Implementing the High Risk Rural Roads Program

DOT National Transportation Integrated Search

2010-03-01

This report documents common challenges, noteworthy practices and lessons learned experienced through the implementation of the High Risk Rural Roads Program. After 4 years of the High Risk Rural Roads Program (HRRRP), the overall obligation rate for...

Widespread triploidy in western North American aspen (Populus tremuloides)

Treesearch

Karen E. Mock; Colin M. Callahan; M. Nurul Islam-Faridi; John D. Shaw; Hardeep S. Rai; Stewart C. Sanderson; Carol A. Rowe; Ronald J. Ryel; Michael D. Madritch; Richard S. Gardner; Paul G. Wolf

2012-01-01

We document high rates of triploidy in aspen (Populus tremuloides) across the western USA (up to 69% of genets), and ask whether the incidence of triploidy across the species range corresponds with latitude, glacial history (as has been documented in other species), climate, or regional variance in clone size. Using a combination of microsatellite genotyping, flow...

A Case Study to Examine Student Retention at a Less Selective University with a High Rate of Retention

ERIC Educational Resources Information Center

Palmisano, Victoria M.

2012-01-01

This case study sheds light on successful matriculation practices which emerge from the combination of institutional efforts and student needs. In order to discern successful matriculation data was collected in the form of interviews, observations, and documents at a less selective college with a high rate of retention. Mortimer Adler College…

Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma.

PubMed

Ong, Sally S; Sanka, Krishna; Mettu, Priyatham S; Brosnan, Thomas M; Stinnett, Sandra S; Lee, Paul P; Challa, Pratap

2013-12-01

To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. Retrospective chart review. One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Quality of cancer family history and referral for genetic counseling and testing among oncology practices: a pilot test of quality measures as part of the American Society of Clinical Oncology Quality Oncology Practice Initiative.

PubMed

Wood, Marie E; Kadlubek, Pamela; Pham, Trang H; Wollins, Dana S; Lu, Karen H; Weitzel, Jeffrey N; Neuss, Michael N; Hughes, Kevin S

2014-03-10

Family history of cancer (CFH) is important for identifying individuals to receive genetic counseling/testing (GC/GT). Prior studies have demonstrated low rates of family history documentation and referral for GC/GT. CFH quality and GC/GT practices for patients with breast (BC) or colon cancer (CRC) were assessed in 271 practices participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative in fall 2011. A total of 212 practices completed measures regarding CFH and GC/GT practices for 10,466 patients; 77.4% of all medical records reviewed documented presence or absence of CFH in first-degree relatives, and 61.5% of medical records documented presence or absence of CFH in second-degree relatives, with significantly higher documentation for patients with BC compared with CRC. Age at diagnosis was documented for all relatives with cancer in 30.7% of medical records (BC, 45.2%; CRC, 35.4%; P ≤ .001). Referall for GC/GT occurred in 22.1% of all patients with BC or CRC. Of patients with increased risk for hereditary cancer, 52.2% of patients with BC and 26.4% of those with CRC were referred for GC/GT. When genetic testing was performed, consent was documented 77.7% of the time, and discussion of results was documented 78.8% of the time. We identified low rates of complete CFH documentation and low rates of referral for those with BC or CRC meeting guidelines for referral among US oncologists. Documentation and referral were greater for patients with BC compared with CRC. Education and support regarding the importance of accurate CFH and the benefits of proactive high-risk patient management are clearly needed.

Validating a strategy for psychosocial phenotyping using a large corpus of clinical text.

PubMed

Gundlapalli, Adi V; Redd, Andrew; Carter, Marjorie; Divita, Guy; Shen, Shuying; Palmer, Miland; Samore, Matthew H

2013-12-01

To develop algorithms to improve efficiency of patient phenotyping using natural language processing (NLP) on text data. Of a large number of note titles available in our database, we sought to determine those with highest yield and precision for psychosocial concepts. From a database of over 1 billion documents from US Department of Veterans Affairs medical facilities, a random sample of 1500 documents from each of 218 enterprise note titles were chosen. Psychosocial concepts were extracted using a UIMA-AS-based NLP pipeline (v3NLP), using a lexicon of relevant concepts with negation and template format annotators. Human reviewers evaluated a subset of documents for false positives and sensitivity. High-yield documents were identified by hit rate and precision. Reasons for false positivity were characterized. A total of 58 707 psychosocial concepts were identified from 316 355 documents for an overall hit rate of 0.2 concepts per document (median 0.1, range 1.6-0). Of 6031 concepts reviewed from a high-yield set of note titles, the overall precision for all concept categories was 80%, with variability among note titles and concept categories. Reasons for false positivity included templating, negation, context, and alternate meaning of words. The sensitivity of the NLP system was noted to be 49% (95% CI 43% to 55%). Phenotyping using NLP need not involve the entire document corpus. Our methods offer a generalizable strategy for scaling NLP pipelines to large free text corpora with complex linguistic annotations in attempts to identify patients of a certain phenotype.

Validating a strategy for psychosocial phenotyping using a large corpus of clinical text

PubMed Central

Gundlapalli, Adi V; Redd, Andrew; Carter, Marjorie; Divita, Guy; Shen, Shuying; Palmer, Miland; Samore, Matthew H

2013-01-01

Objective To develop algorithms to improve efficiency of patient phenotyping using natural language processing (NLP) on text data. Of a large number of note titles available in our database, we sought to determine those with highest yield and precision for psychosocial concepts. Materials and methods From a database of over 1 billion documents from US Department of Veterans Affairs medical facilities, a random sample of 1500 documents from each of 218 enterprise note titles were chosen. Psychosocial concepts were extracted using a UIMA-AS-based NLP pipeline (v3NLP), using a lexicon of relevant concepts with negation and template format annotators. Human reviewers evaluated a subset of documents for false positives and sensitivity. High-yield documents were identified by hit rate and precision. Reasons for false positivity were characterized. Results A total of 58 707 psychosocial concepts were identified from 316 355 documents for an overall hit rate of 0.2 concepts per document (median 0.1, range 1.6–0). Of 6031 concepts reviewed from a high-yield set of note titles, the overall precision for all concept categories was 80%, with variability among note titles and concept categories. Reasons for false positivity included templating, negation, context, and alternate meaning of words. The sensitivity of the NLP system was noted to be 49% (95% CI 43% to 55%). Conclusions Phenotyping using NLP need not involve the entire document corpus. Our methods offer a generalizable strategy for scaling NLP pipelines to large free text corpora with complex linguistic annotations in attempts to identify patients of a certain phenotype. PMID:24169276

The Readiness Agenda: Texas Aligns High School, Entry-Level College Standards

ERIC Educational Resources Information Center

Gewertz, Catherine

2009-01-01

A lot of hope is riding on a little document in the big state of Texas. Educators and policymakers who have long agonized over how the Lone Star State's low college-going rate and its high remediation rate are charting a course they hope will lead to better outcomes. This article discusses the Texas College and Career Readiness Standards as a key…

Sprinkle Treatment experimental project construction and three year evaluation.

DOT National Transportation Integrated Search

1989-06-01

This report documents the construction of a Sprinkle Treatment field trial on a high speed/high volume roadway (55 mph/8520 ADT) and presents the performance data obtained for three years after construction. Normal plant and roadway production rates ...

Washington State's Lystedt law in concussion documentation in Seattle public high schools.

PubMed

Bompadre, Viviana; Jinguji, Thomas M; Yanez, N David; Satchell, Emma K; Gilbert, Kaiulani; Burton, Monique; Conrad, Ernest U; Herring, Stanley A

2014-01-01

The Lystedt law requires high school athletes who have sustained a concussion to be removed from practice and play and not to be allowed to return until cleared by a medical professional. To determine the effect of the Lystedt law on injury and concussion documentation in the Seattle public high schools. Cross-sectional study. Seattle public high schools. The numbers of students, aged 13 to 19 years in the 2008-2009, 2009-2010, and 2010-2011 school years, were 4348, 4925, and 4806, respectively. All injuries documented in SportsWare by athletic trainers in Seattle public high schools. We evaluated all injuries, including concussions recorded during the 2008-2009 school year, before the Lystedt law, and during the 2 school years after the law took effect (2009-2010 and 2010-2011). Incidence rates before and after the law were estimated and compared. The concussion rate was -1.09% in 2008-2009, 2.26% in 2009-2010, and 2.26% in 2010-2011. A comparison of relative risks showed that the incidence rates of concussions were different before and 1 year after the Lystedt law (relative risk = 2.10; 95% confidence interval [CI] = 1.50, 2.93) and 2 years after the law (relative risk = 2.10; 95% CI = 1.49, 2.93). Overall, the mean number of days out of play after 2008-2009 was almost 7 days greater after the law took effect (difference = 6.9 days; 95% CI = 0.70, 13.1). For females, the mean number of days out of play after 2008-2009 was more than 17 days in 2009-2010 (difference = 17.2 days; 95% CI = 4.81, 29.5) and was more than 6 days in 2010-2011 (difference = 6.3 days; 95% CI = 1.62, 11.0). The number of documented concussions more than doubled after the institution of the Lystedt law, which may be attributed to heightened awareness and closer monitoring.

Impact of interventions for patients refusing emergency medical services transport.

PubMed

Alicandro, J; Hollander, J E; Henry, M C; Sciammarella, J; Stapleton, E; Gentile, D

1995-06-01

To evaluate the effect of a documentation checklist and on-line medical control contact on ambulance transport of out-of-hospital patients refusing medical assistance. Consecutive patients served by four suburban ambulance services who initially refused emergency medical services (EMS) transport to the hospital were prospectively enrolled. In phase 1 (control phase), all patients who initially refused medical attention or transport had an identifying data card completed. In phase 2 (documentation phase), out-of-hospital providers completed a similar data card that contained a checklist of high-risk criteria for a poor outcome if not transported. In phase 3 (intervention phase), a data card similar to that used in phase 2 was completed, and on-line medical control was contacted for all patients with high-risk criteria who refused transport. The primary endpoint was the percentage of patients transported to the hospital. A total of 361 patients were enrolled. Transport rate varied by phase: control, 17 of 144 (12%); documentation, 11 of 150 (7%); and intervention, 12 of 67 (18%) (chi-square, p = 0.023). Transport of high-risk patients improved with each intervention: control, two of 60 (3%); documentation, seven of 70 (10%); and intervention, 12 of 34 (35%) (chi-square, p = 0.00003). Transport of patients without high-risk criteria decreased with each intervention: control, 15 of 84 (18%); documentation, four of 80 (5%); and intervention, 0 of 33 (0%) (p = 0.0025). Of the 28 patients for whom medical control was contacted, 12 (43%) were transported to the hospital, and only three of these 12 patients (25%) were released from the ED. Contact with on-line medical control increased the likelihood of transport of high-risk patients who initially refused medical assistance. The appropriateness of the decreased transport rate of patients not meeting high-risk criteria needs further evaluation.

Estimating the terrestrial N processes in subtropical mountainous forestry catchment through INCA-N: A case study in FuShan catchment, Taiwan

NASA Astrophysics Data System (ADS)

Lu, Meng-Chang; Huang, -Chuan, Jr.; Chang, Chung-Te; Shih, Yu-Ting; Lin, Teng-Chiu

2016-04-01

The riverine DIN is a crucial indicator for eutrophication in river network. The riverine DIN export in Taiwan is featured by the extremely high yield, ~3800 kg-N km-2yr-1, nearly 20-fold than the global average, showing the interesting terrestrial N process yet rarely documented. In this study we collected the DIN samples in rainwater, soil water, and stream water in a mountainous forest watershed, FuShan experimental forest watershed 1 (WS1) which is a natural broadleaf forest without human activities. Based on the intensive observations, we applied the INCA-N to simulate the riverine DIN response and thus estimate the terrestrial N processes in a global synthesis. The result showed that both discharge and DIN yield were simulated well with the average Nash-Sutcliffe efficiency coefficient of 0.83 and 0.76 , respectively. Among all N processes, N uptake, mineralization, nitrification, denitrfication, and immobilization are significantly positive correlated with soil moisture (R2>0.99), which indicates that soil moisture greatly influences N cycle processes. The average rate of mineralization and nitrification in wet years are consistent with documented values, whereas the rates in dry years are lower than the observations. Despite the high nitrification rate, the secondary forest may uptake abundant N indicating the plant uptake, which responds for removing considerable nitrate, is a controlling factor in forest ecosystem. Our simulated denitrification rate falls between the documented rates of temperate forest and agricultural area, and that may be affected by the high N-deposition in Taiwan. Simulated in-stream denitrification rate is less than 10% of the rate in soil, and is a little lower than that in temperate forest. This preliminary simulation provides an insightful guide to establish the monitoring programme and improve the understanding of N cycle in subtropical.

Patient use of social media to evaluate cosmetic treatments and procedures.

PubMed

Schlichte, Megan J; Karimkhani, Chante; Jones, Trevor; Trikha, Ritika; Dellavalle, Robert P

2015-04-16

With a growing sphere of influence in the modern world, online social media serves as a readily accessible interface for communication of information. Aesthetic medicine is one of many industries increasingly influenced by social media, as evidenced by the popular website, "RealSelf," an online community founded in 2006 that compiles ratings, reviews, photographs, and expert physician commentary for nearly 300 cosmetic treatments. To investigate the current preferences of patients regarding cosmetic non-surgical, surgical, and dental treatments on RealSelf and in the documented medical literature. On a single day of data collection, all cosmetic treatments or procedures reviewed on the RealSelf website were tabulated, including name, percent "worth it" rating, total number of reviews, and average cost. Patient satisfaction rates documented in the current medical literature for each cosmetic treatment or procedure were also recorded. Statistical t-testingcomparing RealSelf ratings and satisfaction rates in the literature was performed for each category-non-surgical, surgical, and dental. The top ten most-commonly reviewed non-surgical treatments, top ten most-commonly reviewed surgical procedures, and top 5 most-commonly reviewed dental treatments, along with documented satisfaction rates in the medical literature for each treatment or procedure were recorded in table format and ranked by RealSelf "worth it" rating. Paired t-testing revealed that satisfaction rates documented in the literature were significantly higher than RealSelf "worth it" ratings for both non-surgical cosmetic treatments (p=0.00076) and surgical cosmetic procedures (p=0.00056), with no statistically significant difference for dental treatments. For prospective patients interested in cosmetic treatments or procedures, social media sites such as RealSelf may offer information helpful to decision-making as well enable cosmetic treatment providers to build reputations and expand practices. "Worth it" ratings on RealSelf may, in fact, represent a more transparent view of cosmetic treatment or procedural outcomes relative to the high satisfaction rates documented in medical literature. Massive online communication of patient experiences made possible through social media will continue to influence the practice of medicine, both aesthetic and otherwise.

Initial Steps toward Validating and Measuring the Quality of Computerized Provider Documentation

PubMed Central

Hammond, Kenric W.; Efthimiadis, Efthimis N.; Weir, Charlene R.; Embi, Peter J.; Thielke, Stephen M.; Laundry, Ryan M.; Hedeen, Ashley

2010-01-01

Background: Concerns exist about the quality of electronic health care documentation. Prior studies have focused on physicians. This investigation studied document quality perceptions of practitioners (including physicians), nurses and administrative staff. Methods: An instrument developed from staff interviews and literature sources was administered to 110 practitioners, nurses and administrative staff. Short, long and original versions of records were rated. Results: Length transformation did not affect quality ratings. On several scales practitioners rated notes less favorably than administrators or nurses. The original source document was associated with the quality rating, as was tf·idf, a relevance statistic computed from document text. Tf·idf was strongly associated with practitioner quality ratings. Conclusion: Document quality estimates were not sensitive to modifying redundancy in documents. Some perceptions of quality differ by role. Intrinsic document properties are associated with staff judgments of document quality. For practitioners, the tf·idf statistic was strongly associated with the quality dimensions evaluated. PMID:21346983

Chaplain Documentation and the Electronic Medical Record: A Survey of ACPE Residency Programs.

PubMed

Tartaglia, Alexander; Dodd-McCue, Diane; Ford, Timothy; Demm, Charles; Hassell, Alma

2016-01-01

This study explores the extent to which chaplaincy departments at ACPE-accredited residency programs make use of the electronic medical record (EMR) for documentation and training. Survey data solicited from 219 programs with a 45% response rate and interview findings from 11 centers demonstrate a high level of usage of the EMR as well as an expectation that CPE residents document each patient/family encounter. Centers provided considerable initial training, but less ongoing monitoring of chaplain documentation. Centers used multiple sources to develop documentation tools for the EMR. One center was verified as having created the spiritual assessment component of the documentation tool from a peer reviewed published model. Interviews found intermittent use of the student chart notes for educational purposes. One center verified a structured manner of monitoring chart notes as a performance improvement activity. Findings suggested potential for the development of a standard documentation tool for chaplain charting and training.

The Mack Lake fire.

Treesearch

Albert J. Simard; Donald A. Haines; Richard W. Blank; John S. Frost

1983-01-01

Describes the Mack Lake Fire near Mio, Michigan. Few documented wildfires have exceeded its average spread rate (2 mi/h) and energy release rate (8,800 Btu/ft/sec). The extreme behavior resulted from high winds, low humidity, low fuel moisture and jack pine fuels. Horizontal roll vortices may have contributed to the death of one firefighter.

'A major lobbying effort to change and unify the excise structure in six Central American countries': How British American Tobacco influenced tax and tariff rates in the Central American Common Market.

PubMed

Holden, Chris; Lee, Kelley

2011-05-19

Transnational tobacco companies (TTCs) may respond to processes of regional trade integration both by acting politically to influence policy and by reorganising their own operations. The Central American Common Market (CACM) was reinvigorated in the 1990s, reflecting processes of regional trade liberalisation in Latin America and globally. This study aimed to ascertain how British American Tobacco (BAT), which dominated the markets of the CACM, sought to influence policy towards it by member country governments and how the CACM process impacted upon BAT's operations. The study analysed internal tobacco industry documents released as a result of litigation in the US and available from the online Legacy Tobacco Documents Library at http://legacy.library.ucsf.edu/. Documents were retrieved by searching the BAT collection using key terms in an iterative process. Analysis was based on an interpretive approach involving a process of attempting to understand the meanings of individual documents and relating these to other documents in the set, identifying the central themes of documents and clusters of documents, contextualising the documentary data, and choosing representative material in order to present findings. Utilising its multinational character, BAT was able to act in a coordinated way across the member countries of the CACM to influence tariffs and taxes to its advantage. Documents demonstrate a high degree of access to governments and officials. The company conducted a coordinated, and largely successful, attempt to keep external tariff rates for cigarettes high and to reduce external tariffs for key inputs, whilst also influencing the harmonisation of excise taxes between countries. Protected by these high external tariffs, it reorganised its own operations to take advantage of regional economies of scale. In direct contradiction to arguments presented to CACM governments that affording the tobacco industry protection via high cigarette tariffs would safeguard employment, the company's regional reorganisation involved the loss of hundreds of jobs. Regional integration organisations and their member states should be aware of the capacity of TTCs to act in a coordinated transnational manner to influence policy in their own interests, and coordinate their own public health and tax policies in a similarly effective way.

'A major lobbying effort to change and unify the excise structure in six Central American countries': How British American Tobacco influenced tax and tariff rates in the Central American Common Market

PubMed Central

2011-01-01

Background Transnational tobacco companies (TTCs) may respond to processes of regional trade integration both by acting politically to influence policy and by reorganising their own operations. The Central American Common Market (CACM) was reinvigorated in the 1990s, reflecting processes of regional trade liberalisation in Latin America and globally. This study aimed to ascertain how British American Tobacco (BAT), which dominated the markets of the CACM, sought to influence policy towards it by member country governments and how the CACM process impacted upon BAT's operations. Methods The study analysed internal tobacco industry documents released as a result of litigation in the US and available from the online Legacy Tobacco Documents Library at http://legacy.library.ucsf.edu/. Documents were retrieved by searching the BAT collection using key terms in an iterative process. Analysis was based on an interpretive approach involving a process of attempting to understand the meanings of individual documents and relating these to other documents in the set, identifying the central themes of documents and clusters of documents, contextualising the documentary data, and choosing representative material in order to present findings. Results Utilising its multinational character, BAT was able to act in a coordinated way across the member countries of the CACM to influence tariffs and taxes to its advantage. Documents demonstrate a high degree of access to governments and officials. The company conducted a coordinated, and largely successful, attempt to keep external tariff rates for cigarettes high and to reduce external tariffs for key inputs, whilst also influencing the harmonisation of excise taxes between countries. Protected by these high external tariffs, it reorganised its own operations to take advantage of regional economies of scale. In direct contradiction to arguments presented to CACM governments that affording the tobacco industry protection via high cigarette tariffs would safeguard employment, the company's regional reorganisation involved the loss of hundreds of jobs. Conclusions Regional integration organisations and their member states should be aware of the capacity of TTCs to act in a coordinated transnational manner to influence policy in their own interests, and coordinate their own public health and tax policies in a similarly effective way. PMID:21595921

Basic Parameters of Metal Behavior under High Rate Forming

DTIC Science & Technology

1962-03-01

1ii PHOTOGRAPH THIS SHEET II LEVELr• At-ký W •I)-_) -N INVENTORY z DOCUMENT IDENTIFICATION may. 6•t S]/ tp i - 0~o- o’•5,,? 3 ’ \\NAL- TR-/I. -a I .. ~1...TR 111.2/20- 3 BASIC PARAMETERS OF METAL BEHAVIOUR "> UNDER HIGH RATE FORMING L L j Fourth Interim Report to ell- L’,I I U. S. ARMY MATERIALS...RESEARCH AGENCY 1• I iiC::Ur:ui i 1,,i .:1 ’•:, 1 r/ n od I P,101c rolcso. Filing Subjects: I. Explosive forming 2. Dynamic behavior of metals 3 . High rate

Cost-Effectiveness Analysis in Practice: Interventions to Improve High School Completion

ERIC Educational Resources Information Center

Hollands, Fiona; Bowden, A. Brooks; Belfield, Clive; Levin, Henry M.; Cheng, Henan; Shand, Robert; Pan, Yilin; Hanisch-Cerda, Barbara

2014-01-01

In this article, we perform cost-effectiveness analysis on interventions that improve the rate of high school completion. Using the What Works Clearinghouse to select effective interventions, we calculate cost-effectiveness ratios for five youth interventions. We document wide variation in cost-effectiveness ratios between programs and between…

ANSI/ASHRAE/IES Standard 90.1-2010 Performance Rating Method Reference Manual

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

Goel, Supriya; Rosenberg, Michael I.

This document is intended to be a reference manual for the Appendix G Performance Rating Method (PRM) of ANSI/ASHRAE/IES Standard 90.1- 2010 (Standard 90.1-2010).The PRM is used for rating the energy efficiency of commercial and high-rise residential buildings with designs that exceed the requirements of Standard 90.1. The procedures and processes described in this manual are designed to provide consistency and accuracy by filling in gaps and providing additional details needed by users of the PRM. It should be noted that this document is created independently from ASHRAE and SSPC 90.1 and is not sanctioned nor approved by either ofmore » those entities . Potential users of this manual include energy modelers, software developers and implementers of “beyond code” energy programs. Energy modelers using ASHRAE Standard 90.1-2010 for beyond code programs can use this document as a reference manual for interpreting requirements of the Performance Rating method. Software developers, developing tools for automated creation of the baseline model can use this reference manual as a guideline for developing the rules for the baseline model.« less

Moving up the Ladder: How Do States Deliver Quality Improvement Supports within Their Quality Rating and Improvement Systems? Brief

ERIC Educational Resources Information Center

Holod, Aleksandra; Faria, Ann-Marie; Weinberg, Emily; Howard, Eboni

2015-01-01

As national attention has increasingly focused on the potential for high-quality early childhood education (ECE) to improve children's school readiness, states have developed quality rating and improvement systems (QRISs) to document the quality of ECE programs, support systematic quality improvement, and provide clear information to families…

Examining Pre-School Classroom Quality in a Statewide Quality Rating and Improvement System

ERIC Educational Resources Information Center

Jeon, Lieny; Buettner, Cynthia K.; Hur, Eunhye

2014-01-01

Background: Research has documented the importance of high-quality early childhood experiences in preparing children for school. Quality rating and improvement systems (QRIS) have recently emerged in many states as a way to build quality of child care and to promote better child outcomes. Objective: The goal of this study was to determine if…

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

Makarov, Yuri V.; Du, Pengwei; Etingov, Pavel V.

The document titled “WECC Variable Generation Planning Reference Book”. This book is divided into two volumes; one is the main document (volume 1)and the other is appendices (volume 2). The main document is a collection of the best practices and the information regarding the application and impact of variables generation on power system planning. This volume (appendices) has additional information on the following topics: Probabilistic load flow problems. 2. Additional useful indices. 3. high-impact low-frequency (HILF) events. 4. Examples of wide-area nomograms. 5. Transmission line ratings, types of dynamic rating methods. 6. Relative costs per MW-km of different electric powermore » transmission technologies. 7. Ultra-high voltage (UHV) transmission. 8.High voltage direct current (VSC-HVDC). 9. HVDC. 10. Rewiring of existing transmission lines. 11. High-temperature low sag (HTLS) conductors. 12. The direct method and energy functions for transient stability analysis in power systems. 13.Blackouts caused by voltage instability. 14. Algorithm for parameter continuation predictor-corrector methods. 15. Approximation techniques available for security regions. 16. Impacts of wind power on power system small signals stability. 17. FIDVR. 18. FACTS. 19. European planning standard and practices. 20. International experience in wind and solar energy sources. 21. Western Renewable Energy Zones (WREZ). 22. various energy storage technologies. 23. demand response. 24. BA consolidation and cooperation options. 25. generator power management requirements and 26. European planning guidelines.« less

Validation of life-charts documented with the personal life-chart app - a self-monitoring tool for bipolar disorder.

PubMed

Schärer, Lars O; Krienke, Ute J; Graf, Sandra-Mareike; Meltzer, Katharina; Langosch, Jens M

2015-03-14

Long-term monitoring in bipolar affective disorders constitutes an important therapeutic and preventive method. The present study examines the validity of the Personal Life-Chart App (PLC App), in both German and in English. This App is based on the National Institute of Mental Health's Life-Chart Method, the de facto standard for long-term monitoring in the treatment of bipolar disorders. Methods have largely been replicated from 2 previous Life-Chart studies. The participants documented Life-Charts with the PLC App on a daily basis. Clinicians assessed manic and depressive symptoms in clinical interviews using the Inventory of Depressive Symptomatology, clinician-rated (IDS-C) and the Young Mania Rating Scale (YMRS) on a monthly basis on average. Spearman correlations of the total scores of IDS-C and YMRS were calculated with both the Life-Chart functional impairment rating and mood rating documented with the PLC App. 44 subjects used the PLC App in German and 10 subjects used the PLC App in English. 118 clinical interviews from the German sub-sample and 97 from the English sub-sample were analysed separately. The results in both sub-samples are similar to previous Life-Chart validation studies. Again statistically significant high correlations were found between the Life-Chart function rating assigned through the PLC App and well-established observer-rated methods. Again correlations were weaker for the Life-Chart mood rating than for the Life-Chart function impairment. No relevant correlation was found between the Life-chart mood rating and YMRS in the German sub-sample. This study gives further evidence for the validity of the Life-Chart method as a valid tool for the recognition of both manic and depressive episodes. Documenting Life-Charts with the PLC App (English and German) does not seem to impair the validity of patient ratings.

U-10Mo Baseline Fuel Fabrication Process Description

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

Hubbard, Lance R.; Arendt, Christina L.; Dye, Daniel F.

This document provides a description of the U.S. High Power Research Reactor (USHPRR) low-enriched uranium (LEU) fuel fabrication process. This document is intended to be used in conjunction with the baseline process flow diagram (PFD) presented in Appendix A. The baseline PFD is used to document the fabrication process, communicate gaps in technology or manufacturing capabilities, convey alternatives under consideration, and as the basis for a dynamic simulation model of the fabrication process. The simulation model allows for the assessment of production rates, costs, and manufacturing requirements (manpower, fabrication space, numbers and types of equipment, etc.) throughout the lifecycle ofmore » the USHPRR program. This document, along with the accompanying PFD, is updated regularly« less

The Forgotten Summer: Does the Offer of College Counseling after High School Mitigate Summer Melt among College-Intending, Low-Income High School Graduates?

ERIC Educational Resources Information Center

Castleman, Benjamin L.; Page, Lindsay C.; Schooley, Korynn

2014-01-01

Despite decades of policy intervention to increase college entry and success among low-income students, considerable gaps by socioeconomic status remain. To date, policymakers have overlooked the summer after high school as an important time period in students' transition to college, yet recent research documents high rates of summer attrition…

The High Cost of Failing to Reform Public Education in Indiana. School Choice Issues in the State

ERIC Educational Resources Information Center

Gottlob, Brian J.

2006-01-01

This study documents the public costs of high school dropouts in Indiana, and examines how school choice would provide large public benefits by increasing the graduation rate in Indiana public schools. It calculates the annual cost of high school dropouts in Indiana due to lower state income tax payments, increased reliance on Medicaid, and…

Effects of Classroom Cell Phone Use on Expected and Actual Learning

ERIC Educational Resources Information Center

Froese, Arnold D.; Carpenter, Christina N.; Inman, Denyse A.; Schooley, Jessica R.; Barnes, Rebecca B.; Brecht, Paul W.; Chacon, Jasmin D.

2012-01-01

Studies of driving indicate that the conversational aspects of using cell phones generate high risks from divided attention. Prior surveys document high rates at which students carry phones to and use them during class. Some experiments have demonstrated that cell phones distract students from learning. The present studies combined survey and…

Texas Public School Attrition Study, 2011-12. IDRA Report

ERIC Educational Resources Information Center

Johnson, Roy L.; Montes, Felix

2012-01-01

This document contains 3 statistical reports. The first report, "Attrition Rate Decline Seems Promising--Though High Schools are Still Losing One in Four Students" (by Roy L. Johnson), presents results of long-term trend assessments of attrition data in Texas public high schools. The second report, "Slow Declining Pace Keeps Zero…

The High School to College Transition: Minding the Gap

ERIC Educational Resources Information Center

Hirsch, Deborah

2010-01-01

The value of a college degree is well documented. College graduates earn at least 60% more than high school graduates. Beyond the economic value, college graduates show higher rates of civic participation, engage in volunteer work and even have a much higher likelihood of being "happy." Students who drop out without attaining a college…

Hunger and Population. Facts for Action #7.

ERIC Educational Resources Information Center

Phillips, James

The relationship between world hunger and world population is explored in this document for high school global education classes. Reasons for the high birth rates in developing nations are suggested, e.g., a poor family has many children because children are an inexpensive work force, provide extra income, and care for parents in old age. The…

77 FR 46016 - Notice of Determination of the Foot-and-Mouth Disease Status of Japan

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-02

... the number of containers imported per year. Response: The low refusal rate is based on a high level of... Federal Register a notice \\2\\ announcing the availability for review and comment of a document titled... lot. The straw is shipped to Japan in sealed containers and tested upon arrival. The failure rate for...

Effects of Invasive European Fire Ants (Myrmica rubra) on Herring Gull (Larus argentatus) Reproduction

PubMed Central

DeFisher, Luke E.; Bonter, David N.

2013-01-01

Various invasive ant species have negatively affected reproductive success in birds by disrupting nest site selection, incubation patterns, food supply, and by direct predation on nestlings. Impacts can be particularly severe when non-native ants colonize seabird nesting islands where thousands of birds may nest in high densities on the ground or in burrows or crevices. Here we report on the first documented effects of Myrmica rubra, the European fire ant, on the reproduction of birds in its non-native range. We documented herring gulls (Larus argentatus) on Appledore Island, Maine, engaging in more erratic incubation behaviors at nests infested by the ants. Newly-hatched chicks in some nests were swarmed by ants, leading to rapid chick death. Due to high overall rates of chick mortality, survival probabilities did not vary between nests with and without ant activity, however chick growth rates were slower at nests with ants than at ant-free nests. Ant infestation likely leads to longer-term fitness consequences because slower growth rates early in life may ultimately lead to lower post-fledging survival probabilities. PMID:23691168

Factors influencing the documentation of fertility-related discussions for adolescents and young adults with cancer.

PubMed

Skaczkowski, G; White, V; Thompson, K; Bibby, H; Coory, M; Pinkerton, R; Nicholls, W; Orme, L M; Conyers, R; Phillips, M B; Osborn, M; Harrup, R; Anazodo, A

2018-06-01

A cancer diagnosis and treatment may have significant implications for a young patient's future fertility. Documentation of fertility-related discussions and actions is crucial to providing the best follow-up care, which may occur for many years post-treatment. This study examined the rate of medical record documentation of fertility-related discussions and fertility preservation (FP) procedures for adolescents and young adults (AYAs) with cancer in Australia. A retrospective review of medical records for 941 patients in all six Australian states. Patients were identified through population-based cancer registries (four states) and hospital admission lists (two states). Trained data collectors extracted information from medical records using a comprehensive data collection survey. Records were reviewed for AYA patients (aged 15-24 years at diagnosis), diagnosed with acute myeloid leukaemia, acute lymphoblastic leukaemia, central nervous system (CNS) tumours, soft tissue sarcomas (STS), primary bone cancer or Ewing's family tumours between 2007 and 2012. 47.2% of patients had a documented fertility discussion and 35.9% had a documented FP procedure. Fertility-related documentation was less likely for female patients, those with a CNS or STS diagnosis and those receiving high-risk treatments. In multivariable models, adult hospitals with an AYA focus were more likely to document fertility discussions (odds ratio[OR] = 1.60; 95%CI = 1.08-2.37) and FP procedures (OR = 1.74; 95%CI = 1.17-2.57) than adult hospitals with no AYA services. These data provide the first national, population-based estimates of fertility documentation for AYA cancer patients in Australia. Documentation of fertility-related discussions was poor, with higher rates observed in hospitals with greater experience of treating AYA patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

Adequacy of physician documentation and correlation with assessment of transfusion appropriateness: a follow-up study in the setting of prospective audits and patient blood management.

PubMed

Madrigal, Emilio; Prajapati, Shyam; Avadhani, Vaidehi; Annen, Kyle; Friedman, Mark T

2017-02-01

A previous study in our hospitals correlated suboptimal documentation and failure to justify transfusions. In light of implemented blood-conservation strategies, including patient blood management (PBM) and prospective audits (PAs), we performed a follow-up study. We reviewed prospectively audited red blood cell (RBC) transfusions received by adult patients from January to July 2014. Survey forms were used to assess the level of documentation and to classify documentation as adequate, intermediate, or inadequate. Transfusions were deemed justified or not by comparisons with hospital transfusion guidelines. We also analyzed the effect of implemented blood-conservation strategies on our hospital transfusion rates and costs from 2009 to 2015. During the study period, there were 259 prospectively audited transfusion events (TEs) (one or more RBC units transfused to a patient), of which we reviewed 94 TEs (36.3%) in 87 patients. TEs with suboptimal (intermediate and inadequate) documentation accounted for 46.8% of the reviewed TEs, of which 81.8% could not be justified compared with 18.0% of nonjustified, adequately documented TEs. The correlation between suboptimal documentation and failure to justify transfusion was significant (p < 0.001). This correlation remained even in a comparison between the site with a PBM program and the sites without such a program. Overall transfusion rates declined after the introduction of PA, although the decline was only statistically significant at the sites with a PBM program. Suboptimal transfusion documentation remains problematic and is highly correlated with nonjustifiable transfusions. Newly adopted approaches to minimize blood transfusions have not improved transfusion documentation and corresponding out-of-guideline transfusions, although overall transfusions have been reduced by PA, particularly in the setting of a PBM program. © 2016 AABB.

The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

PubMed

Rodriguez Torres, Yasaira; Huang, Jordan; Mihlstin, Melanie; Juzych, Mark S; Kromrei, Heidi; Hwang, Frank S

2017-01-01

This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p < 0.0005). Electronic Health Record A had high compliance (>90%) in 13 elements while Electronic Health Record B had high compliance (>90%) in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

Assessment of the Ability of the Health Care Provider to Detect Manifestations Indicative of TBI Management of care for TBI Through the Utilization of High Fidelity Simulation

DTIC Science & Technology

2015-09-01

position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting...to be tested in the research study were: Hypothesis 1. The study participants will be able to identify the manifestations for patients with traumatic...brain injuries in pre and post evaluation measures. Hypothesis 2. The study participants will have an increased rate of the identification of

Bank erosion along the dam-regulated lower Roanoke River, North Carolina

USGS Publications Warehouse

Hupp, C.R.; Schenk, E.R.; Richter, J.M.; Peet, Robert K.; Townsend, Phil A.

2009-01-01

Dam construction and its impact on downstream fluvial processes may substantially alter ambient bank stability and erosion. Three high dams (completed between 1953 and 1963) were built along the Piedmont portion of the Roanoke River, North Carolina; just downstream the lower part of the river flows across largely unconsolidated Coastal Plain deposits. To document bank erosion rates along the lower Roanoke River, >700 bank-erosion pins were installed along 66 bank transects. Additionally, discrete measurements of channel bathymetry, turbidity, and presence or absence of mass wasting were documented along the entire study reach (153 km). A bank-erosion- floodplain-deposition sediment budget was estimated for the lower river. Bank toe erosion related to consistently high low-flow stages may play a large role in increased mid- and upper-bank erosion. Present bank-erosion rates are relatively high and are greatest along the middle reaches (mean 63 mm/yr) and on lower parts of the bank on all reaches. Erosion rates were likely higher along upstream reaches than present erosion rates, such that erosion-rate maxima have since migrated downstream. Mass wasting and turbidity also peak along the middle reaches; floodplain sedimentation systematically increases downstream in the study reach. The lower Roanoke River isnet depositional (on floodplain) with a surplus of ??2,800,000 m3yr. Results suggest that unmeasured erosion, particularly mass wasting, may partly explain this surplus and should be part of sediment budgets downstream of dams. ?? 2009 The Geological Society of America.

Studies of Dropouts. Status Report.

ERIC Educational Resources Information Center

Austin Independent School District, TX. Office of Research and Evaluation.

This document provides a brief overview of the ongoing dropout studies cited in the press and around the Austin Independent School District (AISD) in Austin, Texas. It includes a list of key observations which notes that the dropout rate among adolescents is too high; that approximately 20% of 16- to 24-year-olds in Texas do not have a high school…

Reported Occurrence and Perceptions of Violence in Middle and High Schools

ERIC Educational Resources Information Center

Algozzine, Bob; McGee, Jennifer R.

2011-01-01

The purpose of this study was to document and compare rates of reported and perceived crime and violence within schools. With highly publicized acts of school violence prevalent in the minds of the American public, there is a perception that schools are unsafe. Reports of school crime and violence from teachers, administrators, and students differ…

Symptoms of nitrogen saturation in two central Appalachian hardwood forest ecosystems

Treesearch

William T. Peterjohn; Mary Beth Adams; Frank S. Gilliam

1996-01-01

By synthesizing more than twenty years of research at the Fernow Experimental Forest, we have documented 7 symptoms of nitrogen saturation in two adjacent watersheds. The symptoms include: 1) high relative rates of net nitrification, 2) long-term increases in streamwater concentrations of nitrate and base cations, 3) relatively high nitrate concentrations in solution...

When does education matter? The protective effect of education for cohorts graduating in bad times.

PubMed

Cutler, David M; Huang, Wei; Lleras-Muney, Adriana

2015-02-01

Using Eurobarometer data, we document large variation across European countries in education gradients in income, self-reported health, life satisfaction, obesity, smoking and drinking. While this variation has been documented previously, the reasons why the effect of education on income, health and health behaviors varies is not well understood. We build on previous literature documenting that cohorts graduating in bad times have lower wages and poorer health for many years after graduation, compared to those graduating in good times. We investigate whether more educated individuals suffer smaller income and health losses as a result of poor labor market conditions upon labor market entry. We confirm that a higher unemployment rate at graduation is associated with lower income, lower life satisfaction, greater obesity, more smoking and drinking later in life. Further, education plays a protective role for these outcomes, especially when unemployment rates are high: the losses associated with poor labor market outcomes are substantially lower for more educated individuals. Variation in unemployment rates upon graduation can potentially explain a large fraction of the variance in gradients across different countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

Analysis of traffic crash data in Kentucky (2011-2015).

DOT National Transportation Integrated Search

2016-09-01

This report documents an analysis of traffic crash data in Kentucky for the years of 2011 through 2015. A primary objective of this study was to determine average crash statistics for Kentucky highways. Rates were calculated for various types of high...

Analysis of Traffic Crash Data in Kentucky (2012-2016).

DOT National Transportation Integrated Search

2017-09-01

This report documents an analysis of traffic crash data in Kentucky for the years of 2012 through 2016. A primary objective of this study was to determine average crash statistics for Kentucky highways. Rates were calculated for various types of high...

Analysis of traffic crash data in Kentucky (2009-2013).

DOT National Transportation Integrated Search

2014-09-01

This report documents an analysis of traffic crash data in Kentucky for the years of 2009 through 2013. A primary objective of this study was to determine average crash statistics for Kentucky highways. Rates were calculated for various types of high...

Obesity perceptions and documentation among primary care clinicians at a rural academic health center.

PubMed

Aleem, Sohaib; Lasky, Rosalind; Brooks, W Blair; Batsis, John A

2015-01-01

Obesity recognition in primary care is important to address the epidemic. We aimed to evaluate primary care clinician-reported documentation, management practices, beliefs and attitudes toward obesity compared to body mass index (BMI) calculation, obesity prevalence and actual documentation of obesity as an active problem in electronic health record in a rural academic center. Our target population for previously validated clinician survey was 56 primary care providers working at 3 sites. We used calendar year 2012 data for assessment of baseline system performance for metrics of documentation of BMI in primary care visits, and proportion of visits in patients with obesity with obesity as a problem. Standard statistical methods assessed the data. Survey response rate was 91%. Average age of respondents was 48.9 years and 62.7% were females. 72.5% clinicians reported having normal BMI. The majority of clinicians reported regularly documenting obesity as an active problem, and utilized motivational interviewing and basic good nutrition and healthy exercise. Clinicians identified lack of discipline and exercise time, access to unhealthy food and psychosocial issues as major barriers. Most denied disliking weight loss discussion or patients taking up too much time. In 21,945 clinic visits and 11,208 annual preventive care visits in calendar year 2012, BMI was calculated in 93% visits but obesity documentation as an active problem only 27% of patients meeting BMI criteria for obesity. Despite high clinician-reported documentation of obesity as an active problem, actual obesity documentation rates remained low in a rural academic medical center. Copyright © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Cross-sectional interview study of fertility, pregnancy, and urogenital schistosomiasis in coastal Kenya: Documented treatment in childhood is associated with reduced odds of subfertility among adult women

PubMed Central

Miller-Fellows, Sarah C.; Howard, Laura; Kramer, Rebekah; Hildebrand, Vanessa; Furin, Jennifer; Mutuku, Francis M.; Mukoko, Dunstan; Ivy, Julianne A.

2017-01-01

Background Previous research has documented an increased risk of subfertility in areas of sub-Saharan Africa, as well as an ecological association between urogenital schistosomiasis prevalence and decreased fertility. This pilot project examined reproductive patterns and the potential effects of childhood urogenital Schistosoma haematobium infection and individual treatment experience on adult subfertility among women who were long-term residents in an S. haematobium-endemic region of coastal Kenya. Methodology/Principal findings We analyzed findings from 162 in-depth interviews with women of childbearing age in a rural, coastal community, linking them, if possible, to their individual treatment records from previous multi-year longitudinal studies of parasitic infections. Reproductive histories indicated a much local higher local rate of subfertility (44%) than worldwide averages (8–12%). Although, due to the very high regional prevalence of schistosomiasis, a clear relationship could not be demonstrated between a history of S. haematobium infection and adult subfertility, among a convenience sub-sample of 61 women who had received documented treatment during previous interventional trials, a significant association was found between age at first anti-schistosomal treatment and later fertility in adulthood, with those women treated before age 21 significantly less likely to have subfertility (P = 0.001). Conclusions/Significance The high subfertility rate documented in this pilot study suggests the importance of programs to prevent and treat pelvic infections in their early stages to preclude reproductive tract damage. The available documented treatment data also suggest that early anti-schistosomal treatment may prevent the fertility-damaging effects of urogenital schistosomiasis, and lend support for programs that provide universal treatment of children in S. haematobium-endemic regions. PMID:29176778

Cross-sectional interview study of fertility, pregnancy, and urogenital schistosomiasis in coastal Kenya: Documented treatment in childhood is associated with reduced odds of subfertility among adult women.

PubMed

Miller-Fellows, Sarah C; Howard, Laura; Kramer, Rebekah; Hildebrand, Vanessa; Furin, Jennifer; Mutuku, Francis M; Mukoko, Dunstan; Ivy, Julianne A; King, Charles H

2017-11-01

Previous research has documented an increased risk of subfertility in areas of sub-Saharan Africa, as well as an ecological association between urogenital schistosomiasis prevalence and decreased fertility. This pilot project examined reproductive patterns and the potential effects of childhood urogenital Schistosoma haematobium infection and individual treatment experience on adult subfertility among women who were long-term residents in an S. haematobium-endemic region of coastal Kenya. We analyzed findings from 162 in-depth interviews with women of childbearing age in a rural, coastal community, linking them, if possible, to their individual treatment records from previous multi-year longitudinal studies of parasitic infections. Reproductive histories indicated a much local higher local rate of subfertility (44%) than worldwide averages (8-12%). Although, due to the very high regional prevalence of schistosomiasis, a clear relationship could not be demonstrated between a history of S. haematobium infection and adult subfertility, among a convenience sub-sample of 61 women who had received documented treatment during previous interventional trials, a significant association was found between age at first anti-schistosomal treatment and later fertility in adulthood, with those women treated before age 21 significantly less likely to have subfertility (P = 0.001). The high subfertility rate documented in this pilot study suggests the importance of programs to prevent and treat pelvic infections in their early stages to preclude reproductive tract damage. The available documented treatment data also suggest that early anti-schistosomal treatment may prevent the fertility-damaging effects of urogenital schistosomiasis, and lend support for programs that provide universal treatment of children in S. haematobium-endemic regions.

A general concept for consistent documentation of computational analyses

PubMed Central

Müller, Fabian; Nordström, Karl; Lengauer, Thomas; Schulz, Marcel H.

2015-01-01

The ever-growing amount of data in the field of life sciences demands standardized ways of high-throughput computational analysis. This standardization requires a thorough documentation of each step in the computational analysis to enable researchers to understand and reproduce the results. However, due to the heterogeneity in software setups and the high rate of change during tool development, reproducibility is hard to achieve. One reason is that there is no common agreement in the research community on how to document computational studies. In many cases, simple flat files or other unstructured text documents are provided by researchers as documentation, which are often missing software dependencies, versions and sufficient documentation to understand the workflow and parameter settings. As a solution we suggest a simple and modest approach for documenting and verifying computational analysis pipelines. We propose a two-part scheme that defines a computational analysis using a Process and an Analysis metadata document, which jointly describe all necessary details to reproduce the results. In this design we separate the metadata specifying the process from the metadata describing an actual analysis run, thereby reducing the effort of manual documentation to an absolute minimum. Our approach is independent of a specific software environment, results in human readable XML documents that can easily be shared with other researchers and allows an automated validation to ensure consistency of the metadata. Because our approach has been designed with little to no assumptions concerning the workflow of an analysis, we expect it to be applicable in a wide range of computational research fields. Database URL: http://deep.mpi-inf.mpg.de/DAC/cmds/pub/pyvalid.zip PMID:26055099

Expected surgical competencies of an Indian medical graduate: a gap analysis using a cross-sectional survey.

PubMed

Jamkar, Arun; Bansal, Payal; Patrikar, Seema; Baxi, Gaurang

2015-01-01

In 2010, the Medical Council of India published the Vision 2015 document, which sought to create an 'Indian Medical Graduate' as a 'physician of first contact of the community while being globally relevant'. This vision for undergraduate medical education is proposed to be realised through a competency-based curriculum. We conducted a gap analysis using a cross-sectional survey to document surgeons' perceptions regarding competencies identified in surgery. Eight competencies specific to surgery are proposed, which formed the basis for the study. We defined sub-competencies for each of these and developed a questionnaire containing ratings of importance and ability for the sub-competencies from low to very high on a 4-point Likert scale. The questionnaire was administered to 450 surgeons attending a state-level annual conference in surgery asking them to provide the importance ratings and their own ability on those (sub) competencies when they graduated. The importance and ability ratings were ranked and a gap analysis was done. The study response rate was 69.8%. While most competencies were perceived by the surgeons as being highly important, their self-ratings revealed a statistically significant gap between importance and ability when they graduated. They also rated themselves as being more competent on some than on others. Some competencies were high on importance as well as on ability, while others were high on importance but low on ability, revealing a gap. A low importance-high ability relationship was seen for a few competencies. Competencies related to emergency and trauma care and communication had the largest gaps. The gaps identified in surgical competencies for graduating physicians are specific and have implications for the competency-based curriculum and implementation in terms of teaching, assessment and faculty development. It also has implications for seamless transition between undergraduate and postgraduate competencies, as all of these are prerequisites at the start of a surgical residency.

Dose and side effects of sublingual misoprostol for treatment of postpartum hemorrhage: what difference do they make?

PubMed Central

2012-01-01

Background Shivering and fever are common side effects of misoprostol. An unexpectedly high rate of fever above 40°C was documented among Ecuadorian women given treatment with 800mcg of sublingual misoprostol to manage postpartum hemorrhage (PPH) (36%). Much lower rates have been reported elsewhere (0-9%). Methods From February to July 2010, an open-label pilot study was conducted in Quito, Ecuador to determine whether a lower dose--600mcg sublingual misoprostol--would result in a lower incidence of high fever (≥40°C). Rates of shivering and fever with 600mcg sublingual regimen were compared to previously documented rates in Ecuador following PPH treatment with 800mcg sublingual misoprostol. Results The 600mcg dose resulted in a 55% lower rate of high fever compared with the 800mcg regimen (8/50; 16% vs. 58/163; 36%; relative risk 0.45 95% CI 0.23-0.88). Only one woman had severe shivering following the 600mcg dose compared with 19 women in the 800mcg cohort (2% vs. 12%; relative risk 0.17 (0.02-1.25)). No cases of delirium/altered sensorium were reported with the 600mcg dose and women’s assessment of severity/tolerability of shivering and fever was better with the lower dose. Conclusions 600mcg sublingual misoprostol was found to decrease the occurrence of high fever among Ecuadorian women when given to treat PPH. This study however was not powered to examine the efficacy of this treatment regimen and cannot be recommended at this time. Future research is needed to confirm whether other populations, outside of Quito, Ecuador, experience unusually high rates of elevated body temperature following sublingual administration of misoprostol for treatment of PPH. If indeed similar trends are found elsewhere, larger trials to confirm the efficacy of lower dosages may be justified. Trial Registration Clinical trials.gov, Registry No. NCT01080846 PMID:22769055

Dose and side effects of sublingual misoprostol for treatment of postpartum hemorrhage: what difference do they make?

PubMed

León, Wilfrido; Durocher, Jill; Barrera, Gustavo; Pinto, Ernesto; Winikoff, Beverly

2012-07-07

Shivering and fever are common side effects of misoprostol. An unexpectedly high rate of fever above 40°C was documented among Ecuadorian women given treatment with 800mcg of sublingual misoprostol to manage postpartum hemorrhage (PPH) (36%). Much lower rates have been reported elsewhere (0-9%). From February to July 2010, an open-label pilot study was conducted in Quito, Ecuador to determine whether a lower dose--600mcg sublingual misoprostol--would result in a lower incidence of high fever (≥40°C). Rates of shivering and fever with 600mcg sublingual regimen were compared to previously documented rates in Ecuador following PPH treatment with 800mcg sublingual misoprostol. The 600mcg dose resulted in a 55% lower rate of high fever compared with the 800mcg regimen (8/50; 16% vs. 58/163; 36%; relative risk 0.45 95% CI 0.23-0.88). Only one woman had severe shivering following the 600mcg dose compared with 19 women in the 800mcg cohort (2% vs. 12%; relative risk 0.17 (0.02-1.25)). No cases of delirium/altered sensorium were reported with the 600mcg dose and women's assessment of severity/tolerability of shivering and fever was better with the lower dose. 600mcg sublingual misoprostol was found to decrease the occurrence of high fever among Ecuadorian women when given to treat PPH. This study however was not powered to examine the efficacy of this treatment regimen and cannot be recommended at this time. Future research is needed to confirm whether other populations, outside of Quito, Ecuador, experience unusually high rates of elevated body temperature following sublingual administration of misoprostol for treatment of PPH. If indeed similar trends are found elsewhere, larger trials to confirm the efficacy of lower dosages may be justified. Clinical trials.gov, Registry No. NCT01080846.

Bank Erosion, Mass Wasting, Water Clarity, Bathymetry and a Sediment Budget Along the Dam-Regulated Lower Roanoke River, North Carolina

USGS Publications Warehouse

Schenk, Edward R.; Hupp, Cliff R.; Richter, Jean M.; Kroes, Daniel E.

2010-01-01

Dam construction and its impact on downstream fluvial processes may substantially alter ambient bank stability, floodplain inundation patterns, and channel morphology. Most of the world's largest rivers have been dammed, which has prompted management efforts to mitigate dam effects. Three high dams (completed between 1953 and 1963) occur along the Piedmont portion of the Roanoke River, North Carolina; just downstream, the lower part of the river flows across largely unconsolidated Coastal Plain deposits. To document bank erosion rates along the lower Roanoke River, more than 700 bank erosion pins were installed along 124 bank transects. Additionally, discrete measurements of channel bathymetry, water clarity, and presence or absence of mass wasting were documented along the entire 153-kilometer-long study reach. Amounts of bank erosion in combination with prior estimates of floodplain deposition were used to develop a bank erosion and floodplain deposition sediment budget for the lower river. Present bank erosion rates are relatively high [mean 42 milimeters per year (mm/yr)] and are greatest along the middle reaches (mean 60 mm/yr) and on lower parts of the bank on all reaches. Erosion rates were likely higher along upstream reaches than present erosion rates such that erosion rate maxima have migrated downstream. Mass wasting and water clarity also peak along the middle reaches.

Understanding Providers' Interaction with Graphical User Interface Pertaining to Clinical Document Usage in an Electronic Health Record System

ERIC Educational Resources Information Center

Rizvi, Rubina Fatima

2017-01-01

Despite high Electronic Health Record (EHR) system adoption rates by hospital and office-based practices, many users remain highly dissatisfied with the current state of EHRs. Sub-optimal EHR usability as a result of insufficient incorporation of User-Centered Design (UCD) approach during System Development Life Cycle process (SDLC) is considered…

Evaluation of the Commitment to Living (CTL) curriculum: a 3-hour training for mental health professionals to address suicide risk.

PubMed

Pisani, Anthony R; Cross, Wendi F; Watts, Arthur; Conner, Kenneth

2012-01-01

Finding effective and efficient options for training mental health professionals to assess and manage suicide risk is a high priority. To test whether an innovative, brief workshop can improve provider knowledge, confidence, and written risk assessment in a multidisciplinary sample of ambulatory and acute services professionals and trainees. We conducted a pre/post evaluation of a 3 h workshop designed to improve clinical competence in suicide risk assessment by using visual concept mapping, medical records documentation, and site-specific crisis response options. Participants (N = 338 diverse mental health professionals) completed pre- and postworkshop questionnaires measuring their knowledge and confidence. Before and after the workshop, participants completed documentation for a clinical vignette. Trained coders rated the quality of risk assessment formulation before and after training. Participants' knowledge, confidence, and objectively-rated documentation skills improved significantly (p < .001), with large effect sizes. Participants' expectation of their ability to transfer workshop content to their clinical practice was high (mean = 4.10 on 1-5 scale). Commitment to Living is a promising, innovative, and efficient curriculum for educating practicing clinicians to assess and respond to suicide risk. Well-designed, brief, suicide risk management programs can improve clinicians' knowledge, confidence, and skill.

2007 Wholesale Power Rate Case Initial Proposal : Wholesale Power Rate Development Study.

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

United States. Bonneville Power Administration.

The Wholesale Power Rate Development Study (WPRDS) calculates BPA proposed rates based on information either developed in the WPRDS or supplied by the other studies that comprise the BPA rate proposal. All of these studies, and accompanying documentation, provide the details of computations and assumptions. In general, information about loads and resources is provided by the Load Resource Study (LRS), WP-07-E-BPA-01, and the LRS Documentation, WP-07-E-BPA-01A. Revenue requirements information, as well as the Planned Net Revenues for Risk (PNNR), is provided in the Revenue Requirement Study, WP-07-E-BPA-02, and its accompanying Revenue Requirement Study Documentation, WP-07-E-BPA-02A and WP-07-E-BPA-02B. The Market Pricemore » Forecast Study (MPFS), WP-07-E-BPA-03, and the MPFS Documentation, WP-07-E-BPA-03A, provide the WPRDS with information regarding seasonal and diurnal differentiation of energy rates, as well information regarding monthly market prices for Demand Rates. In addition, this study provides information for the pricing of unbundled power products. The Risk Analysis Study, WP-07-E-BPA-04, and the Risk Analysis Study Documentation, WP-07-E-BPA-04A, provide short-term balancing purchases as well as secondary energy sales and revenue. The Section 7(b)(2) Rate Test Study, WP-07-E-BPA-06, and the Section 7(b)(2) Rate Test Study Documentation, WP-07-E-BPA-06A, implement Section 7(b)(2) of the Northwest Power Act to ensure that BPA preference customers firm power rates applied to their general requirements are no higher than rates calculated using specific assumptions in the Northwest Power Act.« less

Fast words boundaries localization in text fields for low quality document images

NASA Astrophysics Data System (ADS)

Ilin, Dmitry; Novikov, Dmitriy; Polevoy, Dmitry; Nikolaev, Dmitry

2018-04-01

The paper examines the problem of word boundaries precise localization in document text zones. Document processing on a mobile device consists of document localization, perspective correction, localization of individual fields, finding words in separate zones, segmentation and recognition. While capturing an image with a mobile digital camera under uncontrolled capturing conditions, digital noise, perspective distortions or glares may occur. Further document processing gets complicated because of its specifics: layout elements, complex background, static text, document security elements, variety of text fonts. However, the problem of word boundaries localization has to be solved at runtime on mobile CPU with limited computing capabilities under specified restrictions. At the moment, there are several groups of methods optimized for different conditions. Methods for the scanned printed text are quick but limited only for images of high quality. Methods for text in the wild have an excessively high computational complexity, thus, are hardly suitable for running on mobile devices as part of the mobile document recognition system. The method presented in this paper solves a more specialized problem than the task of finding text on natural images. It uses local features, a sliding window and a lightweight neural network in order to achieve an optimal algorithm speed-precision ratio. The duration of the algorithm is 12 ms per field running on an ARM processor of a mobile device. The error rate for boundaries localization on a test sample of 8000 fields is 0.3

Preliminary Assessment of the Impact on Reactor Vessel dpa Rates Due to Installation of a Proposed Low Enriched Uranium (LEU) Core in the High Flux Isotope Reactor (HFIR)

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

Daily, Charles R.

2015-10-01

An assessment of the impact on the High Flux Isotope Reactor (HFIR) reactor vessel (RV) displacements-per-atom (dpa) rates due to operations with the proposed low enriched uranium (LEU) core described by Ilas and Primm has been performed and is presented herein. The analyses documented herein support the conclusion that conversion of HFIR to low-enriched uranium (LEU) core operations using the LEU core design of Ilas and Primm will have no negative impact on HFIR RV dpa rates. Since its inception, HFIR has been operated with highly enriched uranium (HEU) cores. As part of an effort sponsored by the National Nuclearmore » Security Administration (NNSA), conversion to LEU cores is being considered for future HFIR operations. The HFIR LEU configurations analyzed are consistent with the LEU core models used by Ilas and Primm and the HEU balance-of-plant models used by Risner and Blakeman in the latest analyses performed to support the HFIR materials surveillance program. The Risner and Blakeman analyses, as well as the studies documented herein, are the first to apply the hybrid transport methods available in the Automated Variance reduction Generator (ADVANTG) code to HFIR RV dpa rate calculations. These calculations have been performed on the Oak Ridge National Laboratory (ORNL) Institutional Cluster (OIC) with version 1.60 of the Monte Carlo N-Particle 5 (MCNP5) computer code.« less

Transfer Assembly Project, 2001: VCCS Transfer Rates.

ERIC Educational Resources Information Center

McHewitt, Earl R.; Taylor, Garry

This document discusses the transfer rates of students who entered Virginia's community colleges in the fall of 1995, using the methodology developed by the Center for the Study of Community Colleges. Numerous tables in the document include individual college rates with breakdowns by race/ethnicity and gender. College-specific transfer rates are…

HTLV-I Seroconversion Study.

DTIC Science & Technology

1992-08-25

was delineated, with population-based seroprevalence rates less than 1% in Northern Japan and as high as 37% in the ATL-endemic area of Nagasaki (2...and Africa (Figure 1 in Appendices). These surveys have documented the focal patternI of seropositivity and disease occurrence now known to be...highest endemic rates of HTLV-I in the world, with approximately 15%-40% of adults being infected (2,9,13). It is unique in the military as it is the

High-rate injection is associated with the increase in U.S. mid-continent seismicity

USGS Publications Warehouse

Weingarten, Matthew; Ge, Shemin; Godt, Jonathan W.; Bekins, Barbara A.; Rubinstein, Justin L.

