148.3 months) were pre- and post-tested following instruction in the Me Now series…

On-Board Training for US Payloads

NASA Technical Reports Server (NTRS)

Murphy, Benjamin; Meacham, Steven (Technical Monitor)

2001-01-01

The International Space Station (ISS) crew follows a training rotation schedule that puts them in the United States about every three months for a three-month training window. While in the US, the crew receives training on both ISS systems and payloads. Crew time is limited, and system training takes priority over payload training. For most flights, there is sufficient time to train all systems and payloads. As more payloads are flown, training time becomes a more precious resource. Less training time requires payload developers (PDs) to develop alternatives to traditional ground training. To ensure their payloads have sufficient training to achieve their scientific goals, some PDs have developed on-board trainers (OBTs). These OBTs are used to train the crew when no or limited ground time is available. These lessons are also available on-orbit to refresh the crew about their ground training, if it was available. There are many types of OBT media, such as on-board computer based training (OCBT), video/photo lessons, or hardware simulators. The On-Board Training Working Group (OBTWG) and Courseware Development Working Group (CDWG) are responsible for developing the requirements for the different types of media.

Medical Surveillance Monthly Report (MSMR). Volume 14, Number 6, September/October 2007

DTIC Science & Technology

2007-10-01

can signifi cantly impact the health, well-being and operational eff ectiveness of service members and their units. Th e U.S. military has developed...Young AJ. Sustaining health and performance in cold weather operations. Technical note no. TN/02-2. US Army Research Institute of Environmental ... assesment forms, U.S. Armed Forces, October 2006-September 2007 fourths (73.5%) of deployers rated their “health in general” as “excellent” or

Educational program in crisis management for cardiac surgery teams including high realism simulation.

PubMed

Stevens, Louis-Mathieu; Cooper, Jeffrey B; Raemer, Daniel B; Schneider, Robert C; Frankel, Allan S; Berry, William R; Agnihotri, Arvind K

2012-07-01

Cardiac surgery demands effective teamwork for safe, high-quality care. The objective of this pilot study was to develop a comprehensive program to sharpen performance of experienced cardiac surgical teams in acute crisis management. We developed and implemented an educational program for cardiac surgery based on high realism acute crisis simulation scenarios and interactive whole-unit workshop. The impact of these interventions was assessed with postintervention questionnaires, preintervention and 6-month postintervention surveys, and structured interviews. The realism of the acute crisis simulation scenarios gradually improved; most participants rated both the simulation and whole-unit workshop as very good or excellent. Repeat simulation training was recommended every 6 to 12 months by 82% of the participants. Participants of the interactive workshop identified 2 areas of highest priority: encouraging speaking up about critical information and interprofessional information sharing. They also stressed the importance of briefings, early communication of surgical plan, knowing members of the team, and continued simulation for practice. The pre/post survey response rates were 70% (55/79) and 66% (52/79), respectively. The concept of working as a team improved between surveys (P = .028), with a trend for improvement in gaining common understanding of the plan before a procedure (P = .075) and appropriate resolution of disagreements (P = .092). Interviewees reported that the training had a positive effect on their personal behaviors and patient care, including speaking up more readily and communicating more clearly. Comprehensive team training using simulation and a whole-unit interactive workshop can be successfully deployed for experienced cardiac surgery teams with demonstrable benefits in participant's perception of team performance. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Feasibility of a Team Approach to Complex Congenital Heart Defect Neurodevelopmental Follow-Up: Early Experience of a Combined Cardiology/Neonatal Intensive Care Unit Follow-Up Program.

PubMed

Chorna, Olena; Baldwin, H Scott; Neumaier, Jamie; Gogliotti, Shirley; Powers, Deborah; Mouvery, Amanda; Bichell, David; Maitre, Nathalie L

2016-07-01

Infants with complex congenital heart disease are at high risk for poor neurodevelopmental outcomes. However, implementation of dedicated congenital heart disease follow-up programs presents important infrastructure, personnel, and resource challenges. We present the development, implementation, and retrospective review of 1- and 2-year outcomes of a Complex Congenital Heart Defect Neurodevelopmental Follow-Up program. This program was a synergistic approach between the Pediatric Cardiology, Cardiothoracic Surgery, Pediatric Intensive Care, and Neonatal Intensive Care Unit Follow-Up teams to provide a feasible and responsible utilization of existing infrastructure and personnel, to develop and implement a program dedicated to children with congenital heart disease. Trained developmental testers administered the Ages and Stages Questionnaire-3 over the phone to the parents of all referred children at least once between 6 and 12 months' corrected age. At 18 months' corrected age, all children were scheduled in the Neonatal Intensive-Care Unit Follow-Up Clinic for a visit with standardized neurological exams, Bayley III, multidisciplinary therapy evaluations and continued follow-up. Of the 132 patients identified in the Cardiothoracic Surgery database and at discharge from the hospital, a total number of 106 infants were reviewed. A genetic syndrome was identified in 23.4% of the population. Neuroimaging abnormalities were identified in 21.7% of the cohort with 12.8% having visibly severe insults. As a result, 23 (26.7%) received first-time referrals for early intervention services, 16 (13.8%) received referrals for new services in addition to their existing ones. We concluded that utilization of existing resources in collaboration with established programs can ensure targeted neurodevelopmental follow-up for all children with complex congenital heart disease. © 2016 American Heart Association, Inc.

42 CFR 410.175 - Alien absent from the United States.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Alien absent from the United States. 410.175... Alien absent from the United States. (a) Medicare does not pay Part B benefits for services furnished to... during the first full calendar month the alien is back in the United States. [53 FR 6634, Mar. 2, 1988] ...

42 CFR 410.175 - Alien absent from the United States.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Alien absent from the United States. 410.175... Alien absent from the United States. (a) Medicare does not pay Part B benefits for services furnished to... during the first full calendar month the alien is back in the United States. [53 FR 6634, Mar. 2, 1988] ...

42 CFR 410.175 - Alien absent from the United States.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Alien absent from the United States. 410.175... Alien absent from the United States. (a) Medicare does not pay Part B benefits for services furnished to... during the first full calendar month the alien is back in the United States. [53 FR 6634, Mar. 2, 1988] ...

42 CFR 410.175 - Alien absent from the United States.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Alien absent from the United States. 410.175... Alien absent from the United States. (a) Medicare does not pay Part B benefits for services furnished to... during the first full calendar month the alien is back in the United States. [53 FR 6634, Mar. 2, 1988] ...

42 CFR 410.175 - Alien absent from the United States.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Alien absent from the United States. 410.175... Alien absent from the United States. (a) Medicare does not pay Part B benefits for services furnished to... during the first full calendar month the alien is back in the United States. [53 FR 6634, Mar. 2, 1988] ...

37 CFR 1.495 - Entering the national stage in the United States of America.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in the United States of America. 1.495 Section 1.495 Patents, Trademarks, and Copyrights UNITED... America. (a) The applicant in an international application must fulfill the requirements of 35 U.S.C. 371... abandonment of the international application as to the United States of America. The thirty-month time period...

37 CFR 1.495 - Entering the national stage in the United States of America.

Code of Federal Regulations, 2013 CFR

2013-07-01

... in the United States of America. 1.495 Section 1.495 Patents, Trademarks, and Copyrights UNITED... America. (a) The applicant in an international application must fulfill the requirements of 35 U.S.C. 371... abandonment of the international application as to the United States of America. The thirty-month time period...

37 CFR 1.495 - Entering the national stage in the United States of America.

Code of Federal Regulations, 2011 CFR

2011-07-01

... in the United States of America. 1.495 Section 1.495 Patents, Trademarks, and Copyrights UNITED... America. (a) The applicant in an international application must fulfill the requirements of 35 U.S.C. 371... abandonment of the international application as to the United States of America. The thirty-month time period...

37 CFR 1.495 - Entering the national stage in the United States of America.

Code of Federal Regulations, 2012 CFR

2012-07-01

... in the United States of America. 1.495 Section 1.495 Patents, Trademarks, and Copyrights UNITED... America. (a) The applicant in an international application must fulfill the requirements of 35 U.S.C. 371... abandonment of the international application as to the United States of America. The thirty-month time period...

37 CFR 1.495 - Entering the national stage in the United States of America.

Code of Federal Regulations, 2014 CFR

2014-07-01

... in the United States of America. 1.495 Section 1.495 Patents, Trademarks, and Copyrights UNITED... America. (a) The applicant in an international application must fulfill the requirements of 35 U.S.C. 371... abandonment of the international application as to the United States of America. The thirty-month time period...

[Six-months outcomes after admission in acute geriatric care unit secondary to a fall].

PubMed

Dickes-Sotty, Hélène; Chevalet, Pascal; Fix, Marie-Hélène; Riaudel, Typhaine; Serre-Sahel, Caroline; Ould-Aoudia, Vincent; Berrut, Gilles; De Decker, Laure

2012-12-01

Fall in elderly subject is a main event by its medical and social consequences, but few studies were dedicated to the prognosis from hospitalization in geriatric acute care unit. Describe the outcome of elderly subjects hospitalized after a fall in geriatric acute care unit. Longitudinal study of 6 months follow-up, 100 patients of 75 and more years old hospitalized after a fall in acute care geriatric unit. On a total of 128 patients hospitalized for fall, 100 agreed to participate in the study, 3 died during the hospitalization, so 97 subjects were able to be followed. During 6 months after the hospitalization, 14 patients died (14.9%), 51 (58%) have fallen again (58%) and 11 (22%) of them suffer from severe injuries. Thirty seven (39.7%) were rehospitalized and 10 of them related to fall. Among the patients coming from their home, 25 had been institutionalized. The main risk factor which have been identified to be associated with a new fall during the follow-up was a known dementia at the entry. The medical and social prognosis of an elderly subject hospitalized in an acute care unit is severe. The main comorbidity which influences the medical and social outcome is a known dementia, in addition to a history of previous fall.

[Predictive value of qualitative assessment of general movements for adverse outcomes at 24 months of age in infants with asphyxia].

PubMed

Chen, Nan; Wen, Xiao-Hong; Huang, Jin-Hua; Wang, Shui-Yun; Zhu, Yue-E

2015-12-01

To investigate the predictive value of the qualitative assessment of general movements (GMs) for adverse outcomes at 24 months of age in full-term infants with asphyxia. A total of 114 full-term asphyxiated infants, who were admitted to the neonatal intensive care unit between 2009 and 2012 and took part in follow-ups after discharge were included in the study. All of them received the qualitative assessment of GMs within 3 months after birth. The development quotient was determined with the Bayley Scales of Infant Development at 24 months of age. The results of the qualitative assessment of GMs within 3 months after birth showed that among 114 infants, 20 (17.5%) had poor repertoire movements and 7 (6.1%) had cramped-synchronized movements during the writhing movements period; 8 infants (7.0%) had the absence of fidgety movements during the fidgety movements period. The results of development quotient at 24 months of age showed that 7 infants (6.1%) had adverse developmental outcomes: 6 cases of cerebral palsy and mental retardation and 1 case of mental retardation. There was a poor consistency between poor repertoire movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=-0.019; P>0.05). There was a high consistency between cramped-synchronized movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=0.848; P<0.05), and the results of predictive values of cramped-synchronized movements were shown as follows: predictive validity 98.2%, sensitivity 85.7%, specificity 99.1%, positive predictive value 85.7%, and negative predictive value 99.1%. There was a high consistency between the absence of fidgety movements during the fidgety movements period and the developmental outcomes at 24 months of age (Kappa=0.786; P<0.05), and its predictive values were expressed as follows: predictive validity 97.4%, sensitivity 85.7%, specificity 98.1%, positive predictive value 75.0%, and negative predictive value 99.1%. Cramped-synchronized movements and absence of fidgety movements can predict adverse developmental outcomes at 24 months of age in full-term infants with asphyxia.

Child Development and Refractive Errors in Preschool Children

PubMed Central

Ibironke, Josephine O.; Friedman, David S.; Repka, Michael X.; Katz, Joanne; Giordano, Lydia; Hawse, Patricia; Tielsch, James M.

2011-01-01

Purpose Many parents are concerned about their child's development. The purpose of this study is to determine if parental concerns about overall development are associated with significant refractive errors among urban preschool children. Methods A cross-sectional population-based study was conducted to evaluate the prevalence of ocular disorders in white and African American children 6 through 71 months of age in Baltimore, Maryland, United States. A comprehensive eye examination with cycloplegic refraction was performed. Parental concerns about development were measured with the Parents' Evaluation of Developmental Status screening tool. 2381 of 2546 eligible children (93.5%) completed the refraction and the parental interview. Results Parental concerns about development were present in 510 of the 2381 children evaluated (21.4%; 95% CI: 9.8% – 23.1%). The adjusted odds ratios [OR] of parental concerns with hyperopia (≥ 3.00D) was 1.26 (95% CI: 0.90 – 1.74), with myopia (≥ 1.00D) was 1.29 (95% CI: 0.83 – 2.03), with astigmatism (≥ 1.50D) was 1.44 (95% CI: 1.08 – 1.93) irrespective of the type of astigmatism, and with anisometropia ≥ 2.00D was 2.61 (95% CI: 1.07 – 6.34). The odds of parental concerns about development significantly increased in children older than 36 months with hyperopia ≥ 3.00D, astigmatism ≥ 1.50D, or anisometropia ≥ 2.00D. Conclusions Parental concerns about general developmental problems were associated with some types of refractive error, astigmatism ≥ 1.50D and anisometropia ≥ 2.00D in children ages 6 to 71 months. Parental concerns were also more likely in children older than 36 months of age with hypermetropia, astigmatism or anisometropia. Parental concerns were not associated with myopia. Due to the potential consequences of uncorrected refractive errors, children whose parents have expressed concerns regarding development should be referred for an eye examination with cycloplegic refraction to rule out significant refractive errors. PMID:21150680

A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project.

PubMed

Keyserling, Thomas C; Samuel-Hodge, Carmen D; Pitts, Stephanie Jilcott; Garcia, Beverly A; Johnston, Larry F; Gizlice, Ziya; Miller, Cassandra L; Braxton, Danielle F; Evenson, Kelly R; Smith, Janice C; Davis, Gwen B; Quenum, Emmanuelle L; Elliott, Nadya T Majette; Gross, Myron D; Donahue, Katrina E; Halladay, Jacqueline R; Ammerman, Alice S

2016-08-05

Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population. The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m(2) offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up. Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m(2). In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar. The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest. clinicaltrials.gov Identifier: NCT01433484.

3 CFR 8684 - Proclamation 8684 of May 31, 2011. African-American Music Appreciation Month, 2011

Code of Federal Regulations, 2012 CFR

2012-01-01

... Music Appreciation Month, 2011 8684 Proclamation 8684 Presidential Documents Proclamations Proclamation 8684 of May 31, 2011 Proc. 8684 African-American Music Appreciation Month, 2011By the President of the United States of America A Proclamation The music of our Nation has always spoken to the condition of our...

3 CFR 8527 - Proclamation 8527 of May 28, 2010. African-American Music Appreciation Month, 2010

Code of Federal Regulations, 2011 CFR

2011-01-01

... Music Appreciation Month, 2010 8527 Proclamation 8527 Presidential Documents Proclamations Proclamation 8527 of May 28, 2010 Proc. 8527 African-American Music Appreciation Month, 2010By the President of the United States of America A Proclamation Music can tell a story, assuage our sorrows, provide blessing and...

75 FR 17843 - National Donate Life Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

... Donate Life Month, 2010 By the President of the United States of America A Proclamation As Americans, we..., tissue, stem cell, and blood donation. During National Donate Life Month, we honor donors who provide others with a second chance for a healthy life and encourage more Americans to share this precious gift...

3 CFR 8407 - Proclamation 8407 of August 31, 2009. National Ovarian Cancer Awareness Month, 2009

Code of Federal Regulations, 2010 CFR

2010-01-01

... Ovarian Cancer Awareness Month, 2009 8407 Proclamation 8407 Presidential Documents Proclamations Proclamation 8407 of August 31, 2009 Proc. 8407 National Ovarian Cancer Awareness Month, 2009By the President of the United States of America A Proclamation Ovarian cancer remains the leading cause of death from...

United States housing brief, November 2017

Treesearch

Delton Alderman

2018-01-01

November’s new single-family (SF) sales and SF housing starts were remarkable. Other housing data appear to have stalled on a monthly basis. Regionally, data were mixed across all sectors. New SF construction and remodeling spending remain relatively strong. Existing house sales improved on a month-over-month and year-over-year basis.