2015-01-01

An unprecedented increase in earthquakes in the U.S. mid-continent began in 2009. Many of these earthquakes have been documented as induced by wastewater injection. We examine the relationship between wastewater injection and U.S. mid-continent seismicity using a newly assembled injection well database for the central and eastern United States. We find that the entire increase in earthquake rate is associated with fluid injection wells. High-rate injection wells (>300,000 barrels per month) are much more likely to be associated with earthquakes than lower-rate wells. At the scale of our study, a well’s cumulative injected volume, monthly wellhead pressure, depth, and proximity to crystalline basement do not strongly correlate with earthquake association. Managing injection rates may be a useful tool to minimize the likelihood of induced earthquakes.

Impact of HFIR LEU Conversion on Beryllium Reflector Degradation Factors

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

Ilas, Dan

2013-10-01

An assessment of the impact of low enriched uranium (LEU) conversion on the factors that may cause the degradation of the beryllium reflector is performed for the High Flux Isotope Reactor (HFIR). The computational methods, models, and tools, comparisons with previous work, along with the results obtained are documented and discussed in this report. The report documents the results for the gas and neutronic poison production, and the heating in the beryllium reflector for both the highly enriched uranium (HEU) and LEU HFIR configurations, and discusses the impact that the conversion to LEU may have on these quantities. A time-averagingmore » procedure was developed to calculate the isotopic (gas and poisons) production in reflector. The sensitivity of this approach to different approximations is gauged and documented. The results show that the gas is produced in the beryllium reflector at a total rate of 0.304 g/cycle for the HEU configuration; this rate increases by ~12% for the LEU case. The total tritium production rate in reflector is 0.098 g/cycle for the HEU core and approximately 11% higher for the LEU core. A significant increase (up to ~25%) in the neutronic poisons production in the reflector during the operation cycles is observed for the LEU core, compared to the HEU case, for regions close to the core s horizontal midplane. The poisoning level of the reflector may increase by more than two orders of magnitude during long periods of downtime. The heating rate in the reflector is estimated to be approximately 20% lower for the LEU core than for the HEU core. The decrease is due to a significantly lower contribution of the heating produced by the gamma radiation for the LEU core. Both the isotopic (gas and neutronic poisons) production and the heating rates are spatially non-uniform throughout the beryllium reflector volume. The maximum values typically occur in the removable reflector and close to the midplane.« less

The Role of the School Environment in Relational Aggression and Victimization

ERIC Educational Resources Information Center

Elsaesser, Caitlin; Gorman-Smith, Deborah; Henry, David

2013-01-01

Research conducted over the last decade has documented both the high rates of and serious consequences associated with both victimization and perpetration of relational aggression. This study examines risk for involvement in relational aggression and victimization among middle school youth, evaluating both individual beliefs about violence, as…

Novel Mycobacterium tuberculosis complex pathogen, M. mungi.

PubMed

Alexander, Kathleen A; Laver, Pete N; Michel, Anita L; Williams, Mark; van Helden, Paul D; Warren, Robin M; Gey van Pittius, Nicolaas C

2010-08-01

Seven outbreaks involving increasing numbers of banded mongoose troops and high death rates have been documented. We identified a Mycobacterium tuberculosis complex pathogen, M. mungi sp. nov., as the causative agent among banded mongooses that live near humans in Chobe District, Botswana. Host spectrum and transmission dynamics remain unknown.

Reading Outside Micrometers. Courseware Evaluation for Vocational and Technical Education.

ERIC Educational Resources Information Center

Sommer, Sandra; And Others

This courseware evaluation rates the Reading Outside Micrometers program developed by EMC Publishing Company. (The program--not contained in this document--uses high resolution graphics to illustrate the micrometer's components, functions, and practical applications.) Part A describes the program in terms of subject area and equipment requirements…

Reading Vernier Calipers. Courseware Evaluation for Vocational and Technical Education.

ERIC Educational Resources Information Center

Goldstine, James; And Others

This courseware evaluation rates the Reading Vernier Calipers program developed by EMC Publishing Company. (The program--not contained in this document--uses high resolution graphics to illustrate the micrometer and describe its components, functions, and practical applications.) Part A describes the program in terms of subject area (technical…

Optimal Admission to Higher Education

ERIC Educational Resources Information Center

Albaek, Karsten

2017-01-01

This paper analyses admission decisions when students from different high school tracks apply for admission to university programmes. I derive a criterion that is optimal in the sense that it maximizes the graduation rates of the university programmes. The paper contains an empirical analysis that documents the relevance of theory and illustrates…

PubMed Central

Garceau, D.; Turgeon, M.; Gagnon, S.

1995-01-01

Diabetic nephropathy morbidity and mortality rates are high for both Type I and Type II diabetes. The various stages of diabetic nephropathy have been well documented for Type I diabetes, but not for Type II. We examine the natural history of this problem and recommended treatments, with emphasis on the characteristics of each type. PMID:7756921

Automatic multimodal detection for long-term seizure documentation in epilepsy.

PubMed

Fürbass, F; Kampusch, S; Kaniusas, E; Koren, J; Pirker, S; Hopfengärtner, R; Stefan, H; Kluge, T; Baumgartner, C

2017-08-01

This study investigated sensitivity and false detection rate of a multimodal automatic seizure detection algorithm and the applicability to reduced electrode montages for long-term seizure documentation in epilepsy patients. An automatic seizure detection algorithm based on EEG, EMG, and ECG signals was developed. EEG/ECG recordings of 92 patients from two epilepsy monitoring units including 494 seizures were used to assess detection performance. EMG data were extracted by bandpass filtering of EEG signals. Sensitivity and false detection rate were evaluated for each signal modality and for reduced electrode montages. All focal seizures evolving to bilateral tonic-clonic (BTCS, n=50) and 89% of focal seizures (FS, n=139) were detected. Average sensitivity in temporal lobe epilepsy (TLE) patients was 94% and 74% in extratemporal lobe epilepsy (XTLE) patients. Overall detection sensitivity was 86%. Average false detection rate was 12.8 false detections in 24h (FD/24h) for TLE and 22 FD/24h in XTLE patients. Utilization of 8 frontal and temporal electrodes reduced average sensitivity from 86% to 81%. Our automatic multimodal seizure detection algorithm shows high sensitivity with full and reduced electrode montages. Evaluation of different signal modalities and electrode montages paces the way for semi-automatic seizure documentation systems. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Vaccinations in pneumonia (VIP): pneumococcal and influenza vaccination patterns among patients hospitalized for pneumonia.

PubMed

Greci, Laura S; Katz, David L; Jekel, James

2005-04-01

Although the CDC ACIP (Advisory Committee on Immunization Practices) recommends that appropriate inpatients receive pneumococcal and influenza vaccines, adult vaccination rates for these remain low. We therefore examined perihospitalization vaccination rates for high-risk pneumonia inpatients. A retrospective chart review of all pneumonia patients admitted to one community hospital from 6/1/95 to 5/31/96. Vaccination history, co-morbidity, mortality, and prior and subsequent pneumonia admissions were recorded. Primary care providers and nursing homes were contacted to complete and verify vaccine histories. For 173 total admissions (160 subjects), vaccine histories were documented in the hospital chart in less than 0.5% of patients. While 97% had indications for both vaccines at the time of admission, no vaccines were given in the hospital and less than 5% had documented vaccinations during the subsequent 3 years. Despite clear indications, few patients had documented vaccination at any time. These data lend urgency to the recommendation that pneumococcal and influenza vaccines should be routinely administered to pneumonia inpatients at discharge. Furthermore, they illustrate the need for an improved method for tracking individual adult vaccinations.

Dosimetric characterization of the (60)Co BEBIG Co0.A86 high dose rate brachytherapy source using PENELOPE.

PubMed

Guerrero, Rafael; Almansa, Julio F; Torres, Javier; Lallena, Antonio M

2014-12-01

(60)Co sources are being used as an alternative to (192)Ir sources in high dose rate brachytherapy treatments. In a recent document from AAPM and ESTRO, a consensus dataset for the (60)Co BEBIG (model Co0.A86) high dose rate source was prepared by using results taken from different publications due to discrepancies observed among them. The aim of the present work is to provide a new calculation of the dosimetric characteristics of that (60)Co source according to the recommendations of the AAPM and ESTRO report. Radial dose function, anisotropy function, air-kerma strength, dose rate constant and absorbed dose rate in water have been calculated and compared to the results of previous works. Simulations using the two different geometries considered by other authors have been carried out and the effect of the cable density and length has been studied. Copyright © 2014 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Electronic reminders improve procedure documentation compliance and professional fee reimbursement.

PubMed

Kheterpal, Sachin; Gupta, Ruchika; Blum, James M; Tremper, Kevin K; O'Reilly, Michael; Kazanjian, Paul E

2007-03-01

Medicolegal, clinical, and reimbursement needs warrant complete and accurate documentation. We sought to identify and improve our compliance rate for the documentation of arterial catheterization in the perioperative setting. We first reviewed 12 mo of electronic anesthesia records to establish a baseline compliance rate for arterial catheter documentation. Residents and Certified Registered Nurse Anesthetists were randomly assigned to a control group and experimental group. When surgical incision and anesthesia end were documented in the electronic record keeper, a reminder routine checked for an invasive arterial blood pressure tracing. If a case used an arterial catheter, but no procedure note was observed, the resident or Certified Registered Nurse Anesthetist assigned to the case was sent an automated alphanumeric pager and e-mail reminder. Providers in the control group received no pager or e-mail message. After 2 mo, all staff received the reminders. A baseline compliance rate of 80% was observed (1963 of 2459 catheters documented). During the 2-mo study period, providers in the control group documented 152 of 202 (75%) arterial catheters, and the experimental group documented 177 of 201 (88%) arterial lines (P < 0.001). After all staff began receiving reminders, 309 of 314 arterial lines were documented in a subsequent 2 mo period (98%). Extrapolating this compliance rate to 12 mo of expected arterial catheter placement would result in an annual incremental $40,500 of professional fee reimbursement. The complexity of the tertiary care process results in documentation deficiencies. Inexpensive automated reminders can drastically improve compliance without the need for complicated negative or positive feedback.

Body size development of captive and free-ranging Leopard tortoises (Geochelone pardalis).

PubMed

Ritz, Julia; Hammer, Catrin; Clauss, Marcus

2010-01-01

The growth and weight development of Leopard tortoise hatchings (Geochelone pardalis) kept at the Al Wabra Wildlife Preservation (AWWP), Qatar, was observed for more than four years, and compared to data in literature for free-ranging animals on body weight or carapace measurements. The results document a distinctively faster growth in the captive animals. Indications for the same phenomenon in other tortoise species (Galapagos giant tortoises, G. nigra; Spur-thighed tortoises, Testudo graeca; Desert tortoises, Gopherus agassizi) were found in the literature. The cause of the high growth rate most likely is the constant provision with highly digestible food of low fiber content. Increased growth rates are suspected to have negative consequences such as obesity, high mortality, gastrointestinal illnesses, renal diseases, "pyramiding," fibrous osteodystrophy or metabolic bone disease. The apparently widespread occurrence of high growth rates in intensively managed tortoises underlines how easily ectothermic animals can be oversupplemented with nutrients. (c) 2009 Wiley-Liss, Inc.

DOE-HEP Final Report for 2013-2016: Studies of plasma wakefields for high repetition-rate plasma collider, and Theoretical study of laser-plasma proton and ion acceleration

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

Katsouleas, Thomas C.; Sahai, Aakash A.

2016-08-08

There were two goals for this funded project: 1. Studies of plasma wakefields for high repetition-rate plasma collider, and 2. Theoretical study of laser-plasma proton and ion acceleration. For goal 1, an analytical model was developed to determine the ion-motion resulting from the interaction of non-linear “blow-out” wakefields excited by beam-plasma and laser-plasma interactions. This is key to understanding the state of the plasma at timescales of 1 picosecond to a few 10s of picoseconds behind the driver-energy pulse. More information can be found in the document. For goal 2, we analytically and computationally analyzed the longitudinal instabilities of themore » laser-plasma interactions at the critical layer. Specifically, the process of “Doppler-shifted Ponderomotive bunching” is significant to eliminate the very high-energy spread and understand the importance of chirping the laser pulse frequency. We intend to publish the results of the mixing process in 2-D. We intend to publish Chirp-induced transparency. More information can be found in the document.« less

Some Practical Universal Noiseless Coding Techniques

NASA Technical Reports Server (NTRS)

Rice, Robert F.

1994-01-01

Report discusses noiseless data-compression-coding algorithms, performance characteristics and practical consideration in implementation of algorithms in coding modules composed of very-large-scale integrated circuits. Report also has value as tutorial document on data-compression-coding concepts. Coding techniques and concepts in question "universal" in sense that, in principle, applicable to streams of data from variety of sources. However, discussion oriented toward compression of high-rate data generated by spaceborne sensors for lower-rate transmission back to earth.

Creating a Gold Standard for the Readability Measurement of Health Texts

PubMed Central

Kandula, Sasikiran; Zeng-Treitler, Qing

2008-01-01

Developing easy-to-read health texts for consumers continues to be a challenge in health communication. Though readability formulae such as Flesch-Kincaid Grade Level have been used in many studies, they were found to be inadequate to estimate the difficulty of some types of health texts. One impediment to the development of new readability assessment techniques is the absence of a gold standard that can be used to validate them. To overcome this deficiency, we have compiled a corpus of 324 health documents consisting of six different types of texts. These documents were manually reviewed and assigned a readability level (1-7 Likert scale) by a panel of five health literacy experts. The expert assigned ratings were found to be highly correlated with a patient representative’s readability ratings (r = 0.81, p<0.0001). PMID:18999150

Colony Failure Linked to Low Sperm Viability in Honey Bee (Apis mellifera) Queens and an Exploration of Potential Causative Factors.

PubMed

Pettis, Jeffery S; Rice, Nathan; Joselow, Katie; vanEngelsdorp, Dennis; Chaimanee, Veeranan

2016-01-01

Queen health is closely linked to colony performance in honey bees as a single queen is normally responsible for all egg laying and brood production within the colony. In the U. S. in recent years, queens have been failing at a high rate; with 50% or greater of queens replaced in colonies within 6 months when historically a queen might live one to two years. This high rate of queen failure coincides with the high mortality rates of colonies in the US, some years with >50% of colonies dying. In the current study, surveys of sperm viability in US queens were made to determine if sperm viability plays a role in queen or colony failure. Wide variation was observed in sperm viability from four sets of queens removed from colonies that beekeepers rated as in good health (n = 12; average viability = 92%), were replacing as part of normal management (n = 28; 57%), or where rated as failing (n = 18 and 19; 54% and 55%). Two additional paired set of queens showed a statistically significant difference in viability between colonies rated by the beekeeper as failing or in good health from the same apiaries. Queens removed from colonies rated in good health averaged high viability (ca. 85%) while those rated as failing or in poor health had significantly lower viability (ca. 50%). Thus low sperm viability was indicative of, or linked to, colony performance. To explore the source of low sperm viability, six commercial queen breeders were surveyed and wide variation in viability (range 60-90%) was documented between breeders. This variability could originate from the drones the queens mate with or temperature extremes that queens are exposed to during shipment. The role of shipping temperature as a possible explanation for low sperm viability was explored. We documented that during shipment queens are exposed to temperature spikes (<8 and > 40°C) and these spikes can kill 50% or more of the sperm stored in queen spermathecae in live queens. Clearly low sperm viability is linked to colony performance and laboratory and field data provide evidence that temperature extremes are a potential causative factor.

Small cause - big effect: improvement in interface design results in improved data quality - a multicenter crossover study.

PubMed

Ahlbrandt, Janko; Henrich, Michael; Hartmann, Bernd A; Bundschuh, Bettina B; Schwarz, Julia; Klasen, Joachim; Röhrig, Rainer

2012-01-01

In Germany the core data set for anesthesia version 3.0 was recently introduced for external quality assurance, which includes five surgical tracer procedures. We found a low rate of correctly documented tracers when compared to procedure data (OPS-Codes) documented separately. Examination revealed that the graphical user interface (GUI) contravened the dialogue principles as defined in EN ISO 9241-110. We worked with the manufacturer to implement small improvements and roll out the software. A crossover study was conducted at a university hospital and a municipal hospital chain with five hospitals. All study sites and surgical tracer procedures combined, we found an improvement from 42% to 65% (p<0.001; N=34,610) correctly documented anesthesias. We also saw improvements for most of the observed surgical tracer procedures at all hospitals. Our results show the big effect small changes to the GUI can have on data quality. They also raise the question, if highly flexible and parameterized clinical documentation systems are suited to achieve high usability. Finding the right balance between GUIs designed by usability experts and the flexibility of parameterization by administrators will be a difficult task for the future and subject to further research.

Ticarcillin in Combination with Cephalothin or Gentamicin as Empiric Antibiotic Therapy in Granulocytopenic Cancer Patients

PubMed Central

Schimpff, Stephen C.; Landesman, Sheldon; Hahn, Davis M.; Standiford, Harold C.; Fortner, Clarence L.; Young, Viola Mae; Wiernik, Peter H.

1976-01-01

Ticarcillin was used in combination with either cephalothin or gentamicin as initial empiric antibiotic therapy for 127 patient trials of suspected infection in granulocytopenic cancer patients. Bacteremia was present in 20%, nonbacteremic microbiologically documented infections in 21%, clinically documented infections in 23%, and possible infections in 5%; infection was doubtful in 31%. Although Staphylococcus aureus was the most common single organism isolated (23%), gram-negative bacilli accounted for 54% of all pathogens. Both antibiotic regimens were highly efficacious, with complete resolution in 46% of bacteremias, 88% of nonbacteremic microbiologically documented infections, and 95% of clinically documented infections. Among bacteremias, 8 of 9 caused by S. aureus but only 4 of 15 (27%) caused by gram-negative bacilli were completely resolved with these antibiotic combinations. Reasons for nonresponse in bacteremias were persistent granulocytopenia, mixed infection and, in two patients, antibiotic-resistant organisms. Toxicities other than hypokalemia were minimal. Although the rate of further infections was high overall (18/127), only one occurred among the 39 patients with <4 days of antibiotic therapy. Ticarcillin in combination with either cephalothin or gentamicin was effective as initial empiric therapy of suspected infection in granulocytopenic cancer patients. PMID:795372

VCCS Transfer Project: Transfer Rates, Transfer Performance, and Baccalaureate Completion.

ERIC Educational Resources Information Center

McHewitt, Earl R.; Taylor, Garry

This document analyzes a study done by the Center for the Study of Community Colleges (CSCC), which examined transfer rates in the VCCS. The document provides definitions for transfer rate, academic performance, and completion rate as they are used in the study. The study answers the following questions: (1) which pool of students were used in the…

Tools for Large Graph Mining

DTIC Science & Technology

2005-06-01

regarding criminals among many police departments. The criminal graph links suspects, crimes , locations, previous case histories, etc. These linkages...rebroadcast rate is high enough that dying out is not a concern. With the rise of sensor and peer to peer networks characterized by high churn, theory that...document groups (say, science fiction novels and thrillers ), based on the word groups that occur most frequently in them. A user who prefers one

Laparoscopic management of cystic disease of the liver.

PubMed

Albrink, M H; McAllister, E W; Rosemurgy, A S; Karl, R C; Carey, L C

1994-04-01

Laparoscopic surgical procedures are increasing in scope and in variety. The benefits of decreased wound morbidity and pain have been well documented for multiple procedures that have traditionally required laparotomy. Although there are few controlled studies to document them, these benefits may be evident from simple clinical observation. Cystic disease of the liver is a condition that is treated largely for symptomatic reasons. The so-called noninvasive or radiographic guided methods of treatment for cystic disease of the liver are fraught with high recurrence rates. We present four cases of cystic disease of the liver treated laparoscopically, followed with pertinent discussion.

Assessment of bird populations in a high quality savanna/woodland: a banding approach

USGS Publications Warehouse

Wilmore, Sandra L.; Glowacki, Gary A.; Grundel, Ralph

2005-01-01

During the course of this six year study, the fall migration capture rate declined significantly, suggesting that reduced productivity may have occurred in bird populations. There was a positive response during the spring migration to earlier spring wildfires, indicated by high capture rates in 2000 and 2002 that corresponded with fires affecting most of the bird banding net locations. For several common species found at the Miller Woods site, the ratio of juveniles to adults was compared to ratios at other banding stations in the north central U.S. Breeding site fidelity was documented for 20 species, all common breeders. Variation in capture rates among net locations demonstrated the role of the shrub layer within the savanna habitat mosaic during migration stopover.

A robust omnifont open-vocabulary Arabic OCR system using pseudo-2D-HMM

NASA Astrophysics Data System (ADS)

Rashwan, Abdullah M.; Rashwan, Mohsen A.; Abdel-Hameed, Ahmed; Abdou, Sherif; Khalil, A. H.

2012-01-01

Recognizing old documents is highly desirable since the demand for quickly searching millions of archived documents has recently increased. Using Hidden Markov Models (HMMs) has been proven to be a good solution to tackle the main problems of recognizing typewritten Arabic characters. These attempts however achieved a remarkable success for omnifont OCR under very favorable conditions, they didn't achieve the same performance in practical conditions, i.e. noisy documents. In this paper we present an omnifont, large-vocabulary Arabic OCR system using Pseudo Two Dimensional Hidden Markov Model (P2DHMM), which is a generalization of the HMM. P2DHMM offers a more efficient way to model the Arabic characters, such model offer both minimal dependency on the font size/style (omnifont), and high level of robustness against noise. The evaluation results of this system are very promising compared to a baseline HMM system and best OCRs available in the market (Sakhr and NovoDynamics). The recognition accuracy of the P2DHMM classifier is measured against the classic HMM classifier, the average word accuracy rates for P2DHMM and HMM classifiers are 79% and 66% respectively. The overall system accuracy is measured against Sakhr and NovoDynamics OCR systems, the average word accuracy rates for P2DHMM, NovoDynamics, and Sakhr are 74%, 71%, and 61% respectively.

Methods for semi-automated indexing for high precision information retrieval.

PubMed

Berrios, Daniel C; Cucina, Russell J; Fagan, Lawrence M

2002-01-01

To evaluate a new system, ISAID (Internet-based Semi-automated Indexing of Documents), and to generate textbook indexes that are more detailed and more useful to readers. Pilot evaluation: simple, nonrandomized trial comparing ISAID with manual indexing methods. Methods evaluation: randomized, cross-over trial comparing three versions of ISAID and usability survey. Pilot evaluation: two physicians. Methods evaluation: twelve physicians, each of whom used three different versions of the system for a total of 36 indexing sessions. Total index term tuples generated per document per minute (TPM), with and without adjustment for concordance with other subjects; inter-indexer consistency; ratings of the usability of the ISAID indexing system. Compared with manual methods, ISAID decreased indexing times greatly. Using three versions of ISAID, inter-indexer consistency ranged from 15% to 65% with a mean of 41%, 31%, and 40% for each of three documents. Subjects using the full version of ISAID were faster (average TPM: 5.6) and had higher rates of concordant index generation. There were substantial learning effects, despite our use of a training/run-in phase. Subjects using the full version of ISAID were much faster by the third indexing session (average TPM: 9.1). There was a statistically significant increase in three-subject concordant indexing rate using the full version of ISAID during the second indexing session (p < 0.05). Users of the ISAID indexing system create complex, precise, and accurate indexing for full-text documents much faster than users of manual methods. Furthermore, the natural language processing methods that ISAID uses to suggest indexes contributes substantially to increased indexing speed and accuracy.

3 CFR - Federal Employee Pay Schedules and Rates That Are Set by Administrative Discretion

Code of Federal Regulations, 2013 CFR

2013-01-01

... 3 The President 1 2013-01-01 2013-01-01 false Federal Employee Pay Schedules and Rates That Are Set by Administrative Discretion Presidential Documents Other Presidential Documents Memorandum of December 21, 2012 Federal Employee Pay Schedules and Rates That Are Set by Administrative Discretion...

Lifting the Lid: How Prison Writing Workshops Shed Light on the Social Shadow

ERIC Educational Resources Information Center

Toso, Erec

2016-01-01

While the social, political, economic, educational, and cultural consequences of high rates of incarceration have been well documented, the social psychological dynamics have not received as much discussion. I offer here a first person narrative reflection on the connections between a writing workshops and raising social awareness of the realities…

Beyond Introductory Programming: Success Factors for Advanced Programming

ERIC Educational Resources Information Center

Hoskey, Arthur; Maurino, Paula San Millan

2011-01-01

Numerous studies document high drop-out and failure rates for students in computer programming classes. Studies show that even when some students pass programming classes, they still do not know how to program. Many factors have been considered to explain this problem including gender, age, prior programming experience, major, math background,…

Child Abuse, Street Victimization, and Substance Use among Homeless Young Adults

ERIC Educational Resources Information Center

Tyler, Kimberly A.; Melander, Lisa A.

2015-01-01

Although previous research documents high rates of child abuse, street victimization, and substance use among homeless youth, few studies have investigated these three constructs simultaneously, and thus little is known about how various forms of victimization are uniquely associated with substance use among this population. The purpose of this…

The Dichotomous Relationship between Personality Traits and Repatriation Decisions by Information Technology Workers

ERIC Educational Resources Information Center

Pearson, Marcia L. Y.

2013-01-01

Researchers have consistently documented high turnover rates among repatriated workers after overseas assignments, mainly due to post-repatriation concerns about career advancement, compensation reduction, subsequent use of overseas experience, and job security. What is unknown is a method to alleviate this problem by selecting the types of…

High School Graduation Rates across English Learner Student Subgroups in Arizona. REL 2017-205

ERIC Educational Resources Information Center

Huang, Min; Haas, Eric; Zhu, Niufeng; Tran, Loan

2016-01-01

Recent studies have documented differences in academic achievement between current and former English learner students. These differences validate calls for more focused analyses of achievement across English learner student subgroups. Specifically, there is interest in examining variation in academic success based on the amount of time a student…

Sexual Violence. Work in Progress No. 83-05.

ERIC Educational Resources Information Center

Herman, Judith

Rates of sexual assault on women are sufficiently high that women live with a lifelong, pervasive fear of violence. Research has just begun to identify and analyze the health and mental health effects of sexual assault on victims, and studies are investigating the social and individual motivations of perpetrators. This document contains a…

Impact of Depression and Childhood Trauma in Mothers Receiving Home Visitation

ERIC Educational Resources Information Center

Ammerman, Robert T.; Shenk, Chad E.; Teeters, Angelique R.; Noll, Jennie G.; Putnam, Frank W.; Van Ginkel, Judith B.

2012-01-01

Research has documented the deleterious effects of maternal depression and childhood trauma on parenting and child development. There are high rates of both depression and childhood trauma in new mothers participating in home visitation programs, a prevention approach designed to optimize mother and child outcomes. Little is known about the…

Gender-Nonconforming Lesbian, Gay, Bisexual, and Transgender Youth: School Victimization and Young Adult Psychosocial Adjustment

ERIC Educational Resources Information Center

Toomey, Russell B.; Ryan, Caitlin; Diaz, Rafael M.; Card, Noel A.; Russell, Stephen T.

2010-01-01

Past research documents that both adolescent gender nonconformity and the experience of school victimization are associated with high rates of negative psychosocial adjustment. Using data from the Family Acceptance Project's young adult survey, we examined associations among retrospective reports of adolescent gender nonconformity and adolescent…

A High-Resolution Chronology of Rapid Forest Transitions following Polynesian Arrival in New Zealand

PubMed Central

McWethy, David B.; Wilmshurst, Janet M.; Whitlock, Cathy; Wood, Jamie R.; McGlone, Matt S.

2014-01-01

Human-caused forest transitions are documented worldwide, especially during periods when land use by dense agriculturally-based populations intensified. However, the rate at which prehistoric human activities led to permanent deforestation is poorly resolved. In the South Island, New Zealand, the arrival of Polynesians c. 750 years ago resulted in dramatic forest loss and conversion of nearly half of native forests to open vegetation. This transformation, termed the Initial Burning Period, is documented in pollen and charcoal records, but its speed has been poorly constrained. High-resolution chronologies developed with a series of AMS radiocarbon dates from two lake sediment cores suggest the shift from forest to shrubland occurred within decades rather than centuries at drier sites. We examine two sites representing extreme examples of the magnitude of human impacts: a drier site that was inherently more vulnerable to human-set fires and a wetter, less burnable site. The astonishing rate of deforestation at the hands of small transient populations resulted from the intrinsic vulnerability of the native flora to fire and from positive feedbacks in post-fire vegetation recovery that increased landscape flammability. Spatially targeting burning in highly-flammable seral vegetation in forests rarely experiencing fire was sufficient to create an alternate fire-prone stable state. The New Zealand example illustrates how seemingly stable forest ecosystems can experience rapid and permanent conversions. Forest loss in New Zealand is among the fastest ecological transitions documented in the Holocene; yet equally rapid transitions can be expected in present-day regions wherever positive feedbacks support alternate fire-inhibiting, fire-prone stable states. PMID:25372150

Genetics of Cleft Palate and Velopharyngeal Insufficiency

PubMed Central

Sweeney, Walter M.; Lanier, Steve T.; Purnell, Chad A.; Gosain, Arun K.

2015-01-01

Velopharyngeal insufficiency (VPI) can occur in the setting of an unrepaired or repaired cleft lip and palate. The rate of VPI has been documented as high as 33% in some studies with higher rates of recurrences following surgery associated with genetic syndromes such as 22q11.2 deletions. The primary cause of VPI in these groups is still identified as the anatomic abnormalities of the velum. In this review, the anatomy and physiology of the velum are discussed along with genetic mutations associated with VPI. PMID:27617110

Two millennia of soil dynamics derived from ancient desert terraces using high resolution 3-D data

NASA Astrophysics Data System (ADS)

Filin, Sagi; Arav, Reuma; Avni, Yoav

2017-04-01

Large areas in the arid southern Levant are dotted with ancient terrace-based agriculture systems which were irrigated by runoff harvesting techniques. They were constructed and maintained between the 3rd - 9th centuries AD and abandoned in the 10th century AD. During their 600 years of cultivation, these terraces documented the gradual aggradation of alluvial soils, erosion processes within the drainage basins, as well as flashflood damage. From their abandonment and onwards, they documented 1000 years and more of land degradation and soil erosion processes. Examination of these installations presents an opportunity to study natural and anthropogenic induced changes over almost two millennia. On a global scale, such an analysis is unique as it is rare to find intact manifestations of anthropogenic influences over such time-scales because of landscape dynamics. It is also rare to find a near millennia documentation of soil erosion processes. We study in this paper the aggradation processes within intact agriculture plots in the region surrounding the world heritage Roman-Byzantine ancient city of Avdat, Negev Highlands. We follow the complete cycle of the historical desert agriculture, from the configuration pre-dating the first anthropogenic intervention, through the centuries of cultivation, and up to the present erosion phase, which spans over more than a millennium. We use high resolution 3-D laser scans to document the erosion and the environmental dynamics during these two millennia. The high-resolution data is then utilized to compute siltation rates as well as erosion rates. The long-term measures of soil erosion and land degradation we present here significantly improve our understanding of the mechanism of long-term environmental change acting in arid environments. For sustainable desert inhabitation, the study offers insights into better planning of modern agriculture in similar zones as well as insights on strategies needed to protect such historical installations.

Epidemiology of viral pathogens of free-ranging dogs and Indian foxes in a human-dominated landscape in central India.

PubMed

Belsare, A V; Vanak, A T; Gompper, M E

2014-08-01

There is an increasing concern that free-ranging domestic dog (Canis familiaris) populations may serve as reservoirs of pathogens which may be transmitted to wildlife. We documented the prevalence of antibodies to three viral pathogens, canine parvovirus (CPV), canine distemper virus (CDV) and canine adenovirus (CAV), in free-ranging dog and sympatric Indian fox (Vulpes bengalensis) populations in and around the Great Indian Bustard Wildlife Sanctuary, in Maharashtra, central India. A total of 219 dogs and 33 foxes were sampled during the study period. Ninety-three percentage of dogs and 87% of foxes were exposed to one or more of the three pathogens. Exposure rates in dogs were high: >88% for CPV, >72% for CDV and 71% for CAV. A large proportion of adult dogs had antibodies against these pathogens due to seroconversion following earlier natural infection. The high prevalence of exposure to these pathogens across the sampling sessions, significantly higher exposure rates of adults compared with juveniles, and seroconversion in some unvaccinated dogs documented during the study period suggests that these pathogens are enzootic. The prevalence of exposure to CPV, CDV and CAV in foxes was 48%, 18% and 52%, respectively. Further, a high rate of mortality was documented in foxes with serologic evidence of ongoing CDV infection. Dogs could be playing a role in the maintenance and transmission of these pathogens in the fox population, but our findings show that most dogs in the population are immune to these pathogens by virtue of earlier natural infection, and therefore, these individuals make little current or future contribution to viral maintenance. Vaccination of this cohort will neither greatly improve their collective immune status nor contribute to herd immunity. Our findings have potentially important implications for dog disease control programmes that propose using canine vaccination as a tool for conservation management of wild carnivore populations. © 2014 Blackwell Verlag GmbH.

3 CFR - Freezing Federal Employee Pay Schedules and Rates That Are Set By Administrative Discretion

Code of Federal Regulations, 2011 CFR

2011-01-01

... 3 The President 1 2011-01-01 2011-01-01 false Freezing Federal Employee Pay Schedules and Rates That Are Set By Administrative Discretion Presidential Documents Other Presidential Documents Memorandum of December 22, 2010 Freezing Federal Employee Pay Schedules and Rates That Are Set By...

VCCS Student Outcomes.

ERIC Educational Resources Information Center

McHewitt, Earl; Taylor, Garry

This document discusses the recent measures of VCCS student outcomes by focusing on three areas: (1) graduation rate; (2) retention rate; and (3) further study or employment rate after graduation. The document provides definitions for the following five terms as they are used in the study: (1) Fall to Spring retention; (2) Fall to Fall retention;…

HIV counselling and testing practices for children seen in an urban emergency department of a tertiary referral hospital in Dar es Salaam, Tanzania: a retrospective cross-sectional study

PubMed Central

Sawe, Hendry R; Mfinanga, Juma A; Ringo, Faith H; Mwafongo, Victor; Reynolds, Teri A; Runyon, Michael S

2016-01-01

Objectives To describe the HIV counselling and testing practices for children presenting to an emergency department (ED) in a low-income country. Setting The ED of a large east African national referral hospital. Participants This retrospective review of all paediatric (<18 years old) ED visits in 2012 enrolled patients who had an HIV test ordered and excluded those without testing. Files were available for 5540/5774 (96%) eligible patients and 1632 (30%) were tested for HIV, median age 1.3 years (IQR 9 months to 4 years), 58% <18 months old and 61% male. Primary and secondary outcome measures The primary outcome measure was documentation of pretest and post-test counselling, or deferral of counselling, for children tested for HIV in the ED. Secondary measures included the overall rate of HIV testing, rate of counselling documented in the inpatient record when deferred in the ED, rate of counselling documented when testing was initiated by the inpatient service, rate of counselling documented by test result (positive vs negative) and the rate of referral to follow-up HIV care among patients testing positive. Results Of 418 patients tested in the ED, counselling, or deferral of counselling, was documented for 70 (17%). When deferred to the ward, subsequent counselling was documented for 15/42 (36%). Counselling was documented in 33% of patients testing positive versus 1.1% patients testing negative (OR 43 (95% CI 23 to 83). Of 199 patients who tested positive and survived to hospital discharge, 76 (38%) were referred for follow-up at the HIV clinic on discharge. Conclusions Physicians documented the provision, or deferral, of counselling for <20% of children tested for HIV in the ED. Counselling was much more likely to be documented when the test result was positive. Less than 40% of those testing positive were referred for follow-up care. PMID:26880672

A simple and effective figure caption detection system for old-style documents

NASA Astrophysics Data System (ADS)

Liu, Zongyi; Zhou, Hanning

2011-01-01

Identifying figure captions has wide applications in producing high quality e-books such as kindle books or ipad books. In this paper, we present a rule-based system to detect horizontal figure captions in old-style documents. Our algorithm consists of three steps: (i) segment images into regions of different types such as text and figures, (ii) search the best caption region candidate based on heuristic rules such as region alignments and distances, and (iii) expand caption regions identified in step (ii) with its neighboring text-regions in order to correct oversegmentation errors. We test our algorithm using 81 images collected from old-style books, with each image containing at least one figure area. We show that the approach is able to correctly detect figure captions from images with different layouts, and we also measure its performances in terms of both precision rate and recall rate.

Evaluating the impacts of marine debris on cetaceans.

PubMed

Baulch, Sarah; Perry, Clare

2014-03-15

Global in its distribution and pervading all levels of the water column, marine debris poses a serious threat to marine habitats and wildlife. For cetaceans, ingestion or entanglement in debris can cause chronic and acute injuries and increase pollutant loads, resulting in morbidity and mortality. However, knowledge of the severity of effects lags behind that for other species groups. This literature review examines the impacts of marine debris on cetaceans reported to date. It finds that ingestion of debris has been documented in 48 (56% of) cetacean species, with rates of ingestion as high as 31% in some populations. Debris-induced mortality rates of 0-22% of stranded animals were documented, suggesting that debris could be a significant conservation threat to some populations. We identify key data that need to be collected and published to improve understanding of the threat that marine debris poses to cetaceans. Copyright © 2014 Elsevier Ltd. All rights reserved.

In-situ GPS records of surface mass balance, firn compaction rates, and ice-shelf basal melt rates for Pine Island Glacier, Antarctica

NASA Astrophysics Data System (ADS)

Shean, D. E.; Christianson, K.; Larson, K. M.; Ligtenberg, S.; Joughin, I. R.; Smith, B.; Stevens, C.

2016-12-01

In recent decades, Pine Island Glacier (PIG) has experienced marked retreat, speedup and thinning due to ice-shelf basal melt, internal ice-stream instability and feedbacks between these processes. In an effort to constrain recent ice-stream dynamics and evaluate potential causes of retreat, we analyzed 2008-2010 and 2012-2014 GPS records for PIG. We computed time series of horizontal velocity, strain rate, multipath-based antenna height, surface elevation, and Lagrangian elevation change (Dh/Dt). These data provide validation for complementary high-resolution WorldView stereo digital elevation model (DEM) records, with sampled DEM vertical error of 0.7 m. The GPS antenna height time series document a relative surface elevation increase of 0.7-1.0 m/yr, which is consistent with estimated surface mass balance (SMB) of 0.7-0.9 m.w.e./yr from RACMO2.3 and firn compaction rates from the IMAU-FDM dynamic firn model. An abrupt 0.2-0.3 m surface elevation decrease due to surface melt and/or greater near-surface firn compaction is observed during a period of warm atmospheric temperatures from December 2012 to January 2013. Observed surface Dh/Dt for all PIG shelf sites is highly linear with trends of -1 to -4 m/yr and <0.4 m residuals. Similar Dh/Dt estimates with reduced variability are obtained after removing expected downward GPS pole base velocity from observed GPS antenna Dh/Dt. Estimated Dh/Dt basal melt rates are 10 to 40 m/yr for the outer PIG shelf and 4 m/yr for the South shelf. These melt rates are similar to those derived from ice-bottom acoustic ranging, phase-sensitive ice-penetrating radar, and high-resolution stereo DEM records. The GPS/DEM records document higher melt rates within and near transverse surface depressions and rifts associated with longitudinal extension. Basal melt rates for the 2012-2014 period show limited temporal variability, despite significant change in ocean heat content. This suggests that sub-shelf melt rates are less sensitive to ocean heat content than previously reported, at least for these locations and time periods.

Fusion of Deep Learning and Compressed Domain features for Content Based Image Retrieval.

PubMed

Liu, Peizhong; Guo, Jing-Ming; Wu, Chi-Yi; Cai, Danlin

2017-08-29

This paper presents an effective image retrieval method by combining high-level features from Convolutional Neural Network (CNN) model and low-level features from Dot-Diffused Block Truncation Coding (DDBTC). The low-level features, e.g., texture and color, are constructed by VQ-indexed histogram from DDBTC bitmap, maximum, and minimum quantizers. Conversely, high-level features from CNN can effectively capture human perception. With the fusion of the DDBTC and CNN features, the extended deep learning two-layer codebook features (DL-TLCF) is generated using the proposed two-layer codebook, dimension reduction, and similarity reweighting to improve the overall retrieval rate. Two metrics, average precision rate (APR) and average recall rate (ARR), are employed to examine various datasets. As documented in the experimental results, the proposed schemes can achieve superior performance compared to the state-of-the-art methods with either low- or high-level features in terms of the retrieval rate. Thus, it can be a strong candidate for various image retrieval related applications.

Paving the seafloor: Volcanic emplacement processes during the 2005-2006 eruptions at the fast spreading East Pacific Rise, 9°50‧N

NASA Astrophysics Data System (ADS)

Fundis, A. T.; Soule, S. A.; Fornari, D. J.; Perfit, M. R.

2010-08-01

The 2005-2006 eruptions near 9°50'N at the East Pacific Rise (EPR) marked the first observed repeat eruption at a mid-ocean ridge and provided a unique opportunity to deduce the emplacement dynamics of submarine lava flows. Since these new flows were documented in April 2006, a total of 40 deep-towed imaging surveys have been conducted with the Woods Hole Oceanographic Institution's (WHOI) TowCam system. More than 60,000 digital color images and high-resolution bathymetric profiles of the 2005-2006 flows from the TowCam surveys were analyzed for lava flow morphology and for the presence of kipukas, collapse features, faults and fissures. We use these data to quantify the spatial distributions of lava flow surface morphologies and to investigate how they relate to the physical characteristics of the ridge crest, such as seafloor slope, and inferred dynamics of flow emplacement. We conclude that lava effusion rate was the dominant factor controlling the observed morphological variations in the 2005-2006 flows. We also show that effusion rates were higher than in previously studied eruptions at this site and varied systematically along the length of the eruptive fissure. This is the first well-documented study in which variations in seafloor lava morphology can be directly related to a well documented ridge-crest eruption where effusion rate varied significantly.

Key Factors for a High-Quality Peritoneal Dialysis Program — The Role of the PD Team and Continuous Quality Improvement

PubMed Central

Fang, Wei; Ni, Zhaohui; Qian, Jiaqi

2014-01-01

The proportion of end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) has increased very fast in China over the last decade. Renji Hospital, affiliated with Shanghai Jiaotong University School of Medicine, is a recognized high-quality PD unit with a high PD utilization rate, excellent patient and technique survival (1-year and 5-year patient survival rate of 93% and 71%, and 1-year and 5-year technique survival of 96% and 82%, respectively), low peritonitis rate and a well-documented good quality of life of the treated patients. We believe that a dedicated and experienced PD team, a structured patient training program, continuous patient support, establishing and utilizing standardized protocols, starting PD with low dialysis dose, monitoring key performance indicators (KPIs), and continuous quality improvement (CQI) are the key factors underlying this successful PD program. PMID:24962961

Performance interface document for users of Tracking and Data Relay Satellite System (TDRSS) electromechanically steered antenna systems (EMSAS)

NASA Technical Reports Server (NTRS)

Hockensmith, R.; Devine, E.; Digiacomo, M.; Hager, F.; Moss, R.

1983-01-01

Satellites that use the NASA Tracking and Data Relay Satellite System (TDRSS) require antennas that are crucial for performing and achieving reliable TDRSS link performance at the desired data rate. Technical guidelines are presented to assist the prospective TDRSS medium-and high-data rate user in selecting and procuring a viable, steerable high-gain antenna system. Topics addressed include the antenna gain/transmitter power/data rate relationship; Earth power flux-density limitations; electromechanical requirements dictated by the small beam widths, desired angular coverage, and minimal torque disturbance to the spacecraft; weight and moment considerations; mechanical, electrical and thermal interfaces; design lifetime failure modes; and handling and storage. Proven designs are cited and space-qualified assemblies and components are identified.

Can we document if regulation and Best Available Techniques (BAT) have any positive impact on the marine environment? A case based on a steel mill in Greece.

PubMed

Panagiotoulias, I; Botsou, F; Kaberi, H; Karageorgis, A P; Scoullos, M

2017-10-31

In order to document the impact of Best Available Techniques (BAT) and implementation of regulation on the improvement of the coastal marine environment state, we examined the case of a representative steel mill located at the Gulf of Elefsis (Greece). The evaluation of metal pollution was based on the analysis of major and trace elements, organic carbon, magnetic properties, and sediment accumulation rates, in sediment cores obtained from the vicinity of the plant. The analytical data are discussed in relation to steel production, changes of production routes, and adoption of BAT introduced in order to fulfill EU and national legislation. The results show that the input of pollutants to sediments and the degree of contamination were reduced by approximately 40-70% in the decade 2003-2015 in comparison to the periods of high discharges (1963-2002), whereas the toxicity risks from "high-to-extremely high" were reduced to "medium-to-high."

White-tailed deer population dynamics and adult female survival in the presence of a novel predator: Deer Population Dynamics

DOE PAGES

Chitwood, Michael C.; Lashley, Marcus A.; Kilgo, John C.; ...

2015-02-01

Recent localized declines in white-tailed deer ( Odocoileus virginianus) populations in the southeastern United States have been linked to increasing predation pressure from coyotes ( Canis latrans), a novel predator to the region. Studies have documented coyotes as the leading cause of mortality for neonates, and 1 study documented coyotes as a mortality factor for adult females. However, no study has used field-based vital rates to conduct sensitivity analyses or model deer population trajectories under potential harvest or predator removal strategies. We used low, medium, and high values of fawn survival, adult female survival, and fecundity data collected from Fortmore » Bragg Military Installation, North Carolina to demonstrate the current declining population trajectory for deer (λ = 0.905; low λ = 0.788, high λ = 1.003). Consistent with other studies of ungulates, we determined adult female survival was the most sensitive and elastic vital rate. Further, for 3 potential management (“what if”) scenarios, we projected the population for 10 years using estimated vital rates. Reducing adult female harvest (λ = 0.935; low λ = 0.875, high λ = 1.002) and coyote removal (λ = 0.995; low λ = 0.898, high λ = 1.081) reduced the current population decline, whereas combining both approaches (λ = 1.024; low λ = 0.898, high λ = 1.141) resulted in population increases. Our data indicate that for low-density deer populations with heavy predation pressure on neonates, protecting adult females from harvest may not completely offset population declines. Coyote removal might be a necessary strategy because it could possibly increase very low fawn survival, which appears to be the most important vital rate influencing λ in our study. However, managers may have to start with reductions in adult female harvest because coyote removal would have to be continuous and consistently effective, making it an impractical management approach by itself.« less

White-tailed deer population dynamics and adult female survival in the presence of a novel predator: Deer Population Dynamics

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

Chitwood, Michael C.; Lashley, Marcus A.; Kilgo, John C.

Recent localized declines in white-tailed deer ( Odocoileus virginianus) populations in the southeastern United States have been linked to increasing predation pressure from coyotes ( Canis latrans), a novel predator to the region. Studies have documented coyotes as the leading cause of mortality for neonates, and 1 study documented coyotes as a mortality factor for adult females. However, no study has used field-based vital rates to conduct sensitivity analyses or model deer population trajectories under potential harvest or predator removal strategies. We used low, medium, and high values of fawn survival, adult female survival, and fecundity data collected from Fortmore » Bragg Military Installation, North Carolina to demonstrate the current declining population trajectory for deer (λ = 0.905; low λ = 0.788, high λ = 1.003). Consistent with other studies of ungulates, we determined adult female survival was the most sensitive and elastic vital rate. Further, for 3 potential management (“what if”) scenarios, we projected the population for 10 years using estimated vital rates. Reducing adult female harvest (λ = 0.935; low λ = 0.875, high λ = 1.002) and coyote removal (λ = 0.995; low λ = 0.898, high λ = 1.081) reduced the current population decline, whereas combining both approaches (λ = 1.024; low λ = 0.898, high λ = 1.141) resulted in population increases. Our data indicate that for low-density deer populations with heavy predation pressure on neonates, protecting adult females from harvest may not completely offset population declines. Coyote removal might be a necessary strategy because it could possibly increase very low fawn survival, which appears to be the most important vital rate influencing λ in our study. However, managers may have to start with reductions in adult female harvest because coyote removal would have to be continuous and consistently effective, making it an impractical management approach by itself.« less

Achieving Broad Participation in Congregational Health Surveys at African American and Latino Churches

ERIC Educational Resources Information Center

Hawes-Dawson, Jennifer; Derose, Kathryn P.; Aunon, Frances M.; Dominguez, Blanca X.; Felton, Alexandria; Mata, Michael A.; Oden, Clyde W.; Paffen, Sandra

2017-01-01

Congregation-based health program evaluations often rely on surveys, but little documentation is available regarding specific methods and challenges. Here we describe methods used to achieve acceptable response rates (73-79%) in a survey of HIV-related attitudes and behaviors in two African American and three Latino churches in high HIV-prevalence…

Do High Schools Implementing SWPBIS Have Lower Rates of Illegal Drug and Alcohol Use?

ERIC Educational Resources Information Center

Bastable, Eoin; Kittelman, Angus; McIntosh, Kent; Hoselton, Rob

2015-01-01

School-wide positive behavioral interventions and supports (SWPBIS) is a systems-level framework for improving social and academic outcomes for students in schools through the use of integrated evidence-based practices. Although the effects of SWPBIS are well-documented in elementary schools, there is increasing interest in implementing SWPBIS in…

Tobacco, Caffeine, Alcohol and Illicit Substance Use among Consumers of a National Psychiatric Disability Support Service

ERIC Educational Resources Information Center

Zimmermann, Adam; Lubman, Dan I.; Cox, Merrilee

2012-01-01

Previous research has consistently documented high rates of tobacco smoking and substance use disorders among young people with serious mental illness. However, limited studies have been conducted outside traditional clinical settings. In an attempt to address this shortfall and to better understand the needs of young people accessing its…

Improving Systems Providing Education and Training throughout Life. Flexible Access to Technical and Vocational Education throughout Life.

ERIC Educational Resources Information Center

Bartram, John D.

A large majority of the world's people are denied access to learning. The link between technical and vocational education (TVE) and individual and workplace economic productivity is well documented. Many countries are experiencing combinations of increasing populations of young people and high unemployment rates. Existing traditions of training…

Perspectives and Plans for Graduate Studies. 7. Sociology 1973.

ERIC Educational Resources Information Center

Ontario Council on Graduate Studies, Toronto. Advisory Committee on Academic Planning.

This document reports on a formal planning assessment for sociology conducted by the Advisory Committee on Academic Planning of the Ontario Council on Graduate Studies. Data, reports and comments, and recommendations on a plan for graduate work in sociology in the province is set out. Recommendations are: (1) That the high rates of delay and…

Intimate Partner Violence and Miscarriage: Examination of the Role of Physical and Psychological Abuse and Posttraumatic Stress Disorder

ERIC Educational Resources Information Center

Morland, Leslie A.; Leskin, Gregory A.; Block, Carolyn Rebecca; Campbell, Jacquelyn C.; Friedman, Matthew J.

2008-01-01

Despite research documenting high rates of violence during pregnancy, few studies have examined the impact of physical abuse, psychological abuse, and posttraumatic stress disorder (PTSD) on miscarriage. Secondary analysis of data collected by the Chicago Women's Health Risk Study permitted an exploration of the relationships among physical abuse,…

Municipal Overburden: Its Influence on Education Expenditures in Cities.

ERIC Educational Resources Information Center

Brazer, Harvey E.; McCarty, Therese A.

The study reported in this document found no evidence for the minicipal overburden (m/o) hypothesis of urban school finance. The theory asserts that there is a causal relationship between high levels of non-school municipal expenditure or tax rates and low levels of school spending. Demand for expenditure on education in a sample of school…

Identification of Hypertension Management-related Errors in a Personal Digital Assistant-based Clinical Log for Nurses in Advanced Practice Nurse Training.

PubMed

Lee, Nam-Ju; Cho, Eunhee; Bakken, Suzanne

2010-03-01

The purposes of this study were to develop a taxonomy for detection of errors related to hypertension management and to apply the taxonomy to retrospectively analyze the documentation of nurses in Advanced Practice Nurse (APN) training. We developed the Hypertension Diagnosis and Management Error Taxonomy and applied it in a sample of adult patient encounters (N = 15,862) that were documented in a personal digital assistant-based clinical log by registered nurses in APN training. We used Standard Query Language queries to retrieve hypertension-related data from the central database. The data were summarized using descriptive statistics. Blood pressure was documented in 77.5% (n = 12,297) of encounters; 21% had high blood pressure values. Missed diagnosis, incomplete diagnosis and misdiagnosis rates were 63.7%, 6.8% and 7.5% respectively. In terms of treatment, the omission rates were 17.9% for essential medications and 69.9% for essential patient teaching. Contraindicated anti-hypertensive medications were documented in 12% of encounters with co-occurring diagnoses of hypertension and asthma. The Hypertension Diagnosis and Management Error Taxonomy was useful for identifying errors based on documentation in a clinical log. The results provide an initial understanding of the nature of errors associated with hypertension diagnosis and management of nurses in APN training. The information gained from this study can contribute to educational interventions that promote APN competencies in identification and management of hypertension as well as overall patient safety and informatics competencies. Copyright © 2010 Korean Society of Nursing Science. Published by . All rights reserved.

41 CFR 102-117.75 - How do I reference the rate tender on transportation documents?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false How do I reference the... TRANSPORTATION 117-TRANSPORTATION MANAGEMENT Acquiring Transportation or Related Services § 102-117.75 How do I reference the rate tender on transportation documents? To ensure proper reference of a rate tender on all...

3 CFR - Federal Employee Pay Schedules and Rates That Are Set by Administrative Discretion

Code of Federal Regulations, 2014 CFR

2014-01-01

... 3 The President 1 2014-01-01 2014-01-01 false Federal Employee Pay Schedules and Rates That Are Set by Administrative Discretion Presidential Documents Other Presidential Documents Memorandum of April 5, 2013 Federal Employee Pay Schedules and Rates That Are Set by Administrative Discretion Memorandum for the Heads of Executive Departments and...

Tobacco Use among Emergency Department Patients

PubMed Central

Smith, Patricia M.

2011-01-01

This is the first study to systematically track the tobacco use prevalence in an entire emergency department (ED) population and compare age-stratified rates to the general population using national, provincial, and regional comparisons. A tobacco use question was integrated into the ED electronic registration process from 2007 to 2010 in 11 northern hospitals (10 rural, 1 urban). Results showed that tobacco use documentation (85–89%) and tobacco use (26–27%) were consistent across years with the only discrepancy being higher tobacco prevalence in 2007 (32%) due to higher rates at the urban hospital. Age-stratified outcomes showed that tobacco use remained high up to 50 years old (36%); rates began to decrease for patients in their 50’s (26%) and 60’s (16%), and decreased substantially after age 70 (5%). The age-stratified ED tobacco rates were almost double those of the general population nationally and provincially for all but the oldest age groups but were virtually identical to regional rates. The tobacco use tracking and age-stratified general population comparisons in this study improves on previous attempts to document prevalence in the ED population, and at a more local level, provides a “big picture” overview that highlights the magnitude of the tobacco-use problem in these communities. PMID:21318027

Capillary Viscometer for Fully Automated Measurement of the Concentration and Shear Dependence of the Viscosity of Macromolecular Solutions

PubMed Central

Grupi, Asaf; Minton, Allen P.

2014-01-01

The construction and operation of a novel viscometer/rheometer are described. The instrument is designed to measure the viscosity of a macromolecular solution while automatically varying both solute concentration and shear rate. Viscosity is calculated directly from Poiseuille's Law, given the measured difference in pressure between two ends of a capillary tube through which the solution is flowing at a known rate. The instrument requires as little as 0.75 ml of a solution to provide a full profile of viscosity as a function of concentration and shear rate, and can measure viscosities as high as 500 cP and as low as 1 cP, at shear rates between 10 and 2 × 103 s-1. The results of control experiments are presented to document the accuracy and precision of measurement at both low and high concentration of synthetic polymers and proteins. PMID:23130673

Methods for semi-automated indexing for high precision information retrieval

NASA Technical Reports Server (NTRS)

Berrios, Daniel C.; Cucina, Russell J.; Fagan, Lawrence M.

2002-01-01

OBJECTIVE: To evaluate a new system, ISAID (Internet-based Semi-automated Indexing of Documents), and to generate textbook indexes that are more detailed and more useful to readers. DESIGN: Pilot evaluation: simple, nonrandomized trial comparing ISAID with manual indexing methods. Methods evaluation: randomized, cross-over trial comparing three versions of ISAID and usability survey. PARTICIPANTS: Pilot evaluation: two physicians. Methods evaluation: twelve physicians, each of whom used three different versions of the system for a total of 36 indexing sessions. MEASUREMENTS: Total index term tuples generated per document per minute (TPM), with and without adjustment for concordance with other subjects; inter-indexer consistency; ratings of the usability of the ISAID indexing system. RESULTS: Compared with manual methods, ISAID decreased indexing times greatly. Using three versions of ISAID, inter-indexer consistency ranged from 15% to 65% with a mean of 41%, 31%, and 40% for each of three documents. Subjects using the full version of ISAID were faster (average TPM: 5.6) and had higher rates of concordant index generation. There were substantial learning effects, despite our use of a training/run-in phase. Subjects using the full version of ISAID were much faster by the third indexing session (average TPM: 9.1). There was a statistically significant increase in three-subject concordant indexing rate using the full version of ISAID during the second indexing session (p < 0.05). SUMMARY: Users of the ISAID indexing system create complex, precise, and accurate indexing for full-text documents much faster than users of manual methods. Furthermore, the natural language processing methods that ISAID uses to suggest indexes contributes substantially to increased indexing speed and accuracy.

Methods for Semi-automated Indexing for High Precision Information Retrieval

PubMed Central

Berrios, Daniel C.; Cucina, Russell J.; Fagan, Lawrence M.

2002-01-01

Objective. To evaluate a new system, ISAID (Internet-based Semi-automated Indexing of Documents), and to generate textbook indexes that are more detailed and more useful to readers. Design. Pilot evaluation: simple, nonrandomized trial comparing ISAID with manual indexing methods. Methods evaluation: randomized, cross-over trial comparing three versions of ISAID and usability survey. Participants. Pilot evaluation: two physicians. Methods evaluation: twelve physicians, each of whom used three different versions of the system for a total of 36 indexing sessions. Measurements. Total index term tuples generated per document per minute (TPM), with and without adjustment for concordance with other subjects; inter-indexer consistency; ratings of the usability of the ISAID indexing system. Results. Compared with manual methods, ISAID decreased indexing times greatly. Using three versions of ISAID, inter-indexer consistency ranged from 15% to 65% with a mean of 41%, 31%, and 40% for each of three documents. Subjects using the full version of ISAID were faster (average TPM: 5.6) and had higher rates of concordant index generation. There were substantial learning effects, despite our use of a training/run-in phase. Subjects using the full version of ISAID were much faster by the third indexing session (average TPM: 9.1). There was a statistically significant increase in three-subject concordant indexing rate using the full version of ISAID during the second indexing session (p < 0.05). Summary. Users of the ISAID indexing system create complex, precise, and accurate indexing for full-text documents much faster than users of manual methods. Furthermore, the natural language processing methods that ISAID uses to suggest indexes contributes substantially to increased indexing speed and accuracy. PMID:12386114

Response of Late Cretaceous migrating deltaic facies systems to sea level, tectonics, and sediment supply changes, New Jersey Coastal Plain, U.S.A.

USGS Publications Warehouse

Kulpecz, A.A.; Miller, K.G.; Sugarman, P.J.; Browning, J.V.

2008-01-01

Paleogeographic, isopach, and deltaic lithofacies mapping of thirteen depositional sequences establish a 35 myr high resolution (> 1 Myr) record of Late Cretaceous wave- and tide-influenced deltaic sedimentation. We integrate sequences defined on the basis of lithologic, biostratigraphic, and Sr-isotope stratigraphy from cores with geophysical log data from 28 wells to further develop and extend methods and calibrations of well-log recognition of sequences and facies variations. This study reveals the northeastward migration of depocenters from the Cenomanian (ca. 98 Ma) through the earliest Danian (ca. 64 Ma) and documents five primary phases of paleodeltaic evolution in response to long-term eustatic changes, variations in sediment supply, the location of two long-lived fluvial axes, and thermoflexural basement subsidence: (1) Cenomanian-early Turonian deltaic facies exhibit marine and nonmarine facies and are concentrated in the central coastal plain; (2) high sediment rates, low sea level, and high accommodation rates in the northern coastal plain resulted in thick, marginal to nonmarine mixed-influenced deltaic facies during the Turonign-Coniacian; (3) comparatively low sediment rates and high long-term sea level in the Santonian resulted in a sediment-starved margin with low deltaic influence; (4) well-developed Campanian deltaic sequences expand to the north and exhibit wave reworking and longshore transport of sands, and (5) low sedimentation rates and high long-term sea level during the Maastrichtian resulted in the deposition of a sediment-starved glauconitic shelf. Our study illustrates the widely known variability of mixed-influence deltaic systems, but also documents the relative stability of deltaic facies systems on the 106-107 yr scale, with long periods of cyclically repeating systems tracts controlled by eustasy. Results from the Late Cretaceous further show that although eustasy provides the template for sequences globally, regional tectonics (rates of subsidence and accommodation), changes in sediment supply, proximity to sediment input, and flexural subsidence from depocenter loading determines the regional to local preservation and facies expression of sequences. Copyright ?? 2008, SEPM (Society for Sedimentary Geology).

41 CFR 302-7.106 - What documentation is required to receive an advance under the commuted rate method?

Code of Federal Regulations, 2010 CFR

2010-07-01

... STORAGE OF PROPERTY 7-TRANSPORTATION AND TEMPORARY STORAGE OF HOUSEHOLD GOODS AND PROFESSIONAL BOOKS, PAPERS, AND EQUIPMENT (PBP&E) Commuted Rate § 302-7.106 What documentation is required to receive an...

KABAM Version 1.0 User's Guide and Technical Documentation - Appendix H - Methods for Estimating Metabolism Rate Constant

EPA Pesticide Factsheets

Appendix H of KABAM Version 1.0 documentation related to estimating the metabolism rate constant. KABAM is a simulation model used to predict pesticide concentrations in aquatic regions for use in exposure assessments.

The Matthew effect in environmental science publication: a bibliometric analysis of chemical substances in journal articles.

PubMed

Grandjean, Philippe; Eriksen, Mette L; Ellegaard, Ole; Wallin, Johan A

2011-11-10

While environmental research addresses scientific questions of possible societal relevance, it is unclear to what degree research focuses on environmental chemicals in need of documentation for risk assessment purposes. In a bibliometric analysis, we used SciFinder to extract Chemical Abstract Service (CAS) numbers for chemicals addressed by publications in the 78 major environmental science journals during 2000-2009. The Web of Science was used to conduct title searches to determine long-term trends for prominent substances and substances considered in need of research attention. The 119,636 journal articles found had 760,056 CAS number links during 2000-2009. The top-20 environmental chemicals consisted of metals, (chlorinated) biphenyls, polyaromatic hydrocarbons, benzene, and ethanol and contributed 12% toward the total number of links- Each of the top-20 substances was covered by 2,000-10,000 articles during the decade. The numbers for the 10-year period were similar to the total numbers of pre-2000 articles on the same chemicals. However, substances considered a high priority from a regulatory viewpoint, due to lack of documentation, showed very low publication rates. The persistence in the scientific literature of the top-20 chemicals was only weakly related to their publication in journals with a high impact factor, but some substances achieved high citation rates. The persistence of some environmental chemicals in the scientific literature may be due to a 'Matthew' principle of maintaining prominence for the very reason of having been well researched. Such bias detracts from the societal needs for documentation on less well known environmental hazards, and it may also impact negatively on the potentials for innovation and discovery in research.

The Matthew effect in environmental science publication: A bibliometric analysis of chemical substances in journal articles

PubMed Central

2011-01-01

Background While environmental research addresses scientific questions of possible societal relevance, it is unclear to what degree research focuses on environmental chemicals in need of documentation for risk assessment purposes. Methods In a bibliometric analysis, we used SciFinder to extract Chemical Abstract Service (CAS) numbers for chemicals addressed by publications in the 78 major environmental science journals during 2000-2009. The Web of Science was used to conduct title searches to determine long-term trends for prominent substances and substances considered in need of research attention. Results The 119,636 journal articles found had 760,056 CAS number links during 2000-2009. The top-20 environmental chemicals consisted of metals, (chlorinated) biphenyls, polyaromatic hydrocarbons, benzene, and ethanol and contributed 12% toward the total number of links- Each of the top-20 substances was covered by 2,000-10,000 articles during the decade. The numbers for the 10-year period were similar to the total numbers of pre-2000 articles on the same chemicals. However, substances considered a high priority from a regulatory viewpoint, due to lack of documentation, showed very low publication rates. The persistence in the scientific literature of the top-20 chemicals was only weakly related to their publication in journals with a high impact factor, but some substances achieved high citation rates. Conclusions The persistence of some environmental chemicals in the scientific literature may be due to a 'Matthew' principle of maintaining prominence for the very reason of having been well researched. Such bias detracts from the societal needs for documentation on less well known environmental hazards, and it may also impact negatively on the potentials for innovation and discovery in research. PMID:22074398

Colony Failure Linked to Low Sperm Viability in Honey Bee (Apis mellifera) Queens and an Exploration of Potential Causative Factors

PubMed Central

Pettis, Jeffery S.; Rice, Nathan; Joselow, Katie; vanEngelsdorp, Dennis; Chaimanee, Veeranan

2016-01-01

Queen health is closely linked to colony performance in honey bees as a single queen is normally responsible for all egg laying and brood production within the colony. In the U. S. in recent years, queens have been failing at a high rate; with 50% or greater of queens replaced in colonies within 6 months when historically a queen might live one to two years. This high rate of queen failure coincides with the high mortality rates of colonies in the US, some years with >50% of colonies dying. In the current study, surveys of sperm viability in US queens were made to determine if sperm viability plays a role in queen or colony failure. Wide variation was observed in sperm viability from four sets of queens removed from colonies that beekeepers rated as in good health (n = 12; average viability = 92%), were replacing as part of normal management (n = 28; 57%), or where rated as failing (n = 18 and 19; 54% and 55%). Two additional paired set of queens showed a statistically significant difference in viability between colonies rated by the beekeeper as failing or in good health from the same apiaries. Queens removed from colonies rated in good health averaged high viability (ca. 85%) while those rated as failing or in poor health had significantly lower viability (ca. 50%). Thus low sperm viability was indicative of, or linked to, colony performance. To explore the source of low sperm viability, six commercial queen breeders were surveyed and wide variation in viability (range 60–90%) was documented between breeders. This variability could originate from the drones the queens mate with or temperature extremes that queens are exposed to during shipment. The role of shipping temperature as a possible explanation for low sperm viability was explored. We documented that during shipment queens are exposed to temperature spikes (<8 and > 40°C) and these spikes can kill 50% or more of the sperm stored in queen spermathecae in live queens. Clearly low sperm viability is linked to colony performance and laboratory and field data provide evidence that temperature extremes are a potential causative factor. PMID:26863438

Endemism in the moss flora of North America.

PubMed

Carter, Benjamin E; Shaw, Blanka; Shaw, A Jonathan

2016-04-01

Identifying regions of high endemism is a critical step toward understanding the mechanisms underlying diversification and establishing conservation priorities. Here, we identified regions of high moss endemism across North America. We also identified lineages that contribute disproportionately to endemism and document the progress of efforts to inventory the endemic flora. To understand the documentation of endemic moss diversity in North America, we tabulated species publication dates to document the progress of species discovery across the continent. We analyzed herbarium specimen data and distribution data from the Flora of North America project to delineate major regions of moss endemism. Finally, we surveyed the literature to assess the importance of intercontinental vs. within-continent diversification for generating endemic species. Three primary regions of endemism were identified and two of these were further divided into a total of nine subregions. Overall endemic richness has two peaks, one in northern California and the Pacific Northwest, and the other in the southern Appalachians. Description of new endemic species has risen steeply over the last few decades, especially in western North America. Among the few studies documenting sister species relationships of endemics, recent diversification appears to have played a larger role in western North America, than in the east. Our understanding of bryophyte endemism continues to grow rapidly. Large continent-wide data sets confirm early views on hotspots of endemic bryophyte richness and indicate a high rate of ongoing species discovery in North America. © 2016 Botanical Society of America.

Quality and correlates of medical record documentation in the ambulatory care setting

PubMed Central

Soto, Carlos M; Kleinman, Kenneth P; Simon, Steven R

2002-01-01

Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Methods We reviewed electronic medical records from 834 patients receiving care from 167 physicians (117 internists and 50 pediatricians) at 14 sites of a multi-specialty medical group in Massachusetts. We abstracted information for five measures of medical record documentation quality: smoking history, medications, drug allergies, compliance with screening guidelines, and immunizations. From other sources we determined physicians' specialty, gender, year of medical school graduation, and self-reported time spent teaching and in patient care. Results Among internists, unadjusted rates of documentation were 96.2% for immunizations, 91.6% for medications, 88% for compliance with screening guidelines, 61.6% for drug allergies, 37.8% for smoking history. Among pediatricians, rates were 100% for immunizations, 84.8% for medications, 90.8% for compliance with screening guidelines, 50.4% for drug allergies, and 20.4% for smoking history. While certain physician and patient characteristics correlated with some measures of documentation quality, documentation varied depending on the measure. For example, female internists were more likely than male internists to document smoking history (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.27 – 2.83) but were less likely to document drug allergies (OR, 0.51; 95% CI, 0.35 – 0.75). Conclusions Medical record documentation varied depending on the measure, with room for improvement in most domains. A variety of characteristics correlated with medical record documentation, but no pattern emerged. Further study could lead to targeted interventions to improve documentation. PMID:12473161

Application of process improvement principles to increase the frequency of complete airway management documentation.

PubMed

McCarty, L Kelsey; Saddawi-Konefka, Daniel; Gargan, Lauren M; Driscoll, William D; Walsh, John L; Peterfreund, Robert A

2014-12-01

Process improvement in healthcare delivery settings can be difficult, even when there is consensus among clinicians about a clinical practice or desired outcome. Airway management is a medical intervention fundamental to the delivery of anesthesia care. Like other medical interventions, a detailed description of the management methods should be documented. Despite this expectation, airway documentation is often insufficient. The authors hypothesized that formal adoption of process improvement methods could be used to increase the rate of "complete" airway management documentation. The authors defined a set of criteria as a local practice standard of "complete" airway management documentation. The authors then employed selected process improvement methodologies over 13 months in three iterative and escalating phases to increase the percentage of records with complete documentation. The criteria were applied retrospectively to determine the baseline frequency of complete records, and prospectively to measure the impact of process improvements efforts over the three phases of implementation. Immediately before the initial intervention, a retrospective review of 23,011 general anesthesia cases over 6 months showed that 13.2% of patient records included complete documentation. At the conclusion of the 13-month improvement effort, documentation improved to a completion rate of 91.6% (P<0.0001). During the subsequent 21 months, the completion rate was sustained at an average of 90.7% (SD, 0.9%) across 82,571 general anesthetic records. Systematic application of process improvement methodologies can improve airway documentation and may be similarly effective in improving other areas of anesthesia clinical practice.

Underreporting of Concussions and Concussion-Like Symptoms in Female High School Athletes.

PubMed

McDonald, Tracy; Burghart, Mark A; Nazir, Niaman

2016-01-01

Underreporting of concussions and concussion-like symptoms in athletes continues to be a serious medical concern and research focus. Despite mounting worry, little evidence exists examining incidence of underreporting and documenting characteristics of head injury in female athletes participating in high school sports. This study examined the self-reporting behaviors of female high school athletes. Seventy-seven athletes participated, representing 14 high school sports. Nearly half of the athletes (31 participants) reported a suspected concussion, with 10 of the 31 athletes refraining from reporting symptoms to training staff after injury. Only 66% reported receiving concussion education. Concussion education appeared to have no relationship with diagnosed concussion rates in athletes, removing athletes from play, or follow-up medical care after injury. In conclusion, female high school athletes underreport signs and symptoms of concussions. Concussion education should occur at higher rates among female athletes to influence reporting behaviors.

[Consensus document for the detection and management of chronic kidney disease].

PubMed

Martínez-Castelao, Alberto; Górriz, José L; Bover, Jordi; Segura-de la Morena, Julián; Cebollada, Jesús; Escalada, Javier; Esmatjes, Enric; Fácila, Lorenzo; Gamarra, Javier; Gràcia, Silvia; Hernández-Moreno, Julio; Llisterri-Caro, José L; Mazón, Pilar; Montañés, Rosario; Morales-Olivas, Francisco; Muñoz-Torres, Manuel; de Pablos-Velasco, Pedro; de Santiago, Ana; Sánchez-Celaya, Marta; Suárez, Carmen; Tranche, Salvador

2014-11-01

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

[Consensus document for the detection and management of chronic kidney disease].

PubMed

Martínez-Castelao, Alberto; Górriz, José L; Bover, Jordi; Segura-de la Morena, Julián; Cebollada, Jesús; Escalada, Javier; Esmatjes, Enric; Fácila, Lorenzo; Gamarra, Javier; Gràcia, Silvia; Hernández-Moreno, Julio; Llisterri-Caro, José L; Mazón, Pilar; Montañés, Rosario; Morales-Olivas, Francisco; Muñoz-Torres, Manuel; de Pablos-Velasco, Pedro; de Santiago, Ana; Sánchez-Celaya, Marta; Suárez, Carmen; Tranche, Salvador

2014-11-01

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations. Copyright © 2014. Published by Elsevier Espana.

SCPS-TP, TCP, and Rate-Based Protocol Evaluation. Revised

NASA Technical Reports Server (NTRS)

Tran, Diepchi T.; Lawas-Grodek, Frances J.; Dimond, Robert P.; Ivancic, William D.

2005-01-01

Tests were performed at Glenn Research Center to compare the performance of the Space Communications Protocol Standard Transport Protocol (SCPS TP, otherwise known as "TCP Tranquility") relative to other variants of TCP and to determine the implementation maturity level of these protocols, particularly for higher speeds. The testing was performed over reasonably high data rates of up to 100 Mbps with delays that are characteristic of near-planetary environments. The tests were run for a fixed packet size, but for variously errored environments. This report documents the testing performed to date.

Declining Mortality Inequality within Cities during the Health Transition.

PubMed

Costa, Dora L; Kahn, Matthew E

2015-05-01

In the United States in the late 19th and early 20th century, large cities had extremely high death rates from infectious disease. Within major cities such as New York City and Philadelphia, there was significant variation at any point in time in the mortality rate across neighborhoods. Between 1900 and 1930 neighborhood mortality convergence took place in New York City and Philadelphia. We document these trends and discuss their consequences for neighborhood quality of life dynamics and the economic incidence of who gains from effective public health interventions.

Identification and thermochemical analysis of high-lignin feedstocks for biofuel and biochemical production

PubMed Central

2011-01-01

Background Lignin is a highly abundant biopolymer synthesized by plants as a complex component of plant secondary cell walls. Efforts to utilize lignin-based bioproducts are needed. Results Herein we identify and characterize the composition and pyrolytic deconstruction characteristics of high-lignin feedstocks. Feedstocks displaying the highest levels of lignin were identified as drupe endocarp biomass arising as agricultural waste from horticultural crops. By performing pyrolysis coupled to gas chromatography-mass spectrometry, we characterized lignin-derived deconstruction products from endocarp biomass and compared these with switchgrass. By comparing individual pyrolytic products, we document higher amounts of acetic acid, 1-hydroxy-2-propanone, acetone and furfural in switchgrass compared to endocarp tissue, which is consistent with high holocellulose relative to lignin. By contrast, greater yields of lignin-based pyrolytic products such as phenol, 2-methoxyphenol, 2-methylphenol, 2-methoxy-4-methylphenol and 4-ethyl-2-methoxyphenol arising from drupe endocarp tissue are documented. Conclusions Differences in product yield, thermal decomposition rates and molecular species distribution among the feedstocks illustrate the potential of high-lignin endocarp feedstocks to generate valuable chemicals by thermochemical deconstruction. PMID:22018114

Correlation of patient entry rates and physician documentation errors in dictated and handwritten emergency treatment records.

PubMed

Dawdy, M R; Munter, D W; Gilmore, R A

1997-03-01

This study was designed to examine the relationship between patient entry rates (a measure of physician work load) and documentation errors/omissions in both handwritten and dictated emergency treatment records. The study was carried out in two phases. Phase I examined handwritten records and Phase II examined dictated and transcribed records. A total of 838 charts for three common chief complaints (chest pain, abdominal pain, asthma/chronic obstructive pulmonary disease) were retrospectively reviewed and scored for the presence or absence of 11 predetermined criteria. Patient entry rates were determined by reviewing the emergency department patient registration logs. The data were analyzed using simple correlation and linear regression analysis. A positive correlation was found between patient entry rates and documentation errors in handwritten charts. No such correlation was found in the dictated charts. We conclude that work load may negatively affect documentation accuracy when charts are handwritten. However, the use of dictation services may minimize or eliminate this effect.

Are Charter Schools Making a Difference? A Study of Student Outcomes in Eight States. Research Brief

ERIC Educational Resources Information Center

Li, Jennifer

2009-01-01

Charter schools do not generally draw the top students from other public schools. Their test-score gains are similar to those of traditional public schools, but they have higher rates of students graduating high school and attending college. [This research brief describes work done for RAND Education documented in Charter Schools in Eight States:…

Alabama: Taking Stock and Pushing Forward. 2014 State Progress Report on the Challenge to Lead 2020, Goals for Education

ERIC Educational Resources Information Center

Southern Regional Education Board (SREB), 2014

2014-01-01

"Taking Stock and Pushing Forward" (2014) reports states' progress toward the Challenge to Lead 2020 Goals for Education. State-specific documents report on student achievement as well as essential state policies to improve it. Among the many metrics: how states are improving achievement on NAEP, high school graduation rates, and access…

Virginia: Taking Stock and Pushing Forward. 2014 State Progress Report on the Challenge to Lead 2020, Goals for Education

ERIC Educational Resources Information Center

Southern Regional Education Board (SREB), 2014

2014-01-01

"Taking Stock and Pushing Forward" (2014) reports states' progress toward the Challenge to Lead 2020 Goals for Education. State-specific documents report on student achievement as well as essential state policies to improve it. Among the many metrics: how states are improving achievement on NAEP, high school graduation rates, and access…

Florida: Taking Stock and Pushing Forward. 2014 State Progress Report on the Challenge to Lead 2020, Goals for Education

ERIC Educational Resources Information Center

Southern Regional Education Board (SREB), 2014

2014-01-01

"Taking Stock and Pushing Forward" (2014) reports states' progress toward the Challenge to Lead 2020 Goals for Education. State-specific documents report on student achievement as well as essential state policies to improve it. Among the many metrics: how states are improving achievement on NAEP, high school graduation rates, and access…

Physical activity among Hispanic/Latino and non-Hispanic/Latino white visitors to urban-proximate public lands

Treesearch

Sonia A. Wilhelm Stanis; Ingrid E. Schneider; Kimberly J. Shinew; Deborah J. Chavez; Mary C. Vogel

2008-01-01

Health benefits of physical activity are well recognized and documented, yet obesity rates remain high in the United States, particularly among Hispanics/Latinos. As our population becomes more urban and ethnically diverse, a greater understanding of specific populations may help agencies better address issues related to obesity and sedentary lifestyles. This study...

Changes in the regional abundance of hemlock associated with the invasion of hemlock woolly adelgid (Adelges tsugae Annand)

Treesearch

R. Talbot Trotter; Randall S. Morin; Sonja N. Oswalt; Andrew. Liebhold

2013-01-01

Since its introduction, the non-native hemlock woolly adelgid (Adelges tsugae) has spread to infest hemlock (Tsuga spp.) in at least 18 states in the eastern USA. Previous studies have documented highly variable rates of hemlock mortality among infested stands making it difficult to estimate regional impacts. Here data from the US...

"Saving Sex for Later": Developing a Parent-Child Communication Intervention to Delay Sexual Initiation among Young Adolescents

ERIC Educational Resources Information Center

O'Donnell, Lydia; Wilson-Simmons, Renee; Dash, Kim; Jeanbaptiste, Varzi; Myint-U, Athi; Moss, Jesse; Stueve, Ann

2007-01-01

Young adolescents in communities with high rates of early sexual initiation are at risk of multiple negative health outcomes. Although sex education programs for this age group are often controversial, surveys document that many mothers and fathers would appreciate guidance about how to discuss sexuality with their children. This paper presents an…

Using Web-Based Guided Reflection with Video to Enhance High Fidelity Undergraduate Nursing Clinical Skills Education

ERIC Educational Resources Information Center

Shortridge, Ann; McPherson, Maggie; Loving, Gary

2014-01-01

The United States is currently facing a crisis in health care and health professions education. Various studies (Committee on Quality of Health Care in America 2000; 2001; General Accounting Office, 2001) have documented astonishing death rates from medical errors as well as nursing and physician shortages. Thus it is obvious that the traditional…

Change in Parent- and Child-Reported Internalizing and Externalizing Behaviors among Substance Abusing Runaways: The Effects of Family and Individual Treatments

ERIC Educational Resources Information Center

Slesnick, Natasha; Guo, Xiamei; Feng, Xin

2013-01-01

Shelter-recruited adolescents are known to have high rates of substance abuse and co-occurring internalizing and externalizing problem behaviors. Many studies have documented these mental health concerns, but only a small number of studies have tested interventions that may be useful for ameliorating these vulnerabilities. The current study…

Effects of Prior Knowledge and Concept-Map Structure on Disorientation, Cognitive Load, and Learning

ERIC Educational Resources Information Center

Amadieu, Franck; van Gog, Tamara; Paas, Fred; Tricot, Andre; Marine, Claudette

2009-01-01

This study explored the effects of prior knowledge (high vs. low; HPK and LPK) and concept-map structure (hierarchical vs. network; HS and NS) on disorientation, cognitive load, and learning from non-linear documents on "the infection process of a retrograde virus (HIV)". Participants in the study were 24 adults. Overall subjective ratings of…

MIT Orbital Transfer Vehicle (MOTV): CASTOR Satellite: Design Document

DTIC Science & Technology

2010-11-18

65 Table 2.2-3: MEMS IMU RATE Sensor ...................................................................................... 66 Table 2.2...either high power mode, providing about 4 mN of thrust, or in off mode, in which the cathode will remain heated . The propulsion system will also...subsections: ICD Block Diagram, Heat Transfer Method, Thermal Path, Heat Loads and Fluxes, and Modeling. The ICD Block Diagram identifies the connections

Conceptualising Food Research in Higher Education as a Matter of Social Justice: Philosophical, Methodological and Ethical Considerations

ERIC Educational Resources Information Center

Dominguez-Whitehead, Yasmine

2017-01-01

Globally, food concerns in higher education have emerged as an issue of critical importance. Food acquisition struggles and high rates of food insecurity among students have been documented, yet food within higher education continues to be an under-researched area of study. This paper calls for advancing research that critically engages with food…

Working in High School and Adaptation in the Transition to Young Adulthood among African American Youth

ERIC Educational Resources Information Center

Bauermeister, Jose A.; Zimmerman, Marc A.; Barnett, Tracey E.; Caldwell, Cleopatra Howard

2007-01-01

Researchers have found mixed support for documenting whether work is protective or harmful during adolescence. This study examined the association between work and problem behaviors among African American youth (N = 592; 53% female; M = 14.8 years, SD = 0.60) followed from mid-adolescence to young adulthood over eight Waves (90% response rate over…

HIV counselling and testing practices for children seen in an urban emergency department of a tertiary referral hospital in Dar es Salaam, Tanzania: a retrospective cross-sectional study.

PubMed

Sawe, Hendry R; Mfinanga, Juma A; Ringo, Faith H; Mwafongo, Victor; Reynolds, Teri A; Runyon, Michael S

2016-02-15

To describe the HIV counselling and testing practices for children presenting to an emergency department (ED) in a low-income country. The ED of a large east African national referral hospital. This retrospective review of all paediatric (<18 years old) ED visits in 2012 enrolled patients who had an HIV test ordered and excluded those without testing. Files were available for 5540/5774 (96%) eligible patients and 1632 (30%) were tested for HIV, median age 1.3 years (IQR 9 months to 4 years), 58% <18 months old and 61% male. The primary outcome measure was documentation of pretest and post-test counselling, or deferral of counselling, for children tested for HIV in the ED. Secondary measures included the overall rate of HIV testing, rate of counselling documented in the inpatient record when deferred in the ED, rate of counselling documented when testing was initiated by the inpatient service, rate of counselling documented by test result (positive vs negative) and the rate of referral to follow-up HIV care among patients testing positive. Of 418 patients tested in the ED, counselling, or deferral of counselling, was documented for 70 (17%). When deferred to the ward, subsequent counselling was documented for 15/42 (36%). Counselling was documented in 33% of patients testing positive versus 1.1% patients testing negative (OR 43 (95% CI 23 to 83). Of 199 patients who tested positive and survived to hospital discharge, 76 (38%) were referred for follow-up at the HIV clinic on discharge. Physicians documented the provision, or deferral, of counselling for <20% of children tested for HIV in the ED. Counselling was much more likely to be documented when the test result was positive. Less than 40% of those testing positive were referred for follow-up care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Learning Supervised Topic Models for Classification and Regression from Crowds.

PubMed

Rodrigues, Filipe; Lourenco, Mariana; Ribeiro, Bernardete; Pereira, Francisco C

2017-12-01

The growing need to analyze large collections of documents has led to great developments in topic modeling. Since documents are frequently associated with other related variables, such as labels or ratings, much interest has been placed on supervised topic models. However, the nature of most annotation tasks, prone to ambiguity and noise, often with high volumes of documents, deem learning under a single-annotator assumption unrealistic or unpractical for most real-world applications. In this article, we propose two supervised topic models, one for classification and another for regression problems, which account for the heterogeneity and biases among different annotators that are encountered in practice when learning from crowds. We develop an efficient stochastic variational inference algorithm that is able to scale to very large datasets, and we empirically demonstrate the advantages of the proposed model over state-of-the-art approaches.

Research on B Cell Algorithm for Learning to Rank Method Based on Parallel Strategy.

PubMed

Tian, Yuling; Zhang, Hongxian

2016-01-01

For the purposes of information retrieval, users must find highly relevant documents from within a system (and often a quite large one comprised of many individual documents) based on input query. Ranking the documents according to their relevance within the system to meet user needs is a challenging endeavor, and a hot research topic-there already exist several rank-learning methods based on machine learning techniques which can generate ranking functions automatically. This paper proposes a parallel B cell algorithm, RankBCA, for rank learning which utilizes a clonal selection mechanism based on biological immunity. The novel algorithm is compared with traditional rank-learning algorithms through experimentation and shown to outperform the others in respect to accuracy, learning time, and convergence rate; taken together, the experimental results show that the proposed algorithm indeed effectively and rapidly identifies optimal ranking functions.

Research on B Cell Algorithm for Learning to Rank Method Based on Parallel Strategy

PubMed Central

Tian, Yuling; Zhang, Hongxian

2016-01-01

For the purposes of information retrieval, users must find highly relevant documents from within a system (and often a quite large one comprised of many individual documents) based on input query. Ranking the documents according to their relevance within the system to meet user needs is a challenging endeavor, and a hot research topic–there already exist several rank-learning methods based on machine learning techniques which can generate ranking functions automatically. This paper proposes a parallel B cell algorithm, RankBCA, for rank learning which utilizes a clonal selection mechanism based on biological immunity. The novel algorithm is compared with traditional rank-learning algorithms through experimentation and shown to outperform the others in respect to accuracy, learning time, and convergence rate; taken together, the experimental results show that the proposed algorithm indeed effectively and rapidly identifies optimal ranking functions. PMID:27487242

Adapting the Caesium-137 technique to document soil redistribution rates associated with traditional cultivation practices in Haiti.

PubMed

Velasco, H; Astorga, R Torres; Joseph, D; Antoine, J S; Mabit, L; Toloza, A; Dercon, G; Walling, Des E

2018-03-01

Large-scale deforestation, intensive land use and unfavourable rainfall conditions are responsible for significant continuous degradation of the Haitian uplands. To develop soil conservation strategies, simple and cost-effective methods are needed to assess rates of soil loss from farmland in Haiti. The fallout radionuclide caesium-137 ( 137 Cs) provides one such means of documenting medium-term soil redistribution rates. In this contribution, the authors report the first use in Haiti of 137 Cs measurements to document soil redistribution rates and the associated pattern of erosion/sedimentation rates along typical hillslopes within a traditional upland Haitian farming area. The local 137 Cs reference inventory, measured at an adjacent undisturbed flat area, was 670 Bq m -2 (SD = 100 Bq m -2 , CV = 15%, n = 7). Within the study area, where cultivation commenced in 1992 after deforestation, three representative downslope transects were sampled. These were characterized by 137 Cs inventories ranging from 190 to 2200 Bq m -2 . Although, the study area was cultivated by the local farmers, the 137 Cs depth distributions obtained from the area differed markedly from those expected from a cultivated area. They showed little evidence of tillage mixing within the upper part of the soil or, more particularly, of the near-uniform activities normally associated with the plough layer or cultivation horizon. They were very similar to that found at the reference site and were characterized by high 137 Cs activities at the surface and much lower activities at greater depths. This situation is thought to reflect the traditional manual tillage practices which cause limited disturbance and mixing of the upper part of the soil. It precluded the use of the conversion models normally used to estimate soil redistribution rates from 137 Cs measurements on cultivated soils and the Diffusion and Migration conversion model frequently used for uncultivated soils was modified for application to the cultivated soils of the study area, in order to take account of the unusual local conditions. The model was also modified to take account of the fact that cultivation in the study area commenced in 1992, rather than predating the period of weapons test fallout which extended from the mid 1950s to the 1970s. Erosion rates on the upper parts of the hillside involved in the study were found to be relatively high and ca. -23 t ha -1 y -1 with low spatial variability. In the lower, flatter areas at the bottom of the slope, deposition occurred. Deposition rates were characterized by high spatial variability, ranging from 6.0 to 71 t ha -1 y -1 . Soil redistribution rates of this magnitude are a cause for concern and there is an urgent need to implement soil conservation measures to ensure the longer-term sustainability of the local agricultural practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

Suboptimal identification of patient-specific risk factors for poor wound healing can be improved by simple interventions.

PubMed

Harris, Lauren S; Luck, Joshua E; Atherton, Rachel R

2017-02-01

Poor wound healing is an important surgical complication. At-risk wounds must be identified early and monitored appropriately. Wound surveillance is frequently inadequate, leading to increased rates of surgical site infections (SSIs). Although the literature demonstrates that risk factor identification reduces SSI rates, no studies have focused on wound management at a junior level. Our study assesses documentation rates of patient-specific risk factors for poor wound healing at a large district general hospital in the UK. It critically evaluates the efficacy of interventions designed to promote surveillance of high-risk wounds. We conducted a full-cycle clinical audit examining medical records of patients undergoing elective surgery over 5 days. Interventions included education of the multidisciplinary team and addition of a Wound Healing Risk Assessment (WHRA) checklist to surgical admissions booklets. This checklist provided a simple stratification tool for at-risk wounds and recommendations for escalation. Prior to interventions, the documentation of patient-specific risk factors ranged from 0·0% to 91·7% (mean 42·6%). Following interventions, this increased to 86·4-95·5% (mean 92·5%), a statistically significant increase of 117·1% (P < 0·01). This study demonstrates that documentation of patient-specific risk factors for poor wound healing is inadequate. We have shown the benefit of introducing interventions to increase risk factor awareness. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Melting mountains of Appalachia: exceptionally high weathering rates in mined watersheds

NASA Astrophysics Data System (ADS)

Ross, M. R.; Nippgen, F.; Hassett, B.; McGlynn, B. L.; Bernhardt, E. S.

2016-12-01

Mountaintop mining operations excavate ridges as deep as 200 m and bury adjacent valleys and streams beneath fractured bedrock and coal residues. Post-mining, landscapes have lower slopes, greatly increased water storage potential, and an abundance of acid-generating pyrite, which is intentionally mixed with neutralizing calcareous bedrock. Together these design features of mountaintop mined lands create ideal conditions for long water residence times and rapid weathering rates, leading to widely documented and substantial increases in streamwater ion concentrations. To date, these concentration changes have not been linked to rates of watershed scale element flux. In a paired catchment study, we documented a 4,000% increase in the export of total dissolved solids from a mined watershed, and estimate that pyrite and carbonate weathering in reclaimed mines can export 9,000 kg ha-1 y-1 of dissolved rock to receiving streams. Such high rates of element flux after a disturbance are not only much higher than other watershed disturbances, but are among the highest rates of weathering ever reported globally. Sulfuric acid weathering of carbonate rock drives these patterns of chemical erosion. This strong acid weathering changes Appalachian geology from a slight net geologic CO2 sink-sequestering 800-1,500 kg CO2 km-2 yr-1 through carbonic acid weathering of carbonates-to a substantial net geologic source of CO2, releasing 170,000 kg CO2 km-2 yr-1. Over the more than 4,000 km2 area of Central Appalachia that has undergone mountaintop mining, this rapid weathering represents 4 million tons of dissolved rock being delivered to the streams of West Virginia, potentially releasing 680,000 tons of CO2 in the process.

Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey.

PubMed

Linzer, Mark; Poplau, Sara; Babbott, Stewart; Collins, Tracie; Guzman-Corrales, Laura; Menk, Jeremiah; Murphy, Mary Lou; Ovington, Kay

2016-09-01

General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable. We aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout. We conducted an email survey. Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated. A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses. Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10-56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders' values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p < 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %, p < 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both p < 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education. While GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.

Upcoming Paralympic summer games in Rio: what did the German medical team learn from the London Games?

PubMed

Kubosch, Eva J; Kosel, Jürgen; Steffen, Kathrin; Konstantinidis, Lukas; Kubosch, David; Südkamp, Norbert P; Hirschmüller, Anja

2017-11-01

Musculoskeletal complaints are frequently diagnosed in Paralympic athletes. Despite the increased professionalism in Paralympic Sports, the documentation of injuries and other health complaints during high-level competition is sparse. With respect to the upcoming Paralympic Summer Games in Rio de Janeiro, the aim of this study was the analysis of all musculoskeletal complaints within the German Paralympic Athletes during the London 2012 Paralympic Games. All musculoskeletal complaints (MSC) of the 150 German athletes seeking medical attention, hereby defined as "injury", were recorded during the in-competition period of the London Paralympics Games (22 days), regardless of their severity and consequences. Standardized documentation included the onset of symptoms, the medical diagnoses, the therapeutic measures taken as well as consecutive restrictions in training and competition. Incidence rates and localizations were analyzed by sports discipline. A total of 201 musculoskeletal complaints were recorded for 140 athletes (93.3%), corresponding to 1.4 musculoskeletal complaints per "injured" athlete. The incidence of musculoskeletal complaints in German athletes was 62.9±15.4/1000 athlete-days. High incidence rates (IR) were observed in wheelchair basketball (IR 72/1000 athlete-days, 1.6 injuries per athlete) and equestrian events (IR 72.7, 1.6). Musculoskeletal complaints were mainly located in the upper extremities (37.6%) and the spine (37.6%). The most frequent diagnoses were myalgia (N.=105, 52%). We noted a high rate of musculoskeletal complaints among German Paralympic athletes across sports and body parts, highlighting the need for prevention programs that focus on the upper extremities and spine.

Technical basis for implementation of remote reading capabilities for radiological control instruments at tank farms

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

PIERSON, R.M.

1999-10-27

This document provides the technical basis for use of remote reading capabilities with radiological control instruments at River Protection Project facilities. The purpose of this document is to evaluate applications of remote reading capabilities with Radiological Control instrumentation to allow continuous monitoring of radiation dose rates at River Protection Project (RPP) facilities. In addition this document provides a technical basis and implementing guidelines for remote monitoring of dose rates and their potential contribution to maintaining radiation exposures ALARA.

Sensitivities of Soap Solutions in Leak Detection

NASA Technical Reports Server (NTRS)

Stuck, D.; Lam, D. Q.; Daniels, C.

1985-01-01

Document describes method for determining minimum leak rate to which soap-solution leak detectors sensitive. Bubbles formed at smaller leak rates than previously assumed. In addition to presenting test results, document discusses effects of joint-flange configurations, properties of soap solutions, and correlation of test results with earlier data.

Aerial Photography as a Tool to Document Coastal Change Along Eroding Shorelines in Northern Alaska

NASA Astrophysics Data System (ADS)

Gibbs, A.; Richmond, B. M.; Nolan, M.

2014-12-01

Chronic and widespread coastal erosion along the northern coast of Alaska is threatening traditional lifestyles, sensitive ecosystems, energy and defense related infrastructure, and large tracts of Native Alaskan, State, and Federally managed land. Recent USGS historical shoreline position studies have documented shoreline change rates along most of northern Alaska for the period from 1947 to circa 2000. Rates vary from an erosional high of -18.6 m/yr along vulnerable bluffed coasts, to accretion up to +10.9 m/yr along prograding sand-rich coasts (average rate for entire study area is -1.4 m/yr). The historical analysis gives valuable information regarding long-term rates of change but does not provide details on the timing and processes driving the change. Oblique and vertical aerial photography contains valuable coastal information on such things as bluff failure mechanisms, presence or absence of shorefast ice, beach characteristics including erosional scarps and ice-push ridges, wrack lines produced during storm surge events, and habitat identification. Recent advances in digital photogrammetry applied to oblique aerial photography can be used to construct high quality DEMs at a relatively low cost. Repeat aerial surveys and resultant DEM construction serve as a potential monitoring tool that can be used to quantify volumetric change, and, if conducted frequently enough, provide insights into the mechanisms responsible for coastal change in the Arctic. We provide examples from a few selected sites in northern Alaska where oblique aerial photography has been used to better understand coastal change in remote and threatened areas.

A comparison of approaches for estimating relative impacts of nonnative fishes

USGS Publications Warehouse

Lapointe, N.W.R.; Pendleton, R. M.; Angermeier, Paul

2012-01-01

Lack of standard methods for quantifying impact has hindered risk assessments of high-impact invaders. To understand methodological strengths and weaknesses, we compared five approaches (in parentheses) for quantifying impact of nonnative fishes: reviewing documented impacts in a large-scale database (review); surveying fish biologists regarding three categories of impact (socioeconomic, ecological, abundance); and estimating frequency of occurrence from existing collection records (collection). In addition, we compared game and nongame biologists’ ratings of game and nongame species. Although mean species ratings were generally correlated among approaches, we documented important discrepancies. The review approach required little effort but often inaccurately estimated impact in our study region (Mid-Atlantic United States). Game fishes received lower ratings from the socioeconomic approach, which yielded the greatest consistency among respondents. The ecological approach exhibited lower respondent bias but was sensitive to pre-existing perceptions of high-impact invaders. The abundance approach provided the least-biased assessment of region-specific impact but did not account for differences in per-capita effects among species. The collection approach required the most effort and did not provide reliable estimates of impact. Multiple approaches to assessing a species’ impact are instructive, but impact ratings must be interpreted in the context of methodological strengths and weaknesses and key management issues. A combination of our ecological and abundance approaches may be most appropriate for assessing ecological impact, whereas our socioeconomic approach is more useful for understanding social dimensions. These approaches are readily transferrable to other regions and taxa; if refined, they can help standardize the assessment of impacts of nonnative species.

High renesting rates in arctic-breeding Dunlin (Calidris alpina): A clutch-removal experiment

USGS Publications Warehouse

Gates, H. River; Lanctot, Richard B.; Powell, Abby N.

2013-01-01

The propensity to replace a clutch is a complex component of avian reproduction and poorly understood. We experimentally removed clutches from an Arctic-breeding shorebird, the Dunlin (Calidris alpina arcticola), during early and late stages of incubation to investigate replacement clutch rates, renesting interval, and mate and site fidelity between nesting attempts. In contrast to other Arctic studies, we documented renesting by radiotracking individuals to find replacement clutches. We also examined clutch size and mean egg volume to document changes in individual females’ investment in initial and replacement clutches. Finally, we examined the influence of adult body mass, clutch volume, dates of clutch initiation and nest loss, and year on the propensity to renest. We found high (82–95%) and moderate (35–50%) rates of renesting for early and late incubation treatments. Renesting intervals averaged 4.7–6.8 days and were not different for clutches removed early or late in incubation. Most pairs remained together for renesting attempts. Larger females were more likely to replace a clutch; female body mass was the most important parameter predicting propensity to renest. Clutches lost later in the season were less likely to be replaced. We present evidence that renesting is more common in Arctic-breeding shorebirds than was previously thought, and suggest that renesting is constrained by energetic and temporal factors as well as mate availability. Obtaining rates of renesting in species breeding at different latitudes will help determine when this behavior is likely to occur; such information is necessary for demographic models that include individual and population-level fecundity estimates.

Insectivory versus piscivory in Black Terns: Implications for food provisioning and growth of chicks

USGS Publications Warehouse

Gilbert, A.T.; Servello, F.A.

2005-01-01

The Black Tern (Chlidonias niger) is known for insectivory in their breeding range, but they are piscivorous in winter and feed some fish to chicks. Fish have potentially high value for chick provisioning because of their larger mass, but the relative value of fish and insect diets for chick growth is unknown. In 1999-2000, we documented use of fish and insects for provisioning chicks at four Black Tern colonies in Maine and examined chick growth rates at two colonies (Douglas Pond and Carlton Pond) that differed in fish and insect use. Deliveries of fish and insects to broods were documented using video cameras and observations from blinds, while concurrently measuring chick growth in nest enclosures. Fish use was substantial (>25% of deliveries) at three of four colonies. Fish comprised 29% of items and 56% of metabolizable energy delivered to chicks at Douglas Pond compared to 13% of items and 22% of metabolizeable energy at Carlton Pond. Food delivery rate was inversely related to the proportion of large fish. In brood diets at Douglas and Carlton Ponds and increased with brood age at Carlton Pond only, apparently due to high insect use. Chick growth rate did not vary with respect to fish and insect composition of diets. It is concluded that adults were able to raise chicks through age 12 d at comparable growth rates with insect-or fish-dominated diets. Use of fish may be more energy efficient for adults, and the capability to use both fish and insects may reduce potential variability in food availability during the breeding season.

If you did not document it, it did not happen: rates of documentation of discussion of infertility risk in adolescent and young adult oncology patients' medical records.

PubMed

Quinn, Gwendolyn P; Block, Rebecca G; Clayman, Marla L; Kelvin, Joanne; Arvey, Sarah R; Lee, Ji-Hyun; Reinecke, Joyce; Sehovic, Ivana; Jacobsen, Paul B; Reed, Damon; Gonzalez, Luis; Vadaparampil, Susan T; Laronga, Christine; Lee, M Catherine; Pow-Sang, Julio; Eggly, Susan; Franklin, Anna; Shah, Bijal; Fulp, William J; Hayes-Lattin, Brandon

2015-03-01

The adolescent and young adult (AYA) population is underserved because of unique late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients' medical records at four cancer centers. All centers reviewed randomized records within the top four AYA disease sites (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible records included those of patients: diagnosed in 2011, with no prior receipt of gonadotoxic therapy; age 18 to 45 years; with no multiple primary cancers; and for whom record was not second opinion. Quality Oncology Practice Initiative methods were used to evaluate documentation of discussion of risk of infertility, discussion of FP options, and referral to a fertility specialist. Of 231 records, 26% documented infertility risk discussion, 24% documented FP option discussion, and 13% documented referral to a fertility specialist. Records were less likely to contain evidence of infertility risk and FP option discussions for female patients (P = .030 and .004, respectively) and those with breast cancer (P = .021 and < .001, respectively). Records for Hispanic/Latino patients were less likely to contain evidence of infertility risk discussion (P = .037). Records were less likely to document infertility risk discussion, FP option discussion, and fertility specialist referral for patients age ≥ 40 years (P < .001, < .001, and .002, respectively) and those who already had children (all P < .001). The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups. Although greater numbers of discussions may be occurring, there is a need to create interventions to improve documentation. Copyright © 2014 by American Society of Clinical Oncology.

Reminder Cards Improve Physician Documentation of Obesity But Not Obesity Counseling.

PubMed

Shungu, Nicholas; Miller, Marshal N; Mills, Geoffrey; Patel, Neesha; de la Paz, Amanda; Rose, Victoria; Kropa, Jill; Edi, Rina; Levy, Emily; Crenshaw, Margaret; Hwang, Chris

2015-01-01

Physicians frequently fail to document obesity and obesity-related counseling. We sought to determine whether attaching a physical reminder card to patient encounter forms would increase electronic medical record (EMR) assessment of and documentation of obesity and dietary counseling. Reminder cards for obesity documentation were attached to encounter forms for patient encounters over a 2-week intervention period. For visits in the intervention period, the EMR was retrospectively reviewed for BMI, assessment of "obesity" or "morbid obesity" as an active problem, free-text dietary counseling within physician notes, and assessment of "dietary counseling" as an active problem. These data were compared to those collected through a retrospective chart review during a 2-week pre-intervention period. We also compared physician self-report of documentation via reminder cards with EMR documentation. We found significant improvement in the primary endpoint of assessment of "obesity" or "morbid obesity" as an active problem (42.5% versus 28%) compared to the pre-intervention period. There was no significant difference in the primary endpoints of free-text dietary counseling or assessment of "dietary counseling" as an active problem between the groups. Physician self-reporting of assessment of "obesity" or "morbid obesity" as an active problem (77.7% versus 42.5%), free-text dietary counseling on obesity (69.1% versus 35.4%) and assessment of "dietary counseling" as an active problem (54.3% versus 25.2%) were all significantly higher than those reflected in EMR documentation. This study demonstrates that physical reminder cards are a successful means of increasing obesity documentation rates among providers but do not necessarily increase rates of obesity-related counseling or documentation of counseling. Our study suggests that even with such interventions, physicians are likely under-documenting obesity and counseling compared to self-reported rates.

Smoking behavior of Mexicans: patterns by birth-cohort, gender, and education.

PubMed

Christopoulou, Rebekka; Lillard, Dean R; Balmori de la Miyar, Josè R

2013-06-01

Little is known about historical smoking patterns in Mexico. Policy makers must rely on imprecise predictions of human or fiscal burdens from smoking-related diseases. In this paper we document intergenerational patterns of smoking, project them for future cohorts, and discuss those patterns in the context of Mexico's impressive economic growth. We use retrospectively collected information to generate life-course smoking prevalence rates of five birth-cohorts, by gender and education. With dynamic panel data methods, we regress smoking rates on indicators of economic development. Smoking is most prevalent among men and the highly educated. Smoking rates peaked in the 1980s and have since decreased, slowly on average, and fastest among the highly educated. Development significantly contributed to this decline; a 1 % increase in development is associated with an average decline in smoking prevalence of 0.02 and 0.07 percentage points for women and men, respectively. Mexico's development may have triggered forces that decrease smoking, such as the spread of health information. Although smoking rates are falling, projections suggest that they will be persistently high for several future generations.

Goals of care discussions among hospitalized long-term care residents: Predictors and associated outcomes of care.

PubMed

Wong, Hannah J; Wang, Jamie; Grinman, Michelle; Wu, Robert C

2016-12-01

There are limited data on the occurrence, predictors, and impact of goals of care (GOC) discussions during hospitalization for seriously ill elderly patients, particularly for long-term care (LTC) residents. The study was a retrospective chart review of 200 randomly sampled LTC residents hospitalized via the emergency department and admitted to the general internal medicine service of 2 Canadian academic hospitals, from January 2012 through December 2012. We applied logistic regression models to identify factors associated with, and outcomes of, these discussions. Overall, 9.4% (665 of 7084) of hospitalizations were patients from LTC. In the sample of 200 patients, 37.5% had a documented discussion. No baseline patient characteristic was associated with GOC discussions. Low Glasgow Coma Scale, high respiratory rate, and low oxygen saturation were associated with discussions. Patients with discussions had higher rates of orders for no resuscitation (80% vs 55%) and orders for comfort measures only (7% vs 0%). In adjusted analyses, patients with discussions had higher odds of in-hospital death (52.0, 95% confidence interval [CI]: 6.2-440.4) and 1-year mortality (4.1, 95% CI: 1.7-9.6). Nearly 75% of patients with a change in their GOC did not have this documented in the discharge summary. In hospitalized LTC patients, GOC discussions occurred infrequently and appeared to be triggered by illness severity. Orders for advance directives, in-hospital death, and 1-year mortality were associated with discussions. Rates of GOC documentation in the discharge summary were poor. This study provides direction for developing education and practice standards to improve GOC discussion rates and their communication back to LTC. Journal of Hospital Medicine 2015;11:824-831. © 2015 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Incidence of Staphylococcus aureus nasal colonization and soft tissue infection among high school football players.

PubMed

Lear, Aaron; McCord, Gary; Peiffer, Jeffrey; Watkins, Richard R; Parikh, Arpan; Warrington, Steven

2011-01-01

Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections have been documented with increasing frequency in both team and individual sports in recent years. It also seems that the level of MRSA skin and soft tissue infections in the general population has increased. One hundred ninety athletes from 6 local high school football teams were recruited for this prospective observational study to document nasal colonization and the potential role this plays in skin and soft tissue infections in football players and, in particular, MRSA infections. Athletes had nasal swabs done before their season started, and they filled out questionnaires regarding potential risk factors for skin and soft tissue infections. Those enrolled in the study were then observed over the course of the season for skin and soft tissue infections. Those infected had data about their infections collected. One hundred ninety of 386 available student athletes enrolled in the study. Forty-four of the subjects had nasal colonization with methicillin-susceptible S. aureus, and none were colonized with MRSA. There were 10 skin and soft tissue infections (8 bacterial and 2 fungal) documented over the course of the season. All were treated as outpatients with oral or topical antibiotics, and none were considered serious. Survey data from the preseason questionnaire showed 21% with skin infection, 11% with methicillin-susceptible S. aureus, and none with MRSA infection during the past year. Three reported a remote history of MRSA infection. We documented an overall skin infection rate of 5.3% among high school football players over a single season. Our results suggest that skin and soft tissue infection may not be widespread among high school athletes in northeast Ohio.

A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs.

PubMed

Mackenzie, George; Barnhart, Mathew; Kennedy, Shawn; DeHoff, William; Schertel, Eric

2010-01-01

Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs that has been associated with high mortality rates in previous studies. Factors were evaluated in this study for their influence on overall and postoperative mortality in 306 confirmed cases of GDV between 2000 and 2004. The overall mortality rate was 10%, and the postoperative mortality rate was 6.1%. The factor that was associated with a significant increase in overall mortality was the presence of preoperative cardiac arrhythmias. Factors that were associated with a significant increase in postoperative mortality were postoperative cardiac arrhythmias, splenectomy, or splenectomy with partial gastric resection. The factor that was associated with a significant decrease in the overall mortality rate was time from presentation to surgery. This study documents that certain factors continue to affect the overall and postoperative mortality rates associated with GDV, but these mortality rates have decreased compared to previously reported rates.

Fast title extraction method for business documents

NASA Astrophysics Data System (ADS)

Katsuyama, Yutaka; Naoi, Satoshi

1997-04-01

Conventional electronic document filing systems are inconvenient because the user must specify the keywords in each document for later searches. To solve this problem, automatic keyword extraction methods using natural language processing and character recognition have been developed. However, these methods are slow, especially for japanese documents. To develop a practical electronic document filing system, we focused on the extraction of keyword areas from a document by image processing. Our fast title extraction method can automatically extract titles as keywords from business documents. All character strings are evaluated for similarity by rating points associated with title similarity. We classified these points as four items: character sitting size, position of character strings, relative position among character strings, and string attribution. Finally, the character string that has the highest rating is selected as the title area. The character recognition process is carried out on the selected area. It is fast because this process must recognize a small number of patterns in the restricted area only, and not throughout the entire document. The mean performance of this method is an accuracy of about 91 percent and a 1.8 sec. processing time for an examination of 100 Japanese business documents.

Global Scientific Production on Illicit Drug Addiction: A Two-Decade Analysis.

PubMed

Khalili, Malahat; Rahimi-Movaghar, Afarin; Shadloo, Behrang; Mojtabai, Ramin; Mann, Karl; Amin-Esmaeili, Masoumeh

2018-04-06

Addiction science has made great progress in the past decades. We conducted a scientometric study in order to quantify the number of publications and the growth rate globally, regionally, and at country levels. In October 2015, we searched the Scopus database using the general keywords of addiction or drug-use disorders combined with specific terms regarding 4 groups of illicit drugs - cannabis, opioids, cocaine, and other stimulants or hallucinogens. All documents published during the 20-year period from 1995 to 2014 were included. A total of 95,398 documents were retrieved. The highest number of documents were on opioids, both globally (60.1%) and in each of 5 continents. However, studies on cannabis showed a higher growth rate in the last 5-year period of the study (2010-2014). The United States, the United Kingdom, Germany, Canada, Australia, France, Spain, Italy, China, and Japan - almost all studies were from high-income countries - occupied the top 10 positions and produced 81.4% of the global science on drug addiction. As there are important socio-cultural differences in the epidemiology and optimal clinical care of addictive disorders, it is suggested that low- and more affected middle-income countries increase their capacity to conduct research and disseminate the knowledge in this field. © 2018 S. Karger AG, Basel.

High school completion rates among men with hemophilia.

PubMed

Drake, John H; Soucie, J Michael; Cutter, Susan C; Forsberg, Ann D; Baker, Judith R; Riske, Brenda

2010-04-01

The benefits of a high school diploma are well documented. Studies indicate that people with hemophilia have lower than average academic achievement, particularly if they have >12 bleeding episodes annually. This study compares the high school graduation rate of men with hemophilia to that of the U.S. population of men. Data were obtained from the Universal Data Collection Program, a surveillance project conducted by approximately 130 hemophilia treatment centers in the nation. Data from 7842 men aged >or=18 years were evaluated to determine high school graduation status and were analyzed by race/ethnicity and severity of hemophilia. These data were collected between 1998 and 2008, and analysis was conducted in 2009. Men with hemophilia A had higher or similar high school graduation rates across all racial/ethnic groups and all levels of hemophilia severity, compared with U.S. men of the same age. Graduation rates for black and Hispanic men with hemophilia B were higher or similar to rates of U.S. men, but rates for whites were lower, especially among those with moderate and mild disease. However, when graduation rates were controlled for areas where Amish populations reside, differences in graduation rates for whites disappeared. In this study, participants obtained hemophilia care at comprehensive hemophilia treatment centers. This multidisciplinary, family-centered care emphasizes prevention of complications, encourages medically supervised disease management, and facilitates psychosocial development. The care aims to maximize the affected child's participation in school. This care approach may partially explain the higher-than-expected high school graduation rates among the study population, which is affected by a rare, chronic, and potentially debilitating disorder. Copyright 2010. Published by Elsevier Inc.

Spaceflight Ka-Band High-Rate Radiation-Hard Modulator

NASA Technical Reports Server (NTRS)

Jaso, Jeffery M.

2011-01-01

A document discusses the creation of a Ka-band modulator developed specifically for the NASA/GSFC Solar Dynamics Observatory (SDO). This flight design consists of a high-bandwidth, Quadriphase Shift Keying (QPSK) vector modulator with radiation-hardened, high-rate driver circuitry that receives I and Q channel data. The radiationhard design enables SDO fs Ka-band communications downlink system to transmit 130 Mbps (300 Msps after data encoding) of science instrument data to the ground system continuously throughout the mission fs minimum life of five years. The low error vector magnitude (EVM) of the modulator lowers the implementation loss of the transmitter in which it is used, thereby increasing the overall communication system link margin. The modulator comprises a component within the SDO transmitter, and meets the following specifications over a 0 to 40 C operational temperature range: QPSK/OQPSK modulator, 300-Msps symbol rate, 26.5-GHz center frequency, error vector magnitude less than or equal to 10 percent rms, and compliance with the NTIA (National Telecommunications and Information Administration) spectral mask.

Behavioral health leadership: new directions in occupational mental health.

PubMed

Adler, Amy B; Saboe, Kristin N; Anderson, James; Sipos, Maurice L; Thomas, Jeffrey L

2014-10-01

The impact of stress on mental health in high-risk occupations may be mitigated by organizational factors such as leadership. Studies have documented the impact of general leadership skills on employee performance and mental health. Other researchers have begun examining specific leadership domains that address relevant organizational outcomes, such as safety climate leadership. One emerging approach focuses on domain-specific leadership behaviors that may moderate the impact of combat deployment on mental health. In a recent study, US soldiers deployed to Afghanistan rated leaders on behaviors promoting management of combat operational stress. When soldiers rated their leaders high on these behaviors, soldiers also reported better mental health and feeling more comfortable with the idea of seeking mental health treatment. These associations held even after controlling for overall leadership ratings. Operational stress leader behaviors also moderated the relationship between combat exposure and soldier health. Domain-specific leadership offers an important step in identifying measures to moderate the impact of high-risk occupations on employee health.

[How to reduce the number of cesarean sections?].

PubMed

Guzmán Sánchez, A; González Moreno, J; González Guzmán, M; Villa Villagran, F

1997-07-01

The cesarean section (C) frequency has increased dramatically as high as 62%. This situation has been producing a real preoccupation in all the world as well as in México. Documented bibliography about this subject, is unquestionable. We feel that at this time there is a lack of punctuals strategies in order to reduce the high frequency of C. Our communication analyzes this problem in relation to antecedents, evolution and integrated general strategies in order to reduce the C rates. Special analysis and comments involve amnioinfusion, trials for vaginal deliveries in case of previous cesarean section, prostaglandins, and external version. With these actions, at the Antiguo Hospital Civil de Guadalajara we have achieved 10.8% of C. rates, without any increase in fetomaternal morbility and/or mortality.

Visitor constraints to physical activity in park and recreation areas: differences by race and ethnicity

Treesearch

Sonja A. Wilhelm Stanis; Ingrid E. Schneider; Deborah J Chavez; Kimberly J. Shinew

2009-01-01

Health benefits of physical activity are well recognized and documented, yet inactivity and obesity rates remain high in the U.S., particularly among racially and ethnically diverse populations. A greater understanding of factors that constrain physical activity in parks and recreation areas across various racial and ethnic groups may improve an agency’s ability to...

The Economic and Fiscal Costs of Failing to Reform K-12 Education in Georgia. School Choice Issues in the State

ERIC Educational Resources Information Center

Gottlob, Brian J.

2009-01-01

This study documents the public costs of high school dropouts in Georgia, and examines how policies that increase school choice, such as the recently-enacted tuition tax credit scholarship program will provide large public benefits by increasing public school graduation rates. The study calculates the annual cost of Georgia dropouts caused by…

Sexual behaviour and sexually transmitted infections in sexually transmitted infection clinic attendees in the Netherlands, 2007-2011.

PubMed

de Coul, E L M Op; Warning, T D; Koedijk, F D H

2014-01-01

High annual figures of sexually transmitted infections (STIs) are diagnosed in the Netherlands despite significant efforts to control them. Herein, we analyse trends and determinants of STI diagnoses, co-infections, and sexual risks among visitors of 26 STI clinics between 2007 and 2011. We recorded increased positivity rates of STIs (chlamydia, syphilis, gonorrhoea, and/or HIV) in women and heterosexual men up to 12.6% and 13.4%, respectively, in 2011, while rates in men having sex with men (MSM) were stable but high (18.8%) through the documented years. Younger age, origin from Surinam/Antilles, history of previous STI, multiple partners, or a previous notification are the identified risk factors for an STI in this population. Known HIV-infected men (MSM and heterosexuals) were at highest risk for co-infections (relative rate heterosexual men: 15.6; MSM: 11.6). STI positivity rates remained high (MSM) or increased over time (women and heterosexual men), a fact that highlights the importance of continuing STI prevention. Most importantly, the very high STI co-infection rates among HIV-positive men requires intensified STI reduction strategies to put an end to the vicious circle of re-infection and spread of HIV and other STIs.

National suicide rates a century after Durkheim: do we know enough to estimate error?

PubMed

Claassen, Cynthia A; Yip, Paul S; Corcoran, Paul; Bossarte, Robert M; Lawrence, Bruce A; Currier, Glenn W

2010-06-01

Durkheim's nineteenth-century analysis of national suicide rates dismissed prior concerns about mortality data fidelity. Over the intervening century, however, evidence documenting various types of error in suicide data has only mounted, and surprising levels of such error continue to be routinely uncovered. Yet the annual suicide rate remains the most widely used population-level suicide metric today. After reviewing the unique sources of bias incurred during stages of suicide data collection and concatenation, we propose a model designed to uniformly estimate error in future studies. A standardized method of error estimation uniformly applied to mortality data could produce data capable of promoting high quality analyses of cross-national research questions.

Trauma and PTSD rates in an irish psychiatric population

PubMed Central

Wilson, Fiona E; Hennessy, Eilis; Dooley, Barbara; Kelly, Brendan D; Ryan, Dermot A

2013-01-01

Although Western mental health services are increasingly finding themselves concerned with assisting traumatized individuals migrating from other countries, trauma and posttraumatic stress disorder (PTSD) are under-detected and undiagnosed in psychiatric populations. This study examined and compared rates of traumatic experiences, frequency of traumatic events, trauma symptomatology levels, rates of torture, rates of PTSD and chart documentation of trauma and PTSD between (a) Irish and migrant service-users and (b) forced migrant and voluntary migrant service-users in Dublin, Ireland. Data were gathered from 178 psychiatric outpatients attending using a sociodemographic questionnaire, the Harvard Trauma Questionnaire-Revised Cambodian Version and the SCID-I/P. A substantial number of service-users had experienced at least one lifetime trauma (71.3%), and a high percentage of both the Irish (47.4%) and migrant groups (70.3%) of service-users had experienced two or more events. Overall, analyses comparing rates between Irish, forced migrant and voluntary migrant service-users found that forced migrants displayed more traumatic life events, posttraumatic symptoms, and higher levels of PTSD than their voluntary migrant and Irish counterparts, with over 50% experiencing torture prior to arrival in Ireland. The lifetime rate of PTSD in the overall sample was 15.7% but only 53.57% of cases were documented in patient charts. The results of this study are informative about the nature and extent of the problem of trauma and PTSD among migrant mental health service users as well as highlighting the under-detected levels of trauma among native-born service users. PMID:28228990

77 FR 18963 - Energy Conservation Program: Public Meeting and Availability of the Framework Document for High...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-29

... the Framework Document for High-Intensity Discharge Lamps AGENCY: Office of Energy Efficiency and... availability of framework document for high-intensity discharge (HID) lamps, initiating the rulemaking and data... Availability of Framework Document Regarding Energy Conservation Standards for High-Intensity Discharge (HID...