75 FR 32079 - Lesbian, Gay, Bisexual, and Transgender Pride Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

..., Gay, Bisexual, and Transgender Pride Month, 2010 By the President of the United States of America A... equality on behalf of the lesbian, gay, bisexual, and transgender (LGBT) community. This month, as we.... That is why we must give committed gay couples the same rights and responsibilities afforded to any...

3 CFR 8552 - Proclamation 8552 of August 31, 2010. National Prostate Cancer Awareness Month, 2010

Code of Federal Regulations, 2011 CFR

2011-01-01

... Prostate Cancer Awareness Month, 2010 8552 Proclamation 8552 Presidential Documents Proclamations Proclamation 8552 of August 31, 2010 Proc. 8552 National Prostate Cancer Awareness Month, 2010By the President... last decade, prostate cancer is still the second leading cause of cancer deaths among men in the United...

3 CFR 8702 - Proclamation 8702 of August 31, 2011. National Childhood Obesity Awareness Month, 2011

Code of Federal Regulations, 2012 CFR

2012-01-01

... Childhood Obesity Awareness Month, 2011 8702 Proclamation 8702 Presidential Documents Proclamations Proclamation 8702 of August 31, 2011 Proc. 8702 National Childhood Obesity Awareness Month, 2011By the President of the United States of America A Proclamation Since the 1970s, the rate of childhood obesity in...

78 FR 20215 - National Child Abuse Prevention Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-04

... Child Abuse Prevention Month, 2013 By the President of the United States of America A Proclamation... from fear. But for the millions of children who have experienced abuse or neglect, it is a promise that goes tragically unfulfilled. National Child Abuse Prevention Month is a time to make their struggle our...

77 FR 26649 - National Physical Fitness and Sports Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

... Physical Fitness and Sports Month, 2012 By the President of the United States of America A Proclamation In... Physical Fitness and Sports Month, we rededicate ourselves to empowering Americans young and old with the... on Fitness, Sports, and Nutrition, we are working to give more Americans the tools and information...

3 CFR 8832 - Proclamation 8832 of June 1, 2012. African-American Music Appreciation Month, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

... Music Appreciation Month, 2012 8832 Proclamation 8832 Presidential Documents Proclamations Proclamation 8832 of June 1, 2012 Proc. 8832 African-American Music Appreciation Month, 2012By the President of the United States of America A Proclamation As a long-cherished piece of American culture, music offers a...

3 CFR 9010 - Proclamation 9010 of August 30, 2013. National Prostate Cancer Awareness Month, 2013

Code of Federal Regulations, 2014 CFR

2014-01-01

... Prostate Cancer Awareness Month, 2013 9010 Proclamation 9010 Presidential Documents Proclamations Proclamation 9010 of August 30, 2013 Proc. 9010 National Prostate Cancer Awareness Month, 2013By the President of the United States of America A Proclamation Among American men, prostate cancer is both the second...

3 CFR 8855 - Proclamation 8855 of August 31, 2012. National Prostate Cancer Awareness Month, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

... Prostate Cancer Awareness Month, 2012 8855 Proclamation 8855 Presidential Documents Proclamations Proclamation 8855 of August 31, 2012 Proc. 8855 National Prostate Cancer Awareness Month, 2012By the President of the United States of America A Proclamation Prostate cancer is among the most common cancers for...

3 CFR 9028 - Proclamation 9028 of September 30, 2013. National Breast Cancer Awareness Month, 2013

Code of Federal Regulations, 2014 CFR

2014-01-01

... Breast Cancer Awareness Month, 2013 9028 Proclamation 9028 Presidential Documents Proclamations Proclamation 9028 of September 30, 2013 Proc. 9028 National Breast Cancer Awareness Month, 2013By the President... battling breast cancer and those at risk for breast cancer. This disease touches every corner of the United...

3 CFR 8874 - Proclamation 8874 of October 1, 2012. National Breast Cancer Awareness Month, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

... Breast Cancer Awareness Month, 2012 8874 Proclamation 8874 Presidential Documents Proclamations Proclamation 8874 of October 1, 2012 Proc. 8874 National Breast Cancer Awareness Month, 2012By the President of the United States of America A Proclamation Breast cancer touches the lives of Americans from every...

Influence of safety warnings on ESA prescribing among dialysis patients using an interrupted time series

PubMed Central

2013-01-01

Background In March, 2007, a black box warning was issued by the Food and Drug Administration (FDA) to use the lowest possible erythropoiesis-stimulating agents (ESA) doses for treatment of anemia associated with renal disease. The goal is to determine if a change in ESA use was observed following the warning among US dialysis patients. Methods ESA therapy was examined from September 2004 through August 2009 (thirty months before and after the FDA black box warning) among adult Medicare hemodialysis patients. An interrupted time series model assessed the impact of the warnings. Results The FDA black box warning did not appear to influence ESA prescribing among the overall dialysis population. However, significant declines in ESA therapy after the FDA warnings were observed for selected populations. Patients with a hematocrit ≥36% had a declining month-to-month trend before (−164 units/week, p = <0.0001) and after the warnings (−80 units/week, p = .001), and a large drop in ESA level immediately after the black box (−4,744 units/week, p = <.0001). Not-for-profit facilities had a declining month-to-month trend before the warnings (−90 units/week, p = .009) and a large drop in ESA dose immediately afterwards (−2,487 units/week, p = 0.015). In contrast, for-profit facilities did not have a significant change in ESA prescribing. Conclusions ESA therapy had been both profitable for providers and controversial regarding benefits for nearly two decades. The extent to which a FDA black box warning highlighting important safety concerns influenced use of ESA therapy among nephrologists and dialysis providers was unknown. Our study found no evidence of changes in ESA prescribing for the overall dialysis population resulting from a FDA black box warning. PMID:23927675

Modifying the clinical research infrastructure at a dedicated clinical trials unit: assessment of trial development, activation, and participant accrual

PubMed Central

Tang, Chad; Hess, Kenneth R.; Sanders, Dwana; Davis, Suzanne; Buzdar, Aman; Kurzrock, Razelle; Lee, J. Jack; Meric-Bernstam, Funda; Hong, David

2017-01-01

Purpose Information on processes for trials assessing investigational therapeutics is sparse. We assessed the trial development processes within the Department of Investigational Cancer Therapeutics (ICT) at MD Anderson Cancer Center and analyzed their effects on the trial activation timeline and enrollment. Experimental Design Data were from a prospectively maintained registry that tracks all clinical studies at MD Anderson. From this database we identified 2,261 activated phase I-III trials; 221 were done at the ICT. ICT trials were matched to trials from other MD Anderson departments by phase, sponsorship, and submission year. Trial performance metrics were compared with paired Wilcoxon signed rank tests. Results We identified 3 facets of the ICT research infrastructure: parallel processing of trial approval steps; a physician-led research team; and regular weekly meetings to foster research accountability. Separate analyses were conducted stratified by sponsorship (industry [133 ICT and 133 non-ICT trials] or institutional [68 ICT and 68 non-ICT trials]). ICT trial development was faster from IRB approval to activation (median difference of 1.1 months for industry-sponsored trials vs. 2.3 months for institutional) and from activation to first enrollment (median difference of 0.3 months for industry vs. 1.2 months for institutional) (all matched P<0.05). ICT trials also accrued more patients (median difference of 8 participants for industry vs. 33.5 for institutional) quicker (median difference 4.8 participants/year for industry vs. 11.1 for institutional) (all matched P<0.05). Conclusions Use of a clinical research–focused infrastructure within a large academic cancer center was associated with efficient trial development and participant accrual. PMID:27852698

Exploring Modifiable Risk Factors for Wheezing in African American Premature Infants

PubMed Central

Brooks, Jada L.; Holditch-Davis, Diane; Landerman, Lawrence R.; Miles, Margaret Shandor; Engelke, Stephen C.

2011-01-01

Objective To examine the degree to which obesity during infancy, consistent exposure to secondhand smoke, and parenting (positive attention, maternal involvement, and negative control) were related to early development of wheezing in a cohort of African American premature infants at 2, 6, 12, 18, and 24 months corrected age. Design Secondary analysis of a subset of variables from a larger nursing support intervention study. Setting Two regional perinatal centers in the southeastern United States. Participants One hundred sixty-eight African American premature infants (70 boys, 98 girls) who weighed less than 1,750 g or required mechanical ventilation and their mothers. Methods The presence of wheezing was obtained from maternal report at 2, 6, 12, 18, and 24 months. Infants were considered to have medically significant wheezing if they were using bronchodilators or pulmonary anti-inflammatory medications. Results The percent of infants who had medically significant wheezing increased from 12% at 2 months to 24% at 24 months corrected age. Infants who received more positive attention from their mothers had a slightly higher increase in the probability of developing wheezing over time. Infants of mothers who received public assistance had an increased probability of wheezing. Consistent exposure to secondhand smoke, obesity during infancy, maternal negative control, and maternal involvement were not related to the development of wheezing. Conclusion These findings suggest that the likelihood of developing wheezing in African American premature infants is associated with receiving more positive attention from their mothers and having mothers who receive public assistance. Since modifiable risk factors were not highly related to wheezing, intervention efforts need to focus on early identification and treatment of wheezing and asthma-related symptoms. PMID:21477216

An Evaluation of Provincial Infectious Disease Surveillance Reports in Ontario.

PubMed

Chan, Ellen; Barnes, Morgan E; Sharif, Omar

Public Health Ontario (PHO) publishes various infectious disease surveillance reports, but none have yet been formally evaluated. PHO evaluated its monthly and annual infectious disease surveillance reports to assess public health stakeholders' current perception of the products and to develop recommendations for improving future products. An evaluation consisting of an online survey and a review of public Web sites of other jurisdictions with similar annual reports. For the online survey, stakeholder organizations targeted were the 36 local public health units and the Health health ministry in Ontario, Canada. Survey participants included epidemiologists, managers, directors, and other public health practitioners from participating organizations. Online survey respondents' awareness and access to the reports, their rated usefulness of reports and subsections, and suggestions for improving usefulness; timeliness of select annual reports from other jurisdictions based on the period from data described to report publication. Among 57 survey respondents, between 74% and 97% rated each report as useful; the most common use was for situational awareness. Respondents ranked timeliness as the most important attribute of surveillance reports, followed by data completeness. Among 6 annual reports reviewed, the median time to publication was 11.5 months compared with 23.2 months for PHO. Recommendations based on this evaluation have already been applied to the monthly report (eg, focusing on the most useful sections) and have become key considerations when developing future annual reports and other surveillance reporting tools (eg, need to provide more timely reports). Other public health organizations may also use this evaluation to inform aspects of their surveillance report development and evaluation. The evaluation results have provided PHO with direction on how to improve its provincial infectious disease surveillance reporting moving forward, and formed a basis for future work in surveillance product development and evaluation.

Modifying the Clinical Research Infrastructure at a Dedicated Clinical Trials Unit: Assessment of Trial Development, Activation, and Participant Accrual.

PubMed

Tang, Chad; Hess, Kenneth R; Sanders, Dwana; Davis, Suzanne E; Buzdar, Aman U; Kurzrock, Razelle; Lee, J Jack; Meric-Bernstam, Funda; Hong, David S

2017-03-15

Purpose: Information on processes for trials assessing investigational therapeutics is sparse. We assessed the trial development processes within the Department of Investigational Cancer Therapeutics (ICT) at MD Anderson Cancer Center (Houston, TX) and analyzed their effects on the trial activation timeline and enrolment. Experimental Design: Data were from a prospectively maintained registry that tracks all clinical studies at MD Anderson. From this database, we identified 2,261 activated phase I-III trials; 221 were done at the ICT. ICT trials were matched to trials from other MD Anderson departments by phase, sponsorship, and submission year. Trial performance metrics were compared with paired Wilcoxon signed rank tests. Results: We identified three facets of the ICT research infrastructure: parallel processing of trial approval steps; a physician-led research team; and regular weekly meetings to foster research accountability. Separate analyses were conducted stratified by sponsorship [industry (133 ICT and 133 non-ICT trials) or institutional (68 ICT and 68 non-ICT trials)]. ICT trial development was faster from IRB approval to activation (median difference of 1.1 months for industry-sponsored trials vs. 2.3 months for institutional) and from activation to first enrolment (median difference of 0.3 months for industry vs. 1.2 months for institutional; all matched P < 0.05). ICT trials also accrued more patients (median difference of 8 participants for industry vs. 33.5 for institutional) quicker (median difference 4.8 participants/year for industry vs. 11.1 for institutional; all matched P < 0.05). Conclusions: Use of a clinical research-focused infrastructure within a large academic cancer center was associated with efficient trial development and participant accrual. Clin Cancer Res; 23(6); 1407-13. ©2016 AACR . ©2016 American Association for Cancer Research.

Infant feeding and mental and motor development at 18 months of age in first born singletons.

PubMed

Florey, C D; Leech, A M; Blackhall, A

1995-01-01

To determine the relationship between type of infant feeding and mental and psychomotor development at age 18 months. A follow-up study of children born to primigravidae living in Dundee and booked into antenatal clinics in the City of Dundee (Local Authority District) from 1 May 1985 to 30 April 1986. The study population was 846 first born singletons, of whom 592 attended for developmental assessment at age 18 months. The main outcome measures were the Bayley Scales of Infant Mental and Motor Development. Higher mental development was significantly related to breast feeding on discharge from hospital and according to the health visitors' notes at about 2 weeks after discharge after allowing for partner's social class, mother's education, height, alcohol and cigarette consumption; placental weight and the child's sex, birth weight and gestational age at birth. After adjustment for statistically significant variables, the difference in Bayley mental development index between breast and bottle fed infants was between 3.7 and 5.7 units depending on the source of feeding data. No differences were found for psychomotor development or behaviour. The study provides further evidence of a robust statistical association between type of feeding and child intelligence. However, the literature is replete with suggestions for potential confounding variables which offer alternative causal explanations. To unravel what is an important clinical and public health question, further research should concentrate on randomized trials of supplemented formula feeds for children of mothers opting for bottle feeding and on epidemiological studies designed to disentangle the relation between method of feeding, parental intelligence and social environment.

Supreme Court of the United States Syllabus: Cleveland Board of Education Et Al. v. LaFleur Et Al. Certiorari to the United States Court of Appeals for the Sixth Circuit. No. 72-77, Argued October 15, 1973 -- Decided January 21, 1974.

ERIC Educational Resources Information Center

Supreme Court of the U. S., Washington, DC.

School board rules for the Cleveland, Ohio, and the Chesterfield County, Virginia, districts required pregnant teachers to take unpaid maternity leave five months and four months respectively before expected childbirth. A date for eligibility for return to work was also arbitrarily set. This pamphlet contains the entire official text of the…

U. S. Naval Forces, Vietnam Monthly Historical Summary for May 1966

DTIC Science & Technology

1966-07-06

Nlvm and Unit 27. nt Nlm Trnnp;. Tliey will bo undor CUMINf/.C for administrativo pm’poses. Harbor defense units in the II, III, and IV Corps...beach to investigate. In the process an explosion, possibly a small mine, occurred thirty yards astern of PCF 36, At the same time the Viet Cong...general climate throughout the month remained one of uncertainty, with most of ticers adopting a "wait and see" attitude. As a result the process of

Developing an automatic classification system of vegetation anomalies for early warning with the ASAP (Anomaly hot Spots of Agricultural Production) system

NASA Astrophysics Data System (ADS)

Meroni, M.; Rembold, F.; Urbano, F.; Lemoine, G.

2016-12-01

Anomaly maps and time profiles of remote sensing derived indicators relevant to monitor crop and vegetation stress can be accessed online thanks to a rapidly growing number of web based portals. However, timely and systematic global analysis and coherent interpretation of such information, as it is needed for example for SDG 2 related monitoring, remains challenging. With the ASAP system (Anomaly hot Spots of Agricultural Production) we propose a two-step analysis to provide monthly warning of production deficits in water-limited agriculture worldwide. The first step is fully automated and aims at classifying each administrative unit (1st sub-national level) into a number of possible warning levels, ranging from "none" to "watch" and up to "extended alarm". The second step involves the verification of the automatic warnings and integration into a short national level analysis by agricultural analysts. In this paper we describe the methodological development of the automatic vegetation anomaly classification system. Warnings are triggered only during the crop growing season, defined by a remote sensing based phenology. The classification takes into consideration the fraction of the agricultural and rangelands area for each administrative unit that is affected by a severe anomaly of two rainfall-based indicators (the Standardized Precipitation Index (SPI), computed at 1 and 3-month scale) and one biophysical indicator (the cumulative NDVI from the start of the growing season). The severity of the warning thus depends on the timing, the nature and the number of indicators for which an anomaly is detected. The prototype system is using global NDVI images of the METOP sensor, while a second version is being developed based on 1km Modis NDVI with temporal smoothing and near real time filtering. Also a specific water balance model is under development to include agriculture water stress information in addition to the SPI. The monthly warning classification and crop condition assessment will be made available on a website and will strengthen the JRC support to information products based on consensus assessment such as the GEOGLAM Crop Monitor for Early Warning.