[Trends of cancer mortality rates in children and adolescents by level of marginalization in Mexico (1990-2009)].

PubMed

Escamilla-Santiago, Ricardo Antonio; Narro-Robles, José; Fajardo-Gutiérrez, Arturo; Rascón-Pacheco, Ramón Alberto; López-Cervantes, Malaquías

2012-01-01

To determine childhood and adolescent cancer mortality by the level of marginalization in Mexico. We used 1990-2009 death certificates estimating age-standardized rates. We calculated the Average Annual Percent Change (AAPC) using the Joinpoint Regression program available at the National Cancer Institute to assess tendency. Cancer mortality rates increased. AAPC were 0.87% male and 0.96% female children, and for adolescents were: males 1.22% and females 0.63%. The neoplasm pattern in infants was leukemia -central nervous system- lymphomas; and in adolescents it was leukemia -bone and articulation- lymphomas. The increase in cancer mortality corresponded to the high and highest marginated areas of each state. The increase in highly marginated areas may be partly explained by well-documented local registration of deaths. Further studies focusing on survival are required in order to better assess the effectiveness of cancer detection and medical treatment in our country.

Growth Dynamics of the Threatened Caribbean Staghorn Coral Acropora cervicornis: Influence of Host Genotype, Symbiont Identity, Colony Size, and Environmental Setting

PubMed Central

Lirman, Diego; Schopmeyer, Stephanie; Galvan, Victor; Drury, Crawford; Baker, Andrew C.; Baums, Iliana B.

2014-01-01

Background The drastic decline in the abundance of Caribbean acroporid corals (Acropora cervicornis, A. palmata) has prompted the listing of this genus as threatened as well as the development of a regional propagation and restoration program. Using in situ underwater nurseries, we documented the influence of coral genotype and symbiont identity, colony size, and propagation method on the growth and branching patterns of staghorn corals in Florida and the Dominican Republic. Methodology/Principal Findings Individual tracking of> 1700 nursery-grown staghorn fragments and colonies from 37 distinct genotypes (identified using microsatellites) in Florida and the Dominican Republic revealed a significant positive relationship between size and growth, but a decreasing rate of productivity with increasing size. Pruning vigor (enhanced growth after fragmentation) was documented even in colonies that lost 95% of their coral tissue/skeleton, indicating that high productivity can be maintained within nurseries by sequentially fragmenting corals. A significant effect of coral genotype was documented for corals grown in a common-garden setting, with fast-growing genotypes growing up to an order of magnitude faster than slow-growing genotypes. Algal-symbiont identity established using qPCR techniques showed that clade A (likely Symbiodinium A3) was the dominant symbiont type for all coral genotypes, except for one coral genotype in the DR and two in Florida that were dominated by clade C, with A- and C-dominated genotypes having similar growth rates. Conclusion/Significance The threatened Caribbean staghorn coral is capable of extremely fast growth, with annual productivity rates exceeding 5 cm of new coral produced for every cm of existing coral. This species benefits from high fragment survivorship coupled by the pruning vigor experienced by the parent colonies after fragmentation. These life-history characteristics make A. cervicornis a successful candidate nursery species and provide optimism for the potential role that active propagation can play in the recovery of this keystone species. PMID:25268812

Measuring Clinical Decision Support Influence on Evidence-Based Nursing Practice.

PubMed

Cortez, Susan; Dietrich, Mary S; Wells, Nancy

2016-07-01

To measure the effect of clinical decision support (CDS) on oncology nurse evidence-based practice (EBP).
. Longitudinal cluster-randomized design.
. Four distinctly separate oncology clinics associated with an academic medical center.
. The study sample was comprised of randomly selected data elements from the nursing documentation software. The data elements were patient-reported symptoms and the associated nurse interventions. The total sample observations were 600, derived from a baseline, posteducation, and postintervention sample of 200 each (100 in the intervention group and 100 in the control group for each sample).
. The cluster design was used to support randomization of the study intervention at the clinic level rather than the individual participant level to reduce possible diffusion of the study intervention. An elongated data collection cycle (11 weeks) controlled for temporary increases in nurse EBP related to the education or CDS intervention.
. The dependent variable was the nurse evidence-based documentation rate, calculated from the nurse-documented interventions. The independent variable was the CDS added to the nursing documentation software.
. The average EBP rate at baseline for the control and intervention groups was 27%. After education, the average EBP rate increased to 37%, and then decreased to 26% in the postintervention sample. Mixed-model linear statistical analysis revealed no significant interaction of group by sample. The CDS intervention did not result in an increase in nurse EBP.
. EBP education increased nurse EBP documentation rates significantly but only temporarily. Nurses may have used evidence in practice but may not have documented their interventions.
. More research is needed to understand the complex relationship between CDS, nursing practice, and nursing EBP intervention documentation. CDS may have a different effect on nurse EBP, physician EBP, and other medical professional EBP.

Trace contaminant control simulation computer program, version 8.1

NASA Technical Reports Server (NTRS)

Perry, J. L.

1994-01-01

The Trace Contaminant Control Simulation computer program is a tool for assessing the performance of various process technologies for removing trace chemical contamination from a spacecraft cabin atmosphere. Included in the simulation are chemical and physical adsorption by activated charcoal, chemical adsorption by lithium hydroxide, absorption by humidity condensate, and low- and high-temperature catalytic oxidation. Means are provided for simulating regenerable as well as nonregenerable systems. The program provides an overall mass balance of chemical contaminants in a spacecraft cabin given specified generation rates. Removal rates are based on device flow rates specified by the user and calculated removal efficiencies based on cabin concentration and removal technology experimental data. Versions 1.0 through 8.0 are documented in NASA TM-108409. TM-108409 also contains a source file listing for version 8.0. Changes to version 8.0 are documented in this technical memorandum and a source file listing for the modified version, version 8.1, is provided. Detailed descriptions for the computer program subprograms are extracted from TM-108409 and modified as necessary to reflect version 8.1. Version 8.1 supersedes version 8.0. Information on a separate user's guide is available from the author.

[Consensus document for the detection and management of chronic kidney disease].

PubMed

Martínez-Castelao, Alberto; Górriz, José L; Bover, Jordi; Segura-de la Morena, Julián; Cebollada, Jesús; Escalada, Javier; Esmatjes, Enric; Fácila, Lorenzo; Gamarra, Javier; Gràcia, Silvia; Hernández-Moreno, Julio; Llisterri-Caro, José L; Mazón, Pilar; Montañés, Rosario; Morales-Olivas, Francisco; Muñoz-Torres, Manuel; de Pablos-Velasco, Pedro; de Santiago, Ana; Sánchez-Celaya, Marta; Suárez, Carmen; Tranche, Salvador

2014-01-01

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

[Written information for patients: From papers to documents].

PubMed

Cortés-Criado, M C

2014-01-01

There is a high variability in the level of information intended for patients, with different content, format and presentation. To determine the perceived safety of the patients treated at the Country Hospital of Melilla (HCML) and to assess the quality of the documents using criteria adapted to the «International Patient Decision Aid Standards» (IPDAS). Descriptive study of the documents given to patients by the HCML. They included questionnaires on perceived safety, classification of the documents, and the level of adherence to the IPDAS criteria. The Information given to patients during their stay in the HCML, their participation in decision-making, and the information about medication, did not exceed the average on the acceptance scale. Only 40 documents were studied (of the 131 collected), on being published in-house, and were classified, following the definitions of the RAE, into instructions (20), recommendations (14) and guidelines (6). Of these, only the 27.5% showed hospital logo. In the content analysis according to the IPDAS criteria, there was an overall adherence rate of 24.1% in instructions, 24.8% in recommendations, and 61.5% in guidelines. The perception of patient safety expressed in the questionnaire, and its assessment according IPDAS criteria, shows there may be a significant improvement within the organization. Furthermore, the quality of patient documentation provided can help decision making. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Practice Bulletin No. 161 Summary: External Cephalic Version.

PubMed

2016-02-01

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

Practice Bulletin No. 161: External Cephalic Version.

PubMed

2016-02-01

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

Maintaining high autopsy rates in a Canadian blood and marrow transplant program: preserving a diagnostic and research tool.

PubMed

Allan, D S; Bélanger, R; Busque, L; Cohen, S; Fish, D; Roy, D C; Roy, J

2005-04-01

Autopsy series have revealed patterns of injury in graft-versus-host disease and provided insight into infectious and toxic complications following hematopoietic stem cell transplantation (HSCT). Overall autopsy rates have declined significantly in recent decades including specialized services such as neonatal medicine and cardiac care. However, rates of post-mortem exams at HSCT centers have not been specifically documented. We reviewed hospital records between 1992 and 2002 to determine overall autopsy rates at our hospital and within the HSCT program. Although the overall autopsy rate declined steadily from 24% in 1992 to 9% in 2002, rates of post-mortem exams in the HSCT program remained relatively stable at 32% (24-46%). Autopsy rates were not significantly different for recipients of allogeneic vs autologous transplants and no clear difference was observed for the proportion of autopsies requested on weekdays compared with weekends. Autopsies confirmed major clinical diagnoses and/or suspected causes of death in 45 of 61 autopsies (74%) and yielded major or minor disagreements in clinical diagnosis in 10 cases (16%) and seven cases (11%), respectively. The preservation of high rates of autopsy within our HSCT program demonstrates that specialized programs are able to maintain elevated rates of post-mortem examinations despite overall declining rates.

Race/Ethnicity, Socioeconomic Status, and Satisfaction With Health Care

PubMed Central

Haviland, Mark G.; Morales, Leo S.; Dial, Thomas H.; Pincus, Harold Alan

2006-01-01

The purpose of the present study was to evaluate the effects of race/ethnicity and socioeconomic status on consumer health care satisfaction ratings. The authors analyzed national data from the 2001 National Research Corporation Healthcare Market Guide Survey (N = 99 102). Four global and 3 composite ratings were examined. In general, satisfaction ratings were high across all global and composite measures; however, Asian/Pacific Islanders and Hispanics gave lower ratings than did whites, and African Americans gave a mix of higher and lower ratings (vs whites). Among the lowest ratings were those given by American Indians/Alaska Natives living in poverty. Race/ethnicity effects were independent of education and income. These findings are consistent with reports of continuing racial/ethnic disparities in both coverage and care. Programs to improve quality of care must specifically address these well-documented, severe, and persistent disparities. PMID:16020676

An assistant workforce to improve screening rates and quality of care for older patients in the emergency department: findings of a pre- post, mixed methods study.

PubMed

Hullick, Carolyn; Conway, Jane; Higgins, Isabel; Hewitt, Jacqueline; Stewart, Bernadette; Dilworth, Sophie; Attia, John

2018-05-30

Older people who present to the Emergency Department (ED) experience high rates of prevalent and incident delirium. This study aimed to determine whether an assistant workforce in the ED could effectively conduct screening to inform assessment and care planning for older people as well as enhance supportive care activities for prevention of delirium. Using a pre-post design, data was collected before and after the introduction of Older Person Technical Assistants (OPTAs) in the ED. OPTA activity was recorded during the intervention period and a medical record audit undertaken prior to and 9 months after implementation. Data were analysed using descriptive statistics for OPTA activities. Weighted Kappa scores were calculated comparing concordance in screening scores between OPTAs and Aged Services Emergency Team Registered Nurses. Changes in the rates of documented screening and supportive care were analysed using Chi-square tests. Focus groups were conducted to explore clinicians' experiences of the OPTA role. Three thousand five hundred fourty two people were seen by OPTAs in 4563 ED Presentations between 1st July 2011 and 2012. The reproducibility of all screening tools were found to be high between the OPTAs and the RNs, with Kappas and ICCs generally all above 0.9. The medical record audit showed significant improvement in the rates of documented screening, including cognition from 1.5 to 38% (p < 0.001) and review of pain from 29 to 75% (p < 0.001). Supportive care such as being given fluids or food also improved from 13 to 49% (p < 0.001) and pressure care from 4.8 to 30% (p < 0.001). This was accomplished with no increase in ED length of stay among this age group. Focus group interviews described mixed responses and support for the OPTA role. An assistant workforce in an ED setting was found to provide comparable screening results and improve the rates of documented screening and supportive care provided to older people with or at risk of developing delirium in the ED. There is a need for a shared philosophy to the care of older people in the ED. Australian New Zealand Clinical Trials Registration number is ACTRN12617000742370. It was retrospectively registered on 22nd May 2017.

Examining Changes to Michigan's Early Childhood Quality Rating and Improvement System (QRIS). REL 2015-029

ERIC Educational Resources Information Center

Faria, Ann-Marie; Hawkinson, Laura E.; Greenberg, Ariela C.; Howard, Eboni C.; Brown, Leah

2015-01-01

Documenting and improving early childhood program quality is a national priority, leading to a rapid expansion of Quality Rating and Improvement Systems (QRISs). QRISs document and improve the quality of early childhood education programs and provide clear information to families about their child care choices. The current study described how…

Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates.

PubMed

Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

2017-01-01

To explore possible factors in the organization of nursing homes that could be related to differences in the rate of transfer of residents from nursing homes to emergency department. Explorative. In a single municipality, qualitative and quantitative data were collected from documents and through semi-structured interviews with 11 RNs from five nursing homes identified as having the highest vs. six identified as having the lowest transfer rates to emergency department. Data were analysed by non-parametric tests and basic content analysis. All nursing homes in the highest transfer rate group and one in the lowest transfer rate group were run by private for-profit providers. Compared with the low group, the high group had fewer updated advance care plans and the RNs interviewed had less work experience in care of older people and less training in care of persons with dementia. There was no difference in nursing home size or staff/resident ratio. The RNs described similar possibilities to provide palliative care, medical equipment and perceived medical support from GPs.

Gastronomic nostalgia: Salvadoran immigrants' cravings for their ideal meal.

PubMed

Stowers, Sharon L

2012-01-01

Immigrants typically express cravings for the food of their homeland, but for undocumented and temporarily documented Salvadoran immigrants living in the United States, the hunger for their traditional cuisine is particularly poignant. To cope with a history of food scarcity in El Salvador and their documentation liminality in the United States, Salvadoran immigrants in this study crave symbolically rich foods. Salvadoran women provide these foods by recreating for their families an ideal Salvadoran meal into which they "groom" meanings of an imagined past and a hoped for present and future. Salvadoran immigrants' cravings, more cultural than physiological, are not readily satisfied, thus contributing to the overconsumption of food and the high rate of overweight among first-generation Salvadoran-American children.

Algorithms for Monitoring Heart Rate and Respiratory Rate From the Video of a User’s Face

PubMed Central

Sanyal, Shourjya

2018-01-01

Smartphone cameras can measure heart rate (HR) by detecting pulsatile photoplethysmographic (iPPG) signals from post-processing the video of a subject’s face. The iPPG signal is often derived from variations in the intensity of the green channel as shown by Poh et. al. and Verkruysse et. al.. In this pilot study, we have introduced a novel iPPG method where by measuring variations in color of reflected light, i.e., Hue, and can therefore measure both HR and respiratory rate (RR) from the video of a subject’s face. This paper was performed on 25 healthy individuals (Ages 20–30, 15 males and 10 females, and skin color was Fitzpatrick scale 1–6). For each subject we took two 20 second video of the subject’s face with minimal movement, one with flash ON and one with flash OFF. While recording the videos we simultaneously measuring HR using a Biosync B-50DL Finger Heart Rate Monitor, and RR using self-reporting. This paper shows that our proposed approach of measuring iPPG using Hue (range 0–0.1) gives more accurate readings than the Green channel. HR/Hue (range 0–0.1) (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$r=0.9201$ \\end{document}, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$p$ \\end{document}-value = 4.1617, and RMSE = 0.8887) is more accurate compared with HR/Green (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$r=0.4916$ \\end{document}, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$p$ \\end{document}-value = 11.60172, and RMSE = 0.9068). RR/Hue (range 0–0.1) (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$r=0.6575$ \\end{document}, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$p$ \\end{document}-value = 0.2885, and RMSE = 3.8884) is more accurate compared with RR/Green (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$r=0.3352$ \\end{document}, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$p$ \\end{document}-value = 0.5608, and RMSE = 5.6885). We hope that this hardware agnostic approach for detection of vital signals will have a huge potential impact in telemedicine, and can be used to tackle challenges, such as continuous non-contact monitoring of neo-natal and elderly patients. An implementation of the algorithm can be found at https://pulser.thinkbiosolution.com

Feasibility of a knowledge translation CME program: Courriels Cochrane.

PubMed

Pluye, Pierre; Grad, Roland; Granikov, Vera; Theriault, Guyléne; Frémont, Pierre; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Arroll, Bruce; Luconi, Francesca; Légaré, France; Labrecque, Michel; Ladouceur, Roger; Bouthillier, France; Sridhar, Soumya Bindiganavile; Moscovici, Jonathan

2012-01-01

Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e-mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation). We recruited French-speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed. The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) conta-ined 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively. Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self-reported knowledge translation associated with Cochrane reviews. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators.

PubMed

Barber, Claire E H; Esdaile, John M; Martin, Liam O; Faris, Peter; Barnabe, Cheryl; Guo, Selynne; Lopatina, Elena; Marshall, Deborah A

2016-11-01

Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.

Long-term biological legacies of herbivore density in a landscape-scale experiment: forest understories reflect past deer density treatments for at least 20 years

Treesearch

Tim Nuttle; Todd E. Ristau; Alejandro A. Royo

2014-01-01

Ungulate browsers, when at high densities, are major drivers of vegetation change in forests world-wide. Their effects operate via a variety of generalizable mechanisms related to plant palatability and relative growth rate with respect to browsing pressure. Though such impacts are obviously long-lasting when they determine composition of tree regeneration, we document...

The Radiologist Is in, but Was it Worth the Wait? Radiology Resident Note Quality in an Outpatient Interventional Radiology Clinic.

PubMed

Abboud, Salim E; Soriano, Stephanie; Abboud, Rayan; Patel, Indravadan; Davidson, Jon; Azar, Nami R; Nakamoto, Dean A

Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents. Copyright © 2017 Elsevier Inc. All rights reserved.

CNS infections in Greenland: A nationwide register-based cohort study

PubMed Central

Nordholm, Anne Christine; Søborg, Bolette; Andersson, Mikael; Hoffmann, Steen; Skinhøj, Peter; Koch, Anders

2017-01-01

Background Indigenous Arctic people suffer from high rates of infectious diseases. However, the burden of central nervous system (CNS) infections is poorly documented. This study aimed to estimate incidence rates and mortality of CNS infections among Inuits and non-Inuits in Greenland and in Denmark. Methods We conducted a nationwide cohort study using the populations of Greenland and Denmark 1990–2012. Information on CNS infection hospitalizations and pathogens was retrieved from national registries and laboratories. Incidence rates were estimated as cases per 100,000 person-years. Incidence rate ratios were calculated using log-linear Poisson-regression. Mortality was estimated using Kaplan-Meier curves and Log Rank test. Results The incidence rate of CNS infections was twice as high in Greenland (35.6 per 100,000 person years) as in Denmark (17.7 per 100,000 person years), but equally high among Inuits in Greenland and Denmark (38.2 and 35.4, respectively). Mortality from CNS infections was 2 fold higher among Inuits (10.5%) than among non-Inuits (4.8%) with a fivefold higher case fatality rate in Inuit toddlers. Conclusion Overall, Inuits living in Greenland and Denmark suffer from twice the rate of CNS infections compared with non-Inuits, and Inuit toddlers carried the highest risk of mortality. Further studies regarding risk factors such as genetic susceptibility, life style and socioeconomic factors are warranted. PMID:28158207

Taking the pressure off the spring: the case of rebounding smoking rates when antitobacco campaigns ceased.

PubMed

Dono, Joanne; Bowden, Jacqueline; Kim, Susan; Miller, Caroline

2018-04-07

Smoking rates have been compared with a spring, requiring continuous downward pressure against protobacco forces, rather than a screw, which once driven down stays down. Quality antitobacco mass media campaigns put downward pressure on smoking rates. The suspension of a major Australian state campaign provided a natural experiment to assess effects on smoking. Furthermore, we document the positive influence of robust monitoring and mature advocacy on the political decision to reinstate funding. We also document the misuse by industry of South Australian smoking data from the period between Australia's implementation and subsequent evaluation of plain packaging. A time series analysis was used to examine monthly smoking prevalence trends at each of four intervention points: (A) commencement of high-intensity mass media campaign (August 2010); (B) introduction of plain packaging (December 2012), (C) defunding of campaign (July 2013); and (D) reinstatement of moderate-intensity campaign (July 2014). The suspension of the antitobacco campaign was disruptive to achieving smoking prevalence targets. There was an absence of a downward monthly smoking prevalence trajectory during the non-campaign period. Moreover, there was a significant decline in smoking prevalence during the period of high-intensity advertising, which continued after the introduction of plain packaging laws, and at the recommencement of campaign activity. While the observed declines in smoking prevalence are likely due to a combination of interventions and cannot be attributed exclusively to antitobacco advertising, the results reinforce the political decision to reinstate the campaign and demonstrate the need for maintained investment to keep downward pressure on smoking rates. © 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.

Fetal Alcohol Syndrome Epidemiology in a South African Community: A Second Study of a Very High Prevalence Area*

PubMed Central

VILJOEN, DENIS L.; PHILLIP GOSSAGE, J.; BROOKE, LESLEY; ADNAMS, COLLEEN M.; JONES, KENNETH L.; ROBINSON, LUTHER K.; EUGENE HOYME, H.; SNELL, CUDORE; KHAOLE, NATHANIEL C.O.; KODITUWAKKU, PIYADASA; ASANTE, KWADWO OHENE; FINDLAY, RICHARD; QUINTON, BARBARA; MARAIS, ANNA-SUSAN; KALBERG, WENDY O.; MAY, PHILIP A.

2006-01-01

Objective: The aim of the study was to determine the prevalence and characteristics of fetal alcohol syndrome (FAS) in a second primary school cohort in a community in South Africa. Method: Active case ascertainment, two-tier screening, and Institute of Medicine assessment methodology were employed among 857 first grade pupils, most born in 1993. Characteristics of children with FAS were contrasted with characteristics of a randomly selected control group from the same classrooms. Physical growth and development, dysmorphology and psychological characteristics of the children and measures of maternal alcohol use and smoking were analyzed. Results: The rate of FAS found in this study is the highest yet reported in any overall community in the world, 65.2-74.2 per 1,000 children in the first grade population. These rates are 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000). Detailed documentation of physical features indicates that FAS children in South Africa have characteristics similar to those elsewhere: poor growth and development, facial and limb dysmorphology, and lower intellectual functioning. Frequent, severe episodic drinking of beer and wine is common among mothers and fathers of FAS children. Their lives are characterized by serious familial, social and economic challenges, compared with controls. Heavy episodic maternal drinking is significantly associated with negative outcomes of children in the area of nonverbal intelligence but even more so in verbal intelligence, behavior and overall dysmorphology (physical anomalies). Significantly more FAS exists among children of women who were rural residents (odds ratio: 7.36, 95% confidence interval: 3.31-16.52), usually among workers on local farms. Conclusion: A high rate of FAS was documented in this community. Given social and economic similarities and racial admixture, we suspect that other communities in the Western Cape have rates that also are quite high. PMID:16331845

Boost OCR accuracy using iVector based system combination approach

NASA Astrophysics Data System (ADS)

Peng, Xujun; Cao, Huaigu; Natarajan, Prem

2015-01-01

Optical character recognition (OCR) is a challenging task because most existing preprocessing approaches are sensitive to writing style, writing material, noises and image resolution. Thus, a single recognition system cannot address all factors of real document images. In this paper, we describe an approach to combine diverse recognition systems by using iVector based features, which is a newly developed method in the field of speaker verification. Prior to system combination, document images are preprocessed and text line images are extracted with different approaches for each system, where iVector is transformed from a high-dimensional supervector of each text line and is used to predict the accuracy of OCR. We merge hypotheses from multiple recognition systems according to the overlap ratio and the predicted OCR score of text line images. We present evaluation results on an Arabic document database where the proposed method is compared against the single best OCR system using word error rate (WER) metric.

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons.

PubMed

Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

2017-10-01

The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that coronary revascularization may be appropriate for the clinical scenario.As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with high symptom burden, high-risk features, and high coronary disease burden, as well as in patients receiving antianginal therapy, are deemed appropriate. Additionally, scenarios assessing the appropriateness of revascularization before kidney transplantation or transcatheter valve therapy are now rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.

Design and performance of SiPM-based readout of PbF 2 crystals for high-rate, precision timing applications

DOE PAGES

Kaspar, J.; Fienberg, A. T.; Hertzog, D. W.; ...

2017-01-11

Here, we have developed a custom amplifier board coupled to a large-format 16-channel Hamamatsu silicon photomultiplier device for use as the light sensor for the electromagnetic calorimeters in the Muon g-2 experiment at Fermilab. The calorimeter absorber is an array of lead-fluoride crystals, which produces short-duration Cherenkov light. The detector sits in the high magnetic field of the muon storage ring. The SiPMs selected, and their accompanying custom electronics, must preserve the short pulse shape, have high quantum efficiency, be non-magnetic, exhibit gain stability under varying rate conditions, and cover a fairly large fraction of the crystal exit surface area.more » We describe an optimized design that employs the new-generation of thru-silicon via devices. As a result, the performance is documented in a series of bench and beam tests.« less

Characterizing acoustic shocks in high-performance jet aircraft flyover noise.

PubMed

Reichman, Brent O; Gee, Kent L; Neilsen, Tracianne B; Downing, J Micah; James, Michael M; Wall, Alan T; McInerny, Sally Anne

2018-03-01

Acoustic shocks have been previously documented in high-amplitude jet noise, including both the near and far fields of military jet aircraft. However, previous investigations into the nature and formation of shocks have historically concentrated on stationary, ground run-up measurements, and previous attempts to connect full-scale ground run-up and flyover measurements have omitted the effect of nonlinear propagation. This paper shows evidence for nonlinear propagation and the presence of acoustic shocks in acoustical measurements of F-35 flyover operations. Pressure waveforms, derivatives, and statistics indicate nonlinear propagation, and the resulting shock formation is significant at high engine powers. Variations due to microphone size, microphone height, and sampling rate are considered, and recommendations for future measurements are made. Metrics indicating nonlinear propagation are shown to be influenced by changes in sampling rate and microphone size, and exhibit less variation due to microphone height.

An analysis of pump cavitation damage. [Space Shuttle main engine high pressure oxidizer turbopump

NASA Technical Reports Server (NTRS)

Brophy, M. C.; Stinebring, D. R.; Billet, M. L.

1985-01-01

The cavitation assessment for the space shuttle main engine high pressure oxidizer turbopump is documented. A model of the flow through the pump was developed. Initially, a computational procedure was used to analyze the flow through the inlet casing including the prediction of wakes downstream of the casing vanes. From these flow calculations, cavitation patterns on the inducer blades were approximated and the damage rate estimated. The model correlates the heavy damage on the housing and over the inducer with unsteady blade surface cavitation. The unsteady blade surface cavitation is due to the large incidence changes caused by the wakes of the upstream vanes. Very high cavitation damage rates are associated with this type of cavitation. Design recommendations for reducing the unsteady cavitation include removing the set of vanes closest to the inducer and modifying the remaining vanes.

A study of pump cavitation damage. [space shuttle main engine high pressure oxidizer turbopump

NASA Technical Reports Server (NTRS)

Brophy, M. C.; Stinebring, D. R.; Billet, M. L.

1983-01-01

The cavitation assessment for the space shuttle main engine high pressure oxidizer turbopump is documented. A model of the flow through the pump was developed. Initially, a computational procedure was used to analyze the flow through the inlet casing including the prediction of wakes downstream of the casing vanes. From these flow calculations, cavitation patterns on the inducer blades were approximated and the damage rate estimated. The model correlates the heavy damage on the housing and over the inducer with unsteady blade surface cavitation. The unsteady blade surface cavitation is due to the large incidence changes caused by the wakes of the upstream vanes. Very high cavitation damage rates are associated with this type of cavitation. Design recommendations for reducing the unsteady cavitation include removing the set of vanes closest to the inducer and modifying the remaining vanes.

Assessment and Documentation Considerations for Postsecondary Students with Learning Disabilities

ERIC Educational Resources Information Center

Lindstrom, Jennifer H.; Lindstrom, Will

2011-01-01

In order to gain access to accommodations and services at colleges and universities, students with learning disabilities must provide documentation of their disabilities, and as students with learning disabilities access higher education at increasing rates, the need for documentation of their disabilities and its impact becomes even more…

7 CFR 1717.303 - Requirements of RUS documents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Federal Pre-emption in Rate Making in Connection With Power Supply Borrowers § 1717.303 Requirements of RUS documents. (a) Pursuant to the terms of the RUS documents each power supply borrower shall... wholesale power contract, the Board of Directors or Board of Trustees of the power supply borrower shall...

7 CFR 1717.303 - Requirements of RUS documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Federal Pre-emption in Rate Making in Connection With Power Supply Borrowers § 1717.303 Requirements of RUS documents. (a) Pursuant to the terms of the RUS documents each power supply borrower shall... wholesale power contract, the Board of Directors or Board of Trustees of the power supply borrower shall...

Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

PubMed

Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen

2018-06-26

Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations. ©Seuli Bose-Brill, Michelle Feeney, Laura Prater, Laura Miles, Angela Corbett, Stephen Koesters. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.06.2018.

ANSI/ASHRAE/IES Standard 90.1-2016 Performance Rating Method Reference Manual

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

Goel, Supriya; Rosenberg, Michael I.; Eley, Charles

This document is intended to be a reference manual for the Appendix G Performance Rating Method (PRM) of ANSI/ASHRAE/IES Standard 90.1-2016 (Standard 90.1-2016). The PRM can be used to demonstrate compliance with the standard and to rate the energy efficiency of commercial and high-rise residential buildings with designs that exceed the requirements of Standard 90.1. Use of the PRM for demonstrating compliance with Standard 90.1 is a new feature of the 2016 edition. The procedures and processes described in this manual are designed to provide consistency and accuracy by filling in gaps and providing additional details needed by users ofmore » the PRM.« less

Female white-tailed deer survival across ecoregions in Minnesota and South Dakota

USGS Publications Warehouse

Grovenburg, T.W.; Swanson, C.C.; Jacques, C.N.; Deperno, C.S.; Klaver, R.W.; Jenks, J.A.

2011-01-01

Survival and cause-specific mortality of female white-tailed deer (Odocoileus virginianus) have been well documented in forested and agricultural landscapes, but limited information has been collected in grassland habitats typical of the Northern Great Plains. Our objectives were to document and compare survival and cause-specific mortality of adult female white-tailed deer in four distinct ecoregions. We captured and radiocollared 190 (159 adult, 31 yearling) female white-tailed deer and monitored (including deer from a previous study) a total of 246 (215 adult, 31 yearling) deer from Jan. 2000 to Dec. 2007. We documented 113 mortalities; hunting (including wounding loss) accounted for 69.9% of all mortalities and vehicle collisions accounted for an additional 15.0%. Natural causes (e.g., disease, predation) of mortality were minor compared to human-related causes (e.g., hunting, vehicle collisions). We used known fate modeling in program MARK to estimate survival rates and compare ecoregions and seasons. Model {Sseason (winter = summer)} had the lowest AICc value suggesting that survival differed only between seasons where winter and summer survival was equal and differed with fall season. Annual and seasonal (summer, fall, winter) survival rates using the top model {Sseason (summer = winter)} were 0.76 (95% ci  =  0.70–0.80), 0.97 (95% ci  =  0.96–0.98), 0.80 (95% ci  =  0.76–0.83) and 0.97 (95% ci  =  0.96–0.98), respectively. High human-related mortality was likely associated with limited permanent cover, extensive road networks and high hunter density. Deer management in four distinct ecoregions relies on hunter harvest to maintain deer populations within state management goals.

Deferred modification of antiretroviral regimen following documented treatment failure in Asia: results from the TREAT Asia HIV Observational Database (TAHOD)

PubMed Central

Zhou, J; Li, PCK; Kumarasamy, N; Boyd, M; Chen, YMA; Sirisanthana, T; Sungkanuparph, S; Oka, S; Tau, G; Phanuphak, P; Saphonn, V; Zhang, FJ; Omar, SFS; Lee, CKC; Ditangco, R; Merati, TP; Lim, PL; Choi, JY; Law, MG; Pujari, S

2010-01-01

Objective The aim of the study was to examine the rates and predictors of treatment modification following combination antiretroviral therapy (cART) failure in Asian patients with HIV enrolled in the TREAT Asia HIV Observational Database (TAHOD). Methods Treatment failure (immunological, virological and clinical) was defined by World Health Organization criteria. Countries were categorized as high or low income by World Bank criteria. Results Among 2446 patients who initiated cART, 447 were documented to have developed treatment failure over 5697 person-years (7.8 per 100 person-years). A total of 253 patients changed at least one drug after failure (51.6 per 100 person-years). There was no difference between patients from high- and low-income countries [adjusted hazard ratio (HR) 1.02; P = 0.891]. Advanced disease stage [Centers for Disease Control and Prevention (CDC) category C vs. A; adjusted HR 1.38, P = 0.040], a lower CD4 count (≥ 51 cells/μL vs. ≤ 50 cells/μL; adjusted HR 0.61, P = 0.022) and a higher HIV viral load (≥ 400 HIV-1 RNA copies/mL vs. < 400 copies/mL; adjusted HR 2.69, P < 0.001) were associated with a higher rate of treatment modification after failure. Compared with patients from low-income countries, patients from high-income countries were more likely to change two or more drugs (67% vs. 49%; P = 0.009) and to change to a protease-inhibitor-containing regimen (48% vs. 16%; P< 0.001). Conclusions In a cohort of Asian patients with HIV infection, nearly half remained on the failing regimen in the first year following documented treatment failure. This deferred modification is likely to have negative implications for accumulation of drug resistance and response to second-line treatment. There is a need to scale up the availability of second-line regimens and virological monitoring in this region. PMID:19601993

Determination of Lowest Achievable Emission Rate for Coors Container Corporation

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Transfer of Technology in Determining Lowest Achievable Emission Rate (LAER)

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Helping Clinicians Prevent Pregnancy among Sexually Active Adolescents: U.S. Medical Eligibility Criteria for Contraceptive Use and U.S. Selected Practice Recommendations for Contraceptive Use.

PubMed

Godfrey, Emily M

2015-08-01

The United States has made substantial progress in reducing teenage birth rates in recent decades, but rates remain high. Teen pregnancy can increase the risk of poor health outcomes and lead to decreased educational attainment, increased poverty, and welfare use, as well as increased cost to taxpayers. One of the most effective ways to prevent teenage pregnancy is through the use of effective birth control methods. The Centers for Disease Control (CDC) and Prevention has made the prevention of teenage pregnancy 1 of its 10 winnable battles. The CDC has released 2 evidence-based clinical guideline documents regarding contraceptive use for adolescents and adults. The first guideline, US Medical Eligibility Criteria for Contraceptive Use, 2010, helps clinicians recognize when a contraceptive method may not be safe to use for a particular adolescent but also when not to withhold a contraceptive method that is safe to use. The second document, US Selected Practice Recommendations for Contraceptive Use, 2013, provides guidance for how to use contraceptive methods safely and effectively once they are deemed safe. Health care providers are encouraged to use these documents to provide safe and effective contraceptive care to patients seeking family planning, including adolescents. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. All rights reserved.

The public health aspects of complex emergencies and refugee situations.

PubMed

Toole, M J; Waldman, R J

1997-01-01

Populations affected by armed conflict have experienced severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons have experienced high mortality rates during the period immediately following their migration. In Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrheal diseases, measles, acute respiratory infections, and malaria. High prevalences of acute malnutrition have contributed to high case fatality rates. In conflict-affected European countries, such as the former Yugoslavia, Georgia, Azerbaijan, and Chechnya, war-related injuries have been the most common cause of death among civilian populations; however, increased incidence of communicable diseases, neonatal health problems, and nutritional deficiencies (especially among the elderly) have been documented. The most effective measures to prevent mortality and morbidity in complex emergencies include protection from violence; the provision of adequate food rations, clean water and sanitation; diarrheal disease control; measles immunization; maternal and child health care, including the case management of common endemic communicable diseases; and selective feeding programs, when indicated.

Composition of a dewarped and enhanced document image from two view images.

PubMed

Koo, Hyung Il; Kim, Jinho; Cho, Nam Ik

2009-07-01

In this paper, we propose an algorithm to compose a geometrically dewarped and visually enhanced image from two document images taken by a digital camera at different angles. Unlike the conventional works that require special equipment or assumptions on the contents of books or complicated image acquisition steps, we estimate the unfolded book or document surface from the corresponding points between two images. For this purpose, the surface and camera matrices are estimated using structure reconstruction, 3-D projection analysis, and random sample consensus-based curve fitting with the cylindrical surface model. Because we do not need any assumption on the contents of books, the proposed method can be applied not only to optical character recognition (OCR), but also to the high-quality digitization of pictures in documents. In addition to the dewarping for a structurally better image, image mosaic is also performed for further improving the visual quality. By finding better parts of images (with less out of focus blur and/or without specular reflections) from either of views, we compose a better image by stitching and blending them. These processes are formulated as energy minimization problems that can be solved using a graph cut method. Experiments on many kinds of book or document images show that the proposed algorithm robustly works and yields visually pleasing results. Also, the OCR rate of the resulting image is comparable to that of document images from a flatbed scanner.

Variations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures.

PubMed

Bohl, Daniel D; Russo, Glenn S; Basques, Bryce A; Golinvaux, Nicholas S; Fu, Michael C; Long, William D; Grauer, Jonathan N

2014-12-03

There has been an increasing use of national databases to conduct orthopaedic research. Questions regarding the validity and consistency of these studies have not been fully addressed. The purpose of this study was to test for similarity in reported measures between two national databases commonly used for orthopaedic research. A retrospective cohort study of patients undergoing lumbar spinal fusion procedures during 2009 to 2011 was performed in two national databases: the Nationwide Inpatient Sample and the National Surgical Quality Improvement Program. Demographic characteristics, comorbidities, and inpatient adverse events were directly compared between databases. The total numbers of patients included were 144,098 from the Nationwide Inpatient Sample and 8434 from the National Surgical Quality Improvement Program. There were only small differences in demographic characteristics between the two databases. There were large differences between databases in the rates at which specific comorbidities were documented. Non-morbid obesity was documented at rates of 9.33% in the Nationwide Inpatient Sample and 36.93% in the National Surgical Quality Improvement Program (relative risk, 0.25; p < 0.05). Peripheral vascular disease was documented at rates of 2.35% in the Nationwide Inpatient Sample and 0.60% in the National Surgical Quality Improvement Program (relative risk, 3.89; p < 0.05). Similarly, there were large differences between databases in the rates at which specific inpatient adverse events were documented. Sepsis was documented at rates of 0.38% in the Nationwide Inpatient Sample and 0.81% in the National Surgical Quality Improvement Program (relative risk, 0.47; p < 0.05). Acute kidney injury was documented at rates of 1.79% in the Nationwide Inpatient Sample and 0.21% in the National Surgical Quality Improvement Program (relative risk, 8.54; p < 0.05). As database studies become more prevalent in orthopaedic surgery, authors, reviewers, and readers should view these studies with caution. This study shows that two commonly used databases can identify demographically similar patients undergoing a common orthopaedic procedure; however, the databases document markedly different rates of comorbidities and inpatient adverse events. The differences are likely the result of the very different mechanisms through which the databases collect their comorbidity and adverse event data. Findings highlight concerns regarding the validity of orthopaedic database research. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Rating educational quality: factors in the erosion of professional standards.

PubMed

Albanese, M

1999-06-01

Changes in the health care environment are putting increasing pressure on medical schools to make faculty accountable and to document the quality of the medical education they provide. Faculty's ratings of students' performances and students' ratings of faculty's teaching are important elements in these efforts to document educational quality. This article discusses selected research related to factors affecting raters' judgments, analyzes how changes in the health care environment are influencing such judgments, and links these influences to the system that upholds professional standards. Ratings are known to have a positive bias (generosity error), provide limited discrimination, and often fail to document serious deficits. The potential sources of these problems relate to the mechanics of the rating task, the system used to obtain ratings, and factors affecting rater judgment. As managed care demands reduce the time faculty have for teaching, as system-wide disincentives to provide negative ratings proliferate, and as social engineering challenges, such as the Americans with Disabilities Act, impose differential standards for students, the natural tendency to avoid giving negative ratings becomes even harder to resist. Ultimately, these forces compromise the capability of faculty to uphold the standards of the profession. The author calls for a national effort to stem the erosion of those standards.

Role of Federal Food Assistance Programs in Strategies To Reduce Infant Mortality. Hearing before the Domestic Task Force of the Select Committee on Hunger. House of Representatives, One Hundredth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Select Committee on Hunger.

This document presents oral and written testimony concerning the effectiveness of federal assistance programs in reducing infant mortality. In opening statements, members of the House Select Committee on Hunger voiced their concern over the persistence of high infant death rates among minorities, the rural poor, and urban populations, despite…

Dynamic Pressure Induced Transformation Toughening and Strengthening in Bulk Metallic Glasses

DTIC Science & Technology

2013-11-01

involved impact of 303 stainless steel flyer-plate on 303 stainless steel sample holder containing two BMGMC samples, at varying velocities. The Hugoniot...Technology. An aluminum sabot was used as the projectile with 303 Stainless Steel (SS) flyer plate to impact the DV1 bulk metallic glass composite. As...crystallization; polyamorphism; shear banding; high- strain -rate deformation REPORT DOCUMENTATION PAGE 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 10. SPONSOR

Computational Flow Analysis of Ultra High Pressure Firefighting Technology with Application to Long Range Nozzle Design

DTIC Science & Technology

2010-03-01

release; distribution unlimited. Ref AFRL/RXQ Public Affairs Case # 10-100. Document contains color images . Although aqueous fire fighting agent...in conjunction with the standard Eulerian multiphase flow model. The two- equation k- model was selected due to its wide industrial application in...energy (k) and its dissipation rate (). Because of their heuristic development, RANS models have applicable limitations and in general must be

Usability Assessment of Secure Messaging for Clinical Document Sharing between Health Care Providers and Patients.

PubMed

Jahn, Michelle A; Porter, Brian W; Patel, Himalaya; Zillich, Alan J; Simon, Steven R; Russ, Alissa L

2018-04-01

 Web-based patient portals feature secure messaging systems that enable health care providers and patients to communicate information. However, little is known about the usability of these systems for clinical document sharing.  This article evaluates the usability of a secure messaging system for providers and patients in terms of its ability to support sharing of electronic clinical documents.  We conducted usability testing with providers and patients in a human-computer interaction laboratory at a Midwestern U.S. hospital. Providers sent a medication list document to a fictitious patient via secure messaging. Separately, patients retrieved the clinical document from a secure message and returned it to a fictitious provider. We collected use errors, task completion, task time, and satisfaction.  Twenty-nine individuals participated: 19 providers (6 physicians, 6 registered nurses, and 7 pharmacists) and 10 patients. Among providers, 11 (58%) attached and sent the clinical document via secure messaging without requiring assistance, in a median (range) of 4.5 (1.8-12.7) minutes. No patients completed tasks without moderator assistance. Patients accessed the secure messaging system within 3.6 (1.2-15.0) minutes; retrieved the clinical document within 0.8 (0.5-5.7) minutes; and sent the attached clinical document in 6.3 (1.5-18.1) minutes. Although median satisfaction ratings were high, with 5.8 for providers and 6.0 for patients (scale, 0-7), we identified 36 different use errors. Physicians and pharmacists requested additional features to support care coordination via health information technology, while nurses requested features to support efficiency for their tasks.  This study examined the usability of clinical document sharing, a key feature of many secure messaging systems. Our results highlight similarities and differences between provider and patient end-user groups, which can inform secure messaging design to improve learnability and efficiency. The observations suggest recommendations for improving the technical aspects of secure messaging for clinical document sharing. Schattauer GmbH Stuttgart.

Point of care experience with pneumococcal and influenza vaccine documentation among persons aged ≥65 years: high refusal rates and missing information.

PubMed

Brownfield, Elisha; Marsden, Justin E; Iverson, Patty J; Zhao, Yumin; Mauldin, Patrick D; Moran, William P

2012-09-01

Missed opportunities to vaccinate and refusal of vaccine by patients have hindered the achievement of national health care goals. The meaningful use of electronic medical records should improve vaccination rates, but few studies have examined the content of these records. In our vaccine intervention program using an electronic record with physician prompts, paper prompts, and nursing standing orders, we were unable to achieve national vaccine goals, due in large part to missing information and patient refusal. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Aircraft and satellite thermographic systems for wildfire mapping and assessment

NASA Technical Reports Server (NTRS)

Brass, J. A.; Arvesen, J. C.; Ambrosia, V. G.; Riggan, P. J.; Myers, J. S.

1987-01-01

Two complementary sensors, the DAEDALUS DEI-1260 Multispectral Scanner aboard the NASA U-2 aircraft and the Advanced Very High Resolution Radiometer aboard National Oceanographic and Atmospheric Administration orbiting satellites were tested for their applicability in monitoring and predicting parameters such as fire location, temperature and rate of spread, soil heating and cooling rates, and plume characteristics and dimensions. In addition, the satellite system was tested for its ability to extend the relationships found between fire characteristics and biospheric consequences to regional and global scales. An overall system design is presented, and special requirements are documented for the application of this system for fire research and management.

Delayed gamma-ray spectroscopy with lanthanum bromide detector for non-destructive assay of nuclear material

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

Favalli, Andrea; Iliev, Metodi; Ianakiev, Kiril

High-energy delayed γ-ray spectroscopy is a potential technique for directly assaying spent fuel assemblies and achieving the safeguards goal of quantifying nuclear material inventories for spent fuel handling, interim storage, reprocessing facilities, repository sites, and final disposal. Requirements for the γ-ray detection system, up to ~6 MeV, can be summarized as follows: high efficiency at high γ-ray energies, high energy resolution, good linearity between γ-ray energy and output signal amplitude, ability to operate at very high count rates, and ease of use in industrial environments such as nuclear facilities. High Purity Germanium Detectors (HPGe) are the state of the artmore » and provide excellent energy resolution but are limited in their count rate capability. Lanthanum Bromide (LaBr 3) scintillation detectors offer significantly higher count rate capabilities at lower energy resolution. Thus, LaBr 3 detectors may be an effective alternative for nuclear spent-fuel applications, where count-rate capability is a requirement. This paper documents the measured performance of a 2” (length) × 2” (diameter) of LaBr3 scintillation detector system, coupled to a negatively biased PMT and a tapered active high voltage divider, with count-rates up to ~3 Mcps. An experimental methodology was developed that uses the average current from the PMT’s anode and a dual source method to characterize the detector system at specific very high count rate values. Delayed γ-ray spectra were acquired with the LaBr 3 detector system at the Idaho Accelerator Center, Idaho State University, where samples of ~3g of 235U were irradiated with moderated neutrons from a photo-neutron source. Results of the spectroscopy characterization and analysis of the delayed γ-ray spectra acquired indicate the possible use of LaBr3 scintillation detectors when high count rate capability may outweigh the lower energy resolution.« less

Delayed gamma-ray spectroscopy with lanthanum bromide detector for non-destructive assay of nuclear material

DOE PAGES

Favalli, Andrea; Iliev, Metodi; Ianakiev, Kiril; ...

2017-10-09

High-energy delayed γ-ray spectroscopy is a potential technique for directly assaying spent fuel assemblies and achieving the safeguards goal of quantifying nuclear material inventories for spent fuel handling, interim storage, reprocessing facilities, repository sites, and final disposal. Requirements for the γ-ray detection system, up to ~6 MeV, can be summarized as follows: high efficiency at high γ-ray energies, high energy resolution, good linearity between γ-ray energy and output signal amplitude, ability to operate at very high count rates, and ease of use in industrial environments such as nuclear facilities. High Purity Germanium Detectors (HPGe) are the state of the artmore » and provide excellent energy resolution but are limited in their count rate capability. Lanthanum Bromide (LaBr 3) scintillation detectors offer significantly higher count rate capabilities at lower energy resolution. Thus, LaBr 3 detectors may be an effective alternative for nuclear spent-fuel applications, where count-rate capability is a requirement. This paper documents the measured performance of a 2” (length) × 2” (diameter) of LaBr3 scintillation detector system, coupled to a negatively biased PMT and a tapered active high voltage divider, with count-rates up to ~3 Mcps. An experimental methodology was developed that uses the average current from the PMT’s anode and a dual source method to characterize the detector system at specific very high count rate values. Delayed γ-ray spectra were acquired with the LaBr 3 detector system at the Idaho Accelerator Center, Idaho State University, where samples of ~3g of 235U were irradiated with moderated neutrons from a photo-neutron source. Results of the spectroscopy characterization and analysis of the delayed γ-ray spectra acquired indicate the possible use of LaBr3 scintillation detectors when high count rate capability may outweigh the lower energy resolution.« less

Delayed gamma-ray spectroscopy with lanthanum bromide detector for non-destructive assay of nuclear material

NASA Astrophysics Data System (ADS)

Favalli, Andrea; Iliev, Metodi; Ianakiev, Kiril; Hunt, Alan W.; Ludewigt, Bernhard

2018-01-01

High-energy delayed γ-ray spectroscopy is a potential technique for directly assaying spent fuel assemblies and achieving the safeguards goal of quantifying nuclear material inventories for spent fuel handling, interim storage, reprocessing facilities, repository sites, and final disposal. Requirements for the γ-ray detection system, up to ∼6 MeV, can be summarized as follows: high efficiency at high γ-ray energies, high energy resolution, good linearity between γ-ray energy and output signal amplitude, ability to operate at very high count rates, and ease of use in industrial environments such as nuclear facilities. High Purity Germanium Detectors (HPGe) are the state of the art and provide excellent energy resolution but are limited in their count rate capability. Lanthanum Bromide (LaBr3) scintillation detectors offer significantly higher count rate capabilities at lower energy resolution. Thus, LaBr3 detectors may be an effective alternative for nuclear spent-fuel applications, where count-rate capability is a requirement. This paper documents the measured performance of a 2" (length) × 2" (diameter) of LaBr3 scintillation detector system, coupled to a negatively biased PMT and a tapered active high voltage divider, with count-rates up to ∼3 Mcps. An experimental methodology was developed that uses the average current from the PMT's anode and a dual source method to characterize the detector system at specific very high count rate values. Delayed γ-ray spectra were acquired with the LaBr3 detector system at the Idaho Accelerator Center, Idaho State University, where samples of ∼3g of 235U were irradiated with moderated neutrons from a photo-neutron source. Results of the spectroscopy characterization and analysis of the delayed γ-ray spectra acquired indicate the possible use of LaBr3 scintillation detectors when high count rate capability may outweigh the lower energy resolution.

Evaluating the impact of an educational intervention on documentation of decision-making capacity in an emergency medical services system.

PubMed

Riley, Jennifer; Burgess, Rob; Schwartz, Brian

2004-07-01

To compare the documentation of decision-making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention. The intervention comprised a one-and-a-half-hour module on assessment and documentation of decision-making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two-month periods, and refusals of transport were recorded. Provider compliance with documentation of decision-making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty-percent double data entry was undertaken to evaluate accuracy. Ninety-five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation. From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods). An educational intervention resulted in no change in the rate of decision-making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients.

Discharge documentation of patients discharged to subacute facilities: a three-year quality improvement process across an integrated health care system.

PubMed

Gandara, Esteban; Ungar, Jonathan; Lee, Jason; Chan-Macrae, Myrna; O'Malley, Terrence; Schnipper, Jeffrey L

2010-06-01

Effective communication among physicians during hospital discharge is critical to patient care. Partners Healthcare (Boston) has been engaged in a multi-year process to measure and improve the quality of documentation of all patients discharged from its five acute care hospitals to subacute facilities. Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was established and later refined. Quality improvement interventions were then initiated to address measured deficiencies and included education of physicians and nurses, improvements in information technology, creation of or improvements in discharge documentation templates, training of hospitalists to serve as role models, feedback to physicians and their service chiefs regarding reviewed cases, and case manager review of documentation before discharge. To measure improvement in quality as a result of these efforts, rates of simultaneous inclusion of all 12 applicable data elements ("defect-free rate") were analyzed over time. Some 3,101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008 were retrospectively studied. During the 11 monitored quarters, the defect-free rate increased from 65% to 96% (p < .001 for trend). The largest improvements were seen in documentation of preadmission medication lists, allergies, follow-up, and warfarin information. Institution of rigorous measurement, feedback, and multidisciplinary, multimodal quality improvement processes improved the inclusion of data elements in discharge documentation required for safe hospital discharge across a large integrated health care system.

Impact of Quality Improvement Educational Interventions on Documented Adherence to Quality Measures for Adults with Crohn's Disease.

PubMed

Greene, Laurence; Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Patel, Barry; Higgins, Peter D R

2015-09-01

In recent years, leading organizations in inflammatory bowel disease (IBD) have developed quality measures for the care of adults with Crohn's disease or ulcerative colitis. We used chart audits to assess the impact of quality improvement educational activities on documented adherence to Physician Quality Reporting System measures for IBD. Twenty community-based gastroenterologists were recruited to participate in baseline chart audits (n = 200), a series of 4 accredited educational activities with feedback, and follow-up chart audits (n = 200). Trained abstractors reviewed randomly selected charts of adults with moderate or severe Crohn's disease. The charts were retrospectively abstracted for physicians' documented performance of the 2013 Physician Quality Reporting System IBD quality measures. We compared the physicians' baseline and posteducation rates of documented adherence with 10 of these measures. In a secondary analysis, we compared preeducation with posteducation difference scores of low-performing physicians, those whose baseline documentation rates were in the lowest quartile, and the rest of the cohort. At baseline, documentation of mean provider-level adherence to the 10 quality measures ranged from 3% to 98% (grand mean = 35.8%). In the overall analysis, baseline and posteducation rates of documented adherence did not differ significantly for any of the measures. However, for 4 measures, preeducation to posteducation difference scores were significantly greater among low performers than physicians in the highest 3 quartiles. The results of this preliminary pragmatic study indicate that quality improvement education affords the potential to improve adherence to Physician Quality Reporting System quality measures for IBD among low-performing gastroenterologists.

Care planning for aggression management in a specialist secure mental health service: An audit of user involvement.

PubMed

Hallett, Nutmeg; Huber, Jörg W; Sixsmith, Judith; Dickens, Geoffrey L

2016-12-01

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation. © 2016 Australian College of Mental Health Nurses Inc.

32 CFR 2700.33 - Mandatory review for declassification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... made more specific, no further action will be taken. (4) Subject to paragraph (b)(7) of this section... one hour. (ii) Reproduction of documents: Documents will be reproduced at a rate of $.25 per page for all copying of four pages or more. No fee shall be assessed for reproducing documents which are three...

32 CFR 2700.33 - Mandatory review for declassification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... made more specific, no further action will be taken. (4) Subject to paragraph (b)(7) of this section... one hour. (ii) Reproduction of documents: Documents will be reproduced at a rate of $.25 per page for all copying of four pages or more. No fee shall be assessed for reproducing documents which are three...

32 CFR 2700.33 - Mandatory review for declassification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... made more specific, no further action will be taken. (4) Subject to paragraph (b)(7) of this section... one hour. (ii) Reproduction of documents: Documents will be reproduced at a rate of $.25 per page for all copying of four pages or more. No fee shall be assessed for reproducing documents which are three...

Ethnicity, Race, Class, and Adolescent Violence. Center Paper 006.

ERIC Educational Resources Information Center

Hawkins, Darnell F.

This document critically reviews the empirical evidence and theories that have emerged to document and explain ethnic, racial, and class differences in the rate of adolescent involvement in interpersonal violence. In the first section, recent data are presented on the incidence of violence among adolescents in the United States as documented in…

78 FR 69928 - 35th Meeting: RTCA Special Committee 206, Aeronautical Information and Meteorological Data Link...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-21

...-Groups meetings SG4: SE2020 Eddy Dissipation Rate (EDR) Turbulence Project Plenary--SG3 Architecture Document FRAC Resolution 11 December Plenary--SG3 Architecture Document FRAC Resolution Sub-Group Meetings 12 December Plenary--SG3 Architecture Document FRAC Resolution Sub-Group Meetings 13 December Closing...

Irreverent Soils: Nitrogen Dynamics In Taiga Forests During Winter

NASA Astrophysics Data System (ADS)

Kielland, K.

2003-12-01

We measured annual net nitrogen mineralization, nitrification, and amino acid production in situ across a primary successional sequence in interior Alaska, USA. Net N mineralization rates during the growing season from green-up (late May) through freeze-up (late September) accounted for approximately 60% of the annual inorganic N flux, whereas the remaining N was released during the apparent dormant season. Nitrogen release during winter occurred primarily during October-January with only negligible N mineralization during early spring in stands of willow, alder, balsam poplar and white spruce. By contrast, black spruce stands also exhibited substantial mineralization after snow melt during early spring. The high rates of N mineralization in late autumn through early winter coincides with high turnover of fine root biomass in these stands, suggesting that labile substrate production, rather than temperature, is a major controlling factor over N release in these ecosystems. The results are consistent with the low temperature sensitivity of N mineralization previously documented for taiga soils, and demonstrate that measurements of soil processes restricted to the growing season may greatly underestimate annual flux rates of inorganic nitrogen in high-latitude ecosystems.

An investigation and analysis of safety issues in Polish small construction plants.

PubMed

Dąbrowski, Andrzej

2015-01-01

The construction industry is a booming sector of the Polish economy; however, it is stigmatised by a lower classification due to high occupational risks and an unsatisfactory state of occupational safety. Safety on construction sites is compromised by small construction firms which dominate the market and have high accident rates. This article presents the results of studies (using a checklist) conducted in small Polish construction companies in terms of selected aspects of safety, such as co-operation with the general contractor, occupational health and safety documents, occupational risk assessment, organization of work, protective gear and general work equipment. The mentioned studies and analyses provided the grounds to establish the main directions of preventive measures decreasing occupational risk in small construction companies, e.g., an increase in engagement of investors and general contractors, improvement of occupational health and safety (OSH) documents, an increase in efficiency of construction site managers, better stability of employment and removal of opposing objectives between economic strategy and work safety.

Garment workers in California: health outcomes of the Asian Immigrant Women Workers Clinic.

PubMed

Burgel, Barbara J; Lashuay, Nan; Israel, Leslie; Harrison, Robert

2004-11-01

In this cross sectional descriptive study, the demographics, risk factors, and health outcomes of a volunteer, symptomatic sample of monolingual Cantonese garment workers in the Oakland, California Chinatown area are documented. Methods included a questionnaire and clinical examination and treatment at the Asian Immigrant Women Workers Clinic, a free clinic providing culturally focused occupational health consultation and treatment for painful musculoskeletal disorders. Because garment work involves highly repetitious, sustained awkward postures, focused education on stretching and ergonomics also was provided. Results from the first 100 clients revealed a highly symptomatic sample, with an average age of 48.7 years. Sixty-six percent rated their health status as fair or poor. Sixteen percent of the sample had nerve entrapments, and 99% had a diagnosed strain or sprain of the spine or upper extremities. This population did not file workers' compensation claims because of a lack of knowledge and a fear of reprisal. This study documented the barriers to seeking care for this low wage, immigrant population.

An investigation and analysis of safety issues in Polish small construction plants

PubMed Central

Dąbrowski, Andrzej

2015-01-01

The construction industry is a booming sector of the Polish economy; however, it is stigmatised by a lower classification due to high occupational risks and an unsatisfactory state of occupational safety. Safety on construction sites is compromised by small construction firms which dominate the market and have high accident rates. This article presents the results of studies (using a checklist) conducted in small Polish construction companies in terms of selected aspects of safety, such as co-operation with the general contractor, occupational health and safety documents, occupational risk assessment, organization of work, protective gear and general work equipment. The mentioned studies and analyses provided the grounds to establish the main directions of preventive measures decreasing occupational risk in small construction companies, e.g., an increase in engagement of investors and general contractors, improvement of occupational health and safety (OSH) documents, an increase in efficiency of construction site managers, better stability of employment and removal of opposing objectives between economic strategy and work safety. PMID:26694002

Mass storage technology in networks

NASA Astrophysics Data System (ADS)

Ishii, Katsunori; Takeda, Toru; Itao, Kiyoshi; Kaneko, Reizo

1990-08-01

Trends and features of mass storage subsystems in network are surveyed and their key technologies spotlighted. Storage subsystems are becoming increasingly important in new network systems in which communications and data processing are systematically combined. These systems require a new class of high-performance mass-information storage in order to effectively utilize their processing power. The requirements of high transfer rates, high transactional rates and large storage capacities, coupled with high functionality, fault tolerance and flexibility in configuration, are major challenges in storage subsystems. Recent progress in optical disk technology has resulted in improved performance of on-line external memories to optical disk drives, which are competing with mid-range magnetic disks. Optical disks are more effective than magnetic disks in using low-traffic random-access file storing multimedia data that requires large capacity, such as in archive use and in information distribution use by ROM disks. Finally, it demonstrates image coded document file servers for local area network use that employ 130mm rewritable magneto-optical disk subsystems.

NOTE: Monte Carlo evaluation of kerma in an HDR brachytherapy bunker

NASA Astrophysics Data System (ADS)

Pérez-Calatayud, J.; Granero, D.; Ballester, F.; Casal, E.; Crispin, V.; Puchades, V.; León, A.; Verdú, G.