Petroleum supply monthly, April 1991. [Glossary included

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

Not Available

1991-04-29

Data presented in the PSM (Petroleum Supply Monthly) describe the supply and disposition of petroleum products in the United States and major US geographic regions. The data series describe production, imports and exports, inter-Petroleum Administration for Defense (PAD) District movements, and inventories by the primary suppliers of petroleum products in the United States (50 States and the District of Columbia). The reporting universe includes those petroleum sectors in Primary Supply. Included are: petroleum refiners, motor gasoline blenders, operators of natural gas processing plants and fractionators, inter-PAD transporters, importers, and major inventory holders of petroleum products and crude oil. When aggregated,more » the data reported by these sectors approximately represent the consumption of petroleum products in the United States. The tables and figures in the Summary Statistics section of the PSM present a time series of selected petroleum data on a US level. Most time series include preliminary estimates for one month. The Detailed Statistics tables of the PSM present statistics for the most current month available as well as year-to-date. Industry terminology and product definitions are listed alphabetically in the Glossary. 14 figs., 65 tabs.« less

Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial.

PubMed

Self, Wesley H; Semler, Matthew W; Wanderer, Jonathan P; Ehrenfeld, Jesse M; Byrne, Daniel W; Wang, Li; Atchison, Leanne; Felbinger, Matthew; Jones, Ian D; Russ, Stephan; Shaw, Andrew D; Bernard, Gordon R; Rice, Todd W

2017-04-13

Prior studies in critically ill patients suggest the supra-physiologic chloride concentration of 0.9% ("normal") saline may be associated with higher risk of renal failure and death compared to physiologically balanced crystalloids. However, the comparative effects of 0.9% saline and balanced fluids are largely unexamined among patients outside the intensive care unit, who represent the vast majority of patients treated with intravenous fluids. This study, entitled Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED), is a pragmatic, cluster, multiple-crossover trial at a single institution evaluating clinical outcomes of adults treated with 0.9% saline versus balanced crystalloids for intravenous fluid resuscitation in the emergency department. All adults treated in the study emergency department receiving at least 500 mL of isotonic crystalloid solution during usual clinical care and subsequently hospitalized outside the intensive care unit are included. Treatment allocation of 0.9% saline versus balanced crystalloids is assigned by calendar month, with study patients treated during the same month assigned to the same fluid type. The first month (January 2016) was randomly assigned to balanced crystalloids, with each subsequent month alternating between 0.9% saline and balanced crystalloids. For balanced crystalloid treatment, clinicians can choose either Lactated Ringer's or Plasma-Lyte A©. The study period is set at 16 months, which will result in an anticipated estimated sample size of 15,000 patients. The primary outcome is hospital-free days to day 28, defined as the number of days alive and out of the hospital from the index emergency department visit until 28 days later. Major secondary outcomes include proportion of patients who develop acute kidney injury by creatinine measurements; major adverse kidney events by hospital discharge or day 30 (MAKE30), which is a composite outcome of death, new renal replacement therapy, and persistent creatinine elevation >200% of baseline; and in-hospital mortality. This ongoing pragmatic trial will provide the most comprehensive evaluation to date of clinical outcomes associated with 0.9% saline compared to physiologically balanced fluids in patients outside the intensive care unit. ClinicalTrials.gov, NCT02614040 . Registered on 18 November 2015.

Developing a Peak Wind Probability Forecast Tool for Kennedy Space Center and Cape Canaveral Air Force Station

NASA Technical Reports Server (NTRS)

Lambert, WInifred; Roeder, William

2007-01-01

This conference presentation describes the development of a peak wind forecast tool to assist forecasters in determining the probability of violating launch commit criteria (LCC) at Kennedy Space Center (KSC) and Cape Canaveral Air Force Station (CCAFS) in east-central Florida. The peak winds are an important forecast element for both the Space Shuttle and Expendable Launch Vehicle (ELV) programs. The LCC define specific peak wind thresholds for each launch operation that cannot be exceeded in order to ensure the safety of the vehicle. The 45th Weather Squadron (45 WS) has found that peak winds are a challenging parameter to forecast, particularly in the cool season months of October through April. Based on the importance of forecasting peak winds, the 45 WS tasked the Applied Meteorology Unit (AMU) to develop a short-range peak-wind forecast tool to assist in forecasting LCC violations. The tool will include climatologies of the 5-minute mean and peak winds by month, hour, and direction, and probability distributions of the peak winds as a function of the 5-minute mean wind speeds.

Next-generation dengue vaccines: novel strategies currently under development.

PubMed

Durbin, Anna P; Whitehead, Stephen S

2011-10-01

Dengue has become the most important arboviral infection worldwide with more than 30 million cases of dengue fever estimated to occur each year. The need for a dengue vaccine is great and several live attenuated dengue candidate vaccines are proceeding through clinical evaluation. The need to induce a balanced immune response against all four DENV serotypes with a single vaccine has been a challenge for dengue vaccine developers. A live attenuated DENV chimeric vaccine produced by Sanofi Pasteur has recently entered Phase III evaluation in numerous dengue-endemic regions of the world. Viral interference between serotypes contained in live vaccines has required up to three doses of the vaccine be given over a 12-month period of time. For this reason, novel DENV candidate vaccines are being developed with the goal of achieving a protective immune response with an immunization schedule that can be given over the course of a few months. These next-generation candidates include DNA vaccines, recombinant adenovirus vectored vaccines, alphavirus replicons, and sub-unit protein vaccines. Several of these novel candidates will be discussed.

Imported Cutaneous Diphtheria, United Kingdom

PubMed Central

de Benoist, Anne-Claire; White, Joanne Margaret; Efstratiou, Androulla; Kelly, Carole; Mann, Ginder; Nazareth, Bernadette; Irish, Charles James; Kumar, Deepti

2004-01-01

Cutaneous diphtheria is endemic in tropical countries but unusual in the United Kingdom. Four cases occurred in the United Kingdom within 2 months in 2002. Because cutaneous diphtheria causes outbreaks of both cutaneous and pharyngeal forms, early diagnosis is essential for implementing control measures; high diphtheria vaccination coverage must also be maintained. PMID:15109425

Simulation of daily pesticide concentrations from watershed characteristics and monthly climatic data

USGS Publications Warehouse

Vecchia, Aldo V.; Crawford, Charles G.

2006-01-01

A time-series model was developed to simulate daily pesticide concentrations for streams in the coterminous United States. The model was based on readily available information on pesticide use, climatic variability, and watershed charac-teristics and was used to simulate concentrations for four herbicides [atrazine, ethyldipropylthiocarbamate (EPTC), metolachlor, and trifluralin] and three insecticides (carbofuran, ethoprop, and fonofos) that represent a range of physical and chemical properties, application methods, national application amounts, and areas of use in the United States. The time-series model approximates the probability distributions, seasonal variability, and serial correlation characteristics in daily pesticide concentration data from a national network of monitoring stations. The probability distribution of concentrations for a particular pesticide and station was estimated using the Watershed Regressions for Pesticides (WARP) model. The WARP model, which was developed in previous studies to estimate the probability distribution, was based on selected nationally available watershed-characteristics data, such as pesticide use and soil characteristics. Normality transformations were used to ensure that the annual percentiles for the simulated concentrations agree closely with the percentiles estimated from the WARP model. Seasonal variability in the transformed concentrations was maintained by relating the transformed concentration to precipitation and temperature data from the United States Historical Climatology Network. The monthly precipitation and temperature values were estimated for the centroids of each watershed. Highly significant relations existed between the transformed concentrations, concurrent monthly precipitation, and concurrent and lagged monthly temperature. The relations were consistent among the different pesticides and indicated the transformed concentrations generally increased as precipitation increased but the rate of increase depended on a temperature-dependent growing-season effect. Residual variability of the transformed concentrations, after removal of the effects of precipitation and temperature, was partitioned into a signal (systematic variability that is related from one day to the next) and noise (random variability that is not related from one day to the next). Variograms were used to evaluate measurement error, seasonal variability, and serial correlation of the historical data. The variogram analysis indicated substantial noise resulted, at least in part, from measurement errors (the differences between the actual concen-trations and the laboratory concentrations). The variogram analysis also indicated the presence of a strongly correlated signal, with an exponentially decaying serial correlation function and a correlation time scale (the time required for the correlation to decay to e-1 equals 0.37) that ranged from about 18 to 66 days, depending on the pesticide type. Simulated daily pesticide concentrations from the time-series model indicated the simulated concentrations for the stations located in the northeastern quadrant of the United States where most of the monitoring stations are located generally were in good agreement with the data. The model neither consistently overestimated or underestimated concentrations for streams that are located in this quadrant and the magnitude and timing of high or low concentrations generally coincided reasonably well with the data. However, further data collection and model development may be necessary to determine whether the model should be used for areas for which few historical data are available.

An Exploration of Administrative Heuristics in the United States and the United Kingdom

ERIC Educational Resources Information Center

English, Fenwick W.; Bolton, Cheryl L.

2008-01-01

This article is a report on a study of the use of heuristics, shortcuts, and rules of thumb by middle-line managers in institutions of higher education in the United States and the United Kingdom. Using a nonprobability convenience sample, the coinvestigators interviewed 13 middle-line managers over 5 months from eight institutions. The results…

A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon.

PubMed

Kane, Marlena; Weinacker, Ann; Arthofer, Rudolph; Seay-Morrison, Timothy; Elfman, Wesley; Ramirez, Mark; Ahuja, Neera; Pickham, David; Hereford, James; Welton, Mark

2016-12-01

The aim of this study is to evaluate the effect of 2 hospital-wide interventions on achieving a discharge-before-noon rate of 40%. A multidisciplinary team led by administrative and physician leadership developed a plan to diminish capacity constraints by minimizing late afternoon hospital discharges using 2 patient flow management techniques. The study was a preintervention/postintervention retrospective analysis observing all inpatients discharged across 19 inpatient units in a 484-bed, academic teaching hospital measuring calendar month discharge-before-noon percentage, patient satisfaction, and readmission rates. Patient satisfaction and readmission rates were used as baseline metrics. The discharge-before-noon percentage increased from 14% in the 11-month preintervention period to an average of 24% over the 11-month postintervention period, whereas patient satisfaction scores and readmission rates remained stable. Implementation of the 2 interventions successfully increased the percentage of discharges before noon yet did not achieve the goal of 40%. Patient satisfaction and readmission rates were not negatively impacted by the program.

Does overprotection cause cardiac invalidism after acute myocardial infarction?

PubMed

Riegel, B J; Dracup, K A

1992-01-01

To determine if overprotection on the part of the patient's family and friends contributes to the development of cardiac invalidism after acute myocardial infarction. Longitudinal survey. Nine hospitals in the southwestern United States. One hundred eleven patients who had experienced a first acute myocardial infarction. Subjects were predominantly male, older-aged, married, caucasian, and in functional class I. Eighty-one patients characterized themselves as being overprotected (i.e., receiving more social support from family and friends than desired), and 28 reported receiving inadequate support. Only two patients reported receiving as much support as they desired. Self-esteem, emotional distress, health perceptions, interpersonal dependency, return to work. Overprotected patients experienced less anxiety, depression, anger, confusion, more vigor, and higher self-esteem than inadequately supported patients 1 month after myocardial infarction (p < 0.05). Inadequately supported patients were more dependent 4 months after the event. Overprotection on the part of family and friends may facilitate psychosocial adjustment in the early months after an acute myocardial infarction rather than lead to cardiac invalidism.

Auditory perception in the child.

PubMed

Nicolay-Pirmolin, M

2003-01-01

The development of auditory perception in the infant starts in utero and continues up to the age of 9-10 years. We shall examine the various stages, the various acoustic parameters and the segmental level. Three stages are important: from 7 months onwards: first perceptual reorganization; between 7 and 12 months: second perceptual reorganization; from 10 to 24 months: segmentation of the spoken word. We will note the evolution between 2 and 6 years and between 6 and 9 years: 9 years being the critical age--switching from global treatment to analytic treatment of utterances. We will then examine musical perception and we note that at the prelinguistic level it is the same perceptive units that handle verbal sequences and musical sequences. The stages of musical perception are parallel to those for speech. Bigand posed the question: "should we see in these hierarchies, and in their importance to perception, the manifestation of an overall cognitive constraint restricting the handling of long sequences of acoustic events (including language) and why not even for all processes dealing with symbolic information".

High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit: a predictive model of mortality.

PubMed

Torres, Silvio Fabio; Iolster, Thomas; Schnitzler, Eduardo Julio; Farias, Julio Alberto; Bordogna, Adriana Claudia; Rufach, Daniel; Montes, María José; Siaba, Alejandro Javier; Rodríguez, María Gabriela; Jabornisky, Roberto; Colman, Carmen; Fernández, Analia; Caprotta, Gustavo; Diaz, Silvia; Poterala, Roxana; De Meyer, Marcela; Penazzi, Matías Enrique; González, Gustavo; Saenz, Silvia; Recupero, Oscar; Zapico, Luis; Alarcon, Blanca; Ariel, Esen; Minces, Pablo; Mari, Eduardo; Carnie, Antonio; Garea, Mónica; Jaen, Roxana

2012-03-01

To describe the clinical characteristics and outcome of patients admitted to pediatric intensive care with influenza A (pH1N1) 2009 in Argentina. Retrospective observational study. Thirteen pediatric intensive care units in Argentina. One hundred and forty-two patients with confirmed or suspected influenza A (H1N1). None. We included 142 critically ill patients. The median age was 19 months (range, 2-110 months) with 39% of the patients <24 months of age. Ninety-nine patients (70%) had an underlying disease. Influenza A (pH1N1) 2009 infection was confirmed in 90 patients and the remaining 52 had a positive direct immunofluorescence assay for influenza A. The median length of stay in the pediatric intensive care unit was 12 days (range, 2-52 days). One hundred eighteen patients (83%) received invasive mechanical ventilation and 19 patients were treated with noninvasive ventilation; however, seven of the patients receiving noninvasive ventilation later needed mechanical ventilation. Sixty-eight patients died (47%) with the most frequent cause refractory hypoxemia. Multivariate logistic regression analysis showed that age <24 months (odds ratio, 2.87; 2.35-3.93), asthma (odds ratio, 1.34; 1.20-2.91), and respiratory coinfection with respiratory syncytial virus (odds ratio, 2.92; 1.20-4.10) were associated with higher mortality. As expected, mechanical ventilation and treatment with inotropes were also associated with increased mortality. The mortality of children admitted to the pediatric intensive care unit with 2009 pH1N1 influenza was high (47%) in our population. Age <24 months, asthma, respiratory coinfection, need of mechanical ventilation, and treatment with inotropes were predictors of poorer outcome.

Improving Staff Communication and Transitions of Care Between Obstetric Triage and Labor and Delivery.

PubMed

O'Rourke, Kathleen; Teel, Joseph; Nicholls, Erika; Lee, Daniel D; Colwill, Alyssa Covelli; Srinivas, Sindhu K

2018-03-01

To improve staff perception of the quality of the patient admission process from obstetric triage to the labor and delivery unit through standardization. Preassessment and postassessment online surveys. A 13-bed labor and delivery unit in a quaternary care, Magnet Recognition Program, academic medical center in Pennsylvania. Preintervention (n = 100), postintervention (n = 52), and 6-month follow-up survey respondents (n = 75) represented secretaries, registered nurses, surgical technicians, certified nurse-midwives, nurse practitioners, maternal-fetal medicine fellows, anesthesiologists, and obstetric and family medicine attending and resident physicians from triage and labor and delivery units. We educated staff and implemented interventions, an admission huddle and safety time-out whiteboard, to standardize the admission process. Participants were evaluated with the use of preintervention, postintervention, and 6-month follow-up surveys about their perceptions regarding the admission process. Data tracked through the electronic medical record were used to determine compliance with the admission huddle and whiteboards. A 77% reduction (decrease of 49%) occurred in the perception of incomplete patient admission processes from baseline to 6-month follow-up after the intervention. Postintervention and 6-month follow-up survey results indicated that 100% of respondents responded strongly agree/agree/neutral that the new admission process improved communication surrounding care for patients. Data in the electronic medical record indicated that compliance with use of admission huddles and whiteboards increased from 50% to 80% by 6 months. The new patient admission process, including a huddle and safety time-out board, improved staff perception of the quality of admission from obstetric triage to the labor and delivery unit. Copyright © 2018 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Color Stability Behavior of Methacrylate-based Resin Composites Polymerized with Light-emitting Diodes and Quartz-Tungsten-Halogen.

PubMed

Sabatini, C

2015-01-01

Despite significant developments in improving the optical properties of resin composite materials, their color stability remains a challenge. This study aimed to evaluate the shade stability of light-polymerized, methacrylate-based resin composites with different filler particle composition (microfill, minifill, nanohybrids, and microhybrids) polymerized with quartz-tungsten-halogen (QTH) and light-emitting diodes (LED). Composite discs were fabricated from Tetric EvoCeram, Premise, Artiste, and Beautifil II (nanohybrids); Filtek Supreme Plus and Vit-l-escence (microhybrids); Heliomolar (microfill); and Estelite Sigma Quick (minifill) using a Teflon mold. The specimens were irradiated either with QTH (Elipar 2500; 600 mW/cm(2)) for 40 seconds or with LED (Bluephase G2; 1200 mW/cm(2)) for 20 seconds. Color parameters were measured with a colorimeter before and after polymerization and at 24 hours, one week, one month, and three months. Color change was calculated among the different storage periods. There was a significant effect of the composite, time, and their interaction (p<0.001) but no effect of the polymerization unit on the color stability. Color changes immediately after polymerization and at 24 hours (4.22 and 3.88 for LED; and 4.08 and 3.82 for QTH) were not significantly different from each other but were both significantly higher than changes after one week (0.96 and 0.78), one month (1.12 and 1.02), and three months (1.27 and 1.11) for LED and QTH, respectively (p<0.001). Color changes were observed for all the materials that were dependent on the type of composite but not on the polymerization unit. These color shifts took place primarily immediately after polymerization and after 24 hours and were additive in nature.

The Roles of Maternal Depression, Serotonin Reuptake Inhibitor Treatment, and Concomitant Benzodiazepine Use on Infant Neurobehavioral Functioning Over the First Postnatal Month.

PubMed

Salisbury, Amy L; O'Grady, Kevin E; Battle, Cynthia L; Wisner, Katherine L; Anderson, George M; Stroud, Laura R; Miller-Loncar, Cynthia L; Young, Marion E; Lester, Barry M

2016-02-01

The purpose of this article was to systematically compare the developmental trajectory of neurobehavior over the first postnatal month for infants with prenatal exposure to pharmacologically untreated maternal depression, selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors (collectively: SSRIs), SSRIs with concomitant benzodiazepines (SSRI plus benzodiazepine), and no maternal depression or drug treatment (no exposure). Women (N=184) were assessed at two prenatal time points to determine psychiatric diagnoses, symptom severity, and prenatal medication usage. Infants were examined with a structured neurobehavioral assessment (Neonatal Intensive Care Unit Network Neurobehavioral Scale) at multiple time points across the first postnatal month. SSRI exposure was confirmed in a subset of participants with plasma SSRI levels. General linear-mixed models were used to examine group differences in neurobehavioral scores over time with adjustment for demographic variables and depression severity. Infants in the SSRI and SSRI plus benzodiazepine groups had lower motor scores and more CNS stress signs across the first postnatal month, as well as lower self-regulation and higher arousal at day 14. Infants in the depression group had low arousal throughout the newborn period. Infants in all three clinical groups had a widening gap in scores from the no-exposure group at day 30 in their response to visual and auditory stimuli while asleep and awake. Infants in the SSRI plus benzodiazepine group had the least favorable scores on the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Neonatal adaptation syndrome was not limited to the first 2 weeks postbirth. The profile of neurobehavioral development was different for SSRI exposure than depression alone. Concomitant benzodiazepine use may exacerbate adverse behavioral effects.

Associations between positive and negative affect and 12-month physical disorders in a national sample.

PubMed

Weiser, Eric B

2012-06-01

Associations between positive and negative affect and a range of 12-month physical disorders were investigated in the Midlife Development in the United States Survey, a nationally representative sample of 3,032 adults ages 25-74. These associations were examined, controlling for relevant sociodemographic and psychiatric covariates. High positive affect was associated with decreased risk of physical disorders, whereas high negative affect was associated with increased risk. However, associations between positive affect and physical disorders were partially attenuated following adjustment for concurrent negative affect. Additionally, high affect balance was associated with decreased risk of physical disorders before and after adjustments. These findings underscore the relevance of affective disposition in health status, suggesting that both positive and negative affect may serve as viable health risk parameters.

Evaluative report on the Institute for Materials Research, National Bureau of Standards - fiscal year 1976. Annual report

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

Not Available

The Institute for Materials Research (IMR), one of the major organizational units of the National Bureau of Standards, conducts research to provide a better understanding of the basic properties of materials and develops methodology and standards for measuring their properties to help ensure effective utilization of technologically important materials by the nation's scientific, commercial, and industrial communities. This report covers activities of the Institute during the 12 months preceding the Panel meeting on January 26-27, 1976.

Evaluative report on the Institute for Materials Research, National Bureau of Standards - fiscal year 1977. Annual report

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

Not Available

The Institute for Materials Research (IMR), one of the major organizational units of the National Bureau of Standards, conducts research to provide a better understanding of the basic properties of materials and develops methodology and standards for measuring their properties to help ensure effective utilization of technologically important materials by the nation's scientific, commercial, and industrial communities. This report covers activities of the Institute during the 12 months preceding the Panel meeting on January 25-26, 1977.

Microgravity cultivation of cells and tissues

NASA Technical Reports Server (NTRS)

Freed, L. E.; Pellis, N.; Searby, N.; de Luis, J.; Preda, C.; Bordonaro, J.; Vunjak-Novakovic, G.

1999-01-01

In vitro studies of cells and tissues in microgravity, either simulated by cultivation conditions on earth or actual, during spaceflight, are expected to help identify mechanisms underlying gravity sensing and transduction in biological organisms. In this paper, we review rotating bioreactor studies of engineered skeletal and cardiovascular tissues carried out in unit gravity, a four month long cartilage tissue engineering study carried out aboard the Mir Space Station, and the ongoing laboratory development and testing of a system for cell and tissue cultivation aboard the International Space Station.

Organophosphorus and carbamate pesticides

USGS Publications Warehouse

Glaser, L.C.

1999-01-01

The insecticidal properties of organophosphorus (OP) and carbamate compounds were first discovered in the 1930s, and the compounds were developed for pesticide use in the 1940s. They have been used increasingly since the 1970s when environmentally persistent organochlorine pesticides, such as DDT and dieldrin, were banned for use in the United States. Organophosphorus and carbamate pesticides are generally short-lived in the environment (usually lasting only days to months instead of years) and, generally, chemical breakdown is accelerated as temperatures or pH or both increase.

Designing and testing computer based screening engine for severe sepsis/septic shock.

PubMed

Herasevich, V; Afessa, B; Chute, C G; Gajic, O

2008-11-06

This study addresses the role of a sepsis "sniffer", an automatic screening tool for the timely identification of patients with severe sepsis/septic shock, based electronic medical records. During the two months prospective implementation in a medical intensive care unit, 37 of 320 consecutive patients developed severe sepsis/septic shock. The sniffer demonstrated a sensitivity of 48% and specificity of 86%, and positive predictive value 32%. Further improvements are needed prior to the implementation of sepsis sniffer in clinical practice and research.

How is the United States Naval Academy Developing and Preparing Surface Warfare Officers: A Needs Analysis of the SWO Leadership Capstone Course

DTIC Science & Technology

2007-06-01

the ship. These cognitive needs can be thought of as what would be taught at the five-month SWOSDOC, the DOSP computer -based training modules, at a...137 a. Can NL401 Provide both Closure and Further Exploration? ...................138 b. Can Both be Accomplished in the Time Allotted...Warfare Officer Community, has no follow-on school; SWO Ensigns are trained by coupling the Division Officer at Sea Program (DOSP) computer based

Hola! ADEOS

NASA Astrophysics Data System (ADS)

Carlowicz, Michael

Three months after its launch, Japan's Advanced Earth Observing Satellite (ADEOS) is set to begin day-to-day science operations at the end of November. The global change research satellite, launched August 16 from the Tanegashima Space Center by Japan's National Space Development Agency (NASDA), has settled into a circular polar orbit at 800 km altitude. ADEOS includes instruments from Japan, the United States, and France that will observe ocean chlorophyll production, ocean temperature, atmospheric gases, polarization and direction of solar energy reflected by the Earth, and the distribution of vegetation.

A Longitudinal Study of Social Capital and Acculturation-Related Stress Among Recent Latino Immigrants in South Florida

PubMed Central

Concha, Maritza; Sanchez, Mariana; de la Rosa, Mario; Villar, María Elena

2014-01-01

This study uses social capital to assess the effects of social support on acculturation-related stress among recently immigrated Hispanics in South Florida before and after immigration. At baseline (N = 527), first 12 months in the United States, acculturative stress was negatively related to support from friends (p < .044) and positively related to support from parents (p < .023). At first follow-up (n = 415), 24 months in the United States, emotional/informational support was negatively associated with acculturation-related stress (p < .028). In the second follow-up (n = 478), 36 months in the United States, support from children was negatively associated with acculturation-related stress (p < .016). Limited English proficiency was found to be negatively associated with acculturation stress at all three points (p < .001, p < .025, and p < .001, respectively). Implications of this study can be used in the design of culturally appropriate and family-oriented interventions for recent immigrants to ease the acculturation process. PMID:24478535

A Longitudinal Study of Social Capital and Acculturation-Related Stress Among Recent Latino Immigrants in South Florida.

PubMed

Concha, Maritza; Sanchez, Mariana; de la Rosa, Mario; Villar, María Elena

2013-11-01

This study uses social capital to assess the effects of social support on acculturation-related stress among recently immigrated Hispanics in South Florida before and after immigration. At baseline ( N = 527), first 12 months in the United States, acculturative stress was negatively related to support from friends ( p < .044) and positively related to support from parents ( p < .023). At first follow-up ( n = 415), 24 months in the United States, emotional/informational support was negatively associated with acculturation-related stress ( p < .028). In the second follow-up ( n = 478), 36 months in the United States, support from children was negatively associated with acculturation-related stress ( p < .016). Limited English proficiency was found to be negatively associated with acculturation stress at all three points ( p < .001, p < .025, and p < .001, respectively). Implications of this study can be used in the design of culturally appropriate and family-oriented interventions for recent immigrants to ease the acculturation process.

77 FR 5377 - National Teen Dating Violence Awareness and Prevention Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-03

... violence remains a reality for millions of young people. In a 12 month period, one in 10 high school... National Teen Dating Violence Awareness and Prevention Month, 2012 By the President of the United States of... emotional abuse as part of a controlling or violent dating relationship. The consequences of dating violence...

78 FR 8349 - National Teen Dating Violence Awareness and Prevention Month, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... National Teen Dating Violence Awareness and Prevention Month, 2013 By the President of the United States of... disproportionately affected by both dating violence and sexual assault. This month, we stand with those who have known the pain and isolation of an abusive relationship, and we recommit to ending the cycle of violence...

Pathways to Bilingualism: Young Children's Home Experiences Learning English and Spanish

ERIC Educational Resources Information Center

Rodriguez, M. Victoria

2010-01-01

Nowadays, more and more young children in the United States have the experience of speaking a language other than English at home, and many parents choose to educate their children bilingually. This study explored the home-language experiences, in English and Spanish, of three young Latino girls ages 15 months, 16 months, and 30 months,…

3 CFR 8768 - Proclamation 8768 of December 28, 2011. National Mentoring Month, 2012

Code of Federal Regulations, 2012 CFR

2012-01-01

... December 28, 2011 Proc. 8768 National Mentoring Month, 2012By the President of the United States of America... essential role in preparing our Nation’s youth for a bright future. During National Mentoring Month, we... relative, or a trusted friend, a mentor’s steady and dependable support can inspire a child to strive for...

[New growth references of the World Health Organization based on breast fed infants].

PubMed

Lozano de la Torre, Maria J

2007-02-01

The World Health Organization Multicenter Growth Reference Study is a multinational project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of 8440 children. The new WHO Child Growth Standards confirm that all children worldwide, given an optimum start in life, have the same potential for growth and prove that differences in children's growth to the age of 5 years are more influenced by nutrition, feeding practices, environment, and healthcare than by genetics or ethnicity. The new standards are based on the breast fed child as the norm for growth and development. For the first time, this ensures coherence among the tools used to assess growth and national and international infant feeding guidelines, which recommend breast feeding as the optimal source of nutrition during infancy.

Persistence of vaccine-derived polioviruses among immunodeficient persons with vaccine-associated paralytic poliomyelitis.

PubMed

Khetsuriani, Nino; Prevots, D Rebecca; Quick, Linda; Elder, Melissa E; Pallansch, Mark; Kew, Olen; Sutter, Roland W

2003-12-15

To estimate long-term poliovaccine virus persistence among immunodeficient patients with vaccine-associated paralytic poliomyelitis (iVAPP), cases reported in the United States during 1975-1997 were reviewed, with subsequent follow-up and virological testing. Six (16.2%) of 37 subjects excreted poliovaccine viruses for > or =6 months. Partial genomic sequencing of their available poliovirus isolates showed considerable divergence from the prototype Sabin strain in all cases. Poliovirus persistence declined over time since the last oral poliovaccine dose: at 6 months, 19.4%; 1 year, 14.3%; 5 years, 4%; and 10 years, 0% (P<.05) of patients. Despite the high prevalence of poliovaccine virus persistence among patients with iVAPP, this group appears to be an unlikely source of poliovirus reintroduction in developed countries because of the rarity and high fatality rate of iVAPP and the possible spontaneous clearance of polioviruses. These results are important for developing "endgame" strategies for the Global Poliomyelitis Eradication Program.

Multitemporal Snow Cover Mapping in Mountainous Terrain for Landsat Climate Data Record Development

NASA Technical Reports Server (NTRS)

Crawford, Christopher J.; Manson, Steven M.; Bauer, Marvin E.; Hall, Dorothy K.

2013-01-01

A multitemporal method to map snow cover in mountainous terrain is proposed to guide Landsat climate data record (CDR) development. The Landsat image archive including MSS, TM, and ETM+ imagery was used to construct a prototype Landsat snow cover CDR for the interior northwestern United States. Landsat snow cover CDRs are designed to capture snow-covered area (SCA) variability at discrete bi-monthly intervals that correspond to ground-based snow telemetry (SNOTEL) snow-water-equivalent (SWE) measurements. The June 1 bi-monthly interval was selected for initial CDR development, and was based on peak snowmelt timing for this mountainous region. Fifty-four Landsat images from 1975 to 2011 were preprocessed that included image registration, top-of-the-atmosphere (TOA) reflectance conversion, cloud and shadow masking, and topographic normalization. Snow covered pixels were retrieved using the normalized difference snow index (NDSI) and unsupervised classification, and pixels having greater (less) than 50% snow cover were classified presence (absence). A normalized SCA equation was derived to independently estimate SCA given missing image coverage and cloud-shadow contamination. Relative frequency maps of missing pixels were assembled to assess whether systematic biases were embedded within this Landsat CDR. Our results suggest that it is possible to confidently estimate historical bi-monthly SCA from partially cloudy Landsat images. This multitemporal method is intended to guide Landsat CDR development for freshwaterscarce regions of the western US to monitor climate-driven changes in mountain snowpack extent.

External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom

PubMed Central

Griggs, Kathryn A.; Prabhu, Gita; Gomes, Manuel; Lecky, Fiona E.; Hutchinson, Peter J. A.; Menon, David K.; Rowan, Kathryn M.