2004-12-01

In recent years, the use of high dose rate (HDR) after-loader machines has greatly increased due to the shift from traditional Cs-137/Ir-192 low dose rate (LDR) to HDR brachytherapy. The method used to calculate the required concrete and, where appropriate, lead shielding in the door is based on analytical methods provided by documents published by the ICRP, the IAEA and the NCRP. The purpose of this study is to perform a more realistic kerma evaluation at the entrance maze door of an HDR bunker using the Monte Carlo code GEANT4. The Monte Carlo results were validated experimentally. The spectrum at the maze entrance door, obtained with Monte Carlo, has an average energy of about 110 keV, maintaining a similar value along the length of the maze. The comparison of results from the aforementioned values with the Monte Carlo ones shows that results obtained using the albedo coefficient from the ICRP document more closely match those given by the Monte Carlo method, although the maximum value given by MC calculations is 30% greater.

Rates of sexual history taking and screening in HIV-positive men who have sex with men.

PubMed

MacRae, Alasdair; Lord, Emily; Forsythe, Annabel; Sherrard, Jackie

2017-03-01

A case note audit was undertaken of HIV-positive men who have sex with men (MSM) to ascertain whether national guidelines for taking sexual histories, including recreational drug use and sexually transmitted infection (STI) screening were being met. The notes of 142 HIV-positive men seen in 2015 were available, of whom 85 were MSM. Information was collected regarding sexual history, recreational drug use documentation, sexually transmitted infection screen offer and test results. Seventy-seven (91%) of the MSM had a sexual history documented, of whom 60 (78%) were sexually active. STI screens were offered to 58/60 (97%) of those who were sexually active and accepted by 53 (91%). Twelve (23%) of these had an STI. A recreational drug history was taken in 63 (74%) with 17 (27%) reporting use and 3 (5%) chemsex. The high rate of STIs highlights that regular screening in this group is essential. Additionally, the fact that over a quarter reported recreational drug use and given the increasing concern around chemsex, questions about this should be incorporated into the sexual history proforma.

British American Tobacco's failure in Turkey.

PubMed

Lawrence, S

2009-02-01

Transnational tobacco companies (TTCs) considered Turkey an important, potential investment market because of its high consumption rates and domestic commitment to tobacco. This paper outlines how British American Tobacco (BAT) attempted to establish a joint venture with the government monopoly TEKEL, while waiting for privatisation and a private tender. Analysis of tobacco industry documents from the Guildford Depository and online tobacco document sources. BAT failed to establish a market share in Turkey until 2000 despite repeated attempts to form a joint venture with Turkey's tobacco monopoly, TEKEL, once the market liberalised in the mid 1980s. BAT's failure in the Turkish market was due to a misguided investment strategy focused solely on acquiring TEKEL and is contrasted with Philip Morris success in Turkey despite both TTCs working within Turkey's unstable and corrupt investing climate.

CMS proposes to OK one-midnight inpatient stays.

PubMed

2015-09-01

The Centers for Medicare & Medicaid Services (CMS) has proposed that stays shorter than two midnights be reimbursed as inpatient stays if the documentation in the medical record supports it. CMS made the proposal in the Outpatient Prospective Payment System proposed rule for 2016 and left the policy unchanged for stays of two midnights or longer. CMS also announced that the two Beneficiary and Family Centered Care Quality Improvement Organizations (QIOs), Livanta and KEPRO, will take over the responsibility of Probe and Educate and will review cases for medical necessity when patient stays are one midnight or less, referring hospitals with high denial rates to the Recovery Auditors. Case managers should continue to assist physicians in determining patient status and to make sure that the documentation is complete, accurate, and specifies the severity of illness.

The quality of primary care provided to the elderly in Israel.

PubMed

Podell, Rachel; Shriqui, Vered Kaufman; Sagy, Yael Wolff; Manor, Orly; Ben-Yehuda, Arie

2018-06-04

In view of increasing global and local trends in population ageing and the high healthcare utilization rates among the elderly, this study assesses the quality of primary care provided to the elderly population in Israel. It examines changes in quality over time, how quality varies across sub-groups of the elderly, and how quality in Israel compares with other countries. Data originate from the National Program for Quality Indicators in Community Healthcare (QICH), which operates in full collaboration with Israel's four HMOs. The study population included all elderly Israeli residents aged 65 years or older during 2002-2015 (N = 879,671 residents in 2015). Seven elderly-specific quality indicators from within the QICH framework were included: influenza and pneumococcal vaccinations, benzodiazepine overuse, long-acting benzodiazepine use, body weight documentation, weight loss and underweight. In addition, two non-age specific quality indicators relating to diabetes mellitus were included: the rate of HbA1C documentation and uncontrolled diabetes. Data were collected from patient electronic medical records (EMR) in accordance with each HMO, and aggregated by three variables: gender, age, and socio-economic position (SEP). During the measurement period, vaccination rates significantly increased (Influenza: from 42.0% in 2002 to 63.2% in 2015; and pneumococcal vaccination: from 25.8% in 2005 to 77.0% in 2015). Body weight documentation (in 65-74 year old persons) increased from only 16.3% in 2003 to 80.9% in 2015. The rate of underweight (BMI < 23 kg/m 2 ) and significant weight-loss (10% or more of their body weight) was only measured in 2015. The overall rate of benzodiazepine overuse remained steady from 2011 to 2015 at around 5%, while the rate of long-acting benzodiazepine use decreased from 3.8% in 2011 to 2.4% in 2015. The rate of HbA1c documentation for elderly diabetics was higher than for non-elderly diabetics in 2015 (92.2% vs 87.9%). The rate of uncontrolled diabetes was lower for the elderly than the non-elderly population in 2015 (6.9% vs. 15.7%). Gender disparities were observed across all measures, after age stratification, with worse indicator rates among females compared to males. SEP-disparities were not consistent across measures. In all indicators except benzodiazepine overuse, Israel showed a higher quality of care for the elderly in comparison with the international healthcare community. Overall, the quality of care received by elderly Israelis has improved substantially since measurements first began; yet, females receive lower quality care than males. Monitoring results of primary care quality indicators can contribute to population's successful aging; both chronic conditions at earlier ages (e.g. diabetes), and short-term hazardous conditions such as the use of potentially harmful medications and weight loss should be evaluated.

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities

PubMed Central

Karb, Rebecca A.; Subramanian, S. V.; Fleegler, Eric W.

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999–2012. Complete annual compressed mortality and population data for 1999–2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty. PMID:27144919

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities.

PubMed

Karb, Rebecca A; Subramanian, S V; Fleegler, Eric W

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999-2012. Complete annual compressed mortality and population data for 1999-2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty.

When and how do GPs record vital signs in children with acute infections? A cross-sectional study

PubMed Central

Blacklock, Claire; Haj-Hassan, Tanya Ali; Thompson, Matthew J

2012-01-01

Background NICE recommendations and evidence from ambulatory settings promotes the use of vital signs in identifying serious infections in children. This appears to differ from usual clinical practice where GPs report measuring vital signs infrequently. Aim To identify frequency of vital sign documentation by GPs, in the assessment of children with acute infections in primary care. Design and setting Observational study in 15 general practice surgeries in Oxfordshire and Somerset, UK. Method A standardised proforma was used to extract consultation details including documentation of numerical vital signs, and words or phrases used by the GP in assessing vital signs, for 850 children aged 1 month to 16 years presenting with acute infection. Results Of the children presenting with acute infections 31.6% had one or more numerical vital signs recorded (269, 31.6%), however GP recording rate improved if free text proxies were also considered: at least one vital sign was then recorded in over half (54.1%) of children. In those with recorded numerical values for vital signs, the most frequent was temperature (210, 24.7%), followed by heart rate (62, 7.3%), respiratory rate (58, 6.8%), and capillary refill time (36, 4.2%). Words or phrases for vital signs were documented infrequently (temperature 17.6%, respiratory rate 14.6%, capillary refill time 12.5%, and heart rate 0.5%), Text relating to global assessment was documented in 313/850 (36.8%) of consultations. Conclusion GPs record vital signs using words and phrases as well as numerical methods, although overall documentation of vital signs is infrequent in children presenting with acute infections. PMID:23265227

Perspectives on massive coral growth rates in a changing ocean.

PubMed

Lough, Janice M; Cantin, Neal E

2014-06-01

The tropical ocean environment is changing at an unprecedented rate, with warming and severe tropical cyclones creating obvious impacts to coral reefs within the last few decades and projections of acidification raising concerns for the future of these iconic and economically important ecosystems. Documenting variability and detecting change in global and regional climate relies upon high-quality observational records of climate variables supplemented, prior to the mid-19th century, with reconstructions from various sources of proxy climate information. Here we review how annual density banding patterns that are recorded in the skeletons of massive reef-building corals have been used to document environmental change and impacts within coral reefs. Massive corals provide a historical perspective of continuous calcification processes that pre-date most ecological observations of coral reefs. High-density stress bands, abrupt declines in annual linear extension, and evidence of partial mortality within the skeletal growth record reveal signatures of catastrophic stress events that have recently been attributed to mass bleaching events caused by unprecedented thermal stress. Comparison of recent trends in annual calcification with century-scale baseline calcification rates reveals that the frequency of growth anomalies has increased since the late 1990s throughout most of the world's coral reef ecosystems. Continuous coral growth histories provide valuable retrospective information on the coral response to environmental change and the consequences of anthropogenic climate change. Co-ordinated efforts to synthesize and combine global calcification histories will greatly enhance our understanding of current calcification responses to a changing ocean. © 2014 Marine Biological Laboratory.

Telemetry System Data Latency

DTIC Science & Technology

2017-07-13

ec o n d s Data Rate TELEMETRY SYSTEM DATA LATENCY 15 of 31 Document: JT3-AFC-SRPT-17172-0005 Revision...250 So ft w ar e D ec o m L at en cy N T im es G re at er T h an D xD ec o m L at en cy Data Rate TELEMETRY SYSTEM DATA LATENCY 16 of...20.0 30.0 40.0 50.0 60.0 70.0 M ill is ec o n d s Data Rate TELEMETRY SYSTEM DATA LATENCY 17 of 31 Document:

Can Competitive Athletes Return to High-Level Play After Osteochondral Allograft Transplantation of the Knee?

PubMed

McCarthy, Mark A; Meyer, Maximilian A; Weber, Alexander E; Levy, David M; Tilton, Annemarie K; Yanke, Adam B; Cole, Brian J

2017-09-01

To investigate functional outcomes among competitive athletes undergoing osteochondral allograft (OCA) transplantation of the knee, including rates of return to play (RTP), and factors preventing RTP. A retrospective review identified all competitive athletes (high school, intercollegiate, professional) undergoing isolated femoral condyle OCA from 2004 to 2013. Patient-reported outcome (PRO) questionnaires (Lysholm, International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMasters Universities Arthritis Index [WOMAC], 12-Item Short Form Health Survey [SF-12], Tegner, and Marx) and custom RTP surveys were administered. All subsequent reoperations were documented. Thirteen athletes (4 intercollegiate, 9 high-school) were identified with an average follow-up of 5.9 ± 2.5 years. Seven athletes (54%) returned to competitive sport at an average of 7.9 ± 3.5 months, 5 of whom returned to preinjury functional levels. Of the 8 athletes who either did not return to competitive sport or failed to sustain their high level of play, the most common reasons cited were graduation from high school or college (4 patients, 50%) or fear of reinjury (3 patients, 38%). All 4 patients citing graduation as the primary factor preventing return to preinjury level of competitive sport resumed recreational sport without limitations, yielding an adjusted RTP rate of 10 patients (77%) who either returned to competitive play or believed they could return if they had not graduated. At final follow-up, athletes reported significant improvements in all PRO scores except for KOOS-Sport, WOMAC-Stiffness, and SF-12 Mental subscales. There were 3 reoperations at an average of 3.8 ± 3.3 years after the index OCA. There were no instances of graft failure. OCAs provide an adjusted RTP rate of 77% for high-level adolescent athletes. Social factors may be more likely than persistent pain to prevent return to sport. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Documenting a significant relationship between macroevolutionary origination rates and Phanerozoic pCO2 levels.

PubMed

Cornette, James L; Lieberman, Bruce S; Goldstein, Robert H

2002-06-11

We show that the rates of diversification of the marine fauna and the levels of atmospheric CO(2) have been closely correlated for the past 545 million years. These results, using two of the fundamental databases of the Earth's biota and the Earth's atmospheric composition, respectively, are highly statistically significant (P < 0.001). The strength of the correlation suggests that one or more environmental variables controlling CO(2) levels have had a profound impact on evolution throughout the history of metazoan life. Comparing our work with highly significant correlations described by D. H. Rothman [Rothman, D. H. (2001) Proc. Natl. Acad. Sci. USA 98, 4305-4310] between total biological diversity and a measure of stable carbon isotope fractionation, we find that the rates of diversification rather than total diversification correlate with environmental variables, and that the rate of diversification follows the record of CO(2) projected by R. A. Berner and Z. Kothavala [Berner, R. A. & Kothavala, Z. (2001) Am. J. Sci. 301, 182-204] more closely than that predicted by Rothman.

Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society.

PubMed

Sassi, Roberto; Cerutti, Sergio; Lombardi, Federico; Malik, Marek; Huikuri, Heikki V; Peng, Chung-Kang; Schmidt, Georg; Yamamoto, Yoshiharu

2015-09-01

Following the publication of the Task Force document on heart rate variability (HRV) in 1996, a number of articles have been published to describe new HRV methodologies and their application in different physiological and clinical studies. This document presents a critical review of the new methods. A particular attention has been paid to methodologies that have not been reported in the 1996 standardization document but have been more recently tested in sufficiently sized populations. The following methods were considered: Long-range correlation and fractal analysis; Short-term complexity; Entropy and regularity; and Nonlinear dynamical systems and chaotic behaviour. For each of these methods, technical aspects, clinical achievements, and suggestions for clinical application were reviewed. While the novel approaches have contributed in the technical understanding of the signal character of HRV, their success in developing new clinical tools, such as those for the identification of high-risk patients, has been rather limited. Available results obtained in selected populations of patients by specialized laboratories are nevertheless of interest but new prospective studies are needed. The investigation of new parameters, descriptive of the complex regulation mechanisms of heart rate, has to be encouraged because not all information in the HRV signal is captured by traditional methods. The new technologies thus could provide after proper validation, additional physiological, and clinical meaning. Multidisciplinary dialogue and specialized courses in the combination of clinical cardiology and complex signal processing methods seem warranted for further advances in studies of cardiac oscillations and in the understanding normal and abnormal cardiac control processes. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Simulation Detection in Handwritten Documents by Forensic Document Examiners.

PubMed

Kam, Moshe; Abichandani, Pramod; Hewett, Tom

2015-07-01

This study documents the results of a controlled experiment designed to quantify the abilities of forensic document examiners (FDEs) and laypersons to detect simulations in handwritten documents. Nineteen professional FDEs and 26 laypersons (typical of a jury pool) were asked to inspect test packages that contained six (6) known handwritten documents written by the same person and two (2) questioned handwritten documents. Each questioned document was either written by the person who wrote the known documents, or written by a different person who tried to simulate the writing of the person who wrote the known document. The error rates of the FDEs were smaller than those of the laypersons when detecting simulations in the questioned documents. Among other findings, the FDEs never labeled a questioned document that was written by the same person who wrote the known documents as "simulation." There was a significant statistical difference between the responses of the FDEs and layperson for documents without simulations. © 2015 American Academy of Forensic Sciences.

Ocean acidification: the other CO2 problem.

PubMed

Doney, Scott C; Fabry, Victoria J; Feely, Richard A; Kleypas, Joan A

2009-01-01

Rising atmospheric carbon dioxide (CO2), primarily from human fossil fuel combustion, reduces ocean pH and causes wholesale shifts in seawater carbonate chemistry. The process of ocean acidification is well documented in field data, and the rate will accelerate over this century unless future CO2 emissions are curbed dramatically. Acidification alters seawater chemical speciation and biogeochemical cycles of many elements and compounds. One well-known effect is the lowering of calcium carbonate saturation states, which impacts shell-forming marine organisms from plankton to benthic molluscs, echinoderms, and corals. Many calcifying species exhibit reduced calcification and growth rates in laboratory experiments under high-CO2 conditions. Ocean acidification also causes an increase in carbon fixation rates in some photosynthetic organisms (both calcifying and noncalcifying). The potential for marine organisms to adapt to increasing CO2 and broader implications for ocean ecosystems are not well known; both are high priorities for future research. Although ocean pH has varied in the geological past, paleo-events may be only imperfect analogs to current conditions.

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

PubMed Central

Brusalis, Christopher M.; Lakomkin, Nikita; Suryavanshi, Joash R.; Cruz, Aristides I.; Green, Daniel W.; Jones, Kristofer J.; Fabricant, Peter D.

2017-01-01

Background: Advances in anterior cruciate ligament (ACL) reconstruction procedures in pediatric and adolescent patients have resulted in an increase in recent clinical studies on this topic. However, the consistency with which outcome measures are reported in this demographic is unknown. Purpose: To document outcome reporting patterns of youth ACL reconstruction studies in high-impact journals. Study Design: Systematic review; Level of evidence, 4. Methods: All articles published in 5 high-impact orthopaedic journals from 2010 to 2016 were reviewed to identify those reporting clinical outcomes of young patients who underwent ACL reconstruction. Studies that were nonclinical, reported on patients older than 18 years, or included fewer than 10 patients were excluded. Outcome measures used in all included studies were recorded. Results: Seventeen studies encompassing 772 subjects (mean age, 14.3 years; range, 6.3-18.0 years) were analyzed. Eight studies (47%) reported on Tanner stage of subjects, while 1 study reported skeletal age. Ten studies (59%) clearly documented the presence or absence of surgical complications. Range of motion was reported in 65% of studies. Leg-length discrepancy and angular deformity were each reported in 76% of studies, with 12% quantifying results through radiographic measurements. Ligament testing was variably defined by inclusion of instrumented testing (65%), Lachman test (53%), and pivot-shift test (53%). Fourteen studies (82%) explicitly reported on the rate of ACL rerupture, while 71% reported on the rate of revision surgery. Rate of return to preinjury activity was reported in 8 studies (47%), of which 2 defined criteria for return to sport and 3 defined the level of competitive sport. Patient-reported outcome measures (PROMs) were used variably. For the 3 most commonly reported PROMs (Lysholm, International Knee Documentation Committee, and Tegner), 24% of studies reported all 3 PROMs, 35% of studies reported 2 PROMs, and 6% of studies reported 1 PROM in isolation. A pediatric-specific PROM was reported in 1 of the 17 studies. Conclusion: Studies on pediatric ACL reconstruction published in high-impact journals unreliably defined subjects’ skeletal maturity, inconsistently reported on objective outcome measures, and used disparate adult-validated PROMs to assess subjective outcomes. These findings highlight the need for standardized, pediatric-specific outcome measures to be applied in future studies evaluating ACL reconstruction in children and adolescents. PMID:28840156

Epidemiology of fibromyalgia.

PubMed

Neumann, Lily; Buskila, Dan

2003-10-01

Chronic widespread pain, the cardinal symptom of fibromyalgia (FM), is common in the general population, with comparable prevalence rates of 7.3% to 12.9% across different countries. The prevalence of FM in the general population was reported to range from 0.5% to 5% and up to 15.7% in the clinic. The common association of FM with other rheumatic disorders, chronic viral infections, and systemic illnesses has been well documented in several studies. Up to 65% of patients with systemic lupus erythematosus meet the criteria for FM. FM is considered a member of the family of functional somatic syndromes. These syndromes are very common and share a similar phenomenology, epidemiologic characteristics, high rates of occurrence, a common pathogenesis, and similar management strategies. A high prevalence of FM was demonstrated among relatives of patients with FM and it may be attributed to genetic and environmental factors.

A study of pump cavitation damage

NASA Astrophysics Data System (ADS)

Brophy, M. C.; Stinebring, D. R.; Billet, M. L.

1983-11-01

The cavitation assessment for the space shuttle main engine high pressure oxidizer turbopump is documented. A model of the flow through the pump was developed. Initially, a computational procedure was used to analyze the flow through the inlet casing including the prediction of wakes downstream of the casing vanes. From these flow calculations, cavitation patterns on the inducer blades were approximated and the damage rate estimated. The model correlates the heavy damage on the housing and over the inducer with unsteady blade surface cavitation. The unsteady blade surface cavitation is due to the large incidence changes caused by the wakes of the upstream vanes. Very high cavitation damage rates are associated with this type of cavitation. Design recommendations for reducing the unsteady cavitation include removing the set of vanes closest to the inducer and modifying the remaining vanes.

Automated Classification of Selected Data Elements from Free-text Diagnostic Reports for Clinical Research.

PubMed

Löpprich, Martin; Krauss, Felix; Ganzinger, Matthias; Senghas, Karsten; Riezler, Stefan; Knaup, Petra

2016-08-05

In the Multiple Myeloma clinical registry at Heidelberg University Hospital, most data are extracted from discharge letters. Our aim was to analyze if it is possible to make the manual documentation process more efficient by using methods of natural language processing for multiclass classification of free-text diagnostic reports to automatically document the diagnosis and state of disease of myeloma patients. The first objective was to create a corpus consisting of free-text diagnosis paragraphs of patients with multiple myeloma from German diagnostic reports, and its manual annotation of relevant data elements by documentation specialists. The second objective was to construct and evaluate a framework using different NLP methods to enable automatic multiclass classification of relevant data elements from free-text diagnostic reports. The main diagnoses paragraph was extracted from the clinical report of one third randomly selected patients of the multiple myeloma research database from Heidelberg University Hospital (in total 737 selected patients). An EDC system was setup and two data entry specialists performed independently a manual documentation of at least nine specific data elements for multiple myeloma characterization. Both data entries were compared and assessed by a third specialist and an annotated text corpus was created. A framework was constructed, consisting of a self-developed package to split multiple diagnosis sequences into several subsequences, four different preprocessing steps to normalize the input data and two classifiers: a maximum entropy classifier (MEC) and a support vector machine (SVM). In total 15 different pipelines were examined and assessed by a ten-fold cross-validation, reiterated 100 times. For quality indication the average error rate and the average F1-score were conducted. For significance testing the approximate randomization test was used. The created annotated corpus consists of 737 different diagnoses paragraphs with a total number of 865 coded diagnosis. The dataset is publicly available in the supplementary online files for training and testing of further NLP methods. Both classifiers showed low average error rates (MEC: 1.05; SVM: 0.84) and high F1-scores (MEC: 0.89; SVM: 0.92). However the results varied widely depending on the classified data element. Preprocessing methods increased this effect and had significant impact on the classification, both positive and negative. The automatic diagnosis splitter increased the average error rate significantly, even if the F1-score decreased only slightly. The low average error rates and high average F1-scores of each pipeline demonstrate the suitability of the investigated NPL methods. However, it was also shown that there is no best practice for an automatic classification of data elements from free-text diagnostic reports.

Comparison of immunization rates of adults ages 65 years and older managed within two nurse practitioner-owned clinics with national immunization rates.

PubMed

Wright, Wendy L; Morrell, Elise; Lee, Jennie; Cuellar, Norma Graciela; White, Patricia

2017-07-01

Adults ages ≥65 years are at increased risk for infectious diseases. Ensuring these individuals are fully vaccinated is imperative. The purpose of this study was to assess the immunization rates of adults ages ≥65 years managed by nurse practitioners (NPs) and compare the results with national immunization rates and Healthy People 2020 goals. A convenience sample of adults ages ≥65 years was obtained from two NP-managed clinics. The vaccine records of each subject were reviewed for documentation of having received five vaccines (tetanus, diphtheria, and pertussis; influenza; pneumococcal polysaccharide vaccine 23; pneumococcal conjugate vaccine 13; and herpes zoster vaccine). One hundred and fifty females (70.8%) and 62 males (29.2%) met inclusion criteria. NP-managed patients had higher immunization rates than the national averages across all five major vaccines. The herpes zoster vaccination rates exceeded the recommendations from Healthy People 2020 whereas pneumococcal and influenza rates were below. The stocking of vaccines within the NP-managed clinics, direct billing to Medicare for Part D vaccines, and previsit care planning likely contributed to the high vaccination rates. These high immunization rates in patients managed by NPs provide support for the important role that NPs play in the care of older adults. ©2017 American Association of Nurse Practitioners.

Challenges in using rater judgements in medical education.

PubMed

Albanese, M A

2000-08-01

Changes in the healthcare environment are putting increasing pressure on medical schools to make faculty accountable and to document the quality of the medical education they provide. Faculty's ratings of students' performances and students' ratings of faculty's teaching are important elements in these efforts to document educational quality. This article discusses selected research related to factors affecting raters' judgements, analyses how changes in the health care environment are influencing such judgements, offers some suggestions to moderate some of the effects and links these influences to the system that upholds professional standards. Ratings are known to have a positive bias (generosity error), provide limited discrimination and often fail to document serious deficits. The potential sources of these problems relate to the mechanics of the rating task, the system used to obtain ratings and factors affecting rater judgement. As managed care demands reduce the time faculty have for teaching, as system-wide disincentives to provide negative ratings proliferate and as social engineering challenges, such as the Americans with Disabilities Act, impose differential standards for students, the natural tendency to avoid giving negative ratings becomes even harder to resist. Ultimately, these forces compromise the capability of faculty to uphold the standards of the profession. The author calls for a national effort to stem the erosion of those standards.

Pre-Procedural Patient Education Reduces Fall Risk in an Outpatient Endoscopy Suite.

PubMed

Hilscher, Moira B; Niesen, Cynthia R; Tynsky, Desiree A; Kane, Sunanda V

The purpose of this article was to determine whether scripted pre-procedural fall risk patient education and nurses' intention to assist patients after receiving sedation improves receptiveness of nursing assistance during recovery and decreases fall risk in an outpatient endoscopy suite. We prospectively identified high fall risk patients using the following criteria: (1) use of an assistive device, (2) fallen two or more times within the last year, (3) sustained an injury in a fall within a year, (4) age greater than 85 years, or (5) nursing judgment of high fall risk. Using a scripted dialogue, nurses educated high-risk patients of their fall risk and the nurses' intent to assist them to and in the bathroom. Documentation of patient education, script use, and assistance was monitored. Over 24 weeks, 892 endoscopy patients were identified as high fall risk; 790 (88.5%) accepted post-procedural assistance. Documentation of assistance significantly increased from 33% to 100%. Patients receiving education and postprocedural assistance increased from 27.9% to 100% at week 24. No patient falls occurred 12 months following implementation among patients identified as high fall risk. Scripted pre-procedural fall risk education increases patient awareness and receptiveness to assistance and can lead to decreased fall rates.

Development of an agricultural job-exposure matrix for British Columbia, Canada.

PubMed

Wood, David; Astrakianakis, George; Lang, Barbara; Le, Nhu; Bert, Joel

2002-09-01

Farmers in British Columbia (BC), Canada have been shown to have unexplained elevated proportional mortality rates for several cancers. Because agricultural exposures have never been documented systematically in BC, a quantitative agricultural Job-exposure matrix (JEM) was developed containing exposure assessments from 1950 to 1998. This JEM was developed to document historical exposures and to facilitate future epidemiological studies. Available information regarding BC farming practices was compiled and checklists of potential exposures were produced for each crop. Exposures identified included chemical, biological, and physical agents. Interviews with farmers and agricultural experts were conducted using the checklists as a starting point. This allowed the creation of an initial or 'potential' JEM based on three axes: exposure agent, 'type of work' and time. The 'type of work' axis was determined by combining several variables: region, crop, job title and task. This allowed for a complete description of exposures. Exposure assessments were made quantitatively, where data allowed, or by a dichotomous variable (exposed/unexposed). Quantitative calculations were divided into re-entry and application scenarios. 'Re-entry' exposures were quantified using a standard exposure model with some modification while application exposure estimates were derived using data from the North American Pesticide Handlers Exposure Database (PHED). As expected, exposures differed between crops and job titles both quantitatively and qualitatively. Of the 290 agents included in the exposure axis; 180 were pesticides. Over 3000 estimates of exposure were conducted; 50% of these were quantitative. Each quantitative estimate was at the daily absorbed dose level. Exposure estimates were then rated as high, medium, or low based on comparing them with their respective oral chemical reference dose (RfD) or Acceptable Daily Intake (ADI). This data was mainly obtained from the US Environmental Protection Agency (EPA) Integrated Risk Information System database. Of the quantitative estimates, 74% were rated as low (< 100%) and only 10% were rated as high (>500%). The JEM resulting from this study fills a void concerning exposures for BC farmers and farm workers. While only limited validation of assessments were possible, this JEM can serve as a benchmark for future studies. Preliminary analysis at the BC Cancer Agency (BCCA) using the JEM with prostate cancer records from a large cancer and occupation study/survey has already shown promising results. Development of this JEM provides a useful model for developing historical quantitative exposure estimates where is very little documented information available.

Census Tract Poverty and Racial Disparities in HIV Rates in Milwaukee County, Wisconsin, 2009-2014.

PubMed

Gibson, Crystal; Grande, Katarina; Schumann, Casey; Gasiorowicz, Mari

2018-02-22

Previous work has documented associations between poverty and HIV. Understanding of these relationships at local levels could help target prevention efforts; however, HIV surveillance systems do not capture individual-level poverty measures. We utilized the Public Health Disparities Geocoding Project methods to examine HIV rates by census tract poverty. HIV rates and rate ratios were computed by census tract poverty (< 5.0, 5.0-9.9, 10.0-19.9, > 20.0% of individual below the federal poverty level) for all races and stratified by Black and White race using Poisson regression. We observed higher HIV rates in the highest poverty gradient compared to the lowest poverty gradient for all races combined and among White cases. After adjustment, HIV rates were similar across poverty gradients for all comparisons. Our findings suggest that the association between poverty and HIV may differ by subpopulation, while demonstrating the potential for HIV prevention targeting residents of high poverty areas.

Theoretical Study of the Effects of Di-Muonic Molecules on Muon-Catalyzed Fusion

DTIC Science & Technology

2012-03-01

For example, synthetic zeolites could be used to separate molecular isotopes of hydrogen [12; 10] as could thermal diffusion and gas chromatography... thermal muon flux is large (see Chapter 8). Reactions which have the potential of increasing the muon-catalyzed fusion rate and reactions that could...the remainder of this document. Changes to the muon-catalyzed fusion cycle, that are expected to occur when the thermal muon flux is high, are

Development, Verification and Experimental Analysis of High-Fidelity Mathematical Models for Control Moment Gyros

DTIC Science & Technology

2011-12-01

therefore a more general approach uses the pseudo-inverse shown in Equation (12) to obtain the commanded gimbal rate.     1 /T T b N CMG...gimbal motor. Approaching the problem from this perspective increases the complexity significantly and the relationship between motor current and...included in this document confirms the equations that Schaub and Junkins developed. The approaches used in the two derivations are sufficiently

The rise of injecting drug use in east Africa: a case study from Kenya

PubMed Central

Beckerleg, Susan; Telfer, Maggie; Hundt, Gillian Lewando

2005-01-01

Studies on injecting drug use in East Africa are reviewed. The existingstudies document the spread of heroin injection in Kenya and Tanzania, both countries where HIV rates are high. No data from Uganda on injecting drug use was found by the authors. A case study of the growth of heroin injection in a Kenyan coastal town is presented. The need for needle-exchange programmes and other prevention services is discussed. PMID:16122382

GeoDeepDive: Towards a Machine Reading-Ready Digital Library and Information Integration Resource

NASA Astrophysics Data System (ADS)

Husson, J. M.; Peters, S. E.; Livny, M.; Ross, I.

2015-12-01

Recent developments in machine reading and learning approaches to text and data mining hold considerable promise for accelerating the pace and quality of literature-based data synthesis, but these advances have outpaced even basic levels of access to the published literature. For many geoscience domains, particularly those based on physical samples and field-based descriptions, this limitation is significant. Here we describe a general infrastructure to support published literature-based machine reading and learning approaches to information integration and knowledge base creation. This infrastructure supports rate-controlled automated fetching of original documents, along with full bibliographic citation metadata, from remote servers, the secure storage of original documents, and the utilization of considerable high-throughput computing resources for the pre-processing of these documents by optical character recognition, natural language parsing, and other document annotation and parsing software tools. New tools and versions of existing tools can be automatically deployed against original documents when they are made available. The products of these tools (text/XML files) are managed by MongoDB and are available for use in data extraction applications. Basic search and discovery functionality is provided by ElasticSearch, which is used to identify documents of potential relevance to a given data extraction task. Relevant files derived from the original documents are then combined into basic starting points for application building; these starting points are kept up-to-date as new relevant documents are incorporated into the digital library. Currently, our digital library stores contains more than 360K documents supplied by Elsevier and the USGS and we are actively seeking additional content providers. By focusing on building a dependable infrastructure to support the retrieval, storage, and pre-processing of published content, we are establishing a foundation for complex, and continually improving, information integration and data extraction applications. We have developed one such application, which we present as an example, and invite new collaborations to develop other such applications.

18 CFR 35.9 - Requirements for filing rate schedules, tariffs or service agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... entire document except as provided in paragraphs (b) and (c) of this section. (b) Open Access...) OATT and other open access documents filed by Independent System Operators or Regional Transmission...

18 CFR 35.9 - Requirements for filing rate schedules, tariffs or service agreements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... entire document except as provided in paragraphs (b) and (c) of this section. (b) Open Access...) OATT and other open access documents filed by Independent System Operators or Regional Transmission...

Effects of Fault Segmentation, Mechanical Interaction, and Structural Complexity on Earthquake-Generated Deformation

NASA Astrophysics Data System (ADS)

Haddad, David Elias

Earth's topographic surface forms an interface across which the geodynamic and geomorphic engines interact. This interaction is best observed along crustal margins where topography is created by active faulting and sculpted by geomorphic processes. Crustal deformation manifests as earthquakes at centennial to millennial timescales. Given that nearly half of Earth's human population lives along active fault zones, a quantitative understanding of the mechanics of earthquakes and faulting is necessary to build accurate earthquake forecasts. My research relies on the quantitative documentation of the geomorphic expression of large earthquakes and the physical processes that control their spatiotemporal distributions. The first part of my research uses high-resolution topographic lidar data to quantitatively document the geomorphic expression of historic and prehistoric large earthquakes. Lidar data allow for enhanced visualization and reconstruction of structures and stratigraphy exposed by paleoseismic trenches. Lidar surveys of fault scarps formed by the 1992 Landers earthquake document the centimeter-scale erosional landforms developed by repeated winter storm-driven erosion. The second part of my research employs a quasi-static numerical earthquake simulator to explore the effects of fault roughness, friction, and structural complexities on earthquake-generated deformation. My experiments show that fault roughness plays a critical role in determining fault-to-fault rupture jumping probabilities. These results corroborate the accepted 3-5 km rupture jumping distance for smooth faults. However, my simulations show that the rupture jumping threshold distance is highly variable for rough faults due to heterogeneous elastic strain energies. Furthermore, fault roughness controls spatiotemporal variations in slip rates such that rough faults exhibit lower slip rates relative to their smooth counterparts. The central implication of these results lies in guiding the interpretation of paleoseismically derived slip rates that are used to form earthquake forecasts. The final part of my research evaluates a set of Earth science-themed lesson plans that I designed for elementary-level learning-disabled students. My findings show that a combination of concept delivery techniques is most effective for learning-disabled students and should incorporate interactive slide presentations, tactile manipulatives, teacher-assisted concept sketches, and student-led teaching to help learning-disabled students grasp Earth science concepts.

The present status and problems in document retrieval system : document input type retrieval system

NASA Astrophysics Data System (ADS)

Inagaki, Hirohito

The office-automation (OA) made many changes. Many documents were begun to maintained in an electronic filing system. Therefore, it is needed to establish efficient document retrieval system to extract useful information. Current document retrieval systems are using simple word-matching, syntactic-matching, semantic-matching to obtain high retrieval efficiency. On the other hand, the document retrieval systems using special hardware devices, such as ISSP, were developed for aiming high speed retrieval. Since these systems can accept a single sentence or keywords as input, it is difficult to explain searcher's request. We demonstrated document input type retrieval system, which can directly accept document as an input, and can search similar documents from document data-base.

Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project.

PubMed

Sheth, Heena; Moreland, Larry; Peterson, Hilary; Aggarwal, Rohit

2017-01-01

To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy. This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test. We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p < 0.0001). The documentation rates (vaccine received, vaccine ordered, patient refusal, and deferral reasons) increased from 28% (510/1823) to 72.9% (1133/1554; p < 0.0001). The HZ infection rates decreased significantly from 2% to 0.3% (p = 0.002). Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician's time, and has the potential for self-sustainability and generalizability.

Total Lightning as a Severe Weather Diagnostic in Strongly Baroclinic Systems in Central Florida

NASA Technical Reports Server (NTRS)

Williams, E.; Boldi, B.; Matlin, A.; Weber, M.; Hodanish, S.; Sharp, D.; Goodman, Steven J.; Raghavan, R.; Buechler, Dennis

1998-01-01

The establishment of a consistent behavior of total lightning activity in severe convective storms has been challenged historically by the relative scarcity of these storms combined with the difficulties inherent in documenting the (dominant) intracloud component of total lightning. This situation has changed recently with the abundance of severe weather in central Florida during 1997-98, including the tornado outbreak of February 23, 1998, and with the development of the operational LISDAD system (Boldi et al, this conference) to document these cases. This paper is concerned primarily with the behavior of total lightning in severe weather during the dry season when the Florida atmosphere is most strongly baroclinic. It has been found that all three manifestations of severe weather (ie., hall, wind, tornadoes) are consistently preceded by rapid increases in total flash rate with values often in excess of 100 flashes/minute. Preliminary analysis suggests that this systematic electrical behavior observed in summertime 'pulse severe' storms (Hodanish et al, this conference) also pertains to the more strongly baroclinic, long-track tornadic storms (more common in Oklahoma), as evidenced by the February 23, 1998 outbreak case in central Florida exhibiting two long-tracking F3 tornadoes. The largest flash rates in severe weather anywhere occur in baroclinic conditions at midlatitude. The physical plausibility of flash rates in excess of 100 per minute will be assessed. We will also consider the differences in storm structure for high flash rate storms that are non-severe.

[Are There any Differences in Quality or Complication Rate in Total Knee Arthroplasty after Establishing a Centre for Endoprosthesis?

PubMed

Düzgünoglu, Muzaffer; Hönle, Wolfgang; Scheller, Alexander; Schuh, Alexander

2018-05-18

The aim of the study is to show whether there are any changes in quality or incidence of complications in total knee arthroplasty (TKA) after establishing a centre for endoprothesis (EPZ). We conducted a retrospective study comparing 100 TKAs one year before establishing an EPZ (Group I) with 100 TKAs one year after establishing an EPZ (group II). Data were collected by analysing our electronic documentation system, and the report of the rehabilitation hospital. The following parameters were documented which are necessary to establish an EPZ: existence of X-rays before and after operation. Existence of full length weight bearing X-ray before operation or using a navigation device. Existence of preoperative planning, duration of TKA below 100 minutes. The following complications were documented: Periprosthetic infections, occurrence of periprosthetic fissures/fractures, thrombembolism, neurologic complications, patients' satisfaction rate with the hospital stay and mortality rate. Additionally femorotibial angle, femoral angle, tibial angle and tibial slope were measured. Statistical analysis was performed with SPSS 22.0. using the Kolmogorov-Smirnov test, the Qui-Square test and the Mann-Whitney U test. There were no statistical differences in local or systemic complications. The mean duration of operation was 82.9 min in group I (min.: 55, max.: 141) und 81.5 min in group II (min.: 57, max.: 129; p > 0.05). In group I, there were 20/100 cases (20%) with operation time longer than 100 minutes, in group II 13/100 cases (13%; p < 0.001). Analysis of anatomical femorotibial angle, femur angle, tibial angle and tibial slope showed no significant differences. The rate of documented survey of patients' satisfaction rate improved from 62% in group I to 98% in group II (p < 0.001). By establishing an EPZ, we achieved a significant improvement in the parameters operation time > 100 minutes and documented survey of patients' satisfaction rate, but not in complication rate. Georg Thieme Verlag KG Stuttgart · New York.

Compliance with High-Intensity Radiated Fields Regulations - Emitter's Perspective

NASA Technical Reports Server (NTRS)

Statman, Joseph; Jamnejad, Vahraz; Nguyen, Lee

2012-01-01

NASA's Deep Space Network (DSN) uses high-power transmitters on its large antennas to communicate with spacecraft of NASA and its partner agencies. The prime reflectors of the DSN antennas are parabolic, at 34m and 70m in diameter. The DSN transmitters radiate Continuous Wave (CW) signals at 20 kW - 500 kW at X-band and S-band frequencies. The combination of antenna reflector size and high frequency results in a very narrow beam with extensive oscillating near-field pattern. Another unique feature of the DSN antennas is that they (and the radiated beam) move mostly at very slow sidereal rate, essentially identical in magnitude and at the opposite direction of Earth rotation.The DSN is in the process of revamping its documentation to provide analysis of the High Intensity Radiation Fields (HIRF) environment resulting from radio frequency radiation from DSN antennas for comparison to FAA regulations regarding certification of HIRF protection as outlined in the FAA regulations on HIRF protection for aircraft electrical and electronic systems (Title 14, Code of Federal Regulations (14 CFR) [section sign][section sign] 23.1308, 25.1317, 27.1317, and 29.1317).This paper presents work done at JPL, in consultation with the FAA. The work includes analysis of the radiated field structure created by the unique DSN emitters (combination of transmitters and antennas) and comparing it to the fields defined in the environments in the FAA regulations. The paper identifies areas that required special attention, including the implications of the very narrow beam of the DSN emitters and the sidereal rate motion. The paper derives the maximum emitter power allowed without mitigation and the mitigation zones, where required.Finally, the paper presents summary of the results of the analyses of the DSN emitters and the resulting DSN process documentation.

Capturing, using, and managing quality assurance knowledge for shuttle post-MECO flight design

NASA Technical Reports Server (NTRS)

Peters, H. L.; Fussell, L. R.; Goodwin, M. A.; Schultz, Roger D.

1991-01-01

Ascent initialization values used by the Shuttle's onboard computer for nominal and abort mission scenarios are verified by a six degrees of freedom computer simulation. The procedure that the Ascent Post Main Engine Cutoff (Post-MECO) group uses to perform quality assurance (QA) of the simulation is time consuming. Also, the QA data, checklists and associated rationale, though known by the group members, is not sufficiently documented, hindering transfer of knowledge and problem resolution. A new QA procedure which retains the current high level of integrity while reducing the time required to perform QA is needed to support the increasing Shuttle flight rate. Documenting the knowledge is also needed to increase its availability for training and problem resolution. To meet these needs, a knowledge capture process, embedded into the group activities, was initiated to verify the existing QA checks, define new ones, and document all rationale. The resulting checks were automated in a conventional software program to achieve the desired standardization, integrity, and time reduction. A prototype electronic knowledge base was developed with Macintosh's HyperCard to serve as a knowledge capture tool and data storage.

Inconsistency in the Calculation of Volatile Organic Compound (VOC) Emission Rates Using the Results of U.S. Environmental Protection Agency (EPA) Methods 25 and 25A.

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Comparisons of false negative rates from a trend test alone and from a trend test jointly with a control-high groups pairwise test in the determination of the carcinogenicity of new drugs.

PubMed

Lin, Karl K; Rahman, Mohammad A

2018-05-21

Interest has been expressed in using a joint test procedure that requires that the results of both a trend test and a pairwise comparison test between the control and the high groups be statistically significant simultaneously at the levels of significance recommended in the FDA 2001 draft guidance for industry document for the separate tests in order for the drug effect on the development of an individual tumor type to be considered as statistically significant. Results of our simulation studies show that there is a serious consequence of large inflations of the false negative rate through large decreases of false positive rate in the use of the above joint test procedure in the final interpretation of the carcinogenicity potential of a new drug if the levels of significance recommended for separate tests are used. The inflation can be as high as 204.5% of the false negative rate when the trend test alone is required to test if the effect is statistically significant. To correct the problem, new sets of levels of significance have also been developed for those who want to use the joint test in reviews of carcinogenicity studies.

[Efficacy of high versus low plasma: red blood cell ratio resuscitation in patients with severe trauma requiring massive blood transfusion: a meta-analysis].

PubMed

Yu, Fang; Zhong, Tao; Wu, Gang

2017-01-20

To evaluate the efficacy of high (≥1:2) and low (<1:2) plasma: red blood cell (RBC) ratio resuscitation in patients with severe trauma requiring massive blood transfusion. The databases including the Cochrane Library, Pubmed, Web of Science, and EMBASE were systemically searched for relevant studies published between January, 2009 and April, 2016. The selection of studies, assessment of methodological quality and data extraction were performed by two researchers independently according to the inclusion and exclusion criteria. The main endpoint was 24-h mortality, 30-day mortality and 24-h survival rate. Five observational studies reporting outcomes of 1024 patients were included in this meta-analysis. Four studies documented civilian cases and one study had a military setting. No significant differences were found in the Injury Severity Score (ISS) between patient groups receiving high and low plasma: RBC ratio resuscitation. Compared with the low-ratio group, the patients with high-ratio resuscitation showed a significant reduction in the 24-h mortality rate (OR=0.35, 95%CI [0.25, 0.48], P<0.000 01) and the 30-day mortality rate (OR=0.55, 95%CI [0.41, 0.75], P=0.0001). An increased survival rate was observed in patients receiving high plasma: RBC ratio resuscitation within the initial 24 h following the trauma (HR=2.34, 95%CI [1.46, 3.73], P=0.00001). Raising the plasma: RBC ratio to 0.5 or higher may decrease the mortality rate of the patients with severe trauma who need massive blood transfusion.

A physician-led initiative to improve clinical documentation results in improved health care documentation, case mix index, and increased contribution margin.

PubMed

Aiello, Francesco A; Judelson, Dejah R; Durgin, Jonathan M; Doucet, Danielle R; Simons, Jessica P; Durocher, Dawn M; Flahive, Julie M; Schanzer, Andres

2018-05-04

Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin. A physician-led coding initiative to educate physicians on the documentation of comorbidities and conditions was initiated with concurrent chart review sessions with coding specialists for 3 months, and then as needed, after the creation of a vascular surgery documentation guide. Clinical documentation and billing for all carotid endarterectomy (CEA) and open infrainguinal procedures (OIPs) performed between January 2013 and July 2016 were stratified into precoding and postcoding initiative groups. Age, duration of stay, direct costs, actual reimbursements, contribution margin (CM), CMI, rate of complication or comorbidity, major complication or comorbidity, severity of illness, and risk of mortality assigned to each discharge were abstracted. Data were compared over time by standardizing Centers for Medicare and Medicaid Services (CMS) values for each diagnosis related group and using a CMS base rate reimbursement. Among 458 CEA admissions, postcoding initiative CEA patients (n = 253) had a significantly higher CMI (1.36 vs 1.25; P = .03), CM ($7859 vs $6650; P = .048), and CMS base rate reimbursement ($8955 vs $8258; P = .03) than precoding initiative CEA patients (n = 205). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (43% vs 27%; P < .01). Among 504 OIPs, postcoding initiative patients (n = 227) had a significantly higher CMI (2.23 vs 2.05; P < .01), actual reimbursement ($23,203 vs $19,909; P < .01), CM ($12,165 vs $8840; P < .01), and CMS base rate reimbursement ($14,649 vs $13,496; P < .01) than precoding initiative patients (n = 277). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (61% vs 43%; P < .01). For both CEA and OIPs, there were no differences in age, duration of stay, total direct costs, or primary insurance status between the precoding and postcoding patient groups. Accurate and detailed clinical documentation is required for key stakeholders to characterize the acuity of inpatient admissions and ensure appropriate reimbursement; it is also a key component of risk-adjustment methods for assessing quality of care. A physician-led documentation initiative significantly increased CMI and CM. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Inconsistency in the Calculation of Volatile Organic Compound (VOC) Emission Rates Using the Results of U.S. Environmental Protection Agency (EPA) Methods 25 and 25A.

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Policy and Guidance Database available at www2.epa.gov/title-v-operating-permits/title-v-operating-permit-policy-and-guidance-document-index. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

AIS Modeling and a Satellite for AIS Observations in the High North + Draft New ITU-R Report Improved Satellite Detection of AIS

DTIC Science & Technology

2008-09-01

20 Aug 08) Report Documentation Page Form ApprovedOMB No . 0704-0188 Public reporting burden for the collection of information is estimated to average...Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person...to eliminate propagation delay – 3 min. reporting interval to lower message rate • Vessel consequences: – No extra hardware – Transponder software

Initial retrieval sequence and blending strategy

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

Pemwell, D.L.; Grenard, C.E.

1996-09-01

This report documents the initial retrieval sequence and the methodology used to select it. Waste retrieval, storage, pretreatment and vitrification were modeled for candidate single-shell tank retrieval sequences. Performance of the sequences was measured by a set of metrics (for example,high-level waste glass volume, relative risk and schedule).Computer models were used to evaluate estimated glass volumes,process rates, retrieval dates, and blending strategy effects.The models were based on estimates of component inventories and concentrations, sludge wash factors and timing, retrieval annex limitations, etc.

Identification of a Human Airway Epithelial Cell Subpopulation with Altered Biophysical, Molecular, and Metastatic Properties. | Office of Cancer Genomics

Cancer.gov

Lung cancers are documented to have remarkable intratumoral genetic heterogeneity. However, little is known about the heterogeneity of biophysical properties, such as cell motility, and its relationship to early disease pathogenesis and micrometastatic dissemination. In this study, we identified and selected a subpopulation of highly migratory premalignant airway epithelial cells that were observed to migrate through microscale constrictions at up to 100-fold the rate of the unselected immortalized epithelial cell lines.

WSES guidelines for emergency repair of complicated abdominal wall hernias

PubMed Central

2013-01-01

Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. PMID:24289453

A Posteriori Quantification of Rate-Controlling Effects from High-Intensity Turbulence-Flame Interactions Using 4D Measurements

DTIC Science & Technology

2016-11-22

Unclassified REPORT DOCUMENTATION PAGE Form ApprovedOMB No. 0704-0188 The public reporting burden for this collection of information is estimated to average 1...compact at all conditions tested, as indicated by the overlap of OH and CH2O distributions. 5. We developed analytical techniques for pseudo- Lagrangian ...condition in a constant density flow requires that the flow divergence is zero, ∇ · ~u = 0. Three smoothing schemes were examined, a moving average (i.e

Unique Case of Disseminated Plague With Multifocal Osteomyelitis.

PubMed

Tovar Padua, Leidy; Kamali, Amanda; Kim, Hannah; Green, Nicole M; Civen, Rachel; Schwartz, Benjamin; Krogstad, Paul; Deville, Jaime; Yeganeh, Nava; Lugo, Debra; Baker, Amira; Soni, Priya; Cho, Catherine; Svircic, Natalia; Dry, Sarah; Seeger, Leanne; Lloyd, Jessica; Deukmedjian, Grace; Bowen, Richard; Hale, Gillian; Zaki, Sherif R; Mead, Paul; Nielsen-Saines, Karin

2017-09-01

Plague is a disease caused by Yersinia pestis. Septicemic and pneumonic plague have a high mortality rate if untreated. Here we describe the challenges of accurately diagnosing a nonfatal pediatric case of septicemic plague with involvement of multiple organs; to our knowledge, the first documented case of multifocal plague osteomyelitis. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Improvement of the system of medical equipmet rationing for military units during the wartime].

PubMed

Miroshnichenko, Iu V; Goriachev, A B; Popov, A A; Morgunov, V A; Ryzhikov, M V; Merkulov, A V

2013-07-01

The authors analyze new legal regulatory document--Medical equipment and reserves supply rate for military units and organisations of the Armed Forces of the Russian Federation, developed in the process of modernization of the system of medical equipment rationing for military units. New legal regulatory document was developed with the aim to replace the similar document d.d 1996-1997. The authors came to conclusion that costs of new medical equipment and reserves supply rates are similar to previous rates. At the same time costs new medical equipment supply rates for medical service increased more than 25%. It is related to change of the role of medical service in the system of medical supply of the Armed Forces of the Russian Federation. Modernization of the system of medical equipment supply rates for military unit of the Armed Forces of the Russian Federation, performed for the purpose of medical supplement for military unit in accordance with new state of the Armed Forces of the Russian Federation, allowed to actualize the regulatory framework of medical supply by means of development and adoption of new Supply and reserves rates be the Ministry of defence. Use if these rates will increase effectiveness and quality of medical supply during the wartime, provide a commonality of reserves of medical equipment and maintenance of established level of combat readiness of medical service of the Armed Forces of the Russian Federation.

Variations in Student Mental Health and Treatment Utilization Across US Colleges and Universities.

PubMed

Ketchen Lipson, Sarah; Gaddis, S Michael; Heinze, Justin; Beck, Kathryn; Eisenberg, Daniel

2015-01-01

On US college campuses, mental health problems are highly prevalent, appear to be increasing, and are often untreated. Concerns about student mental health are well documented, but little is known about potential variations across the diversity of institutions of higher education. Participants were 43,210 undergraduates at 72 campuses that participated in the Healthy Minds Study from 2007 to 2013. Multivariable logistic regressions focus on associations between institutional characteristics and student mental health and treatment utilization. The following institutional characteristics are associated with worse mental health: doctoral-granting, public, large enrollment, nonresidential, less competitive, and lower graduation rates. Among students with apparent mental health problems, treatment utilization is higher at doctorate-granting institutions, baccalaureate colleges, institutions with small enrollments, and schools with strong residential systems. Although high rates of mental health problems and low treatment utilization are major concerns at all types of institutions of higher education, substantial variation occurs across campuses.

UltraNet Target Parameters. Chapter 1

NASA Technical Reports Server (NTRS)

Kislitzin, Katherine T.; Blaylock, Bruce T. (Technical Monitor)

1992-01-01

The UltraNet is a high speed network capable of rates up to one gigabit per second. It is a hub based network with four optical fiber links connecting each hub. Each link can carry up to 256 megabits of data, and the hub backplane is capable of one gigabit aggregate throughput. Host connections to the hub may be fiber, coax, or channel based. Bus based machines have adapter boards that connect to transceivers in the hub, while channel based machines use a personality module in the hub. One way that the UltraNet achieves its high transfer rates is by off-loading the protocol processing from the hosts to special purpose protocol engines in the UltraNet hubs. In addition, every hub has a PC connected to it by StarLAN for network management purposes. Although there is hub resident and PC resident UltraNet software, this document treats only the host resident UltraNet software.

The Great Recession, Public Transfers, and Material Hardship

PubMed Central

Pilkauskas, Natasha V.; Currie, Janet; Garfinkel, Irwin

2013-01-01

Economic downturns lead to lost income and increased poverty. Although high unemployment almost certainly also increases material hardship, and government transfers likely decrease hardship, the first relationship has not yet been documented and the second is poorly understood. We use data from five waves of the Fragile Families and Child Well-being Study to study the relationships between unemployment, government transfers, and material hardship. The latest wave of data was collected during the Great Recession, the worst recession since the Great Depression, providing a unique opportunity to look at how high unemployment rates affect the well-being of low income families. We find that the unemployment rate is associated with increased overall material hardship, difficulty paying bills, having utilities disconnected, and with increased usage of TANF, SNAP, UI and Medicaid. If not for SNAP, food hardship might have increased by twice the amount actually observed. PMID:24379487

Alligator diet in relation to alligator mortality on Lake Griffin, FL

USGS Publications Warehouse

Rice, A.N.; Ross, J.P.; Woodward, A.R.; Carbonneau, D.A.; Percival, H.F.

2007-01-01

Alligator mississippiensis (American Alligators) demonstrated low hatch-rate success and increased adult mortality on Lake Griffin, FL, between 1998 and 2003. Dying Lake Griffin alligators with symptoms of poor motor coordination were reported to show specific neurological impairment and brain lesions. Similar lesions were documented in salmonines that consumed clupeids with high thiaminase levels. Therefore, we investigated the diet of Lake Griffin alligators and compared it with alligator diets from two lakes that exhibited relatively low levels of unexplained alligator mortality to see if consumption of Dorosoma cepedianum (gizzard shad) could be correlated with patterns of mortality. Shad in both lakes Griffin and Apopka had high levels of thiaminase and Lake Apopka alligators were consuming greater amounts of shad relative to Lake Griffin without showing mortality rates similar to Lake Griffin alligators. Therefore, a relationship between shad consumption alone and alligator mortality is not supported.

Ovulatory Shifts in Women’s Attractions to Primary Partners and Other Men: Further Evidence of the Importance of Primary Partner Sexual Attractiveness

PubMed Central

2012-01-01

Previous research has documented shifts in women’s attractions to their romantic partner and to men other than their partner across the ovulation cycle, contingent on the degree to which her partner displays hypothesized indicators of high-fitness genes. The current study set out to replicate and extend this finding. Forty-one couples in which the woman was naturally cycling participated. Female partners reported their feelings of in-pair attraction and extra-pair attraction on two occasions, once on a low-fertility day of the cycle and once on a high-fertility day of the cycle just prior to ovulation. Ovulation was confirmed using luteinizing hormone tests. We collected two measures of male partner sexual attractiveness. First, the women in the study rated their partner’s sexual attractiveness. Second, we photographed the partners and had the photos independently rated for attractiveness. Shifts in women’s in-pair attractions across the cycle were significantly moderated by women’s ratings of partner sexual attractiveness, such that the less sexually attractive women rated their partner, the less in-pair attraction they reported at high fertility compared with low fertility (partial r = .37, p dir = .01). Shifts in women’s extra-pair attractions across the cycle were significantly moderated by third-party ratings of partner attractiveness, such that the less attractive the partner was, the more extra-pair attraction women reported at high relative to low fertility (partial r = −.33, p dir = .03). In line with previous findings, we found support for the hypothesis that the degree to which a woman’s romantic partner displays indicators of high-fitness genes affects women’s attractions to their own partner and other men at high fertility. PMID:22984512

An updated Holocene sea-level curve for the Delaware coast

USGS Publications Warehouse

Nikitina, D.L.; Pizzuto, J.E.; Schwimmer, R.A.; Ramsey, K.W.

2000-01-01

We present an updated Holocene sea-level curve for the Delaware coast based on new calibrations of 16 previously published radiocarbon dates (Kraft, 1976; Belknap and Kraft, 1977) and 22 new radiocarbon dates of basal peat deposits. A review of published and unpublished 137Cs and 210Pb analyses, and tide gauge data provide the basis for evaluating shorter-term (102 yr) sea-level trends. Paleosea-level elevations for the new basal peat samples were determined from the present vertical zonation of marsh plants relative to mean high water along the Delaware coast and the composition of plant fossils and foraminifera. Current trends in tidal range along the Delaware coast were used to reduce elevations from different locations to a common vertical datum of mean high water at Breakwater Harbor, Delaware. The updated curve is similar to Belknap and Kraft's [J. Sediment. Petrol., 47 (1977) 610-629] original sea-level curve from 12,000 to about 2000 yr BP. The updated curve documents a rate of sea-level rise of 0.9 mm/yr from 1250 yr BP to present (based on 11 dates), in good agreement with other recent sea-level curves from the northern and central U.S. Atlantic coast, while the previous curve documents rates of about 1.3 mm/yr (based on 4 dates). The precision of both estimates, however, is very low, so the significance of these differences is uncertain. A review of 210Pb and 137Cs analyses from salt marshes of Delaware indicates average marsh accretion rates of 3 mm/yr for the last 100 yr, in good agreement with shorter-term estimates of sea-level rise from tide gauge records. ?? 2000 Elsevier Science B.V.

Suicide risk factors among Australian Vietnam era draftees.

PubMed

O'Toole, B I; Cantor, C

1995-01-01

The cohort of all Australian former army conscripts of the Vietnam conflict ea was followed from 1965 to 1982 to determine mortality rates and causes of death following completion of their National Service. Suiciders were compared with a random sample of survivors using information contained in their military documents in a nested case-control study. Their military document information was recorded before men were selected for Vietnam service and is uncontaminated by "recall bias." Suicide victims had lower mean scores on the army general intelligence and mechanical comprehension tests, were less likely to have continued education beyond high school, were less likely to be employed in white-collar or skilled blue-collar jobs between leaving school and being drafted, and more likely to have volunteered for the draft. They were more likely to have committed a civilian offense before joining the army, more likely to have gone absent without leave (AWOL), and more likely to have committed other offenses during military service. Suiciders were more likely to have a history of diagnosis and treatment for psychological disorder during service and to be judged to be less than emotionally stable at discharge. Service in Vietnam was not associated with suicide. A log-linear regression model was used to analyze death rates associated with five types of variables: cognitive abilities, education, preservice employment, conduct while in service, and physical and mental health. This analysis produced a model containing only four variables: intelligence test score, postschool education, AWOL charge during service, and history of diagnosis and treatment of psychological problems. The difference in death rates between high scorers on these items and low scorers was 46-fold, from 5.2 to 240.9 per 10,000 person-years.