2015-01-01

Abstract This study validates risk prediction models for acute traumatic brain injury (TBI) in critical care units in the United Kingdom and recalibrates the models to this population. The Risk Adjustment In Neurocritical care (RAIN) Study was a prospective, observational cohort study in 67 adult critical care units. Adult patients admitted to critical care following acute TBI with a last pre-sedation Glasgow Coma Scale score of less than 15 were recruited. The primary outcomes were mortality and unfavorable outcome (death or severe disability, assessed using the Extended Glasgow Outcome Scale) at six months following TBI. Of 3626 critical care unit admissions, 2975 were analyzed. Following imputation of missing outcomes, mortality at six months was 25.7% and unfavorable outcome 57.4%. Ten risk prediction models were validated from Hukkelhoven and colleagues, the Medical Research Council (MRC) Corticosteroid Randomisation After Significant Head Injury (CRASH) Trial Collaborators, and the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) group. The model with the best discrimination was the IMPACT “Lab” model (C index, 0.779 for mortality and 0.713 for unfavorable outcome). This model was well calibrated for mortality at six months but substantially under-predicted the risk of unfavorable outcome. Recalibration of the models resulted in small improvements in discrimination and excellent calibration for all models. The risk prediction models demonstrated sufficient statistical performance to support their use in research and audit but fell below the level required to guide individual patient decision-making. The published models for unfavorable outcome at six months had poor calibration in the UK critical care setting and the models recalibrated to this setting should be used in future research. PMID:25898072

External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom.

PubMed

Harrison, David A; Griggs, Kathryn A; Prabhu, Gita; Gomes, Manuel; Lecky, Fiona E; Hutchinson, Peter J A; Menon, David K; Rowan, Kathryn M

2015-10-01

This study validates risk prediction models for acute traumatic brain injury (TBI) in critical care units in the United Kingdom and recalibrates the models to this population. The Risk Adjustment In Neurocritical care (RAIN) Study was a prospective, observational cohort study in 67 adult critical care units. Adult patients admitted to critical care following acute TBI with a last pre-sedation Glasgow Coma Scale score of less than 15 were recruited. The primary outcomes were mortality and unfavorable outcome (death or severe disability, assessed using the Extended Glasgow Outcome Scale) at six months following TBI. Of 3626 critical care unit admissions, 2975 were analyzed. Following imputation of missing outcomes, mortality at six months was 25.7% and unfavorable outcome 57.4%. Ten risk prediction models were validated from Hukkelhoven and colleagues, the Medical Research Council (MRC) Corticosteroid Randomisation After Significant Head Injury (CRASH) Trial Collaborators, and the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) group. The model with the best discrimination was the IMPACT "Lab" model (C index, 0.779 for mortality and 0.713 for unfavorable outcome). This model was well calibrated for mortality at six months but substantially under-predicted the risk of unfavorable outcome. Recalibration of the models resulted in small improvements in discrimination and excellent calibration for all models. The risk prediction models demonstrated sufficient statistical performance to support their use in research and audit but fell below the level required to guide individual patient decision-making. The published models for unfavorable outcome at six months had poor calibration in the UK critical care setting and the models recalibrated to this setting should be used in future research.

Infant feeding patterns and eczema in children in the first 6 years of life.

PubMed

Soto-Ramírez, N; Kar, S; Zhang, H; Karmaus, W

2017-10-01

Modes of infant feeding such as direct and indirect breastfeeding, and formula feeding, and their combinations may play a role in child health. The aim was to investigate which feeding patterns in the first 6 months pose risks of eczema/skin allergy in children up to 6 years compared to direct breastfeeding for at least 3 months. The Infant Feeding Practices Study II in the United States and its 6-year follow-up provided data on feeding modes in infancy and doctor's diagnosed eczema/skin allergy in the first 6 years of life (1387 infants), based on parental reports. Different feeding patterns were identified. Log-linear models were used to estimate prevalence ratios (PRs) of feeding patterns for doctor's diagnosed eczema/skin allergy in the first 6 years of life, adjusting for confounders. Compared to "direct breastfeeding for at least 3 months" (DBF3m), the combination of "direct feeding at the breast (DBF), pumping and feeding breast milk (BM), and formula (FF) in the first months" (DBF/BM/FF) showed a statistically significant higher risk of eczema/skin allergy in the first 6 years of life (PR = 1.46), adjusting for confounders. DBF combined with BM for the first 3 months followed by mixed feeding also had an increased risk (PR = 1.26), although not statistically significant. Formula feeding introduced since birth had no effect on eczema. Among the confounders, paternal eczema and race/ethnicity (Hispanic vs White) were associated with a higher risk of eczema/skin allergy. Mixed infant feeding may carry a higher risk of eczema/skin allergy compared to direct feeding at the breast. The recent epidemic of pumping and feeding in the United States and the use of mixed infant feeding modes requires additional studies to provide appropriate and renewed assessments of the risks of feeding modes for the future development of allergies. © 2017 John Wiley & Sons Ltd.

Leadership Stability in Army Reserve Component Units

DTIC Science & Technology

2013-01-01

or recognized, RC units could have more time because they may appear late in the force flow , particularly if AC units go earlier or the flow is...8, or deployment minus eight months), many new arrivals flowed into the unit, including many who would eventually deploy with the unit. Almost all...mobilization. Thus, those assigned are treated as 100 percent. To the right, we display the percentage (out of those assigned) who flowed into various

Your Health Care May Kill You: Medical Errors.

PubMed

Anderson, James G; Abrahamson, Kathleen

2017-01-01

Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death. Error rates are significantly higher in the U.S. than in other developed countries such as Canada, Australia, New Zealand, Germany and the United Kingdom (U.K). At the same time less than 10 percent of medical errors are reported. This study describes the results of an investigation of the effectiveness of the implementation of the MEDMARX Medication Error Reporting system in 25 hospitals in Pennsylvania. Data were collected on 17,000 errors reported by participating hospitals over a 12-month period. Latent growth curve analysis revealed that reporting of errors by health care providers increased significantly over the four quarters. At the same time, the proportion of corrective actions taken by the hospitals remained relatively constant over the 12 months. A simulation model was constructed to examine the effect of potential organizational changes resulting from error reporting. Four interventions were simulated. The results suggest that improving patient safety requires more than voluntary reporting. Organizational changes need to be implemented and institutionalized as well.

Treatment of congenital tracheal stenosis by balloon-expandable metallic stents in paediatric intensive care unit

PubMed Central

Xu, Xuan; Li, Dandan; Zhao, Shuyu; Liu, Xicheng; Feng, Zhichun; Ding, Hui

2012-01-01

The aim of this study was to evaluate the use of balloon-expandable metallic stents in the treatment of children with congenital tracheal stenosis in whom conventional therapy has failed. From 2010 to 2011, balloon-expandable metallic stents were implanted into the trachea of eight infants aged 2–20 months in the paediatric intensive care unit. The infants had severe airway obstruction caused by congenital tracheal stenosis. Tracheal stents were placed after intraluminal balloon dilatation of the tracheal stenosis, inserted with balloon catheters and implanted into the desired position bronchoscopically. The stents were 12 to 29 mm long and 4 mm in diameter. Seven children were relieved of airway obstruction after this procedure. However, a child died due to severe sepsis after the placement of bronchial stents. No granulation tissue developed over the stents in any of the children. Stents have been in place for 1–6 months after insertion without any other complication. Balloon-expandable metallic stents are effective in relieving airway obstruction by congenital tracheal stenosis in children. This technique may provide an important remedy for congenital tracheal stenosis in children. PMID:22361127

Central diabetes insipidus in children with acute brain insult.

PubMed

Yang, Yun-Hsuan; Lin, Jainn-Jim; Hsia, Shao-Hsuan; Wu, Chang-Teng; Wang, Huei-Shyong; Hung, Po-Cheng; Chou, Min-Liang; Hsieh, Meng-Ying; Lin, Kuang-Lin

2011-12-01

Central diabetes insipidus occurs in patients with overwhelming central nervous system injuries, and may be associated with brain death. The clinical picture of children with acquired central diabetes insipidus after acute brain insult is seldom reported. We retrospectively reviewed cases dating from January 2000-February 2008 at a tertiary pediatric intensive care unit. Fifty-four patients (28 girls, 26 boys), aged 3 months to 18 years, were enrolled. Etiologies included severe central nervous system infection (35.2%), hypoxic-ischemic events (31.5%), head injury (18.5%), and vascular lesions (14.8%). In 39 (72.2%) patients, diabetes insipidus was diagnosed during the first 2 days after acute central nervous system injury, and 40 (74.0%) developed maximum serum sodium concentrations of >160 mEq/L. In 16, sequential cerebral salt wasting syndrome developed after their initial diabetes insipidus presentation. Overall mortality at 2 months after admission was 77.8%. Our results demonstrate that patients who develop central diabetes insipidus after acute central nervous system injury manifest high mortality. Development of central diabetes insipidus within the first 2 days and a maximum plasma sodium >160 mEq/L were significant predictors of outcomes. Copyright © 2011 Elsevier Inc. All rights reserved.

Infants' use of category knowledge and object attributes when segregating objects at 8.5 months of age.

PubMed

Needham, Amy; Cantlon, Jessica F; Ormsbee Holley, Susan M

2006-12-01

The current research investigates infants' perception of a novel object from a category that is familiar to young infants: key rings. We ask whether experiences obtained outside the lab would allow young infants to parse the visible portions of a partly occluded key ring display into one single unit, presumably as a result of having categorized it as a key ring. This categorization was marked by infants' perception of the keys and ring as a single unit that should move together, despite their attribute differences. We showed infants a novel key ring display in which the keys and ring moved together as one rigid unit (Move-together event) or the ring moved but the keys remained stationary throughout the event (Move-apart event). Our results showed that 8.5-month-old infants perceived the keys and ring as connected despite their attribute differences, and that their perception of object unity was eliminated as the distinctive attributes of the key ring were removed. When all of the distinctive attributes of the key ring were removed, the 8.5-month-old infants perceived the display as two separate units, which is how younger infants (7-month-old) perceived the key ring display with all its distinctive attributes unaltered. These results suggest that on the basis of extensive experience with an object category, infants come to identify novel members of that category and expect them to possess the attributes typical of that category.

Quality of attachment, perinatal risk, and mother-infant interaction in a high-risk premature sample.

PubMed

Udry-Jørgensen, Laura; Pierrehumbert, Blaise; Borghini, Ayala; Habersaat, Stephanie; Forcada-Guex, Margarita; Ansermet, François; Muller-Nix, Carole

2011-05-01

Thirty-three families, each with a premature infant born less than 33 gestational weeks, were observed in a longitudinal exploratory study. Infants were recruited in a neonatal intensive care unit, and follow-up visits took place at 4 months and 12 months of corrected age. The severity of the perinatal problems was evaluated using the Perinatal Risk Inventory (PERI; A.P. Scheiner & M.E. Sexton, 1991). At 4 months, mother-infant play interaction was observed and coded according to the CARE-index (P.M. Crittenden, 2003); at 12 months, the Strange Situation Procedure (SSP; M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978) was administered. Results indicate a strong correlation between the severity of perinatal problems and the quality of attachment at 12 months. Based on the PERI, infants with high medical risks more frequently tended to be insecurely attached. There also was a significant correlation between insecure attachment and dyadic play interaction at 4 months (i.e., maternal controlling behavior and infant compulsive compliance). Moreover, specific dyadic interactive patterns could be identified as protective or as risk factors regarding the quality of attachment. Considering that attachment may have long-term influence on child development, these results underline the need for particular attention to risk factors regarding attachment among premature infants. Copyright © 2011 Michigan Association for Infant Mental Health.

New bulking agent for the treatment of vesicoureteral reflux: Polymethylmethacrylate/dextranomer.

PubMed

Kim, Sang Woon; Lee, Yong Seung; Im, Young Jae; Han, Sang Won

2018-05-01

The aim of this study was to report preliminary results of endoscopic treatment of vesicoureteral reflux in children with a single injection of a new bulking agent, cross-linked dextran and polymethylmethacrylate mixture. We performed a single-center, single surgeon, prospective, off-label study using polymethylmethacrylate/dextranomer to treat vesicoureteral reflux. All patients underwent endoscopic injection, followed by renal ultrasound and voiding cystourethrogram at 3 months postoperatively to identify de novo or worsening hydronephrosis and vesicoureteral reflux correction (to Grade 0 or I). Eighteen patients underwent injection of polymethylmethacrylate/dextranomer at our institution between April 2013 and December 2013. Ten were males and eight were females, with a median age of 58 months (range, 6 months to 5 years). Vesicoureteral reflux was unilateral in three patients and bilateral in 15, for a total of 33 renal refluxing units. Vesicoureteral reflux was Grade I in one renal refluxing unit, Grade II in 12, Grade III in 16, and Grade IV in four. Mean injected volume was 0.86 mL. Reflux was corrected in 23 renal refluxing units (69.7%) according to the 3-month voiding cystourethrogram. Complications included urinary retention in one patient. Mild pyelectasis was noted in one patient at 3 months, which spontaneously resolved 3 months later. Our short-term data show that polymethylmethacrylate/dextranomer injection can be used to treat vesicoureteral reflux with comparable efficacy to other substances currently used and a low rate of complications. Long-term follow-up is required to confirm the usefulness of this material in treating vesicoureteral reflux.

A Comparison of Anthropogenic Carbon Dioxide Emissions Datasets: UND and CDIAC

NASA Astrophysics Data System (ADS)

Gregg, J. S.; Andres, R. J.

2005-05-01

Using data from the Department of Energy's Energy Information Administration (EIA), a technique is developed to estimate the monthly consumption of solid, liquid and gaseous fossil fuels for each state in the union. This technique employs monthly sales data to estimate the relative monthly proportions of the total annual carbon dioxide emissions from fossil-fuel use for all states in the union. The University of North Dakota (UND) results are compared to those published by Carbon Dioxide Information Analysis Center (CDIAC) at the Oak Ridge National Laboratory (ORNL). Recently, annual emissions per U.S. state (Blasing, Broniak, Marland, 2004a) as well as monthly CO2 emissions for the United States (Blasing, Broniak, Marland, 2004b) have been added to the CDIAC website. To determine the success of this technique, the individual state results are compared to the annual state totals calculated by CDIAC. In addition, the monthly country totals are compared with those produced by CDIAC. In general, the UND technique produces estimates that are consistent with those available on the CDIAC Trends website. Comparing the results from these two methods permits an improved understanding of the strengths and shortcomings of both estimation techniques. The primary advantages of the UND approach are its ease of implementation, the improved spatial and temporal resolution it can produce, and its universal applicability.

Nomograms for predicting graft function and survival in living donor kidney transplantation based on the UNOS Registry.

PubMed

Tiong, H Y; Goldfarb, D A; Kattan, M W; Alster, J M; Thuita, L; Yu, C; Wee, A; Poggio, E D

2009-03-01

We developed nomograms that predict transplant renal function at 1 year (Modification of Diet in Renal Disease equation [estimated glomerular filtration rate]) and 5-year graft survival after living donor kidney transplantation. Data for living donor renal transplants were obtained from the United Network for Organ Sharing registry for 2000 to 2003. Nomograms were designed using linear or Cox regression models to predict 1-year estimated glomerular filtration rate and 5-year graft survival based on pretransplant information including demographic factors, immunosuppressive therapy, immunological factors and organ procurement technique. A third nomogram was constructed to predict 5-year graft survival using additional information available by 6 months after transplantation. These data included delayed graft function, any treated rejection episodes and the 6-month estimated glomerular filtration rate. The nomograms were internally validated using 10-fold cross-validation. The renal function nomogram had an r-square value of 0.13. It worked best when predicting estimated glomerular filtration rate values between 50 and 70 ml per minute per 1.73 m(2). The 5-year graft survival nomograms had a concordance index of 0.71 for the pretransplant nomogram and 0.78 for the 6-month posttransplant nomogram. Calibration was adequate for all nomograms. Nomograms based on data from the United Network for Organ Sharing registry have been validated to predict the 1-year estimated glomerular filtration rate and 5-year graft survival. These nomograms may facilitate individualized patient care in living donor kidney transplantation.

Lung protection: an intervention for tidal volume reduction in a teaching intensive care unit

PubMed Central

Briva, Arturo; Gaiero, Cristina

2016-01-01

Objective To determine the effect of feedback and education regarding the use of predicted body weight to adjust tidal volume in a lung-protective mechanical ventilation strategy. Methods The study was performed from October 2014 to November 2015 (12 months) in a single university polyvalent intensive care unit. We developed a combined intervention (education and feedback), placing particular attention on the importance of adjusting tidal volumes to predicted body weight bedside. In parallel, predicted body weight was estimated from knee height and included in clinical charts. Results One hundred fifty-nine patients were included. Predicted body weight assessed by knee height instead of visual evaluation revealed that the delivered tidal volume was significantly higher than predicted. After the inclusion of predicted body weight, we observed a sustained reduction in delivered tidal volume from a mean (standard error) of 8.97 ± 0.32 to 7.49 ± 0.19mL/kg (p < 0.002). Furthermore, the protocol adherence was subsequently sustained for 12 months (delivered tidal volume 7.49 ± 0.54 versus 7.62 ± 0.20mL/kg; p = 0.103). Conclusion The lack of a reliable method to estimate the predicted body weight is a significant impairment for the application of a worldwide standard of care during mechanical ventilation. A combined intervention based on education and repeated feedbacks promoted sustained tidal volume education during the study period (12 months). PMID:27925055

Arthrodesis of the knee with intramedullary nail fixation.

PubMed

Puranen, J; Kortelainen, P; Jalovaara, P

1990-03-01

Thirty-three patients had an arthrodesis of the knee by means of an intramedullary nail introduced through the greater trochanter. Fifteen of the procedures were done for a failed knee arthroplasty; eight had failed because of infection and seven, because of aseptic loosening. Twenty-nine of the thirty-three knees united three to four months after the first attempt at arthrodesis and three united after technical errors were corrected. One knee had a broken nail and a non-union; this was still untreated at the time of writing. Four nails broke: three in the line of fusion and one in the line of an infected supracondylar pseudarthrosis of the femur. No new infections developed after the arthrodesis. Three patients had had an infection and a chronic fistula before the arthrodesis, and the fistulae healed six, fourteen, and eighteen months postoperatively. In another patient, who had had infection and necrosis of the skin preoperatively, the wound healed in six months. All of these knees healed without an additional major operation. The functional result was satisfactory in all patients. After the arthrodesis, seventeen of the thirty-three patients needed less aid when walking, and no patient needed more aid. Fusion of the knee with a long intramedullary nail can be safe and effective, even in the presence of infection, if the revision is performed properly and certain technical principles are followed. It is especially important to establish good contact between the resected bones.

Breastfeeding infants with phenylketonuria in the United States and Canada.

PubMed

Banta-Wright, Sandra A; Press, Nancy; Knafl, Kathleen A; Steiner, Robert D; Houck, Gail M

2014-04-01

This study described the prevalence and duration of mothers' breastfeeding infants with phenylketonuria (PKU) and explored factors related to duration of breastfeeding as a surrogate for breastfeeding success. Descriptive analysis as performed from an international Internet survey of mothers (n=103) who met the inclusion criteria: (1) at least 21 years of age, (2) able to read and write in English, (3) child with PKU, and (4) living in the United States or Canada. Of the 103 mothers, 89 (86%) initiated breastfeeding immediately following delivery, whereas 14 (14%) chose bottle feeding. In comparison to breastfeeding after delivery, significantly fewer mothers breastfed after diagnosis (McNemar's χ(2)=30.33, p<0.001; n=72 vs. n=89). Breastfeeding duration ranged from less than 1 month to 24 months with one modal duration category (n=20, 22%) at less than 1 month. The timing of the addition of commercial infant formula to supplement breastfeeding or expressed mothers' milk was associated with a shorter duration of breastfeeding among infants with PKU: χ(2) (42, n=73)=88.13, p<0.001. PKU is treated with phenylalanine (Phe) restriction. Breastfeeding infants with PKU is challenging in part because Phe intake is difficult to determine precisely. We studied breastfeeding duration in infants with PKU and factors associated with success. Further research should identify the unique needs of mothers' breastfeeding infants with PKU to guide the development of interventions specific to these mothers to support their efforts to continue breastfeeding after the diagnosis of PKU.

Barriers and Challenges in Seeking Psychiatric Intervention in a General Hospital, by the Collaborative Child Response Unit, (A Multidisciplinary Team Approach to Handling Child Abuse) A Qualitative Analysis

PubMed Central

Subramaniyan, Vyjayanthi Kanugodu Srinivasa; Mital, Anukant; Rao, Chandrika; Chandra, Girish

2017-01-01

Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services. Methodology: Members of the team were recruited from different disciplines and trained by experts. A mission statement, protocol to assess the victims and provide treatment was formulated as an algorithm. The barriers to psychiatric treatment among the stakeholders were analyzed using framework method of qualitative analysis. Results (After 20 months) the unit received 27 referrals in 20 months, 24 females, and 3 males. Age of the victims was between 8 months and 17 years. Two cases found to be physically abused. Penetrative sexual abuse was found in 23 cases, pregnant victims were 4. Most referrals were by police, trafficking found in 6 cases. Discussion: It was possible to provide multidisciplinary care to the victims and families. Recurrent themes of barriers to psychiatric treatment were stigma, victim blaming; focus on termination of pregnancy, minimization of abuse in males by stakeholders. Conclusion is collaboration needs more effort to integrate psychiatric services but can minimize the reduplication of services. PMID:28250553

Cross-cultural analysis of the motor development of Brazilian, Greek and Canadian infants assessed with the Alberta Infant Motor Scale

PubMed Central

Saccani, Raquel; Valentini, Nadia Cristina

2013-01-01

OBJECTIVE: To compare the motor development of infants from three population samples (Brazil, Canada and Greece), to investigate differences in the percentile curves of motor development in these samples, and to investigate the prevalence of motor delays in Brazilian children. METHODS: Observational, descriptive and cross-sectional study with 795 Brazilian infants from zero to 18 months of age, assessed by the Alberta Infant Motor Scale (AIMS) at day care centers, nurseries, basic health units and at home. The Brazilian infants' motor scores were compared to the results of two population samples from Greece (424 infants) and Canada (2,400 infants). Descriptive statistics was used, with one-sample t-test and binomial tests, being significant p≤0.05. RESULTS: 65.4% of Brazilian children showed typical motor development, although with lower mean scores. In the beginning of the second year of life, the differences in the motor development among Brazilian, Canadian and Greek infants were milder; at 15 months of age, the motor development became similar in the three groups. A non-linear motor development trend was observed. CONCLUSIONS: The lowest motor percentiles of the Brazilian sample emphasized the need for national norms in order to correctly categorize the infant motor development. The different ways of motor development may be a consequence of cultural differences in infant care. PMID:24142318

Cross-cultural analysis of the motor development of Brazilian, Greek and Canadian infants assessed with the Alberta Infant Motor Scale.

PubMed

Saccani, Raquel; Valentini, Nadia Cristina

2013-09-01

To compare the motor development of infants from three population samples (Brazil, Canada and Greece), to investigate differences in the percentile curves of motor development in these samples, and to investigate the prevalence of motor delays in Brazilian children. Observational, descriptive and cross-sectional study with 795 Brazilian infants from zero to 18 months of age, assessed by the Alberta Infant Motor Scale (AIMS) at day care centers, nurseries, basic health units and at home. The Brazilian infants' motor scores were compared to the results of two population samples from Greece (424 infants) and Canada (2,400 infants). Descriptive statistics was used, with one-sample t-test and binomial tests, being significant p ≤ 0.05. 65.4% of Brazilian children showed typical motor development, although with lower mean scores. In the beginning of the second year of life, the differences in the motor development among Brazilian, Canadian and Greek infants were milder; at 15 months of age, the motor development became similar in the three groups. A non-linear motor development trend was observed. The lowest motor percentiles of the Brazilian sample emphasized the need for national norms in order to correctly categorize the infant motor development. The different ways of motor development may be a consequence of cultural differences in infant care.

Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study.

PubMed

Spittal, Matthew J; Grant, Genevieve; O'Donnell, Meaghan; McFarlane, Alexander C; Studdert, David M

2018-04-28

We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury. Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury. Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia. 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers' compensation scheme. 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey. Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R 2 =0.37) and calibration. The disability risk score had a score range of 0-180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0-220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes. The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Similar and functionally typical kinematic reaching parameters in 7- and 15-month-old in utero cocaine-exposed and unexposed infants.

PubMed

Tronick, E Z; Fetters, Linda; Olson, Karen L; Chen, Yuping

2004-04-01

This study examined the effects of intrauterine cocaine exposure on the reaches of 19 exposed and 15 unexposed infants at 7 and 15 months using kinematic measures. Infants sat at a table and reached for a rattle, a toy doll, and a chair. Videotaped reaches were digitized using the Peak Performance system. Kinematic movement variables were extracted (e.g., reach duration, peak velocity, movement units, path length) and ratios computed (e.g., path length divided by number of movement units). Regardless of exposure status, reaches of older infants were faster, more direct, had fewer movement units, and covered more distance with the first movement unit. Exposed infants covered more distance per movement unit than unexposed infants, but there were no other significant differences. Reaches of exposed and unexposed infants were essentially similar. Importantly, reach parameters for these high-risk infants were similar to reach parameters for infants at lower social and biological risk. Copyright 2004 Wiley Periodicals, Inc.

The effect of migration to the United States on substance use disorders among returned Mexican migrants and families of migrants.

PubMed

Borges, Guilherme; Medina-Mora, Maria Elena; Breslau, Joshua; Aguilar-Gaxiola, Sergio

2007-10-01

We examined the association between substance use disorders and migration to the United States in a nationally representative sample of the Mexican population. We used the World Mental Health version of the Composite International Diagnostic Interview to conduct structured, computer-assisted, face-to-face interviews with a cross-sectional sample of household residents aged 18 to 65 years who lived in Mexico in cities with a population of at least 2500 people in 2001 and 2002. The response rate was 76.6%, with 5826 respondents interviewed. Respondents who had migrated to the United States and respondents who had family members who migrated in the United States were more likely to have used alcohol, marijuana, or cocaine at least once in their lifetime; to develop a substance use disorder; and to have a current (in the past 12 months) substance use disorder than were other Mexicans. International migration appears to play a large role in transforming substance use norms and pathology in Mexico. Future studies should examine how networks extending over international boundaries influence substance use.

Examination of Duct Physiology in the Human Mammary Gland

PubMed Central

Mills, Dixie; Gomberawalla, Ameer; Gordon, Eva J.; Tondre, Julie; Nejad, Mitra; Nguyen, Tinh; Pogoda, Janice M.; Rao, Jianyu; Chatterton, Robert; Henning, Susanne; Love, Susan M.

2016-01-01

Background The human breast comprise several ductal systems, or lobes, which contain a small amount of fluid containing cells, hormones, proteins and metabolites. The complex physiology of these ducts is likely a contributing factor to the development of breast cancer, especially given that the vast majority of breast cancers begin in a single lobular unit. Methods We examined the levels of total protein, progesterone, estradiol, estrone sulfate, dehydroepiandrosterone sulfate, and macrophages in ductal fluid samples obtained from 3 ducts each in 78 women, sampled twice over a 6 month period. Samples were processed for both cytological and molecular analysis. Intraclass correlation coefficients and mixed models were utilized to identify significant data. Results We found that the levels of these ductal fluid components were generally uncorrelated among ducts within a single breast and over time, suggesting that each lobe within the breast has a distinct physiology. However, we also found that estradiol was more correlated in women who were nulliparous or produced nipple aspirate fluid. Conclusions Our results provide evidence that the microenvironment of any given lobular unit is unique to that individual unit, findings that may provide clues about the initiation and development of ductal carcinomas. PMID:27073976

The Nottingham Fatigue After Stroke (NotFAST) study: results from follow-up six months after stroke.

PubMed

Hawkins, Louise; Lincoln, Nadina B; Sprigg, Nikola; Ward, Nick S; Mistri, Amit; Tyrrell, Pippa; Worthington, Esme; Drummond, Avril

2017-12-01

Background Post-stroke fatigue is common and disabling. Objectives The aim of NotFAST was to examine factors associated with fatigue in stroke survivors without depression, six months after stroke. Methods Participants were recruited from four UK stroke units. Those with high levels of depressive symptoms (score ≥7 on Brief Assessment Schedule Depression Cards) or aphasia were excluded. Follow-up assessment was conducted at six months after stroke. They were assessed on the Fatigue Severity Scale, Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Barthel Index, Beck Anxiety Index, Brief Assessment Schedule Depression Cards, Impact of Event Scale-Revised, and Sleep Hygiene Index. Results Of the 371 participants recruited, 263 (71%) were contacted at six months after stroke and 213 (57%) returned questionnaires. Approximately half (n = 109, 51%) reported fatigue at six months. Of those reporting fatigue initially (n = 88), 61 (69%) continued to report fatigue. 'De novo' (new) fatigue was reported by 48 (38%) of those not fatigued initially. Lower Nottingham Extended Activities of Daily Living scores and higher Beck Anxiety Index scores were independently associated with fatigue at six months. Conclusions Half the stroke survivors reported fatigue at six months post-stroke. Reduced independence in activities of daily living and higher anxiety levels were associated with the level of fatigue. Persistent and delayed onset fatigue may affect independence and participation in rehabilitation, and these findings should be used to inform the development of appropriate interventions.

Cost of influenza hospitalization at a tertiary care children's hospital and its impact on the cost-benefit analysis of the recommendation for universal influenza immunization in children age 6 to 23 months.

PubMed

Hall, Jennifer L; Katz, Ben Z

2005-12-01

To calculate the costs of influenza hospitalization at a tertiary care children's hospital as the basis of a cost-benefit analysis of the new influenza vaccine recommendation for children age 6 to 23 months. We reviewed the medical records of all patients admitted to Children's Memorial Hospital (CMH) in 2002 diagnosed with influenza. Total hospital costs were obtained from the Business Development Office. Thirty-five charts were analyzed. Both of the 2 patients requiring mechanical ventilation and 4 of 6 patients admitted to the intensive care unit had high-risk underlying medical conditions. Nine children were age 6 to 23 months; 4 of these 9 had no preexisting medical conditions. Had all 18 high-risk children over age 6 months been protected from influenza, approximately $350,000 in hospital charges could have been saved. Preventing the additional 4 hospitalizations in the otherwise low-risk children age 6 to 23 months for whom vaccine is currently recommended would have cost approximately $281,000 ($46/child) more than the hospital charges saved. When all children age 6 to 23 months are considered, influenza vaccination is less costly than other prophylactic measures. Addition of indirect costs, deaths, outpatient costs, and the cost of secondary cases would favor the cost:benefit ratio for influenza vaccination of all children age 6 to 23 months.

Cost-Effectiveness of a Specialist Geriatric Medical Intervention for Frail Older People Discharged from Acute Medical Units: Economic Evaluation in a Two-Centre Randomised Controlled Trial (AMIGOS).

PubMed

Tanajewski, Lukasz; Franklin, Matthew; Gkountouras, Georgios; Berdunov, Vladislav; Edmans, Judi; Conroy, Simon; Bradshaw, Lucy E; Gladman, John R F; Elliott, Rachel A

2015-01-01

Poor outcomes and high resource-use are observed for frail older people discharged from acute medical units. A specialist geriatric medical intervention, to facilitate Comprehensive Geriatric Assessment, was developed to reduce the incidence of adverse outcomes and associated high resource-use in this group in the post-discharge period. To examine the costs and cost-effectiveness of a specialist geriatric medical intervention for frail older people in the 90 days following discharge from an acute medical unit, compared with standard care. Economic evaluation was conducted alongside a two-centre randomised controlled trial (AMIGOS). 433 patients (aged 70 or over) at risk of future health problems, discharged from acute medical units within 72 hours of attending hospital, were recruited in two general hospitals in Nottingham and Leicester, UK. Participants were randomised to the intervention, comprising geriatrician assessment in acute units and further specialist management, or to control where patients received no additional intervention over and above standard care. Primary outcome was incremental cost per quality adjusted life year (QALY) gained. We undertook cost-effectiveness analysis for 417 patients (intervention: 205). The difference in mean adjusted QALYs gained between groups at 3 months was -0.001 (95% confidence interval [CI]: -0.009, 0.007). Total adjusted secondary and social care costs, including direct costs of the intervention, at 3 months were £4412 (€5624, $6878) and £4110 (€5239, $6408) for the intervention and standard care groups, the incremental cost was £302 (95% CI: 193, 410) [€385, $471]. The intervention was dominated by standard care with probability of 62%, and with 0% probability of cost-effectiveness (at £20,000/QALY threshold). The specialist geriatric medical intervention for frail older people discharged from acute medical unit was not cost-effective. Further research on designing effective and cost-effective specialist service for frail older people discharged from acute medical units is needed. ISRCTN registry ISRCTN21800480 http://www.isrctn.com/ISRCTN21800480.

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

PubMed Central

Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B.; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

2016-01-01

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations. PMID:27694661

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness.