Characterization of Carbapenem-Resistant Enterobacteriaceae with High Rate of Autochthonous Transmission in the Arabian Peninsula

PubMed Central

Sonnevend, Ágnes; Ghazawi, Akela A.; Hashmey, Rayhan; Jamal, Wafaa; Rotimi, Vincent O.; Shibl, Atef M.; Al-Jardani, Amina; Al-Abri, Seif S.; Tariq, Waheed U. Z.; Weber, Stefan; Pál, Tibor

2015-01-01

To establish the role of local transmission versus possible pathogen import due to previous foreign exposure in infections caused by carbapenem non-susceptible Enterobacteriaceae in the Arabian Peninsula, 200 independent isolates collected in 16 hospitals of Saudi Arabia, Kuwait, Oman and the United Arab Emirates were studied. All strains were multidrug resistant; 42.5% of them also qualified as extremely drug resistant. The frequency of various carbapenemases varied according to the participating countries, but in the collection, as a whole, bla NDM-1 was the most frequently encountered carbapenemase gene (46.5%) followed by bla OXA-48-like gene (32.5%). A comparatively high rate (8.9%) of multi-clonal strains carrying both bla NDM and bla OXA-48-like genes in the United Arab Emirates, representing the most resistant subgroup, was encountered. No KPC-expressing isolates were detected. Three major clones of bla NDM-1 carrying Klebsiella pneumoniae of ST152 (n = 22, Saudi Arabia), ST14 (n = 7, United Arab Emirates) and ST147 types (n = 9, Oman) were identified, the latter two clones carrying similar, but not identical HI1b incompatibility type plasmids of >170kb. While from 78.6% of the cases with documented foreign hospitalization bla NDM positive strains were isolated, these strains formed only 25.6% of all the isolates expressing this enzyme. In fact, 56.8% of the NDM, 75.7% of OXA-48-like and 90.9% of VIM positive strains were recovered from patients without documented foreign exposure, neither in the form of travel or prior hospitalization abroad, suggesting a high rate of autochthonous infections. This, considering the extensive links of these countries to the rest of the world, predicts that trends in the local epidemiology of carbapenem resistant strains may increasingly affect the spread of these pathogens on the global scale. These results call for improved surveillance of carbapenem resistant Enterobacteriaceae in the countries of the Arabian Peninsula. PMID:26110660

Assessing spring direct mortality to avifauna from wind energy facilities in the Dakotas

USGS Publications Warehouse

Graff, Brianna J.; Jenks, Jonathan A.; Stafford, Joshua D.; Jensen, Kent C.; Grovenburg, Troy W.

2016-01-01

The Northern Great Plains (NGP) contains much of the remaining temperate grasslands, an ecosystem that is one of the most converted and least protected in the world. Within the NGP, the Prairie Pothole Region (PPR) provides important habitat for >50% of North America's breeding waterfowl and many species of shorebirds, waterbirds, and grassland songbirds. This region also has high wind energy potential, but the effects of wind energy developments on migratory and resident bird and bat populations in the NGP remains understudied. This is troubling considering >2,200 wind turbines are actively generating power in the region and numerous wind energy projects have been proposed for development in the future. Our objectives were to estimate avian and bat fatality rates for wind turbines situated in cropland- and grassland-dominated landscapes, document species at high risk to direct mortality, and assess the influence of habitat variables on waterfowl mortality at 2 wind farms in the NGP. From 10 March to 7 June 2013–2014, we completed 2,398 searches around turbines for carcasses at the Tatanka Wind Farm (TAWF) and the Edgeley-Kulm Wind Farm (EKWF) in South Dakota and North Dakota. During spring, we found 92 turbine-related mortalities comprising 33 species and documented a greater diversity of species (n = 30) killed at TAWF (predominately grassland) than at EKWF (n = 9; predominately agricultural fields). After accounting for detection rates, we estimated spring mortality of 1.86 (SE = 0.22) deaths/megawatt (MW) at TAWF and 2.55 (SE = 0.51) deaths/MW at EKWF. Waterfowl spring (Mar–Jun) fatality rates were 0.79 (SE = 0.11) and 0.91 (SE = 0.10) deaths/MW at TAWF and EKWF, respectively. Our results suggest that future wind facility siting decisions consider avoiding grassland habitats and locate turbines in pre-existing fragmented and converted habitat outside of high densities of breeding waterfowl and major migration corridors.

Evaluation of an occupational rehabilitation program.

PubMed

Goodman, Glenn; Browning, Margaret; Campbell, Sims; Hudak, Huison

2005-01-01

The purpose of this study was to report the findings of a program evaluation for an occupational rehabilitation program in the Midwest. An ex-post facto chart review was performed on 50 charts using demographic data, results from tests of performance and pain measures, and data from patient satisfaction questionnaires to find evidence of excellence in the program, and to identify areas for improvement. Over 97% of the participants actually completed the program and 76% returned to work within 3 months after program completion. Ninety-two percent indicated overall satisfaction with the program, and all aspects of the program were rated with a mean score of 4.25 or above on a 1 to 5 Likert scale. Evaluation of perceived pain scales of the participants indicate no discernable relationship between intensity of pain and successful return to work. The program showed a high completion rate, a high return to work rate, and high levels of patient satisfaction. Suggestions for improvement include an increase in use of real and simulated work activities, better documentation of pain measures, better programs to address psychosocial issues, lengthening the program, and increased communication with case managers and professionals outside of the work program.

[Literature review on human influenza epidemics occurred before the implementation plan for sentinel surveillance program in the DRC].

PubMed

Nkwembe-Ngabana, Edith; Ahuka-Mundeke, Steve; Kebela-Ilunga, Benoit; Londa, Emile Okitolo; Muyembe-Tamfum, Jean-Jacques

2017-01-01

In the Democratic Republic of the Congo (DRC), several influenza epidemics are ignored because they are confused with other infectious diseases which have similar symptoms. Our study aims to assess influenza epidemics occurred in the DRC before 2008, year of the implementation of the influenza surveillance program in the DRC. We searched all the documents [articles, report,…] about influenza epidemic or acute respiratory infections [ARI] in the DRC before 2008 by using chosen key words. Epidemic description elements were identified and analyzed in each report. 4 documents have been found that had no article published. The sites of the epidemic outbreak were the rural health zones in Koshibanda and Kahemba, Bandundu [1995 and 2007], in Bosobolo, Equator [2002] and in Kinshasa [2002-2003]. Attack and lethality rates were 3.9% and 16% in Koshibanda respectively; 0.1% and 2% in Kinshasa; 47.5% and 1.5% in Bosobolo and 14.6% and 2.9% in Kahemba. Children less than 5 years of age were the most affected. Their attack rates ranged between 22.6 and 57.7% and lethality rates ranged between 3.2 and 3.7%. The two epidemics in Bosobolo and Kinshasa were associated with H3N2 influenza virus. This literature review highlights a high morbidity and mortality due to rare influenza epidemics in the DRC.

Allopolyploidy, diversification, and the Miocene grassland expansion

PubMed Central

Estep, Matt C.; McKain, Michael R.; Vela Diaz, Dilys; Zhong, Jinshun; Hodge, John G.; Hodkinson, Trevor R.; Layton, Daniel J.; Malcomber, Simon T.; Pasquet, Rémy; Kellogg, Elizabeth A.

2014-01-01

The role of polyploidy, particularly allopolyploidy, in plant diversification is a subject of debate. Whole-genome duplications precede the origins of many major clades (e.g., angiosperms, Brassicaceae, Poaceae), suggesting that polyploidy drives diversification. However, theoretical arguments and empirical studies suggest that polyploid lineages may actually have lower speciation rates and higher extinction rates than diploid lineages. We focus here on the grass tribe Andropogoneae, an economically and ecologically important group of C4 species with a high frequency of polyploids. A phylogeny was constructed for ca. 10% of the species of the clade, based on sequences of four concatenated low-copy nuclear loci. Genetic allopolyploidy was documented using the characteristic pattern of double-labeled gene trees. At least 32% of the species sampled are the result of genetic allopolyploidy and result from 28 distinct tetraploidy events plus an additional six hexaploidy events. This number is a minimum, and the actual frequency could be considerably higher. The parental genomes of most Andropogoneae polyploids diverged in the Late Miocene coincident with the expansion of the major C4 grasslands that dominate the earth today. The well-documented whole-genome duplication in Zea mays ssp. mays occurred after the divergence of Zea and Sorghum. We find no evidence that polyploidization is followed by an increase in net diversification rate; nonetheless, allopolyploidy itself is a major mode of speciation. PMID:25288748

Outpatient evaluation, recognition, and initial management of pediatric overweight and obesity in U.S. military medical treatment facilities.

PubMed

Dickey, Wayne; Arday, David R; Kelly, Joseph; Carnahan, Col David

2017-02-01

As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3-17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling. Administrative data for these patients were merged to assess coded diagnostic and counseling rates and receipt of recommended laboratory screenings. Generic BMI documentation was high, but BMI percentile assessments were found among fewer than half the patients. Diagnostic recording or recognition totaled 10.9% of overweight and 32.0% of obese. Counseling rates were higher, with 46.4% and 61.0% of overweight and obese patients, respectively, receiving weight related counseling. Among patients 10 years of age or older, rates of recommended lab screenings for diabetes, liver abnormality, and dyslipidemia were not greater than 33%. BMI percentile recording was strongly associated with diagnostic recording, and diagnostic recording was strongly associated with counseling. Improvements to electronic health records or implementation of local procedures to facilitate better diagnostic recording would likely improve adherence to clinical practice guidelines. ©2016 American Association of Nurse Practitioners.

Fabrication of light water reactor tritium targets

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

Pilger, J.P.

1991-11-01

The mission of the Fabrication Development Task of the Tritium Target Development Project is: to produce a documented technology basis, including specifications and procedures for target rod fabrication; to demonstrate that light water tritium targets can be manufactured at a rate consistent with tritium production requirements; and to develop quality control methods to evaluate target rod components and assemblies, and establish correlations between evaluated characteristics and target rod performance. Many of the target rod components: cladding tubes, end caps, plenum springs, etc., have similar counterparts in LWR fuel rods. High production rate manufacture and inspection of these components has beenmore » adequately demonstrated by nuclear fuel rod manufacturers. This summary describes the more non-conventional manufacturing processes and inspection techniques developed to fabricate target rod components whose manufacturability at required production rates had not been previously demonstrated.« less

Variations in the long-term uplift rate due to the Altiplano-Puna magma body observed with Sentinel-1 interferometry

NASA Astrophysics Data System (ADS)

Lau, Nicholas; Tymofyeyeva, Ekaterina; Fialko, Yuri

2018-06-01

We present new Interferometric Synthetic Aperture Radar (InSAR) observations of surface deformation in the Altiplano-Puna region (South America) where previous studies documented a broad uplift at an average rate of ∼10 mm/yr. We use data from the Sentinel-1 satellite mission to produce high-resolution velocity maps and time series of surface displacements between years 2014-2017. The data reveal that the uplift has slowed down substantially compared to the 1992-2010 epoch and is characterized by short-term fluctuations on time scales of months to years. The observed variations in uplift rate may indicate a non-steady supply of melt and/or volatiles from the partially molten Altiplano-Puna Magma Body (APMB) into an incipient diapir forming in the roof of the APMB.

Denudation rates and tectonic geomorphology of the Spanish Betic Cordillera

NASA Astrophysics Data System (ADS)

Bellin, N.; Vanacker, V.; Kubik, P. W.

2014-03-01

The tectonic control on landscape morphology and long-term denudation is largely documented for settings with high uplift rates. Relatively little is known about the rates of geomorphic response in areas of low tectonic uplift. Here, we evaluate spatial variations in denudation of the Spanish Betic Cordillera based on cosmogenic 10Be-derived denudation rates. Denudation rates are compared to published data on rock uplift and exhumation of the Betic Cordillera to evaluate steady-state topography. The spatial patterns of catchment-wide denudation rates (n=20) are then analysed together with topographic metrics of hillslope and channel morphology. Catchments draining the Betic ranges have relatively low denudation rates (64±54 mm kyr), but also show large variation as they range from 14 to 246 mm kyr-1. Catchment-wide denudation is linearly proportional to the mean hillslope gradient and local relief. Despite large spatial variation in denudation, the magnitude and spatial pattern of denudation rates are generally consistent with longer-term local uplift rates derived from elevated marine deposits, fission-track measurements and vertical fault slip rates. This might be indicative of a steady-state topography where rock uplift is balanced by denudation.

Lost in translation: Focused documentation improvement benefits trauma surgeons.

PubMed

Fox, Nicole; Swierczynski, Patricia; Willcutt, Rebecca; Elberfeld, Adrienne; Mazzarelli, Anthony J

2016-09-01

There is a translational gap between physicians who document in the medical record and coders, who ultimately determine which codes are submitted. This gap exists because physicians are never formally educated about documentation strategies despite the fact that the quality of physician documentation directly affects revenue, outcomes and public profiling. We evaluated the effect of a formal model of focused documentation improvement (FDI) on the trauma/critical care division. We hypothesized that FDI would improve physician documentation, resulting in revenue recovery and a shift in the case mix index (CMI) to more accurately reflect the clinical complexity of trauma patients. FDI is defined as targeted physician education followed by concurrent inpatient chart review for documentation improvement opportunities by a clinical documentation specialist (CDS). All trauma surgeons (n=9) at our Level 1 trauma center first completed three hours of mandatory training on documentation improvement. A CDS was subsequently assigned to the trauma service. They reviewed the charts of Medicare patients (n=776) from January-December 2014 to identify opportunities for documentation improvement, participated in ICU rounds and provided ongoing education. Requests to clarify documentation (queries) were posted in the electronic medical record (EMR) and physicians were required to respond within 48h. Data was collected on physician response rate, CMI and revenue recovery. 411 of 776 (57%) charts were reviewed. Opportunities for FDI were identified in 177 (43%) cases. The physician response rate to queries was 100%. The CMI for reviewed cases increased (1.80 (SD 0.15) vs. 2.11 (SD 0.19); p<0.001) after FDI. Overall revenue recovery was $1,132,581 with an average of $154,092 in revenue recovery/clinical full time equivalent. The total cost for administration of FDI was $353,265 resulting in a 220% return on investment (ROI). FDI is an effective strategy to engage physicians in documentation improvement. It provides an infrastructure to assist physicians and yields a significant ROI. Copyright © 2016 Elsevier Ltd. All rights reserved.

Implementation of Patient Decision Support Interventions in Primary Care: The Role of Relational Coordination.

PubMed

Tietbohl, Caroline K; Rendle, Katharine A S; Halley, Meghan C; May, Suepattra G; Lin, Grace A; Frosch, Dominick L

2015-11-01

The benefits of patient decision support interventions (DESIs) have been well documented. However, DESIs remain difficult to incorporate into clinical practice. Relational coordination (RC) has been shown to improve performance and quality of care in health care settings. This study aims to demonstrate how applying RC theory to DESI implementation could elucidate underlying issues limiting widespread uptake. Five primary care clinics in Northern California participated in a DESI implementation project. We used a deductive thematic approach guided by behaviors outlined in RC theory to analyze qualitative data collected from ethnographic field notes documenting the implementation process and focus groups with health care professionals. We then systematically compared the qualitative findings with quantitative DESI distribution data. Based on DESI distribution rates, clinics were placed into 3 performance categories: high, middle, and low. Qualitative data illustrated how each clinic's performance related to RC behaviors. Consistent with RC theory, the high-performing clinic exhibited frequent, timely, and accurate communication and positive working relationships. The 3 middle-performing clinics exhibited high-quality communication within physician-staff teams but limited communication regarding DESI implementation across the clinic. The lowest-performing clinic was characterized by contentious relationships and inadequate communication. Limitations of the study include nonrandom selection of clinics and limited geographic diversity. In addition, ethnographic data collected documented only DESI implementation practices and not larger staff interactions contributing to RC. These findings suggest that a high level of RC within clinical settings may be a key component and facilitator of successful DESI implementation. Future attempts to integrate DESIs into clinical practice should consider incorporating interventions designed to increase positive RC behaviors as a potential means to improve uptake. © The Author(s) 2015.

Is there an association between local health department organizational and administrative factors and childhood immunization coverage rates?

PubMed

Ransom, James; Schaff, Katherine; Kan, Lilly

2012-01-01

Vaccines are valuable, cost-effective tools for preventing disease and improving community health. Despite the importance and ubiquity of vaccinations, childhood immunization coverage rates vary widely by geography, race, and ethnicity. These differences have been documented for nearly two decades, but their sources are poorly understood. Between 2005 and 2008, immunization staff of the National Association of County & City Health Officials (NACCHO) visited 17 local health department (LHD) immunization programs in 10 states to assess their immunization service delivery (ISD) practices and their impact on community childhood immunization coverage rates. To qualitatively characterize LHD immunization programs and specific organizational factors underlying ISD performance challenges and successes related to community childhood immunization coverage rates. Case studies were conducted in a convenience sample of 17 geographically and demographically diverse LHDs, predicated on each LHD's childhood immunization coverage rates per data from the National Immunization Survey and/or Kindergarten Retrospective Survey. NACCHO staff selected LHDs with high (> or = 80% up to date [UTD]), moderate (> or = 75% UTD but < 80% UTD), and low (< 75% UTD) coverage rates. All immunization staff members interviewed (n = 112) were included in focus group interviews at each LHD per a standard semi-structured interview script developed by NACCHO staff. Supporting documents from each LHD immunization program were also collected for inclusion in the analysis. Content and thematic analyses of interview transcripts and supporting documents were conducted. Two thematic dimensions and six key factors emerged from the data. The dimensions of the themes were success and challenge elements. The organizational factors that were associated with success and/or challenges with regard to improving childhood immunization coverage rates included 1) leadership: organizational leadership and management related to aligning ISD with other child-focused services within the LHD; 2) resources: organizational efforts focused on aligning federal and state ISD financing with local ISD needs; 3) politics: political advocacy and partnering with local community stakeholders, including local political entities and boards of health to better organize ISD; 4) community engagement/coalitions and partnerships: partnerships, coalitions, and community engagement to support local immunization-related decision-making and prioritization; 5) credibility: agency credibility and its ability to influence community attitudes and perspectives on the health department's value in terms of child health; and 6) cultural competency of LHD staff: LHD staff members' perceptions and understandings of its community's cultural, economic, and demographic attributes shaped their responses to and understandings of the community and how they interacted with it in terms of service delivery. Public health researchers are in a nascent stage of understanding how health department organizational factors may contribute to specific community health outcomes, such as childhood immunization coverage rates. An implicit challenge to LHD immunization programs is to implement strategies that lead to equitable and high vaccination coverage among children, despite shrinking resources and community demographic differences. Community-specific attributes (e.g., poverty, lack of health insurance, or geographic isolation) affect childhood immunization coverage rates, but internal LHD aspects such as leadership and organizational culture also likely have a significant impact.

18 CFR 5.6 - Pre-application document.

Code of Federal Regulations, 2011 CFR

2011-04-01

... project, including any daily or seasonal ramping rates, flushing flows, reservoir operations, and flood... document must describe the existing and proposed (if any) project facilities and operations, provide...)(viii). (2) Project location, facilities, and operations. The potential applicant must include in the...

Replication of High Fetal Alcohol Spectrum Disorders Prevalence Rates, Child Characteristics, and Maternal Risk Factors in a Second Sample of Rural Communities in South Africa.

PubMed

May, Philip A; De Vries, Marlene M; Marais, Anna-Susan; Kalberg, Wendy O; Buckley, David; Adnams, Colleen M; Hasken, Julie M; Tabachnick, Barbara; Robinson, Luther K; Manning, Melanie A; Bezuidenhout, Heidre; Adam, Margaret P; Jones, Kenneth L; Seedat, Soraya; Parry, Charles D H; Hoyme, H Eugene

2017-05-12

Background : Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods : Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results : Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 9-129 per 1000 children. Total FASD affect 196-276 per 1000 or 20-28% of the children in these communities. Conclusions : Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.

Text-line extraction in handwritten Chinese documents based on an energy minimization framework.

PubMed

Koo, Hyung Il; Cho, Nam Ik

2012-03-01

Text-line extraction in unconstrained handwritten documents remains a challenging problem due to nonuniform character scale, spatially varying text orientation, and the interference between text lines. In order to address these problems, we propose a new cost function that considers the interactions between text lines and the curvilinearity of each text line. Precisely, we achieve this goal by introducing normalized measures for them, which are based on an estimated line spacing. We also present an optimization method that exploits the properties of our cost function. Experimental results on a database consisting of 853 handwritten Chinese document images have shown that our method achieves a detection rate of 99.52% and an error rate of 0.32%, which outperforms conventional methods.

An Interventional Quality Improvement Study to Assess the Compliance to Cardiopulmonary Resuscitation Documentation in an Indian Teaching Hospital

PubMed Central

Nevrekar, Viraj; Panda, Prasan Kumar; Wig, Naveet; Pandey, R. M.; Agarwal, Praveen; Biswas, Ashutosh

2017-01-01

Background: Cardiopulmonary resuscitation (CPR) should be performed as per the international guidelines; however, compliance to these guidelines is difficult to assess. This study was conducted to determine the compliance to American Heart Association (2010) guideline on CPR documentation by among resident physicians before and after resident training (two arms). Methods: This pre–postinterventional quality improvement study was conducted in a referral center, North India. Data of hospitalized in-hospital CPR patients were collected in the form of quality indicators (checklists) as defined by the guideline and compared between two arms of before–after resident training. Residents were given appropriate training in CPR technique as per the guideline. The compliance of CPR documentation was assessed pre- and post-intervention. Results: The baseline arm compliance of various components of CPR documentation was low. The postintervention arm compliances of all components significantly increased (baseline, 2.5% to postintervention, 15.11%, P = 0.03). Individual components assessed were documentation of assessment of responsiveness (65% to 77.9%, P = 0.19), assessment of breathing (37.5% to 58.1%, P = 0.03), assessment of carotid pulse (62.5% to 79%, P = 0.05), rate of chest compressions (20% to 39.5%, P = 0.04), airway management (62.5% to 82.5%, P = 0.02), and compressions to breaths ratio (12.5% to 31.4%, P = 0.02). Documentation of chest compression rate compared to nondocumentation (12 of 42 vs. 11 of 84, P = 0.04) was independently associated with a higher rate of return of spontaneous circulation. The study however did not show any survival benefits. Conclusions: This study establishes that the compliance to CPR documentation is poor as assessed by CPR documentation content and quality, which improves after physician training, but not up to the mark level (100%) that may be due to busy Indian hospital settings and human behavioral factors. Due to ethical constraints of live CPR assessment, this document checklist approach may be considered as an internal quality assessment method for CPR compliance. Furthermore, correct instruction in CPR technique along with proper documentation of the procedure is required, followed up with periodic re-education during the residency period and beyond. PMID:29279637

[Quality of and Attendance at Healthy Child Clinics in Germany].

PubMed

Weithase, Alexandra; Vogel, Mandy; Kiep, Henriette; Schwarz, Sarah; Meißner, Laura; Herrmann, Janine; Rieger, Kristin; Koch, Christiane; Schuster, Volker; Kiess, Wieland

2017-04-01

Background  For several years the German healthy child clinics program has been a highly appreciated preventive measure and is subject to constant development. However, attendance depends on the families' sociodemographic situation. Findings are documented in a medical checkup booklet (the so-called Gelbes Heft). Currently, there is no procedure to use the data collected for epidemiological purposes nor to evaluate the pediatric prevention measures in Germany. Methods  Between 2011 and 2016, we recruited 3480 study participants for our population-based cohort study LIFE Child in Leipzig. 90.6 % submitted their check-up booklets which were subsequently scanned, the data was digitalized and transmitted to a computerized form. Furthermore, data on social status (so-called Winkler-Index) were collected for each family using a structured questionnaire. The study population consisted of the families' oldest child for whom both data sets were available. Results  The transmission of data from the check-up booklets was time-consuming and cost-intensive due to large datasets, uncoded diagnoses as well as the necessity of trained employees for transferring often illegible handwriting. Early diagnostic tests for children enjoy a high level of acceptance among all social classes. With increasing age, attendance rate decreases gradually. Only 83 % of the population with a lower social status attend the U9 test. The documentation of diagnoses in the check-up booklets was implausible because the frequency fluctuated heavily between the different check-up time points. With only less than 2 %, the documentation of psychosocial difficulties in a child was particularly surprising Conclusion  It is not possible to draw conclusions regarding the prevalence of target diseases from the frequency of documented findings in the check-up booklets. In order to make the data both comparable and evaluable, documentation must be digitalized in the future. © Georg Thieme Verlag KG Stuttgart · New York.

Alvarado Flood Risk Management Modifications to Existing Project Section 408 Review. Review Plan

DTIC Science & Technology

2012-12-26

Digital Flood Insurance Rate Maps) through the Nationa l Flood Insurance Program ( NFIP ). In order to obtain FEMA accreditation, the levee owner...compliance documentation for meeting NFIP requirements. Barr conducted a thorough review of relevant documents to gain a better understanding of...compliance documentation for meeting NFIP requirements. Barr Engineering has prepared a Phase I Engineer’s Report and is developing plans and

Magma ascent and lava flow emplacement rates during the 2011 Axial Seamount eruption based on CO2 degassing

NASA Astrophysics Data System (ADS)

Jones, M. R.; Soule, S. A.; Gonnermann, H. M.; Le Roux, V.; Clague, D. A.

2018-07-01

Quantitative metrics for eruption rates at mid-ocean ridges (MORs) would improve our understanding of the structure and formation of the uppermost oceanic crust and would provide a means to link volcanic processes with the conditions of the underlying magmatic system. However, these metrics remain elusive because no MOR eruptions have been directly observed. The possibility of disequilibrium degassing in mid-ocean ridge basalts (MORB), due to high eruptive depressurization rates, makes the analysis of volatile concentrations in MORB glass a promising method for evaluating eruption rates. In this study, we estimate magma ascent and lava flow emplacement rates during the 2011 eruption of Axial Seamount based on numerical modeling of diffusion-controlled bubble growth and new measurements of dissolved volatiles, vesicularity, and vesicle size distributions in erupted basalts. This dataset provides a unique view of the variability in magma ascent (∼0.02-1.2 m/s) and lava flow rates (∼0.1-0.7 m/s) during a submarine MOR eruption based on 50 samples collected from a >10 km long fissure system and three individual lava flow lobes. Samples from the 2011 eruption display an unprecedented range in dissolved CO2 concentrations, nearly spanning the full range observed on the global MOR system. The variable vesicularity and dissolved CO2 concentrations in these samples can be explained by differences in the extent of degassing, dictated by flow lengths and velocities during both vertical ascent and horizontal flow along the seafloor. Our results document, for the first time, the variability in magma ascent rates during a submarine eruption (∼0.02-1.2 m/s), which spans the global range previously proposed based on CO2 degassing. The slowest ascent rates are associated with hummocky flows while faster ascent rates produce channelized sheet flows. This study corroborates degassing-based models for eruption rates using comparisons with independent methods and documents the relationship between eruption dynamics, magma ascent rates, and the morphology of eruptive products. Globally, this approach allows interrogation of the processes that govern mid-ocean ridge eruptions and influence the formation of the oceanic crust.

Does mobility explain variation in colonisation and population recovery among stream fishes?

USGS Publications Warehouse

Angermeier, Paul L.; Albanese, Brett; Peterson, James T.

2009-01-01

1. Colonisation and population recovery are crucial to species persistence in environmentally variable ecosystems, but are poorly understood processes. After documenting movement rates for several species of stream fish, we predicted that this variable would influence colonisation rates more strongly than local abundance, per cent occupancy, body size and taxonomic family. We also predicted that populations of species with higher movement rates would recover more rapidly than species with lower movement rates and that assemblage structure would change accordingly. 2. To test these predictions, we removed fishes from a headwater and a mainstem creek in southwest Virginia and monitored colonisation over a 2-year period. Using an information–theoretic approach, we evaluated the relative plausibility of 15 alternative models containing different combinations of our predictor variables. Our best-supported model contained movement rate and abundance and was 41 times more likely to account for observed patterns in colonisation rates than the next-best model. Movement rate and abundance were both positively related to colonisation rates and explained 88% of the variation in colonisation rates among species. 3. Population recovery, measured as the per cent of initial abundance restored, was also positively associated with movement rate. One species recovered within 3 months, most recovered within 2 years, but two species still had not recovered after 2 years. Despite high variation in recovery, the removal had only a slight impact on assemblage structure because species that were abundant in pre-removal samples were also abundant in post-removal samples. 4. The significance of interspecific variation in colonisation and recovery rates has been underappreciated because of the widely documented recovery of stream fish assemblages following fish kills and small-scale experimental defaunations. Our results indicate that recovery of the overall assemblage does not imply recovery of each component species. Populations of species that are rare and less mobile will recover more slowly and will be more vulnerable to extinction in systems where chemical spills, hydrological alteration, extreme droughts and other impacts are frequent.

2001 Safety belt usage survey in Kentucky

DOT National Transportation Integrated Search

2001-08-01

The objective of this study was to establish 2001 safety belt and child safety seat usage rates in Kentucky. The 2001 survey continues to document the results after enactment of a statewide mandatory safety belt law in 1994. It also documented the lo...

Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions.

PubMed

O'Keefe, James H; Abuissa, Hussam; Sastre, Antonio; Steinhaus, David M; Harris, William S

2006-04-15

We explored possible mechanisms by which recommended intakes of omega-3 fatty acids may decrease the risk for sudden cardiac death in patients with documented coronary heart disease. The cardioprotective effects of omega-3 fatty acids have been documented in epidemiologic and randomized controlled trials. These fatty acids are presumed to decrease susceptibility to fatal arrhythmias, but whether this is mediated by classic risk factors or direct cardiac mechanisms is not known. Eighteen white men with a history of myocardial infarction and ejection fractions <40% were randomized to placebo or omega-3 fatty acids (585 mg of docosahexaenoic acid and 225 mg of eicosapentaenoic acid) for two 4-month periods in a crossover design. At the end of each period, heart rate (HR), HR variability, and rate of HR recovery after exercise were determined, as were effects on arterial compliance, blood pressure, cardiac function, and fasting serum levels of lipids and inflammatory markers. Omega-3 fatty acids decreased HR at rest from 73 +/- 13 to 68 +/- 13 beats/min (p <0.0001) and improved 1-minute HR recovery after exercise (-27 +/- 10 to -32 +/- 12 beats/min, p <0.01). HR variability in the high-frequency band increased (p <0.02), but no change was noted in overall HR variability. There were no significant effects on blood pressure, arterial compliance, lipids, or inflammatory markers. These changes are consistent with an increase in vagal activity and may in part explain the observed decrease in risk for sudden cardiac death seen with omega-3 fatty acid supplementation.

Rate of Dehydration and Cumulative Desiccation Stress Interacted to Modulate Desiccation Tolerance of Recalcitrant Cocoa and Ginkgo Embryonic Tissues1

PubMed Central

Liang, Yongheng; Sun, Wendell Q.

2002-01-01

Rate of dehydration greatly affects desiccation tolerance of recalcitrant seeds. This effect is presumably related to two different stress vectors: direct mechanical or physical stress because of the loss of water and physicochemical damage of tissues as a result of metabolic alterations during drying. The present study proposed a new theoretic approach to represent these two types of stresses and investigated how seed tissues responded differently to two stress vectors, using the models of isolated cocoa (Theobroma cacao) and ginkgo (Ginkgo biloba) embryonic tissues dehydrated under various drying conditions. This approach used the differential change in axis water potential (ΔΨ/Δt) to quantify rate of dehydration and the intensity of direct physical stress experienced by embryonic tissues during desiccation. Physicochemical effect of drying was expressed by cumulative desiccation stress [∫\\documentclass[10pt]{article} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\pagestyle{empty} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{o}^{t}}}\\end{equation*}\\end{document}f(ψ,t)], a function of both the rate and time of dehydration. Rapid dehydration increased the sensitivity of embryonic tissues to desiccation as indicated by high critical water contents, below which desiccation damage occurred. Cumulative desiccation stress increased sharply under slow drying conditions, which was also detrimental to embryonic tissues. This quantitative analysis of the stress-time-response relationship helps to understand the physiological basis for the existence of an optimal dehydration rate, with which maximum desiccation tolerance could be achieved. The established numerical analysis model will prove valuable for the design of experiments that aim to elucidate biochemical and physiological mechanisms of desiccation tolerance. PMID:11950981

SU-G-201-01: An Automated Treatment Plan Quality Assurance Program for High-Dose Rate (HDR) Brachytherapy with a VaginalCylinder Applicator

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

Zhou, Y; Tan, J; Jiang, S

Purpose: Plan specific quality assurance (QA) is an important step in high dose rate (HDR) brachytherapy to ensure the integrity of a treatment plan. The conventional approach is to assemble a set of plan screen-captures in a document and have an independent plan-checker to verify it. Not only is this approach cumbersome and time-consuming, using a document also limits the items that can be verified, hindering plan quality and patient safety. We have initiated efforts to develop a web-based HDR brachytherapy QA system called AutoBrachy QA, for comprehensive and efficient QA. This abstract reports a new plugin in this systemmore » for the QA of a cylinder HDR brachytherapy treatment. Methods: A cylinder plan QA module was developed using Python. It was plugged into our AutoBrachy QA system. This module extracted information from CT images and treatment plan. Image processing techniques were employed to obtain geometric parameters, e.g. cylinder diameter. A comprehensive set of eight geometrical and eight dosimetric features of the plan were validated against user specified planning parameter, such as prescription value, treatment depth and length, etc. A PDF document was generated, consisting of a summary QA sheet with all the QA results, as well as images showing plan details. Results: The cylinder QA program has been implemented in our clinic. To date, it has been used in 11 patient cases and was able to successfully perform QA tests in all of them. The QA program reduced the average plan QA time from 7 min using conventional manual approach to 0.5 min. Conclusion: Being a new module in our AutoBrachy QA system, an automated treatment plan QA module for cylinder HDR brachytherapy has been successfully developed and clinically implemented. This module improved clinical workflow and plan integrity compared to the conventional manual approach.« less

Differences in U.S. Suicide Rates by Educational Attainment, 2000-2014.

PubMed

Phillips, Julie A; Hempstead, Katherine

2017-10-01

The purpose of this study was to document the association between education and suicide risk, in light of rising suicide rates and socioeconomic differentials in mortality in the U.S. Differentials and trends in U.S. suicide rates by education were examined from 2000 to 2014 using death certificate data on 442,135 suicides from the National Center for Health Statistics and Census data. Differences in the circumstances and characteristics of suicide deaths by education were investigated using 2013 data from the National Violent Death Reporting System for nine states. Analyses were conducted in 2016. Between 2000 and 2014, men and women aged ≥25 years with at least a college degree exhibited the lowest suicide rates; those with a high school degree displayed the highest rates. Men with a high school education were twice as likely to die by suicide compared with those with a college degree in 2014. The education gradient in suicide mortality generally remained constant over the study period. Interpersonal/relationship problems and substance abuse were more common circumstances for less educated decedents. Mental health issues and job problems were more prevalent among college-educated decedents. The findings highlight the importance of social determinants in suicide risk, with important prevention implications. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

School practices to promote social distancing in K-12 schools: review of influenza pandemic policies and practices.

PubMed

Uscher-Pines, Lori; Schwartz, Heather L; Ahmed, Faruque; Zheteyeva, Yenlik; Meza, Erika; Baker, Garrett; Uzicanin, Amra

2018-03-27

During an evolving influenza pandemic, community mitigation strategies, such as social distancing, can slow down virus transmission in schools and surrounding communities. To date, research on school practices to promote social distancing in primary and secondary schools has focused on prolonged school closure, with little attention paid to the identification and feasibility of other more sustainable interventions. To develop a list and typology of school practices that have been proposed and/or implemented in an influenza pandemic and to uncover any barriers identified, lessons learned from their use, and documented impacts. We conducted a review of the peer-reviewed and grey literature on social distancing interventions in schools other than school closure. We also collected state government guidance documents directed to local education agencies or schools to assess state policies regarding social distancing. We collected standardized information from each document using an abstraction form and generated descriptive statistics on common plan elements. The document review revealed limited literature on school practices to promote social distancing, as well as limited incorporation of school practices to promote social distancing into state government guidance documents. Among the 38 states that had guidance documents that met inclusion criteria, fewer than half (42%) mentioned a single school practice to promote social distancing, and none provided any substantive detail about the policies or practices needed to enact them. The most frequently identified school practices were cancelling or postponing after-school activities, canceling classes or activities with a high rate of mixing/contact that occur within the school day, and reducing mixing during transport. Little information is available to schools to develop policies and procedures on social distancing. Additional research and guidance are needed to assess the feasibility and effectiveness of school practices to promote social distancing.

Consensus document of the Spanish Urological Association on the management of uncomplicated recurrent urinary tract infections.

PubMed

Prieto, L; Esteban, M; Salinas, J; Adot, J M; Arlandis, S; Peri, L; Cozar, J M

2015-01-01

The clinical manifestations of urinary infections, commonly mild and uncomplicated, have resulted in a generally empirical therapeutic decision-making process, which does not help fight resistances to antibacterial agents, thus causing a high rate of recurrence. This study seeks to reduce the clinical variability in the diagnosis and treatment of uncomplicated recurrent urinary tract infections (RUTIs). The consensus document was developed using a nominal group methodology, using scientific evidence on RUTIs extracted from a systematic (noncomprehensive) literature review, along with the expert judgment of specialists and their experience in clinical practice. RUTIs are considered the manifestation of at least 3 episodes of uncomplicated infection, with a positive culture in the past 12 months, in addition to (for men) the absence of structural or functional abnormalities. We maintain that the treatment should be empiric when suspecting RUTIs (prior to obtaining a urine sample for culture) in those patients who have a high probability of recurrence, associated risk factors and/or urinary or general symptoms, such as fever and chills. Homogeneous criteria are recommended for the diagnosis and treatment in order to fight the increased rates of resistance that the microorganisms develop against antimicrobial agents. Imprecision in the identification of the infection requires a search for agreements on homogenized criteria and decision algorithms that guide the management of these patients. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

High Rates of Antimicrobial Drug Resistance Gene Acquisition after International Travel, the Netherlands

PubMed Central

von Wintersdorff, Christian J.H.; Penders, John; Stobberingh, Ellen E.; Lashof, Astrid M.L. Oude; Hoebe, Christian J.P.A.; Savelkoul, Paul H.M.

2014-01-01

We investigated the effect of international travel on the gut resistome of 122 healthy travelers from the Netherlands by using a targeted metagenomic approach. Our results confirm high acquisition rates of the extended-spectrum β-lactamase encoding gene blaCTX-M, documenting a rise in prevalence from 9.0% before travel to 33.6% after travel (p<0.001). The prevalence of quinolone resistance encoding genes qnrB and qnrS increased from 6.6% and 8.2% before travel to 36.9% and 55.7% after travel, respectively (both p<0.001). Travel to Southeast Asia and the Indian subcontinent was associated with the highest acquisition rates of qnrS and both blaCTX-M and qnrS, respectively. Investigation of the associations between the acquisitions of the blaCTX-M and qnr genes showed that acquisition of a blaCTX-M gene was not associated with that of a qnrB (p = 0.305) or qnrS (p = 0.080) gene. These findings support the increasing evidence that travelers contribute to the spread of antimicrobial drug resistance. PMID:24655888

High rates of antimicrobial drug resistance gene acquisition after international travel, The Netherlands.

PubMed

von Wintersdorff, Christian J H; Penders, John; Stobberingh, Ellen E; Oude Lashof, Astrid M L; Hoebe, Christian J P A; Savelkoul, Paul H M; Wolffs, Petra F G

2014-04-01

We investigated the effect of international travel on the gut resistome of 122 healthy travelers from the Netherlands by using a targeted metagenomic approach. Our results confirm high acquisition rates of the extended-spectrum β-lactamase encoding gene blaCTX-M, documenting a rise in prevalence from 9.0% before travel to 33.6% after travel (p<0.001). The prevalence of quinolone resistance encoding genes qnrB and qnrS increased from 6.6% and 8.2% before travel to 36.9% and 55.7% after travel, respectively (both p<0.001). Travel to Southeast Asia and the Indian subcontinent was associated with the highest acquisition rates of qnrS and both blaCTX-M and qnrS, respectively. Investigation of the associations between the acquisitions of the blaCTX-M and qnr genes showed that acquisition of a blaCTX-M gene was not associated with that of a qnrB (p = 0.305) or qnrS (p = 0.080) gene. These findings support the increasing evidence that travelers contribute to the spread of antimicrobial drug resistance.

Factors Affecting Sexual History Taking in a Health Center Serving Homeless Persons.

PubMed

Sowicz, Timothy Joseph; Bradway, Christine K

2018-03-01

Low rates of documentation of sexual histories have been reported and research on sexual history taking (SHT) has focused on the content of, barriers to collecting, and interventions to improve documentation of sexual histories. Absent from this literature is an understanding of the contextual factors affecting SHT. To address this gap, a focused ethnography of one health center was conducted. Data were collected through observations of health care encounters and interviews with health care providers (HCPs). No SHT was observed and this was likely influenced by patients' characteristics, communication between patients and HCPs, the prioritization of patients' basic needs, and time constraints imposed upon encounters. Given that the health center studied serves patients experiencing homelessness, behavioral health concerns, and opioid use disorder, findings illuminate areas for future inquiry into a patient population affected by social as well as physiologic determinants of health and potentially at high risk for adverse sexual health outcomes.

British American Tobacco’s failure in Turkey

PubMed Central

Lawrence, S

2009-01-01

Background and objectives Transnational tobacco companies (TTCs) considered Turkey an important, potential investment market because of its high consumption rates and domestic commitment to tobacco. This paper outlines how British American Tobacco (BAT) attempted to establish a joint venture with the government monopoly TEKEL, while waiting for privatisation and a private tender. Methods Analysis of tobacco industry documents from the Guildford Depository and online tobacco document sources. Results BAT failed to establish a market share in Turkey until 2000 despite repeated attempts to form a joint venture with Turkey’s tobacco monopoly, TEKEL, once the market liberalised in the mid 1980s. Conclusions BAT’s failure in the Turkish market was due to a misguided investment strategy focused solely on acquiring TEKEL and is contrasted with Philip Morris success in Turkey despite both TTCs working within Turkey’s unstable and corrupt investing climate. PMID:18845622

Advance and Retreat: Tobacco Control Policy in the U.S. Military

PubMed Central

Arvey, Sarah R.; Malone, Ruth E.

2009-01-01

This archival study explored why military tobacco control initiatives have thus far largely failed to meet their goals. We analyzed more than 5,000 previously undisclosed internal tobacco industry documents made public via an online database and additional documents obtained from the U.S. military. In four case studies, we illustrate how pressures exerted by multiple political actors resulted in weakening or rescinding military tobacco control policy initiatives. Our findings suggest that lowering military smoking rates will require health policymakers to better anticipate and counter political opponents. The findings also suggest that effective tobacco control policies may require strong, explicit implementation instructions and high-level Department of Defense support. Finally, policy designers should also consider ways to reduce or eliminate existing perverse incentives to increase tobacco consumption, such as allowing exchange store tobacco sales to fund Morale, Recreation, and Welfare Programs. PMID:19160617

Engaging staff to improve quality and safety in an austere medical environment: a case-control study in two Sierra Leonean hospitals.

PubMed

Rosen, Michael A; Chima, Adaora M; Sampson, John B; Jackson, Eric V; Koka, Rahul; Marx, Megan K; Kamara, Thaim B; Ogbuagu, Onyebuchi U; Lee, Benjamin H

2015-08-01

Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies. In the study site, only 12.4% of four critical vital signs were documented in the pre-intervention period. Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate. FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site. Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the post-implementation period (95% CI [1.35, 2.38]). FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

The clinical applicability of a daily summary of patients' self-reported postoperative pain-A repeated measure analysis.

PubMed

Wikström, Lotta; Eriksson, Kerstin; Fridlund, Bengt; Nilsson, Mats; Årestedt, Kristofer; Broström, Anders

2017-12-01

(i) To determine whether a central tendency, median, based on patients' self-rated pain is a clinically applicable daily measure to show patients' postoperative pain on the first day after major surgery (ii) and to determine the number of self-ratings required for the calculation of this measure. Perioperative pain traits in medical records are difficult to overview. The clinical applicability of a daily documented summarising measure of patients' self-rated pain scores is little explored. A repeated measure design was carried out at three Swedish country hospitals. Associations between the measures were analysed with nonparametric statistical methods; systematic and individual group changes were analysed separately. Measure I: pain scores at rest and activity postoperative day 1; measure II: retrospective average pain from postoperative day 1. The sample consisted of 190 general surgery patients and 289 orthopaedic surgery patients with a mean age of 65; 56% were men. Forty-four percent had a pre-operative daily intake of analgesia, and 77% used postoperative opioids. A range of 4-9 pain scores seem to be eligible for the calculation of the daily measures of pain. Rank correlations for individual median scores, based on four ratings, vs. retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. A systematic group change towards a higher level of reported retrospective pain was significant. The median values were clinically applicable daily measures. The risk of obtaining a higher value than was recalled by patients seemed to be low. Applicability increased with increased frequency of self-rated pain scores and with high-quality pain assessments. The documenting of daily median pain scores at rest and during activity could constitute the basis for obtaining patients' experiences by showing their pain severity trajectories. The measures could also be an important key to predicting postoperative health-related consequences. © 2017 John Wiley & Sons Ltd.

Monitoring and Modelling the Rapid Evolution of Earth's Newest Volcanic Island: Hunga Tonga Hunga Ha'apai (Tonga) Using High Spatial Resolution Satellite Observations

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

Garvin, James B.; Slayback, Daniel A.; Ferrini, Vi

2018-04-16

We have monitored a newly-erupted surtseyan volcanic island in the Kingdom of Tonga, unofficially known as Hunga Tonga Hunga Ha’apai (HTHH), by means of very high-resolution satellite observations. The new ~1.8 km2 island formed as a tuff cone over the course of a month-long hydro-volcanic eruption in early 2015 in the Tonga-Kermadec Islands volcanic arc. Such tephra-dominated eruptions usually produce fragile subaerial landscapes that wash away rapidly due to marine abrasion, as documented in 2009. Our measured rates of erosion are five to twenty times greater than observed at Surtsey (Iceland). Preliminary measurements of the topographic expression of the primarymore » tuff cone from the past ~ 30 months suggest an extended lifetime of at least ~ 6.5 years (and potentially up to 29 years), documenting details of its landscape evolution using satellite and ship-based remote sensing approaches never-before available at such scales for this type of newly-formed island. A new volcanic island in the southwestern Pacific Ocean that formed by means of an eruption style similar to that of Surtsey (Iceland) was monitored and observed via high resolution satellite imaging for over ~30 months since its time of formation in early 2015. This island, unofficially named Hunga Tonga Hunga Ha'apai (HTHH), was not expected to persist as land for more than a few months, but our observations have documented its lifetime for 30 months. Using topography derived from high resolution satellite images, the above-sea-level volume of the island was measured over time, leading to a "volumetric" erosion rate that was compared with other oceanic islands. The HTHH island is disappearing five times (or more) faster than Surtsey, but much slower than typical models predict, allowing detailed measurement of its erosional history at new spatial scales. Regional submarine topography (bathymetry) shows that shallow-water topology may be an important factor in explaining the unexpected lifetime of this new island, together with the likelihood of internal strengthening by hydrothermal mineralization. The stages of erosion of the HTHH island may have implications for similar landforms discovered on Mars and their formation and evolution.« less

Monitoring and Modeling the Rapid Evolution of Earth's Newest Volcanic Island: Hunga Tonga Hunga Ha'apai (Tonga) Using High Spatial Resolution Satellite Observations

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

Garvin, J. B.; Slayback, D. A.; Ferrini, V.

We have monitored a newly-erupted surtseyan volcanic island in the Kingdom of Tonga, unofficially known as Hunga Tonga Hunga Ha’apai (HTHH), by means of very high-resolution satellite observations. The new ~1.8 km2 island formed as a tuff cone over the course of a month-long hydro-volcanic eruption in early 2015 in the Tonga-Kermadec Islands volcanic arc. Such tephra-dominated eruptions usually produce fragile subaerial landscapes that wash away rapidly due to marine abrasion, as documented in 2009. Our measured rates of erosion are five to twenty times greater than observed at Surtsey (Iceland). Preliminary measurements of the topographic expression of the primarymore » tuff cone from the past ~ 30 months suggest an extended lifetime of at least ~ 6.5 years (and potentially up to 29 years), documenting details of its landscape evolution using satellite and ship-based remote sensing approaches never-before available at such scales for this type of newly-formed island. A new volcanic island in the southwestern Pacific Ocean that formed by means of an eruption style similar to that of Surtsey (Iceland) was monitored and observed via high resolution satellite imaging for over ~30 months since its time of formation in early 2015. This island, unofficially named Hunga Tonga Hunga Ha'apai (HTHH), was not expected to persist as land for more than a few months, but our observations have documented its lifetime for 30 months. Using topography derived from high resolution satellite images, the above-sea-level volume of the island was measured over time, leading to a "volumetric" erosion rate that was compared with other oceanic islands. The HTHH island is disappearing five times (or more) faster than Surtsey, but much slower than typical models predict, allowing detailed measurement of its erosional history at new spatial scales. Regional submarine topography (bathymetry) shows that shallow-water topology may be an important factor in explaining the unexpected lifetime of this new island, together with the likelihood of internal strengthening by hydrothermal mineralization. The stages of erosion of the HTHH island may have implications for similar landforms discovered on Mars and their formation and evolution.« less

Robust keyword retrieval method for OCRed text

NASA Astrophysics Data System (ADS)

Fujii, Yusaku; Takebe, Hiroaki; Tanaka, Hiroshi; Hotta, Yoshinobu

2011-01-01

Document management systems have become important because of the growing popularity of electronic filing of documents and scanning of books, magazines, manuals, etc., through a scanner or a digital camera, for storage or reading on a PC or an electronic book. Text information acquired by optical character recognition (OCR) is usually added to the electronic documents for document retrieval. Since texts generated by OCR generally include character recognition errors, robust retrieval methods have been introduced to overcome this problem. In this paper, we propose a retrieval method that is robust against both character segmentation and recognition errors. In the proposed method, the insertion of noise characters and dropping of characters in the keyword retrieval enables robustness against character segmentation errors, and character substitution in the keyword of the recognition candidate for each character in OCR or any other character enables robustness against character recognition errors. The recall rate of the proposed method was 15% higher than that of the conventional method. However, the precision rate was 64% lower.

Growth dynamics of Australia's polar dinosaurs.

PubMed

Woodward, Holly N; Rich, Thomas H; Chinsamy, Anusuya; Vickers-Rich, Patricia

2011-01-01

Analysis of bone microstructure in ornithopod and theropod dinosaurs from Victoria, Australia, documents ontogenetic changes, providing insight into the dinosaurs' successful habitation of Cretaceous Antarctic environments. Woven-fibered bone tissue in the smallest specimens indicates rapid growth rates during early ontogeny. Later ontogeny is marked by parallel-fibered tissue, suggesting reduced growth rates approaching skeletal maturity. Bone microstructure similarities between the ornithopods and theropods, including the presence of LAGs in each group, suggest there is no osteohistologic evidence supporting the hypothesis that polar theropods hibernated seasonally. Results instead suggest high-latitude dinosaurs had growth trajectories similar to their lower-latitude relatives and thus, rapid early ontogenetic growth and the cyclical suspensions of growth inherent in the theropod and ornithopod lineages enabled them to successfully exploit polar regions.

Effects of cardiopulmonary baroreceptor activation on pain may be moderated by risk for hypertension.

PubMed

Ditto, Blaine; Lewkowski, Maxim D; Rainville, Pierre; Duncan, Gary H

2009-10-01

Cardiopulmonary baroreceptor stimulation may modulate pain, though the literature is much smaller than research showing that sinoaortic baroreceptor stimulation can buffer pain. To examine the possibility that risk for established high blood pressure may moderate the effects of cardiopulmonary baroreceptor stimulation on pain, 22 borderline hypertensive and 18 normotensive men participated in a laboratory experiment. Group differences in blood pressure were documented by 24-h ambulatory blood pressure recording. Ratings of the intensity of acute heat pain were influenced by both group membership and leg position. Passive elevation of the legs, a technique that stimulates cardiopulmonary baroreceptors, reduced ratings of heat pain though only among borderline hypertensives. Alteration of pain sensitivity may reflect the development of the hypertensive process.

Breech presentation: an audit project as means of pursuing clinical excellence.

PubMed

Siassakos, D; Anderson, H; Panter, K

2005-10-01

Clinical audit is an effective quality improvement process to evaluate important clinical issues. Breech presentation is such an issue due to its contribution to the rising caesarean section (CS) rate. We set out to assess the management of breech presentation using, as standards, the delivery suite protocol and national guidelines. Our first audit revealed a low success rate of external cephalic version (ECV) and deficient documentation of written consent for ECV, other aspects of care being satisfactory. The results were presented to a multidisciplinary meeting and disseminated to relevant stakeholders. A re-audit was then performed. It confirmed significant improvement in the documentation of consent for ECV. It also revealed a good detection rate of breech, optimal offer rate of ECV and good neonatal outcome. However, uptake of ECV as well as the success rate could both be improved so as to reduce the CS rate for breech presentation. We discuss options for improving the uptake and success rate for ECV.

75 FR 65279 - Schedule for Rating Disabilities; AL Amyloidosis (Primary Amyloidosis)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 4 RIN 2900-AN75 Schedule for Rating Disabilities; AL... document proposes to amend the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (rating... establish criteria for disability evaluation to fully implement the decision by the Secretary of Veterans...

Stimulating ammonia oxidizing bacteria (AOB) activity drives the ammonium oxidation rate in a constructed wetland (CW).

PubMed

Su, Yu; Wang, Weidong; Wu, Di; Huang, Wei; Wang, Mengzi; Zhu, Guibing

2018-05-15

An integrated approach to document high ammonium oxidation rate in Guanjinggang constructed wetland (GJG-CW) was performed and the results showed that the substantial ammonium oxidation rate could be obtained by enhancing Ammonia Oxidizing Bacteria (AOB) activity rather than Ammonia Oxidizing Archaea (AOA) activity. In the plant-bed/ditch system, ditch center and plant-bed fringe were two active zones for NH 4 + -N removal with ammonium oxidation rate peaking at 2.98±0.04 and 2.15±0.02mgNkg -1 d -1 , respectively. The enhanced AOB activity were achieved by increasing water level fluctuations, extending hydraulic retention time (HRT) and stimulating substrate availability, which subsequently enhanced NH 4 + -N removal by 34.06% in GJG-CW. However, the high AOB activity was not correlated with high AOB abundance, but was instead mostly determined by specific AOB taxa, particularly Nitrosomonas, which dominated in the active AOB. The increased cell-specific AOA activity and high AOA diversity were also achieved using those engineering measures. Although the AOA activity decreased overall with extended HRT and increased NH 4 + -N contents in GJG-CW, AOA still played a major role on ammonium oxidation in plant-bed soil. The study illustrated that artificially enhancing AOB activity and certain species in anthropogenically polluted water ecosystems would be an effective strategy to improve NH 4 + -N removal. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluating intervention fidelity: an example from a high-intensity interval training study.

PubMed

Taylor, Kathryn L; Weston, Matthew; Batterham, Alan M

2015-01-01

Intervention fidelity refers to the degree to which an experimental manipulation has been implemented as intended, but simple, robust methods for quantifying fidelity have not been well documented. Therefore, we aim to illustrate a rigorous quantitative evaluation of intervention fidelity, using data collected during a high-intensity interval training intervention. Single-group measurement study. Seventeen adolescents (mean age ± standard deviation [SD] 14.0 ± 0.3 years) attended a 10-week high-intensity interval training intervention, comprising two exercise sessions per week. Sessions consisted of 4-7 45-s maximal effort repetitions, interspersed with 90-s rest. We collected heart rate data at 5-s intervals and recorded the peak heart rate for each repetition. The high-intensity exercise criterion was ≥ 90% of individual maximal heart rate. For each participant, we calculated the proportion of total exercise repetitions exceeding this threshold. A linear mixed model was applied to properly separate the variability in peak heart rate between- and within-subjects. Results are presented both as intention to treat (including missed sessions) and per protocol (only participants with 100% attendance; n=8). For intention to treat, the median (interquartile range) proportion of repetitions meeting the high-intensity criterion was 58% (42% to 68%). The mean peak heart rate was 85% of maximal, with a between-subject SD of 7.8 (95% confidence interval 5.4 to 11.3) percentage points and a within-subject SD of 15.1 (14.6 to 15.6) percentage points. For the per protocol analysis, the median proportion of high-intensity repetitions was 68% (47% to 86%). The mean peak heart rate was 91% of maximal, with between- and within-subject SDs of 3.1 (-1.3 to 4.6) and 3.4 (3.2 to 3.6) percentage points, respectively. Synthesising information on exercise session attendance and compliance (exercise intensity) quantifies the intervention dose and informs evaluations of treatment fidelity.

Measures of follow-up in early hearing detection and intervention programs: a need for standardization.

PubMed

Mason, Craig A; Gaffney, Marcus; Green, Denise R; Grosse, Scott D

2008-06-01

To demonstrate the need for standardized data definitions and reporting for early hearing detection and intervention (EHDI) programs collecting information on newborn hearing screening and follow-up, and types of information best collected in a standardized manner. A hypothetical birth cohort was used to show the potential effects of nonstandardized definitions and data classifications on rates of hearing screening, audiologic follow-up, and hearing loss. The true screening rate in this cohort was 92.4%. The calculated rate was between 90.0% and 96.5%, depending on the measure used. Among children documented as screened and referred for follow-up, 61.0% received this testing. Only 49.0% were documented to have been tested. Despite a true prevalence of 3.7 per 1,000 births, only 1.5 per 1,000 children were documented with a hearing loss. Ensuring that children receive recommended follow-up is challenging. Without complete reporting by audiologists to EHDI programs, accurate calculation of performance measures is impossible. Lack of documentation can lead to the overstatement of "loss to follow-up." Also, standardization of measures is essential for programs to evaluate how many children receive recommended services and assess progress toward national goals. A new survey has been implemented to collect more detailed and standardized information about recommended services.

Distribution and characteristic of nitrite-dependent anaerobic methane oxidation bacteria by comparative analysis of wastewater treatment plants and agriculture fields in northern China

PubMed Central

Ma, Ru

2016-01-01

Nitrite-dependent anaerobic methane oxidation (n-damo) is a recently discovered biological process which has been arousing global attention because of its potential in minimizing greenhouse gases emissions. In this study, molecular biological techniques and potential n-damo activity batch experiments were conducted to investigate the presence and diversity of M. oxyfera bacteria in paddy field, corn field, and wastewater treatment plant (WWTP) sites in northern China, as well as lab-scale n-damo enrichment culture. N-damo enrichment culture showed the highest abundance of M. oxyfera bacteria, and positive correlation was observed between potential n-damo rate and abundance of M. oxyfera bacteria. Both paddy field and corn field sites were believed to be better inoculum than WWTP for the enrichment of M. oxyfera bacteria due to their higher abundance and the diversity of M. oxyfera bacteria. Comparative analysis revealed that long biomass retention time, low NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}${}_{4}^{+}$\\end{document}4+ and high NO\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}${}_{2}^{-}$\\end{document}2− content were suitable for the growth of M. oxyfera bacteria. PMID:27994974

Concave 1-norm group selection

PubMed Central

Jiang, Dingfeng; Huang, Jian

2015-01-01

Grouping structures arise naturally in many high-dimensional problems. Incorporation of such information can improve model fitting and variable selection. Existing group selection methods, such as the group Lasso, require correct membership. However, in practice it can be difficult to correctly specify group membership of all variables. Thus, it is important to develop group selection methods that are robust against group mis-specification. Also, it is desirable to select groups as well as individual variables in many applications. We propose a class of concave \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$1$\\end{document}-norm group penalties that is robust to grouping structure and can perform bi-level selection. A coordinate descent algorithm is developed to calculate solutions of the proposed group selection method. Theoretical convergence of the algorithm is proved under certain regularity conditions. Comparison with other methods suggests the proposed method is the most robust approach under membership mis-specification. Simulation studies and real data application indicate that the \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} }{}$1$\\end{document}-norm concave group selection approach achieves better control of false discovery rates. An R package grppenalty implementing the proposed method is available at CRAN. PMID:25417206

Space Communication Artificial Intelligence for Link Evaluation Terminal (SCAILET)

NASA Technical Reports Server (NTRS)

Shahidi, Anoosh K.; Schlegelmilch, Richard F.; Petrik, Edward J.; Walters, Jerry L.

1992-01-01

A software application to assist end-users of the high burst rate (HBR) link evaluation terminal (LET) for satellite communications is being developed. The HBR LET system developed at NASA Lewis Research Center is an element of the Advanced Communications Technology Satellite (ACTS) Project. The HBR LET is divided into seven major subsystems, each with its own expert. Programming scripts, test procedures defined by design engineers, set up the HBR LET system. These programming scripts are cryptic, hard to maintain and require a steep learning curve. These scripts were developed by the system engineers who will not be available for the end-users of the system. To increase end-user productivity a friendly interface needs to be added to the system. One possible solution is to provide the user with adequate documentation to perform the needed tasks. With the complexity of this system the vast amount of documentation needed would be overwhelming and the information would be hard to retrieve. With limited resources, maintenance is another reason for not using this form of documentation. An advanced form of interaction is being explored using current computer techniques. This application, which incorporates a combination of multimedia and artificial intelligence (AI) techniques to provided end-users with an intelligent interface to the HBR LET system, is comprised of an intelligent assistant, intelligent tutoring, and hypermedia documentation. The intelligent assistant and tutoring systems address the critical programming needs of the end-user.

Moving East: how the transnational tobacco industry gained entry to the emerging markets of the former Soviet Union-part I: establishing cigarette imports.