PubMed

Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

2016-04-11

Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations. © 2016 by Kerman University of Medical Sciences

Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort

PubMed Central

Aris, Izzuddin M; Bernard, Jonathan Y; Chen, Ling-Wei; Tint, Mya Thway; Pang, Wei Wei; Lim, Wai Yee; Soh, Shu E; Saw, Seang-Mei; Godfrey, Keith M; Gluckman, Peter D; Chong, Yap-Seng; Yap, Fabian; Kramer, Michael S; Lee, Yung Seng

2017-01-01

Abstract Background: Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher. Methods: We utilized data among 1020 infants from a mother-offspring cohort, who were Singapore citizens or permanent residents of Chinese, Malay or Indian ethnicity with homogeneous parental ethnic backgrounds, and did not receive chemotherapy, psychotropic drugs or have diabetes mellitus. Ethnicity was self-reported at recruitment and later confirmed using genotype analysis. Subject-specific BMI curves were fitted to infant BMI data using natural cubic splines with random coefficients to account for repeated measures in each child. We estimated characteristics of the child’s BMI peak [age and magnitude at peak, average pre-peak velocity (aPPV)]. Systolic (SBP) and diastolic blood pressure (DBP), BMI, sum of skinfolds (SSF) and fat-mass index (FMI) were measured during a follow-up visit at age 48 months. Weighted multivariable linear regression was used to assess the predictors (maternal BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational age and breastfeeding duration) of infant BMI peak and its associations with outcomes at 48 months. Comparisons between ethnicities were tested using Bonferroni post-hoc correction. Results: Of 1020 infants, 80.5% were followed up at the 48-month visit. Mean (SD) BMI, SSF and FMI at 48 months were 15.6 (1.8) kg/m2, 16.5 (5.3) mm and 3.8 (1.3) kg/m2, respectively. Mean (SD) age at peak BMI was 6.0 (1.6) months, with a magnitude of 17.2 (1.4) kg/m2 and pre-peak velocity of 0.7 (0.3) kg/m2/month. Compared with Chinese infants, the peak occurred later in Malay {B [95% confidence interval (CI): 0.64 mo (0.36, 0.92)]} and Indian infants [1.11 mo (0.76, 1.46)] and was lower in magnitude in Indian infants [–0.45 kg/m2 (–0.69, –0.20)]. Adjusting for maternal education, BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational-age and breastfeeding duration, higher peak and aPPV were associated with greater BMI, SSF and FMI at 48 months. Age at peak was positively associated with BMI at 48 months [0.15 units (0.09, 0.22)], whereas peak magnitude was associated with SBP [0.17 units (0.05, 0.30)] and DBP at 48 months [0.10 units (0.01, 0.22)]. Older age and higher magnitude at peak were associated with increased risk of overweight at 48 months [Relative Risk (95% CI): 1.35 (1.12–1.62) for age; 1.89 (1.60–2.24) for magnitude]. The associations of BMI peak with BMI and SSF at 48 months were stronger in Malay and Indian children than in Chinese children. Conclusions: Ethnic-specific differences in BMI peak characteristics, and associations of BMI peak with early childhood cardio-metabolic markers, suggest an important impact of early BMI development on later metabolic outcomes in Asian populations. PMID:27649801

Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort.

PubMed

Aris, Izzuddin M; Bernard, Jonathan Y; Chen, Ling-Wei; Tint, Mya Thway; Pang, Wei Wei; Lim, Wai Yee; Soh, Shu E; Saw, Seang-Mei; Godfrey, Keith M; Gluckman, Peter D; Chong, Yap-Seng; Yap, Fabian; Kramer, Michael S; Lee, Yung Seng

2017-04-01

: Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher. : We utilized data among 1020 infants from a mother-offspring cohort, who were Singapore citizens or permanent residents of Chinese, Malay or Indian ethnicity with homogeneous parental ethnic backgrounds, and did not receive chemotherapy, psychotropic drugs or have diabetes mellitus. Ethnicity was self-reported at recruitment and later confirmed using genotype analysis. Subject-specific BMI curves were fitted to infant BMI data using natural cubic splines with random coefficients to account for repeated measures in each child. We estimated characteristics of the child's BMI peak [age and magnitude at peak, average pre-peak velocity (aPPV)]. Systolic (SBP) and diastolic blood pressure (DBP), BMI, sum of skinfolds (SSF) and fat-mass index (FMI) were measured during a follow-up visit at age 48 months. Weighted multivariable linear regression was used to assess the predictors (maternal BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational age and breastfeeding duration) of infant BMI peak and its associations with outcomes at 48 months. Comparisons between ethnicities were tested using Bonferroni post-hoc correction. : Of 1020 infants, 80.5% were followed up at the 48-month visit. Mean (SD) BMI, SSF and FMI at 48 months were 15.6 (1.8) kg/m 2 , 16.5 (5.3) mm and 3.8 (1.3) kg/m 2 , respectively. Mean (SD) age at peak BMI was 6.0 (1.6) months, with a magnitude of 17.2 (1.4) kg/m 2 and pre-peak velocity of 0.7 (0.3) kg/m 2 /month. Compared with Chinese infants, the peak occurred later in Malay {B [95% confidence interval (CI): 0.64 mo (0.36, 0.92)]} and Indian infants [1.11 mo (0.76, 1.46)] and was lower in magnitude in Indian infants [-0.45 kg/m 2 (-0.69, -0.20)]. Adjusting for maternal education, BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational-age and breastfeeding duration, higher peak and aPPV were associated with greater BMI, SSF and FMI at 48 months. Age at peak was positively associated with BMI at 48 months [0.15 units (0.09, 0.22)], whereas peak magnitude was associated with SBP [0.17 units (0.05, 0.30)] and DBP at 48 months [0.10 units (0.01, 0.22)]. Older age and higher magnitude at peak were associated with increased risk of overweight at 48 months [Relative Risk (95% CI): 1.35 (1.12-1.62) for age; 1.89 (1.60-2.24) for magnitude]. The associations of BMI peak with BMI and SSF at 48 months were stronger in Malay and Indian children than in Chinese children. : Ethnic-specific differences in BMI peak characteristics, and associations of BMI peak with early childhood cardio-metabolic markers, suggest an important impact of early BMI development on later metabolic outcomes in Asian populations. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Effectiveness of infection prevention measures featuring advanced source control and environmental cleaning to limit transmission of extremely-drug resistant Acinetobacter baumannii in a Thai intensive care unit: An analysis before and after extensive flooding.

PubMed

Apisarnthanarak, Anucha; Pinitchai, Uayporn; Warachan, Boonyasit; Warren, David K; Khawcharoenporn, Thana; Hayden, Mary K

2014-02-01

Advanced source control (once-daily bathing and 4-times daily oral care with chlorhexidine aqueous solution) and thorough environmental cleaning were implemented in response to an increased incidence of colonization and infection with extremely drug-resistant (XDR) Acinetobacter baumannii in a Thai medical intensive care unit (MICU). During the 12-month baseline period (P1), contact isolation, active surveillance for XDR A baumannii, cohorting of XDR A baumannii patients, twice-daily environmental cleaning with detergent-disinfectant, and antibiotic stewardship were implemented. In the 5.5-month intervention period (P2), additional measures were introduced. Sodium hypochlorite was substituted for detergent-disinfectant, and advanced source control was implemented. All interventions except cleaning with sodium hypochlorite were continued during the 12.5-month follow-up period (P3). Extensive flooding necessitating closure of the hospital for 2 months occurred between P2 and P3. A total of 1,365 patients were studied. Compared with P1 (11.1 cases/1,000 patient-days), the rate of XDR A baumannii clinical isolates declined in P2 (1.74 cases/1,000 patient-days; P < .001) and further in P3 (0.69 cases/1,000 patient-days; P < .001). Compared with P1 (12.15 cases/1,000 patient-days), the rate of XDR A baumannii surveillance isolates also declined in P2 (2.11 cases/1,000 patient-days; P < .001) and P3 (0.98 cases/1,000 patient-days; P < .001). Incidence of nosocomial infections remained stable. Six patients developed chlorhexidine-induced rash (1.4/1,000 patient-days); 31 patients developed mucositis (17.1/1,000 patient-days). These results support advanced source control and thorough environmental cleaning to limit colonization and infection with XDR A baumannii in MICUs in resource-limited settings. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

PubMed

Parr, Jenny M; Bell, Jeanette; Koziol-McLain, Jane

2018-06-01

The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care. Five phases were used to explore the evidence, and design and test a measurement and improvement framework. Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements. © 2018 John Wiley & Sons Ltd.

3 CFR 8642 - Proclamation 8642 of March 31, 2011. National Donate Life Month, 2011

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Proclamation 8642 of March 31, 2011. National Donate... 31, 2011 Proc. 8642 National Donate Life Month, 2011By the President of the United States of America... difference in many lives. As we observe National Donate Life Month, we reflect on an important opportunity to...

Top sources of dietary sodium from birth to 24 months, United States, 2003-2010

USDA-ARS?s Scientific Manuscript database

Sodium intake is high among U.S. children. Data are limited on the dietary sources of sodium, especially from birth to age 24 months. The objective of this study was to identify top sources of dietary sodium among U.S. children from birth to 24 months. For this study, we used data from the Nation...

3 CFR 8428 - Proclamation 8428 of October 1, 2009. National Domestic Violence Awareness Month, 2009

Code of Federal Regulations, 2010 CFR

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false Proclamation 8428 of October 1, 2009. National Domestic Violence Awareness Month, 2009 8428 Proclamation 8428 Presidential Documents Proclamations Proclamation 8428 of October 1, 2009 Proc. 8428 National Domestic Violence Awareness Month, 2009By the President of the United States of America A...

3 CFR 8356 - Proclamation 8356 of April 1, 2009. National Donate Life Month, 2009

Code of Federal Regulations, 2010 CFR

2010-01-01

... www.organdonor.gov. NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by... Independence of the United States of America the two hundred and thirty-third.BARACK OBAMA ...

Impact of an osteoporosis specialized unit on bone health in breast cancer survivals treated with aromatase inhibitors.

PubMed

Martínez, Purificación; Galve, Elena; Arrazubi, Virginia; Sala, M Ángeles; Fernández, Seila; Pérez, Clara E; Arango, Juan F; Torre, Iñaki

2017-10-11

Considering the increased fracture risk in early breast cancer patients treated with aromatase inhibitors (AI), we assessed the impact of a preventive intervention conducted by a specialized osteoporosis unit on bone health at AI treatment start. Retrospective cohort of postmenopausal women who started treatment with AI after breast cancer surgical/chemotherapy treatment and were referred to the osteoporosis unit for a comprehensive assessment of bone health. Bone densitometry and fracture screening by plain X-ray were performed at the baseline visit and once a year for 5 years. The final record included 130 patients. At AI treatment start, 49% had at least one high-risk factor for fractures, 55% had osteopenia, and 39% osteoporosis. Based on the baseline assessment, 79% of patients initiated treatment with bisphosphonates, 88% with calcium, and 79% with vitamin D. After a median of 65 (50-77) months, 4% developed osteopenia or osteoporosis, and 14% improved their densitometric diagnosis. Fifteen fractures were recorded in 11 (8.5%) patients, all of them receiving preventive treatment (10 with bisphosphonates). During the follow-up period, patients with one or more high-risk factors for fracture showed a greater frequency of fractures (15% vs. 3%) and experienced the first fracture earlier than those without high-risk factors (mean of 99 and 102 months, respectively; P=0.023). The preventive intervention of a specialized unit at the start of AI treatment in breast cancer survivors allows the identification of patients with high fracture risk and may contribute to preventing bone events in these patients. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Complementary-relationship-based 30 year normals (1981-2010) of monthly latent heat fluxes across the contiguous United States

NASA Astrophysics Data System (ADS)

Szilagyi, Jozsef

2015-11-01

Thirty year normal (1981-2010) monthly latent heat fluxes (ET) over the conterminous United States were estimated by a modified Advection-Aridity model from North American Regional Reanalysis (NARR) radiation and wind as well as Parameter-Elevation Regressions on Independent Slopes Model (PRISM) air and dew-point temperature data. Mean annual ET values were calibrated with PRISM precipitation (P) and validated against United States Geological Survey runoff (Q) data. At the six-digit Hydrologic Unit Code level (sample size of 334) the estimated 30 year normal runoff (P - ET) had a bias of 18 mm yr-1, a root-mean-square error of 96 mm yr-1, and a linear correlation coefficient value of 0.95, making the estimates on par with the latest Land Surface Model results but without the need for soil and vegetation information or any soil moisture budgeting.

Comparison of the Output in Weighted Work Units of Installation Dental Laboratories with that of Regional Dental Activities. Part II.

DTIC Science & Technology

1980-07-01

at the study sites and compare it to the total production at each site. Orthodontics was excepted be- cause it is not done at all laboratories, nor is...DENTAC laboratories. It is sometimes tempting to relate productivity in terms of weighted work units to the type of work being done. Orthodontic laboratory...hypotheses. DENTAC Sites 2 and 3 both produce a heavy orthodontic workload, whereas Site 1 did very little in Month 1. In Month 2, when Site 1 reported a

Post-fall reporting in aged acute inpatient mental health units: an 18-month observational cohort study.

PubMed

Furness, Trentham; Mnatzaganian, George; Garlick, Robyn; Ireland, Susan; McKenna, Brian; Hill, Keith D

2017-12-01

Despite the high risk of falling for people with severe mental illness, there is limited falls research in mental health settings. Therefore, the objective of this observational cohort study was to conduct a focused post-fall review of fall episodes within aged acute inpatient mental health units at one of Australia's largest publicly funded mental health organizations. A post-fall reporting tool was developed to collect intrinsic and extrinsic fall risk factors among three aged acute mental health inpatient units over an 18-month period. Descriptive and inferential analyses were conducted to describe fall risk factors and predictors of fall risk. There were a total of 115 falls, of which the tool was used for 93 (80.9%) episodes. Falls occurred most often in consumer's bedroom/bathroom and were unwitnessed. Intrinsic risk factors were most often attributed to postural drop and losing balance during walking. However, that was in contrast to consumer's who self-reported feeling dizzy as the reason of the fall. Based on the cohort, future falls could be reduced by targeting those aged above 82 years, or with a diagnosis of dementia. Recurrent falls during admission could be reduced by targeting those with psychotic illness and males with a diagnosis of dementia. A clearer dialogue among consumers and clinical staff reporting about fall episodes may support future remedial interventions and inform programs to reduce fall risk and assist the challenge of describing unwitnessed falls in aged acute inpatient mental health settings.

Psychosocial risk and protective factors for postpartum depression in the United Arab Emirates.

PubMed

Hamdan, Aisha; Tamim, Hani

2011-04-01

Limited research has been conducted in the United Arab Emirates in relation to postpartum depression. The purpose of this study was to investigate the risk and protective factors of postpartum depression in women in Sharjah, United Arab Emirates. We carried out a prospective study in which we followed women from the second trimester of pregnancy until 4 months postpartum. Data were collected during the second and third trimesters and then at 2- and 4- months postpartum. The risk/protective factors that were investigated included: depression and anxiety during pregnancy, stressful life events, breastfeeding, employment status following delivery, religiosity, and socio-demographic variables. The Edinburgh Postnatal Depression Scale (screening) and the Mini International Neuropsychiatric Inventory (diagnostic) were used as outcome variables. Using the Mini International Neuropsychiatric Inventory (diagnostic), 10% of the 137 participants in the study were diagnosed with postpartum depression. The following variables were found to be predictive of postpartum depression: depression during pregnancy in both the second and third trimesters: number of children, religion, and use of formula for feeding. Several factors were of borderline significance including educational level of mother, lack of breastfeeding, personal stressful life events, and employment status following delivery. These risk factors are important as they indicate potential areas for early identification. Screening of pregnant women during pregnancy and in the postpartum phase would be important. This study forms the foundation for further research and development related to prevention and intervention for postpartum depression in this Arab context.

A Look into Students' Retention of Acquired Nature of Science Understandings

NASA Astrophysics Data System (ADS)

Khishfe, Rola

2015-07-01

Having the learning and retention of science content and skills as a goal of scientific literacy, it is significant to study the issue of retention as it relates to teaching and learning about nature of science (NOS). Then, the purpose of this study was to investigate the development of NOS understandings of students, and the retention of these understandings four months after being acquired through explicit reflective instruction in relation to two contexts. Participants were 24 tenth-grade students at a private high school in a city in the Middle East. Explicit NOS instruction was addressed within a six-week unit about genetic engineering. Three NOS aspects were integrated and dispersed across the unit. A questionnaire, together with semi-structured interviews, was administered as pre-, post-, and delayed post-test to assess the retention of participants' NOS understandings. The questionnaire had two open-ended scenarios addressing controversial socioscientific issues about genetically modified food and water fluoridation. Results showed that most students improved their naïve understandings of NOS in relation to the two contexts following the six-week unit with the explicit NOS instruction. However, these newly acquired NOS understandings were not retained by all students four months after instruction. Many of the students reverted back to their earlier naïve understandings. Conclusions about the factors facilitating the process of retention as the orientation to meaningful learning and the prolonged exposure to the domain were discussed in relation to practical implications in the classroom.

The First Ten Months of the Rubella Living-Unit

ERIC Educational Resources Information Center

Dolan, William S.

1972-01-01

The first 10 months of a residential school's educational program for preschool rubella children are described, followed by the case studies of the original six children in the program who are all multiply handicapped (deaf blind and mentally handicapped). (CB)

76 FR 76023 - National Impaired Driving Prevention Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

... enforcement measures and effective substance abuse prevention programs. During National Impaired Driving... legislation, and support successful, evidence-based prevention programs. These ongoing initiatives are... National Impaired Driving Prevention Month, 2011 By the President of the United States of America A...

Jointly structuring triadic spaces of meaning and action: book sharing from 3 months on

PubMed Central

Rossmanith, Nicole; Costall, Alan; Reichelt, Andreas F.; López, Beatriz; Reddy, Vasudevi

2014-01-01

This study explores the emergence of triadic interactions through the example of book sharing. As part of a naturalistic study, 10 infants were visited in their homes from 3–12 months. We report that (1) book sharing as a form of infant-caregiver-object interaction occurred from as early as 3 months. Using qualitative video analysis at a micro-level adapting methodologies from conversation and interaction analysis, we demonstrate that caregivers and infants practiced book sharing in a highly co-ordinated way, with caregivers carving out interaction units and shaping actions into action arcs and infants actively participating and co-ordinating their attention between mother and object from the beginning. We also (2) sketch a developmental trajectory of book sharing over the first year and show that the quality and dynamics of book sharing interactions underwent considerable change as the ecological situation was transformed in parallel with the infants' development of attention and motor skills. Social book sharing interactions reached an early peak at 6 months with the infants becoming more active in the coordination of attention between caregiver and book. From 7 to 9 months, the infants shifted their interest largely to solitary object exploration, in parallel with newly emerging postural and object manipulation skills, disrupting the social coordination and the cultural frame of book sharing. In the period from 9 to 12 months, social book interactions resurfaced, as infants began to effectively integrate manual object actions within the socially shared activity. In conclusion, to fully understand the development and qualities of triadic cultural activities such as book sharing, we need to look especially at the hitherto overlooked early period from 4 to 6 months, and investigate how shared spaces of meaning and action are structured together in and through interaction, creating the substrate for continuing cooperation and cultural learning. PMID:25540629

Jointly structuring triadic spaces of meaning and action: book sharing from 3 months on.

PubMed

Rossmanith, Nicole; Costall, Alan; Reichelt, Andreas F; López, Beatriz; Reddy, Vasudevi

2014-01-01

This study explores the emergence of triadic interactions through the example of book sharing. As part of a naturalistic study, 10 infants were visited in their homes from 3-12 months. We report that (1) book sharing as a form of infant-caregiver-object interaction occurred from as early as 3 months. Using qualitative video analysis at a micro-level adapting methodologies from conversation and interaction analysis, we demonstrate that caregivers and infants practiced book sharing in a highly co-ordinated way, with caregivers carving out interaction units and shaping actions into action arcs and infants actively participating and co-ordinating their attention between mother and object from the beginning. We also (2) sketch a developmental trajectory of book sharing over the first year and show that the quality and dynamics of book sharing interactions underwent considerable change as the ecological situation was transformed in parallel with the infants' development of attention and motor skills. Social book sharing interactions reached an early peak at 6 months with the infants becoming more active in the coordination of attention between caregiver and book. From 7 to 9 months, the infants shifted their interest largely to solitary object exploration, in parallel with newly emerging postural and object manipulation skills, disrupting the social coordination and the cultural frame of book sharing. In the period from 9 to 12 months, social book interactions resurfaced, as infants began to effectively integrate manual object actions within the socially shared activity. In conclusion, to fully understand the development and qualities of triadic cultural activities such as book sharing, we need to look especially at the hitherto overlooked early period from 4 to 6 months, and investigate how shared spaces of meaning and action are structured together in and through interaction, creating the substrate for continuing cooperation and cultural learning.

A simple, inexpensive, and field-relevant microcosm tidal simulator for use in marsh macrophyte studies1

PubMed Central

MacTavish, Rachel M.; Cohen, Risa A.

2014-01-01

• Premise of the study: A microcosm unit with tidal simulation was developed to address the challenge of maintaining ecologically relevant tidal regimes while performing controlled greenhouse experiments on smooth cordgrass, Spartina alterniflora. • Methods and Results: We designed a simple, inexpensive, easily replicated microcosm unit with tidal simulation and tested whether S. alterniflora growth in microcosms with tidal simulation was similar to that of tidally influenced plants in the field on Sapelo Island, Georgia. After three months of exposure to either natural or simulated tidal treatment, plants in microcosms receiving tidal simulation had similar stem density, height, and above- and belowground biomass to plants in field plots. • Conclusions: The tidal simulator developed may provide an inexpensive, effective method for conducting studies on S. alterniflora and other tidally influenced plants in controlled settings to be used not only to complement field studies, but also in locations without coastal access. PMID:25383265

The International Space Station: Stepping-stone to Exploration

NASA Technical Reports Server (NTRS)

Gerstenmaier, William H.; Kelly, Brian K.; Kelly, Brian K.

2005-01-01

As the Space Shuttle returns to flight this year, major reconfiguration and assembly of the International Space Station continues as the United States and our 5 International Partners resume building and carry on operating this impressive Earth-orbiting research facility. In his January 14, 2004, speech announcing a new vision for America's space program, President Bush ratified the United States' commitment to completing construction of the ISS by 2010. The current ongoing research aboard the Station on the long-term effects of space travel on human physiology will greatly benefit human crews to venture through the vast voids of space for months at a time. The continual operation of ISS leads to new knowledge about the design, development and operation of system and hardware that will be utilized in the development of new deep-space vehicles needed to fulfill the Vision for Exploration. This paper will provide an overview of the ISS Program, including a review of the events of the past year, as well as plans for next year and the future.

Breast-feeding and lactational amenorrhea in the United Arab Emirates.

PubMed

Radwan, Hadia; Mussaiger, Abdulrahman O; Hachem, Fatima

2009-02-01

This study was designed to investigate the relation of breast-feeding and weaning practices with the duration of lactational amenorrhea among breast-feeding mothers in the United Arab Emirates. A total of 593 mothers were interviewed in the Maternal and Child Health Centers in three areas: Abu Dhabi, Dubai, and Al Ain. The total mean duration of lactational amenorrhea in this study was 6.1 months, and there was a direct relation with the length of exclusive breast-feeding. The duration of postpartum amenorrhea was the longest in Al Ain (7.2 months), as compared with Dubai (6.9 months) and Abu Dhabi (4.3 months). The age of the infant when formula milk and solid supplements were introduced was significantly related to the duration of lactational amenorrhea. This study confirms the results of other studies concerning the effectiveness of the lactational amenorrhea method as a natural method of contraception for the first 6 months postpartum, especially for mothers who breast-feed exclusively and more frequently and who delay the introduction of food supplements.

Improving the culture of safety on a high-acuity inpatient child/adolescent psychiatric unit by mindfulness-based stress reduction training of staff.

PubMed

Hallman, Ilze S; O'Connor, Nancy; Hasenau, Susan; Brady, Stephanie

2014-11-01

The purpose of this study was to reduce perceived levels of interprofessional staff stress and to improve patient and staff safety by implementing a brief mindfulness-based stress reduction (MBSR) training program on a high-acuity psychiatric inpatient unit. A one-group repeated measure design was utilized to measure the impact of the (MBSR) training program on staff stress and safety immediately post-training and at 2 months. Two instruments were utilized in the study: the Toronto Mindfulness Scale and the Perceived Stress Scale. The MBSR program reduced staff stress across the 2-month post-training period and increased staff mindfulness immediately following the brief training period of 8 days, and across the 2-month post-training period. A trend toward positive impact on patient and staff safety was also seen in a decreased number of staff call-ins, decreased need for 1:1 staffing episodes, and decreased restraint use 2 months following the training period. A brief MBSR training program offered to an interprofessional staff of a high-acuity inpatient adolescent psychiatric unit was effective in decreasing their stress, increasing their mindfulness, and improving staff and patient safety. © 2014 Wiley Periodicals, Inc.

Alternative strategies for stroke care: a prospective randomised controlled trial.

PubMed

Kalra, L; Evans, A; Perez, I; Knapp, M; Donaldson, N; Swift, C G

2000-09-09

Organised specialist care for stroke improves outcome, but the merits of different methods of organisation are in doubt. This study compares the efficacy of stroke unit with stroke team or domiciliary care. A single-blind, randomised, controlled trial was undertaken in 457 acute-stroke patients (average age 76 years, 48% women) randomly assigned to stroke unit, general wards with stroke team support, or domiciliary stroke care, within 72 h of stroke onset. Outcome was assessed at 3, 6, and 12 months. The primary outcome measure was death or institutionalisation at 12 months. Analyses were by intention to treat. 152 patients were allocated to the stroke unit, 152 to stroke team, and 153 to domiciliary stroke care. 51 (34%) patients in the domiciliary group were admitted to hospital after randomisation. Mortality or institutionalisation at 1 year were lower in patients on a stroke unit than for those receiving care from a stroke team (21/152 [14%] vs 45/149 [30%]; p<0.001) or domiciliary care (21/152 [14%] vs 34/144 [24%]; p=0.03), mainly as a result of reduction in mortality. The proportion of patients alive without severe disability at 1 year was also significantly higher on the stroke unit compared with stroke team (129/152 [85%] vs 99/149 [66%]; p<0.001) or domiciliary care (129/152 [85%] vs 102/144 [71%]; p=0.002). These differences were present at 3 and 6 months after stroke. Stroke units are more effective than a specialist stroke team or specialist domiciliary care in reducing mortality, institutionalisation, and dependence after stroke.

Development and Evaluation of a Pilot Nurse Case Management Model to Address Multidrug-Resistant Tuberculosis (MDR-TB) and HIV in South Africa

PubMed Central

Farley, Jason E.; Kelly, Ana M.; Reiser, Katrina; Brown, Maria; Kub, Joan; Davis, Jeane G.; Walshe, Louise; Van der Walt, Martie

2014-01-01

Setting Multidrug-resistant tuberculosis (MDR-TB) unit in KwaZulu-Natal, South Africa. Objective To develop and evaluate a nurse case management model and intervention using the tenets of the Chronic Care Model to manage treatment for MDR-TB patients with a high prevalence of human immunodeficiency virus (HIV) co-infection. Design A quasi-experimental pilot programme utilizing a nurse case manager to manage care for 40 hospitalized MDR-TB patients, 70% HIV co-infected, during the intensive phase of MDR-TB treatment. Patients were followed for six months to compare proximal outcomes identified in the model between the pre- and post-intervention period. Results The greatest percent differences between baseline and six-month MDR-TB proximal outcomes were seen in the following three areas: baseline symptom evaluation on treatment initiation (95% improvement), baseline and monthly laboratory evaluations completed per guidelines (75% improvement), and adverse drug reactions acted upon by medical and/or nursing intervention (75% improvement). Conclusion Improvements were identified in guideline-based treatment and monitoring of adverse drug reactions following implementation of the nurse case management intervention. Further study is required to determine if the intervention introduced in this model will ultimately result in improvements in final MDR-TB treatment outcomes. PMID:25405988

Comparison of artificial intelligence techniques for prediction of soil temperatures in Turkey

NASA Astrophysics Data System (ADS)

Citakoglu, Hatice

2017-10-01

Soil temperature is a meteorological data directly affecting the formation and development of plants of all kinds. Soil temperatures are usually estimated with various models including the artificial neural networks (ANNs), adaptive neuro-fuzzy inference system (ANFIS), and multiple linear regression (MLR) models. Soil temperatures along with other climate data are recorded by the Turkish State Meteorological Service (MGM) at specific locations all over Turkey. Soil temperatures are commonly measured at 5-, 10-, 20-, 50-, and 100-cm depths below the soil surface. In this study, the soil temperature data in monthly units measured at 261 stations in Turkey having records of at least 20 years were used to develop relevant models. Different input combinations were tested in the ANN and ANFIS models to estimate soil temperatures, and the best combination of significant explanatory variables turns out to be monthly minimum and maximum air temperatures, calendar month number, depth of soil, and monthly precipitation. Next, three standard error terms (mean absolute error (MAE, °C), root mean squared error (RMSE, °C), and determination coefficient ( R 2 )) were employed to check the reliability of the test data results obtained through the ANN, ANFIS, and MLR models. ANFIS (RMSE 1.99; MAE 1.09; R 2 0.98) is found to outperform both ANN and MLR (RMSE 5.80, 8.89; MAE 1.89, 2.36; R 2 0.93, 0.91) in estimating soil temperature in Turkey.

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

PubMed Central

Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko

2017-01-01

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148

Handbook of solar energy data for south-facing surfaces in the United States. Volume 2: Average hourly and total daily insolation data for 235 localities. Alaska - Montana

NASA Technical Reports Server (NTRS)

Smith, J. H.

1980-01-01

Average hourly and daily total insolation estimates for 235 United States locations are presented. Values are presented for a selected number of array tilt angles on a monthly basis. All units are in kilowatt hours per square meter.

45 CFR 400.209 - Claims involving family units which include refugees who have been in the United States more than...

Code of Federal Regulations, 2010 CFR

2010-10-01

... refugees who have been in the United States more than 36 months. 400.209 Section 400.209 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Federal Funding Federal...

24 CFR 982.503 - Voucher tenancy: Payment standard amount and schedule.

Code of Federal Regulations, 2014 CFR

2014-04-01

... to provide a family who has made sustained efforts to locate suitable housing with additional search... used to calculate the monthly housing assistance payment for a family (§ 982.505). (3) The PHA voucher... section for all units, or for all units of a given unit size, leased by program families in the exception...

24 CFR 982.503 - Voucher tenancy: Payment standard amount and schedule.

Code of Federal Regulations, 2013 CFR

2013-04-01

... to provide a family who has made sustained efforts to locate suitable housing with additional search... used to calculate the monthly housing assistance payment for a family (§ 982.505). (3) The PHA voucher... section for all units, or for all units of a given unit size, leased by program families in the exception...

24 CFR 982.503 - Voucher tenancy: Payment standard amount and schedule.

Code of Federal Regulations, 2011 CFR

2011-04-01

... to provide a family who has made sustained efforts to locate suitable housing with additional search... used to calculate the monthly housing assistance payment for a family (§ 982.505). (3) The PHA voucher... section for all units, or for all units of a given unit size, leased by program families in the exception...

24 CFR 982.503 - Voucher tenancy: Payment standard amount and schedule.

Code of Federal Regulations, 2012 CFR

2012-04-01

... to provide a family who has made sustained efforts to locate suitable housing with additional search... used to calculate the monthly housing assistance payment for a family (§ 982.505). (3) The PHA voucher... section for all units, or for all units of a given unit size, leased by program families in the exception...

20 CFR 408.232 - When do you lose your foreign resident status?

Code of Federal Regulations, 2010 CFR

2010-04-01

... CERTAIN WORLD WAR II VETERANS SVB Qualification and Entitlement Residence Outside the United States § 408... abandoned your residence outside the United States if you: (1) Enter the United States and stay for more than 1 full calendar month (see § 408.234 for exceptions to this rule); (2) Tell us that you no longer...

20 CFR 408.232 - When do you lose your foreign resident status?

Code of Federal Regulations, 2014 CFR

2014-04-01

... CERTAIN WORLD WAR II VETERANS SVB Qualification and Entitlement Residence Outside the United States § 408... abandoned your residence outside the United States if you: (1) Enter the United States and stay for more than 1 full calendar month (see § 408.234 for exceptions to this rule); (2) Tell us that you no longer...

Thankful for Family and Foods! (An ABLE Teaching Unit).

ERIC Educational Resources Information Center

Barringer, Mary Dean; And Others

The teaching unit focuses on a month (November) of primary grade learning activities which focus on being thankful for food, family, and friends. Concepts stressed throughout the unit include: We are all part of the large family of Americans; Families are made up of a variety of people and our families are usually different from each other;…