PubMed

Gilmore, A B; McKee, M

2004-06-01

To identify British American Tobacco's (BAT) reasons for targeting the former Soviet Union following its collapse in 1991 and the initial strategies BAT used to enter the region. Analysis of tobacco industry documents held at the Guildford BAT archive. Desire to expand to new markets was based in part on the decline in old markets. The large population, proximity to China, scope to expand sales to women and, in Central Asia, a young population with high growth rates made the former Soviet Union particularly attractive. High consumption rates and unfilled demand caused by previous shortages offered potential for rapid returns on investment. A series of steps were taken to penetrate the markets with the initial focus on establishing imports. The documents suggest that BAT encouraged the use of aid money and barter trade to fund imports and directed the smuggling of cigarettes which graduated from an opportunistic strategy to a highly organised operation. In establishing a market presence, promotion of BAT's brands and corporate image were paramount, and used synonymously to promote both the cigarettes and the company. The tobacco industry targeted young people and women. It used the allure of western products to promote its brands and brand stretching and corporate imagery to pre-empt future marketing restrictions. BAT used the chaotic conditions in the immediate post-transition period in the former Soviet Union to exploit legislative loopholes and ensure illegal cigarette imports. Governments of countries targeted by the tobacco industry need to be aware of industry tactics and develop adequate tobacco control policies in order to prevent the exploitation of vulnerable populations. Marketing restrictions that focus on advertising without restricting the use of brand or company promotions will have a limited impact.

Electronic camera-management system for 35-mm and 70-mm film cameras

NASA Astrophysics Data System (ADS)

Nielsen, Allan

1993-01-01

Military and commercial test facilities have been tasked with the need for increasingly sophisticated data collection and data reduction. A state-of-the-art electronic control system for high speed 35 mm and 70 mm film cameras designed to meet these tasks is described. Data collection in today's test range environment is difficult at best. The need for a completely integrated image and data collection system is mandated by the increasingly complex test environment. Instrumentation film cameras have been used on test ranges to capture images for decades. Their high frame rates coupled with exceptionally high resolution make them an essential part of any test system. In addition to documenting test events, today's camera system is required to perform many additional tasks. Data reduction to establish TSPI (time- space-position information) may be performed after a mission and is subject to all of the variables present in documenting the mission. A typical scenario would consist of multiple cameras located on tracking mounts capturing the event along with azimuth and elevation position data. Corrected data can then be reduced using each camera's time and position deltas and calculating the TSPI of the object using triangulation. An electronic camera control system designed to meet these requirements has been developed by Photo-Sonics, Inc. The feedback received from test technicians at range facilities throughout the world led Photo-Sonics to design the features of this control system. These prominent new features include: a comprehensive safety management system, full local or remote operation, frame rate accuracy of less than 0.005 percent, and phase locking capability to Irig-B. In fact, Irig-B phase lock operation of multiple cameras can reduce the time-distance delta of a test object traveling at mach-1 to less than one inch during data reduction.

The topology and dynamics of complex networks

NASA Astrophysics Data System (ADS)

Dezso, Zoltan

We start with a brief introduction about the topological properties of real networks. Most real networks are scale-free, being characterized by a power-law degree distribution. The scale-free nature of real networks leads to unexpected properties such as the vanishing epidemic threshold. Traditional methods aiming to reduce the spreading rate of viruses cannot succeed on eradicating the epidemic on a scale-free network. We demonstrate that policies that discriminate between the nodes, curing mostly the highly connected nodes, can restore a finite epidemic threshold and potentially eradicate the virus. We find that the more biased a policy is towards the hubs, the more chance it has to bring the epidemic threshold above the virus' spreading rate. We continue by studying a large Web portal as a model system for a rapidly evolving network. We find that the visitation pattern of a news document decays as a power law, in contrast with the exponential prediction provided by simple models of site visitation. This is rooted in the inhomogeneous nature of the browsing pattern characterizing individual users: the time interval between consecutive visits by the same user to the site follows a power law distribution, in contrast with the exponential expected for Poisson processes. We show that the exponent characterizing the individual user's browsing patterns determines the power-law decay in a document's visitation. Finally, we turn our attention to biological networks and demonstrate quantitatively that protein complexes in the yeast, Saccharomyces cerevisiae, are comprised of a core in which subunits are highly coexpressed, display the same deletion phenotype (essential or non-essential) and share identical functional classification and cellular localization. The results allow us to define the deletion phenotype and cellular task of most known complexes, and to identify with high confidence the biochemical role of hundreds of proteins with yet unassigned functionality.

77 FR 26061 - Self-Regulatory Organizations; Municipal Securities Rulemaking Board; Order Granting Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

...-Regulatory Organizations; Municipal Securities Rulemaking Board; Order Granting Approval of Proposed Rule Change Consisting of Establishment of a Subscription to Historical Information and Documents Submitted to... historical information and documents submitted to the MSRB's Short-Term Obligation Rate Transparency System...

Informatics can identify systemic sclerosis (SSc) patients at risk for scleroderma renal crisis.

PubMed

Redd, Doug; Frech, Tracy M; Murtaugh, Maureen A; Rhiannon, Julia; Zeng, Qing T

2014-10-01

Electronic medical records (EMR) provide an ideal opportunity for the detection, diagnosis, and management of systemic sclerosis (SSc) patients within the Veterans Health Administration (VHA). The objective of this project was to use informatics to identify potential SSc patients in the VHA that were on prednisone, in order to inform an outreach project to prevent scleroderma renal crisis (SRC). The electronic medical data for this study came from Veterans Informatics and Computing Infrastructure (VINCI). For natural language processing (NLP) analysis, a set of retrieval criteria was developed for documents expected to have a high correlation to SSc. The two annotators reviewed the ratings to assemble a single adjudicated set of ratings, from which a support vector machine (SVM) based document classifier was trained. Any patient having at least one document positively classified for SSc was considered positive for SSc and the use of prednisone≥10mg in the clinical document was reviewed to determine whether it was an active medication on the prescription list. In the VHA, there were 4272 patients that have a diagnosis of SSc determined by the presence of an ICD-9 code. From these patients, 1118 patients (21%) had the use of prednisone≥10mg. Of these patients, 26 had a concurrent diagnosis of hypertension, thus these patients should not be on prednisone. By the use of natural language processing (NLP) an additional 16,522 patients were identified as possible SSc, highlighting that cases of SSc in the VHA may exist that are unidentified by ICD-9. A 10-fold cross validation of the classifier resulted in a precision (positive predictive value) of 0.814, recall (sensitivity) of 0.973, and f-measure of 0.873. Our study demonstrated that current clinical practice in the VHA includes the potentially dangerous use of prednisone for veterans with SSc. This present study also suggests there may be many undetected cases of SSc and NLP can successfully identify these patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Famous North American wolves and the credibility of early wildlife literature

USGS Publications Warehouse

Gipson, P.S.; Ballard, W.B.; Nowak, R.M.

1999-01-01

We evaluated the credibility of early literature about famous North American wolves (Canis lupus). Many famous wolves were reported to be older than they actually were, and we estimated they did not live long enough to have caused purported damage to livestock and game animals. Wolf kill rates on free-ranging livestock appeared to be inflated compared to recently published kill rates on native ungulates and livestock. Surplus killing of sheep and goats may have accounted for some high kill rates, but surplus killing of free-ranging longhorn cattle probably did not occur. Some famous wolves may actually have been dogs (C. familiaris), wolf-dog hybrids, or possibly coyote (C. latrans)-dog hybrids. We documented instances where early authors appeared to embellish or fabricate information about famous wolves. Caution should be exercised when using early literature about wolves as a basis for wolf management decisions.

Decreasing influenza impact in lodges: 1997-2000 Calgary Regional Health Authority.

PubMed

McLeod, L; Lau, W W

2001-01-01

Influenza causes high morbidity and hospitalization rates in residents of seniors lodges, I causing increased pressure on emergency departments and hospital beds every winter. This quasi-experimental study assessed the prevention of influenza outbreaks and their consequences in Calgary lodges. A multidisciplinary team worked to improve communication between health professionals, increase resident and staff immunization coverage, obtain weights and creatinines prior to influenza season, and facilitate amantadine prophylaxis during influenza A outbreaks. We had an increase in standing orders for amantadine and up to 56% of residents from one lodge had documented creatinine levels. Amantadine was administered to residents within two days of outbreak notification. Influenza morbidity in lodge outbreaks decreased from a rate of 37% to 9% over the three years and hospitalization rates decreased from 9% to 1%. We recommend that other regions consider a similar approach to decreasing influenza morbidity and hospitalization in lodge residents.

Heart rate variability reactivity and new romance: Cause or consequence?

PubMed

Bailey, Laura K; Davis, Ron

2017-09-01

There are documented physiological differences between single and coupled individuals during the "honeymoon period" of nascent romantic relationships. One such difference is in autonomic reactivity, specifically heart rate variability (HRV) reactivity. This finding had previously been interpreted as evidence of a stress buffering effect of relationship formation. The present study explored among university women two competing longitudinal hypotheses conceptualizing differences in HRV reactivity as either a cause or a consequence of romantic relationship formation. Results did not support the hypothesis that HRV reactivity changes as a consequence of beginning a new romantic relationship. Instead, lower HRV reactivity predicted greater relationship formation amongst women with low BMI and higher resting HRV. The functioning of the heart therefore predicted the likelihood that an individual would find love. These interactions may be the result of differing success rates of various mating strategies for women with low and high BMI and HRV. Copyright © 2017 Elsevier B.V. All rights reserved.

The Effect of Surface Preparation on the Precipitation of Sigma During High Temperature Exposure of S32205 Duplex Stainless Steel

NASA Astrophysics Data System (ADS)

Jepson, Mark A. E.; Rowlett, Matthew; Higginson, Rebecca L.

2017-03-01

Although the formation of sigma phase in duplex stainless steels is reasonably well documented, the effect of surface finish on its formation rate in surface regions has not been previously noted. The growth of the sigma phase precipitated in the subsurface region (to a maximum depth of 120 μm) has been quantified after heat treatment of S32205 duplex stainless steel at 1073 K (800 °C) and 1173 K (900 °C) after preparation to two surface finishes. Here, results are presented that show that there is a change in the rate of sigma phase formation in the surface region of the material, with a coarser surface finish leading to a greater depth of precipitation at a given time and temperature of heat treatment. The growth rate and morphology of the precipitated sigma has been examined and explored in conjunction with thermodynamic equilibrium phase calculations.

78 FR 645 - Federal Employee Pay Schedules and Rates That Are Set by Administrative Discretion

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-03

...--Federal Employee Pay Schedules and Rates That Are Set by Administrative Discretion Executive Order 13635--Adjustments of Certain Rates of Pay #0; #0; #0; Presidential Documents #0; #0; #0;#0;Federal Register / Vol... President [[Page 647

Poisson-Like Spiking in Circuits with Probabilistic Synapses

PubMed Central

Moreno-Bote, Rubén

2014-01-01

Neuronal activity in cortex is variable both spontaneously and during stimulation, and it has the remarkable property that it is Poisson-like over broad ranges of firing rates covering from virtually zero to hundreds of spikes per second. The mechanisms underlying cortical-like spiking variability over such a broad continuum of rates are currently unknown. We show that neuronal networks endowed with probabilistic synaptic transmission, a well-documented source of variability in cortex, robustly generate Poisson-like variability over several orders of magnitude in their firing rate without fine-tuning of the network parameters. Other sources of variability, such as random synaptic delays or spike generation jittering, do not lead to Poisson-like variability at high rates because they cannot be sufficiently amplified by recurrent neuronal networks. We also show that probabilistic synapses predict Fano factor constancy of synaptic conductances. Our results suggest that synaptic noise is a robust and sufficient mechanism for the type of variability found in cortex. PMID:25032705

Faxed document image restoration method based on local pixel patterns

NASA Astrophysics Data System (ADS)

Akiyama, Teruo; Miyamoto, Nobuo; Oguro, Masami; Ogura, Kenji

1998-04-01

A method for restoring degraded faxed document images using the patterns of pixels that construct small areas in a document is proposed. The method effectively restores faxed images that contain the halftone textures and/or density salt-and-pepper noise that degrade OCR system performance. The halftone image restoration process, white-centered 3 X 3 pixels, in which black-and-white pixels alternate, are identified first using the distribution of the pixel values as halftone textures, and then the white center pixels are inverted to black. To remove high-density salt- and-pepper noise, it is assumed that the degradation is caused by ill-balanced bias and inappropriate thresholding of the sensor output which results in the addition of random noise. Restored image can be estimated using an approximation that uses the inverse operation of the assumed original process. In order to process degraded faxed images, the algorithms mentioned above are combined. An experiment is conducted using 24 especially poor quality examples selected from data sets that exemplify what practical fax- based OCR systems cannot handle. The maximum recovery rate in terms of mean square error was 98.8 percent.

Comparison of handheld computer-assisted and conventional paper chart documentation of medical records. A randomized, controlled trial.

PubMed

Stengel, Dirk; Bauwens, Kai; Walter, Martin; Köpfer, Thilo; Ekkernkamp, Axel

2004-03-01

Daily documentation and maintenance of medical record quality is a crucial issue in orthopaedic surgery. The purpose of the present study was to determine whether the introduction of a handheld computer could improve both the quantitative and qualitative aspects of medical records. A series of consecutive patients who were admitted for the first time to a thirty-six-bed orthopaedic ward of an academic teaching hospital for a planned operation or any other treatment of an acute injury or chronic condition were randomized to daily documentation of their clinical charts on a handheld computer or on conventional paper forms. The electronic documentation consisted of a specially designed software package on a handheld computer for bedside use with structured decision trees for examination, obtaining a history, and coding. In the control arm, chart notes were compiled on standard paper forms and were subsequently entered into the hospital's information system. The number of documented ICD (International Classification of Diseases) diagnoses was the primary end point for sample size calculations. All patient charts were reread by an expert panel consisting of two surgeons and the surgical quality assurance manager. These experts assigned quality ratings to the different documentation systems by scrutinizing the extent and accuracy of the patient histories and the physical findings as assessed by daily chart notes. Eighty patients were randomized to one of the two documentation arms, and seventy-eight (forty-seven men and thirty-one women) of them were eligible for final analysis. Documentation with the handheld computer increased the median number of diagnoses per patients from four to nine (p < 0.0001), but it produced some overcoding for false or redundant items. Documentation quality ratings improved significantly with the introduction of the handheld device (p < 0.01) with respect to the correct assessment of a patient's progress and translation into ICD diagnoses. Various learning curve effects were observed with different operators. Study physicians assigned slightly better practicability ratings to the handheld device. The preliminary data from this study suggest that handheld computers may improve the quality of hospital charts in orthopaedic surgery. Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Measurement of deforestation in the Brazilian Amazon using satellite remote sensing

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

Skole, D.L.

1992-01-01

Understanding of the role of the biota in the global carbon cycle is limited by an absence of accurate measurements of deforestation rates in the tropics. This study measures the rate and extent of deforestation in the Brazilian Amazon, the largest extant tropical forest biome in the world. The study uses remote sensing measurements of deforestation rates, the area of secondary vegetation, and tabular data to document deforestation. The analysis concludes: (1) AVHRR will greatly overestimate deforestation and be highly variable; the use of a brightness temperature threshold is highly sensitive and unreliable. The upward bias of AVHRR is amore » function of the density of deforestation. (2) Accurate measurement of deforestation requires Landsat TM data, and can be accomplished using low cost visual interpretation of photographic products at 1:250,000 scales. (3) Secondary growth in the Brazilian Amazon represents a large fraction of the total deforested area, and the abandonment of agricultural land is an important land cover transition. Abandonment rates were 70--83% of clearing rates from primary forests. At any one point in time, approximately 30% of the deforested area is in some stage of abandonment, and quite likely nearly all deforested land becomes abandoned after approximately 5 years. (4) Previous estimates of the total area deforested in the Amazon, as well as deforestation rates, have been too high by as much as 4-fold. A complete assessment of the entire Legal Amazon using over 200 Landsat images measures 251 [times] 10[sup 3] km[sup 2] deforestation as of 1988, or approximately 6% of the closed forests of the region. The average annual rate of deforestation between 1978 and 1988 was 18 [times] 10[sup 3] km[sup 2] yr[sup [minus]1]. These findings suggest the estimates of carbon emissions from the Amazon for the late 1980s have been too high, since the area of regrowth is large and rates of deforestation are lower than previously believed.« less

Knowledge Construction and Knowledge Representation in High School Students' Design of Hypermedia Documents

ERIC Educational Resources Information Center

Chen, Pearl; McGrath, Diane

2003-01-01

This study documented the processes of knowledge construction and knowledge representation in high school students' hypermedia design projects. Analysis of knowledge construction in linking and structural building yielded distinct types and subtypes of hypermedia documents, which were characterized by four features of knowledge representation: (a)…

Reversible and Irreversible Time-Dependent Behavior of GRCop-84

NASA Technical Reports Server (NTRS)

Lerch, Bradley A.; Arnold, Steven M.; Ellis, David L.

2017-01-01

A series of mechanical tests were conducted on a high-conductivity copper alloy, GRCop-84, in order to understand the time dependent response of this material. Tensile, creep, and stress relaxation tests were performed over a wide range of temperatures, strain rates, and stress levels to excite various amounts of time-dependent behavior. At low applied stresses the deformation behavior was found to be fully reversible. Above a certain stress, termed the viscoelastic threshold, irreversible deformation was observed. At these higher stresses the deformation was observed to be viscoplastic. Both reversible and irreversible regions contained time dependent deformation. These experimental data are documented to enable characterization of constitutive models to aid in design of high temperature components.

Intergenerational Ties in Context: Grandparents Caring for Grandchildren in China

PubMed Central

Chen, Feinian; Liu, Guangya; Mair, Christine A.

2012-01-01

Guided by theories and empirical research on intergenerational relationships, we examine the phenomenon of grandparents caring for grandchildren in contemporary China. Using a longitudinal dataset (China Health and Nutrition Survey), we document a high level of structural and functional solidarity in grandparent-grandchildren relationships. Intergenerational solidarity is indicated by a high rate of coresidence between grandchildren and grandparents, a sizable number of skipped-generation households (no parent present), extensive childcare involvement by non-coresidential grandparents, and a large amount of care provided by coresidential grandparents. Multivariate analysis further suggests that grandparents’ childcare load is adaptive to familial needs, as reflected by the characteristics of the household, household members, and work activities of the mothers. PMID:22544978

Planting Healthy Roots: Using Documentary Film to Evaluate and Disseminate Community-Based Participatory Research

PubMed Central

Brandt, Heather M.; Freedman, Darcy A.; Friedman, Daniela B.; Choi, Seul Ki; Seel, Jessica S.; Guest, M. Aaron; Khang, Leepao

2016-01-01

The study purpose was twofold: (1) to evaluate a documentary film featuring the formation and implementation of a farmers’ market and (2) to assess whether the film affected awareness regarding food access issues in a food desert community with high rates of obesity. The coalition model of filmmaking, a model consistent with a community-based participatory research (CBPR) approach, and personal stories, community profiles, and expert interviews were used to develop a documentary film (Planting Healthy Roots). Evaluation demonstrated high levels of approval and satisfaction with the film and CBPR essence of the film. The documentary film aligned with a CBPR approach to document, evaluate, and disseminate research processes and outcomes. PMID:27536929

Guidelines for the assessment and acceptance of potential brain-dead organ donors

PubMed Central

Westphal, Glauco Adrieno; Garcia, Valter Duro; de Souza, Rafael Lisboa; Franke, Cristiano Augusto; Vieira, Kalinca Daberkow; Birckholz, Viviane Renata Zaclikevis; Machado, Miriam Cristine; de Almeida, Eliana Régia Barbosa; Machado, Fernando Osni; Sardinha, Luiz Antônio da Costa; Wanzuita, Raquel; Silvado, Carlos Eduardo Soares; Costa, Gerson; Braatz, Vera; Caldeira Filho, Milton; Furtado, Rodrigo; Tannous, Luana Alves; de Albuquerque, André Gustavo Neves; Abdala, Edson; Gonçalves, Anderson Ricardo Roman; Pacheco-Moreira, Lúcio Filgueiras; Dias, Fernando Suparregui; Fernandes, Rogério; Giovanni, Frederico Di; de Carvalho, Frederico Bruzzi; Fiorelli, Alfredo; Teixeira, Cassiano; Feijó, Cristiano; Camargo, Spencer Marcantonio; de Oliveira, Neymar Elias; David, André Ibrahim; Prinz, Rafael Augusto Dantas; Herranz, Laura Brasil; de Andrade, Joel

2016-01-01

Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors. PMID:27737418

[Smallpox virus as biological weapon].

PubMed

Kondrusik, Maciej; Hermanowska-Szpakowicz, Teresa

2003-02-01

Smallpox, because of its high case-fatality rate, easy transmission from human to human, lack of specific treatment represents nowadays one of the main threats in bioterrorist attacks. Over the centuries, naturally occurring smallpox with its case-fatality over 30 percent and its ability to spread in any climate and season has been treated as the most dangerous infectious disease. But it is now, 25 years after the last documented case of smallpox and cessation of routine vaccination in present mobile and susceptible population, smallpox virus spread might be rapid and devastating.

Low Adoption Rates of Electronic Medical Records Systems: A Qualitative Study

ERIC Educational Resources Information Center

Slaughter, Andre

2017-01-01

This qualitative phenomenological research study explored the challenges of physicians working with Electronic Medical Records (EMR) systems for medical documentation. Additionally, this study sought to understand why many providers sought alternate means of patient documentation. Previous research studies focused on the use of EMR systems from…

40 CFR 17.13 - Documentation of fees and expenses.

Code of Federal Regulations, 2010 CFR

2010-07-01

... documentation of fees and expenses, including the cost of any study, engineering report, test, or project, for...) The affidavit shall itemize in detail the services performed by the date, number of hours per date, and the services performed during those hours. In order to establish the hourly rate, the affidavit...

40 CFR 17.13 - Documentation of fees and expenses.

Code of Federal Regulations, 2011 CFR

2011-07-01

... documentation of fees and expenses, including the cost of any study, engineering report, test, or project, for...) The affidavit shall itemize in detail the services performed by the date, number of hours per date, and the services performed during those hours. In order to establish the hourly rate, the affidavit...

40 CFR 98.57 - Records that must be retained.

Code of Federal Regulations, 2010 CFR

2010-07-01

... calendar year. (d) Documentation of how accounting procedures were used to estimate production rate. (e...) Performance test reports of N2O emissions. (g) Measurements, records and calculations used to determine reported parameters. (h) Documentation of the procedures used to ensure the accuracy of the measurements of...

Principles of Technology Curriculum Guide. Curriculum Development. Bulletin 1812.

ERIC Educational Resources Information Center

Louisiana State Dept. of Education, Baton Rouge. Div. of Vocational Education.

This document describes minimum competencies and suggested student activities for a seven-unit course called Principles of Technology. The instructional units are called Force, Work, Rate, Resistance, Energy, Power, and Force Transformers. The first section of the document contains information on how to use the guide, goals for industrial…

19 CFR 10.588 - Effect of noncompliance; failure to provide documentation regarding transshipment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... RATE, ETC. Dominican Republic-Central America-United States Free Trade Agreement Import Requirements... 19 Customs Duties 1 2010-04-01 2010-04-01 false Effect of noncompliance; failure to provide documentation regarding transshipment. 10.588 Section 10.588 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION...

Gravel Mobility in a High Sand Content Riverbed

NASA Astrophysics Data System (ADS)

Haschenburger, J. K.

2017-12-01

In sand-gravel channels, sand may modify gravel transport by changing conditions of entrainment and promoting longer displacements or gravel may inhibit sand transport if concentrated into distinct deposits, which restrict sand supply with consequences for migrating bedform size or form. This study reports on gravel mobility in the lower San Antonio River, Texas, where gravel content in the bed material ranges from about 1% to more than 20%. Sediment transport observations were collected at three U.S. Geological Survey gauging stations by deploying a Helley-Smith sampler with a 0.2 mm mesh bag from which transport rates and mobile grain sizes were determined. The flow rates sampled translate into an annual exceedance expectation from 0.2% to 98%. Gravel transport rates are generally two orders of magnitude smaller than the rates of sand transport. However, the finest gravels are transported at rates on the same order of magnitude as the coarsest sands. At all sites, the 2 and 2.8 mm fractions are transported at the lowest flow rate sampled, suggesting mobility for at least 38% to as much as 98% of the year. Fractions as large as 8 mm are mobilized at flow rates that are expected between 25% and 53% of the year. The largest fractions captured in the sampling (16 to 32 mm) require flows closer to bankfull conditions that occur no more than 0.8% of the year. Results document that some gravel sizes can be frequently transported in low gradient riverbeds with high sand content.

Flood-Inundation Maps of Selected Areas Affected by the Flood of October 2015 in Central and Coastal South Carolina

USGS Publications Warehouse

Musser, Jonathan W.; Watson, Kara M.; Painter, Jaime A.; Gotvald, Anthony J.

2016-02-22

Heavy rainfall occurred across South Carolina during October 1–5, 2015, as a result of an upper atmospheric low-pressure system that funneled tropical moisture from Hurricane Joaquin into the State. The storm caused major flooding in the central and coastal parts of South Carolina. Almost 27 inches of rain fell near Mount Pleasant in Charleston County during this period. U.S. Geological Survey (USGS) streamgages recorded peaks of record at 17 locations, and 15 other locations had peaks that ranked in the top 5 for the period of record. During the October 2015 flood event, USGS personnel made about 140 streamflow measurements at 86 locations to verify, update, or extend existing rating curves (which are used to compute streamflow from monitored river stage). Immediately after the storm event, USGS personnel documented 602 high-water marks, noting the location and height of the water above land surface. Later in October, 50 additional high-water marks were documented near bridges for South Carolina Department of Transportation. Using a subset of these high-water marks, 20 flood-inundation maps of 12 communities were created. Digital datasets of the inundation area, modeling boundary, and water depth rasters are all available for download.

Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature.

PubMed

Grimm, Lars J; Bookhout, Christine E; Bentley, Rex C; Jordan, Sheryl G; Lawton, Thomas J

2018-05-01

Non-atypical papillomas (NAPs) diagnosed on core needle biopsy (CNB) frequently undergo surgical excision due to highly variable upstaging rates. The purpose of this study is to document our dual-institution upgrade rates of NAPs diagnosed on core needle biopsy and review the upgrade rates reported in the literature. Following IRB approval, CNB results from Duke University (7/1/2004-6/30/2014) and the University of North Carolina Chapel Hill (1/1/04-6/30/2013) were reviewed to identify non-atypical papillomas. All cases with surgical excision or 2 years of imaging follow up were included. In addition, a literature review identified 60 published studies on upgrades of NAPs diagnosed at CNB. Cases in our cohort and the published literature were reviewed for confounding factors: [1] missing radiologic-pathologic concordance and/or discordance, [2] papillomas included with high-risk lesions, [3] high risk lesions counted as upgrades, [4] review by a nonspecialized breast pathologist, and [5] cancer incidentally detected. Of the 388 CNBs in our dual-institution cohort, 136 (35%) patients underwent surgical excision and 252 (65%) patients had imaging follow up. After controlling for confounders, no cancers (0/388) were found at surgical excision or during follow up imaging. The literature review upstaging rate was 4.0% (166/4157) but 1.8% (4/227) after excluding studies with confounders. The combined upstaging rate from the literature and this study was 0.6% (4/615). The upstaging rate for CNB diagnosed NAPs was 0% in our cohort and 0.6% overall after adjusting for confounders. This low rate does not warrant reflexive surgical excision and diagnostic imaging follow up should be discretionary. Copyright © 2018 Elsevier Inc. All rights reserved.

Low vagally-mediated heart rate variability and increased susceptibility to ventricular arrhythmias in rats bred for high anxiety.

PubMed

Carnevali, Luca; Trombini, Mimosa; Graiani, Gallia; Madeddu, Denise; Quaini, Federico; Landgraf, Rainer; Neumann, Inga D; Nalivaiko, Eugene; Sgoifo, Andrea

2014-04-10

In humans, there is a documented association between anxiety disorders and cardiovascular disease. Putative underlying mechanisms may include an impairment of the autonomic nervous system control of cardiac function. The primary objective of the present study was to characterize cardiac autonomic modulation and susceptibility to arrhythmias in genetic lines of rats that differ largely in their anxiety level. To reach this goal, electrocardiographic recordings were performed in high-anxiety behavior (HAB, n=10) and low-anxiety behavior (LAB, n=10) rats at rest, during stressful stimuli and under autonomic pharmacological manipulations, and analyzed by means of time- and frequency-domain indexes of heart rate variability. During resting conditions, HAB rats displayed a reduced heart rate variability, mostly in terms of lower parasympathetic (vagal) modulation compared to LAB rats. In HAB rats, this relatively low cardiac vagal control was associated with smaller heart rate responsiveness to acute stressors compared to LAB counterparts. In addition, beta-adrenergic pharmacological stimulation induced a larger incidence of ventricular tachyarrhythmias in HABs compared to LABs. At sacrifice, a moderate increase in heart-body weight ratio was observed in HAB rats. We conclude that high levels of anxiety-related behavior in rats are associated with signs of i) impaired autonomic modulation of heart rate (low vagally-mediated heart rate variability), ii) poor adaptive heart rate responsiveness to stressful stimuli, iii) increased arrhythmia susceptibility, and iv) cardiac hypertrophy. These results highlight the utility of the HAB/LAB model for investigating the mechanistic basis of the comorbidity between anxiety disorders and cardiovascular disease. Copyright © 2014 Elsevier Inc. All rights reserved.

12 CFR 619.9170 - Fixed interest rate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Fixed interest rate. 619.9170 Section 619.9170 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM DEFINITIONS § 619.9170 Fixed interest rate. The rate of interest specified in the note or loan document which will prevail as the maximum...

29 CFR 4022.8 - Form of payment.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Unisex mortality rates that are a fixed blend of 50 percent of the male mortality rates and 50 percent of the female mortality rates from the 1983 Group Annuity Mortality Table as prescribed in Rev. Rul. 95-6... Documents, Government Printing Office, Washington, DC 20402); and (ii) Interest. An interest rate of six...

29 CFR 4022.8 - Form of payment.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Unisex mortality rates that are a fixed blend of 50 percent of the male mortality rates and 50 percent of the female mortality rates from the 1983 Group Annuity Mortality Table as prescribed in Rev. Rul. 95-6... Documents, Government Printing Office, Washington, DC 20402); and (ii) Interest. An interest rate of six...

29 CFR 4022.8 - Form of payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Unisex mortality rates that are a fixed blend of 50 percent of the male mortality rates and 50 percent of the female mortality rates from the 1983 Group Annuity Mortality Table as prescribed in Rev. Rul. 95-6... Documents, Government Printing Office, Washington, DC 20402); and (ii) Interest. An interest rate of six...

78 FR 18585 - Energy Technology Savings LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-27

... facilitate electronic service, persons with Internet access who will eFile a document and/or be listed as a... Technology Savings LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes Request for... Energy Technology Savings LLC's application for market-based rate authority, with an accompanying rate...

75 FR 41854 - SGE Energy Sourcing, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... Sourcing, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes Request for Blanket... of SGE Energy Sourcing, LLC's application for market-based rate authority, with an accompanying rate... . To facilitate electronic service, persons with Internet access who will eFile a document and/or be...

Infectious Complications in Children With Acute Myeloid Leukemia and Down Syndrome: Analysis of the Prospective Multicenter Trial AML-BFM 2004.

PubMed

Hassler, Angela; Bochennek, Konrad; Gilfert, Julia; Perner, Corinna; Schöning, Stefan; Creutzig, Ursula; Reinhardt, Dirk; Lehrnbecher, Thomas

2016-06-01

Children with acute myeloid leukemia (AML) and Down syndrome have high survival rates with intensity-reduced chemotherapeutic regimens, although the optimal balance between dose intensity and treatment toxicity has not been determined. We, therefore, characterized infectious complications in children with AML and Down syndrome treated according to AML-BFM 2004 study (ClinicalTrials.gov NCT00111345; amended 2006 for Down syndrome with reduced intensity). Data on infectious complications were gathered from the medical records in the hospital where the patient was treated. Infectious complications were categorized as fever without identifiable source (FUO), or as microbiologically or clinically documented infections. A total of 157 infections occurred in 61 patients (60.5% FUO, 9.6% and 29.9% clinically and microbiologically documented infections, respectively). Almost 90% of the pathogens isolated from the bloodstream were Gram-positive bacteria, and approximately half of them were viridans group streptococci. All seven microbiologically documented episodes of pneumonia were caused by viruses. Infection-related mortality was 4.9%, and all three patients died due to viral infection. Our data demonstrate that a reduced-intensity chemotherapeutic regimen in children with AML and Down syndrome is still associated with high morbidity. Although no patient died due to bacteria or fungi, viruses were responsible for all lethal events. Future studies, therefore, have to focus on the impact of viruses on morbidity and mortality of patients with AML and Down syndrome. © 2016 Wiley Periodicals, Inc.

High risk of streptococcal septicemia after high dose cytosine arabinoside treatment for acute myelogenous leukemia.

PubMed

Kern, W; Kurrle, E; Vanek, E

1987-08-17

Twenty-nine adult patients with acute myelogenous leukemia AML who received 40 treatment courses with high dose cytosine arabinoside (HD-A), alone or combined with other cytotoxic drugs, for remission induction (RI) or postremission intensive consolidation (IC) were retrospectively analysed for types and severity of infectious complications. In this paper, we report the unusually high rate of streptococcal septicemia in our patients. Of 13 bacteremic infections in a total of 45 infectious episodes, 10 were caused by streptococci (9 viridans streptococci, 1 group B hemolytic streptococcus). Three of them were lethal. After reviewing all documented cases of streptococcal septicemia in the same study period, four additional cases among adult patients with AML were identified. Three of them have had antileukemic chemotherapy without HD-A, while one have had HD-A as a conditioning regimen for bone marrow transplantation. Only three cases were documented to occur in adult patients with AML. Patients treated with HD-A for RI or IC had a significantly lower risk of streptococcal septicemia during previous chemotherapy-associated febrile neutropenic episodes (1/55 vs 10/45; P = 0.01). Neither prophylactic regimens including trimethoprim-sulfamethoxazole nor those without it were effective in preventing streptococcal septicemia. Further studies are needed to confirm these data before the value of additional or alternative prophylactic antibiotics is proven necessary.

76 FR 48152 - Commercial Building Asset Rating Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-08

...: Occupancy schedule. HVAC system operation. Hot water use. Both the user-entered and the internally defined.... Technical Support Full documentation of the rating methodology would be available online for public review... welcome. Potential for Additional Supported Options While a national performance metric and rating system...

77 FR 37421 - Reimbursement Rates for Calendar Year 2012 Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-21

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2012 Correction AGENCY: Indian Health Service, HHS. ACTION: Notice; correction. SUMMARY: The Indian Health Service published a document in the Federal Register on June 6, 2012, concerning rates for...

Warped document image correction method based on heterogeneous registration strategies

NASA Astrophysics Data System (ADS)

Tong, Lijing; Zhan, Guoliang; Peng, Quanyao; Li, Yang; Li, Yifan

2013-03-01

With the popularity of digital camera and the application requirement of digitalized document images, using digital cameras to digitalize document images has become an irresistible trend. However, the warping of the document surface impacts on the quality of the Optical Character Recognition (OCR) system seriously. To improve the warped document image's vision quality and the OCR rate, this paper proposed a warped document image correction method based on heterogeneous registration strategies. This method mosaics two warped images of the same document from different viewpoints. Firstly, two feature points are selected from one image. Then the two feature points are registered in the other image base on heterogeneous registration strategies. At last, image mosaics are done for the two images, and the best mosaiced image is selected by OCR recognition results. As a result, for the best mosaiced image, the distortions are mostly removed and the OCR results are improved markedly. Experimental results show that the proposed method can resolve the issue of warped document image correction more effectively.

Quality of care in patients with atrial fibrillation in primary care: a cross-sectional study comparing clinical and claims data.

PubMed

Preuss, Rebekka; Chenot, Jean-François; Angelow, Aniela

2016-01-01

Objectives: Atrial fibrillation (AF) is a common cardiac arrhythmia with increased risk of thromboembolic stroke. Oral anticoagulation (OAC) reduces stroke risk by up to 68%. The aim of our study was to evaluate quality of care in patients with AF in a primary health care setting with a focus on physician guideline adherence for OAC prescription and heart rate- and rhythm management. In a second step we aimed to compare OAC rates based on primary care data with rates based on claims data. Methods: We included all GP practices in the region Vorpommern-Greifswald, Germany, which were willing to participate (N=29/182, response rate 16%). Claims data was derived from the regional association of statutory health insurance physicians. Patients with a documented AF diagnosis (ICD-10-GM-Code ICD I48.-) from 07/2011-06/2012 were identified using electronic medical records (EMR) and claims data. Stroke and bleeding risk were calculated using the CHA 2 DS 2 -VASc and HAS-BLED scores. We calculated crude treatment rates for OAC, rate and rhythm control medications and adjusted OAC treatment rates based on practice and claims data. Adjusted rates were calculated including the CHA 2 DS 2 -VASc and HAS-BLED scores and individual factors affecting guideline based treatment. Results: We identified 927 patients based on EMR and 1,247 patients based on claims data. The crude total OAC treatment rate was 69% based on EMR and 61% based on claims data. The adjusted OAC treatment rates were 90% for patients based on EMR and 63% based on claims data. 82% of the AF patients received a treatment for rate control and 12% a treatment for rhythm control. The most common reasons for non-prescription of OAC were an increased risk of falling, dementia and increased bleeding risk. Conclusion: Our results suggest that a high rate of AF patients receive a drug therapy according to guidelines. There is a large difference between crude and adjusted OAC treatment rates. This is due to individual contraindications and comorbidities which cannot be documented using ICD coding. Therefore, quality indicators based on crude EMR data or claims data would lead to a systematic underestimation of the quality of care. A possible overtreatment of low-risk patients cannot be ruled out.

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

PubMed Central

Choto, R. C.; Harries, A. D.; Mutasa-Apollo, T.; Chakanyuka-Musanhu, C.

2017-01-01

Setting: Seven pilot sites in Zimbabwe implementing 6 months of isoniazid preventive therapy (IPT) for people living with the human immunodeficiency virus (PLHIV). Objectives: To determine, among PLHIV started on IPT, the completion rates for a 6-month course of IPT and factors associated with non-adherence. Design: A retrospective cohort study. Results: Of 578 patients, 466 (81%) completed IPT. Of the 112 patients who failed to complete IPT, 69 (60%) were lost to follow-up, 30 (27%) stopped treatment with no documented reasons, 8 (7%) developed toxicity/adverse reactions, 5 (5%) were documented as having drug stock-outs and the remainder transferred out or refused to continue treatment. Currently being on antiretroviral therapy (ART) (aOR 0.09, 95%CI 0.03–0.28) and receiving a ⩾2 month supply of isoniazid at the start of treatment were associated with a lower risk of not completing IPT, while missing clinic visits prior to starting IPT (aOR 5.25, 95%CI 2.10–13.14) was associated with a higher risk of non-completion. Conclusion: IPT completion rates in seven pilot sites of Zimbabwe were comparatively high, showing that IPT roll-out in public health facilities is feasible. Enhanced adherence counselling or active tracing among pre-ART patients and those with a history of loss to follow-up may improve IPT completion rates, along with synchronising IPT and ART resupplies. PMID:28775944

Unintended pregnancy and induced abortion among unmarried women in China: a systematic review

PubMed Central

Qian, Xu; Tang, Shenglan; Garner, Paul

2004-01-01

Background Until recently, premarital examination for both men and women was a legal requirement before marriage in China. Researchers have carried out surveys of attendees' sexual activity, pregnancy and abortion before their marriages, trying to map out reproductive health needs in China, according to this unique population-based data. To systematically identify, appraise and summarise all available studies documenting pregnancy and induced abortion among unmarried Chinese women attending premarital examinations. Methods We searched the Chinese Biomedical Literature Index from 1978 to 2002; PUBMED; and EMBASE. Trials were assessed and data extracted by two people independently. Results Nine studies, of which seven were conducted in the urban areas, one in the rural areas, and one in both urban and rural areas, met the inclusion criteria. In the seven studies in urban areas, the majority of unmarried women had experienced sexual intercourse, with estimates ranging from 54% to 82% in five studies. Estimates of a previous pregnancy ranged from 12% to 32%. Abortion rates were high, ranging between 11 to 55% in 8 studies reporting this, which exclude the one rural study. In the three studies reporting both pregnancy and abortion, most women who had become pregnant had an induced abortion (range 86% to 96%). One large rural study documented a lower low pregnancy rate (20%) and induced abortion rate (0.8%). Conclusions There is a large unmet need for temporary methods of contraception in urban areas of China. PMID:14736336

Implementation of the common phrase index method on the phrase query for information retrieval

NASA Astrophysics Data System (ADS)

Fatmawati, Triyah; Zaman, Badrus; Werdiningsih, Indah

2017-08-01

As the development of technology, the process of finding information on the news text is easy, because the text of the news is not only distributed in print media, such as newspapers, but also in electronic media that can be accessed using the search engine. In the process of finding relevant documents on the search engine, a phrase often used as a query. The number of words that make up the phrase query and their position obviously affect the relevance of the document produced. As a result, the accuracy of the information obtained will be affected. Based on the outlined problem, the purpose of this research was to analyze the implementation of the common phrase index method on information retrieval. This research will be conducted in English news text and implemented on a prototype to determine the relevance level of the documents produced. The system is built with the stages of pre-processing, indexing, term weighting calculation, and cosine similarity calculation. Then the system will display the document search results in a sequence, based on the cosine similarity. Furthermore, system testing will be conducted using 100 documents and 20 queries. That result is then used for the evaluation stage. First, determine the relevant documents using kappa statistic calculation. Second, determine the system success rate using precision, recall, and F-measure calculation. In this research, the result of kappa statistic calculation was 0.71, so that the relevant documents are eligible for the system evaluation. Then the calculation of precision, recall, and F-measure produces precision of 0.37, recall of 0.50, and F-measure of 0.43. From this result can be said that the success rate of the system to produce relevant documents is low.

Implementation of a Clinical Documentation Improvement Curriculum Improves Quality Metrics and Hospital Charges in an Academic Surgery Department.

PubMed

Reyes, Cynthia; Greenbaum, Alissa; Porto, Catherine; Russell, John C

2017-03-01

Accurate clinical documentation (CD) is necessary for many aspects of modern health care, including excellent communication, quality metrics reporting, and legal documentation. New requirements have mandated adoption of ICD-10-CM coding systems, adding another layer of complexity to CD. A clinical documentation improvement (CDI) and ICD-10 training program was created for health care providers in our academic surgery department. We aimed to assess the impact of our CDI curriculum by comparing quality metrics, coding, and reimbursement before and after implementation of our CDI program. A CDI/ICD-10 training curriculum was instituted in September 2014 for all members of our university surgery department. The curriculum consisted of didactic lectures, 1-on-1 provider training, case reviews, e-learning modules, and CD queries from nurse CDI staff and hospital coders. Outcomes parameters included monthly documentation completion rates, severity of illness (SOI), risk of mortality (ROM), case-mix index (CMI), all-payer refined diagnosis-related groups (APR-DRG), and Surgical Care Improvement Program (SCIP) metrics. Financial gain from responses to CDI queries was determined retrospectively. Surgery department delinquent documentation decreased by 85% after CDI implementation. Compliance with SCIP measures improved from 85% to 97%. Significant increases in surgical SOI, ROM, CMI, and APR-DRG (all p < 0.01) were found after CDI/ICD-10 training implementation. Provider responses to CDI queries resulted in an estimated $4,672,786 increase in charges. Clinical documentation improvement/ICD-10 training in an academic surgery department is an effective method to improve documentation rates, increase the hospital estimated reimbursement based on more accurate CD, and provide better compliance with surgical quality measures. Copyright © 2016 American College of Surgeons. All rights reserved.

FBI Fingerprint Image Capture System High-Speed-Front-End throughput modeling

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

Rathke, P.M.

1993-09-01

The Federal Bureau of Investigation (FBI) has undertaken a major modernization effort called the Integrated Automated Fingerprint Identification System (IAFISS). This system will provide centralized identification services using automated fingerprint, subject descriptor, mugshot, and document processing. A high-speed Fingerprint Image Capture System (FICS) is under development as part of the IAFIS program. The FICS will capture digital and microfilm images of FBI fingerprint cards for input into a central database. One FICS design supports two front-end scanning subsystems, known as the High-Speed-Front-End (HSFE) and Low-Speed-Front-End, to supply image data to a common data processing subsystem. The production rate of themore » HSFE is critical to meeting the FBI`s fingerprint card processing schedule. A model of the HSFE has been developed to help identify the issues driving the production rate, assist in the development of component specifications, and guide the evolution of an operations plan. A description of the model development is given, the assumptions are presented, and some HSFE throughput analysis is performed.« less

Florida Red Tides, Manatee Brevetoxicosis, and Lung Models

PubMed Central

Kirkpatrick, Barbara; Colbert, Debborah E.; Dalpra, Dana; Newton, Elizabeth A. C.; Gaspard, Joseph; Littlefield, Brandi; Manire, Charles

2010-01-01

In 1996, 149 Florida manatees, Trichechus manatus latirostris, died along the southwest coast of Florida. Necropsy pathology results of these animals indicated that brevetoxin from the Florida red tide, Karenia brevis, caused their death. A red tide bloom had been previously documented in the area where these animals stranded. The necropsy data suggested the mortality occurred from chronic inhalation and/or ingestion. Inhalation theories include high doses of brevetoxin deposited/stored in the manatee lung or significant manatee sensitivity to the brevetoxin. Laboratory models of the manatee lungs can be constructed from casts of necropsied animals for further studies; however, it is necessary to define the breathing pattern in the manatee, specifically the volumes and flow rates per breath to estimate toxin deposition in the lung. To obtain this information, two captive-born Florida manatees, previously trained for husbandry and research behaviors, were trained to breathe into a plastic mask placed over their nares. The mask was connected to a spirometer that measured volumes and flows in situ. Results reveal high volumes, short inspiratory and expiratory times and high flow rates, all consistent with observed breathing patterns. PMID:26448968

State Budgets, Unit Allocations, and Unit Emissions Rates

EPA Pesticide Factsheets

This Technical Support Document (TSD) provides information that supports EPA’s determination of state emissions budgets, unit-level allocations, direct control rate limits, and new unit set-asides for the Transport Rule proposal.

The mortality rates and the space-time patterns of John Snow's cholera epidemic map.

PubMed

Shiode, Narushige; Shiode, Shino; Rod-Thatcher, Elodie; Rana, Sanjay; Vinten-Johansen, Peter

2015-06-17

Snow's work on the Broad Street map is widely known as a pioneering example of spatial epidemiology. It lacks, however, two significant attributes required in contemporary analyses of disease incidence: population at risk and the progression of the epidemic over time. Despite this has been repeatedly suggested in the literature, no systematic investigation of these two aspects was previously carried out. Using a series of historical documents, this study constructs own data to revisit Snow's study to examine the mortality rate at each street location and the space-time pattern of the cholera outbreak. This study brings together records from a series of historical documents, and prepares own data on the estimated number of residents at each house location as well as the space-time data of the victims, and these are processed in GIS to facilitate the spatial-temporal analysis. Mortality rates and the space-time pattern in the victims' records are explored using Kernel Density Estimation and network-based Scan Statistic, a recently developed method that detects significant concentrations of records such as the date and place of victims with respect to their distance from others along the street network. The results are visualised in a map form using a GIS platform. Data on mortality rates and space-time distribution of the victims were collected from various sources and were successfully merged and digitised, thus allowing the production of new map outputs and new interpretation of the 1854 cholera outbreak in London, covering more cases than Snow's original report and also adding new insights into their space-time distribution. They confirmed that areas in the immediate vicinity of the Broad Street pump indeed suffered from excessively high mortality rates, which has been suspected for the past 160 years but remained unconfirmed. No distinctive pattern was found in the space-time distribution of victims' locations. The high mortality rates identified around the Broad Street pump are consistent with Snow's theory about cholera being transmitted through contaminated water. The absence of a clear space-time pattern also indicates the water-bourne, rather than the then popular belief of air bourne, nature of cholera. The GIS data constructed in this study has an academic value and would cater for further research on Snow's map.

Incidence Rates of Sexual Harassment in Mass Communications Internship Programs: An Initial Study Comparing Intern, Student, and Professional Rates.

ERIC Educational Resources Information Center

Bowen, Michelle; Laurion, Suzanne

A study documented, using a telephone survey, the incidence rates of sexual harassment of mass communication interns, and compared those rates to student and professional rates. A probability sample of 44 male and 52 female mass communications professionals was generated using several random sampling techniques from among professionals who work in…

Assessment of Telemedicine in Surgical Education and Patient Care

PubMed Central

Demartines, Nicolas; Mutter, Didier; Vix, Michel; Leroy, Joël; Glatz, Dieter; Rösel, Fritz; Harder, Felix; Marescaux, Jacques

2000-01-01

Objective To analyze the value of teleconferencing for patient care and surgical education by assessing the activity of an international academic network. Summary Background Data The uses of telemedicine include teleeducation, training, and consulting, and surgical teams are now involved, sharing diagnostic information and opinions without the need for travel. However, the value of telematics in surgery remains to be assessed. Methods During a 2-year period, weekly surgical teleconferences were held among six university hospitals in four European countries. To assess the accuracy of telediagnosis for surgical cases, 60 randomly selected cases were analyzed by a panel of surgeons. Participants’ opinions were analyzed by questionnaire. Results Seventy teleconferences (50 lectures and 271 case presentations) were held. Ninety-five of the 114 participants (83.3%) completed the final questionnaire. Eighty-six percent rated the surgical activity as good or excellent, 75.7% rated the scientific level as good or excellent, 55.8% rated the daily clinical activity as good or excellent, and 28.4% rated the manual surgical technique as good or excellent. The target organ was identified in all the cases; the organ structure and pathology were considered well defined in 93.3%, and the fine structure was considered well defined in 58.3%. Diagnosis was accurate in 17 cases (28.3%), probable in 25 (41.7%), possible but uncertain in 16 (26.7%), and not possible in 2 cases (3.3%). Discussion among the remote sites increased the rate of valuable therapeutic advice from 55% of cases before the discussion to 95% after the discussion. Eighty-six percent of the surgeons expressed satisfaction with telematics for medical education and patient care. Conclusions Participant satisfaction was high, transmission of clinical documents was accurate, and the opportunity to discuss case documentation and management significantly improved diagnostic potential, resulting in an accuracy rate of up to 95%. Teleeducation and teleconsultation in surgery appear to be beneficial. PMID:10674622

Continued Investigations of the Accretion History of Extraterrestrial Matter over Geologic Time

NASA Technical Reports Server (NTRS)

Farley, Kenneth

2001-01-01

This grant supported our ongoing project to characterize the accretion rate of interplanetary dust particles (IDPs) to Earth over geologic time using He-3 as a tracer. IDPs are derived from collisions in the asteroid belt and from disaggregation of active comets. Owing to their small size (few to few hundred micrometers diameter) these particles spiral into the sun under Poynting-Robertson drag typically in less than a few tens of kyrs. Thus IDPs must be continually resupplied to the zodiacal cloud, and because the processes of IDP production are likely to be sporadic, time variation in the IDP accretion rate to Earth is likely to be time-varying. For example, major asteroidal collisions and comet showers should greatly enhance the IDP accretion rate. Our ultimate objective (still ongoing) is to document this time variance so as to better understand the history of the solar system, the source of IDPs accreting to Earth, and the details of the mechanism by which particles are captured by Earth. To document variations in IDP accretion rate through time we use He-3 as a tracer. This isotope is in extremely low abundance in terrestrial matter, but IDPs have very high concentrations of He-3 from implantation of solar wind ions. By measuring He-3 in seafloor sediments, we can estimate the IDP accretion rate for at least the last few hundred Myrs. Under an earlier NASA grant we identified the existence of a large increase in He-3 flux in the Late Eocene (35 Myr ago), coincident with the two largest impact craters of the Cenozoic Era. The simplest interpretation of this observation is the occurrence of a shower of long period comets at that time, simultaneously increasing the impact cratering probability and accretion rate of IDPs to Earth (Farley et al., 1998). Comet showers produced by stellar perturbation of the Oort cloud should be fairly common in the geologic record, so this is not an unreasonable interpretation of our observations.

High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 7. Revision 1

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

Burt, D.L.

1994-04-01

The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 7) presents the standards and requirements for the following sections: Occupational Safety and Health, and Environmental Protection.

Response rates for mailout survey-driven studies in patients waiting for thyroid surgery.

PubMed

Eskander, Antoine; Freeman, Jeremy; Rotstein, Lorne; Higgins, Kevin; Enepekides, Danny; Gilbert, Ralph; Brown, Dale; Gullane, Patrick; Irish, Jonathan; Sawka, Anna M; Goldstein, David P

2011-12-01

In the surgical literature, mailout survey studies are becoming more prevalent. The objective of this article is to summarize response rates in patients waiting for thyroid surgery and to document the methodology of mailout survey questionnaires. The results reported here are from a study assessing clinical and sociodemographic factors associated with high levels of anxiety while patients are waiting for thyroid surgery. The surveys used in this study include a sociodemographic patient opinion questionnaire, the Hospital Anxiety Depression Scale (HADS), the Illness Intrusiveness Ratings Scale (IIRS), the Perceived Stress Scale (PSS), and the Impact of Events Scale-Revised (IES-R). A modified Dillman tailored design approach was used. Assessment of nonresponders was performed. The methods used yielded a response rate of 54% with this patient population. Some differences were noted among responders and nonresponders. This response rate is comparable to but in the lower spectrum of that stated in the oncology literature likely owing to the increase in the length of the survey, number of sensitive questions, limitations in the number of mailouts, and limited familiarity with the surgeon requesting participation in research.

Replication of High Fetal Alcohol Spectrum Disorders Prevalence Rates, Child Characteristics, and Maternal Risk Factors in a Second Sample of Rural Communities in South Africa

PubMed Central

May, Philip A.; De Vries, Marlene M.; Marais, Anna-Susan; Kalberg, Wendy O.; Buckley, David; Adnams, Colleen M.; Hasken, Julie M.; Tabachnick, Barbara; Robinson, Luther K.; Manning, Melanie A.; Bezuidenhout, Heidre; Adam, Margaret P.; Jones, Kenneth L.; Seedat, Soraya; Parry, Charles D.H.; Hoyme, H. Eugene

2017-01-01

Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 89–129 per 1000 children. Total FASD affect 196–276 per 1000 or 20–28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions. PMID:28498341

Enhancement of T cell recruitment and infiltration into tumours

PubMed Central

Oelkrug, C; Ramage, J M

2014-01-01

Studies have documented that cancer patients with tumours which are highly infiltrated with cytotoxic T lymphocytes show enhanced survival rates. The ultimate goal of cancer immunotherapy is to elicit high-avidity tumour-specific T cells to migrate and kill malignant tumours. Novel antibody therapies such as ipilumimab (a cytotoxic T lymphocyte antigen-4 blocking antibody) show enhanced T cell infiltration into the tumour tissue and increased survival. More conventional therapies such as chemotherapy or anti-angiogenic therapy and recent therapies with oncolytic viruses have been shown to alter the tumour microenvironment and thereby lead to enhanced T cell infiltration. Understanding the mechanisms involved in the migration of high-avidity tumour-specific T cells into tumours will support and provide solutions for the optimization of therapeutic options in cancer immunotherapy. PMID:24828133

Built Heritage Documentation and Management: AN Integrated Conservation Approach in Bagan

NASA Astrophysics Data System (ADS)

Mezzino, D.; Chan, L.; Santana Quintero, M.; Esponda, M.; Lee, S.; Min, A.; Pwint, M.

2017-08-01

Good practices in heritage conservation are based on accurate information about conditions, materials, and transformation of built heritage sites. Therefore, heritage site documentation and its analysis are essential parts for their conservation. In addition, the devastating effects of recent catastrophic events in different geographical areas have highly affected cultural heritage places. Such areas include and are not limited to South Europe, South East Asia, and Central America. Within this framework, appropriate acquisition of information can effectively provide tools for the decision-making process and management. Heritage documentation is growing in innovation, providing dynamic opportunities for effectively responding to the alarming rate of destruction by natural events, conflicts, and negligence. In line with these considerations, a multidisciplinary team - including students and faculty members from Carleton University and Yangon Technological University, as well as staff from the Department of Archaeology, National Museum and Library (DoA) and professionals from the CyArk foundation - developed a coordinated strategy to document four temples in the site of Bagan (Myanmar). On-field work included capacity-building activities to train local emerging professionals in the heritage field (graduate and undergraduate students from the Yangon Technological University) and to increase the technical knowledge of the local DoA staff in the digital documentation field. Due to the short time of the on-field activity and the need to record several monuments, a variety of documentation techniques, including image and non-image based ones, were used. Afterwards, the information acquired during the fieldwork was processed to develop a solid base for the conservation and monitoring of the four documented temples. The relevance of developing this kind of documentation in Bagan is related to the vulnerability of the site, often affected by natural seismic events and flooding, as well as the lack of maintenance. Bagan provided an excellent case study to test the effectiveness of the proposed approach, to prevent and manage the damages of catastrophic events, and to support retrofitting actions. In order to test the flexibility of adopted methodology and workflow, temples with different features - in terms of architectural design, shape, and geometry - were selected. The goals of these documentation activities range from testing digital documentation workflows for the metric and visual recording of the site (reviewing strengths and limitations of particular recording techniques), to the definition of effective conditions assessment strategies.

76 FR 53478 - Food Safety Modernization Act Domestic and Foreign Facility Reinspections, Recall, and Importer...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

...The Food and Drug Administration (FDA) is correcting a notice that appeared in the Federal Register of August 1, 2011 (76 FR 45820). The document announced the fiscal year 2012 fee rates for certain domestic and foreign facility reinspections, failure to comply with a recall order, and importer reinspections that are mandated in the FDA Food Safety Modernization Act (FSMA). The document was published with two typographical errors. This document corrects those errors.

Counting seizures: The primary outcome measure in epileptology from the patients' perspective.

PubMed

Blachut, Barbara; Hoppe, Christian; Surges, Rainer; Stahl, Jutta; Elger, Christian E; Helmstaedter, Christoph

2015-07-01

Patient-reported seizure counts represent a key outcome measure for individual treatments and clinical studies in epileptology. Video-EEG based research, however, demonstrated lack of validity due to underreporting. Here we examined the practice of keeping seizure diaries and the patients' attitudes toward seizure counting. Anticipating a low return rate, a comprehensive survey was mailed to 1100 adult outpatients. Besides methods and reasons to document or not to document seizures, the questionnaire addressed clinical, personality and sociodemographic characteristics as well as the subjective experience of seizures. Questionnaires from 170 patients (15%) could be included in our analysis. Patients estimated to be aware of 5.3 out of 10 daytime seizures (nocturnal seizures: 2.6) while they supposed that relatives/colleagues noticed 7.1 (nocturnal: 4.6). Almost two-thirds of the patients reported to keep a seizure diary with a self-estimated documentation rate of 8.7 out of 10 noticed daytime seizures (nocturnal: 7.7). Documenters and non-documenters showed only marginal group differences with regard to clinical, personality and sociodemographic characteristics. Importantly, patients were more committed to keep a seizure diary when they judged it to be relevant for clinical treatment decisions. Patients appear to know that they underreport seizures. According to their view, seizure unawareness as induced by seizures themselves seems to be a more important factor than omitting documentation of noticed seizures. Thus, the potential to improve the validity of seizure diaries of electronic devices which facilitate documenting noticed seizures appears limited. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Evaluation of interventions to prevent injuries: an overview

PubMed Central

Dannenberg, A.; Fowler, C.

1998-01-01

Overview of issues involved in evaluating the effectiveness of injury interventions is presented. An intervention should be evaluated to show it prevents injuries in the target population, to identify unintended consequences, to correct problems that limit effectiveness, to justify current and future resources from funding agencies, and to guide its replication elsewhere. Problems in conducting evaluations include obtaining sufficient resources, coping with rare events, establishing reliability and validity of measurement instruments, separating effects of multiple simultaneous events, and adjusting for the time lag between an intervention and its effects. When feasible, changes in injury rates (documented by medical records) should be used. These are more convincing for demonstrating intervention effectiveness than changes in observed or reported behaviors or in knowledge and attitudes (documented by surveys). Quasiexperimental evaluation designs are often useful, such as measuring injury rates before and after an intervention in a time series design, or intervening in one of two comparable communities in a non-equivalent control group design. Evaluations using true experimental designs, in which individuals or groups are randomized to receive or not receive an intervention, are highly desirable but are often difficult due to logistical or ethical considerations. An evaluation component should be integral to the introduction of any new injury intervention. PMID:9666371

Effect of implementation of safety measures in tae kwon do competition

PubMed Central

Burke, D; Barfoot, K; Bryant, S; Schneider, J; Kim, H; Levin, G

2003-01-01

Background: Previous reviews of tae kwon do (TKD) tournaments have documented injury rates of 25/1000 to 12.7/100 athlete exposures. Most injuries have been reported to be to the head and the neck and are occasionally very serious. Many of these studies involved high level TKD competitions with minimal safety precautions. Recently, safety measures have been implemented in many TKD competitions. Objective: To evaluate retrospectively the incidence of injuries in TKD competitions involving a wide range of participants and featuring extensive safety precautions. Methods: A total of 2498 participants ranged in age from 18 to 66, included both men and women, and ranged in rank from yellow to black belt. Traumas, defined as any event requiring interaction with medical staff, were documented with respect to mechanism, diagnosis, treatment, and follow up recommendations. An injury was defined as a trauma that prevented a contestant from resuming competition on the day that the trauma occurred, according to National Collegiate Athletic Association criteria. Results: The injury rate was 0.4/1000 athlete exposures. This is lower than reported in previous studies of TKD tournaments and in many other sports. Conclusion: TKD tournaments that emphasise limited contact, protective equipment, and medical supervision are relatively safe and compare favourably with other sports. PMID:14514529

The German Lipoprotein Apheresis Registry (GLAR) - almost 5 years on.

PubMed

Schettler, V J J; Neumann, C L; Peter, C; Zimmermann, T; Julius, U; Roeseler, E; Heigl, F; Grützmacher, P; Blume, H; Vogt, A

2017-03-01

Since 2005 an interdisciplinary German apheresis working group has been established by members of both German Societies of Nephrology and of Lipidologists and completed the data set for the registry according to the current guidelines and the German indication guideline for apheresis in 2009. In 2011 the German Lipoprotein Apheresis Registry (GLAR) was launched and data are available over nearly 5 years now. During the time period 2012-2016, 71 German apheresis centers collected retrospective and prospective observational data of 1435 patients undergoing lipoprotein apheresis (LA) treatment of high LDL-C levels and/or high Lp (a) levels suffering from cardiovascular disease (CVD) or progressive CVD. A total of 15,527 completely documented LA treatments were entered into the database. All patients treated by LA showed a median LDL-C reduction rate of 67.5%, and a median Lp (a) reduction rate of 71.1%. Analog to the Pro(a)LiFe pattern, patient data were analyzed to the incidence rate of coronary events (MACE) 1 and 2 years before the beginning of LA treatment (y-2 and y‑1) and prospectively two years on LA treatment (y + 1 and y + 2). During two years of LA treatment a MACE reduction of 78% was observed. In the years considered, side effects of LA treatment were low (5.9%) and mainly comprised puncture problems. The data generated by the GLAR shows that LA lowers the incidence rate of cardiovascular events in patients with high LDL-C and/or high Lp (a) levels, progressive CVD, and maximally tolerated lipid lowering medication. In addition, LA treatments were found to be safe with a low rate of side effects.

Long-term health implications of school quality.

PubMed

Dudovitz, Rebecca N; Nelson, Bergen B; Coker, Tumaini R; Biely, Christopher; Li, Ning; Wu, Lynne C; Chung, Paul J

2016-06-01

Individual academic achievement is a well-known predictor of adult health, and addressing education inequities may be critical to reducing health disparities. Disparities in school quality are well documented. However, we lack nationally representative studies evaluating the impact of school quality on adult health. We aim to determine whether high school quality predicts adult health outcomes after controlling for baseline health, socio-demographics and individual academic achievement. We analyzed data from 7037 adolescents who attended one of 77 high schools in the Unites States and were followed into adulthood from the National Longitudinal Study of Adolescent to Adult Health. Selected school-level quality measures-average daily attendance, school promotion rate, parental involvement, and teacher experience-were validated based on ability to predict high school graduation and college attendance. Individual adult health outcomes included self-rated health, diagnosis of depression, and having a measured BMI in the obese range. Logistic regressions controlling for socio-demographics, baseline health, health insurance, and individual academic performance demonstrated that school quality significantly predicted all health outcomes. As hypothesized, attending a school with lower average daily attendance predicted lower self-rated health (Adjusted Odds Ratio (AOR) 1.59, p = 0.003) and higher odds of depression diagnosis (AOR 1.35, p = 0.03); and attending a school with higher parent involvement predicted lower odds of obesity (AOR 0.69, p = 0.001). However, attending a school with higher promotion rate also predicted lower self-rated health (AOR1.20, p < 0.001). High school quality may be an important, but complex, social determinant of health. These findings highlight the potential inter-dependence of education and health policy. Copyright © 2016 Elsevier Ltd. All rights reserved.

The impact of an electronic health record on nurse sensitive patient outcomes: an interrupted time series analysis.

PubMed

Dowding, Dawn W; Turley, Marianne; Garrido, Terhilda

2012-01-01

To evaluate the impact of electronic health record (EHR) implementation on nursing care processes and outcomes. Interrupted time series analysis, 2003-2009. A large US not-for-profit integrated health care organization. 29 hospitals in Northern and Southern California. An integrated EHR including computerized physician order entry, nursing documentation, risk assessment tools, and documentation tools. Percentage of patients with completed risk assessments for hospital acquired pressure ulcers (HAPUs) and falls (process measures) and rates of HAPU and falls (outcome measures). EHR implementation was significantly associated with an increase in documentation rates for HAPU risk (coefficient 2.21, 95% CI 0.67 to 3.75); the increase for fall risk was not statistically significant (0.36; -3.58 to 4.30). EHR implementation was associated with a 13% decrease in HAPU rates (coefficient -0.76, 95% CI -1.37 to -0.16) but no decrease in fall rates (-0.091; -0.29 to 0.11). Irrespective of EHR implementation, HAPU rates decreased significantly over time (-0.16; -0.20 to -0.13), while fall rates did not (0.0052; -0.01 to 0.02). Hospital region was a significant predictor of variation for both HAPU (0.72; 0.30 to 1.14) and fall rates (0.57; 0.41 to 0.72). The introduction of an integrated EHR was associated with a reduction in the number of HAPUs but not in patient fall rates. Other factors, such as changes over time and hospital region, were also associated with variation in outcomes. The findings suggest that EHR impact on nursing care processes and outcomes is dependent on a number of factors that should be further explored.

Myths in funding ocean research at the National Science Foundation

NASA Astrophysics Data System (ADS)

Duce, Robert A.; Benoit-Bird, Kelly J.; Ortiz, Joseph; Woodgate, Rebecca A.; Bontempi, Paula; Delaney, Margaret; Gaines, Steven D.; Harper, Scott; Jones, Brandon; White, Lisa D.

2012-12-01

Every 3 years the U.S. National Science Foundation (NSF), through its Advisory Committee on Geosciences, forms a Committee of Visitors (COV) to review different aspects of the Directorate for Geosciences (GEO). This year a COV was formed to review the Biological Oceanography (BO), Chemical Oceanography (CO), and Physical Oceanography (PO) programs in the Ocean Section; the Marine Geology and Geophysics (MGG) and Integrated Ocean Drilling Program (IODP) science programs in the Marine Geosciences Section; and the Ocean Education and Ocean Technology and Interdisciplinary Coordination (OTIC) programs in the Integrative Programs Section of the Ocean Sciences Division (OCE). The 2012 COV assessed the proposal review process for fiscal year (FY) 2009-2011, when 3843 proposal actions were considered, resulting in 1141 awards. To do this, COV evaluated the documents associated with 206 projects that were randomly selected from the following categories: low-rated proposals that were funded, high-rated proposals that were funded, low-rated proposals that were declined, high-rated proposals that were declined, some in the middle (53 awarded, 106 declined), and all (47) proposals submitted to the Rapid Response Research (RAPID) funding mechanism. NSF provided additional data as requested by the COV in the form of graphs and tables. The full COV report, including graphs and tables, is available at http://www.nsf.gov/geo/acgeo_cov.jsp.

Manufacture and evaluation of Li/BCX DD cells

NASA Technical Reports Server (NTRS)

Meyer, S.; Takeuchi, E.

1990-01-01

This project is divided into four main tasks: cell manufacture, acceptance, and lot certification of cells, performance testing of cells, and abuse testing of cells. Lithium/bromine chloride in thionyl chloride (Li/BCX) 149 DD cells (PN 3B2085-XA) were built according to the provisions of Electrochem Industries Quality Plan 17096. Acceptance and lot certification testing was performed according to NASA JSC Document EP5-83-025, Revision B. Acceptance testing included open circuit and load voltage check, visual examination, size and weight measurements, and high temperature exposure. Lot certification tests were performed for capacity performance and for performance under conditions of thermal and electrical abuse. These tests included 149 C exposure, capacity discharge, fuse check, high temperature exposure, high rate discharge, short circuit, vibration, and overdischarge testing. A quantity of 200 cells was delivered to Johnson Space Center for life test evaluation. A parametric evaluation of the capacity discharge of Li/BCX DD cells was performed over a variety of temperatures and discharge rates. This testing served to map the performance capability of the cell. Tests were also performed over a variety of electrical and thermal abuse conditions. Abuse tests included short circuit, charging, overdischarge, high temperature exposure, shock, and vibration.

Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences

PubMed Central

Atwoli, Lukoye; Stein, Dan J.; Koenen, Karestan C.; McLaughlin, Katie A.

2015-01-01

Purpose of review This review discusses recent findings from epidemiological surveys of traumatic events and posttraumatic stress disorder (PTSD) globally, including their prevalence, risk factors, and consequences in the community. Recent findings A number of studies on the epidemiology of PTSD have recently been published from diverse countries, with new methodological innovations introduced. Such work has not only documented the prevalence of PTSD in different settings, but has also shed new light on the PTSD conditional risk associated with specific traumatic events, and on the morbidity and comorbidities associated with these events. Summary Recent community studies show that trauma exposure is higher in lower-income countries compared with high-income countries. PTSD prevalence rates are largely similar across countries, however, with the highest rates being found in postconflict settings. Trauma and PTSD-risk factors are distributed differently in lower-income countries compared with high-income countries, with sociodemographic factors contributing more to this risk in high-income than low-income countries. Apart from PTSD, trauma exposure is also associated with several chronic physical conditions. These findings indicate a high burden of trauma exposure in low-income countries and postconflict settings, where access to trained mental health professionals is typically low. PMID:26001922

Real-Time Monitoring of Psychotherapeutic Processes: Concept and Compliance

PubMed Central

Schiepek, Günter; Aichhorn, Wolfgang; Gruber, Martin; Strunk, Guido; Bachler, Egon; Aas, Benjamin

2016-01-01

Objective: The feasibility of a high-frequency real-time monitoring approach to psychotherapy is outlined and tested for patients' compliance to evaluate its integration to everyday practice. Criteria concern the ecological momentary assessment, the assessment of therapy-related cognitions and emotions, equidistant time sampling, real-time nonlinear time series analysis, continuous participative process control by client and therapist, and the application of idiographic (person-specific) surveys. Methods: The process-outcome monitoring is technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System. Its feasibility is documented by a compliance study on 151 clients treated in an inpatient and a day-treatment clinic. Results: We found high compliance rates (mean: 78.3%, median: 89.4%) amongst the respondents, independent of the severity of symptoms or the degree of impairment. Compared to other diagnoses, the compliance rate was lower in the group diagnosed with personality disorders. Conclusion: The results support the feasibility of high-frequency monitoring in routine psychotherapy settings. Daily collection of psychological surveys allows for the assessment of highly resolved, equidistant time series data which gives insight into the nonlinear qualities of therapeutic change processes (e.g., pattern transitions, critical instabilities). PMID:27199837

Crystal methamphetamine, its analogues, and HIV infection: medical and psychiatric aspects of a new epidemic.

PubMed

Urbina, Antonio; Jones, Kristina

2004-03-15

The use of the recreational drug crystal methamphetamine among younger homosexual men is expanding, and with it, unsafe sex behaviors that increase the transmission of human immunodeficiency virus (HIV). This article reviews available literature on the medical and psychiatric morbidities associated with methamphetamine abuse in HIV-infected patients. Medical complications include hypertension, hyperthermia, rhabdoymyolysis, and stroke. One fatal case of ingestion of methamphetamine with HIV medication has been documented. Two fatal cases of ingestion of HIV medication with the amphetamine analogue n-methyl-3,4 methylenedioxymethamphetamine (MDMA, or "ecstasy") have also been reported. Some molecular researchers suggest that dopaminergic systems are vulnerable to the combined neurotoxicity of HIV infection and methamphetamine. Population surveys indicate high rates of HIV infection among methamphetamine abusers and high rates of unprotected anal intercourse during drug intoxication. Intoxication can sometimes produce paranoia, auditory hallucinations, and, occasionally, violent behavior. Amphetamine withdrawal commonly results in symptoms of depression. Methamphetamine is a new challenge related to treatment and prevention of HIV infection.

American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Performance of High-Dose-Rate Brachytherapy

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

Erickson, Beth A.; Demanes, D. Jeffrey; Ibbott, Geoffrey S.

2011-03-01

High-Dose-Rate (HDR) brachytherapy is a safe and efficacious treatment option for patients with a variety of different malignancies. Careful adherence to established standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for HDR brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrists. Review of the leading indications for HDR brachytherapy in the management of gynecologic, thoracic, gastrointestinal,more » breast, urologic, head and neck, and soft tissue tumors is presented. Logistics with respect to the brachytherapy implant procedures and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful HDR brachytherapy program.« less

Hepatitis A/B vaccine completion among homeless adults with history of incarceration.

PubMed

Nyamathi, Adeline M; Marlow, Elizabeth; Branson, Catherine; Marfisee, Mary; Nandy, Karabi

2012-03-01

Hepatitis B virus (HBV) vaccination rates for incarcerated adults remain low despite their high risk for infection. This study determined predictors of vaccine completion in homeless adults (N= 297) who reported histories of incarceration and who participated in one of three nurse-led hepatitis programs of different intensity. Moreover time since release from incarceration was also considered. Just over half of the former prisoners completed the vaccine series. Older age (≥40), having a partner, and chronic homelessness were associated with vaccine completion. Recent research has documented the difficulty in providing vaccine services to younger homeless persons and homeless males at risk for HBV. Additional strategies are needed to achieve HBV vaccination completion rates greater than 50% for formerly incarcerated homeless men. © 2012 International Association of Forensic Nurses.

78 FR 53152 - Prescription Drug User Fee Rates for Fiscal Year 2014; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-28

...] Prescription Drug User Fee Rates for Fiscal Year 2014; Correction AGENCY: Food and Drug Administration, HHS... ``Prescription Drug User Fee Rates for Fiscal Year 2014'' that appeared in the Federal Register of August 2, 2013 (78 FR 46980). The document announced the Fiscal Year 2014 fee rates for the Prescription Drug User...

17 CFR 240.17g-2 - Records to be made and retained by nationally recognized statistical rating organizations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... rating. (9) Internal documents that contain information, analysis, or statistics that were used to... account record for each subscriber to the credit ratings and/or credit analysis reports of the nationally... consideration the internal credit analysis of another person; or (iv) Determining credit ratings or private...

17 CFR 240.17g-2 - Records to be made and retained by nationally recognized statistical rating organizations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... rating. (9) Internal documents that contain information, analysis, or statistics that were used to... account record for each subscriber to the credit ratings and/or credit analysis reports of the nationally... consideration the internal credit analysis of another person; or (iv) Determining credit ratings or private...

17 CFR 240.17g-2 - Records to be made and retained by nationally recognized statistical rating organizations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... rating. (9) Internal documents that contain information, analysis, or statistics that were used to... account record for each subscriber to the credit ratings and/or credit analysis reports of the nationally... consideration the internal credit analysis of another person; or (iv) Determining credit ratings or private...

17 CFR 240.17g-2 - Records to be made and retained by nationally recognized statistical rating organizations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... rating. (9) Internal documents that contain information, analysis, or statistics that were used to... account record for each subscriber to the credit ratings and/or credit analysis reports of the nationally... consideration the internal credit analysis of another person; or (iv) Determining credit ratings or private...

Unimodal relationship between small-scale barnacle recruitment and the density of pre-existing barnacle adults.

PubMed

Scrosati, Ricardo A; Ellrich, Julius A

2017-01-01

Recruitment is a key demographic process for population persistence. This paper focuses on barnacle ( Semibalanus balanoides ) recruitment. In rocky intertidal habitats from the Gulf of St. Lawrence coast of Nova Scotia (Canada), ice scour is common during the winter. At the onset of intertidal barnacle recruitment in early May (after sea ice has fully melted), mostly only adult barnacles and bare substrate are visible at high elevations in wave-exposed habitats. We conducted a multiannual study to investigate if small-scale barnacle recruitment could be predicted from the density of pre-existing adult barnacles. In a year that exhibited a wide adult density range (ca. 0-130 individuals dm -2 ), the relationship between adult density and recruit density (scaled to the available area for recruitment, which excluded adult barnacles) was unimodal. In years that exhibited a lower adult density range (ca. 0-40/50 individuals dm -2 ), the relationship between adult and recruit density was positive and resembled the lower half of the unimodal relationship. Overall, adult barnacle density was able to explain 26-40% of the observed variation in recruit density. The unimodal adult-recruit relationship is consistent with previously documented intraspecific interactions. Between low and intermediate adult densities, the positive nature of the relationship relates to the previously documented fact that settlement-seeking larvae are chemically and visually attracted to adults, which might be important for local population persistence. Between intermediate and high adult densities, where population persistence may be less compromised and the abundant adults may limit recruit growth and survival, the negative nature of the relationship suggests that adult barnacles at increasingly high densities stimulate larvae to settle elsewhere. The unimodal pattern may be especially common on shores with moderate rates of larval supply to the shore, because high rates of larval supply may swamp the coast with settlers, decoupling recruit density from local adult abundance.

How to Prepare an Indirect Cost Rate Proposal for a Non-profit Organization

EPA Pesticide Factsheets

The indirect cost rate proposal is the documentation prepared by a grantee organization, in accordance with applicable federal cost principles, to substantiate its claim for the reimbursement of indirect costs.

Documentation for the 2003-04 Schools and Staffing Survey. NCES 2007-337

ERIC Educational Resources Information Center

Tourkin, Steven C.; Warner, Toni; Parmer, Randall; Cole, Cornette; Jackson, Betty; Zukerberg, Andrew; Cox, Shawna; Soderberg, Andrew

2007-01-01

This report serves as the survey documentation for the design and implementation of the 2003-04 Schools and Staffing Survey. Topics covered include the sample design, survey methodology, data collection procedures, data processing, response rates, imputation procedures, weighting and variance estimation, review of the quality of data, the types of…

Teaching Dossier Documents: A Comparison of Importance by Major Stakeholders

ERIC Educational Resources Information Center

Burnap, Charles A.; Kohut, Gary F.; Yon, Maria G.

2010-01-01

Most institutions of higher education require evidence of effective teaching as part of the review process for reappointment and for tenure/promotion. This study examines the relative importance of various documents placed in the teaching section of the dossier as rated by pre-tenured faculty members and review committee members. Results indicate…

31 CFR 6.10 - Documentation of fees and expenses.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Documentation of fees and expenses. 6.10 Section 6.10 Money and Finance: Treasury Office of the Secretary of the Treasury APPLICATIONS FOR... attorneys or agents with similar experience, who perform similar work, stating their hourly rate. (c) The...

Representations of a High-Quality System of Undergraduate Education in English Higher Education Policy Documents

ERIC Educational Resources Information Center

Ashwin, Paul; Abbas, Andrea; McLean, Monica

2015-01-01

This article examines the ways in which a high-quality system of undergraduate education is represented in recent policy documents from a range of actors interested in higher education. Drawing on Basil Bernstein's ideas, the authors conceptualise the policy documents as reflecting a struggle over competing views of quality that are expressed…

Reducing hospital-acquired pressure ulcers with a silicone-based dermal nourishing emollient-associated skincare regimen.

PubMed

Shannon, Ronald J; Coombs, Martha; Chakravarthy, Debashish

2009-10-01

To determine the effect of a silicone-based dermal nourishing emollient (SBDNE) regimen on the reduction of pressure ulcers (PrUs) and costs in a hospital medical unit. PrUs represent a serious problem for patients within the acute care setting and are a significant care management challenge for clinicians. Effective October 1, 2008, the Centers for Medicare and Medicaid Services will no longer reimburse hospitals at the higher diagnosis-related group rate for Stages III and IV PrUs that are not documented on admission. In addition, formation of PrUs in the hospital also puts the institution at financial risk of lawsuits. The wound healing center at Porter Adventist Hospital, Denver, Colorado, documented the hospital-acquired incidence rate of PrU patients in the hospital from May 2006 to December 2007. A retrospective, quasi-experimental design was used to examine the changes in PrU incidence rates and the economic effect of introducing a SBDNE regimen into an existing PrU prevention protocol. The replacement of a mixture of ad hoc skin care products, none of which contained silicone-based emollients, with an SBDNE skin care regimen into an existing prevention program significantly reduced the proportion of hospital-acquired PrUs to 0% after 8 months. Estimated cost savings per patient admitted to the medical unit attributed to SBDNE averaged $6677.11 per patient. The use of an SBDNE skin care regimen was important in bringing about a significant reduction in the number of patients with PrUs and respective treatment costs in a medical unit experiencing high incidence rates of PrUs.

Low rate of interchromosomal rearrangements during old radiation of gekkotan lizards (Squamata: Gekkota).

PubMed

Johnson Pokorná, Martina; Trifonov, Vladimir A; Rens, Willem; Ferguson-Smith, Malcolm A; Kratochvíl, Lukáš

2015-06-01

Gekkotan lizards are a highly specious (∼1600 described species) clade of squamate lizards with nearly cosmopolitan distribution in warmer areas. The clade is primarily nocturnal and forms an ecologically dominant part of the world nocturnal herpetofauna. However, molecular cytogenetic methods to study the evolution of karyotypes have not been widely applied in geckos. Our aim here was to uncover the extent of chromosomal rearrangements across the whole group Gekkota and to search for putative synapomorphies supporting the newly proposed phylogenetic relationships within this clade. We applied cross-species chromosome painting with the recently derived whole-chromosomal probes from the gekkonid species Gekko japonicus to members of the major gekkotan lineages. We included members of the families Diplodactylidae, Carphodactylidae, Pygopodidae, Eublepharidae, Phyllodactylidae and Gekkonidae. Our study demonstrates relatively high chromosome conservatism across the ancient group of gekkotan lizards. We documented that many changes in chromosomal shape across geckos can be attributed to intrachromosomal rearrangements. The documented rearrangements are not totally in agreement with the recently newly erected family Phyllodactylidae. The results also pointed to homoplasy, particularly in the reuse of chromosome breakpoints, in the evolution of gecko karyotypes.

Impact of registration on clinical trials on infection risk in pediatric acute myeloid leukemia.

PubMed

Dix, David; Aplenc, Richard; Bowes, Lynette; Cellot, Sonia; Ethier, Marie-Chantal; Feusner, Jim; Gillmeister, Biljana; Johnston, Donna L; Lewis, Victor; Michon, Bruno; Mitchell, David; Portwine, Carol; Price, Victoria; Silva, Mariana; Stobart, Kent; Yanofsky, Rochelle; Zelcer, Shayna; Beyene, Joseph; Sung, Lillian

2016-04-01

Little is known about the impact of enrollment on therapeutic clinical trials on adverse event rates. Primary objective was to describe the impact of clinical trial registration on sterile site microbiologically documented infection for children with newly diagnosed acute myeloid leukemia (AML). We conducted a multicenter cohort study that included children aged ≤18 years with de novo AML. Primary outcome was microbiologically documented sterile site infection. Infection rates were compared between those registered and not registered on clinical trials. Five hundred seventy-four children with AML were included of which 198 (34.5%) were registered on a therapeutic clinical trial. Overall, 400 (69.7%) had at least one sterile site microbiologically documented infection. In multiple regression, registration on clinical trials was independently associated with a higher risk of microbiologically documented sterile site infection [adjusted odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.53; p = 0.040] and viridans group streptococcal infection (OR 1.46, 95% CI 1.08-1.98; p = 0.015). Registration on trials was not associated with Gram-negative or invasive fungal infections. Children with newly diagnosed AML enrolled on clinical trials have a higher risk of microbiologically documented sterile site infection. This information may impact on supportive care practices in pediatric AML. © 2015 UICC.

Protocolised approach to end-of-life care in the ICU--the ICU PALCare Pilot Project.

PubMed

Rajamani, A; Barrett, E; Weisbrodt, L; Bourne, J; Palejs, P; Gresham, R; Huang, S

2015-05-01

International literature on end-of-life care in intensive care units (ICUs) supports the use of 'protocol bundles', which is not common practice in our 18-bed adult general ICU in Sydney, New South Wales. We conducted a prospective observational study to identify problems related to end-of-life care practices and to determine whether there was a need to develop protocol bundles. Any ICU patient who had 'withdrawal' of life-sustaining treatment to facilitate a comfortable death was eligible. Exclusion criteria included organ donors, unsuitable family dynamics and lack of availability of research staff to obtain family consent. Process-of-care measures were collected using a standardised form. Satisfaction ratings were obtained using de-identified questionnaire surveys given to the healthcare staff shortly after the withdrawal of therapy and to the families 30 days later. Twenty-three patients were enrolled between June 2011 and July 2012. Survey questionnaires were given to 25 family members and 30 healthcare staff, with a high completion rate (24 family members [96%] and 28 staff [93.3%]). Problems identified included poor documentation of family meetings (39%) and symptom management. Emotional/spiritual support was not offered to families (39.1%) or ICU staff (0%). The overall level of end-of-life care was good. The overwhelming majority of families and healthcare staff were highly satisfied with the care provided. Problems identified related to communication documentation and lack of spiritual/emotional support. To address these problems, targeted measures would be more useful than the adoption of protocol bundles. Alternate models of satisfaction surveys may be needed.

Extremely rapid directional change during Matuyama-Brunhes geomagnetic polarity reversal

NASA Astrophysics Data System (ADS)

Sagnotti, Leonardo; Scardia, Giancarlo; Giaccio, Biagio; Liddicoat, Joseph C.; Nomade, Sebastien; Renne, Paul R.; Sprain, Courtney J.

2014-11-01

We report a palaeomagnetic investigation of the last full geomagnetic field reversal, the Matuyama-Brunhes (M-B) transition, as preserved in a continuous sequence of exposed lacustrine sediments in the Apennines of Central Italy. The palaeomagnetic record provides the most direct evidence for the tempo of transitional field behaviour yet obtained for the M-B transition. 40Ar/39Ar dating of tephra layers bracketing the M-B transition provides high-accuracy age constraints and indicates a mean sediment accumulation rate of about 0.2 mm yr-1 during the transition. Two relative palaeointensity (RPI) minima are present in the M-B transition. During the terminus of the upper RPI minimum, a directional change of about 180 ° occurred at an extremely fast rate, estimated to be less than 2 ° per year, with no intermediate virtual geomagnetic poles (VGPs) documented during the transit from the southern to northern hemisphere. Thus, the entry into the Brunhes Normal Chron as represented by the palaeomagnetic directions and VGPs developed in a time interval comparable to the duration of an average human life, which is an order of magnitude more rapid than suggested by current models. The reported investigation therefore provides high-resolution integrated palaeomagnetic and radioisotopic data that document the fine details of the anatomy and tempo of the M-B transition in Central Italy that in turn are crucial for a better understanding of Earth's magnetic field, and for the development of more sophisticated models that are able to describe its global structure and behaviour.

[Prevalence of psychiatric disorders, psychopathology, and the need for treatment in female and male prisoners].

PubMed

von Schönfeld, C-E; Schneider, F; Schröder, T; Widmann, B; Botthof, U; Driessen, M

2006-07-01

While the international literature documents a high prevalence of psychiatric disorders in prisoners, German studies in this field are rare. The base of knowledge is even worse with regard to female prisoners. The purpose of this study was to investigate DSM-IV axis I and II psychiatric disorders and current psychopathology and to estimate treatment needs in prisoners. On the 1st of May 2002, all female prisoners in Brackwede I Prison in Bielefeld, Germany, were included; and a sample of incarcerated men was matched according to age, nationality, and length of stay. Sixty-three women and 76 men participated. Criminal history and current living conditions were investigated using a questionnaire and prison documents. Psychopathology and psychiatric disorders were investigated using structured clinical interviews. In 88.2% of the sample, at least one current axis I (83.5%) and/or axis II personality disorder (53.2%) was found. Comorbidity rates were high, with 3.5+/-2.7 diagnoses per case. Mean SCL scores revealed a substantial psychopathologic burden. In female prisoners, opiate-related and polysubstance use disorders and affective and post-traumatic stress disorders were more frequent than in the male subsample, which in turn showed higher rates of alcohol-related disorders. Specific treatment needs were indicated in 83.4% of the sample. These results indicate that the proportion of mentally ill persons in prisons is substantially higher than in specialized hospitals for mentally ill criminals. More treatment options are urgently needed than has been realized up to now.

D0 Solenoid Upgrade Project: Pressure Ratings for Some Chimney and Control Dewar Componenets

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

Rucinski, R.; /Fermilab

1993-05-25

Pressure rating calculations were done for some of the chimney and control dewar components. This engineering note documents these calculations. The table below summarizes the components looked at, and what pressure rating are. The raw engineering calculations for each of the components is given.

77 FR 36563 - Indian Health Service; Reimbursement Rates for Calendar Year 2012 Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service; Reimbursement Rates for Calendar Year 2012 Correction AGENCY: Indian Health Service, HHS. ACTION: Notice; correction. SUMMARY: The Indian Health Service published a document in the Federal Register on June 6, 2012, concerning rates for...

78 FR 20503 - Energy Conservation Program: Availability of the Interim Technical Support Document for High...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-05

... Conservation Program: Availability of the Interim Technical Support Document for High-Intensity Discharge Lamps... high-intensity discharge (HID) lamps energy conservation standards in the Federal Register. This... interim analysis for high- intensity discharge lamps energy conservation standards. The notice provided...

Perampanel as adjunctive therapy in highly refractory epilepsies: Real-world data from an Italian tertiary care epilepsy centre.

PubMed

Morano, Alessandra; Fattouch, Jinane; Albini, Mariarita; Casciato, Sara; Fanella, Martina; Basili, Luca Manfredi; Viganò, Alessandro; Manfredi, Mario; Giallonardo, Anna Teresa; Di Bonaventura, Carlo

2018-07-15

Perampanel (PER) is a selective non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor antagonist, licensed as adjunctive therapy in focal epilepsy and primary generalized tonic-clonic seizures (pGTCSs). We performed a retrospective study on highly refractory adult patients taking PER, with 1-year follow-up. Retention rate represented the primary outcome of our work; seizure frequency reduction (≥50%), "switch rate" and proportion of adverse events (AEs) were evaluated as secondary endpoints. Eighty-nine subjects (47 females, age range: 19-78 years) were included. Seventy-three had focal epilepsy (FE), 9 generalized epilepsy and 7 epileptic encephalopathy. All patients were highly drug-resistant (medication failures: 5-17). Retention rate was 87.6%, 63% and 51.7% at 3, 6 and 12 months. Responders were 27/89 (30.3%), with 8/27 seizure-free. The number of previous treatment failures and the concomitant use of enzyme inducers negatively influenced clinical response, whereas no correlation was documented between PER dose and outcome. Responder proportion was more satisfying in structural FE than in FE of unknown etiology (33% versus 20%), and in secondarily GTCSs than focal seizures (54% vs 28%), whereas pGTCSs showed a lower reponse rate (25%). Mild-to-moderate AEs (mainly dizziness, gait disturbances and psychiatric effects) were reported by 40% of patients; serious psychiatric AEs usually occurred in subjects with psychiatric comorbidities. Our study confirms the tolerability and effectiveness of PER in highly drug-resistant patients with different epilepsy syndromes and aetiologies. Copyright © 2018 Elsevier B.V. All rights reserved.

The staying power of pain. A comparison of torture survivors from Bosnia and Colombia and their rates of anxiety, depression and PTSD.

PubMed

Alexander, Abigail; Blake, Stacie; Bernstein, Michael A

2007-01-01

The article describes symptoms of anxiety, depression and PTSD among Bosnian (n=17) and Colombian (n=17) torture survivors served by the Florida Center for Survivors of Torture, a programme of Gulf Coast Jewish Family Services, Inc. Information from clients enrolled in the programme for six months or more was collated over a 14 month period in order to better prioritize and design services for the two distinct populations. On average, the Bosnians in this sample experienced torture approximately 14 years ago while the Colombians'experience was approximately six years ago. Types of torture experienced by clients are documented using HURIDOCS and the number of family and friends affected by extreme trauma are counted. Employment and education levels attained are also identified. Findings show that 100% of Bosnians are symptomatic for depression and over half possess symptoms of PTSD compared to 35% of Colombians for depression and 18% for PTSD, despite the differences in years since trauma occurred. High incidences of torture experienced by Bosnian clients and high numbers of family and friends affected support the high rates of symptoms. For the Colombian clients, high rates of employment and years of education, as well as earlier intervention, may contribute to their lower rates of symptoms. The two client groups are distinguished by the unique circumstances experienced by each, including punctuated wartime versus a prolonged insurgency, as well as the refugee versus asylum seeker experience. This exploratory project informs the torture treatment model while recognizing the importance of ethnic, political and cultural perspectives affecting the healing process.

Timing and prognosis of surgery for spinal epidural abscess: A review

PubMed Central

Epstein, Nancy E.

2015-01-01

Background: The nonsurgical versus surgical management of spinal epidural abscesses (SEAs) remains controversial. Even with the best preoperative screening for multiple risk factors, high nonoperative failure rates are attended by considerable morbidity (e.g., irreversible paralysis) and mortality. Therefore, the focus remains on early surgery. Methods: Most papers promote early recognition of the clinical triad (e.g., fever [50%], spinal pain [92–100%], and neurological deficits [47%]) for SEA. They also identify SEA-related risk factors for choosing nonsurgical versus surgical approaches; advanced age (>65 or 80), diabetes (15–30%), cancer, intravenous drug abuse (25%), smoking (23%), elevated white blood cell count (>12.5), high C-reactive protein >115, positive blood cultures, magnetic resonance imaging/computed tomographic documented cord compression, and significant neurological deficits (e.g., 19–45%). Results: Surgical options include: decompressions, open versus minimally invasive biopsy/culture/irrigation, or fusions. Up to 75% of SEA involve the thoracolumbar spine, and 50% are located ventrally. Wound cultures are positive in up to 78.8% of cases and are often (60%) correlated with positive blood cultures. The most typical offending organism is methicillin resistant Staphylococcus aureus, followed by methicillin sensitive S. aureus. Unfortunately, the failure rates for nonoperative treatment of SEA remain high (e.g., 41–42.5%), contributing to significant morbidity (22% risk of permanent paralysis), and mortality (3–25%). Conclusion: The vast majority of studies advocated early surgery to achieve better outcomes for treating SEA; this avoids high failure rates (41–42.5%) for nonoperative therapy, and limits morbidity/mortality rates. PMID:26605109

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

PubMed

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

2018-05-04

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

Correlates of human papillomavirus vaccination rates in low-income, minority adolescents: a multicenter study.

PubMed

Perkins, Rebecca B; Brogly, Susan B; Adams, William G; Freund, Karen M

2012-08-01

Low rates of human papillomavirus (HPV) vaccination in low-income, minority adolescents may exacerbate racial disparities in cervical cancer incidence. Using electronic medical record data and chart abstraction, we examined correlates of HPV vaccine series initiation and completion among 7702 low-income and minority adolescents aged 11-21 receiving primary care at one of seven medical centers between May 1, 2007, and June 30, 2009. Our population included 61% African Americans, 13% Caucasians, 15% Latinas, and 11% other races; 90% receive public insurance (e.g., Medicaid). We used logistic regression to estimate the associations between vaccine initiation and completion and age, race/ethnicity, number of contacts with the healthcare system, provider documentation, and clinical site of care. Of the 41% of adolescent girls who initiated HPV vaccination, 20% completed the series. A higher proportion of girls aged 11-<13 (46%) and 13-<18 (47%) initiated vaccination than those aged 18-21 (28%). In adjusted analyses, receipt of other recommended adolescent vaccines was associated with vaccine initiation, and increased contact with the medical system was associated with both initiation and completion of the series. Conversely, provider failure to document risky health behaviors predicted nonvaccination. Manual review of a subset of unvaccinated patients' charts revealed no documentation of vaccine discussions in 67% of cases. Fewer than half of low-income and minority adolescents receiving health maintenance services initiated HPV vaccination, and only 20% completed the series. Provider failure to discuss vaccination with their patients appears to be an important contributor to nonvaccination. Future research should focus on improving both initiation and completion of HPV vaccination in high-risk adolescents.

Debris flow susceptibility mapping using a qualitative heuristic method and Flow-R along the Yukon Alaska Highway Corridor, Canada

NASA Astrophysics Data System (ADS)

Blais-Stevens, A.; Behnia, P.

2016-02-01

This research activity aimed at reducing risk to infrastructure, such as a proposed pipeline route roughly parallel to the Yukon Alaska Highway Corridor (YAHC), by filling geoscience knowledge gaps in geohazards. Hence, the Geological Survey of Canada compiled an inventory of landslides including debris flow deposits, which were subsequently used to validate two different debris flow susceptibility models. A qualitative heuristic debris flow susceptibility model was produced for the northern region of the YAHC, from Kluane Lake to the Alaska border, by integrating data layers with assigned weights and class ratings. These were slope angle, slope aspect, surficial geology, plan curvature, and proximity to drainage system. Validation of the model was carried out by calculating a success rate curve which revealed a good correlation with the susceptibility model and the debris flow deposit inventory compiled from air photos, high-resolution satellite imagery, and field verification. In addition, the quantitative Flow-R method was tested in order to define the potential source and debris flow susceptibility for the southern region of Kluane Lake, an area where documented debris flow events have blocked the highway in the past (e.g. 1988). Trial and error calculations were required for this method because there was not detailed information on the debris flows for the YAHC to allow us to define threshold values for some parameters when calculating source areas, spreading, and runout distance. Nevertheless, correlation with known documented events helped define these parameters and produce a map that captures most of the known events and displays debris flow susceptibility in other, usually smaller, steep channels that had not been previously documented.

Debris flow susceptibility mapping using a qualitative heuristic method and Flow-R along the Yukon Alaska Highway Corridor, Canada

NASA Astrophysics Data System (ADS)

Blais-Stevens, A.; Behnia, P.

2015-05-01

This research activity aimed at reducing risk to infrastructure, such as a proposed pipeline route roughly parallel to the Yukon Alaska Highway Corridor (YAHC) by filling geoscience knowledge gaps in geohazards. Hence, the Geological Survey of Canada compiled an inventory of landslides including debris flow deposits, which were subsequently used to validate two different debris flow susceptibility models. A qualitative heuristic debris flow susceptibility model was produced for the northern region of the YAHC, from Kluane Lake to the Alaska border, by integrating data layers with assigned weights and class ratings. These were slope angle, slope aspect (derived from a 5 m × 5 m DEM), surficial geology, permafrost distribution, and proximity to drainage system. Validation of the model was carried out by calculating a success rate curve which revealed a good correlation with the susceptibility model and the debris flow deposit inventory compiled from air photos, high resolution satellite imagery, and field verification. In addition, the quantitative Flow-R method was tested in order to define the potential source and debris flow susceptibility for the southern region of Kluane Lake, an area where documented debris flow events have blocked the highway in the past (e.g., 1988). Trial and error calculations were required for this method because there was not detailed information on the debris flows for the YAHC to allow us to define threshold values for some parameters when calculating source areas, spreading, and runout distance. Nevertheless, correlation with known documented events helped define these parameters and produce a map that captures most of the known events and displays debris flow susceptibility in other, usually smaller, steep channels that had not been previously documented.

The Management of Horses during Fireworks in New Zealand

PubMed Central

Gronqvist, Gabriella; Rogers, Chris; Gee, Erica

2016-01-01

Simple Summary The negative effects of fireworks on companion animals have been reported, but little has been documented on the impact on horses. Horse anxiety was commonly associated with fireworks, and 26% of owners reported horse injuries as a result of fireworks. Many management strategies were seen as ineffective. The majority of horse owners were in favour of a ban on the sale of fireworks for private use. Abstract Within popular press there has been much coverage of the negative effects associated with firework and horses. The effect of fireworks has been documented in companion animals, yet no studies have investigated the negative effects, or otherwise, of fireworks on horses. This study aims to document horse responses and current management strategies to fireworks via an online survey. Of the total number of horses, 39% (1987/4765) were rated as “anxious”, 40% (1816/4765) “very anxious” and only 21% (965/4765) rated as “not anxious” around fireworks. Running (82%, 912/1107) was the most common behaviour reported, with no difference between property type (p > 0.05) or location (p > 0.05). Possibly as a consequence of the high frequency of running, 35% (384/1107) of respondents reported having horses break through fences in response to fireworks and a quarter (26%, 289/1099) reported that their horse(s) had received injuries associated with fireworks. The most common management strategy was moving their horse(s) to a paddock away from the fireworks (77%) and to stable/yard them (55%). However, approximately 30% reported these management strategies to be ineffective. Of the survey participants, 90% (996/1104) were against the sale of fireworks for private use. PMID:27005667

Heart rate turbulence.

PubMed

Cygankiewicz, Iwona

2013-01-01

Heart rate turbulence (HRT) is a baroreflex-mediated biphasic reaction of heart rate in response to premature ventricular beats. Heart rate turbulence is quantified by: turbulence onset (TO) reflecting the initial acceleration of heart rate following premature beat and turbulence slope (TS) describing subsequent deceleration of heart rate. Abnormal HRT identifies patients with autonomic dysfunction or impaired baroreflex sensitivity due to variety of disorders, but also may reflect changes in autonomic nervous system induced by different therapeutic modalities such as drugs, revascularization, or cardiac resynchronization therapy. More importantly, impaired HRT has been shown to identify patients at high risk of all-cause mortality and sudden death, particularly in postinfarction and congestive heart failure patients. It should be emphasized that abnormal HRT has a well-established role in stratification of postinfarction and heart failure patients with relatively preserved left ventricular ejection fraction. The ongoing clinical trials will document whether HRT can be used to guide implantation of cardioverter-defibrillators in this subset of patients, not covered yet by ICD guidelines. This review focuses on the current state-of-the-art knowledge regarding clinical significance of HRT in detection of autonomic dysfunction and regarding the prognostic significance of this parameter in predicting all-cause mortality and sudden death. © 2013.

10 CFR 9.35 - Duplication fees.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) copying of ADAMS documents to paper (applies to images, OCR TIFF, and PDF text) is $0.30 per page. (B) EFT... is $0.30 per page. (vi) Priority rates (rush processing) are as follows: (A) The priority rate...

10 CFR 9.35 - Duplication fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) copying of ADAMS documents to paper (applies to images, OCR TIFF, and PDF text) is $0.30 per page. (B) EFT... is $0.30 per page. (vi) Priority rates (rush processing) are as follows: (A) The priority rate...

10 CFR 9.35 - Duplication fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) copying of ADAMS documents to paper (applies to images, OCR TIFF, and PDF text) is $0.30 per page. (B) EFT... is $0.30 per page. (vi) Priority rates (rush processing) are as follows: (A) The priority rate...

76 FR 8871 - Walnuts Grown in California; Decreased Assessment Rate

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-16

... than the rate previously in effect. The quantity of assessable walnuts for the 2010-11 marketing year... contains regulatory documents #0;having general applicability and legal effect, most of which are keyed #0... 8871

7 CFR 1717.308 - RUS approval of nonconforming rates.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Federal Pre-emption in Rate Making in Connection With Power Supply Borrowers § 1717.308 RUS approval of... of the RUS wholesale power contract and other RUS documents if RUS determines, in its sole discretion...

7 CFR 1717.308 - RUS approval of nonconforming rates.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Federal Pre-emption in Rate Making in Connection With Power Supply Borrowers § 1717.308 RUS approval of... of the RUS wholesale power contract and other RUS documents if RUS determines, in its sole discretion...

[A longitudinal entomologic survey on the transmission of malaria in Ouagadougou (Burkina Faso)].

PubMed

Rossi, P; Belli, A; Mancini, L; Sabatinelli, G

1986-04-01

A longitudinal entomological malaria survey was carried out in five zones of the town of Ouagadougou, Burkina Faso, and in three neighbouring villages. The main vector is Anopheles gambiae s.l. with An. funestus having a role in some localities during the dry season. Pyrethrum spray catches were carried out once or twice per month to determine variations in vector density. Inoculation rates were estimated from the number of blood-fed vectors per man and from the sporozoite rates. Larval sampling was routinely carried out all over the urban area in order to map the larval breeding sites. Widely different degrees of malaria transmission were documented in the urban area mainly related to the spatial and temporal distribution of An. gambiae larval breeding sites. Higher inoculation rates, depending both on higher vector densities and sporozoite rates, were documented in the villages.

Multigrid Strategies for Viscous Flow Solvers on Anisotropic Unstructured Meshes

NASA Technical Reports Server (NTRS)

Movriplis, Dimitri J.

1998-01-01

Unstructured multigrid techniques for relieving the stiffness associated with high-Reynolds number viscous flow simulations on extremely stretched grids are investigated. One approach consists of employing a semi-coarsening or directional-coarsening technique, based on the directions of strong coupling within the mesh, in order to construct more optimal coarse grid levels. An alternate approach is developed which employs directional implicit smoothing with regular fully coarsened multigrid levels. The directional implicit smoothing is obtained by constructing implicit lines in the unstructured mesh based on the directions of strong coupling. Both approaches yield large increases in convergence rates over the traditional explicit full-coarsening multigrid algorithm. However, maximum benefits are achieved by combining the two approaches in a coupled manner into a single algorithm. An order of magnitude increase in convergence rate over the traditional explicit full-coarsening algorithm is demonstrated, and convergence rates for high-Reynolds number viscous flows which are independent of the grid aspect ratio are obtained. Further acceleration is provided by incorporating low-Mach-number preconditioning techniques, and a Newton-GMRES strategy which employs the multigrid scheme as a preconditioner. The compounding effects of these various techniques on speed of convergence is documented through several example test cases.

Sediment color and reflectance record from Ocean Drilling Program Hole 625B, Gulf of Mexico (marine isotope stage 5 interval)

USGS Publications Warehouse

Dowsett, Harry J.

1999-01-01

Analysis of climate indicators from the North Atlantic, California Margin, and ice cores from Greenland suggest millennial scale climate variability is a component of earth's climate system during the last interglacial period (marine oxygen isotope stage 5). The USGS is involved in a survey of high resolution marine records covering the last interglacial period (MIS 5) to further document the variability of climate and assess the rate at which climate can change during warm intervals. The Gulf of Mexico (GOM) is an attractive area for analysis of climate variability and rapid change. Changes in the Mississippi River Basin presumably are translated to the GOM via the river and its effect on sediment distribution and type. Likewise, the summer monsoon in the southwestern US is driven by strong southerly winds. These winds may produce upwelling in the GOM which will be recorded in the sedimentary record. Several areas of high accumulation rate have been identified in the GOM. Ocean Drilling Program (ODP) Site 625 appears to meet the criteria of having a well preserved carbonate record and accumulation rate capable of discerning millennial scale changes.

Indo-Pacific humpback dolphin occurrence north of Lantau Island, Hong Kong, based on year-round passive acoustic monitoring.

PubMed

Munger, Lisa; Lammers, Marc O; Cifuentes, Mattie; Würsig, Bernd; Jefferson, Thomas A; Hung, Samuel K

2016-10-01

Long-term passive acoustic monitoring (PAM) was conducted to study Indo-Pacific humpback dolphins, Sousa chinensis, as part of environmental impact assessments for several major coastal development projects in Hong Kong waters north of Lantau Island. Ecological acoustic recorders obtained 2711 days of recording at 13 sites from December 2012 to December 2014. Humpback dolphin sounds were manually detected on more than half of days with recordings at 12 sites, 8 of which were within proposed reclamation areas. Dolphin detection rates were greatest at Lung Kwu Chau, with other high-occurrence locations northeast of the Hong Kong International Airport and within the Lung Kwu Tan and Siu Ho Wan regions. Dolphin detection rates were greatest in summer and autumn (June-November) and were significantly reduced in spring (March-May) compared to other times of year. Click detection rates were significantly higher at night than during daylight hours. These findings suggest high use of many of the proposed reclamation/development areas by humpback dolphins, particularly at night, and demonstrate the value of long-term PAM for documenting spatial and temporal patterns in dolphin occurrence to help inform management decisions.

Structural Design Requirements and Factors of Safety for Spaceflight Hardware: For Human Spaceflight. Revision A

NASA Technical Reports Server (NTRS)

Bernstein, Karen S.; Kujala, Rod; Fogt, Vince; Romine, Paul

2011-01-01

This document establishes the structural requirements for human-rated spaceflight hardware including launch vehicles, spacecraft and payloads. These requirements are applicable to Government Furnished Equipment activities as well as all related contractor, subcontractor and commercial efforts. These requirements are not imposed on systems other than human-rated spacecraft, such as ground test articles, but may be tailored for use in specific cases where it is prudent to do so such as for personnel safety or when assets are at risk. The requirements in this document are focused on design rather than verification. Implementation of the requirements is expected to be described in a Structural Verification Plan (SVP), which should describe the verification of each structural item for the applicable requirements. The SVP may also document unique verifications that meet or exceed these requirements with NASA Technical Authority approval.

Design of Automatic Extraction Algorithm of Knowledge Points for MOOCs

PubMed Central

Chen, Haijian; Han, Dongmei; Zhao, Lina

2015-01-01

In recent years, Massive Open Online Courses (MOOCs) are very popular among college students and have a powerful impact on academic institutions. In the MOOCs environment, knowledge discovery and knowledge sharing are very important, which currently are often achieved by ontology techniques. In building ontology, automatic extraction technology is crucial. Because the general methods of text mining algorithm do not have obvious effect on online course, we designed automatic extracting course knowledge points (AECKP) algorithm for online course. It includes document classification, Chinese word segmentation, and POS tagging for each document. Vector Space Model (VSM) is used to calculate similarity and design the weight to optimize the TF-IDF algorithm output values, and the higher scores will be selected as knowledge points. Course documents of “C programming language” are selected for the experiment in this study. The results show that the proposed approach can achieve satisfactory accuracy rate and recall rate. PMID:26448738

Randomized prospective study comparing vancomycin with teicoplanin in the treatment of infections associated with Hickman catheters.

PubMed Central

Smith, S R; Cheesbrough, J; Spearing, R; Davies, J M

1989-01-01

In 72 episodes of suspected or proven Hickman-catheter-associated infection occurring in 59 patients with various hematological disorders, patients were assigned to treatment with either vancomycin or teicoplanin in a randomized nonblinded prospective study. Of 60 episodes evaluable for response, 28 were treated with vancomycin and 32 were treated with teicoplanin. Sixteen infective episodes were microbiologically documented in the vancomycin group, and twenty-one were microbiologically documented in the teicoplanin group. Microbiologically and clinically documented infections treated with vancomycin had an 80% response rate, compared with a 69% response rate for those treated with teicoplanin (P = 0.316). Adverse events occurred in nine (25%) of the episodes in the vancomycin group, compared with three (8%) in the teicoplanin group (P = 0.044). Teicoplanin may provide an effective alternative to vancomycin in the treatment of Hickman-catheter-associated infection in patients with hematological malignancies. PMID:2529814

Randomized prospective study comparing vancomycin with teicoplanin in the treatment of infections associated with Hickman catheters.

PubMed

Smith, S R; Cheesbrough, J; Spearing, R; Davies, J M

1989-08-01

In 72 episodes of suspected or proven Hickman-catheter-associated infection occurring in 59 patients with various hematological disorders, patients were assigned to treatment with either vancomycin or teicoplanin in a randomized nonblinded prospective study. Of 60 episodes evaluable for response, 28 were treated with vancomycin and 32 were treated with teicoplanin. Sixteen infective episodes were microbiologically documented in the vancomycin group, and twenty-one were microbiologically documented in the teicoplanin group. Microbiologically and clinically documented infections treated with vancomycin had an 80% response rate, compared with a 69% response rate for those treated with teicoplanin (P = 0.316). Adverse events occurred in nine (25%) of the episodes in the vancomycin group, compared with three (8%) in the teicoplanin group (P = 0.044). Teicoplanin may provide an effective alternative to vancomycin in the treatment of Hickman-catheter-associated infection in patients with hematological malignancies.

Futile transmembrane NH4+ cycling: A cellular hypothesis to explain ammonium toxicity in plants

PubMed Central

Britto, Dev T.; Siddiqi, M. Yaeesh; Glass, Anthony D. M.; Kronzucker, Herbert J.

2001-01-01

Most higher plants develop severe toxicity symptoms when grown on ammonium (NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document}) as the sole nitrogen source. Recently, NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} toxicity has been implicated as a cause of forest decline and even species extinction. Although mechanisms underlying NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} toxicity have been extensively sought, the primary events conferring it at the cellular level are not understood. Using a high-precision positron tracing technique, we here present a cell-physiological characterization of NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} acquisition in two major cereals, barley (Hordeum vulgare), known to be susceptible to toxicity, and rice (Oryza sativa), known for its exceptional tolerance to even high levels of NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document}. We show that, at high external NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} concentration ([NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document}]o), barley root cells experience a breakdown in the regulation of NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} influx, leading to the accumulation of excessive amounts of NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} in the cytosol. Measurements of NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} efflux, combined with a thermodynamic analysis of the transmembrane electrochemical potential for NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document}, reveal that, at elevated [NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document}]o, barley cells engage a high-capacity NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document}-efflux system that supports outward NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} fluxes against a sizable gradient. Ammonium efflux is shown to constitute as much as 80% of primary influx, resulting in a never-before-documented futile cycling of nitrogen across the plasma membrane of root cells. This futile cycling carries a high energetic cost (we record a 40% increase in root respiration) that is independent of N metabolism and is accompanied by a decline in growth. In rice, by contrast, a cellular defense strategy has evolved that is characterized by an energetically neutral, near-Nernstian, equilibration of NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} at high [NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document}]o. Thus our study has characterized the primary events in NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} nutrition at the cellular level that may constitute the fundamental cause of NH\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{_{4}^{+}}}\\end{equation*}\\end{document} toxicity in plants. PMID:11274450

Identifying Adolescents at Highly Elevated Risk for Suicidal Behavior in the Emergency Department

PubMed Central

Berona, Johnny; Czyz, Ewa; Horwitz, Adam G.; Gipson, Polly Y.

2015-01-01

Abstract Objective: The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample. Method: Participants were 81 adolescents, ages 14–19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up. Results: Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%). Conclusions: In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior. PMID:25746114

[Quality of documentation of intraoperative and postoperative complications : improvement of documentation for a nationwide quality assurance program and comparison with routine data].

PubMed

Jakob, J; Marenda, D; Sold, M; Schlüter, M; Post, S; Kienle, P

2014-08-01

Complications after cholecystectomy are continuously documented in a nationwide database in Germany. Recent studies demonstrated a lack of reliability of these data. The aim of the study was to evaluate the impact of a control algorithm on documentation quality and the use of routine diagnosis coding as an additional validation instrument. Completeness and correctness of the documentation of complications after cholecystectomy was compared over a time interval of 12 months before and after implementation of an algorithm for faster and more accurate documentation. Furthermore, the coding of all diagnoses was screened to identify intraoperative and postoperative complications. The sensitivity of the documentation for complications improved from 46 % to 70 % (p = 0.05, specificity 98 % in both time intervals). A prolonged time interval of more than 6 weeks between patient discharge and documentation was associated with inferior data quality (incorrect documentation in 1.5 % versus 15 %, p < 0.05). The rate of case documentation within the 6 weeks after hospital discharge was clearly improved after implementation of the control algorithm. Sensitivity and specificity of screening for complications by evaluating routine diagnoses coding were 70 % and 85 %, respectively. The quality of documentation was improved by implementation of a simple memory algorithm.

Hanford High-Level Waste Vitrification Program at the Pacific Northwest National Laboratory: technology development - annotated bibliography

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

Larson, D.E.

1996-09-01

This report provides a collection of annotated bibliographies for documents prepared under the Hanford High-Level Waste Vitrification (Plant) Program. The bibliographies are for documents from Fiscal Year 1983 through Fiscal Year 1995, and include work conducted at or under the direction of the Pacific Northwest National Laboratory. The bibliographies included focus on the technology developed over the specified time period for vitrifying Hanford pretreated high-level waste. The following subject areas are included: General Documentation; Program Documentation; High-Level Waste Characterization; Glass Formulation and Characterization; Feed Preparation; Radioactive Feed Preparation and Glass Properties Testing; Full-Scale Feed Preparation Testing; Equipment Materials Testing; Meltermore » Performance Assessment and Evaluations; Liquid-Fed Ceramic Melter; Cold Crucible Melter; Stirred Melter; High-Temperature Melter; Melter Off-Gas Treatment; Vitrification Waste Treatment; Process, Product Control and Modeling; Analytical; and Canister Closure, Decontamination, and Handling« less

Contingency Contractor Optimization Phase 3 Sustainment Requirements Document Contingency Contractor Optimization Tool - Prototype

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

Bandlow, Alisa; Durfee, Justin David; Frazier, Christopher Rawls

2016-05-01

This requirements document serves as an addendum to the Contingency Contractor Optimization Phase 2, Requirements Document [1] and Phase 3 Requirements Document [2]. The Phase 2 Requirements document focused on the high-level requirements for the tool. The Phase 3 Requirements document provided more detailed requirements to which the engineering prototype was built in Phase 3. This document will provide detailed requirements for features and enhancements being added to the production pilot in the Phase 3 Sustainment.

Program documentation: Surface heating rate of thin skin models (THNSKN)

NASA Technical Reports Server (NTRS)

Mcbryde, J. D.

1975-01-01

Program THNSKN computes the mean heating rate at a maximum of 100 locations on the surface of thin skin transient heating rate models. Output is printed in tabular form and consists of time history tabulation of temperatures, average temperatures, heat loss without conduction correction, mean heating rate, least squares heating rate, and the percent standard error of the least squares heating rates. The input tape used is produced by the program EHTS03.

Aviation Structural Mechanic S 3 & 2. NAVTRA-10308-C. Rate Training Manual.

ERIC Educational Resources Information Center

Bureau of Naval Personnel, Washington, DC.

This document is one of a series of rate training manuals designed to provide enlisted personnel of the Navy or Naval Reserve with the background information that will be useful in preparing for advancement in Aviation Structural Mechanics S (AMS) rating and to present necessary information for the proper performance of duties in that rating. The…

In-Situ Atmospheric Sounding Data Lifecycle from Data Collection, Analysis and Quality Control to Documentation, Archival and Tracking

NASA Astrophysics Data System (ADS)

Young, K.; Voemel, H.; Morris, D.

2015-12-01

In-situ measurement systems are used to monitor the atmosphere whereby instruments are located in the area of interest and are in direct contact with what is being measured. Dropsondes and radiosondes are instruments used to collect high-vertical-resolution profiles of the atmosphere. The dropsondes are deployed from aircraft and, as they descend, they collect pressure, temperature and humidity data at a half-second rate, and GPS wind data at a quarter-second rate. Radiosondes are used to collect high-resolution measurements of the atmosphere, from the ground to approximately 30 kilometers. Carried by a large helium-filled balloon, they ascend upward through the atmosphere measuring pressure, temperature, relative humidity, and GPS winds at a one-second rate. Advancements in atmospheric research, technology and data assimilation techniques have contributed to driving the need for higher quality, higher resolution radiosonde and dropsonde data at an increasingly rapid rate. These data most notably represent a valuable resource for initializing numerical prediction models, calibrating and validating satellite retrieval techniques for atmospheric profiles, and for climatological research. The In-Situ Sensing Facility, at NCAR, has developed an extensive, multi-step process of quality control (QC). Traditionally, QC has been a time intensive process that involves evaluating data products using a variety of visualization tools and statistical methods. With a greater need for real-time data in the field and a reduced turn-around time for final quality controlled data, new and improved procedures for streamlining statistical analysis and QC are being implemented. Improvements have also been made on two fronts regarding implementation of a comprehensive data management plan. The first was ensuring ease of data accessibility through an intuitive centralized data archive system, that both keeps a record of data users and assigns digital object identifiers to each unique data set. The second improvement was to define appropriate criteria needed for documentation and metadata so that data users have all of the relevant information needed to properly use and understand the complexities of these measurements.

Health system guidance appraisal--concept evaluation and usability testing.

PubMed

Ako-Arrey, Denis E; Brouwers, Melissa C; Lavis, John N; Giacomini, Mita K

2016-01-05

Health system guidance (HSG) provides recommendations aimed to address health system challenges. However, there is a paucity of methods to direct, appraise, and report HSG. Earlier research identified 30 candidate criteria (concepts) that can be used to evaluate the quality of HSG and guide development and reporting requirements. The objective of this paper was to describe two studies aimed at evaluating the importance of these 30 criteria, design a draft HSG appraisal tool, and test its usability. This study involved a two-step survey process. In step 1, respondents rated the 30 concepts for appropriateness to, relevance to, and priority for health system decisions and HSG. This led to a draft tool. In step 2, respondents reviewed HSG documents, appraised them using the tool, and answered a series of questions. Descriptive analyses were computed. Fifty participants were invited in step 1, and we had a response rate of 82 %. The mean response rates for each concept within each survey question were universally favorable. There was also an overall agreement about the need for a high-quality tool to systematically direct the development, appraisal, and reporting of HSG. Qualitative feedback and a consensus process by the team led to refinements to some of the concepts and the creation of a beta (draft) version of the HSG tool. In step 2, 35 participants were invited and we had a response rate of 74 %. Exploratory analyses showed that the quality of the HSGs reviewed varied as a function of the HSG item and the specific document assessed. A favorable consensus was reached with participants agreeing that the HSG items were easy to understand and easy to apply. Moreover, the overall agreement was high for the usability of the tool to systematically direct the development (85 %), appraisal (92 %), and reporting (81 %) of HSG. From this process, version 1.0 of the HSG appraisal tool was generated complete with 32 items (and their descriptions) and 4 domains. The final tool, named the Appraisal of Guidelines for Research and Evaluation for Health Systems (AGREE-HS) (version 1), defines expectations of HSG and facilitates informed decisions among policymakers on health system delivery, financial, and governance arrangements.